A 5-year-old patient with near drowning in icy water presents with fixed dilated pupils and deep coma. He is apneic and pulseless with a temperature of 25°C. The most appropriate approach to his care is

Correct Answer: D

Rationale: The correct answer is D) begin resuscitation with rescue breaths and chest compressions. In this scenario, the patient's presentation of fixed dilated pupils, deep coma, apnea, and pulselessness indicates a need for immediate resuscitation efforts. Starting with rescue breaths and chest compressions is crucial to provide oxygenation and circulation to the vital organs. The priority is to initiate basic life support measures to increase the chances of successful resuscitation. Option A is incorrect because it goes against the principles of pediatric resuscitation, which emphasize the importance of immediate intervention in cases of cardiac arrest. Option B is incorrect as waiting for the core temperature to reach 32°C before starting CPR can lead to further deterioration and decrease the chances of survival. Option C is incorrect as administering medications and defibrillation should not precede basic life support measures in this critical situation. In an educational context, it is essential for healthcare providers, especially those working with pediatric patients, to be well-versed in pediatric resuscitation protocols. Understanding the sequence of actions in a pediatric emergency, such as the ABCs (Airway, Breathing, Circulation), can help save lives. Regular training and practice in pediatric resuscitation scenarios are crucial to ensure healthcare providers can respond effectively and confidently in high-stress situations.

Correct Answer: C

Rationale: In this scenario, the MOST important risk factor for the development of serious youth violence in the 14-year-old boy is having antisocial delinquent friends (Option C). This is because peer influence plays a significant role in shaping behavior during adolescence. Being surrounded by peers who engage in delinquent behavior increases the likelihood of the individual also engaging in such behaviors, including serious violence. Option A (male gender) is not the most important risk factor in this case because while statistics show males are more frequently involved in violent behaviors, the question specifically asks for the MOST important risk factor for this individual. Option B (substance abuse) is a risk factor for violence, but in this case, the influence of antisocial delinquent friends is considered more significant. Option D (low IQ) is not the most important risk factor for serious youth violence in this context as intelligence level alone does not directly correlate with violent behavior. Educationally, understanding the influence of peer relationships on behavior is crucial in pediatric nursing. By recognizing the impact of social factors like peer groups on adolescent behavior, healthcare providers can better assess and intervene in situations involving youth violence. It highlights the importance of comprehensive assessments and interventions that consider the social determinants of health in pediatric care.

Correct Answer: C

Rationale: Rationale: The correct answer is C) Wear and tear of cartilage. Osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage in the joints. This breakdown is primarily due to the continuous wear and tear on the joints over time, leading to inflammation, pain, and reduced mobility. Option A) Autoimmune reaction is incorrect because osteoarthritis is not an autoimmune disease. It is a result of mechanical stress on the joints rather than the body's immune system attacking its own tissues. Option B) Infection is also incorrect as osteoarthritis is not caused by an infectious agent. Infections in joints typically lead to a different condition known as septic arthritis. Option D) Genetic predisposition is a contributing factor to osteoarthritis, but it is not the primary cause. While genetics can play a role in predisposing individuals to developing the condition, the main mechanism of osteoarthritis development is the mechanical stress on the joints. Educational Context: Understanding the primary cause of osteoarthritis is crucial for healthcare providers, especially pediatric nurses, as they may encounter children or adolescents with juvenile osteoarthritis. By recognizing that wear and tear of cartilage is the main factor in osteoarthritis development, nurses can educate patients and families on preventive measures such as maintaining a healthy weight, exercising regularly, and protecting joints from excessive strain. This knowledge empowers nurses to provide comprehensive care and support to pediatric patients with or at risk of developing osteoarthritis.

Correct Answer: A

Rationale: In pediatric nursing, the first-line treatment for juvenile idiopathic arthritis is typically NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) like ibuprofen or naproxen. NSAIDs are preferred due to their effectiveness in reducing pain and inflammation in children with arthritis. They are considered safer than other options for initial treatment in this population. Biologics (Option B) are often used if NSAIDs are ineffective or if the disease is more severe. These medications target specific components of the immune system involved in the inflammatory process. However, they are usually reserved for cases that do not respond to NSAIDs. Corticosteroids (Option C) may be used in some cases to quickly reduce inflammation and pain, but their long-term use in children is associated with significant side effects. Therefore, they are not typically recommended as the first-line treatment. DMARDs (Disease-Modifying Anti-Rheumatic Drugs) (Option D) are more commonly used in adults with arthritis, and their use in children is limited due to safety concerns and the availability of other effective options. Educationally, understanding the rationale behind the choice of NSAIDs as the first-line treatment for juvenile idiopathic arthritis is crucial for pediatric nurses. It ensures safe and effective management of this chronic condition in children. Nurses must be aware of the indications, contraindications, and potential side effects of different treatment options to provide comprehensive care to pediatric patients with arthritis.

Correct Answer: D

Rationale: In the management of systemic lupus erythematosus (SLE), hydroxychloroquine is considered a first-line treatment due to its efficacy and relatively low risk profile. Hydroxychloroquine is a disease-modifying anti-rheumatic drug (DMARD) that helps control disease activity by reducing inflammation, preventing flares, and protecting against organ damage. Corticosteroids (Option A) are often used to manage acute flares and severe symptoms in SLE but are not typically considered a first-line treatment due to their long-term side effects and the goal of minimizing their use. Mycophenolate mofetil (Option B) and azathioprine (Option C) are immunosuppressants that may be used in SLE cases that are refractory to first-line treatments or in severe organ involvement cases. They are not usually the initial choices due to their potential side effects and the desire to start with less aggressive therapies if possible. Educationally, understanding the rationale behind the choice of hydroxychloroquine as a first-line treatment in SLE is crucial for nurses specializing in pediatric care. It emphasizes the importance of early intervention with appropriate medications to control disease activity and prevent long-term complications in pediatric patients with SLE. Nurses need to be aware of the different treatment options available, their mechanisms of action, and potential side effects to provide comprehensive care to pediatric patients with SLE.