A 1-year-old is being screened for retinoblastoma based on family history of the disease. The nurse recognizes which sign as being most characteristic of the disease?
White glow of the pupil.
Ptosis of the eye
Fixed and dilated pupil
Purulent eye discharge
The Correct Answer is A
A white glow of the pupil, often referred to as "cat's eye reflex" or "leukocoria," is a significant and characteristic sign of retinoblastoma. It occurs when the tumor within the eye reflects light, resulting in a white or yellowish glow in the pupil when light is shined into it. This can be seen in flash photographs or in certain lighting conditions. It's a crucial sign that may indicate the presence of retinoblastoma, a rare eye cancer that primarily affects young children.
The other options, B (ptosis of the eye), C (fixed and dilated pupil), and D (purulent eye discharge), are not typically associated with retinoblastoma. Ptosis is the drooping of the upper eyelid, a fixed and dilated pupil is usually a sign of neurological issues, and purulent eye discharge is often associated with eye infections rather than retinoblastoma.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Option A (Place the infant in reverse Trendelenburg position) and option B (Place the infant in the knee to chest position) are not the immediate actions to address this situation. While these positions might be used in specific situations, assessing blood pressure is more appropriate in this context to evaluate for potential vascular issues.
Option C. Take the infant's blood pressure in all extremities.
In an infant with weaker femoral pulses compared to the brachial and radial pulses, there might be a concern about coarctation of the aorta (a narrowing of the aorta), which can affect blood flow to the lower extremities. To confirm this and assess for potential issues, taking blood pressure measurements in all four extremities is crucial. This comparison can help identify pressure differentials between the upper and lower extremities, which is a hallmark sign of coarctation of the aorta.
Option D (Notify the Physician) is generally a good step, but taking the blood pressure in all extremities should be done first to provide comprehensive information for the physician when discussing the infant's condition.
Correct Answer is ["A","B","D","E"]
Explanation
A. Fever: Osteomyelitis is often associated with fever as it is an infectious process that can cause an elevated body temperature.
B. Unwillingness to move the affected extremity: Children with osteomyelitis may experience pain and discomfort, leading to a reluctance to move the affected limb.
C. A previous closed fracture of an extremity is not typically a direct assessment finding for osteomyelitis. Osteomyelitis is more commonly associated with infections that can spread to the bone, and a previous fracture may not always be present.
D. Redness and swelling at the site: Osteomyelitis can cause local inflammation, leading to redness and swelling at the affected area.
E. Severe pain: Pain is a common symptom of osteomyelitis, and it can be severe, leading to the child's unwillingness to move the affected extremity.
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