A 5-year-old boy has systemic juvenile idiopathic arthritis (sJIA) with systemic manifestations including fever, hepatosplenomegaly, and pericarditis. Of the following, the BEST initial treatment for this boy is

Correct Answer: B

Rationale: In treating a 5-year-old boy with systemic juvenile idiopathic arthritis (sJIA) presenting with systemic manifestations like fever, hepatosplenomegaly, and pericarditis, the BEST initial treatment is systemic glucocorticoids (Option B). Systemic glucocorticoids are the preferred initial therapy in sJIA due to their potent anti-inflammatory effects. They help to rapidly control inflammation and alleviate symptoms, especially in cases of systemic involvement like pericarditis. NSAIDs (Option A) are commonly used in managing arthritis symptoms but may not be sufficient for systemic manifestations in sJIA. TNF-a inhibitors (Option C) and IL-1 antagonists (Option D) are typically reserved for cases refractory to glucocorticoids or with specific indications, not as initial therapy. Educationally, understanding the rationale behind choosing systemic glucocorticoids as the initial treatment in sJIA is crucial for pediatric healthcare providers. It underscores the importance of prompt and effective management of systemic inflammation in these patients to prevent long-term complications and improve outcomes. Familiarity with appropriate treatment strategies in pediatric rheumatologic conditions is essential for providing quality care to children with complex autoimmune diseases.

Correct Answer: D

Rationale: In juvenile dermatomyositis (JDM), the correct answer is D) facial erythema sparing the nasolabial folds. This is because JDM commonly presents with a characteristic facial rash that involves the cheeks but spares the nasolabial folds. This distinction is important for accurate diagnosis. Option A) heliotrope rash of the eyelids is a common cutaneous manifestation of JDM characterized by a purplish discoloration of the upper eyelids, seen in about 50% of cases. Option B) photosensitivity to ultraviolet light is a common feature in JDM, leading to skin rashes upon sun exposure. Option C) Gottron papules are also classic findings in JDM, presenting as raised, scaly, violaceous papules over the knuckles and finger joints. Educationally, understanding the characteristic cutaneous manifestations of JDM is crucial for pediatric nurses to recognize and differentiate this condition from other dermatological issues. This knowledge aids in early detection, appropriate management, and improved outcomes for pediatric patients with JDM. By explaining the rationale behind each answer choice, nurses can enhance their diagnostic skills and provide comprehensive care for children with complex dermatological conditions.

Correct Answer: A

Rationale: Rationale: The correct answer is A) kidney. Secondary amyloidosis is a serious complication of Familial Mediterranean Fever (FMF), a genetic autoinflammatory disorder. In FMF, recurrent episodes of inflammation can lead to the deposition of amyloid protein in various organs. The kidney is the most commonly affected organ in secondary amyloidosis associated with FMF. Amyloid deposits in the kidney can lead to renal impairment and ultimately renal failure if left untreated. Option B) lung is incorrect because while amyloidosis can affect the lungs in some cases, it is not the most common or serious manifestation of secondary amyloidosis in FMF. Option C) nerve is incorrect as amyloidosis affecting the nerves is not a typical feature of secondary amyloidosis in FMF. Option D) heart is incorrect as well. While amyloidosis can affect the heart in some cases, kidney involvement is more prevalent and severe in FMF-related secondary amyloidosis. Educationally, understanding the complications of FMF, such as secondary amyloidosis and its organ manifestations, is crucial for nurses caring for pediatric patients with this condition. Recognizing the signs and symptoms of kidney involvement can aid in early detection and intervention to prevent further renal damage. This knowledge is essential in providing holistic care and improving outcomes for pediatric patients with FMF.

Correct Answer: D

Rationale: The correct answer is D) Takayasu arteritis, as it predominantly affects large blood vessels. Takayasu arteritis is a rare autoimmune disease that causes inflammation of the aorta and its main branches. This condition typically affects young women of Asian descent. A) Henoch-Schonlein purpura primarily involves small blood vessels and is characterized by palpable purpura, joint pain, abdominal pain, and renal involvement in children. B) Polyarteritis nodosa affects medium-sized arteries and is associated with systemic symptoms such as weight loss, fever, fatigue, and muscle aches. C) Kawasaki disease mainly involves medium-sized arteries, particularly the coronary arteries, and presents with fever, rash, conjunctivitis, swollen lymph nodes, and changes in the extremities. In an educational context, understanding the specific vasculitis diseases and their target vessels is crucial for accurate diagnosis and treatment in pediatric nursing practice. Differentiating between the types of vasculitis based on the vessels affected helps healthcare providers tailor interventions and monitor for potential complications. This knowledge enhances the quality of care provided to children with these conditions.

Correct Answer: D

Rationale: In cases of retinal hemorrhage caused by abusive head trauma (AHT), it is crucial for healthcare providers, especially pediatric nurses, to be able to recognize the characteristic features to aid in early detection and intervention. The correct answer, option D, "traumatic retinoschisis," is not a characteristic of AHT-related retinal hemorrhages. Traumatic retinoschisis refers to a splitting of the retinal layers and is not typically seen in cases of AHT. Option A, "multiple," is a common characteristic of AHT-related retinal hemorrhages. These hemorrhages often present in multiple locations within the retina. Option B, "involving more than one layer of the retina," is also typical in AHT cases, as the forceful impact on the head can lead to hemorrhages that affect multiple layers of the retina. Option C, "central," is another common feature of AHT-related retinal hemorrhages. These hemorrhages often occur in the central part of the retina due to the distribution of force during abusive head trauma. For pediatric nurses, understanding these characteristic features of AHT-related retinal hemorrhages is essential for early identification, reporting, and intervention in cases of suspected child abuse. Recognizing these signs can lead to prompt intervention and protection of the child from further harm. It is crucial for nurses to be knowledgeable about the specific manifestations of abuse-related injuries to advocate for the well-being of their pediatric patients.