Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 3-year-old child is diagnosed with neuroblastoma after presenting with a mass in the abdomen, abnormal eye movements, and swelling of the face. Which of the following is the most common site of origin for neuroblastoma in children?
A. Liver
Liver is incorrect because the liver is not the primary site of neuroblastoma. While the liver can become involved through metastasis, the tumor originates elsewhere along the sympathetic chain.
B. Brain
Brain is incorrect because neuroblastoma develops from peripheral sympathetic tissue, not the central nervous system. Brain tumors in children are a separate category of malignancies.
C. Kidneys
Kidneys is incorrect. Although neuroblastoma can present as an abdominal mass that seems near the kidneys, the tumor originates from the adrenal glands, not the renal tissue itself. Wilms’ tumor, not neuroblastoma, arises from the kidneys in children.
D. Adrenal glands
Adrenal glands is correct. Approximately 40% of neuroblastomas originate in the adrenal medulla, located above the kidneys. Other tumors may arise along the sympathetic chain, including the chest, neck, and pelvis. The adrenal origin explains why children may present with abdominal masses, abdominal pain, or systemic symptoms. Metastatic spread can cause periorbital ecchymosis (“raccoon eyes”), proptosis, and facial edema, as seen in this child, reflecting tumor spread to orbital bones and lymphatic structures.
This question is an excerpt from Nurse Dive's nursing test bank - Ati dmmsn 650 OB/Pediatrics Proctored Exams. Take the full exam now
Full Explanation
A. Liver is incorrect because the liver is not the primary site of neuroblastoma. While the liver can become involved through metastasis, the tumor originates elsewhere along the sympathetic chain.
B. Brain is incorrect because neuroblastoma develops from peripheral sympathetic tissue, not the central nervous system. Brain tumors in children are a separate category of malignancies.
C. Kidneys is incorrect. Although neuroblastoma can present as an abdominal mass that seems near the kidneys, the tumor originates from the adrenal glands, not the renal tissue itself. Wilms’ tumor, not neuroblastoma, arises from the kidneys in children.
D. Adrenal glands is correct. Approximately 40% of neuroblastomas originate in the adrenal medulla, located above the kidneys. Other tumors may arise along the sympathetic chain, including the chest, neck, and pelvis. The adrenal origin explains why children may present with abdominal masses, abdominal pain, or systemic symptoms. Metastatic spread can cause periorbital ecchymosis (“raccoon eyes”), proptosis, and facial edema, as seen in this child, reflecting tumor spread to orbital bones and lymphatic structures.
Similar Questions
The nurse teaches a pregnant patient about the signs of pregnancy. The patient demonstrates understanding when she states that a positive sign of pregnancy is:
A. quickening experienced by the patient.
Quickening experienced by the patient is incorrect because quickening (the first perception of fetal movement by the mother) is considered a presumptive sign of pregnancy, not a positive sign. While it suggests pregnancy, it can be mistaken for gastrointestinal activity.
B. patient reports of a positive pregnancy test.
Patient reports of a positive pregnancy test is incorrect because this is a probable sign of pregnancy. Laboratory tests detecting human chorionic gonadotropin (hCG) are more reliable than presumptive signs, but they can occasionally give false positives (e.g., due to certain medications or medical conditions).
C. Braxton Hicks contractions felt by the patient.
Braxton Hicks contractions felt by the patient is incorrect because these are also presumptive or possible signs of pregnancy. They indicate uterine activity, but they do not confirm the presence of a fetus.
D. fetal movement palpated by the provider.
Fetal movement palpated by the provider is correct. This is considered a positive sign of pregnancy, as only a developing fetus can cause these movements to be felt by an examiner. Other positive signs include visualization of the fetus on ultrasound and auscultation of the fetal heartbeat. Positive signs provide definitive confirmation of pregnancy, distinguishing them from presumptive or probable signs.
Full Explanation
A. Quickening experienced by the patient is incorrect because quickening (the first perception of fetal movement by the mother) is considered a presumptive sign of pregnancy, not a positive sign. While it suggests pregnancy, it can be mistaken for gastrointestinal activity.
B. Patient reports of a positive pregnancy test is incorrect because this is a probable sign of pregnancy. Laboratory tests detecting human chorionic gonadotropin (hCG) are more reliable than presumptive signs, but they can occasionally give false positives (e.g., due to certain medications or medical conditions).
C. Braxton Hicks contractions felt by the patient is incorrect because these are also presumptive or possible signs of pregnancy. They indicate uterine activity, but they do not confirm the presence of a fetus.
D. Fetal movement palpated by the provider is correct. This is considered a positive sign of pregnancy, as only a developing fetus can cause these movements to be felt by an examiner. Other positive signs include visualization of the fetus on ultrasound and auscultation of the fetal heartbeat. Positive signs provide definitive confirmation of pregnancy, distinguishing them from presumptive or probable signs.
A nurse is assessing a newborn's head after a vaginal delivery. The nurse notes a soft, edematous area that crosses suture lines on the scalp. The parents ask how this differs from a cephalohematoma. Which of the following statements is correct?
A. Both caput succedaneum and cephalohematoma are superficial scalp swellings that are visible at birth, can cross suture lines, and generally resolve spontaneously within a few hours to a few days without any risk of complications.
Both caput succedaneum and cephalohematoma are superficial scalp swellings that are visible at birth, can cross suture lines, and generally resolve spontaneously within a few hours to a few days without any risk of complications is incorrect. While caput succedaneum crosses suture lines and resolves quickly, cephalohematoma does not cross suture lines and takes longer to resolve.
