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 the case of a 4-year-old girl diagnosed with persistent oligoarticular juvenile idiopathic arthritis (JIA) with positive antinuclear antigen (ANA), the most important regular examination of the locomotor system is a slit-lamp examination. This is because children with JIA, especially those with positive ANA, are at increased risk for developing uveitis, an inflammatory eye condition that can lead to vision loss if not detected and treated early. Regular slit-lamp examinations are essential for early detection of uveitis in JIA patients. Option B) periodic erythrocyte sedimentation rate (ESR) monitoring and option C) periodic C-reactive protein (CRP) monitoring are not as crucial in this case as they are general markers of inflammation and do not specifically address the risk of uveitis in JIA patients with positive ANA. ANA measurement (option D) has already been done and is not the most important ongoing examination for monitoring the girl's condition. In an educational context, it is vital for pediatric nurses to understand the specific monitoring and management protocols for children with JIA to provide comprehensive care. Regular and appropriate assessments, such as slit-lamp examinations, can help prevent complications and improve the quality of life for pediatric patients with chronic conditions like JIA.

Correct Answer: A

Rationale: The correct answer is A) isoniazid. Isoniazid is a medication commonly used to treat tuberculosis. Drug-induced lupus is a rare side effect associated with certain medications, including isoniazid. It is believed to result from the body's immune response to the drug, leading to symptoms similar to systemic lupus erythematosus. Rifampin (option B) is not typically associated with drug-induced lupus. It is a medication also used to treat tuberculosis but does not commonly cause lupus-like symptoms. Nitrofurantoin (option C) is an antibiotic used to treat urinary tract infections. While it can cause side effects like pulmonary reactions, it is not a known cause of drug-induced lupus. Penicillin (option D) is an antibiotic commonly used to treat various infections. Penicillin is not known to be associated with drug-induced lupus. Educationally, understanding the potential side effects and adverse reactions of medications is crucial for healthcare professionals, especially in pediatric nursing. Recognizing drug-induced lupus as a potential complication of isoniazid can aid in early identification and management of this condition in pediatric patients, ensuring safe and effective care.

Correct Answer: A

Rationale: In the context of pediatric nursing and rheumatic diseases, understanding the distinguishing features of Raynaud phenomenon (RP) and rheumatic disease (RD) is crucial for accurate assessment and diagnosis. The correct answer, option A) independent occurrence of periungual tissue necrosis, is most likely consistent with RD rather than RP. This is because periungual tissue necrosis is a more specific and characteristic feature of certain rheumatic diseases, such as systemic sclerosis, rather than RP. Option B) asymmetric involvement is a common feature of RP, where affected extremities may exhibit uneven symptoms, making it less indicative of RD. Option C) associated telangiectasia is also more commonly associated with RP rather than RD, as it refers to the dilatation of small blood vessels near the surface of the skin, a hallmark of RP. Option D) paresthesia and gangrene are more severe manifestations that can occur in either RP or RD but are not as specific to RD as periungual tissue necrosis. Educationally, understanding these nuances is important for nurses caring for pediatric patients with rheumatic diseases. By recognizing the distinguishing features of RP and RD, nurses can provide more targeted assessments, interventions, and patient education. This knowledge can also aid in timely referrals to specialists for further evaluation and management of these conditions.

Correct Answer: D

Rationale: In the acute stage of Kawasaki disease (KD), the correct answer, D) mitral regurgitation, is not a common cardiac complication. Myocarditis, pericarditis, and coronary artery aneurysm are all possible complications seen in KD due to the systemic inflammatory response affecting the heart and blood vessels. Myocarditis involves inflammation of the heart muscle, pericarditis is inflammation of the pericardium (the sac around the heart), and coronary artery aneurysm is a serious complication where the coronary arteries become weakened and form aneurysms. These complications can lead to serious cardiac issues and even result in long-term heart problems if not managed promptly. Educationally, understanding the cardiac complications of KD is crucial for pediatric nurses as early recognition and intervention can help prevent serious outcomes. Knowing the specific complications associated with KD aids in timely assessment, monitoring, and treatment, ultimately improving patient outcomes. Nurses need to be able to differentiate between potential complications to provide effective care and support for children with KD.

Correct Answer: D

Rationale: In the context of pediatric nursing, understanding the psychosocial impact of war on children is crucial for providing comprehensive care. The correct answer, option D, "acute stress reaction," is not a factor that shows the psychosocial impact of war on children. Acute stress reactions are immediate responses to a traumatic event and do not necessarily encompass the long-term effects of war on children's mental health. Option A, "loss of family members," is a significant psychosocial impact of war on children as it can lead to feelings of grief, abandonment, and emotional distress. Children rely heavily on their families for support and stability, so losing family members can have profound effects on their well-being. Option B, "separation from community," is another important factor as war often displaces families, forcing children to leave their familiar environments, friends, and support systems. This can result in feelings of isolation, loneliness, and a lack of belonging. Option C, "lack of education," is also a relevant factor as war disrupts educational systems, leading to limited access to schooling, resources, and opportunities for children. This can impact their cognitive development, social interactions, and future prospects. Educationally, it is essential for pediatric nurses to be aware of these psychosocial impacts to provide holistic care for children affected by war. By understanding these factors, nurses can implement appropriate interventions, offer support services, and advocate for policies that promote the well-being of these vulnerable populations.