Which of the following chromosomal abnormalities of childhood ALL carries the highest risk of relapse despite intensive chemotherapy?

Correct Answer: A

Rationale: The correct answer is A) t(9;22) for the chromosomal abnormality of childhood ALL that carries the highest risk of relapse despite intensive chemotherapy. This abnormality is known as the Philadelphia chromosome, resulting from a translocation between chromosomes 9 and 22. This translocation leads to the formation of the BCR-ABL fusion gene, which is a hallmark of a more aggressive form of ALL. Option B) t(4;11) is associated with MLL rearrangements and has a relatively poor prognosis, but it is not as strongly linked to high relapse rates as the Philadelphia chromosome. Option C) hypodiploidy is a chromosomal abnormality associated with high-risk ALL due to the presence of fewer than 44 chromosomes. However, it does not carry as high a risk of relapse as the Philadelphia chromosome. Option D) t(1;19) is associated with the TCF3-PBX1 fusion gene and is considered a favorable risk factor in childhood ALL, with a lower risk of relapse compared to the Philadelphia chromosome. Understanding the prognostic significance of different chromosomal abnormalities in childhood ALL is crucial for pediatric nurses and healthcare professionals involved in the care of these patients. Recognizing high-risk factors like the Philadelphia chromosome can inform treatment decisions and monitoring strategies to improve patient outcomes.

Correct Answer: B

Rationale: In this scenario, the BEST confirmatory diagnostic evaluation for a suspected case of retinoblastoma in a 10-month-old infant is option B) examination under general anesthesia by an experienced ophthalmologist. This is the most appropriate choice because retinoblastoma is a malignant tumor of the retina that requires detailed evaluation under anesthesia to assess the extent of the tumor, its location, and the involvement of the optic nerve. Option A) indirect ophthalmoscopy with slit-lamp examination may not provide a comprehensive view of the entire retina, especially in infants who may not cooperate fully during the examination. Option C) orbital ultrasonography can be useful in certain cases, but it may not offer the detailed visualization needed to confirm a diagnosis of retinoblastoma definitively. Option D) brain MRI is not the first line of diagnostic evaluation for retinoblastoma, as the primary site of concern is the eye and not the brain. In an educational context, it is crucial for healthcare providers, especially pediatric nurses, to understand the importance of prompt and accurate diagnosis of conditions like retinoblastoma that can significantly impact a child's vision and overall health. By selecting the most appropriate diagnostic evaluation, healthcare professionals can ensure timely intervention and appropriate management of the condition, ultimately improving outcomes for the child.

Correct Answer: D

Rationale: In patients with disseminated intravascular coagulation (DIC), the laboratory results typically show a consumption of clotting factors leading to a bleeding tendency. The correct answer is D) prolonged prothrombin and partial thromboplastin times. This is because in DIC, there is widespread activation of the clotting cascade, leading to the depletion of clotting factors and platelets, which results in prolonged clotting times. Option A) decreased levels of fibrin split products is incorrect because in DIC, there is an increase in fibrin split products due to the breakdown of fibrinogen and fibrin clots. Option B) increased levels of fibrinogen is incorrect because in DIC, there is consumption of fibrinogen along with other clotting factors, leading to decreased levels. Option C) increased platelet counts is incorrect because in DIC, there is consumption and destruction of platelets, resulting in decreased platelet counts, a condition known as thrombocytopenia. Understanding the laboratory findings in DIC is crucial for nurses caring for pediatric patients as prompt recognition and intervention are essential to prevent further complications such as hemorrhage or thrombosis. Nurses play a key role in monitoring these laboratory values, recognizing trends, and collaborating with the healthcare team to provide appropriate care for patients with DIC.

Correct Answer: D

Rationale: In the fetal period of development, various key milestones occur as the baby grows and matures in the womb. In this question, the correct answer is D) 26 weeks - face clearly recognizable. This is because by around 26 weeks gestation, the baby's facial features have developed significantly, making the face clearly recognizable on ultrasound imaging or to the naked eye in some cases. Option A) 10 weeks - midgut returns to abdomen is true as it is a normal developmental process where the midgut, initially located outside the abdomen, returns to the abdominal cavity during this period. Option B) 12 weeks - external genitalia formed is also true, as by around 12 weeks gestation, the external genitalia of the baby have typically formed, though it may not yet be distinguishable on ultrasound. Option C) 24 weeks - surfactant production begun is also accurate. Surfactant production in the lungs begins around 24 weeks gestation and is crucial for the baby's lung development and function. Understanding these fetal developmental milestones is essential in pediatric nursing as it helps healthcare providers monitor the progress of the fetus, identify any potential issues or abnormalities, and provide appropriate care and interventions to support optimal growth and development. Being able to recognize these milestones can also aid in identifying any deviations from normal development that may require further evaluation or intervention.

Correct Answer: B

Rationale: The correct answer is B) 30 months. At this age, children typically demonstrate the ability to imitate construction of a gate with 2-4 parts, draw longer lines, and draw a man using 5 cubes. This milestone indicates the child's progressing fine motor skills, cognitive development, and creativity. Option A) 24 months is incorrect because children at this age usually engage in simpler forms of drawing and construction, focusing on basic shapes and lines. They are not yet at the developmental stage described in the question. Option C) 48 months and Option D) 54 months are also incorrect as children in these age groups would typically demonstrate more advanced drawing skills and complex construction abilities beyond what is described in the question. Understanding typical developmental milestones in children is crucial for pediatric nurses as it helps them assess children's growth and development accurately. By recognizing age-appropriate behaviors and skills, nurses can provide appropriate interventions and support to promote healthy development in pediatric patients.