In neuroblastoma, metastatic spread can occur via local invasion or distant hematogenous/lymphatic routes. The LEAST common site of metastases in neuroblastoma is

Correct Answer: D

Rationale: In neuroblastoma, the least common site of metastasis is the skin (Option D). This is because neuroblastoma tends to metastasize to organs and tissues such as the long bones (Option A), bone marrow (Option B), and lungs (Option C) before involving the skin. Metastasis to the long bones and bone marrow is common in neuroblastoma due to their rich blood supply and hematopoietic function, which make them favorable sites for cancer spread. Additionally, neuroblastoma commonly metastasizes to the lungs due to their direct connection to the primary tumor site in the abdomen or chest. Understanding the pattern of metastasis in neuroblastoma is crucial for healthcare providers caring for pediatric patients. It helps in early detection of metastases, appropriate staging of the disease, and planning effective treatment strategies. Educators teaching pediatric oncology should emphasize the common sites of metastasis in neuroblastoma to ensure students have a comprehensive understanding of the disease process and its implications for patient care.

Correct Answer: B

Rationale: In the context of Maternity and Pediatric Nursing, it is essential to understand the implications of various diseases on pediatric patients. In this case, Hepatitis C virus infection poses a risk factor for splenic lymphoma. The correct answer is B) splenic lymphoma because chronic Hepatitis C infection can lead to lymphoproliferative disorders like splenic lymphoma due to the continuous stimulation of the immune system and inflammation associated with the infection. Option A) hepatoblastoma is a pediatric liver cancer commonly associated with other risk factors like low birth weight and certain genetic conditions, not specifically linked to Hepatitis C. Option C) Hodgkin lymphoma is a type of lymphoma involving the lymphatic system, but it is not directly associated with Hepatitis C infection. Option D) nasopharyngeal carcinoma is a type of head and neck cancer linked to factors like Epstein-Barr virus infection and genetic predisposition, not primarily Hepatitis C. Understanding these associations is crucial for nurses caring for pediatric patients with Hepatitis C, as it informs their assessment, monitoring, and potential complications related to the disease.

Correct Answer: D

Rationale: In pediatric oncology, late neurologic sequelae following craniospinal irradiation are a significant concern due to potential long-term effects on a child's development. The correct answer, D) second malignancy, is the least common late neurologic sequelae in a 9-year-old child with medulloblastoma post-irradiation. This is because while craniospinal irradiation is effective in treating medulloblastoma, it also increases the risk of developing a second malignancy later in life due to the exposure to radiation. Option A) microcephaly is incorrect as it refers to a condition where a child's head is significantly smaller than expected, which is not typically associated with late neurologic sequelae post-irradiation. Option B) learning disabilities and option C) cognitive impairment are more commonly seen as late neurologic sequelae following craniospinal irradiation due to the impact of radiation on brain function and development. Educationally, understanding the potential late neurologic sequelae of craniospinal irradiation in pediatric patients is crucial for nurses and healthcare providers working in pediatric oncology. It underscores the importance of long-term monitoring, supportive care, and early intervention to mitigate the impact of these sequelae on a child's quality of life and neurodevelopmental outcomes. By knowing the least common sequelae, healthcare providers can tailor their care plans to address the specific needs of each child post-treatment.

Correct Answer: D

Rationale: In pediatric rhabdomyosarcoma, staging is crucial for treatment planning and prognosis. The correct answer is D) paranasal sinuses. This site is considered unfavorable due to its proximity to critical structures like the eyes and brain, which can complicate surgical removal and increase the risk of spread. Option A) vagina is a favorable site in rhabdomyosarcoma because it is easily accessible for surgery and has a lower risk of metastasis. Option B) uterus is also a more favorable site as it can be surgically removed with less impact on surrounding structures. Option C) testis is considered favorable due to its surgical accessibility and lower risk of complications during treatment. Understanding the staging criteria for pediatric rhabdomyosarcoma is essential for nurses caring for pediatric oncology patients. Knowing which sites are considered favorable or unfavorable helps in anticipating treatment challenges and potential outcomes for patients and their families. The detailed rationale provided here can enhance nursing students' understanding of pediatric oncology and improve their clinical decision-making skills.

Correct Answer: A

Rationale: The correct answer is A) may feel guilty about the patient's death. In this situation, the pediatric nurse understands that young children often internalize feelings of guilt when a sibling dies, thinking they may have caused it due to their actions or thoughts. It is crucial to address this potential feeling of guilt to support the emotional well-being of the four-year-old sibling. Option B) may mistrust the parent is incorrect because the primary concern in this scenario is the emotional response of the sibling to the sudden death, rather than the trust in the parent. Option C) understands the permanence of death is incorrect as preschool-aged children typically do not fully comprehend the finality of death and may have more magical or reversible thinking about it. Option D) will role-play the patient's death is incorrect as this is not a typical or expected response from a four-year-old sibling in this situation. Educationally, this question highlights the importance of understanding child development and psychology in pediatric nursing. By recognizing common emotional responses in children to difficult situations, nurses can provide appropriate support and guidance to both the child and their family during times of grief and loss.