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 option D: begin resuscitation with rescue breaths and chest compressions. In this scenario, the patient is in cardiac arrest with fixed dilated pupils, deep coma, apnea, and pulselessness due to hypothermia from near-drowning in icy water. The priority is to initiate basic life support measures immediately. Option A is incorrect because it is essential to attempt resuscitation in cases of cardiac arrest, as death is not pronounced until efforts to resuscitate have been unsuccessful. Option B is incorrect because waiting for the core temperature to reach above 32°C before initiating CPR can lead to further irreversible damage. Option C is also incorrect as epinephrine, atropine, and defibrillation are not the initial interventions in pediatric hypothermic cardiac arrest. Educationally, it is crucial to understand the unique considerations in pediatric resuscitation, especially in cases of hypothermia. Prompt recognition and initiation of basic life support measures can significantly impact the chances of survival and minimize neurological sequelae in pediatric patients. It is essential for healthcare providers to be well-versed in the appropriate algorithms and interventions for pediatric resuscitation to optimize outcomes.

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 behaviors during adolescence. The boy is at higher risk of engaging in serious violence if he is surrounded by friends who exhibit antisocial behaviors, as he may be more likely to mimic their actions or be pressured into risky behaviors. Substance abuse (Option B) is a significant risk factor for various negative outcomes in adolescents, including violence, but in this case, the influence of delinquent friends is considered the most important factor. Male gender (Option A) is a demographic factor that may contribute to a higher overall risk of violence in adolescence, but it is not as influential as the immediate social environment of having delinquent friends. Low IQ (Option D) may impact decision-making and problem-solving abilities, but in the context of serious youth violence, the influence of peer relationships on behavior is considered a more critical factor. Educationally, this question highlights the importance of understanding the social determinants of behavior in adolescents. It emphasizes the significant impact that peer relationships can have on shaping behaviors and the need for interventions that address both individual risk factors and social influences in preventing youth violence.

Correct Answer: C

Rationale: The correct answer is C) Wear and tear of cartilage. Osteoarthritis is primarily caused by the breakdown of cartilage in the joints over time due to wear and tear. Cartilage serves as a cushion between the bones in a joint, and when it deteriorates, it leads to pain, swelling, and difficulty in movement typical of osteoarthritis. Option A) Autoimmune reaction is incorrect because osteoarthritis is not an autoimmune disease. It is a degenerative joint disease. Option B) Infection is incorrect as infections typically cause a different type of arthritis called infectious arthritis, which is caused by bacteria, viruses, or fungi invading the joint. Option D) Genetic predisposition is incorrect because while genetics can play a role in increasing the risk of developing osteoarthritis, it is not the primary cause. Environmental factors and lifestyle choices also contribute significantly to its development. In an educational context, understanding the primary cause of osteoarthritis is crucial for healthcare professionals, especially in pediatric nursing, as they work with children who may have conditions affecting their joints. Knowing the etiology of osteoarthritis helps in providing appropriate care, education, and support to patients and their families to manage the condition effectively.

Correct Answer: A

Rationale: In pediatric nursing, it is crucial to understand the appropriate treatment options for conditions like juvenile idiopathic arthritis (JIA). The first-line treatment for JIA is nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. NSAIDs are preferred initially due to their effectiveness in managing pain and inflammation in JIA without the systemic side effects associated with other medications. They are also well-tolerated by children in general. Biologics, corticosteroids, and disease-modifying antirheumatic drugs (DMARDs) are not typically used as first-line treatments for JIA. Biologics and DMARDs are usually reserved for cases where NSAIDs are ineffective or if there is a need for more aggressive therapy. Corticosteroids may be used for short-term management of severe symptoms but are not preferred due to their potential long-term side effects in children. Educationally, understanding the rationale behind selecting NSAIDs as the first-line treatment for JIA not only reinforces knowledge of appropriate pharmacological interventions but also highlights the importance of considering factors such as efficacy, safety, and patient age when making treatment decisions in pediatric patients with chronic conditions.

Correct Answer: D

Rationale: In managing systemic lupus erythematosus (SLE), a multisystem autoimmune disease, the first-line treatment often includes hydroxychloroquine (Option D). Hydroxychloroquine is considered a cornerstone therapy for SLE as it helps in controlling disease activity, reducing flares, and protecting against organ damage. It is beneficial in managing skin and joint symptoms commonly seen in SLE patients. Additionally, hydroxychloroquine has been shown to improve overall outcomes and reduce mortality in SLE. Corticosteroids (Option A) are commonly used in the treatment of SLE to quickly suppress inflammation during disease flares. However, they are typically used in conjunction with other medications for long-term management due to their potential for significant side effects when used alone or for extended periods. Mycophenolate mofetil (Option B) and azathioprine (Option C) are immunosuppressive medications that are often used in SLE when patients do not respond adequately to first-line therapies or in cases of severe organ involvement. They are considered second-line treatments due to their stronger immunosuppressive effects and potential for more serious side effects compared to hydroxychloroquine. In an educational context, understanding the rationale behind treatment choices in SLE is crucial for nurses working with pediatric patients with this condition. By knowing the appropriate first-line therapy like hydroxychloroquine, nurses can contribute to effective disease management, symptom control, and improved quality of life for pediatric patients with SLE. It is important for nurses to stay updated on current treatment guidelines and be able to explain the rationale behind different treatment options to patients and their families.