Biopsy is not usually performed for a child with suspicion of Wilms tumor EXCEPT

Correct Answer: E

Rationale: In the context of pediatric oncology and Wilms tumor, the correct answer is E) none of the above. Wilms tumor, a common childhood kidney cancer, typically presents as a painless abdominal mass. Biopsy is generally contraindicated in suspected cases of Wilms tumor due to the risk of seeding cancer cells during the procedure. Option A) age of 2-3 years is incorrect because Wilms tumor commonly affects children in this age group. Option B) signs of inflammation or infection is incorrect as these are not contraindications for biopsy in suspected Wilms tumor cases. Option C) significant lymph node enlargement radiologically is incorrect as it may be present in cases of advanced Wilms tumor and does not preclude the need for further investigation. Option D) intratumoral calcification radiologically is also not a contraindication for biopsy in suspected Wilms tumor cases. Educationally, it is important for healthcare providers to understand the diagnostic approach to pediatric tumors like Wilms tumor to ensure appropriate management and avoid unnecessary risks associated with biopsies in these cases. Biopsies can lead to complications and should be avoided when clinical and radiological findings strongly suggest Wilms tumor.

Correct Answer: B

Rationale: In this scenario, the most valuable test for the child with ALL experiencing mucositis and myelosuppression is pharmacogenetic testing of the thiopurine S-methyltransferase (TPMT) gene (Option B). The rationale behind this choice is that TPMT is an enzyme responsible for metabolizing thiopurine drugs like mercaptopurine, which are commonly used in ALL treatment. Children with genetic variations leading to low TPMT activity are at higher risk for severe myelosuppression when treated with thiopurine drugs. Pharmacogenetic testing helps identify these variations, allowing for personalized dosing to avoid adverse reactions and optimize treatment outcomes. While a complete blood count (Option A) and bone marrow study (Option D) are important in monitoring disease progression and treatment response in ALL, they do not directly address the issue of drug metabolism and adverse reactions in this context. Renal function tests (Option C) may be relevant for monitoring kidney function but are not as crucial as pharmacogenetic testing for optimizing drug therapy in this case. Educationally, understanding the importance of pharmacogenetic testing in pediatric oncology highlights the shift towards personalized medicine to enhance treatment efficacy, minimize adverse effects, and improve patient outcomes. It emphasizes the need for comprehensive patient assessments that consider genetic factors impacting drug metabolism and response, ultimately enhancing the quality of care in pediatric oncology.

Correct Answer: B

Rationale: The correct answer is option B) hyperdiploidy. In pediatric neuroblastoma, hyperdiploidy is associated with a better prognosis. Hyperdiploidy refers to an extra set of chromosomes, which is a favorable genetic characteristic in neuroblastoma and is linked to a less aggressive form of the disease. This leads to a lower risk of disease progression and better treatment response. Option A) amplification of the MYCN proto-oncogene is associated with a poorer prognosis in neuroblastoma. This genetic alteration indicates a more aggressive form of the disease with a higher risk of progression. Option C) loss of heterozygosity of 17q chromosome and option D) loss of 1p chromosome are also associated with unfavorable outcomes in neuroblastoma. These genetic changes are linked to higher-risk disease features and poorer response to treatment. In an educational context, understanding the genetic characteristics of pediatric neuroblastoma is crucial for nurses and healthcare professionals caring for pediatric oncology patients. Recognizing the implications of different genetic alterations can guide treatment decisions and help predict patient outcomes, ultimately improving the quality of care provided to children with neuroblastoma.

Correct Answer: C

Rationale: The correct answer is C) one year. The physiological decrease of serum alpha-fetoprotein (AFP) levels to normal adult levels occurs by one year of age. During infancy, AFP levels are typically elevated but gradually decrease as the child grows. This normalization of AFP levels by one year is important to understand when interpreting lab results in pediatric patients. Option A) three months is incorrect because AFP levels do not fall to normal adult levels by this age. Option B) eight months is also incorrect as the physiological decrease to adult levels has not occurred by this time. Option D) three years is incorrect as AFP levels should normalize by one year, not by three years. Understanding the age at which AFP levels should reach adult levels is crucial for pediatric healthcare providers to accurately assess treatment response and monitor for recurrence in patients with malignant germ cell tumors. This knowledge aids in making informed clinical decisions and providing optimal care for pediatric patients.

Correct Answer: C

Rationale: The correct answer is C) Breastfeeding can continue without significant changes; ensure proper positioning to accommodate the cast. This response is the best because breastfeeding is important for the infant's nutrition, bonding, and overall well-being. The hip spica cast should not hinder breastfeeding significantly if the mother is mindful of positioning to ensure comfort for both herself and the baby. Option A is not the best response as it only addresses positioning after breastfeeding, but does not affirm that breastfeeding itself can continue as normal. Option B is incorrect because it discourages breastfeeding without proper justification. Breastfeeding can still be done successfully with a hip spica cast in place. Providing this educational context is crucial for pediatric nurses to support and empower mothers to continue breastfeeding despite challenges such as a hip spica cast. It is essential to promote breastfeeding as the optimal feeding choice for infants whenever possible. Supporting mothers in overcoming obstacles helps to ensure the best outcomes for both the baby and the mother.