The nurse evaluates a certified nursing assistant. Which of the following actions by the CAN demonstrates understanding of standard precautions?

Correct Answer: A

Rationale: The correct action that demonstrates understanding of standard precautions is wearing gloves during all client contact. Standard precautions are designed to prevent the transmission of infectious agents from both recognized and unrecognized sources of infection. Wearing gloves during client contact helps protect both the patient and the healthcare worker from potential infection transmission through contact with bodily fluids, skin, mucous membranes, and non-intact skin. Cleaning blood spills with soap and water is also part of standard precautions to prevent the spread of infection. However, pouring bulk blood and other secretions down a drain connected to a sanitary sewer and carrying a blood sample to the lab in an open basket do not align with standard precautions and could pose infection control risks.

Correct Answer: C

Rationale: In this scenario, option C is the correct answer because a 5th degree family history of adenomatous polyposis increases the infant's risk of hepatoblastoma, a type of liver cancer commonly associated with this genetic condition. Hepatoblastoma is a malignant tumor that originates in the liver and is more prevalent in individuals with a family history of adenomatous polyposis due to genetic predisposition. Options A, B, and D are incorrect because they mention different types of cancers that are not directly linked to a family history of adenomatous polyposis. Acute lymphocytic leukemia (Option A) is a type of blood cancer, intestinal Burkitt lymphoma (Option B) is a type of non-Hodgkin lymphoma, and germ cell tumor (Option D) develops in the cells that produce sperm or eggs, none of which are specifically associated with adenomatous polyposis. Educationally, understanding the implications of a family history of certain conditions on a child's health is crucial in pediatric practice. This knowledge helps healthcare providers assess and manage the child's risk factors effectively, enabling early detection and intervention when necessary. It also highlights the importance of thorough family history documentation and genetic counseling in pediatric care to provide comprehensive and personalized healthcare to children.

Correct Answer: D

Rationale: In this scenario, the most effective treatment is option D) recombinant urate oxidase. This is because the child has ileocecal Burkitt lymphoma, a malignancy associated with rapid cell turnover leading to tumor lysis syndrome (TLS). The elevated uric acid level of 12 mg/dl indicates TLS, which can lead to renal failure and other complications if not addressed promptly. Recombinant urate oxidase (rasburicase) is the treatment of choice for TLS as it rapidly breaks down uric acid into a more soluble form, preventing uric acid crystallization and subsequent renal damage. This therapy is crucial in preventing acute kidney injury and other TLS-related complications. Option A) excessive hydration is not the most effective treatment as it alone may not be sufficient to rapidly reduce the dangerously high uric acid levels seen in TLS. Option B) sodium bicarbonate is used to alkalinize the urine and prevent uric acid crystallization but is not as effective as recombinant urate oxidase in rapidly lowering uric acid levels. Option C) xanthine oxidase inhibitor (such as allopurinol) is used for chronic management of hyperuricemia but is not as effective as recombinant urate oxidase in the acute setting of TLS. Educationally, understanding the pathophysiology of TLS and the appropriate management is crucial for healthcare providers caring for pediatric oncology patients. Recognizing the urgency of treating elevated uric acid levels in TLS with recombinant urate oxidase can prevent severe complications and improve patient outcomes.

Correct Answer: A

Rationale: In this case, the correct answer is A) nephroblastoma. Nephroblastoma, also known as Wilms tumor, is the most common renal tumor in children. It typically presents as an asymptomatic abdominal mass, often incidentally discovered by parents or caregivers. The age of the patient described in the scenario (2-month-old) also aligns with the typical age range for Wilms tumor diagnosis. Option B) neuroblastoma is a tumor that arises from neural crest cells and usually presents with symptoms such as abdominal distension, weight loss, and other systemic signs. It is less likely in this scenario as the mass is described as a left renal mass, which is not characteristic of neuroblastoma. Option C) mesoblastic nephroma is a rare benign renal tumor that typically presents in the neonatal period. However, it is less likely in this case given the age of the infant and the fact that nephroblastoma is more common in the pediatric population. Option D) clear cell sarcoma is a rare tumor that typically occurs in older children and adolescents. It is not commonly associated with renal masses in infants. Educationally, understanding the typical presentations, age groups affected, and characteristics of different pediatric renal tumors is crucial for healthcare providers to make accurate diagnoses and provide appropriate treatment. Knowledge of these distinctions can guide clinical decision-making and improve patient outcomes.

Correct Answer: A

Rationale: In nasopharyngeal carcinoma (NPC) patients, an elevated lactate dehydrogenase (LDH) level carries the worst outcome. LDH is a marker of tissue damage and its elevation indicates more aggressive disease and poorer prognosis in cancer patients. Elevated LDH levels are associated with increased tumor burden, metastasis, and overall disease progression in NPC. Advanced disease (option B) is a significant factor affecting prognosis in NPC, but it is not as specific or indicative of poor outcome as elevated LDH levels. Extensive cervical lymph node involvement (option C) is also a negative prognostic factor in NPC, but it is more related to disease stage rather than a direct marker of poor outcome. Evidence of Epstein-Barr virus (EBV) DNA (option D) is commonly seen in NPC patients but does not necessarily correlate with worse prognosis as much as elevated LDH levels. In an educational context, understanding the significance of different prognostic factors in NPC is crucial for healthcare professionals involved in the care of these patients. Recognizing the impact of elevated LDH levels on prognosis can guide treatment decisions and help in optimizing patient outcomes. Students and practitioners need to be aware of the specific markers and factors that influence prognosis in NPC to provide comprehensive care to these patients.