B. Caput succedaneum is a collection of blood beneath the periosteum that is limited to a single cranial bone, does not cross suture lines, and may take several weeks to resolve, while cephalohematoma is a superficial scalp swelling caused by pressure during delivery that crosses suture lines and resolves within days
Caput succedaneum is a collection of blood beneath the periosteum that is limited to a single cranial bone, does not cross suture lines, while cephalohematoma is a superficial scalp swelling that crosses suture lines is incorrect. This description reverses the characteristics of caput succedaneum and cephalohematoma. Caput succedaneum is a superficial edema that crosses suture lines, whereas cephalohematoma is a subperiosteal hemorrhage limited to one cranial bone.
C. Caput succedaneum is usually firm and may be associated with bruising or ecchymosis of the scalp that develops within 24-48 hours after birth, while cephalohematoma is a soft, fluid-filled swelling of the scalp that crosses suture lines and resolves within a few days.
Caput succedaneum is usually firm and may be associated with bruising or ecchymosis, while cephalohematoma is a soft swelling that crosses suture lines is incorrect. Caput succedaneum is soft and edematous, not firm, and cephalohematoma does not cross suture lines.
D. Caput succedaneum crosses suture lines and usually resolves within a few days without intervention, while cephalohematoma is a subperiosteal hemorrhage confined to one cranial bone that may take weeks to months to resolve and can slightly increase the risk of hyperbilirubinemia.
Caput succedaneum crosses suture lines and usually resolves within a few days without intervention, while cephalohematoma is a subperiosteal hemorrhage confined to one cranial bone that may take weeks to months to resolve and can slightly increase the risk of hyperbilirubinemia is correct. Caput succedaneum results from pressure on the fetal head during delivery, causing soft tissue edema, while cephalohematoma results from ruptured blood vessels under the periosteum and resolves more slowly, with a small risk of hyperbilirubinemia.
Full Explanation
A. Both caput succedaneum and cephalohematoma are superficial scalp swellings that are visible at birth, can cross suture lines, and generally resolve spontaneously within a few hours to a few days without any risk of complications is incorrect. While caput succedaneum crosses suture lines and resolves quickly, cephalohematoma does not cross suture lines and takes longer to resolve.
B. Caput succedaneum is a collection of blood beneath the periosteum that is limited to a single cranial bone, does not cross suture lines, while cephalohematoma is a superficial scalp swelling that crosses suture lines is incorrect. This description reverses the characteristics of caput succedaneum and cephalohematoma. Caput succedaneum is a superficial edema that crosses suture lines, whereas cephalohematoma is a subperiosteal hemorrhage limited to one cranial bone.
C. Caput succedaneum is usually firm and may be associated with bruising or ecchymosis, while cephalohematoma is a soft swelling that crosses suture lines is incorrect. Caput succedaneum is soft and edematous, not firm, and cephalohematoma does not cross suture lines.
D. Caput succedaneum crosses suture lines and usually resolves within a few days without intervention, while cephalohematoma is a subperiosteal hemorrhage confined to one cranial bone that may take weeks to months to resolve and can slightly increase the risk of hyperbilirubinemia is correct. Caput succedaneum results from pressure on the fetal head during delivery, causing soft tissue edema, while cephalohematoma results from ruptured blood vessels under the periosteum and resolves more slowly, with a small risk of hyperbilirubinemia.
A 3-week-old infant is brought to the emergency department with a history of forceful, projectile vomiting after feedings and signs of weight loss. On assessment, the nurse palpates a small, olive-shaped mass in the upper abdomen. Which condition does this clinical picture most likely indicate?
A. Intussusception
Intussusception is incorrect because this condition typically presents with intermittent abdominal pain, drawing up of the legs, and “currant jelly” stools caused by blood and mucus. Vomiting may occur, but the presence of a palpable olive-shaped mass and projectile vomiting is not characteristic.
B. Pyloric stenosis
Pyloric stenosis is correct. Pyloric stenosis occurs when the pyloric muscle hypertrophies, causing gastric outlet obstruction. It usually presents in infants around 3–6 weeks of age with forceful, projectile vomiting immediately after feedings, signs of weight loss or poor weight gain, dehydration, and a palpable, firm, olive-shaped mass in the right upper abdomen. Vomiting is non-bilious because the obstruction is proximal to the duodenum.
C. A. Gastroesophageal reflux (GER)
Gastroesophageal reflux (GER) is incorrect because GER typically causes spitting up or regurgitation, which is usually non-forceful and not associated with an olive-shaped mass or significant weight loss. GER is common in infants and often resolves spontaneously.
D. Hirschsprung's disease
Hirschsprung's disease is incorrect because it presents with chronic constipation, abdominal distension, and delayed passage of meconium in the newborn period. Projectile vomiting and a palpable pyloric mass are not typical features.
Full Explanation
A. Intussusception is incorrect because this condition typically presents with intermittent abdominal pain, drawing up of the legs, and “currant jelly” stools caused by blood and mucus. Vomiting may occur, but the presence of a palpable olive-shaped mass and projectile vomiting is not characteristic.
B. Pyloric stenosis is correct. Pyloric stenosis occurs when the pyloric muscle hypertrophies, causing gastric outlet obstruction. It usually presents in infants around 3–6 weeks of age with forceful, projectile vomiting immediately after feedings, signs of weight loss or poor weight gain, dehydration, and a palpable, firm, olive-shaped mass in the right upper abdomen. Vomiting is non-bilious because the obstruction is proximal to the duodenum.
C. Gastroesophageal reflux (GER) is incorrect because GER typically causes spitting up or regurgitation, which is usually non-forceful and not associated with an olive-shaped mass or significant weight loss. GER is common in infants and often resolves spontaneously.
D. Hirschsprung's disease is incorrect because it presents with chronic constipation, abdominal distension, and delayed passage of meconium in the newborn period. Projectile vomiting and a palpable pyloric mass are not typical features.