An adult has a central venous line. Which of the following should the nurse include in the plan of care?

Correct Answer: D

Rationale: An adult with a central venous line should include monitoring for any signs of infection, air embolus, and leakage or puncture in the plan of care. Central venous lines carry a risk of complications such as infection, air embolism, and mechanical issues like leakage or puncture. These complications can be serious and require immediate attention to prevent further harm to the patient. Regular monitoring and assessment for these potential issues are crucial in providing safe care for a patient with a central venous line. Other options (A, B, C) may be important in the overall care but monitoring for complications is the priority.

Correct Answer: A

Rationale: The correct answer is option A) age of more than 15 years at the time of diagnosis. In pediatric Hodgkin lymphoma, a younger age at diagnosis is actually considered a poor prognostic factor due to the aggressive nature of the disease in children. Option B) stage IV disease is a poor prognostic factor as it indicates advanced disease spread and typically worse outcomes. Option C) manifested by PET scan positivity is also a poor prognostic factor as it suggests active disease. Option D) presence of a bulky mediastinal mass is another poor prognostic factor due to the potential for compression of vital structures and poorer response to treatment. In an educational context, it is crucial for pediatric emergency nurses to understand the key prognostic factors in pediatric Hodgkin lymphoma to provide optimal care and support to these young patients and their families. Recognizing these factors can help nurses in early identification of high-risk cases, prompt referral to specialized care, and better communication with the healthcare team to ensure appropriate treatment plans are implemented.

Correct Answer: D

Rationale: The correct answer is D) biopsy of the mass. In pediatric patients with suspected Wilms tumor, the least likely investigation is biopsy of the mass. This is because biopsy can potentially seed tumor cells and upstage the disease, making subsequent treatment more challenging. Option A) plain abdominal radiography is not typically used in the diagnosis of Wilms tumor as it provides limited information compared to other imaging modalities. Option B) and C) CT scans of the abdomen and chest are essential in staging and determining the extent of the tumor. In an educational context, understanding the appropriate diagnostic approach in pediatric oncology is crucial for nurses working in emergency settings. By knowing which investigations are most appropriate and why others should be avoided, nurses can contribute to timely and accurate diagnosis, leading to better outcomes for pediatric patients with suspected malignancies.

Correct Answer: D

Rationale: Kasabach-Merritt syndrome is a rare but serious condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, and coagulopathy. The correct answer is D) association with infantile hemangiomas because Kasabach-Merritt syndrome is not associated with infantile hemangiomas. Thrombocytopenia is a key feature of Kasabach-Merritt syndrome, where there is a significant decrease in platelet count leading to an increased risk of bleeding. Microangiopathic hemolytic anemia is also seen in this syndrome, where red blood cells are destroyed as they pass through small blood vessels. Coagulopathy refers to a clotting disorder that can manifest as abnormal bleeding or clotting tendencies. In an educational context, understanding the distinguishing features of Kasabach-Merritt syndrome is crucial for pediatric emergency nurses to recognize and manage this potentially life-threatening condition promptly. The incorrect options help reinforce the specific diagnostic criteria that differentiate Kasabach-Merritt syndrome from other similar conditions, aiding in accurate assessment and timely interventions for affected pediatric patients.

Correct Answer: D

Rationale: The correct answer is D) the majority of affected boys can be successfully retreated, and the survival rate is good. This statement should be mentioned to the parents because it provides reassurance and hope regarding the child's prognosis. In pediatric oncology, relapse is a challenging situation, but letting parents know about the high success rate of retreatment and good survival outcomes can alleviate anxiety and help them make informed decisions. Option A is incorrect because testicular relapse in ALL is not as common as implied. Option B is incorrect as well since testicular relapse does not always present with painful swelling. Option C is incorrect because the diagnosis of testicular relapse is typically confirmed through a combination of clinical evaluation, imaging studies, and possibly biopsy, rather than solely relying on ultrasonography. In an educational context, it is crucial for healthcare providers to have effective communication skills when discussing sensitive topics like relapse with families. Providing accurate and hopeful information like the high success rate of retreatment can empower parents to be active participants in their child's care and treatment decisions.