A previously healthy 7-month-old white male presents one summer day with a temperature of 41.1°C, a pulse of 190, a respiratory rate of 70, and a blood pressure of 65/20. He has a 1-day history of diarrhea (five stools in 24 hours) and is now unresponsive to verbal commands or painful stimuli. The most appropriate initial therapy is

Correct Answer: C

Rationale: In this scenario, the most appropriate initial therapy for the 7-month-old patient with a high fever, tachycardia, tachypnea, hypotension, altered mental status, and a history of diarrhea is option C: normal saline (20-40 mL/kg). This choice is correct because the patient is presenting with signs of severe dehydration and shock, which require immediate fluid resuscitation to restore intravascular volume and improve perfusion to vital organs. Option A, cooling blankets, may help reduce fever, but the priority in this case is to address the underlying dehydration and shock. Option B, aspirin, is contraindicated in children with viral illnesses due to the risk of Reye syndrome. Option D, dantrolene, is used to treat malignant hyperthermia, which is not the primary concern in this case. From an educational standpoint, it is crucial for pediatric clinical nurse specialists to recognize the signs of dehydration and shock in pediatric patients and understand the appropriate interventions to stabilize the patient's condition. Prompt recognition and treatment of dehydration and shock can prevent further deterioration and improve patient outcomes. It is essential to prioritize interventions based on the patient's clinical presentation and immediate needs to provide safe and effective care.

Correct Answer: A

Rationale: The correct answer is A) adolescents. Adolescents are the subset of children who are more likely to exhibit severe violence behavior that can persist into adulthood. During adolescence, individuals undergo significant physical, emotional, and social changes, making them more susceptible to engaging in risky behaviors, including violence. This period is crucial for identity formation and peer influence, which can contribute to violent behavior. Option B) school-aged children are typically between 6 to 12 years old and may exhibit violent behavior, but it is often less severe compared to adolescents. Option C) children of all ages with intermittent violence may display sporadic violent behavior, but it does not necessarily indicate a pattern of escalating violence seen in adolescents. Option D) preschoolers are at an early stage of development and are less likely to exhibit severe violence that continues into adulthood. In an educational context, understanding the developmental stages and risk factors associated with youth violence is crucial for pediatric clinical nurse specialists. By recognizing that adolescents are a high-risk group for persistent violent behavior, healthcare providers can implement targeted interventions, early prevention strategies, and support services to address and mitigate the long-term consequences of youth violence.

Correct Answer: D

Rationale: In the context of systemic lupus erythematosus (SLE), it is crucial for Pediatric Clinical Nurse Specialists to understand the key clinical features associated with this autoimmune condition. The correct answer, D) Hyperglycemia, is not a common feature of SLE. While individuals with SLE may experience a wide range of symptoms, hyperglycemia is not typically associated with this condition. A) Malar rash is a common feature of SLE, characterized by a butterfly-shaped rash across the cheeks and bridge of the nose. B) Arthritis is another common manifestation of SLE, with joint pain and inflammation being prevalent. C) Kidney involvement, known as lupus nephritis, is a serious complication of SLE, affecting the kidneys and potentially leading to renal failure if not managed appropriately. In an educational context, understanding the distinguishing features of SLE is essential for accurate assessment, diagnosis, and management of pediatric patients with this condition. By recognizing the key clinical manifestations of SLE, Pediatric Clinical Nurse Specialists can provide comprehensive care, monitor for complications, and collaborate effectively with the healthcare team to optimize patient outcomes.

Correct Answer: D

Rationale: In the context of the Pediatric Clinical Nurse Specialist Exam, understanding the implications of long-term corticosteroid use is crucial. The correct answer is D) All of the above. Long-term corticosteroid use can lead to a myriad of complications, including osteoporosis, hypertension, and diabetes mellitus. Osteoporosis is a well-known side effect of corticosteroid use due to its impact on bone density. Hypertension can occur as corticosteroids can cause sodium retention and increased blood volume. Diabetes mellitus is another common complication as corticosteroids can disrupt glucose metabolism. It is important for pediatric nurses to be aware of these potential complications to monitor and manage patients effectively. Educating patients and families about the risks associated with long-term corticosteroid use is essential in promoting adherence to treatment plans and mitigating these adverse effects. Understanding these complications and their management is vital for pediatric nurses to provide comprehensive care to pediatric patients requiring corticosteroid therapy. This knowledge ensures safe medication administration, close monitoring for side effects, and effective patient education regarding the importance of adherence and monitoring for signs of complications.

Correct Answer: D

Rationale: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that primarily affects the joints. As the disease progresses, if left untreated, it can lead to various complications. Among these, joint deformity is a common consequence of untreated RA. The inflammatory process in RA can damage the cartilage and bone in the joints, leading to deformities and loss of function. In addition to joint deformity, untreated RA can also increase the risk of developing cardiovascular disease. The systemic inflammation associated with RA can affect the cardiovascular system, leading to conditions such as atherosclerosis and an increased risk of heart attacks and strokes. Vision loss is not a common complication of untreated RA. While RA can affect the eyes in some cases, leading to conditions like dry eyes or inflammation of the eye, significant vision loss is not a typical outcome of the disease. Choosing option D, "All of the above," as the correct answer is appropriate because both joint deformity and cardiovascular disease are well-established complications of untreated RA. This comprehensive understanding is crucial for healthcare providers, especially pediatric clinical nurse specialists, who may encounter pediatric patients with juvenile idiopathic arthritis, a form of arthritis that can affect children and adolescents. Recognizing these potential complications is essential for early intervention and management to prevent long-term disability and improve the quality of life for pediatric patients with RA.