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NCLEX RN Question of The Day 45th Edition (August 2019)
1. A nurse is assigned to care for a child with a diagnosis of Wilms’ tumor. In planning care for the child, the nurse understands that this tumor is:
A. An abdominal tumor
B. A renal tumor
C. A brain tumor
D. A bone tumor
Answer: B. A renal tumor
Rationale: Wilms’ tumor, or nephroblastoma, is the most common renal tumor in children. Arising from the renal parenchyma of the kidney, this tumor grows very rapidly. It may be present unilaterally and localized, or bilaterally, and sometimes with metastasis to other organs.
Test-Taking Strategy: Knowledge regarding the location of Wilms’ tumor is required to answer this question. Remember, Wilms’ tumor, or nephroblastoma, is the most common renal tumor in children. Review this type of tumor if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Child Health
Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 204.
2. A nursing instructor assigns a student nurse to present a clinical conference to the student group about brain tumors in children. The student prepares for the conference and plans to include which of the following in the presentation?
A. Surgery is not normally performed because of the risk of functional deficits occurring as a result of the surgery
B. Head shaving is no longer required before removal of a brain tumor
C. The most common site of metastasis is the kidneys
D. The most significant symptoms are headaches and morning vomiting
Answer: D. The most significant symptoms are headaches and morning vomiting
Rationale: The hallmark symptoms of children with brain tumors are headache and morning vomiting related to the child getting out of bed. Initial intervention is “debulking” or operating to remove as much of the tumor as possible while minimally disturbing the surrounding brain tissue, so that the child’s neurological functioning is preserved as much as possible. Before surgery, the child’s head will be shaved although every effort is made to shave only as much hair as is necessary. Depending on the type of tumor, a myelogram may be done to determine metastatic disease in the spinal cord.
Test-Taking Strategy: Knowledge regarding the clinical manifestations and therapeutic interventions associated with a brain tumor is required to answer this question. Focus on the child’s diagnosis and note the relationship of the diagnosis to the symptoms in option D. Review this content if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Child Health
Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 304.
3. Bethanechol (Urecholine) is prescribed for the client with urinary retention, and an injectable form of bethanechol is available for use as prescribed. The nurse informs the client of the physician’s order knowing that the medication will be administered:
A. Intravenously
B. Intramuscularly
C. Intradermally
D. Subcutaneously
Answer: D. Subcutaneously
Rationale: The injectable form of bethanechol is intended for subcutaneous administration only. Bethanechol must never be injected intramuscularly or by the intravenous route because the resulting high drug levels can cause severe toxicity, such as bloody diarrhea, bradycardia, profound hypotension, and cardiovascular collapse.
Test-Taking Strategy: Knowledge regarding the route of administration of this medication is required to answer this question. Remember, bethanechol is administered by the subcutaneous route. Review this medication and administration route if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Pharmacology
References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W. B. Saunders, p. 121.
Lehne, R. (2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B. Saunders, p. 114.
4. A child with a brain tumor returns from the recovery room following “debulking” of the tumor. The nurse assigned to care for the child monitors the child for brain stem involvement. Which of the following signs would indicate that brain stem involvement occurred during the surgical procedure?
A. Elevated temperature
B. Orthostatic hypotension
C. Inability to swallow
D. Altered hearing ability
Answer: A. Elevated temperature
Rationale: Vital signs and neurological status are checked frequently. Special attention is paid to the child’s temperature, which may be elevated because of hypothalamus or brain stem involvement during surgery. A cooling blanket should either be in place on the bed or be readily available if the child becomes hyperthermic. Options 3 and 4 are related to functional deficits following surgery. An elevated blood pressure and a widened pulse pressure may be associated with increased intracranial pressure.
Test-Taking Strategy: Use the process of elimination. Recalling the functions of the hypothalamus and brain stem will easily direct you to option A. If you had difficulty with this question, review the complications that can occur following debulking of a brain tumor.
Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Child Health
Reference: Wong, D., & Hockenberry, M. (2003). Nursing care of infants and children (7th ed.). St. Louis: Mosby, p. 1663.
5. Following surgical removal of a brain tumor, the nurse is monitoring the child and notes that the child is restless, the pulse rate is elevated, and the blood pressure has dropped significantly from the baseline value. The nurse suspects that the child is in shock. Which of the following would be the appropriate nursing action?
A. Place the child in Trendelenburg position
B. Elevate the head of the bed
C. Increase the administration of intravenous (IV) fluids
D. Notify the registered nurse
Answer: D. Notify the registered nurse
Rationale: The child is never placed in the Trendelenburg position because it increases intracranial pressure (ICP) and the risk of bleeding. In the event of shock, the registered nurse is notified, who immediately notifies the physician. Increasing IV fluids can cause an increase in ICP and should not be done without a physician’s order.
Test-Taking Strategy: Use the process of elimination. Recall the complications associated with cranial surgery to answer this question. Eliminate options 1 and 3 because these actions increase ICP. Eliminate option 2 because this intervention will not assist in alleviating shock. In fact, this action could cause harm to the child. Eliminate option 3 because the nurse should not increase IV fluids without a physician’s order. Review care to the child following removal of a brain tumor if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Child Health
References: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 1348.
Wong, D., & Hockenberry, M. (2003). Nursing care of infants and children (7th ed.). St. Louis: Mosby, p. 1662.
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