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 context, the correct answer, option D, "young age at diagnosis," is the exception among the adverse prognostic factors. Children diagnosed at a young age with Wilms tumor typically have a more favorable prognosis compared to older children. This is due to the fact that younger children tend to respond better to treatment and have a higher survival rate. Options A, B, and C are adverse prognostic factors in children with Wilms tumor. Large tumors (option A) can indicate a more advanced stage of the disease, making treatment more challenging. Anaplastic histology (option B) is associated with a more aggressive form of Wilms tumor, leading to a poorer prognosis. Loss of heterozygosity at chromosome 1p and 16q (option C) is a genetic abnormality that can also indicate a higher risk of disease progression and worse outcomes. Educationally, recognizing these prognostic factors is essential for healthcare professionals caring for pediatric oncology patients. Understanding these factors helps in treatment planning, monitoring patient progress, and providing families with accurate prognostic information. It also underscores the importance of personalized and evidence-based care in pediatric oncology practice.

Correct Answer: E

Rationale: In this case, the correct answer is "E) easily bleeds." This option does not raise suspicion of melanoma because bleeding is not typically a characteristic feature of melanoma. Melanomas usually present with specific signs that help differentiate them from benign nevi. Option A, an enlarging nevus, is concerning for melanoma as melanomas often grow in size. Option B, changing colors, is also a red flag as melanomas can exhibit various colors within the lesion. Option C, irregular margins, is another classic sign of melanoma as benign nevi typically have smooth, well-defined borders. Educationally, it is crucial for nurses to understand the key characteristics of melanoma to differentiate it from benign skin lesions. Assessing nevi in pediatric patients requires a keen eye for changes that may indicate malignancy. By knowing these distinguishing features, nurses can provide appropriate guidance and referrals for further evaluation to ensure early detection and treatment if necessary.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) the patient can receive volume expanders. This is because Jehovah's Witnesses do not accept blood transfusions due to religious beliefs, but they do accept other blood products and treatments that do not involve direct blood transfusion. Volume expanders, such as saline solutions, can be used to help maintain blood volume and circulation in the patient without contradicting the parents' wishes. Option A is incorrect because in an emergency, obtaining parental approval for medical interventions is still essential, even if it may delay treatment. Option B is incorrect as Jehovah's Witnesses typically do not distinguish between blood from family members and others when it comes to transfusions. It is important for pediatric nurses to respect and accommodate the religious beliefs of patients and families while ensuring that appropriate alternative treatments are provided to meet the patient's medical needs. This case highlights the significance of cultural competence and ethical considerations in pediatric nursing practice.

Correct Answer: D

Rationale: In the case of a 12-year-old patient with septic shock, the pediatric nurse should be vigilant for signs of fluid overload or pulmonary edema as potential complications of fluid resuscitation. Septic shock often leads to capillary leak syndrome, causing fluid to shift from the vascular space into the interstitial space, potentially leading to fluid overload. This can manifest as increased work of breathing, crackles in the lungs, and decreased oxygen saturation. Option A, a heart rate of 50 beats/min, is not indicative of fluid overload but rather bradycardia, which can be a sign of impending cardiovascular collapse in septic shock. Option B, a temperature of 102°F (38.9°C), is a common symptom of infection and sepsis, not necessarily a direct result of fluid resuscitation. Option C, reports of leg pain, could indicate compartment syndrome or ischemia but is not directly related to fluid resuscitation complications. Understanding the potential complications of fluid resuscitation in pediatric patients with septic shock is crucial for pediatric nurses to provide timely interventions and prevent further deterioration. Monitoring for signs of fluid overload or pulmonary edema, such as respiratory distress, crackles, and decreased oxygen saturation, is vital for ensuring patient safety and optimal outcomes in this critical condition.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) visual-motor coordination. At 22 months of age, a child is typically in the stage of early toddlerhood. Building a tower involves the child utilizing both visual perception and motor skills to stack blocks or objects on top of each other. Visual-motor coordination refers to the ability to process visual information and use it to coordinate a physical response, such as reaching, grasping, or stacking. Option B) using visual and motor skills in combination is closely related to the correct answer, but it lacks the specificity of visual-motor coordination, which is the precise skill required for tower building. Option C) gross and fine motor coordination is not directly related to the task of building a tower, as it involves more complex movements that are not as precise as required for stacking blocks. Option D) symbolic thought is not relevant to this particular task as it pertains to the child's ability to understand symbols and represent objects with words or mental images. In an educational context, understanding the developmental milestones and appropriate activities for each age group is crucial for pediatric nurses. By recognizing the specific skills involved in tasks like tower building, nurses can assess a child's developmental progress and provide appropriate interventions or support if needed. Encouraging activities that promote visual-motor coordination can help foster a child's physical and cognitive development during this critical stage of early childhood.