A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client’s chemotherapy regimen is to:

Correct Answer: A

Rationale: The correct answer is A) Prevent metabolic breakdown of xanthine to uric acid. In pediatric oncology, especially during leukemia treatment, tumor lysis syndrome (TLS) is a potential complication due to the rapid breakdown of cancer cells leading to the release of intracellular contents like purines. Allopurinol is administered to inhibit xanthine oxidase, preventing the conversion of xanthine to uric acid, thus reducing the risk of uric acid crystal formation and subsequent renal damage. Option B is incorrect because allopurinol is not directly involved in preventing uric acid from precipitating in the ureters but rather in inhibiting its formation. Option C is incorrect as allopurinol does not enhance uric acid production but rather inhibits its formation. Option D is incorrect as allopurinol's primary role in this scenario is related to preventing the metabolic breakdown of purines, not protecting the bone marrow from chemotherapy. Understanding the rationale behind using allopurinol in the context of TLS risk during leukemia treatment is crucial for pediatric nurses to provide safe and effective care to their patients undergoing chemotherapy.

Correct Answer: A

Rationale: Rationale: The correct answer is A) Apply cool air under the cast with a blow-dryer. Itching under a cast is a common complaint, and applying cool air can help relieve the sensation without compromising the cast or skin integrity. Using a blow-dryer on the cool setting can help alleviate itching without introducing moisture, which could lead to skin breakdown or infection. Option B) Using sterile applicators to scratch the itch is incorrect as it can damage the skin under the cast, leading to potential complications such as infection or injury. Option C) Applying cool water under the cast is not recommended as it can introduce moisture, potentially leading to skin maceration and breakdown, increasing the risk of infection. Option D) Applying hydrocortisone cream under the cast using a sterile applicator is not advised as it can also introduce moisture and may not effectively relieve the itching sensation in this scenario. Educational Context: It is essential for nurses working in pediatric cardiovascular nursing to be knowledgeable about proper cast care, especially when dealing with itching, a common issue among pediatric patients. Understanding the appropriate interventions to relieve itching while maintaining the integrity of the cast and the patient's skin is crucial for promoting optimal healing and preventing complications. Nurses play a vital role in educating patients and families on safe and effective methods to address common concerns like itching under a cast, ensuring positive outcomes for their patients.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) Blood is circulated through the lungs again, causing pulmonary circulatory congestion. When an infant has a patent ductus arteriosus (PDA), a congenital heart defect where the ductus arteriosus fails to close after birth, it leads to a shunt of blood from the aorta to the pulmonary artery. This causes increased blood flow to the lungs, leading to pulmonary circulatory congestion and eventually resulting in dyspnea (difficulty breathing) as the lungs become overloaded with blood. Option B) Blood is shunted past the pulmonary circulation, causing pulmonary hypoxia, is incorrect because in PDA, blood is actually shunted towards the pulmonary circulation, leading to increased blood flow to the lungs rather than bypassing them. Option C) Blood is shunted past cardiac arteries, causing myocardial hypoxia, is incorrect because PDA primarily affects pulmonary circulation, not cardiac arteries, leading to pulmonary congestion rather than myocardial hypoxia. Option D) Blood is circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart, is incorrect because PDA causes blood to flow from the aorta to the pulmonary artery, bypassing the lungs and overloading them with blood, rather than bypassing the left side of the heart. Understanding the pathophysiology of congenital heart defects like PDA is crucial for pediatric cardiovascular nursing. Nurses need to recognize the signs and symptoms of PDA, including dyspnea, to provide appropriate care and interventions to improve the infant's respiratory status and overall condition.

Correct Answer: A

Rationale: The correct answer is option A: "If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest." This response demonstrates understanding because holding the infant in a position that promotes chest expansion can help improve blood flow and oxygenation. Option B is incorrect because laying the baby down on a firm surface with the head lower than the body can further compromise oxygenation by reducing blood flow to the heart and brain. Option C is not ideal as placing the baby upright in an infant seat may not facilitate optimal chest expansion and can restrict respiratory effort. Option D is also incorrect as putting the baby in a supine position with the head elevated may not be as effective as positioning the infant with knees bent up to the chest for improving oxygenation in tetralogy of Fallot. Educationally, understanding the correct positioning for an infant with tetralogy of Fallot during a cyanotic spell is crucial for parents and caregivers to effectively manage such situations and optimize the infant's outcomes. It is essential to provide clear and accurate information to parents to empower them in caring for their child with a congenital heart condition.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) A bulging, red tympanic membrane. This finding is indicative of acute otitis media, which is an infection of the middle ear commonly seen in children. A bulging, red tympanic membrane suggests inflammation and fluid accumulation behind the eardrum, characteristic of this condition. Option A) Bilateral eye discharge and fever is more indicative of conjunctivitis or an eye infection, not acute otitis media. Option C) Nasal congestion and headache are more commonly associated with upper respiratory infections like the common cold, sinusitis, or allergies. Option D) Persistent cough and sore throat are symptoms seen in conditions such as pharyngitis or bronchitis, but not typically in acute otitis media. Educationally, it is important for nurses to be able to recognize key clinical manifestations associated with different pediatric conditions to provide appropriate care and interventions. Understanding the specific signs and symptoms of acute otitis media can aid in accurate assessment, diagnosis, and treatment of children presenting with ear pain and related complaints. This knowledge is crucial for pediatric nurses who frequently encounter children with ear infections in clinical practice.