One of the unfavorable prognostic factors in acute lymphoblastic leukemia is:

Correct Answer: B

Rationale: In pediatric nursing, understanding prognostic factors in conditions like acute lymphoblastic leukemia (ALL) is crucial for providing effective care. In this case, the correct answer is B) T-ALL by immunophenotyping. T-ALL subtype of ALL is associated with poorer outcomes compared to B-cell ALL. Immunophenotyping helps in determining the subtype and guides treatment decisions. Option A) Age <10 years old is actually a favorable prognostic factor in ALL, as younger age is associated with better response to treatment and overall prognosis. Option C) Initial WBCs <50,000/mm³ is also a favorable prognostic factor, as lower WBC count indicates a less aggressive disease. Option D) CSF free from blast cells is important for staging and treatment planning in ALL, but it is not considered an unfavorable prognostic factor in and of itself. Educationally, it is important for nursing students to grasp the significance of prognostic factors in pediatric oncology to provide holistic and tailored care to young patients with leukemia. Understanding how different factors can impact the prognosis helps in individualizing care plans and setting realistic expectations for patients and their families.

Correct Answer: C

Rationale: In hemophilia A, which is a genetic disorder caused by a deficiency in clotting factor VIII, the correct answer is C) Prolonged APPT (Activated Partial Thromboplastin Time). This is because hemophilia A specifically affects the intrinsic pathway of the coagulation cascade, leading to a prolonged APPT due to the deficiency of factor VIII. Option A) Prolonged bleeding time is incorrect because bleeding time primarily assesses platelet function, not the clotting factors affected in hemophilia A. Option B) Prolonged prothrombin time is incorrect because prothrombin time evaluates the extrinsic pathway of the coagulation cascade, which is not primarily affected in hemophilia A. Option D) Prolonged thrombin time is incorrect because thrombin time measures the conversion of fibrinogen to fibrin, which is not directly impacted in hemophilia A. Educationally, understanding the specific clotting factors involved in hemophilia A and how they affect different parts of the coagulation pathway is crucial for nurses caring for pediatric patients with this condition. Recognizing the unique laboratory findings in hemophilia A can guide appropriate treatment strategies and interventions to prevent bleeding complications in these patients.

Correct Answer: D

Rationale: In roseola infantum infection, also known as sixth disease, the characteristic skin rash typically appears once the fever subsides. This is because the rash is a result of the body's immune response to the virus causing the fever. As the body fights off the infection, the fever eventually decreases, and the rash emerges. Option A) 1st day of fever is incorrect because the rash does not appear at the onset of fever. Option B) 3rd day of fever is incorrect as well, as the rash usually appears after the fever has been present for some time. Option C) 4th day of fever is also incorrect; the rash typically appears after this point. From an educational perspective, understanding the timing of the appearance of the rash in roseola infantum is crucial for nurses caring for pediatric patients. Recognizing the progression of symptoms can aid in accurate diagnosis and appropriate management of the infection. This knowledge helps healthcare professionals provide quality care and education to families about the course of the illness.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Prostaglandin E1. Infants with marked cyanotic heart defects and decreased pulmonary vascularity often have conditions like ductal-dependent congenital heart diseases (CHD) where a patent ductus arteriosus (PDA) is necessary to maintain systemic blood flow. Prostaglandin E1 helps keep the ductus arteriosus open, allowing for adequate systemic blood flow in these infants. Option A) Epinephrine is used in situations of cardiac arrest or severe hypotension, not specifically for treating cyanotic heart defects. Option C) Dopamine is a medication used to improve cardiac output and blood pressure, but it is not the primary treatment for cyanotic heart defects. Option D) Digoxin is a cardiac glycoside used to treat heart failure and certain arrhythmias, but it is not the appropriate treatment for cyanotic heart defects with decreased pulmonary vascularity. Educationally, understanding the importance of prostaglandin E1 in managing ductal-dependent CHD in infants is crucial for pediatric nursing practice. This knowledge ensures timely and appropriate interventions to support these vulnerable patients, highlighting the significance of accurate medication administration in pediatric cardiac care.

Correct Answer: A

Rationale: In pediatric nursing, understanding heart murmurs is crucial for accurate assessment and diagnosis. Innocent murmurs are common in children and are typically benign, occurring due to normal blood flow patterns rather than underlying cardiac pathology. The timing of a murmur refers to when during the cardiac cycle the murmur occurs. The correct answer is A) Ejection systolic. Innocent murmurs are often ejection systolic in timing, meaning they occur during systole when the blood is being ejected from the heart. This type of murmur is typically heard best at the left sternal border and may have a musical or vibratory quality. Option B) Pansystolic murmurs occur throughout systole and are typically associated with conditions like mitral regurgitation or ventricular septal defects, not innocent murmurs in children. Option C) Early diastolic murmurs occur during early diastole when the heart is filling with blood, seen in conditions like aortic regurgitation, not innocent murmurs. Option D) Mid diastolic murmurs occur in mid-diastole and are associated with conditions like mitral stenosis, not innocent murmurs commonly heard in pediatric patients. Educationally, it is important for nursing students to grasp the different types of heart murmurs, their timing, associated conditions, and significance in pediatric patients. Recognizing innocent murmurs helps differentiate them from pathological murmurs, leading to appropriate patient management and referrals to cardiology for further evaluation when necessary. This knowledge enhances the quality of care provided to pediatric populations and contributes to improved patient outcomes.