A nurse is caring for a pediatric client who is suspected to have Wilms tumor.
Which of the following diagnostic procedures is key in confirming the diagnosis of Wilms tumor?
Biopsy of the tumor.
Bone marrow aspiration.
CT scan of the abdomen and chest.
Abdominal ultrasonography.
The Correct Answer is A
Choice A rationale
Biopsy of the tumor is the definitive diagnostic procedure for Wilms tumor. This involves the surgical removal of a tissue sample from the suspected mass, which is then examined microscopically by a pathologist. Histopathological analysis confirms the presence of malignant cells characteristic of nephroblastoma, differentiating it from other renal masses and guiding subsequent treatment protocols. Normal renal tissue structure is preserved in healthy kidneys.
Choice B rationale
Bone marrow aspiration is primarily used to diagnose hematological malignancies or assess for metastatic disease in certain cancers. While Wilms tumor can metastasize, particularly to the lungs, bone marrow involvement is uncommon and not the primary diagnostic method for confirming the initial diagnosis of the tumor itself. Normal bone marrow contains hematopoietic stem cells and a balanced cellularity.
Choice C rationale
A CT scan of the abdomen and chest provides detailed anatomical information about the tumor's size, location, and extent of involvement within the kidney and surrounding structures, as well as checking for metastasis to the lungs. While crucial for staging and surgical planning, a CT scan is an imaging modality and does not provide a definitive tissue diagnosis. Normal abdominal organs appear with distinct densities.
Choice D rationale
Abdominal ultrasonography is often the initial imaging modality used to evaluate a suspected abdominal mass in children due to its non-invasive nature and lack of radiation exposure. It can identify the presence of a renal mass and distinguish between solid and cystic lesions, but like CT, it cannot definitively diagnose Wilms tumor without tissue sampling. Normal kidneys appear as solid, homogeneous organs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Administering medication without a competent client's knowledge or consent constitutes battery, an intentional tort. Battery involves an unconsented touching of another person, even if the intent is benevolent. This action violates the client's autonomy and right to self-determination regarding their medical treatment, which is a fundamental ethical and legal principle in healthcare.
Choice B rationale
Applying restraints to a competent, alert, and oriented client who wishes to leave against medical advice is false imprisonment, an intentional tort. False imprisonment involves the unlawful restraint of a person against their will. Competent adults have the right to refuse treatment and discharge themselves, and their freedom of movement cannot be unduly restricted.
Choice C rationale
Threatening to apply restraints to a client for not adhering to a dietary restriction constitutes assault, an intentional tort. Assault involves placing another person in reasonable apprehension of an immediate harmful or offensive contact. While dietary adherence is important, threatening physical restraint for non-compliance is an inappropriate and unlawful response.
Choice D rationale
This scenario exemplifies negligence, which is unintentional tort. Negligence occurs when a healthcare professional fails to act as a reasonably prudent nurse would under similar circumstances, resulting in harm to the patient. The delay in reporting a critical change in a client's condition, such as absent peripheral pulsation, falls below the standard of care and can lead to severe and irreversible tissue damage or limb loss.
Correct Answer is ["A","C","F"]
Explanation
Choice A rationale
Post-kidney transplant, immunosuppressive medications are crucial to prevent rejection, which also compromises the immune system. Engaging in contact sports significantly increases the risk of direct trauma to the transplanted kidney, potentially causing injury or rupture, which could necessitate re-transplantation or lead to graft loss.
Choice E rationale
Grapefruit contains furanocoumarins, compounds that inhibit the cytochrome P450 3A4 (CYP3A4) enzyme system in the liver and intestines. Many immunosuppressants, like calcineurin inhibitors (e.g., cyclosporine, tacrolimus), are metabolized by CYP3A4. Inhibition of this enzyme can lead to increased drug concentrations and elevated risk of toxicity.
Choice F rationale
Fluid restriction post-kidney transplant may be necessary, particularly in the immediate postoperative period or if the patient experiences fluid overload or delayed graft function. Excessive fluid intake could contribute to hypertension or pulmonary edema, complicating recovery and potentially stressing the newly transplanted kidney.
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