In Langerhans cell histiocytosis (LCH), all the following manifestations are at high risk of mortality in patients EXCEPT

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.

Correct Answer: D

Rationale: The correct answer is D) biopsy of the mass. In the case of a suspected Wilms tumor in a pediatric patient, a biopsy of the mass is the least likely investigation to be performed initially. This is because biopsy carries the risk of causing tumor spillage and seeding, potentially complicating future surgical management. Option A) plain abdominal radiography is not the most useful imaging modality for evaluating a suspected Wilms tumor. Option B) and C) involve CT scans of the abdomen and chest, respectively, which are crucial in staging the tumor and evaluating any possible metastasis. In an educational context, it is important to emphasize the diagnostic approach in pediatric oncology. Understanding the appropriate sequence of investigations and their implications is vital for providing optimal care for pediatric patients suspected of having malignancies. Biopsy is often reserved for cases where imaging studies are inconclusive or for definitive diagnosis after surgical resection.

Correct Answer: D

Rationale: In Kasabach-Merritt syndrome, a rare and serious condition seen in pediatric patients, the correct answer is D) association with infantile hemangiomas. This is the exception among the listed characteristics. Infantile hemangiomas are not associated with this syndrome. Thrombocytopenia (low platelet count), microangiopathic hemolytic anemia (breakdown of red blood cells due to abnormal blood vessels), and coagulopathy (bleeding disorder) are all typical features of Kasabach-Merritt syndrome. These abnormalities result from the consumption of platelets and clotting factors within the abnormal blood vessels. Educationally, understanding the distinguishing features of Kasabach-Merritt syndrome is crucial for healthcare providers caring for pediatric patients. Recognizing the syndrome's typical presentation can lead to prompt diagnosis and appropriate management to prevent potentially life-threatening complications. Identifying the absence of infantile hemangiomas in this context is vital for accurate clinical assessment and decision-making.

Correct Answer: A

Rationale: The best response for the pediatric nurse in this scenario is option A: "Let's talk about preventing and managing your asthma on a daily basis at home." This response is the most appropriate because it addresses the patient's expressed concern about repeatedly getting sick after going home and focuses on empowering the adolescent to take an active role in managing their asthma. Option B is not the best response because it deflects the conversation away from the patient and places the responsibility solely on the parents. While involving parents in asthma management is important, it is crucial to empower the adolescent to understand and take ownership of their condition. Option C, "We can arrange for you to stay in the hospital longer," is not the best response either. Prolonged hospital stays should be reserved for acute exacerbations or severe cases, and encouraging a patient to stay in the hospital longer without addressing the underlying issue may not be in the patient's best interest. In an educational context, it is essential for pediatric nurses to foster open communication with adolescent patients, validate their feelings, and empower them to actively participate in their care. By addressing the patient's concerns and involving them in the management of their asthma, the nurse can help promote self-care skills and better health outcomes for the adolescent.

Correct Answer: D

Rationale: In this question, the correct answer is D) speaks inhibition word 'no.' At 10 months old, a child typically does not yet possess the ability to use inhibition words like 'no.' This is because at this stage, infants are still in the early stages of language development and are more focused on basic communication skills. Option A) says mama or dada is correct because by 10 months old, many children are able to start saying simple words like "mama" or "dada" as part of their language development. Option B) follows one-step command without gesture is correct as well because by this age, children are usually able to understand and follow simple commands without the need for accompanying gestures. Option C) points to objects or real first word is also correct as many children at 10 months old are able to point to objects or may start saying their first real words as they continue to develop their language skills. Educationally, understanding these developmental milestones in infants is crucial for healthcare professionals and caregivers to monitor a child's growth and development. Knowing what is typical at different ages helps in early identification of any potential developmental delays or issues that may require intervention or support.