The nurse is aware that in communicating with an elderly client, the nurse will

Correct Answer: B

Rationale: When communicating with an elderly client, it is important to use a low-pitched voice because high frequencies can be difficult for older individuals to hear. A low-pitched voice is easier for them to understand and can help enhance communication. Speaking clearly and directly in a calm manner with a lower pitch can make it easier for the elderly client to hear and comprehend what is being said. Additionally, it is important to speak at a moderate pace and volume to ensure effective communication with elderly clients.

Correct Answer: B

Rationale: The first action the nurse should take upon the arrival of the adult who suffered a diving accident and is intubated and on a backboard with a cervical collar is to insert a large bore IV line. This is a priority because the person may require urgent fluid resuscitation or medication administration, and having IV access is crucial for immediate intervention in trauma cases. After establishing IV access, other assessments such as vital signs, lung sounds, and neurological checks can follow.

Correct Answer: B

Rationale: The correct answer is B) neurofibromatosis. Neurofibromatosis is a genetic disorder that can increase the risk of developing optic gliomas, which are tumors that form along the optic nerve. This association is well-documented in medical literature, making it the most likely genetic syndrome in the given options to be associated with optic glioma. Option A) Down syndrome is a chromosomal disorder caused by an extra copy of chromosome 21 and is not typically associated with an increased risk of optic glioma. Option C) Monosomy refers to a chromosomal abnormality where a cell is missing one chromosome, which is not known to be associated with an increased risk of optic glioma. Option D) Bloom's syndrome is a rare genetic disorder characterized by short stature and an increased risk of cancer, but it is not typically associated with optic glioma. In an educational context, understanding the association between genetic syndromes and specific health risks, such as optic glioma in the case of neurofibromatosis, is crucial for healthcare professionals, especially those working with pediatric patients. This knowledge can aid in early detection, management, and providing appropriate support to patients and their families affected by these conditions.

Correct Answer: D

Rationale: In pediatric oncology, tumor lysis syndrome (TLS) is a serious complication that can occur during the treatment of malignancies due to the rapid breakdown of cancer cells. Burkitt lymphoma, which is a fast-growing type of non-Hodgkin lymphoma, is more likely to manifest TLS because of its high proliferation rate and sensitivity to chemotherapy. The rapid destruction of Burkitt lymphoma cells can lead to the release of large amounts of intracellular contents, such as potassium, phosphate, and uric acid, overwhelming the body's ability to eliminate them. In contrast, the other malignancies listed in the options are less likely to result in TLS. Acute myelogenous leukemia (AML) is more associated with bone marrow involvement and may not lead to the same extent of tumor lysis as Burkitt lymphoma. Nephroblastoma (Wilms tumor) and neuroblastoma are solid tumors that are less prone to rapid cell turnover compared to hematologic malignancies like Burkitt lymphoma, making TLS less common in these cases. From an educational perspective, understanding the risk factors for TLS in different pediatric malignancies is crucial for nurses and healthcare providers caring for pediatric oncology patients. Recognizing the malignancies that are more likely to manifest TLS can guide clinical management decisions, such as implementing preventive measures and close monitoring to prevent potential complications associated with TLS, such as renal failure, cardiac arrhythmias, and metabolic disturbances.

Correct Answer: D

Rationale: In the context of pediatric oncology, understanding the prognostic factors of Wilms tumor is crucial for nurses preparing for the NCLEX RN exam. The correct answer, option D, "young age at diagnosis," is not an adverse prognostic factor in children with Wilms tumor. Children diagnosed at a young age actually have a more favorable prognosis in Wilms tumor cases. This is because younger children tend to respond better to treatment and have a higher overall survival rate compared to older children. Options A, B, and C are incorrect because they are adverse prognostic factors in children with Wilms tumor. Large tumors, anaplastic histology, and loss of heterozygosity at chromosome 1p and 16q are all associated with a poorer prognosis and may indicate a more aggressive form of Wilms tumor that is less responsive to treatment. In an educational context, nurses need to be able to differentiate between favorable and adverse prognostic factors in pediatric oncology to provide optimal care for children with cancer. Understanding these factors helps nurses anticipate complications, plan appropriate interventions, and support the child and their family through the treatment process.