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A nurse is caring for a 7-month-old who is eight days post-op from an open heart surgery to repair her Tetralogy of Fallot (TOF). Which statement regarding post-operative care by the parent would require additional education from the nurse?

"I understand that my baby will be given multiple IV medications. Some of these medications might include opioids for pain management and antibiotics to protect her from infection."

"I understand that I will need to be careful when picking up my baby, I will need to pick her up by the head and bottom to protect her sternum."

"I understand that it is important my baby continues to do tummy time once a day so her motor development does not suffer while in the hospital."

"I understand that we will be in the hospital for a couple of weeks for treatment and monitoring post-op and then we will need close follow up with cardiology and the surgery team."

Answer and Explanation

The Correct Answer is C

Rationale:

A. "I understand that my baby will be given multiple IV medications. Some of these medications might include opioids for pain management and antibiotics to protect her from infection.": Pain control and infection prevention are essential after open heart surgery.

B. "I understand that I will need to be careful when picking up my baby, I will need to pick her up by the head and bottom to protect her sternum.": Sternal precautions are critical to prevent strain on the healing sternum.

C. "I understand that it is important my baby continues to do tummy time once a day so her motor development does not suffer while in the hospital.": Tummy time after recent sternotomy can place pressure on the chest incision and stress the healing sternum, increasing risk of complications. It should be delayed until cleared by the surgical team.

D. "I understand that we will be in the hospital for a couple of weeks for treatment and monitoring post-op and then we will need close follow up with cardiology and the surgery team.": Post-op recovery often requires extended hospitalization and long-term follow-up to monitor cardiac function and surgical healing.

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Correct Answer is C

Explanation

Rationale:

A. Oxygenation: While maintaining adequate oxygen is important for overall care, it does not directly prevent acute tumor lysis syndrome (TLS), which is caused by the rapid breakdown of malignant cells and release of intracellular contents.

B. Pain management: Managing discomfort is necessary for patient well-being, but it does not address the metabolic imbalances (hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia) that occur in TLS.

C. Hydration: Adequate IV hydration increases urine output, helps flush out excess potassium and uric acid, and reduces the risk of uric acid crystal precipitation in the kidneys.

D. Corticosteroids: While steroids may be part of leukemia treatment protocols, they are not the primary intervention to prevent TLS and may even contribute to rapid tumor breakdown if used in high doses.

A. The infant's eye appears to be protruding B. The infant tugs and pulls at one ear. C. The infant always keeps her eyes tightly closed. D. One pupil appears white.

Correct Answer is D

Explanation

Rationale:

A. The infant's eye appears to be protruding: Protrusion of the eye, or proptosis, is more often linked to orbital tumors, severe infections, or trauma rather than retinoblastoma. Retinoblastoma primarily affects the retina inside the eye, not surrounding orbital structures.

B. The infant tugs and pulls at one ear: Ear pulling is more commonly associated with otitis media or ear discomfort. This behavior is not connected to retinoblastoma and would not be expected in a history related to an intraocular tumor.

C. The infant always keeps her eyes tightly closed: Persistent eye closure could be a sign of photophobia, eye irritation, or pain from corneal abrasions or infections, but it is not the hallmark presentation of retinoblastoma.

D. One pupil appears white: A white reflex in the pupil, known as leukocoria, is a classic finding in retinoblastoma. Parents may notice this when light shines in the child’s eye, where one pupil appears white instead of the normal red reflex.

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A nurse is caring for a 7-month-old who is eight days post-op from an open heart surgery to repair her Tetralogy of Fallot (TOF). Which statement regarding post-operative care by the parent would require additional education from the nurse?

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After chemotherapy has begun for a child with acute leukemia, which of the following interventions to prevent acute tumor lysis syndrome would the nurse perform?

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Correct Answer is D

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