A 9-year-old girl builds a clubhouse in her backyard and hangs a sign reading 'No boys allowed.' What should the school nurse tell the parents?

Correct Answer: B

Rationale: The correct answer to the question is option B) Her behavior is common among school-age children. This response is accurate because at around 9 years old, children often start to develop a stronger sense of identity and may show preferences for same-gender peer groups. Building a clubhouse and excluding boys is a typical behavior seen in children of this age as they explore their interests and social dynamics. It is important for the school nurse to reassure the parents that this behavior is within the normal range of development for a 9-year-old. Option A) Her behavior is concerning and should be addressed is incorrect because in this context, the behavior displayed by the girl is not a cause for concern. It is a normal part of her social and emotional development. Option C) Her feelings about boys will subside within a year is incorrect as it simplifies the complexity of social development in children. While her attitudes may change over time, it is not accurate to predict a specific timeline for this. Option D) They should have her speak with a school counselor is also not the best course of action in this scenario. Consulting a school counselor for this behavior may be unnecessary and could potentially pathologize a normal aspect of childhood development. In an educational context, understanding the typical behaviors and development stages of children is crucial for educators and healthcare professionals. Recognizing and normalizing age-appropriate behaviors helps in providing appropriate support and guidance to children and their families. It is essential to differentiate between normal developmental variations and behaviors that may require intervention to promote children's healthy growth and well-being.

Correct Answer: D

Rationale: In the context of pediatric nursing and birth-related injuries, understanding risk factors for birth brachial plexus injury is crucial. The correct answer, option D, diabetic mother, is the exception among the listed risk factors. Option A, shoulder dystocia, is a known risk factor for birth brachial plexus injury due to the difficulty in delivering the baby's shoulder after the head has emerged. This can put excessive traction on the baby's brachial plexus nerves. Option B, birthweight greater than 4 kg, is another risk factor because larger babies may have a harder time passing through the birth canal, leading to increased risk of nerve injury during delivery. Option C, primiparous mothers, are also at higher risk as they have not given birth before and may have a higher likelihood of experiencing complications during delivery that could result in brachial plexus injury. Educationally, knowing these risk factors is essential for nurses caring for newborns and mothers during labor and delivery. By recognizing these factors, healthcare providers can take preventive measures or be prepared to manage potential complications to reduce the incidence of birth brachial plexus injuries and improve overall maternal and neonatal outcomes.

Correct Answer: C

Rationale: The correct answer is C) 6 symptoms of inattention or 6 symptoms of hyperactivity-impulsivity for at least 6 months in two or more environments. This criteria is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) guidelines for diagnosing ADHD in children up to the age of 16 years. Choosing option A) is incorrect because it does not meet the minimum criteria specified in the DSM-5 for the duration of symptoms. Option B) also falls short of the required duration of symptoms. Option D) has the correct number of symptoms but fails to meet the duration criteria. Understanding the diagnostic criteria for ADHD is crucial for healthcare professionals working with children. By knowing the specific symptoms and duration required for diagnosis, healthcare providers can accurately assess and support children with ADHD. This knowledge helps in early identification, intervention, and management of ADHD, leading to better outcomes for affected children.

Correct Answer: B

Rationale: The most valuable test for the 6-year-old child with Acute Lymphoblastic Leukemia (ALL) experiencing frequent mucositis and myelosuppression, necessitating frequent treatment discontinuation, is pharmacogenetic testing of the thiopurine S-methyltransferase (TPMT) gene (Option B). Pharmacogenetic testing of TPMT gene is crucial in this scenario because thiopurine drugs like mercaptopurine are commonly used in ALL treatment. TPMT enzyme activity affects how the body processes these drugs; individuals with low TPMT activity are at higher risk of severe myelosuppression. By identifying TPMT gene variations, clinicians can personalize drug dosages to minimize adverse effects and optimize treatment efficacy. The other options are less relevant in this context: A) Complete blood count (CBC) is a standard test but may not provide specific information on drug metabolism or toxicity related to thiopurine drugs. C) Renal function test is important for monitoring kidney function but is not directly related to optimizing thiopurine drug therapy. D) Bone marrow study is invasive and not indicated solely for assessing drug metabolism issues. Educationally, understanding the role of pharmacogenetics in pediatric oncology highlights the importance of personalized medicine in improving treatment outcomes and reducing adverse effects in children with cancer. By incorporating genetic testing into clinical practice, healthcare providers can tailor treatments to individual genetic profiles, leading to more effective and safer therapies for pediatric patients.

Correct Answer: B

Rationale: In pediatric oncology, understanding the genetic characteristics of tumors like neuroblastoma is crucial for determining prognosis and guiding treatment. In this scenario, the correct answer is B) hyperdiploidy, which carries a better outcome. Hyperdiploidy refers to the presence of extra copies of chromosomes, which can indicate a less aggressive form of neuroblastoma with a more favorable prognosis. Option A) amplification of the MYCN proto-oncogene is associated with a poor prognosis in neuroblastoma, indicating a higher risk of aggressive tumor behavior. Option C) loss of heterozygosity of 17q chromosome and Option D) loss of 1p chromosome are also genetic alterations associated with high-risk neuroblastoma and poor outcomes. Educationally, understanding the genetic markers of neuroblastoma not only helps in answering questions correctly but also informs clinical practice. Nurses caring for pediatric oncology patients need to grasp these concepts to provide holistic care and support to patients and their families. This knowledge can also aid in patient education and counseling regarding treatment options and expected outcomes.