A 9-year-old boy develops acute myelogenous leukemia (AML) one year after completion of therapy for soft tissue sarcoma at his right thigh. Which of the following chemotherapeutic agents is MOST likely the cause of secondary acute myelogenous leukemia AML in this boy?

Correct Answer: C

Rationale: In understanding why etoposide is the most likely cause of secondary acute myelogenous leukemia (AML) in the 9-year-old boy, we need to consider the drug's mechanism of action. Etoposide is a topoisomerase II inhibitor, which can lead to DNA damage and chromosomal translocations associated with the development of secondary malignancies like AML. Regarding the other options: A) Cyclophosphamide is alkylating agent associated with secondary malignancies but less commonly linked to AML compared to etoposide. B) Vincristine is a microtubule inhibitor and is not typically associated with secondary AML. D) Doxorubicin is an anthracycline that can cause secondary leukemias, but etoposide has a stronger association with AML development. Educationally, this question highlights the importance of understanding the long-term effects of chemotherapy in pediatric oncology patients. Healthcare providers need to be aware of the potential risks associated with different chemotherapeutic agents to provide comprehensive care and long-term surveillance for these vulnerable patients.

Correct Answer: B

Rationale: In this scenario, the BEST therapeutic approach for a 2-year-old child with a ruptured Wilms tumor is concomitant chemotherapy-radiotherapy (Option B). This approach is chosen because Wilms tumor is a type of kidney cancer that commonly affects children, and a multimodal treatment plan involving both chemotherapy and radiotherapy has been shown to be the most effective in improving survival rates and reducing the risk of recurrence. Option A, radiotherapy alone, is not the preferred treatment because Wilms tumor typically requires a combination of chemotherapy and radiotherapy for optimal outcomes. Option C, another surgery, is not the immediate course of action for a ruptured Wilms tumor as the primary treatment involves a combination of chemotherapy and radiotherapy. Option D, observation, is not suitable in this case as Wilms tumor is an aggressive cancer that requires prompt and aggressive treatment to improve outcomes. Educationally, it is crucial for healthcare providers, especially those specializing in pediatric oncology, to understand the importance of multimodal treatment approaches in managing pediatric cancers like Wilms tumor. This case emphasizes the significance of evidence-based practice and multidisciplinary collaboration in providing the best possible care for pediatric oncology patients.

Correct Answer: C

Rationale: In this scenario, option C, stating that supraphysiologic levothyroxine therapy is required during long-term follow-up, is the most appropriate statement to include in the discussion with the parents of a 12-year-old girl diagnosed with papillary thyroid carcinoma (PTC). The rationale for choosing option C is that children with PTC often require thyroid hormone replacement therapy to suppress thyroid-stimulating hormone (TSH) levels, which can help prevent the recurrence of cancer. Supraphysiologic doses of levothyroxine are often necessary to achieve this goal, making this statement crucial for the long-term management of the condition. Option A is incorrect because PTC, while a serious condition, does not necessarily have a grim overall prognosis, especially with appropriate treatment and follow-up care. Option B is incorrect because radioactive iodine therapy is commonly used in the treatment of differentiated thyroid cancers like PTC. Option D is incorrect because calcitonin/carcinogenic antigen monitoring is more relevant for medullary thyroid carcinoma, not papillary thyroid carcinoma. In an educational context, understanding the specific management strategies and follow-up care for pediatric patients with papillary thyroid carcinoma is essential for healthcare providers working with this population. Providing accurate information to parents and caregivers can help them better understand the treatment plan and support the long-term health and well-being of their child.

Correct Answer: A

Rationale: In this scenario, the correct action for the pediatric nurse to take is option A) ask the parent in a nonjudgmental manner about the herbs. This is the most appropriate initial step because it allows the nurse to gather information directly from the parent about the herbs, their purpose, and their administration to the child. By approaching the parent in a nonjudgmental manner, the nurse can establish open communication, gather pertinent information, and address any concerns or misconceptions the parent may have regarding the use of herbs. Option B) coordinating a nursing care conference to discuss the patient's plan of care is not the most immediate or relevant action in this situation. While discussing the patient's plan of care is important, addressing the use of herbs should take precedence as it directly impacts the child's treatment and well-being. Option C) discussing the risks of using alternative therapies with the parent may be appropriate but should follow gathering more information about the specific herbs being used. Jumping straight to discussing risks without understanding the parent's perspective may lead to misunderstandings and hinder effective communication. Option D) referring the family to a social worker for possible nonadherence with the healthcare regimen is premature without first clarifying the situation with the parent. This option assumes nonadherence without gathering facts and could potentially strain the nurse-parent relationship. In an educational context, this question highlights the importance of effective communication and collaboration with families in pediatric care. Nurses must approach situations with cultural humility, respect for diverse beliefs and practices, and a commitment to understanding families' perspectives to provide holistic and patient-centered care. Asking open-ended, nonjudgmental questions promotes trust and allows nurses to address parental concerns, ensure safe care practices, and enhance overall patient outcomes.

Correct Answer: C

Rationale: In this question, the correct answer is C) 36 months. At around 36 months of age, a child typically develops the fine motor skills necessary to make a tower of 9 cubes and imitate a circular stroke. This milestone is an important indicator of a child's fine motor coordination and cognitive development at this age. Option A) 24 months is too early for most children to demonstrate this level of fine motor control and cognitive ability. At 24 months, children are usually still developing basic motor skills and may not have the precision required for tasks like making a tower of 9 cubes or imitating a circular stroke. Option B) 30 months is also too early for most children to achieve this milestone. While some children may start to show progress in fine motor skills by this age, it is less common for them to be able to consistently make a tower of 9 cubes and imitate a circular stroke. Option D) 42 months is too late for this milestone. By 42 months, most children would have already mastered the ability to make a tower of 9 cubes and imitate a circular stroke. Waiting until 42 months to achieve this milestone would suggest a delay in fine motor skill development. Understanding these developmental milestones is crucial for pediatric nurses and healthcare providers working with young children. It helps them assess a child's growth and development accurately, identify any potential delays or concerns early on, and provide appropriate support and interventions when needed.