Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)?

Correct Answer: A

Rationale: In the case of a child receiving aspirin therapy for Kawasaki disease (KD), exposure to chickenpox or influenza should be a cause to discontinue therapy and substitute dipyridamole (Persantine). This is because aspirin therapy in the presence of a viral infection like chickenpox or influenza can increase the risk of Reye's syndrome, a rare but serious condition that affects the liver and brain. Option A is correct because both chickenpox and influenza are viral infections that can increase the risk of Reye's syndrome when aspirin is used concurrently. Option B (E. coli or staphylococcus) and Option D (Streptococcus A or staphylococcus) are incorrect as these bacterial infections do not pose the same risk in relation to aspirin therapy in KD. Option C (Mumps or streptococcus A) is also incorrect as mumps is a viral infection that, like chickenpox and influenza, can increase the risk of Reye's syndrome with aspirin therapy. Educationally, it is crucial for healthcare providers to be aware of the potential complications and interactions that can arise in pediatric pharmacotherapy, especially in conditions like KD where aspirin is a key component of treatment. Understanding the specific contraindications and risks associated with different infections and medications is essential for safe and effective patient care.

Correct Answer: B

Rationale: The correct answer is B) Your baby's defect is small and will likely close on its own by 1 year of age. This response is the best because it reflects the current understanding of ventricular septal defects (VSDs) in pediatric patients. In infants, small VSDs often close spontaneously as the child grows, reducing the need for surgical intervention. This information is crucial for parents to understand to alleviate unnecessary anxiety and concern about their baby's condition. Option A) It is always helpful to get a second opinion about any serious condition like this. While seeking a second opinion is generally a good practice in medical decision-making, in this case, it may not address the specific nature of VSDs in infants and could potentially lead to unnecessary procedures or interventions. Option C) It is common for physicians to wait until an infant develops respiratory distress before they do the surgery. This statement is incorrect as waiting for the development of respiratory distress in an infant with a small VSD is not a recommended approach. Surgical intervention is typically not the first-line treatment for small VSDs in infants. Option D) With a small defect like this, they wait until the child is 10 years old to do the surgery. This option is incorrect as it provides misinformation about the appropriate timing for surgical intervention in cases of small VSDs in infants. Waiting until the child is 10 years old for surgery is not aligned with current medical guidelines for managing VSDs in pediatric patients. Educational Context: Educating parents about the natural course of VSDs in infants is essential for promoting informed decision-making and reducing unnecessary anxiety. Providing accurate information about the expected outcomes and management strategies for small VSDs helps parents feel empowered and involved in their child's care. It is crucial for nurses to have a solid understanding of pediatric cardiovascular disorders like VSDs to effectively communicate with parents and support them in navigating their child's healthcare journey.

Correct Answer: C

Rationale: In the context of pediatric cardiovascular disorders like congestive heart failure (CHF), adherence to treatment is crucial for optimal management. Option C, 50th percentile height and weight for age, indicates that the parent is following the prescribed treatment. Children with CHF may have poor growth due to the condition, so achieving the 50th percentile suggests that the treatment is effective in supporting growth and development. Option A, a heart rate of 56 beats per minute, may not necessarily indicate treatment adherence as it could be within the normal range for a 7-year-old. Elevated red blood cell count (Option B) may be a sign of chronic hypoxia, which is common in CHF, but it does not directly indicate treatment adherence. Option D, urine output of 0.5 cc/kg/hr, is important in assessing kidney function in CHF, but it does not specifically reflect treatment compliance by the parent. Educationally, understanding these assessment parameters helps nurses and healthcare providers evaluate treatment effectiveness in pediatric patients with CHF. Monitoring growth parameters like height and weight can provide valuable insights into the overall management of the condition and guide treatment adjustments if needed.

Correct Answer: A

Rationale: In congestive heart failure (CHF), hypoxemia occurs due to inadequate oxygen delivery to tissues. This triggers compensatory mechanisms, such as increased erythropoietin production, leading to polycythemia (option A). Polycythemia is the body's response to hypoxemia, aiming to increase oxygen-carrying capacity. Clubbing may also develop due to chronic hypoxemia. Option B, anemia and barrel chest, are not typical physiological changes seen in response to hypoxemia in CHF. Anemia is more commonly associated with conditions like chronic kidney disease or nutritional deficiencies. Barrel chest is a physical finding seen in conditions like chronic obstructive pulmonary disease (COPD) due to air trapping. Option C, increased white blood cells and low platelets, are not direct consequences of hypoxemia in CHF. Elevated white blood cells may indicate infection or inflammation, while low platelets can occur in conditions like immune thrombocytopenia. Option D, elevated erythrocyte sedimentation rate and peripheral edema, are not specific changes related to hypoxemia in CHF. Elevated erythrocyte sedimentation rate is a nonspecific marker of inflammation, while peripheral edema is more commonly associated with fluid retention in CHF. Understanding the physiological responses to hypoxemia in CHF is crucial for nurses caring for pediatric patients with cardiovascular disorders. Recognizing these changes helps in early identification of complications and appropriate management to optimize patient outcomes.

Correct Answer: D

Rationale: In the context of pediatric pharmacology, understanding the interaction between gamma globulin administration and vaccines is crucial for safe and effective patient care. The correct answer, option D (Measles, mumps, and rubella), must be delayed for 11 months after the administration of gamma globulin due to the risk of reduced vaccine efficacy. Gamma globulin contains antibodies that can neutralize live attenuated vaccines like the measles, mumps, and rubella (MMR) vaccine, leading to decreased immune response and protection. Option A (Diphtheria, tetanus, and pertussis), option B (Hepatitis B), and option C (Inactivated polio virus) are not affected by gamma globulin administration and do not need to be delayed. These vaccines are either not live vaccines or are not significantly impacted by the presence of passively acquired antibodies from gamma globulin. Educationally, this question highlights the importance of understanding the timing and interactions of vaccines in pediatric patients, especially in scenarios where passive immunity from gamma globulin administration may affect vaccine efficacy. Nurses and healthcare providers must be aware of these interactions to ensure optimal immunization outcomes and protect vulnerable pediatric populations from preventable diseases.