Risk factors for birth brachial plexus injury include the following EXCEPT

Correct Answer: D

Rationale: In the context of pediatric nursing and birth-related injuries, understanding risk factors for birth brachial plexus injury is crucial. The correct answer, option D, diabetic mother, is the exception among the listed risk factors. Option A, shoulder dystocia, is a known risk factor for birth brachial plexus injury due to the difficulty in delivering the baby's shoulder after the head has emerged. This can put excessive traction on the baby's brachial plexus nerves. Option B, birthweight greater than 4 kg, is another risk factor because larger babies may have a harder time passing through the birth canal, leading to increased risk of nerve injury during delivery. Option C, primiparous mothers, are also at higher risk as they have not given birth before and may have a higher likelihood of experiencing complications during delivery that could result in brachial plexus injury. Educationally, knowing these risk factors is essential for nurses caring for newborns and mothers during labor and delivery. By recognizing these factors, healthcare providers can take preventive measures or be prepared to manage potential complications to reduce the incidence of birth brachial plexus injuries and improve overall maternal and neonatal outcomes.

Correct Answer: B

Rationale: The most valuable test for the 6-year-old child with Acute Lymphoblastic Leukemia (ALL) experiencing frequent mucositis and myelosuppression, necessitating frequent treatment discontinuation, is pharmacogenetic testing of the thiopurine S-methyltransferase (TPMT) gene (Option B). Pharmacogenetic testing of TPMT gene is crucial in this scenario because thiopurine drugs like mercaptopurine are commonly used in ALL treatment. TPMT enzyme activity affects how the body processes these drugs; individuals with low TPMT activity are at higher risk of severe myelosuppression. By identifying TPMT gene variations, clinicians can personalize drug dosages to minimize adverse effects and optimize treatment efficacy. The other options are less relevant in this context: A) Complete blood count (CBC) is a standard test but may not provide specific information on drug metabolism or toxicity related to thiopurine drugs. C) Renal function test is important for monitoring kidney function but is not directly related to optimizing thiopurine drug therapy. D) Bone marrow study is invasive and not indicated solely for assessing drug metabolism issues. Educationally, understanding the role of pharmacogenetics in pediatric oncology highlights the importance of personalized medicine in improving treatment outcomes and reducing adverse effects in children with cancer. By incorporating genetic testing into clinical practice, healthcare providers can tailor treatments to individual genetic profiles, leading to more effective and safer therapies for pediatric patients.

Correct Answer: B

Rationale: In pediatric oncology, understanding the genetic characteristics of tumors like neuroblastoma is crucial for determining prognosis and guiding treatment. In this scenario, the correct answer is B) hyperdiploidy, which carries a better outcome. Hyperdiploidy refers to the presence of extra copies of chromosomes, which can indicate a less aggressive form of neuroblastoma with a more favorable prognosis. Option A) amplification of the MYCN proto-oncogene is associated with a poor prognosis in neuroblastoma, indicating a higher risk of aggressive tumor behavior. Option C) loss of heterozygosity of 17q chromosome and Option D) loss of 1p chromosome are also genetic alterations associated with high-risk neuroblastoma and poor outcomes. Educationally, understanding the genetic markers of neuroblastoma not only helps in answering questions correctly but also informs clinical practice. Nurses caring for pediatric oncology patients need to grasp these concepts to provide holistic care and support to patients and their families. This knowledge can also aid in patient education and counseling regarding treatment options and expected outcomes.

Correct Answer: C

Rationale: In pediatric oncology, understanding tumor markers like alpha-fetoprotein (AFP) is crucial for diagnosis and monitoring treatment response. The correct answer is C) one year because AFP physiologically falls to normal adult levels around this age. During infancy, AFP levels are naturally elevated, making it challenging to detect abnormalities. By one year of age, the AFP levels typically decrease to adult levels, allowing for accurate interpretation in the context of GCTs. Option A) three months is incorrect because AFP levels are still elevated at this age, reflecting normal infant physiology. Option B) eight months is also incorrect as AFP levels usually remain elevated in infancy. Option D) three years is incorrect as AFP levels should normalize by one year, not three years. Educationally, this question highlights the importance of understanding age-related variations in tumor markers like AFP in pediatric oncology. Recognizing the normal developmental patterns of AFP levels can help healthcare providers differentiate between benign elevations and those indicative of malignant conditions, guiding appropriate clinical management.

Correct Answer: B

Rationale: The correct answer is B) nasopharyngeal T-cell lymphoma. Epstein-Barr virus (EBV) infection is associated with several malignancies due to its ability to transform infected B cells. Burkitt lymphoma, Hodgkin lymphoma, and certain carcinomas are known to be linked to EBV infection. Burkitt lymphoma is a B-cell lymphoma strongly associated with EBV. Hodgkin lymphoma can also be EBV-related, particularly in cases of mixed cellularity subtype. Carcinomas, particularly nasopharyngeal carcinoma, are also linked to EBV infection. In the context of education, understanding the association between EBV and various malignancies is crucial for healthcare professionals, especially those working in pediatric care. This knowledge aids in early detection, appropriate management, and patient education. It also highlights the importance of preventive measures, such as vaccination against EBV where available. By knowing which malignancies are commonly associated with EBV, healthcare providers can offer better care and support to pediatric patients at risk.