Enthesitis-Related Arthritis (ERA) is a subtype of rheumatic disease that falls in the juvenile idiopathic arthritis (JIA) category. The clinical feature that is highly suggestive of ERA is

Correct Answer: C

Rationale: The correct answer is C) asymmetrical enthesitis. Enthesitis-Related Arthritis (ERA) is characterized by inflammation at the site where tendons and ligaments insert into the bone, known as entheses. This is a key feature of ERA and distinguishes it from other subtypes of juvenile idiopathic arthritis (JIA). Asymmetrical enthesitis, especially involving the lower limbs, is a hallmark of ERA. Option A) symmetrical arthritis early in the disease course is more indicative of other subtypes of JIA, such as oligoarticular JIA, rather than ERA. Option B) early involvement of more than 5 joints is more commonly seen in polyarticular JIA, not specifically indicative of ERA. Option D) involvement of upper limb joints is not a distinguishing feature of ERA, as it typically affects the lower limbs more prominently. Understanding the specific clinical features of different subtypes of JIA, such as ERA, is crucial for pediatric nurses to accurately assess, diagnose, and provide appropriate care for children with rheumatic diseases. Recognizing these distinctions can lead to early intervention and better outcomes for patients.

Correct Answer: A

Rationale: In this question, the correct answer is A) independent occurrence of periungual tissue necrosis. This feature is most likely consistent with rheumatic disease (RD) rather than Raynaud phenomenon (RP) because periungual tissue necrosis is a more specific symptom associated with certain rheumatic diseases like systemic sclerosis, rather than RP alone. Option B) asymmetric involvement is a common feature of RP and does not specifically point towards RD. Option C) associated telangiectasia is more commonly associated with RP rather than RD. Option D) paresthesia and gangrene are symptoms that can occur in severe cases of RP but are not specific to RD. Educationally, this question highlights the importance of recognizing specific clinical features to differentiate between RP and RD in pediatric patients. Understanding these distinctions is crucial for accurate diagnosis and appropriate treatment interventions in pediatric nursing practice.

Correct Answer: D

Rationale: In the acute stage of Kawasaki disease (KD), cardiac complications are common due to the systemic inflammatory response affecting the blood vessels, including the coronary arteries. Myocarditis, pericarditis, and coronary artery aneurysm are all potential complications seen in KD due to the inflammation and damage to the heart and blood vessels. The correct answer, D) mitral regurgitation, is not typically associated with the acute phase of KD. Mitral regurgitation is a condition where the heart's mitral valve does not close tightly, causing blood to flow backward in the heart. Although it can occur in the long-term complications of KD, it is not a typical cardiac manifestation in the acute phase. Educationally, understanding the cardiac complications of KD is crucial for nurses caring for pediatric patients. Recognizing these potential complications early can help in prompt intervention and prevent long-term cardiac sequelae. By knowing the specific cardiac issues that can arise in KD, nurses can advocate for appropriate diagnostic tests and treatments to optimize patient outcomes.

Correct Answer: D

Rationale: In the context of pediatric nursing, understanding the psychosocial impact of war on children is crucial for providing holistic care. In this question, the correct answer is D) acute stress reaction. This is because acute stress reactions are a common and expected response to traumatic events such as war in children. It is a normal reaction to an abnormal situation and can manifest in various ways including anxiety, fear, and behavioral changes. Option A) loss of family members is a psychosocial impact of war on children as it can lead to grief, trauma, and a sense of abandonment. Option B) separation from community is also a valid psychosocial impact as it can result in feelings of isolation and loss of support systems. Option C) lack of education is another significant impact as war often disrupts schools and educational opportunities for children, impacting their future prospects and well-being. In an educational context, it is important for pediatric nurses to be aware of the various psychosocial impacts of war on children to provide effective care and support. By recognizing these effects, nurses can implement appropriate interventions to address the unique needs of children who have experienced war-related trauma. This knowledge helps in promoting resilience, facilitating healing, and promoting overall well-being in pediatric patients affected by war.

Correct Answer: D

Rationale: In pediatric nursing, the assessment and management of failure to thrive is crucial. When evaluating a child with failure to thrive, it is important to consider various underlying factors such as chromosomal abnormalities, intrauterine infections, and metabolic disorders. In this scenario, the correct answer is D) renal symptoms. Renal symptoms are not typically suggestive of metabolic problems in the context of failure to thrive. Metabolic disorders often present with insidious history, recurrent vomiting, and neurologic symptoms. Therefore, ruling out renal symptoms can help to narrow down the differential diagnosis in these cases. Insidious history, recurrent vomiting, and neurologic symptoms are common features of metabolic disorders in children. An insidious history refers to a gradual onset of symptoms, which is characteristic of metabolic conditions. Recurrent vomiting can be a sign of metabolic dysfunction affecting the gastrointestinal system. Neurologic symptoms such as seizures, developmental delay, and altered mental status are often seen in metabolic disorders due to their impact on the nervous system. Educationally, understanding the clinical presentation of different underlying factors in failure to thrive is essential for pediatric nurses to provide comprehensive care. By differentiating between symptoms suggestive of metabolic disorders and other conditions, nurses can assist in the early identification and appropriate management of children with failure to thrive.