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 with a high fever, tachycardia, tachypnea, hypotension, and altered mental status due to dehydration is option C: normal saline (20-40 mL/kg). Normal saline is crucial to rapidly address the hypovolemia and shock that can result from severe dehydration. Replenishing fluids will help restore perfusion to vital organs and improve the patient's condition. Option A, cooling blankets, is not the priority in this case as the primary concern is addressing the dehydration and shock. Option B, aspirin, is contraindicated in children due to the risk of Reye syndrome. Option D, dantrolene, is used to treat malignant hyperthermia, not dehydration-induced shock. Educationally, this question highlights the importance of recognizing and promptly treating pediatric patients with dehydration and shock. It emphasizes the critical role of fluid resuscitation in stabilizing a child in a state of hypovolemic shock, which can be life-saving in such emergencies. Understanding the appropriate interventions for pediatric dehydration is crucial for pediatric clinical nurse specialists to provide safe and effective care to children in critical conditions.

Correct Answer: A

Rationale: The correct answer is A) adolescents. Adolescents are more likely to exhibit more severe violence behavior that can persist into adulthood due to various factors such as hormonal changes, peer influences, and cognitive development. During adolescence, individuals undergo significant emotional and psychological changes, leading to increased risk-taking behaviors, impulsivity, and susceptibility to peer pressure, all of which can contribute to violent behaviors. Option B) school-aged children typically exhibit less severe violence behavior compared to adolescents as they are still developing their social and emotional skills and are more likely to respond to interventions and support. Option C) children of all ages with intermittent violence may display sporadic violent behavior, but it is less likely to be as severe or persistent as in adolescents. Option D) preschoolers are less likely to engage in severe violence behavior that continues into adulthood due to their early stage of development, limited exposure to external influences, and ongoing development of social skills. In an educational context, understanding the developmental stages and risk factors associated with youth violence is crucial for pediatric clinical nurse specialists to identify at-risk individuals, implement appropriate interventions, and collaborate with multidisciplinary teams to address and prevent violence in children and adolescents. By recognizing the subset of children more prone to severe violence behaviors, healthcare professionals can tailor their approaches to provide targeted support and resources for those most in need.

Correct Answer: D

Rationale: The correct answer is D) Hyperglycemia. Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects multiple organ systems. Hyperglycemia, which refers to high levels of glucose in the blood, is not a common feature of SLE. A) Malar rash is a common feature of SLE, characterized by a butterfly-shaped rash on the face, typically over the cheeks and bridge of the nose. B) Arthritis is another common feature of SLE, presenting as joint pain, stiffness, and swelling. C) Kidney involvement is also frequently seen in SLE, with manifestations such as lupus nephritis leading to kidney damage. Educationally, understanding the clinical manifestations of SLE is crucial for healthcare providers, especially pediatric clinical nurse specialists who care for children with this condition. By differentiating between common and less common features of SLE, nurses can contribute to early detection, effective management, and improved outcomes for pediatric patients with this complex autoimmune disease.

Correct Answer: D

Rationale: Corticosteroids are commonly prescribed for various pediatric conditions, and long-term use can lead to several complications. The correct answer, option D, "All of the above," is the most appropriate choice as osteoporosis, hypertension, and diabetes mellitus are all common complications associated with long-term corticosteroid use. Osteoporosis is a well-known complication of corticosteroid use due to its negative effects on bone density and mineralization, especially in children whose bones are still developing. This can increase the risk of fractures and musculoskeletal issues. Hypertension can occur as a result of corticosteroids causing sodium retention and fluid imbalance, leading to increased blood pressure. Monitoring blood pressure regularly in pediatric patients on long-term corticosteroids is crucial to detect and manage hypertension promptly. Diabetes mellitus can also develop or worsen with prolonged corticosteroid use due to its impact on glucose metabolism. Children may experience elevated blood sugar levels, insulin resistance, or even steroid-induced diabetes, necessitating close monitoring and potential adjustments in management. In the pediatric clinical setting, understanding these potential complications of corticosteroid therapy is vital for nurses, especially Pediatric Clinical Nurse Specialists. They play a key role in monitoring patients, educating families about side effects, collaborating with the healthcare team to mitigate risks, and ensuring optimal outcomes for pediatric patients requiring long-term corticosteroid treatment. By recognizing and addressing these complications early, nurses can help minimize the impact on the child's health and well-being.

Correct Answer: D

Rationale: The correct answer is D) All of the above. Rheumatoid arthritis is a chronic inflammatory disorder that primarily affects the joints. Untreated rheumatoid arthritis can lead to various complications, making all the options plausible. A) Joint deformity is a common complication of untreated rheumatoid arthritis due to the progressive erosion of cartilage and bone in the joints. This can result in deformities and loss of function. B) Cardiovascular disease is a significant comorbidity in individuals with rheumatoid arthritis. The chronic inflammation associated with the condition can also affect the cardiovascular system, leading to an increased risk of heart disease, stroke, and other related issues. C) While less common than the previous two, vision loss can occur in rheumatoid arthritis due to inflammation affecting the eyes, leading to conditions like scleritis, uveitis, or dry eye syndrome. Educational context: Understanding the potential complications of untreated rheumatoid arthritis is crucial for healthcare providers, especially pediatric clinical nurse specialists, as they play a vital role in early detection, management, and referral of pediatric patients with rheumatic conditions. By recognizing these complications, nurses can help facilitate timely interventions, improve patient outcomes, and enhance the quality of life for children with rheumatoid arthritis.