Which medication is most likely included in post-operative care of a child with repair of bladder exstrophy?

Correct Answer: D

Rationale: In the post-operative care of a child with repair of bladder exstrophy, the most likely medication included is Oxybutynin (Option D). Oxybutynin is a medication commonly used to treat bladder spasms by relaxing the bladder muscles, which is crucial in this scenario to prevent discomfort and complications post-surgery. Lasix (Option A) and Mannitol (Option B) are diuretics and are not typically indicated in the immediate post-operative care of bladder exstrophy repair in children. Meperidine (Option C) is an opioid analgesic that may be used for pain management but is not specifically targeted at addressing bladder-related issues post-surgery. In an educational context, it is important for pediatric emergency nurses to understand the rationale behind post-operative medication choices to ensure safe and effective care for pediatric patients. Understanding the pharmacological actions and indications of medications used in different clinical scenarios is essential for providing quality nursing care in pediatric emergency settings.

Correct Answer: D

Rationale: In pediatric emergency nursing, understanding the features of rapid eye movement (REM) is crucial for assessing a child's neurological status. The correct answer, option D - CT scan of head and neck, is not typically associated with assessing REM. A) Polysomnography is a test used to monitor and record various physiological activities during sleep, including REM. It is a key tool in diagnosing sleep disorders but is not specific to REM alone. B) EEG (electroencephalogram) is a valuable tool for assessing brain activity, including during sleep stages like REM. EEG can detect abnormal brain waves associated with certain conditions, but it is not exclusive to REM. C) Fiberoptic nasopharyngeal examination may be used to assess airway patency and structures in emergency situations but is not directly related to monitoring REM. Educationally, understanding the features and monitoring techniques for REM in pediatric patients is essential for providing comprehensive care. By knowing the appropriate diagnostic tools and assessments for different aspects of neurological function, nurses can effectively evaluate and manage pediatric emergencies.

Correct Answer: A

Rationale: In pediatric emergency nursing, understanding poor prognostic factors in conditions like Hodgkin lymphoma is crucial for providing effective care. In this scenario, the correct answer is option A - age of more than 15 years at the time of diagnosis. This is because younger age at diagnosis is generally associated with better outcomes in Hodgkin lymphoma due to factors like better tolerance to treatment and lower risk of complications. Option B - stage IV disease is a poor prognostic factor as it indicates advanced disease with spread to distant sites, making treatment more challenging and outcomes less favorable. Option C - manifestation by PET scan positivity is also a poor prognostic factor as it suggests a higher tumor burden and more aggressive disease, which can impact treatment response and overall prognosis. Option D - presence of bulky mediastinal mass is another poor prognostic factor as it is associated with more extensive disease involvement and can complicate treatment and increase the risk of complications. Educationally, understanding these prognostic factors is vital for nurses caring for pediatric patients with Hodgkin lymphoma. It helps in anticipating potential challenges, individualizing care plans, and providing appropriate support to patients and their families throughout the treatment process. By differentiating between these factors, nurses can contribute to improved patient outcomes and quality of care in pediatric oncology settings.

Correct Answer: D

Rationale: In the case of a 2-year-old with an asymptomatic right flank mass suspected to be a Wilms tumor, the least likely investigation to be performed is a biopsy of the mass (Option D). This is because in pediatric oncology, especially when dealing with suspected Wilms tumor, biopsies are generally avoided due to the risk of tumor spillage and seeding. A plain abdominal radiography (Option A) is less likely to provide detailed information compared to a CT scan of the abdomen (Option B) which is preferred for evaluating the extent of the tumor. A CT scan of the chest (Option C) is important to assess for metastasis, a common occurrence in Wilms tumor. Educationally, understanding the appropriate diagnostic approach in pediatric oncology is crucial for nurses caring for children with suspected malignancies. It is essential to grasp the rationale behind choosing specific investigations to ensure accurate diagnosis and appropriate management without compromising the child's well-being.

Correct Answer: D

Rationale: In the context of pediatric emergency nursing, understanding Kasabach-Merritt syndrome is crucial for providing effective care to pediatric patients. Kasabach-Merritt syndrome is a rare condition characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, and coagulopathy. The correct answer, D) association with infantile hemangiomas, is the exception because Kasabach-Merritt syndrome is actually associated with kaposiform hemangioendotheliomas, not infantile hemangiomas. Thrombocytopenia in Kasabach-Merritt syndrome results from platelet consumption within the vascular tumor, leading to bleeding tendencies. Microangiopathic hemolytic anemia occurs due to red blood cell damage as they pass through the abnormal vasculature. Coagulopathy is also a common feature, manifesting as prolonged clotting times and increased risk of bleeding. Educationally, recognizing the distinguishing features of Kasabach-Merritt syndrome is essential for timely diagnosis and management in pediatric emergency settings. By understanding the correct association and the pathophysiology of this syndrome, nurses can intervene promptly to prevent life-threatening complications such as severe bleeding or disseminated intravascular coagulation. This knowledge empowers pediatric nurses to advocate for appropriate treatment strategies and collaborate effectively with the interprofessional team to optimize patient outcomes.