An adult has been stung by a bee and is in anaphylactic shock. An epinephrine (adrenaline) injection has been given. The nurse would expect which the following if the injection has been effective?

Correct Answer: A

Rationale: An epinephrine (adrenaline) injection is the first-line treatment for anaphylaxis, as it helps to relax the muscles in the airway and improve breathing. This results in the client's breathing becoming easier. Epinephrine also acts to increase blood pressure, while angioedema (swelling) and a decreased level of consciousness are not expected effects of an effective epinephrine injection.

Correct Answer: D

Rationale: In this scenario, the most effective treatment is option D) recombinant urate oxidase. This is because the child has ileocecal Burkitt lymphoma, a malignancy associated with rapid cell turnover leading to tumor lysis syndrome (TLS). The elevated uric acid level of 12 mg/dl indicates TLS, which can lead to renal failure and other complications if not addressed promptly. Recombinant urate oxidase (rasburicase) is the treatment of choice for TLS as it rapidly breaks down uric acid into a more soluble form, preventing uric acid crystallization and subsequent renal damage. This therapy is crucial in preventing acute kidney injury and other TLS-related complications. Option A) excessive hydration is not the most effective treatment as it alone may not be sufficient to rapidly reduce the dangerously high uric acid levels seen in TLS. Option B) sodium bicarbonate is used to alkalinize the urine and prevent uric acid crystallization but is not as effective as recombinant urate oxidase in rapidly lowering uric acid levels. Option C) xanthine oxidase inhibitor (such as allopurinol) is used for chronic management of hyperuricemia but is not as effective as recombinant urate oxidase in the acute setting of TLS. Educationally, understanding the pathophysiology of TLS and the appropriate management is crucial for healthcare providers caring for pediatric oncology patients. Recognizing the urgency of treating elevated uric acid levels in TLS with recombinant urate oxidase can prevent severe complications and improve patient outcomes.

Correct Answer: A

Rationale: In this case, the correct answer is A) nephroblastoma. Nephroblastoma, also known as Wilms tumor, is the most common renal tumor in children. It typically presents as an asymptomatic abdominal mass, often incidentally discovered by parents or caregivers. The age of the patient described in the scenario (2-month-old) also aligns with the typical age range for Wilms tumor diagnosis. Option B) neuroblastoma is a tumor that arises from neural crest cells and usually presents with symptoms such as abdominal distension, weight loss, and other systemic signs. It is less likely in this scenario as the mass is described as a left renal mass, which is not characteristic of neuroblastoma. Option C) mesoblastic nephroma is a rare benign renal tumor that typically presents in the neonatal period. However, it is less likely in this case given the age of the infant and the fact that nephroblastoma is more common in the pediatric population. Option D) clear cell sarcoma is a rare tumor that typically occurs in older children and adolescents. It is not commonly associated with renal masses in infants. Educationally, understanding the typical presentations, age groups affected, and characteristics of different pediatric renal tumors is crucial for healthcare providers to make accurate diagnoses and provide appropriate treatment. Knowledge of these distinctions can guide clinical decision-making and improve patient outcomes.

Correct Answer: A

Rationale: In nasopharyngeal carcinoma (NPC) patients, an elevated lactate dehydrogenase (LDH) level carries the worst outcome. LDH is a marker of tissue damage and its elevation indicates more aggressive disease and poorer prognosis in cancer patients. Elevated LDH levels are associated with increased tumor burden, metastasis, and overall disease progression in NPC. Advanced disease (option B) is a significant factor affecting prognosis in NPC, but it is not as specific or indicative of poor outcome as elevated LDH levels. Extensive cervical lymph node involvement (option C) is also a negative prognostic factor in NPC, but it is more related to disease stage rather than a direct marker of poor outcome. Evidence of Epstein-Barr virus (EBV) DNA (option D) is commonly seen in NPC patients but does not necessarily correlate with worse prognosis as much as elevated LDH levels. In an educational context, understanding the significance of different prognostic factors in NPC is crucial for healthcare professionals involved in the care of these patients. Recognizing the impact of elevated LDH levels on prognosis can guide treatment decisions and help in optimizing patient outcomes. Students and practitioners need to be aware of the specific markers and factors that influence prognosis in NPC to provide comprehensive care to these patients.

Correct Answer: A

Rationale: The correct answer is A) intensive chemotherapy. In this scenario, the presence of blast cells in the peripheral blood of a 20-day-old infant with hepatomegaly and abnormal blood counts suggests a high likelihood of acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), both of which require intensive chemotherapy for treatment. Option B) low dose chemotherapy pulses would not be the best approach as aggressive treatment is usually required for acute myeloproliferative disorders to achieve remission and prevent disease progression. Option C) bone marrow transplantation is typically reserved for cases of refractory or relapsed disease, not as initial management. Option D) close follow-up alone is insufficient as immediate treatment is necessary in the presence of blast cells and abnormal blood counts in a pediatric patient. From an educational standpoint, it is crucial for healthcare providers to recognize the urgency of appropriate management in pediatric patients presenting with concerning findings like blast cells in the blood. Understanding the treatment approaches for pediatric leukemias is essential for providing timely and effective care to these vulnerable patients.