One of the following metabolic abnormalities may be associated with tumor lysis syndrome:

Correct Answer: B

Rationale: Tumor lysis syndrome (TLS) is a potentially life-threatening oncologic emergency that occurs as a result of the massive lysis of tumor cells leading to the release of intracellular contents into the bloodstream. This release can cause metabolic imbalances, including hyperkalemia. Option B, hyperkalemia, is the correct answer because during tumor lysis, there is a significant release of potassium from the lysed cells into the bloodstream, leading to elevated serum potassium levels. This can result in dangerous cardiac arrhythmias and other complications if not promptly managed. Options A, C, and D are incorrect for the following reasons: - Hypernatremia (Option A) is not typically associated with tumor lysis syndrome. It is more commonly seen in conditions like dehydration or diabetes insipidus. - Hypokalemia (Option C) is the opposite of what would be expected in TLS due to the massive release of potassium from lysed cells. - Hyponatremia (Option D) is also not a typical finding in TLS. It is more commonly seen in conditions like syndrome of inappropriate antidiuretic hormone (SIADH) or fluid overload. In an educational context, understanding the metabolic abnormalities associated with tumor lysis syndrome is crucial for nurses caring for pediatric patients with cancer. Recognizing the signs and symptoms of TLS and knowing how to manage its complications, such as hyperkalemia, are essential for providing safe and effective care to these vulnerable patients.

Correct Answer: B

Rationale: In the context of pediatric nursing, understanding the causes of hyperkalemia is crucial for providing safe and effective care to children. The correct answer is B) Metabolic acidosis. In metabolic acidosis, hydrogen ions move into cells in exchange for potassium ions, leading to a shift of potassium from the extracellular to the intracellular space, causing hyperkalemia without an actual excess of potassium. Option A) Addison's disease is incorrect because it is associated with primary adrenal insufficiency leading to decreased aldosterone secretion, which can result in hyperkalemia due to potassium retention. Option C) Renal failure is incorrect because it can lead to hyperkalemia by impairing the kidneys' ability to excrete potassium, resulting in potassium buildup in the body. Option D) Potassium-sparing diuretics are incorrect because they can cause hyperkalemia by reducing potassium excretion in the kidneys, leading to an excess of potassium in the body. Educationally, this question highlights the importance of understanding the pathophysiology of hyperkalemia and its various causes in pediatric patients. Nurses must be able to differentiate between conditions that can lead to hyperkalemia with or without actual potassium excess to provide appropriate interventions and prevent potential complications in pediatric patients.

Correct Answer: C

Rationale: The correct answer is C) The difference between unmeasured plasma cations and anions. The anion gap is a calculated value used in medicine to help diagnose certain conditions, particularly acid-base disorders. It represents the difference between the major measured cations (sodium and potassium) and the major measured anions (chloride and bicarbonate) in the blood. The unmeasured plasma cations and anions, such as sulfate, phosphate, and organic acids, contribute to the anion gap. Option A is incorrect because it oversimplifies the concept by only focusing on positively and negatively charged plasma molecules, without considering specific ions involved in the anion gap calculation. Option B is incorrect because it misidentifies the components involved in the anion gap. While sodium is a major cation, the anion gap is not just the difference between sodium and unmeasured negatively charged molecules. Option D is incorrect because it confuses the anion gap with the normal reference range for bicarbonate levels, which is not the same as the anion gap calculation. Understanding the anion gap is crucial for healthcare professionals, especially in pediatrics, as it can help in diagnosing conditions like metabolic acidosis or alkalosis. It is essential for nurses working in pediatric settings to grasp this concept to provide optimal care for their patients and effectively communicate with other healthcare team members.

Correct Answer: B

Rationale: In the context of pediatric nursing, understanding the causes of metabolic acidosis is crucial for providing quality care to children. In this question, the correct answer is B) Diarrhea, which can lead to metabolic acidosis with a normal anion gap. Diarrhea causes the loss of bicarbonate-rich fluid from the body, leading to an increase in chloride concentration in the blood. This results in a normal anion gap metabolic acidosis due to the loss of bicarbonate without a corresponding increase in anions. Option A) Diabetic ketoacidosis causes an increased anion gap metabolic acidosis due to the accumulation of ketones in the blood. Option C) Salicylate poisoning leads to an increased anion gap metabolic acidosis from the presence of salicylates. Option D) Renal failure can cause a normal or increased anion gap metabolic acidosis, depending on the underlying cause. Educationally, understanding these different etiologies of metabolic acidosis is essential for nurses caring for pediatric patients. Recognizing the specific causes helps in accurate assessment, diagnosis, and treatment planning for children presenting with acid-base imbalances. This knowledge also underlines the importance of a thorough patient history, physical examination, and diagnostic tests in pediatric nursing practice.

Correct Answer: D

Rationale: In pediatric nursing, the administration of drugs during resuscitation is crucial to support a child's cardiovascular and respiratory systems. The correct answer, D) Digitalis, is not typically used in pediatric resuscitation scenarios due to its potential toxicity in children and the availability of safer alternatives. A) Atropine is used to treat bradycardia by blocking the action of the vagus nerve, increasing heart rate. B) Bicarbonate is used to correct metabolic acidosis and can be administered during resuscitation to help correct pH imbalances. C) Epinephrine is a key drug in pediatric resuscitation as it acts as a vasoconstrictor and inotrope, helping to improve cardiac output and blood pressure. Educationally, understanding the appropriate use of drugs in pediatric resuscitation is vital for nurses caring for children in emergency situations. It is essential to be aware of the indications, dosages, and potential side effects of each medication to provide safe and effective care. Digitalis, being inappropriate for pediatric resuscitation, highlights the importance of tailored interventions for this vulnerable population.