NORCET 10 Prelims-2026: A child with craniopharyngioma is being monitored for complications. What is the most appropriate nursing act…

NORCET 10 Prelims-2026

Child Health Nursing (Pediatrics)

Hard

Appeared in: NORCET 10 Prelims-2026

Explanation

Craniopharyngiomas are tumors located near the pituitary gland and hypothalamus, structures crucial for hormone regulation.
This proximity creates a high risk for disrupting the production or release of Antidiuretic Hormone (ADH), leading to Diabetes Insipidus (DI).
DI is a condition where the kidneys fail to concentrate urine, resulting in the excretion of large volumes of very dilute urine.
Checking the urine specific gravity is the most direct and effective nursing action to assess the urine's concentration and thereby monitor for the onset of DI.
A low urine specific gravity (e.g., less than 1.005) is a hallmark sign of DI, allowing for early intervention.

Option A: Measuring abdominal girth is used to assess for conditions like ascites or bowel obstruction, which are not primary or common complications of a craniopharyngioma.
Option B: Measuring head circumference is a key assessment for increased intracranial pressure (ICP), but its utility is primarily in infants with open cranial sutures. In an older child, other neurologic signs are more sensitive indicators of ICP.
Option C: While monitoring blood pressure is a routine part of care, it is not the most specific or earliest indicator of DI. Hypotension is a late sign of severe dehydration that occurs after significant fluid loss.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management of complications associated with craniopharyngioma to guide bedside assessment, documentation, and the next nursing action.
Nurses play a critical role in the early detection of DI in patients with brain tumors or after neurosurgery by meticulously monitoring fluid balance and urine concentration.
Early identification and reporting of high urine output and low specific gravity can prevent life-threatening dehydration and electrolyte imbalances, particularly hypernatremia.
What if? If the patient's urine specific gravity was high (e.g., 1.035) with low urine output, the nurse should suspect an opposite complication: Syndrome of Inappropriate Antidiuretic Hormone (SIADH). The priority action would then shift to implementing fluid restriction and monitoring for hyponatremia.

How to Approach the Question

First, identify the key diagnosis in the question: 'craniopharyngioma'.
Recall the anatomical location of this tumor, which is near the pituitary gland and hypothalamus in the brain.
Connect this location to its most common and specific complications. The pituitary gland's function is hormone regulation, so hormonal imbalances are a major risk.
Specifically, consider the posterior pituitary's role in producing Antidiuretic Hormone (ADH). Damage to this area often causes ADH deficiency, leading to Diabetes Insipidus (DI).
Evaluate the given options to determine which one is the best for monitoring DI. DI is characterized by excessive urination of dilute urine.
Conclude that checking urine specific gravity is the most direct way to measure urine concentration and is therefore the most appropriate action to monitor for this specific complication.

Concept Tested & Keywords

Concept Tested: Nursing management of complications associated with craniopharyngioma.
Stem keywords: craniopharyngioma, child, complications, nursing action
Lead-in keywords: most appropriate
Clinical cues: Diagnosis of craniopharyngioma implies a risk for pituitary and hypothalamic dysfunction.

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 37-39