The initial management of localized renal cell carcinoma in children is

Correct Answer: A

Rationale: In the context of pediatric renal cell carcinoma, the initial management of localized disease is a critical decision. The correct answer is A) radical nephrectomy. Radical nephrectomy involves the surgical removal of the entire affected kidney, along with any surrounding tissues if necessary. This option is the most appropriate initial management for localized renal cell carcinoma in children because it aims to completely remove the tumor and prevent its spread to other parts of the body. In pediatric cases, where preserving renal function is crucial for long-term health, radical nephrectomy is preferred over partial nephrectomy which involves removing only part of the kidney. Chemotherapy followed by surgery (option C) is not the standard approach for localized renal cell carcinoma. Chemotherapy is typically used for metastatic disease or in combination with surgery in certain cases. Radiation therapy (option D) is not a primary treatment for renal cell carcinoma in children, as surgery is the mainstay of treatment. In an educational context, understanding the appropriate management of pediatric renal cell carcinoma is essential for healthcare providers caring for pediatric oncology patients. Knowledge of the most effective treatment options ensures optimal outcomes for children with this condition. It highlights the importance of considering the unique aspects of pediatric oncology when making treatment decisions.

Correct Answer: D

Rationale: The correct answer is D) It would be best to keep your child home to monitor urinary output. The child diagnosed with hemolytic uremic syndrome (HUS) is at risk for renal complications. Monitoring urinary output is crucial to assess renal function and ensure that the kidneys are functioning properly after the episode of HUS. By keeping the child at home, the parent can closely observe the child's urinary output and promptly report any changes to the healthcare provider. This helps in early detection of any potential relapse or complications, allowing for timely intervention and management. Option A is incorrect because although HUS is not typically contagious, the focus should be on monitoring the child's health status rather than solely on contagion. Option B is incorrect as it inaccurately states that the immune system is weak post-recovery from HUS, which is not necessarily true. It is more critical to monitor renal function than to focus on immune system weakness in this context. Option C is incorrect as HUS is not considered contagious after the resolution of the acute illness phase, so there is no need to keep the child home based on contagion concerns. In an educational context, understanding the importance of monitoring urinary output in a child recovering from HUS is crucial for nursing practice. Nurses play a key role in educating parents about post-discharge care and monitoring parameters to ensure the child's well-being. By providing accurate information and guidance, nurses empower parents to actively participate in their child's recovery process and promote optimal health outcomes.

Correct Answer: A

Rationale: In the context of pediatric peritoneal dialysis, the correct answer is A) Increase the glucose concentration of the dialysate. This adjustment would help to increase the osmotic gradient in the peritoneal cavity, leading to enhanced ultrafiltration and removal of excess fluid from the body. Increasing the glucose concentration in the dialysate is a common strategy to address inadequate fluid removal in peritoneal dialysis patients. This approach helps to improve the efficiency of the dialysis process and manage conditions like edema and hypertension more effectively. Now, let's analyze why the other options are incorrect: B) Decreasing the glucose concentration of the dialysate would further reduce the osmotic gradient, potentially worsening the issue of inadequate volume removal. C) Administering antihypertensives and diuretics without addressing the underlying cause of inadequate fluid removal through dialysis may not effectively resolve the edema and hypertension in this scenario. D) Decreasing the dwell time of the dialysate would not address the fundamental issue of inadequate volume removal and may not lead to the desired improvement in the patient's condition. In an educational context, understanding the principles of osmosis, ultrafiltration, and the role of dialysate composition in peritoneal dialysis is crucial for nurses caring for pediatric patients undergoing this procedure. It is essential to recognize the significance of appropriate dialysate composition adjustments to optimize treatment outcomes and manage complications effectively.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Take him to the emergency room immediately. This is the most appropriate action because the symptoms described - intense pain and swelling of the scrotal area, abdominal pain, and vomiting - could indicate a serious medical emergency such as testicular torsion. Testicular torsion is a condition where the spermatic cord twists, cutting off blood supply to the testicle, which requires immediate surgical intervention to prevent testicular damage or loss. Option A is incorrect because encouraging clear liquids while the teen is experiencing severe pain, swelling, and vomiting may delay necessary medical intervention. Option B is also incorrect as a pediatrician's office may not have the resources to address a potentially urgent situation like testicular torsion. Option D is incorrect because resting and applying ice are not appropriate interventions for a condition as serious as testicular torsion. Educationally, this scenario highlights the importance of recognizing urgent signs and symptoms in pediatric patients. It underscores the need for healthcare providers, including nurses, to act swiftly and decisively when faced with potentially life-threatening conditions, even if the presentation is initially vague or nonspecific. Timely assessment and appropriate referral can significantly impact patient outcomes in such critical situations.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Corticosteroids. Rationale: 1. Corticosteroids are commonly prescribed post-kidney transplant to suppress the immune system and prevent rejection of the new organ. This medication can lead to fluid retention, weight gain, and elevated BUN and creatinine levels due to its impact on renal function. 2. A) Codeine tablets are unlikely to cause these specific symptoms and are not typically used in the immediate post-transplant period. 3. B) Furosemide is a diuretic that would typically be used to reduce fluid retention, the opposite effect seen in this case. 4. C) MiraLAX powder is a laxative and would not explain the symptoms of abdominal pain, irritability, weight gain, and elevated BUN and creatinine levels. Educational context: Understanding the pharmacological management post-kidney transplant is crucial for healthcare professionals caring for pediatric patients. Corticosteroids are a cornerstone of immunosuppressive therapy in transplant recipients, but their side effects must be carefully monitored and managed to ensure the success of the transplant. Recognizing the signs and symptoms of corticosteroid-related adverse effects is essential for early intervention and optimal patient outcomes.