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 in Wilms tumor is crucial for providing optimal care. In this scenario, the correct answer is D) young age at diagnosis. This is because younger age at diagnosis is actually associated with a more favorable prognosis in Wilms tumor, contrary to the other options. Option A) large tumors are considered an adverse prognostic factor in Wilms tumor due to increased risk of metastasis and complications. Option B) anaplastic histology is associated with a poorer prognosis as it indicates a more aggressive form of the tumor. Option C) loss of heterozygosity at chromosome 1p and 16q is also a negative prognostic factor in Wilms tumor. Educationally, it is important for nurses caring for pediatric oncology patients to be aware of these prognostic factors to assist in providing comprehensive care, educating families, and understanding the treatment implications based on these factors. Understanding these nuances helps nurses in advocating for their young patients and supporting families through the complexities of cancer treatment.

Correct Answer: E

Rationale: In this scenario, the correct answer is option E, none of the findings raise suspicion of melanoma. This question assesses the student's understanding of the characteristics of melanoma in pediatric patients. Explanation: A) An enlarging nevus is concerning as it can be a sign of melanoma. Melanomas often grow in size over time. B) Changing colors in a nevus can be indicative of melanoma. Variegated colors are a warning sign. C) Irregular margins are a classic feature of melanoma. Well-defined borders are typical of benign nevi. D) A nevus that easily bleeds can be a sign of melanoma, as melanomas are prone to bleeding due to their abnormal blood supply. Educational context: It is crucial for pediatric nurses to recognize the signs of potential skin malignancies like melanoma in children. Understanding the specific characteristics of melanoma helps in early detection and intervention, leading to better outcomes for patients. Nurses play a key role in educating parents about monitoring moles and seeking medical evaluation if concerning changes are noted. This question reinforces the importance of vigilance and knowledge in pediatric dermatological assessments.

Correct Answer: C

Rationale: The correct answer is C) the patient can receive volume expanders. In the scenario described, the parents' religious beliefs prohibit blood transfusions. As a pediatric nurse, it is crucial to respect the parents' beliefs while also ensuring the best care for the child. Volume expanders are a suitable alternative to blood transfusions in cases where increasing the circulating blood volume is necessary. They help maintain blood pressure and tissue perfusion without violating the parents' wishes. Option A is incorrect because in an emergency situation where immediate intervention is required to save the child's life, parental consent may not be necessary, but it is important to respect the parents' beliefs whenever possible. Option B is incorrect as it imposes a specific restriction on blood donation sources, which may not align with the parents' preferences or beliefs. As an educator, it is essential to teach nursing students about the importance of cultural and religious sensitivity in providing care to pediatric patients and involving families in decision-making processes to the extent possible while ensuring patient safety and well-being.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D) fluid overload or pulmonary edema. When caring for a pediatric patient with septic shock and administering fluid resuscitation, the nurse should monitor for signs of fluid overload, which can lead to pulmonary edema. This is a potential complication of rapid fluid administration in patients with septic shock. Pulmonary edema presents with symptoms such as respiratory distress, crackles on lung auscultation, and increased work of breathing. Option A) a heart rate of 50 beats/min is not directly related to fluid overload or pulmonary edema. In septic shock, tachycardia is a common finding due to the body's response to infection. Option B) a temperature of 102°F (38.9°C) is indicative of an ongoing infection and inflammatory response, which are expected in septic shock. It is not a specific sign of fluid overload. Option C) reports of leg pain could indicate muscle pain, joint issues, or poor perfusion, but it is not a typical sign of fluid overload or pulmonary edema. Educationally, this question highlights the importance of recognizing potential complications of fluid resuscitation in pediatric patients with septic shock. It emphasizes the need for close monitoring and assessment to detect early signs of fluid overload, which can impact the patient's respiratory status and overall outcome. Nurses must be vigilant in assessing for both desired effects and potential adverse reactions to interventions such as fluid resuscitation in critically ill pediatric patients.

Correct Answer: A

Rationale: Rationale: The correct answer is A) visual-motor coordination. At 22 months, children are in the early stages of development and are starting to explore and engage in activities that require coordination between their visual perception and motor skills. Building a tower involves looking at the blocks, planning how to stack them, and then using their hands to carry out the action. This process demonstrates the integration of visual information with physical movements, which is known as visual-motor coordination. Option B) using visual and motor skills in combination is similar to the correct answer, but it lacks the specificity of the term "coordination," which is crucial in understanding the complexity of the task for a toddler. Option C) gross and fine motor coordination is not entirely accurate in this context. While building a tower does involve both gross (large muscle movements) and fine (small muscle movements) motor skills, the key aspect being tested in this question is the coordination between visual input and motor output. Option D) symbolic thought is not relevant to the task of building a tower with blocks for a 22-month-old child. Symbolic thought typically develops later in childhood and involves the ability to understand and use symbols to represent objects or ideas. Educational Context: Understanding the developmental milestones and skills required at different ages is essential for pediatric nurses to provide appropriate care and support to children and their families. By recognizing the significance of visual-motor coordination in activities like building a tower, nurses can assess a child's developmental progress and intervene if there are any concerns or delays. This knowledge also informs nurses on how to engage children in play activities that promote their physical and cognitive development.