A healthy 4-year-old child has a left flank mass. Computerized tomography (CT) scan of the abdomen shows a localized renal mass. Radical nephrectomy is performed; the histology shows clear cell sarcoma of the kidney. The MOST appropriate next step in the management is

Correct Answer: C

Rationale: The correct answer is C) bone scan. In this scenario, the child has been diagnosed with clear cell sarcoma of the kidney, which is a rare type of kidney cancer that can metastasize to other parts of the body, particularly the bones. Therefore, the next step in management would be to perform a bone scan to assess for any potential bone metastases. Option A) CT scan of the chest is not the most appropriate next step because clear cell sarcoma of the kidney is more likely to spread to the bones rather than the chest. Option B) CT scan of the brain is not necessary at this point since the primary concern is to rule out bone metastases in clear cell sarcoma of the kidney. Option D) MRI of the brain is also not indicated as there is no current indication of brain involvement in this case. In an educational context, understanding the appropriate diagnostic steps in managing pediatric oncology cases is crucial for pediatric nurses. This question highlights the importance of considering the metastatic potential of certain cancers and choosing the most appropriate diagnostic tests based on the specific type of cancer involved. It also emphasizes the need for thorough assessment and monitoring in pediatric oncology to provide optimal care for the young patients.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) AML M6. The rationale behind this is that children with Down syndrome have a higher risk of developing Acute Myeloid Leukemia (AML) compared to Acute Lymphoblastic Leukemia (ALL) or Chronic Myeloid Leukemia (CML). AML M6, also known as acute megakaryoblastic leukemia, is a type of AML that is more commonly associated with Down syndrome. This specific subtype of AML is characterized by the proliferation of abnormal megakaryoblasts in the bone marrow. Option A) ALL is less likely in this case because children with Down syndrome are more predisposed to AML. Option B) CML is a chronic leukemia and is less common in pediatric patients, especially those with Down syndrome. Option C) AML M1 is another subtype of AML but is not as commonly associated with Down syndrome as AML M6. Educationally, understanding the association between Down syndrome and different types of leukemia is crucial for pediatric nurses as it helps in early detection, appropriate management, and providing comprehensive care to these vulnerable patients. This knowledge also highlights the importance of tailored screening protocols and close monitoring for children with Down syndrome to detect any signs of leukemia early on.

Correct Answer: A

Rationale: The BEST therapeutic approach for the infant with poorly differentiated neuroblastoma and ipsilateral lymph node involvement is chemotherapy (Option A). Neuroblastoma in infants often presents as a highly malignant tumor, and chemotherapy is the primary treatment modality for disseminated disease. In this case, with microscopic lymph node involvement, systemic treatment like chemotherapy is crucial to target potential metastatic disease. Option B (radiotherapy) is not the best initial therapy for neuroblastoma in infants due to their young age and the potential for long-term side effects on developing tissues. Option C (concomitant chemo-radiotherapy) is not typically used as the primary treatment for neuroblastoma. Option D (chemotherapy followed by radiotherapy) may be considered in cases with high-risk features post-chemotherapy, but initial treatment for an infant with neuroblastoma and lymph node involvement would still be chemotherapy. Educationally, understanding the rationale behind treatment decisions in pediatric oncology is vital for nurses caring for pediatric oncology patients. Chemotherapy is often the cornerstone of treatment for pediatric malignancies, and knowing the appropriate sequencing and combination of therapies is crucial for providing safe and effective care to these vulnerable patients.

Correct Answer: B

Rationale: The correct answer is B) female infant. Hemangiomas are more common in females, with a female-to-male ratio of about 3:1. This is due to the role of estrogen in the development of these benign tumors. Estrogen has been suggested to promote the growth of hemangiomas, hence the higher prevalence in female infants. Option A) male infant is incorrect as hemangiomas are more commonly seen in females. Option C) infant of diabetic mother is incorrect as there is no established direct link between maternal diabetes and the development of hemangiomas in infants. Option D) infant delivered by cesarean section is incorrect as the mode of delivery does not impact the development of hemangiomas. In an educational context, understanding the risk factors associated with certain conditions, like hemangiomas in this case, is crucial for healthcare providers working with pediatric patients. This knowledge enables healthcare professionals to provide better care, anticipate potential issues, and educate parents about the condition. It also highlights the importance of considering gender-specific factors in pediatric healthcare.

Correct Answer: A

Rationale: The most appropriate nursing intervention for preparing a preschool-aged patient for an injection is option A) allow the patient to administer an injection to a doll. This technique, known as therapeutic play, helps the child understand and become familiar with the procedure in a non-threatening way. Through play, the child can gain a sense of control and mastery over the situation, reducing anxiety and fear associated with the injection. Option B) arranging for the patient to watch a peer receive an injection may inadvertently increase the child's anxiety by witnessing another child in distress. This approach lacks the hands-on involvement and active participation that therapeutic play provides. Option C) having the parents explain the process to the patient may not be as effective as the direct experiential learning gained from administering an injection to a doll. While parental support and education are important, they may not address the child's emotional and psychological needs in the same way that therapeutic play does. Option D) suggesting diversionary activities like singing may help momentarily distract the child, but it does not actively involve the child in the preparation process or address their underlying fears and anxieties about the injection. In an educational context, understanding the rationale behind using therapeutic play in pediatric nursing is crucial for creating a supportive and effective care environment for young patients. By engaging children in hands-on learning experiences that are developmentally appropriate and non-threatening, nurses can help alleviate anxiety, build trust, and empower children to cope with medical procedures in a positive way.