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 the context of pediatric oncology, understanding the prognostic factors of Wilms tumor is crucial for nurses preparing for the NCLEX RN exam. The correct answer, option D, "young age at diagnosis," is not an adverse prognostic factor in children with Wilms tumor. Children diagnosed at a young age actually have a more favorable prognosis in Wilms tumor cases. This is because younger children tend to respond better to treatment and have a higher overall survival rate compared to older children. Options A, B, and C are incorrect because they are adverse prognostic factors in children with Wilms tumor. Large tumors, anaplastic histology, and loss of heterozygosity at chromosome 1p and 16q are all associated with a poorer prognosis and may indicate a more aggressive form of Wilms tumor that is less responsive to treatment. In an educational context, nurses need to be able to differentiate between favorable and adverse prognostic factors in pediatric oncology to provide optimal care for children with cancer. Understanding these factors helps nurses anticipate complications, plan appropriate interventions, and support the child and their family through the treatment process.

Correct Answer: A

Rationale: In the case of childhood Acute Myeloid Leukemia (AML) associated with granulocytic sarcoma mass, the correct translocation type is inv(16). This translocation involves inversion of chromosome 16, leading to the fusion of the CBFB and MYH11 genes. This fusion gene is characteristic of AML with eosinophilia and is associated with a more favorable prognosis. Option B, t(8;21), is commonly associated with AML-M2 subtype but not specifically with granulocytic sarcoma mass. Option C, t(6;9), is associated with AML with poor prognosis and does not typically present with granulocytic sarcoma. Option D, inv(3), is associated with AML and myelodysplastic syndrome, but not usually with granulocytic sarcoma mass. In an educational context, understanding the specific genetic abnormalities associated with different subtypes of AML is crucial for accurate diagnosis and treatment planning. Recognizing the significance of inv(16) in the context of granulocytic sarcoma helps healthcare professionals provide targeted and effective care for pediatric patients with this condition.

Correct Answer: D

Rationale: In neuroblastoma, the LEAST common site of metastases is the skin (Option D). This is because neuroblastoma typically metastasizes to sites such as the long bones (Option A), bone marrow (Option B), and lungs (Option C) before involving the skin. Metastases to the long bones are common due to their rich vascular supply, making them a favorable site for tumor spread. Bone marrow involvement is also common in neuroblastoma due to its hematopoietic nature and proximity to the primary tumor site. Additionally, neuroblastoma frequently metastasizes to the lungs, likely due to the direct hematogenous spread from the primary tumor. Understanding the pattern of metastases in neuroblastoma is crucial for nurses preparing for the NCLEX RN exam as it helps in differentiating between common and uncommon sites of spread. This knowledge can aid in early detection of metastatic disease and appropriate treatment planning for pediatric patients with neuroblastoma.

Correct Answer: C

Rationale: In the context of treating malignant germ cell tumors (GCTs), cisplatin is the most effective chemotherapeutic agent due to its high efficacy against these types of tumors. Cisplatin works by causing DNA damage in rapidly dividing cells, which is a characteristic feature of cancer cells. This mechanism of action makes cisplatin particularly effective in targeting and killing cancer cells in GCTs. Vincristine, although commonly used in pediatric cancers, is not as effective in treating GCTs compared to cisplatin. Vincristine works by disrupting the formation of the mitotic spindle in cancer cells, which is not as specific to GCTs as cisplatin. Cyclophosphamide and methotrexate are also commonly used in pediatric oncology, but they are not the most effective agents for treating GCTs. Cyclophosphamide interferes with DNA replication and cell division, while methotrexate inhibits folic acid metabolism in cancer cells. However, their mechanisms of action are not as targeted towards GCTs as cisplatin. In an educational context, understanding the specific chemotherapeutic agents effective against different types of tumors is crucial for providing optimal care to pediatric patients with cancer. Knowing the mechanisms of action of these agents helps healthcare providers make informed decisions when designing treatment plans tailored to the individual needs of each patient.

Correct Answer: C

Rationale: The correct answer is C) normal, and indicate no need for intervention. In a pediatric patient who has undergone a hydrocele repair, swelling and discoloration of the scrotum are expected postoperative findings. This is due to the surgical procedure and the body's natural response to trauma. It is essential for the nurse to recognize these expected postoperative changes to provide appropriate care and prevent unnecessary interventions. Option A) suggesting the need for a cool compress is incorrect because applying cold therapy to the scrotum can potentially cause vasoconstriction and impair blood flow, which is not advisable in this situation. Option B) indicating the presence of hemorrhaging is incorrect as some degree of swelling and discoloration is normal after a hydrocele repair and does not necessarily indicate hemorrhage. Option D) stating the need for a position change is also incorrect as the swelling and discoloration in this case do not require a change in position but rather observation and reassurance to the patient and family. Educationally, understanding the expected postoperative findings following specific pediatric procedures is crucial for providing safe and effective nursing care. This knowledge helps nurses differentiate between normal and abnormal findings, thus guiding appropriate interventions and preventing unnecessary alarm or actions that could potentially harm the patient.