Nursing Elites

1. In which type of cancer are the urinary excretion of the breakdown products of catecholamines, especially vanillylmandelic acid (VMA) and homovanillic acid (HVA), detected?

• A. Neuroblastoma
• B. Nephroblastoma
• C. Leukemia
• D. Osteosarcoma

Correct answer: A

Rationale: The correct answer is A: Neuroblastoma. Neuroblastoma, a cancer that arises from nerve tissue, is associated with increased levels of catecholamine metabolites, including VMA and HVA, in the urine. Nephroblastoma (Wilms tumor) is a type of kidney cancer and is not typically associated with elevated levels of catecholamine breakdown products. Leukemia is a cancer of the blood and bone marrow and does not lead to increased VMA and HVA excretion in urine. Osteosarcoma is a bone cancer and is not linked to elevated levels of catecholamine metabolites in the urine.

2. A school-age client is in the playroom when the respiratory therapist arrives to give a scheduled breathing treatment. What is the most appropriate nursing action?

• A. Escort the child to their room and ask the child-life specialist to bring toys to the bedside
• B. Reschedule the treatment for a later time
• C. Assist the child back to their room for the treatment but reassure them that they may return when the procedure is completed
• D. Show the respiratory therapist to the playroom

Correct answer: C

Rationale: The most appropriate action is to assist the child back to their room for the treatment but reassure them that they may return when the procedure is completed. This approach ensures that the child receives the necessary treatment while also acknowledging their desire to continue playing in the playroom. Choice A is incorrect because it suggests moving the child to the room and asking the child-life specialist to bring toys, which may not be necessary. Choice B is incorrect as rescheduling the treatment may not be in the best interest of the child's health. Choice D is incorrect as the nurse should guide the child back to their room for the treatment.

3. As children grow and develop, their style of play changes. Which play style is seen in the preschooler?

• A. Solitary
• B. Associative
• C. Cooperative
• D. Parallel

Correct answer: B

Rationale: The correct answer is B: Associative. Associative play is common in preschoolers, where children engage in separate activities but interact by sharing toys and talking with each other. This stage is characterized by more social interaction than solitary play (option A), where children play alone without interacting with others. Cooperative play (option C) involves children working together towards a common goal, which is typically seen in older children. Parallel play (option D) is when children play alongside each other but do not actively engage with one another, which is more common in toddlers.

4. What is an approximate method of estimating output for a child who is not toilet trained?

• A. Have parents estimate output.
• B. Weigh diapers after each void.
• C. Place a urine collection device on the child.
• D. Have the child sit on a potty chair 30 minutes after eating.

Correct answer: B

Rationale: Weighing diapers is the most accurate way to estimate urine output in a child who is not toilet trained. This method provides a measurable and reliable estimate of fluid output.

5. Which immunization is typically administered at birth?

• A. Hepatitis B
• B. DTaP
• C. MMR
• D. Varicella

Correct answer: A

Rationale: The correct answer is A, Hepatitis B. The Hepatitis B vaccine is usually given at birth to protect against hepatitis B, a virus that can lead to chronic liver disease and liver cancer. This vaccination is crucial for newborns, especially those born to mothers who are carriers of hepatitis B. Choices B, C, and D are incorrect because DTaP (B), MMR (C), and Varicella (D) vaccines are not typically administered at birth. DTaP is given in a series starting at 2 months, MMR is usually given around 12-15 months, and Varicella is given between 12-15 months of age.

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