A nurse is collecting data from a 1-year-old child who has Wilms’ tumor. Which of the following findings should the nurse expect?
Abdominal mass
Diarrhea
Jaundice
Swollen joints
The Correct Answer is A
Choice A reason: Wilms’ tumor, a pediatric kidney malignancy, presents as a painless abdominal mass, often palpable in the flank, due to tumor growth in the renal parenchyma. This disrupts normal kidney structure, causing a firm, non-tender mass. It’s the most common finding, reflecting the tumor’s physical presence in the abdomen.
Choice B reason: Diarrhea is not associated with Wilms’ tumor, which primarily affects the kidney, causing mass effect or hematuria. Gastrointestinal symptoms may occur in other conditions like neuroblastoma, but Wilms’ tumor typically presents with an abdominal mass, making diarrhea an incorrect expected finding in this malignancy.
Choice C reason: Jaundice results from liver dysfunction or biliary obstruction, not Wilms’ tumor, which affects the kidney. While metastasis to the liver is possible, it’s rare and not a primary feature. An abdominal mass is the hallmark sign, making jaundice an incorrect expected manifestation in a 1-year-old.
Choice D reason: Swollen joints suggest rheumatologic or metastatic bone disease, not Wilms’ tumor, which primarily causes a renal mass. Joint involvement is uncommon, as Wilms’ tumor affects the kidney, leading to an abdominal mass. This makes swollen joints an incorrect expected finding in this pediatric malignancy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Long-acting insulins, like glargine, provide basal coverage over 24 hours with no peak. Regular insulin has a shorter duration (6-8 hours) and peak (2-4 hours), making it unsuitable for basal control. Its rapid onset classifies it as short-acting, not long-acting, for managing postprandial glucose spikes in diabetes.
Choice B reason: Rapid-acting insulins, like aspart, have an onset of 10-15 minutes and peak at 1-2 hours. Regular insulin has a slower onset (30-60 minutes) and longer duration (6-8 hours), making it short-acting, not rapid-acting. This distinction is critical for timing insulin administration in diabetes management.
Choice C reason: Intermediate-acting insulins, like NPH, have an onset of 1-2 hours and duration of 12-18 hours. Regular insulin’s shorter duration (6-8 hours) and peak (2-4 hours) classify it as short-acting, used for prandial coverage, not intermediate basal control, making this an incorrect classification.
Choice D reason: Regular insulin is short-acting, with an onset of 30-60 minutes, peak at 2-4 hours, and duration of 6-8 hours. It effectively controls postprandial glucose spikes in diabetes by mimicking physiological insulin release. This classification guides its use in meal-time dosing, making it the correct choice.
Correct Answer is A
Explanation
Choice A reason: The Somogyi phenomenon involves rebound hyperglycemia in the morning following nocturnal hypoglycemia, triggering counter-regulatory hormones (e.g., glucagon, cortisol), causing diaphoresis and headaches. Excess insulin at night lowers glucose, prompting a hyperglycemic rebound. This explains the child’s symptoms, requiring insulin dose adjustment to prevent nocturnal hypoglycemia.
Choice B reason: The Honeymoon effect is a temporary period of improved insulin production post-diagnosis in type 1 diabetes, not causing hyperglycemia, diaphoresis, or headaches. It reflects residual beta-cell function, not a morning rebound. The Somogyi phenomenon better explains the symptoms, making this an incorrect diagnosis.
Choice C reason: Ketoacidosis causes hyperglycemia, but with fruity breath, lethargy, and dehydration, not diaphoresis or headaches alone. It results from insulin deficiency, not nocturnal hypoglycemia rebound. The Somogyi phenomenon’s counter-regulatory response better matches the morning symptoms, making ketoacidosis an incorrect suspicion for this presentation.
Choice D reason: The Dawn phenomenon causes morning hyperglycemia due to growth hormone surges, not diaphoresis or headaches, which suggest a hypoglycemic event. It lacks the rebound mechanism of the Somogyi phenomenon, which explains the combination of symptoms, making this an incorrect suspicion for the child’s condition.
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