During the initial assessment, he is placed in a modified Trendelenburg position. What desired effect should the position have on the client?

Correct Answer: A

Rationale: Placing a client in a modified Trendelenburg position involves having the client lie flat on the back with the legs elevated above the level of the heart. The main purpose of this position is to help increase blood pressure in cases of hypotension or shock. By raising the legs above the heart level, gravity helps to facilitate the return of venous blood to the heart, which can increase cardiac output and, consequently, blood pressure. This position is commonly used in clinical settings to help improve perfusion to vital organs and assist in stabilizing a client's blood pressure.

Correct Answer: B

Rationale: In pediatric patients with tumor lysis syndrome (TLS), metabolic derangements can occur due to the rapid release of intracellular contents into the bloodstream following cancer treatment. The correct answer, B) hypernatremia, is not typically associated with TLS in children. A) Hyperuricemia is a common feature of TLS as tumor cells release large amounts of uric acid into the blood, leading to potential kidney damage. C) Hyperkalemia is also common in TLS due to the release of potassium from lysed cells, which can result in cardiac arrhythmias and muscle weakness. D) Hyperphosphatemia occurs in TLS as a result of the release of phosphate from lysed cells, leading to potential complications such as hypocalcemia and renal failure. Educationally, understanding the metabolic derangements in TLS is crucial for pediatric critical care nurses to provide prompt and effective interventions to prevent serious complications. Recognizing the signs and symptoms associated with TLS and knowing the appropriate management strategies can significantly impact patient outcomes. By differentiating between the metabolic abnormalities commonly seen in TLS, nurses can prioritize care and advocate for timely interventions to prevent life-threatening consequences.

Correct Answer: C

Rationale: In this question, the correct answer is C) anaplastic histology. Anaplastic histology in Wilms tumor is associated with a higher risk of relapse and poorer outcomes compared to other histological subtypes. This is because anaplastic Wilms tumor is more aggressive and less responsive to treatment, leading to a higher likelihood of relapse. Option A) low stage (I/II) at diagnosis is incorrect because even children with low-stage disease can experience relapse, although the risk is lower compared to higher-stage disease. Option B) no prior radiotherapy is incorrect because the absence of prior radiotherapy does not preclude the possibility of relapse in Wilms tumor patients. Option D) more than 12 months from nephrectomy is incorrect because relapse can occur at any time after nephrectomy, not just within a specific timeframe. Educationally, understanding the factors associated with relapse in Wilms tumor is crucial for pediatric oncology nurses and healthcare providers caring for these patients. Recognizing the risk factors for relapse can help guide surveillance strategies and treatment decisions to improve outcomes for children with Wilms tumor.

Correct Answer: B

Rationale: In pediatric CCRN practice, understanding risk factors for melanoma in children is crucial for early detection and management. The correct answer is B) dark-skinned child. Melanoma is predominantly seen in fair-skinned individuals with a history of sun exposure. Dark skin has more melanin, providing natural protection against UV radiation, hence reducing the risk of melanoma. A) A positive family history of melanoma is a well-established risk factor due to genetic predisposition. Individuals with a family history are at a higher risk of developing melanoma themselves. C) A hairy nevus, also known as a congenital mole, is a risk factor for melanoma due to the presence of a higher number of melanocytes. These moles have a potential for malignant transformation. D) Dysplastic nevus, or atypical mole, is considered a risk factor for melanoma as these moles exhibit irregular features that may progress to melanoma. Educationally, it is important to teach healthcare providers to recognize these risk factors to conduct thorough assessments and provide appropriate education to patients and families about sun protection and regular skin checks. Early identification and intervention can significantly impact the prognosis of pediatric melanoma cases.

Correct Answer: C

Rationale: Rationale: The correct answer is C) children with Down syndrome have a slightly inferior outcome ratio of ALL/AML in general. This statement is incorrect because research shows that children with Down syndrome have a better outcome when they develop leukemia compared to children without Down syndrome. This is due to the unique genetic and immunological characteristics of individuals with Down syndrome that make them more responsive to certain treatments. Option A is incorrect because acute leukemia does indeed occur more frequently in children with Down syndrome than in the general population due to the genetic predisposition associated with Down syndrome. Option B is incorrect as AML (Acute Myeloid Leukemia) is more common in children with Down syndrome compared to ALL (Acute Lymphoblastic Leukemia) as Down syndrome predisposes individuals to myeloid leukemia. Option D is incorrect as children with Down syndrome who develop AML actually demonstrate remarkable sensitivity to antimetabolites, making them more responsive to this type of chemotherapy. In an educational context, understanding the specific risks and outcomes of leukemia in children with Down syndrome is crucial for medical students to provide appropriate care and treatment to this unique patient population. By understanding these nuances, future healthcare providers can tailor their approach to effectively manage leukemia in children with Down syndrome.