Which child is at risk for developing glomerulonephritis?

Correct Answer: A

Rationale: In this question on pediatric Nclex practice, the child at risk for developing glomerulonephritis is option A) A 3-year-old who had impetigo 1 week ago. Glomerulonephritis is commonly caused by a preceding streptococcal infection such as impetigo. The infection triggers an immune response that affects the glomeruli in the kidneys, leading to inflammation and potential kidney damage. Option B) A 5-year-old with five UTIs in the previous year is at risk for urinary tract infections but not specifically for glomerulonephritis unless the UTIs are recurrent and severe. Option C) A 6-year-old with new-onset type 1 diabetes is at risk for diabetic nephropathy, a different kidney condition associated with diabetes. Option D) A 10-year-old recovering from viral pneumonia is not necessarily at increased risk for glomerulonephritis unless there were complications during the pneumonia episode affecting the kidneys. Educationally, understanding the link between certain infections like impetigo and glomerulonephritis is crucial for nurses caring for pediatric patients. Recognizing risk factors and early signs of kidney complications can lead to prompt intervention and prevention of long-term kidney damage in children.

Correct Answer: C

Rationale: The correct answer is C) 6 symptoms of inattention or 6 symptoms of hyperactivity-impulsivity for at least 6 months in two or more environments. This criteria is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) guidelines for diagnosing ADHD in children up to the age of 16 years. Choosing option A) is incorrect because it does not meet the minimum criteria specified in the DSM-5 for the duration of symptoms. Option B) also falls short of the required duration of symptoms. Option D) has the correct number of symptoms but fails to meet the duration criteria. Understanding the diagnostic criteria for ADHD is crucial for healthcare professionals working with children. By knowing the specific symptoms and duration required for diagnosis, healthcare providers can accurately assess and support children with ADHD. This knowledge helps in early identification, intervention, and management of ADHD, leading to better outcomes for affected children.

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.