Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) can be caused by all the following EXCEPT

Correct Answer: C

Rationale: In the context of the Pediatric Clinical Nurse Specialist exam, understanding Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) is crucial for providing safe and effective care to pediatric patients. The correct answer is C) allopurinol. Allopurinol is a xanthine oxidase inhibitor used in the treatment of gout and hyperuricemia. It is known to cause DRESS syndrome in some patients. DRESS syndrome is a severe drug reaction characterized by rash, fever, eosinophilia, and systemic organ involvement. Anticonvulsants, sulfonamides, and minocycline are all known culprits in causing DRESS syndrome. Anticonvulsants like carbamazepine and phenytoin, sulfonamides like trimethoprim-sulfamethoxazole, and minocycline, a tetracycline antibiotic, have all been associated with DRESS syndrome in pediatric patients. Educationally, knowing the drugs that can cause DRESS syndrome is essential for nurses to recognize and manage this potentially life-threatening condition promptly. By understanding the specific medications implicated in DRESS syndrome, nurses can advocate for appropriate medication management and provide comprehensive care to pediatric patients experiencing adverse drug reactions.

Correct Answer: B

Rationale: The correct answer is B) three or more episodes of wheezing that lasted more than 1 day. Daily long-term control therapy is recommended for infants and young children in this age group who have had three or more episodes of wheezing in the previous year. This recommendation is based on evidence that children who experience frequent wheezing episodes are at higher risk for developing asthma. Option A) two or more episodes is not the correct answer because the threshold for initiating daily long-term control therapy is set at three or more episodes. Option C) four or more episodes and Option D) five or more episodes are also incorrect as they exceed the threshold recommended for initiating daily long-term control therapy in this age group. From an educational perspective, understanding the criteria for initiating daily long-term control therapy in infants and young children is crucial for pediatric clinical nurse specialists. It allows for early intervention and management of asthma symptoms, ultimately improving outcomes for these young patients. Nurses need to be knowledgeable about evidence-based guidelines to provide optimal care to pediatric patients with respiratory conditions.

Correct Answer: C

Rationale: In the management of nasal congestion associated with rhinitis, pseudoephedrine (Option C) is the preferred choice for relief. Pseudoephedrine is a decongestant that works by constricting blood vessels in the nasal passages, thereby reducing swelling and congestion. It is effective in providing symptomatic relief of nasal congestion. Option A, diphenhydramine, is an antihistamine that may help with allergies and itching but is not as effective in relieving nasal congestion compared to decongestants like pseudoephedrine. Option B, hydroxyzine, is also an antihistamine that is more commonly used for itching and anxiety rather than nasal congestion. Option D, cetirizine, is a second-generation antihistamine that is effective for treating allergies and associated symptoms like sneezing and itching, but it is not as effective in relieving nasal congestion as pseudoephedrine. Educationally, understanding the appropriate pharmacological management of symptoms related to rhinitis is crucial for healthcare providers, especially pediatric clinical nurse specialists, as they play a vital role in managing pediatric patients with respiratory conditions. It is essential to differentiate between various classes of medications and their specific uses to provide safe and effective care to pediatric patients with rhinitis.

Correct Answer: A

Rationale: In the management of urticaria and angioedema, the MAINSTAY of pharmacologic treatment is second-generation H1 antihistamines (Option A). These antihistamines are preferred due to their efficacy in blocking histamine receptors, which are responsible for the symptoms of urticaria and angioedema. They have fewer side effects like sedation compared to first-generation antihistamines, making them a safer and more effective choice. Tricyclic antidepressants (Option B) are not typically used as a first-line treatment for urticaria and angioedema. While they may have some antihistaminic properties, their side effect profile and potential for drug interactions make them less suitable. Corticosteroids (Option C) are reserved for severe cases or when antihistamines alone are ineffective. They are not considered the MAINSTAY of treatment due to their potential for long-term side effects and lack of specificity in targeting the underlying histamine-mediated pathway. Leukotriene receptor blockers (Option D) are more commonly used in conditions like asthma and allergic rhinitis, where leukotrienes play a larger role. They are not the first-line treatment for urticaria and angioedema, as histamine is the primary mediator in these conditions. In an educational context, understanding the rationale behind choosing second-generation H1 antihistamines as the MAINSTAY of treatment for urticaria and angioedema is crucial for nurses specializing in pediatric care. This knowledge helps ensure safe and effective management of these common pediatric dermatologic conditions, emphasizing the importance of evidence-based practice in providing quality care to pediatric patients.

Correct Answer: B

Rationale: The correct answer is B) Deliver a correction bolus of rapid-acting insulin via an insulin syringe or pen. In this scenario, the 14-year-old girl with type 1 diabetes is experiencing hyperglycemia and ketones despite being on insulin pump therapy. Rapid-acting insulin given via syringe or pen allows for a more immediate and precise delivery of insulin to address the high blood sugar levels and ketones. This method ensures faster correction and can help prevent potential complications of hyperglycemia and ketosis. Option A is incorrect because delivering a correction bolus through the insulin pump may not be as effective in this situation due to possible insulin pump malfunction or absorption issues. Option C, delivering a dose of long-acting insulin, is not appropriate for correcting acute hyperglycemia and ketones as it acts over an extended period and does not provide immediate relief. Option D, performing exercise and increasing water intake, is not recommended for treating high blood sugar and ketones in this case as it may worsen the condition by leading to dehydration and further ketone production. Educationally, it is crucial for pediatric clinical nurse specialists to understand the management of acute complications in pediatric patients with diabetes. Providing detailed explanations for the correct and incorrect options helps reinforce the importance of prompt and appropriate interventions to prevent complications and promote optimal health outcomes in pediatric patients with diabetes.