A 5-year-old underwent a tonsillectomy and an adenoidectomy under general anesthesia. The parents tell you that the anesthesiologist said that she “fought the mask and cried a lot” on induction. You are the pediatrician for this child, and 8 days after surgery, the parents call to report that the child, who previously slept well at night, now awakens nightly screaming with bad dreams. She is more irritable and cranky than before surgery and has angry outbursts. She is more “clingy” and wants her parents to cuddle her frequently. She reports that in her dreams, she can’t move, there is a tube in her throat, and she feels the surgeon cutting her throat. A review of her anesthetic record suggests an uneventful intraoperative course, with stable vital signs. All of the following statements about this situation are true EXCEPT

Correct Answer: A

Rationale: The correct answer is A) this is an extreme reaction and suggests a severe underlying tendency toward psychiatric illness. This statement is incorrect because the child's postoperative behavioral changes are likely due to the traumatic induction of anesthesia and not indicative of a severe underlying psychiatric illness. Option B is true as traumatic induction of anesthesia can commonly produce behavioral changes that usually resolve within 4-6 weeks. Option C is also true as parental presence during mask induction can help reduce distress for some children. Option D is true as intraoperative awareness can lead to the content of disturbing dreams and behavioral changes. In an educational context, it is important for healthcare providers to recognize and address the potential psychological impact of medical procedures on children. Understanding the effects of anesthesia induction and postoperative behavioral changes can help healthcare professionals provide appropriate support and interventions for pediatric patients and their families.

Correct Answer: D

Rationale: The correct answer is D) cocaine. Cocaine is a potent vasoconstrictor that can lead to vasoconstriction of placental blood vessels, reducing blood flow to the fetus and increasing the risk of placental abruption. This can result in fetal hypoxia and subsequent intracranial hemorrhage in the neonate. Alcohol (option A) can lead to fetal alcohol syndrome and other developmental issues but is not typically associated with intracranial hemorrhage. Codeine (option B) is a less likely cause of intracranial hemorrhage compared to cocaine. Cigarette smoking (option C) can lead to low birth weight and other complications, but it is not typically associated with intracranial hemorrhage. Educationally, this question highlights the importance of understanding the effects of maternal substance use during pregnancy on the developing fetus. It underscores the need for healthcare providers to educate pregnant women about the dangers of using drugs like cocaine during pregnancy and the potential serious consequences it can have on the baby's health.

Correct Answer: B

Rationale: In this question from the Pediatric NCLEX Practice Quiz, the correct answer is option B) Vasculitis, which is characterized by inflammation of the blood vessels. Vasculitis is the correct answer because it specifically refers to the inflammation of blood vessels, which is a key characteristic of this condition. In vasculitis, the body's immune system mistakenly attacks blood vessels, leading to inflammation and potential damage to the vessels. Option A) Lupus is an autoimmune disease that can cause inflammation throughout the body, including blood vessels. However, it is a broader term compared to vasculitis, which specifically focuses on blood vessel inflammation. Option C) Scleroderma is a connective tissue disorder that involves thickening and hardening of the skin and other tissues. While it can affect blood vessels, it is not primarily characterized by inflammation of blood vessels. Option D) Fibromyalgia is a chronic pain condition that does not involve inflammation of blood vessels. It is characterized by widespread musculoskeletal pain and other symptoms such as fatigue and sleep disturbances. In an educational context, understanding the differences between these conditions is crucial for healthcare professionals, especially those working with pediatric patients. Recognizing the specific characteristics of each condition helps in accurate diagnosis, treatment planning, and patient care. Identifying vasculitis correctly in a pediatric patient is important for timely intervention to prevent potential complications associated with inflammation of blood vessels.

Correct Answer: D

Rationale: In diagnosing systemic lupus erythematosus (SLE), it is essential to understand the criteria involved. The correct answer, D) High cholesterol, is not a criterion for diagnosing SLE. The presence of a positive ANA test, renal disorder, and joint involvement are all important criteria for diagnosing SLE. A positive ANA test is a common finding in SLE due to the presence of autoantibodies. Renal disorder, such as lupus nephritis, is a serious complication of SLE affecting the kidneys. Joint involvement, often presenting as arthritis, is a common symptom in SLE due to inflammation in the joints. Understanding these criteria is crucial for healthcare professionals, especially nurses, working with pediatric patients. Recognizing the key features of SLE helps in early detection, appropriate management, and improved outcomes for pediatric patients with this complex autoimmune condition. Nurses play a vital role in assessment, monitoring, and educating patients and families about SLE, making it essential for them to have a solid understanding of the diagnostic criteria and clinical manifestations associated with the disease.

Correct Answer: D

Rationale: In the management of rheumatic diseases in pediatric patients, physical therapy plays a crucial role in improving their overall quality of life. The correct answer is D) All of the above because physical therapy addresses various aspects of the condition. A) Improve joint mobility: Physical therapy helps in maintaining and improving joint mobility by incorporating exercises, stretches, and manual techniques tailored to the individual needs of the child. This is essential in preventing joint stiffness and deformities associated with rheumatic diseases. B) Reduce pain: Physical therapy interventions such as modalities, therapeutic exercises, and manual therapy techniques can help reduce pain and discomfort experienced by pediatric patients with rheumatic diseases. By improving their functional abilities and movement patterns, physical therapy contributes to pain management. C) Enhance muscle strength: Children with rheumatic diseases may experience muscle weakness due to inactivity, pain, or disease progression. Physical therapy programs are designed to target specific muscle groups to improve strength, endurance, and overall functional capacity, enabling children to perform daily activities more effectively. Educational context: Understanding the role of physical therapy in managing rheumatic diseases is essential for healthcare professionals working with pediatric patients. By integrating physical therapy into the multidisciplinary approach to care, children with rheumatic diseases can experience improved physical function, reduced pain, and enhanced quality of life. This comprehensive approach highlights the importance of addressing mobility, pain, and muscle strength to optimize outcomes for pediatric patients with rheumatic diseases.