A preschool-age child is brought to the clinic by the mother, who says the child has been lethargic and anorexic lately and complains of bone pain. On exam, the nurse notes petechiae, joint pain, and an enlarged liver. Which diagnosis does the nurse anticipate for this child?

Correct Answer: B

Rationale: The correct answer is B: Leukemia. The child's symptoms of lethargy, anorexia, bone pain, petechiae, joint pain, and an enlarged liver are indicative of leukemia, a type of cancer that affects the blood and bone marrow. The combination of symptoms suggests hematologic malignancy, which is characteristic of leukemia. Hodgkin disease (A), Rhabdomyosarcoma (C), and Ewing sarcoma (D) are not typically associated with the constellation of symptoms described. Leukemia commonly presents with bone pain, fatigue, bruising, and hepatosplenomegaly, aligning with the child's clinical findings.

Correct Answer: C

Rationale: The correct answer is C: Escherichia coli. E. coli is a common cause of urinary tract infections due to its ability to colonize the urinary tract and cause infection. It is a gram-negative bacterium commonly found in the gut. Clostridium botulinum causes botulism, Corynebacterium diphtheriae causes diphtheria, and Helicobacter pylori causes stomach ulcers, not urinary tract infections. E. coli's presence in the urinary tract can lead to inflammation and infection, making it the correct choice in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Supine or side-lying positioning. This positioning helps prevent trauma to the surgical site, promotes comfort, and facilitates optimal healing. Prone positioning (A) may increase the risk of pressure on the surgical area. Suctioning with a Yankauer device (B) is not indicated unless necessary for airway clearance. Avoiding soft elbow restraints (D) is not directly related to cleft-lip repair care.

Correct Answer: A

Rationale: The correct answer is A: Observing for signs of hypovolemic shock. This is the highest-priority nursing intervention because a lacerated spleen can lead to severe internal bleeding and hypovolemic shock, which is a life-threatening condition. Monitoring for signs such as tachycardia, hypotension, pallor, and altered mental status is crucial for early detection and prompt intervention. Maintaining IV fluids (B) is important, but monitoring for shock takes precedence. Implementing strict bedrest (C) may be necessary, but it is not the highest priority. Administering blood products (D) may be needed, but assessing for shock comes first to guide the need for blood products.

Correct Answer: B

Rationale: The correct answer is B because it emphasizes the importance of monitoring the child's weight and height to ensure they reach normal levels, which is crucial for their overall health and growth. This information helps the parents understand the expected timeline for improvement. A: Ice cream may contain gluten unless specified gluten-free, so it is not a safe dessert option for a child with celiac disease. C: Processed foods often contain hidden sources of gluten, so it is essential for parents to carefully read labels and choose certified gluten-free options. D: While insurance coverage for celiac diets varies, it is not the most critical aspect to emphasize when educating parents of a newly diagnosed child.