A 3-week-old male baby develops a rash involving the face and periorbital area after exposure to sunlight; you suspect neonatal lupus. The NEXT step of management of the baby is

Correct Answer: A

Rationale: In this scenario, the correct next step in managing a 3-week-old baby with a rash suggestive of neonatal lupus after sun exposure is to measure anti-Ro antibodies (Option A). Neonatal lupus is often associated with the presence of maternal autoantibodies, particularly anti-Ro and anti-La antibodies. These antibodies can cross the placenta and affect the baby, leading to various manifestations including skin rashes. Option A is correct because measuring anti-Ro antibodies can help confirm the diagnosis of neonatal lupus. Positive anti-Ro antibodies in the baby's blood would support the diagnosis and guide further management. This step is crucial as it can prompt appropriate interventions and monitoring for potential complications. Options B, C, and D are incorrect in this context. Measuring anti-La antibodies (Option B) is less specific for neonatal lupus compared to anti-Ro antibodies. While neonatal lupus can be associated with cardiac manifestations (Option C), the initial presentation of a rash prompts the need for confirming the diagnosis through antibody testing before proceeding to cardiac evaluation. Hematological evaluation (Option D) is not indicated as the primary concern in this case is the skin rash and its association with neonatal lupus. From an educational perspective, understanding the significance of maternal autoantibodies in neonatal lupus is crucial for pediatric nurses. Recognizing the importance of specific antibody testing in confirming the diagnosis and guiding management is essential for providing optimal care to infants with suspected neonatal lupus. This case underscores the need for a systematic approach to assessing and managing neonatal conditions, emphasizing the importance of appropriate diagnostic steps in clinical practice.

Correct Answer: A

Rationale: In treating a 5-year-old boy with Henoch-Schonlein purpura (HSP) presenting with acute onset palpable purpura over the lower extremities and buttocks, the BEST treatment is supportive measures (Option A). Rationale: 1. Supportive Measures: The primary approach in managing HSP is supportive care, including rest, hydration, and pain management. HSP is a self-limiting condition in most cases, and supportive measures help alleviate symptoms and promote recovery. Why others are wrong: 1. Steroids (Option B): While steroids may be used in severe cases of HSP with significant renal or gastrointestinal involvement, they are not the first-line treatment for uncomplicated cases like the one described in the question. 2. Azathioprine (Option C) and Cyclophosphamide (Option D): These are immunosuppressive medications that are not typically indicated for initial treatment of uncomplicated HSP in children. They are reserved for cases with severe organ involvement or refractory disease. Educational context: Understanding the appropriate treatment for common pediatric conditions like HSP is crucial for pediatric nurses. By opting for supportive measures as the initial management strategy, nurses can provide safe and effective care for children with HSP, promoting positive outcomes and minimizing unnecessary interventions. This knowledge enhances nursing practice and ensures evidence-based care delivery in pediatric settings.

Correct Answer: A

Rationale: In pediatric nursing, it is crucial to be able to recognize signs of physical abuse in children to ensure their safety and well-being. The correct answer to this question is A) history of inflicted trauma. This is because a history of inflicted trauma is often the most common and reliable clue of physical abuse in children. When a child presents with injuries that are not consistent with the reported history or seem suspicious, it raises red flags for possible abuse. Option B) burn marks, Option C) bruises, and Option D) intestinal injury are commonly seen in physically abused children as well. However, these physical signs alone may not always definitively point to abuse, as they can sometimes be explained by other factors such as accidents or medical conditions. It is the thorough assessment of the history of trauma that often provides the most reliable indication of abuse in children. Educationally, understanding the nuances of recognizing signs of physical abuse in children is essential for nurses and healthcare professionals working with pediatric populations. By emphasizing the importance of looking beyond just physical signs and considering the context and history of injuries, healthcare providers can better advocate for the safety and well-being of their pediatric patients.

Correct Answer: A

Rationale: In this scenario, the least common cause of the child's symptoms is asthma. Asthma is a common respiratory condition in children characterized by reversible airway obstruction, wheezing, and shortness of breath. However, in this case, the child's presentation of failure to thrive, recurrent wheezing, and pulmonary infections is more indicative of other conditions. Aspiration (Option B) can lead to recurrent respiratory infections and wheezing, especially in young children who may aspirate food or liquids into their lungs. This can mimic symptoms of asthma but is not as common. Food allergy (Option C) can also present with respiratory symptoms such as wheezing and recurrent infections. Children with food allergies may experience respiratory distress as a result of an allergic reaction, which can be mistaken for asthma. Cystic fibrosis (Option D) is a genetic disorder that primarily affects the lungs and digestive system. It commonly presents with respiratory symptoms like recurrent infections, wheezing, and failure to thrive in children. Cystic fibrosis is a more likely cause of the child's symptoms compared to asthma in this case. Educationally, understanding the differential diagnosis of common pediatric conditions is crucial for healthcare providers caring for children. By recognizing the key differences between asthma, aspiration, food allergy, and cystic fibrosis, healthcare professionals can provide appropriate treatment and management tailored to the specific underlying cause of a child's symptoms.

Correct Answer: D

Rationale: In this case, the correct answer is D) Hypothyroidism. The infant presents with signs and symptoms consistent with congenital hypothyroidism, also known as cretinism. This condition can lead to persistent hyperbilirubinemia, poor weight gain, decreased tone, umbilical hernia, and delayed fontanel closure. Option A) Crigler-Najjar syndrome is a rare genetic disorder leading to unconjugated hyperbilirubinemia but would not present with the other signs observed in the infant. Option B) Gilbert disease is a benign condition causing mild unconjugated hyperbilirubinemia without the associated physical findings. Option C) Biliary atresia presents with jaundice, but not with the specific constellation of symptoms seen in this case. Educationally, understanding the clinical manifestations of hypothyroidism in infants is crucial for pediatric nursing practice. Recognizing these signs early can lead to prompt diagnosis and treatment, preventing potential complications associated with untreated hypothyroidism in infants.