Although children with Wilms tumor have a favorable prognosis, there are some adverse prognostic factors in children with Wilms tumor EXCEPT

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.

Correct Answer: A

Rationale: The correct answer is A) inv(16) when considering translocation of childhood acute myeloid leukemia (AML) associated with granulocytic sarcoma mass. This translocation involves inversion of chromosome 16, leading to the fusion of the CBFB and MYH11 genes. This genetic abnormality is commonly seen in cases of AML with eosinophilia and is also associated with extramedullary involvement like granulocytic sarcoma. Option B) t(8;21) involves the fusion of the AML1 (RUNX1) gene with the ETO (RUNX1T1) gene. This translocation is more commonly associated with AML M2 subtype, not specifically linked to granulocytic sarcoma. Option C) t(6;9) is associated with the fusion of DEK and CAN genes, typically seen in AML M2 subtype. This translocation is not typically linked to granulocytic sarcoma. Option D) inv(3) involves inversion of chromosome 3 and is associated with AML M4 subtype. This translocation is not specifically associated with granulocytic sarcoma. In an educational context, understanding the genetic basis of AML subtypes and their associated translocations is crucial for accurate diagnosis and targeted treatment. Recognizing the specific translocations and their clinical correlations can aid in predicting disease behavior and guiding therapeutic decisions in pediatric patients with AML.

Correct Answer: D

Rationale: In neuroblastoma, metastatic spread can occur via local invasion or distant hematogenous/lymphatic routes. The LEAST common site of metastases in neuroblastoma is the skin (Option D). The correct answer is D because neuroblastoma typically metastasizes to organs such as the bone marrow, long bones, and lungs due to the nature of the disease. Skin metastases are rare in neuroblastoma compared to other sites. Option A (long bone) is a common site of metastasis in neuroblastoma due to the rich blood supply and bone marrow content, making it a favorable environment for tumor spread. Option B (bone marrow) is also a common site of metastasis as neuroblastoma is an embryonal cancer arising from neural crest cells that can infiltrate the bone marrow. Option C (lung) is another common site of metastasis in neuroblastoma as the lungs receive a high volume of blood flow, allowing cancer cells to potentially spread there. Educationally, understanding the patterns of metastatic spread in neuroblastoma is crucial for nurses preparing for the NCLEX RN Pediatric exam. This knowledge helps in early detection, appropriate staging, and treatment planning for pediatric patients with neuroblastoma. It also highlights the importance of comprehensive assessments and vigilant monitoring for signs of metastases in these patients.

Correct Answer: C

Rationale: In the treatment of malignant germ cell tumors (GCTs), cisplatin is the most effective chemotherapeutic agent. This is because cisplatin is a platinum-based chemotherapy drug that has shown high efficacy in treating GCTs by disrupting DNA synthesis in rapidly dividing cancer cells, leading to cell death. Vincristine (Option A) is not as effective in GCTs compared to cisplatin, as it primarily acts by disrupting microtubule function and is more commonly used in other types of cancers. Cyclophosphamide (Option B) is an alkylating agent that is less specific to GCTs and is not considered the first-line treatment for this type of cancer. Methotrexate (Option D) is a folate antagonist that is also not as effective as cisplatin in treating GCTs. In an educational context, it is important for medical students to understand the mechanism of action of different chemotherapeutic agents and their specific applications in various types of cancers. Understanding the rationale behind choosing cisplatin over other agents for treating GCTs helps students grasp the principles of personalized medicine and evidence-based practice in oncology.

Correct Answer: C

Rationale: In this scenario, option C is correct because post-hydrocele repair, it is normal for the scrotum to be swollen and discolored due to the inflammatory response triggered by the surgical procedure. This swelling and discoloration are expected and typically resolve on their own without the need for intervention. Option A is incorrect because applying a cool compress may not be necessary and could potentially interfere with the body's natural healing process. Option B is incorrect because while hemorrhaging is a concern postoperatively, swelling and discoloration alone do not definitively indicate hemorrhaging without other accompanying signs such as significant pain or changes in vital signs. Option D is incorrect as the need for a position change is not relevant to the findings described in the scenario. Educationally, understanding the normal postoperative course following a hydrocele repair is essential for pediatric nurses to provide safe and effective care to patients. Recognizing expected outcomes helps nurses differentiate between normal healing processes and complications, enabling timely interventions when necessary. It also promotes patient and family education, reassuring them about common postoperative changes and reducing anxiety.