All the following are common classic clinical features of Kawasaki disease (KD) EXCEPT

Correct Answer: D

Rationale: The correct answer is D) vesicular rash. Kawasaki disease (KD) is a systemic vasculitis that primarily affects children. The classic clinical features of KD include bilateral non-exudative bulbar conjunctivitis (A), cracked lips (B), and edema and erythema of the hands and feet (C). These symptoms are commonly seen in KD and help healthcare providers in making a diagnosis. The incorrect options (A, B, and C) are typical manifestations of Kawasaki disease. Bilateral non-exudative bulbar conjunctivitis is a hallmark sign, cracked lips are part of the mucocutaneous involvement often seen in KD, and edema and erythema of the hands and feet are classic findings due to the systemic vasculitis affecting small- to medium-sized vessels. Understanding the clinical features of KD is crucial for pediatric clinical nurse specialists as early recognition and treatment are vital in preventing complications such as coronary artery aneurysms. Nurses play a key role in monitoring patients, educating families, and collaborating with the healthcare team to provide comprehensive care for children with KD.

Correct Answer: A

Rationale: The most helpful investigation in this scenario is a factor VII assay. Factor VII deficiency is a rare inherited bleeding disorder that presents with symptoms like ecchymosis, bleeding from the nose and urine, and prolonged PT and/or PTT. In this case, the child's symptoms, family history of a similar undiagnosed illness, and response to vitamin K administration suggest a possible factor VII deficiency. Therefore, measuring factor VII levels through an assay would confirm the diagnosis and guide appropriate treatment. The other options are less relevant in this context: - Factor II assay: Factor II deficiency is rare and typically presents with bleeding after injury or surgery, not spontaneous bleeding like in this case. - Drug level: There is no indication of drug involvement in this scenario based on the presented symptoms and history. - Von Willebrand factor assay: Von Willebrand disease typically presents with mucocutaneous bleeding and abnormal platelet function, which are not consistent with the symptoms described in the case. Educationally, understanding the diagnostic approach to bleeding disorders in pediatric patients is crucial for clinical nurse specialists working in pediatric settings. This case highlights the importance of considering rare bleeding disorders in children with unexplained bleeding tendencies and the significance of appropriate laboratory investigations in confirming a diagnosis.

Correct Answer: D

Rationale: The correct answer is D) lumbar puncture. In this case, the infant presents with symptoms suggestive of non-accidental trauma, such as retinal hemorrhages and severe pallor, which indicate a need for further investigation into possible bleeding disorders or coagulopathies. Coagulation studies would help in assessing the infant's clotting ability in this context. Option A) coagulation studies is relevant due to the presentation of retinal hemorrhages and pallor, which may indicate a bleeding disorder. Option B) skeletal survey is important to rule out any skeletal injuries that may suggest non-accidental trauma. Option C) CT scan may be needed to assess for any intracranial injuries or abnormalities. In a pediatric clinical setting, it is crucial to consider child abuse or non-accidental trauma as a differential diagnosis when presented with certain findings. Understanding the significance of each diagnostic test in the context of the clinical presentation is essential for a Pediatric Clinical Nurse Specialist to provide comprehensive care to pediatric patients.

Correct Answer: B

Rationale: The blueberry muffin appearance in infants with TORCH infections most likely represents dermal erythropoiesis (Option B). This is because TORCH infections (Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, Herpes simplex virus) can lead to extramedullary hematopoiesis, where the skin becomes a site for erythropoiesis, resulting in the characteristic blueberry muffin rash. Option A, palpable purpura, is incorrect as it typically presents as small purple spots on the skin due to bleeding underneath. Option C, metastatic hepatic tissue, is not associated with the blueberry muffin appearance seen in TORCH infections. Option D, viral lesions, do not typically manifest as the blueberry muffin rash. In an educational context, understanding the clinical manifestations of TORCH infections is crucial for pediatric nurses to provide timely and appropriate care. Recognizing the blueberry muffin rash can prompt further investigation and intervention. This question highlights the importance of recognizing dermatological manifestations in pediatric patients with infectious diseases.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Hypoglycemia. Newborns are particularly vulnerable to hypoglycemia due to their limited glycogen stores and high metabolic demands. Hypoglycemia can lead to bradycardia, hypotension, cyanosis, and metabolic acidosis, which align with the patient's symptoms. Option A) Subcapsular hepatic hematoma is less likely as it typically presents with abdominal distension, not the cardiovascular and metabolic symptoms described. Option B) Intraventricular hemorrhage is unlikely in this case as it presents with neurological symptoms like seizures or altered mental status, rather than the cardiovascular and metabolic issues seen here. Option C) Pneumomediastinum would not typically cause bradycardia, hypotension, and cyanosis with metabolic acidosis in a newborn. Understanding the pathophysiology of common conditions in newborns is crucial for pediatric clinical nurse specialists. Recognizing the signs and symptoms of hypoglycemia, especially in the first days of life, is essential for prompt diagnosis and treatment to prevent serious complications. This knowledge ensures the best outcomes for newborn patients and highlights the importance of thorough assessment and critical thinking skills in pediatric nursing practice.