A newborn with hypospadias: The parents ask if circumcision is an option. Which is the best response?

Correct Answer: C

Rationale: The correct response is C) Circumcision is an option but should be delayed, as the foreskin may be needed for surgical repair in a newborn with hypospadias. This answer is the best because in hypospadias, where the urethral opening is on the underside of the penis, the foreskin tissue may be used in surgical correction. Circumcision may remove this tissue needed for future surgeries to correct the condition. Option A is incorrect because circumcision is not contraindicated in all cases, especially in hypospadias where surgical repair may be necessary. Option B is incorrect as circumcision solely for preventing infection is not a primary indication in this scenario. Option D is incorrect because circumcision can be performed in a child with hypospadias but timing and consideration of surgical needs are crucial. Educationally, this question highlights the importance of understanding specific considerations in pediatric conditions like hypospadias. It underscores the need for healthcare providers to be aware of the potential impact of procedures like circumcision on future treatment options and to provide accurate and patient-centered information to families.

Correct Answer: C

Rationale: In this scenario, option C, bruises over bony prominences, is the least likely suggestive of physical abuse in a 2-year-old boy. This is because bruises over bony areas such as knees or shins are common in toddlers due to their explorative nature and frequent falls. These bruises are often accidental and not indicative of abuse. Option A, bruises over the neck, can be concerning for abuse as it is an uncommon site for accidental bruising in children. Option B, looped extension cord marks on the body, indicates a specific pattern of injury that is highly suggestive of abuse. Option D, bruising of the torso, can also be concerning especially if there are specific patterns or multiple bruises in different stages of healing. Educationally, it is essential for nurses to be able to differentiate between accidental and abusive injuries in pediatric patients. Understanding the patterns and locations of bruises that are more likely indicative of abuse can help healthcare professionals intervene and protect vulnerable children. Recognizing these signs is crucial in advocating for the well-being of pediatric patients.

Correct Answer: B

Rationale: In this question, the correct answer is B) neurofibromatosis. Neurofibromatosis is a genetic disorder characterized by the development of tumors along nerves, including optic gliomas. Optic gliomas are a common manifestation of neurofibromatosis type 1, making it the most likely genetic syndrome associated with an increased risk of optic glioma. Option A) Down syndrome is not typically associated with an increased risk of optic glioma. Down syndrome is a chromosomal disorder caused by the presence of an extra chromosome 21. Option C) Monosomy, which refers to the presence of only one copy of a particular chromosome instead of the usual two, is not directly related to an increased risk of optic glioma. Monosomy can lead to various genetic disorders, but optic glioma is not a common feature. Option D) Bloom's syndrome is a rare genetic disorder characterized by a predisposition to cancer but is not specifically linked to an increased risk of optic glioma. Educationally, understanding the associations between genetic syndromes and specific health conditions is crucial for healthcare professionals, especially for nurses preparing for the NCLEX RN exam. This knowledge helps in providing appropriate care, recognizing potential complications, and guiding patient education and support.

Correct Answer: D

Rationale: In pediatric oncology, tumor lysis syndrome (TLS) is a serious complication that can occur due to the rapid breakdown of cancer cells leading to metabolic imbalances. Burkitt lymphoma is more likely to manifest TLS because it is a highly proliferative malignancy with a high tumor burden, resulting in a significant release of intracellular contents upon treatment initiation. Acute myelogenous leukemia (AML) is a rapidly dividing cancer, but it usually presents with a lower tumor burden compared to Burkitt lymphoma. Nephroblastoma (Wilms tumor) and neuroblastoma are also childhood malignancies but are not typically associated with the high tumor burden that predisposes to TLS. Educationally, understanding the risk factors associated with TLS in pediatric oncology is crucial for nurses and healthcare providers caring for these patients. Recognizing the malignancies that are more likely to manifest TLS can help in early identification, monitoring, and prevention of this potentially life-threatening complication during cancer treatment. It also emphasizes the importance of close monitoring and prompt intervention to prevent TLS-related complications and improve patient outcomes.

Correct Answer: D

Rationale: In pediatric oncology, understanding prognostic factors for Wilms tumor is crucial. The correct answer, option D, "young age at diagnosis," is not an adverse prognostic factor. Children diagnosed at a younger age actually have a better prognosis for Wilms tumor. Option A, "large tumors," is an adverse prognostic factor because larger tumors often indicate a more advanced stage of the disease, which can impact outcomes. Option B, "anaplastic histology," is also an adverse prognostic factor as this histology is associated with a higher risk of tumor recurrence and poorer outcomes. Option C, "loss of heterozygosity at chromosome 1p and 16q," is an adverse prognostic factor because genetic abnormalities like these can indicate a more aggressive form of Wilms tumor. Educationally, understanding these prognostic factors helps nurses and healthcare providers in the care of pediatric oncology patients. Recognizing which factors may impact outcomes allows for tailored treatment plans and better communication with families about prognosis and treatment options.