Tumor lysis syndrome is a common complication during treatment of pediatric malignancies. Which malignancy is more likely to manifest such complication?

Correct Answer: D

Rationale: In pediatric oncology, tumor lysis syndrome (TLS) is a serious complication that can occur due to the rapid breakdown of cancer cells leading to metabolic imbalances. Burkitt lymphoma is more likely to manifest TLS because it is a highly proliferative malignancy with a high tumor burden, resulting in a significant release of intracellular contents upon treatment initiation. Acute myelogenous leukemia (AML) is a rapidly dividing cancer, but it usually presents with a lower tumor burden compared to Burkitt lymphoma. Nephroblastoma (Wilms tumor) and neuroblastoma are also childhood malignancies but are not typically associated with the high tumor burden that predisposes to TLS. Educationally, understanding the risk factors associated with TLS in pediatric oncology is crucial for nurses and healthcare providers caring for these patients. Recognizing the malignancies that are more likely to manifest TLS can help in early identification, monitoring, and prevention of this potentially life-threatening complication during cancer treatment. It also emphasizes the importance of close monitoring and prompt intervention to prevent TLS-related complications and improve patient outcomes.

Correct Answer: E

Rationale: In this scenario, the correct answer is "Easily bleeds" (Option D) as it is the finding that does not raise suspicion of melanoma in a nevus. Explanation: A) An enlarging nevus (Option A) raises suspicion of melanoma as rapid growth can be a sign of malignancy. B) Changing colors (Option B) in a nevus can indicate melanoma as irregular or multiple colors are concerning. C) Irregular margins (Option C) are also a red flag for melanoma as well-defined borders are typical of a benign nevus. Educational Context: It is crucial for healthcare providers, especially pediatric nurses, to be able to differentiate between benign nevi and potentially malignant melanomas. Understanding the key characteristics that raise suspicion of melanoma, such as changes in size, color, and margins, is essential for early detection and appropriate management. By recognizing the concerning features and knowing which findings do not typically indicate melanoma, healthcare professionals can provide accurate information to parents and ensure timely referrals for further evaluation if needed. This knowledge is vital in pediatric care to promote early intervention and improve outcomes for children at risk for skin malignancies.

Correct Answer: A

Rationale: The correct answer is A) inv(16) when considering translocation of childhood acute myeloid leukemia (AML) associated with granulocytic sarcoma mass. This translocation involves inversion of chromosome 16, leading to the fusion of the CBFB and MYH11 genes. This genetic abnormality is commonly seen in cases of AML with eosinophilia and is also associated with extramedullary involvement like granulocytic sarcoma. Option B) t(8;21) involves the fusion of the AML1 (RUNX1) gene with the ETO (RUNX1T1) gene. This translocation is more commonly associated with AML M2 subtype, not specifically linked to granulocytic sarcoma. Option C) t(6;9) is associated with the fusion of DEK and CAN genes, typically seen in AML M2 subtype. This translocation is not typically linked to granulocytic sarcoma. Option D) inv(3) involves inversion of chromosome 3 and is associated with AML M4 subtype. This translocation is not specifically associated with granulocytic sarcoma. In an educational context, understanding the genetic basis of AML subtypes and their associated translocations is crucial for accurate diagnosis and targeted treatment. Recognizing the specific translocations and their clinical correlations can aid in predicting disease behavior and guiding therapeutic decisions in pediatric patients with AML.

Correct Answer: D

Rationale: In neuroblastoma, metastatic spread can occur via local invasion or distant hematogenous/lymphatic routes. The LEAST common site of metastases in neuroblastoma is the skin (Option D). The correct answer is D because neuroblastoma typically metastasizes to organs such as the bone marrow, long bones, and lungs due to the nature of the disease. Skin metastases are rare in neuroblastoma compared to other sites. Option A (long bone) is a common site of metastasis in neuroblastoma due to the rich blood supply and bone marrow content, making it a favorable environment for tumor spread. Option B (bone marrow) is also a common site of metastasis as neuroblastoma is an embryonal cancer arising from neural crest cells that can infiltrate the bone marrow. Option C (lung) is another common site of metastasis in neuroblastoma as the lungs receive a high volume of blood flow, allowing cancer cells to potentially spread there. Educationally, understanding the patterns of metastatic spread in neuroblastoma is crucial for nurses preparing for the NCLEX RN Pediatric exam. This knowledge helps in early detection, appropriate staging, and treatment planning for pediatric patients with neuroblastoma. It also highlights the importance of comprehensive assessments and vigilant monitoring for signs of metastases in these patients.

Correct Answer: C

Rationale: In the treatment of malignant germ cell tumors (GCTs), cisplatin is the most effective chemotherapeutic agent. This is because cisplatin is a platinum-based chemotherapy drug that has shown high efficacy in treating GCTs by disrupting DNA synthesis in rapidly dividing cancer cells, leading to cell death. Vincristine (Option A) is not as effective in GCTs compared to cisplatin, as it primarily acts by disrupting microtubule function and is more commonly used in other types of cancers. Cyclophosphamide (Option B) is an alkylating agent that is less specific to GCTs and is not considered the first-line treatment for this type of cancer. Methotrexate (Option D) is a folate antagonist that is also not as effective as cisplatin in treating GCTs. In an educational context, it is important for medical students to understand the mechanism of action of different chemotherapeutic agents and their specific applications in various types of cancers. Understanding the rationale behind choosing cisplatin over other agents for treating GCTs helps students grasp the principles of personalized medicine and evidence-based practice in oncology.