An adult is to receive an IM injection of Morphine for post op pain. Which of the following is necessary for the nurse to assess prior to giving a narcotic analgesic?

Correct Answer: A

Rationale: When administering a narcotic analgesic like Morphine, assessing the client's level of alertness and respiratory rate is crucial to monitor for any adverse effects such as respiratory depression. Morphine can cause respiratory depression as one of its side effects, especially in higher doses. By assessing the client's respiratory rate and level of alertness before administering the medication, the nurse can ensure the client's safety and take appropriate action if any signs of respiratory depression occur. This assessment is essential in preventing potential complications and ensuring the client's well-being during pain management.

Correct Answer: D

Rationale: The correct answer is D) hepatoblastoma, as this type of malignancy is least likely to occur in a 10-month-old infant. Hepatoblastoma is a rare liver cancer that typically occurs in young children, with the highest incidence in children under the age of 3. While hepatoblastoma can occur in infancy, it is less common compared to other malignancies in this age group. Option A) neuroblastoma is a common malignancy in infants and young children, arising from neural crest cells. Option B) nephroblastoma, also known as Wilms tumor, is a kidney cancer that primarily affects children. Option C) retinoblastoma is a tumor of the retina that often presents in young children. In an educational context, understanding the typical age range and common malignancies in pediatric patients is crucial for healthcare providers working in pediatrics. Recognizing the age patterns and common types of cancers in children can aid in early detection, prompt intervention, and improved outcomes. Awareness of the likelihood of specific malignancies in different age groups helps guide clinical decision-making and appropriate diagnostic workup in pediatric oncology.

Correct Answer: B

Rationale: In pediatric oncology, understanding the impact of radiotherapy on children with brain tumors is crucial. The correct answer, option B, stating that late neurological sequelae post radiotherapy are more severe in children less than 3 years old, aligns with the knowledge that younger children have developing brains that are more vulnerable to the effects of radiation. Option A is incorrect because craniospinal irradiation, while encompassing a larger area, is associated with more acute rather than late neurological complications. Option C, concomitant chemo-radiotherapy, may increase the overall toxicity but doesn't specifically correlate with increased late neurological sequelae. Option D is incorrect as the severity of late neurological sequelae is not determined by tumor grade. Educationally, this question underscores the importance of considering age as a factor in the risk assessment of late effects of radiotherapy in pediatric patients with medulloblastoma. It highlights the need for personalized treatment approaches based on age-related vulnerabilities in pediatric oncology. Understanding these nuances can help healthcare providers tailor discussions with parents to address concerns and make informed treatment decisions.

Correct Answer: C

Rationale: In pediatric rhabdomyosarcoma (RMS), the alveolar type constitutes a significant portion of cases and is associated with a poor prognosis. The MOST common site of involvement by alveolar RMS is the extremities. This is because alveolar RMS commonly arises in the limbs, especially the large muscles of the extremities. Option A, the orbit, is more commonly associated with embryonal RMS. Option B, the middle ear, is also typically seen in embryonal RMS. Option D, the bladder, is often affected by embryonal RMS as well. Educationally, understanding the different types of RMS and their common sites of involvement is crucial for accurate diagnosis and management in pediatric oncology. Recognizing the specific characteristics of alveolar RMS, such as its predilection for the extremities, aids in early identification and appropriate treatment planning.

Correct Answer: C

Rationale: In Langerhans cell histiocytosis (LCH), manifestations in certain organs can pose a high risk of mortality due to potential complications. The correct answer, option C - lung, is not typically associated with high mortality risk in LCH patients. This is because lung involvement in LCH usually presents with pulmonary nodules or cysts, which are often manageable and do not directly lead to mortality. Options A, B, and D (liver, spleen, hematopoietic system) are at higher risk of mortality in LCH patients. Liver involvement can cause liver failure, spleen involvement can lead to severe cytopenias and hypersplenism, and hematopoietic system involvement can result in bone marrow dysfunction and subsequent complications. Educationally, understanding the specific organ manifestations and associated risks in Langerhans cell histiocytosis is crucial for healthcare providers managing these patients. Recognizing which organ involvement carries a higher mortality risk helps in timely intervention and appropriate management to improve patient outcomes.