A red-haired, blue-eyed, Caucasian 15-year-old with a small congenital nevus undergoes a biopsy to rule out melanoma. For pain control, naproxen 15 mg/kg TID is given. Two days after surgery, blood is noted to be oozing from the wound, which won’t stop bleeding. All of the following are correct EXCEPT

Correct Answer: C

Rationale: In this scenario, option C is correct because bleeding from the wound is not related to the choice of naproxen over ibuprofen. The bleeding is likely due to the anticoagulant properties of naproxen itself, not because ibuprofen would have prevented it. Option A is incorrect because the dose of naproxen is within the recommended range for pain control in this patient. Option B is incorrect because while naproxen can increase bleeding risk, it is not a common complication at this dose. Option D is also incorrect as naproxen, like aspirin, can increase bleeding risk, but naproxen is preferred in this case due to its lower association with Reye syndrome compared to aspirin in pediatric patients. Educationally, this question emphasizes the importance of understanding pharmacological effects on patients, especially in pediatric populations. It highlights the need to consider individual patient factors, such as age, underlying conditions, and drug interactions when selecting medications for pain management. It also underscores the significance of monitoring for potential adverse effects and complications post-surgery.

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.

Correct Answer: D

Rationale: In the context of fibromyalgia, selecting option D, "All of the above," as the correct answer is essential due to the interconnected nature of the symptoms associated with this condition. Fibromyalgia is characterized by widespread pain, which is a hallmark feature of the condition. This pain is often accompanied by chronic fatigue, another common symptom experienced by individuals with fibromyalgia. Additionally, sleep disturbance is prevalent in those with fibromyalgia, with issues such as insomnia and non-restorative sleep being common complaints. Options A, B, and C provide individual symptoms of fibromyalgia, but it is crucial to understand that fibromyalgia is a complex and multifaceted condition that often presents with a combination of symptoms rather than isolated ones. By selecting option D, test-takers demonstrate an understanding of the comprehensive nature of fibromyalgia and how it manifests in patients. From an educational perspective, emphasizing the constellation of symptoms associated with fibromyalgia helps learners recognize the importance of holistic assessment and management in nursing practice. Understanding the interconnectedness of symptoms in fibromyalgia is crucial for providing comprehensive care and support to patients with this condition. By grasping the relationship between pain, fatigue, and sleep disturbances, nurses can tailor interventions to address the diverse needs of individuals living with fibromyalgia.