A 4-year-old girl recently diagnosed with persistent oligoarticular juvenile idiopathic arthritis (JIA); she has 3 involved joints including left elbow; right knee, right ankle. Antinuclear antigen (ANA) is significantly positive. The MOST important regular examination of locomotor system step in the management this girl is

Correct Answer: A

Rationale: The correct answer is A) periodic slit-lamp examination. In a child with juvenile idiopathic arthritis (JIA), especially with a positive ANA, it is crucial to monitor for the development of uveitis, a common complication. Uveitis can be asymptomatic initially but can lead to serious ocular complications if not detected early. Periodic slit-lamp examinations are recommended to screen for uveitis in children with JIA, particularly those with positive ANA. Option B) periodic erythrocyte sedimentation rate (ESR) monitoring and option C) periodic C-reactive protein (CRP) monitoring are general inflammatory markers used in JIA management but do not specifically address the risk of uveitis in this case. Option D) ANA measurement has already been done and found to be significantly positive, indicating an increased risk for uveitis. However, monitoring ANA levels alone does not provide direct information about the ocular complications associated with JIA. In an educational context, understanding the importance of specific monitoring and examinations tailored to the individual needs of pediatric patients with JIA is crucial for early detection and management of potential complications, such as uveitis, to optimize their outcomes and quality of life.

Correct Answer: A

Rationale: In this question, the correct answer is A) isoniazid. Isoniazid is a medication commonly used to treat tuberculosis, but it is also known to be associated with drug-induced lupus erythematosus (DILE). Drug-induced lupus is a rare condition where certain medications can trigger lupus-like symptoms in susceptible individuals. Isoniazid is particularly known to cause DILE due to its association with anti-histone antibodies, a hallmark of drug-induced lupus. Symptoms of DILE typically resolve once the medication is stopped. Now, let's discuss why the other options are incorrect: B) Rifampin is a medication used to treat tuberculosis as well, but it is not commonly associated with drug-induced lupus. C) Nitrofurantoin is an antibiotic used to treat urinary tract infections, and while it can cause drug-induced autoimmune reactions, it is not typically associated with lupus. D) Penicillin is a commonly used antibiotic that is not known to be associated with drug-induced lupus. Educational Context: Understanding the side effects and adverse reactions of medications is crucial for healthcare professionals, especially in pediatrics where dosages and drug interactions need to be carefully monitored. Recognizing drug-induced lupus as a potential adverse effect of certain medications, like isoniazid, helps nurses and pediatric caregivers provide safe and effective care to their patients. By knowing the characteristics of DILE-inducing drugs, healthcare providers can promptly identify and manage such reactions, ensuring the best outcomes for pediatric patients.

Correct Answer: A

Rationale: In this question, the correct answer is A) independent occurrence of periungual tissue necrosis. This feature is most likely consistent with rheumatic disease (RD) rather than Raynaud phenomenon (RP) because periungual tissue necrosis is a more specific symptom associated with certain rheumatic diseases like systemic sclerosis, rather than RP alone. Option B) asymmetric involvement is a common feature of RP and does not specifically point towards RD. Option C) associated telangiectasia is more commonly associated with RP rather than RD. Option D) paresthesia and gangrene are symptoms that can occur in severe cases of RP but are not specific to RD. Educationally, this question highlights the importance of recognizing specific clinical features to differentiate between RP and RD in pediatric patients. Understanding these distinctions is crucial for accurate diagnosis and appropriate treatment interventions in pediatric nursing practice.

Correct Answer: D

Rationale: In the acute stage of Kawasaki disease (KD), cardiac complications are common due to the systemic inflammatory response affecting the blood vessels, including the coronary arteries. Myocarditis, pericarditis, and coronary artery aneurysm are all potential complications seen in KD due to the inflammation and damage to the heart and blood vessels. The correct answer, D) mitral regurgitation, is not typically associated with the acute phase of KD. Mitral regurgitation is a condition where the heart's mitral valve does not close tightly, causing blood to flow backward in the heart. Although it can occur in the long-term complications of KD, it is not a typical cardiac manifestation in the acute phase. Educationally, understanding the cardiac complications of KD is crucial for nurses caring for pediatric patients. Recognizing these potential complications early can help in prompt intervention and prevent long-term cardiac sequelae. By knowing the specific cardiac issues that can arise in KD, nurses can advocate for appropriate diagnostic tests and treatments to optimize patient outcomes.

Correct Answer: D

Rationale: In the context of pediatric nursing, understanding the psychosocial impact of war on children is crucial for providing holistic care. In this question, the correct answer is D) acute stress reaction. This is because acute stress reactions are a common and expected response to traumatic events such as war in children. It is a normal reaction to an abnormal situation and can manifest in various ways including anxiety, fear, and behavioral changes. Option A) loss of family members is a psychosocial impact of war on children as it can lead to grief, trauma, and a sense of abandonment. Option B) separation from community is also a valid psychosocial impact as it can result in feelings of isolation and loss of support systems. Option C) lack of education is another significant impact as war often disrupts schools and educational opportunities for children, impacting their future prospects and well-being. In an educational context, it is important for pediatric nurses to be aware of the various psychosocial impacts of war on children to provide effective care and support. By recognizing these effects, nurses can implement appropriate interventions to address the unique needs of children who have experienced war-related trauma. This knowledge helps in promoting resilience, facilitating healing, and promoting overall well-being in pediatric patients affected by war.