A 4-year-old boy presents with failure to thrive, irritability, bloating, and a symmetrical rash on his elbows and knees. Transglutaminase IgA antibodies are positive. What is the most likely diagnosis?

Correct Answer: A

Rationale: The correct answer is A) Dermatitis herpetiformis. Dermatitis herpetiformis is a skin manifestation of celiac disease, an autoimmune disorder triggered by gluten ingestion. In this case, the positive transglutaminase IgA antibodies indicate an immune response to gluten, which is characteristic of celiac disease. The symptoms of failure to thrive, irritability, bloating, and a symmetrical rash on the elbows and knees are classic presentations of dermatitis herpetiformis in children with celiac disease. Option B) Discoid eczema is an inflammatory skin condition characterized by coin-shaped patches of irritated skin, which is not associated with the gastrointestinal symptoms and positive antibodies seen in celiac disease. Option C) Henoch–Schönlein purpura is a systemic vasculitis that presents with palpable purpura, joint pain, abdominal pain, and kidney involvement. It is not typically associated with failure to thrive and the specific rash pattern described. Option D) Impetigo is a bacterial skin infection characterized by honey-colored crusts or blisters, which is unrelated to the autoimmune response seen in celiac disease. Educationally, understanding the association between dermatitis herpetiformis and celiac disease is crucial for pediatric nurses as early recognition and diagnosis can lead to appropriate management and improved outcomes for children with celiac disease. Recognizing the specific symptoms and laboratory findings can guide healthcare providers in providing targeted interventions and dietary modifications to alleviate symptoms and prevent complications associated with celiac disease.

Correct Answer: D

Rationale: In this scenario, the most likely diagnosis for the condition described in Question 3 is anaphylaxis (Option D). Anaphylaxis is a severe, life-threatening allergic reaction that can occur rapidly and requires immediate medical attention. The correct answer is D because anaphylaxis presents with sudden onset symptoms such as difficulty breathing, swelling of the face and throat, a rapid drop in blood pressure, and hives or rash. Prompt recognition and treatment with epinephrine are crucial in managing anaphylaxis. Option A, streptococcal toxic shock, is incorrect because it is a rare condition caused by toxins released by certain strains of streptococcus bacteria, leading to shock and multi-organ dysfunction. Option B, scarlet fever, is incorrect as it is a bacterial infection caused by group A Streptococcus, presenting with a characteristic rash, sore throat, and fever. Option C, infectious mononucleosis, is incorrect as it is a viral infection caused by the Epstein-Barr virus, presenting with symptoms like fever, sore throat, swollen lymph nodes, and fatigue. Educationally, understanding the distinguishing features of these conditions is crucial for pediatric nurses to provide accurate and timely care to pediatric patients. Recognizing the signs and symptoms of anaphylaxis is essential for nurses to intervene promptly and prevent serious complications. This question reinforces the importance of differentiating between various pediatric conditions based on their unique clinical presentations to ensure proper management and positive patient outcomes.

Correct Answer: C

Rationale: In pediatric nursing, understanding the role of mast cells and their released factors is crucial in managing various health conditions. In this case, the correct answer is C) Histamine. Histamine is a key inflammatory mediator released from mast cells in response to allergens or injury. It plays a significant role in allergic reactions, causing symptoms such as itching, swelling, and bronchoconstriction. Option A) Eosinophil major basic protein is released by eosinophils, not mast cells. Eosinophils play a role in allergic reactions and parasitic infections. Option B) Platelet-activating factor is a lipid mediator involved in inflammation, but it is not primarily released from mast cells. Option D) Bradykinin is a potent inflammatory mediator that is generated locally in response to tissue injury, not released from mast cells. Understanding the specific functions of these mediators helps nurses in assessing and managing pediatric patients with allergic conditions, asthma, and other inflammatory disorders. It is essential for nurses to be able to differentiate between these mediators to provide appropriate interventions and ensure positive patient outcomes.

Correct Answer: D

Rationale: In pediatric nursing, managing asthma requires a comprehensive approach tailored to the severity of the symptoms. The most appropriate treatment option in this scenario is D) Daily inhaled corticosteroid and a long-acting inhaled β₂-agonist. This combination therapy is indicated for children with persistent asthma symptoms that are worsening and of moderate severity. Inhaled corticosteroids help reduce airway inflammation, while long-acting β₂-agonists provide bronchodilation and symptom control over an extended period, addressing both underlying inflammation and bronchoconstriction. Option A) Oral theophylline is not the first-line treatment for persistent asthma in children due to its narrow therapeutic window, potential for toxicity, and need for frequent monitoring. Option B) Inhaled β₂-agonist as needed is suitable for mild intermittent asthma, not for persistent symptoms. Option C) Daily inhaled corticosteroid alone is appropriate for persistent symptoms but may not provide optimal control in moderate to severe cases. Educationally, understanding the rationale behind different asthma treatment options is crucial for pediatric nurses to provide safe and effective care to children with asthma. Tailoring treatment to the child's symptom severity and individual needs is key to achieving optimal asthma management outcomes.

Correct Answer: D

Rationale: Rationale: The correct answer is D) Foods. Allergic conjunctivitis is primarily caused by airborne allergens, and foods are not a common cause of this condition. Pollens, animal dander, and mold spores are known to trigger allergic reactions in susceptible individuals, leading to symptoms like red, itchy, and watery eyes. In an educational context, it's important for nursing students to understand the common triggers of allergic conjunctivitis to effectively assess and manage patients presenting with these symptoms. By recognizing the typical culprits, nurses can provide appropriate patient education on allergen avoidance strategies and pharmacological interventions to alleviate symptoms. Understanding the distinction between common allergens and less likely triggers like foods is crucial for accurate assessment and treatment planning in pediatric patients with allergic conjunctivitis.