Of the following, the NSAID that has been associated with the highest chronic term toxicity.

Correct Answer: D

Rationale: The correct answer is D) naproxen. Naproxen has been associated with the highest chronic term toxicity among the listed NSAIDs. This is due to its longer half-life compared to other NSAIDs, leading to prolonged exposure and increased risk of adverse effects. Celecoxib (A) is a selective COX-2 inhibitor and is often chosen for its relatively lower risk of gastrointestinal side effects compared to traditional NSAIDs. Meloxicam (B) is a commonly used NSAID with a moderate risk profile. Indomethacin (C) is known for its potency in treating inflammation but also carries a higher risk of adverse effects. In an educational context, understanding the differences in NSAIDs and their associated toxicities is crucial for pediatric nursing practice. Nurses need to be aware of the potential risks and benefits of each medication to ensure safe and effective care for pediatric patients. Monitoring for signs of toxicity and educating caregivers on medication administration are also important aspects of pediatric nursing care.

Correct Answer: B

Rationale: In Juvenile Ankylosing Spondylitis (JAS) compared to Adult-Onset Ankylosing Spondylitis (AOAS), the correct answer, option B, states that axial disease occurs more frequently early in the disease course. This is incorrect because in JAS, peripheral arthritis is more common early on, unlike in AOAS where axial involvement is predominant. Option A is true because JAS typically presents in patients younger than 16 years old. Option C is also accurate as inflammatory back pain is less common at the onset of JAS compared to AOAS. Option D is true as enthesitis, inflammation at tendon and ligament insertions, is more commonly observed in JAS. Understanding these differences is crucial for healthcare providers to accurately diagnose and manage JAS in pediatric patients. Recognizing the unique clinical presentation of JAS compared to AOAS can lead to timely interventions and better outcomes for pediatric patients with this condition.

Correct Answer: C

Rationale: In this scenario, the most appropriate initial therapy for a 12-year-old female adolescent with mild arthritis and a faint malar rash is option C) hydroxychloroquine. Hydroxychloroquine is the preferred initial treatment in pediatric patients with mild arthritis and a faint malar rash, as seen in conditions like juvenile idiopathic arthritis with possible early signs of systemic lupus erythematosus. It is well-tolerated and has a favorable safety profile in children. Hydroxychloroquine helps in managing arthritis symptoms and can also improve the skin manifestations like the malar rash. Option A) steroids are not typically the initial choice for mild arthritis and malar rash in this age group due to their potential side effects and long-term risks, especially in children. Systemic methotrexate (option B) and cyclophosphamide (option D) are more potent immunosuppressants that are usually reserved for more severe cases of arthritis or lupus with organ involvement, not as first-line treatments for mild symptoms in a 12-year-old. Educationally, understanding the rationale behind selecting appropriate initial therapy based on the severity of symptoms, safety profile in pediatric patients, and the specific characteristics of the conditions being treated is crucial for healthcare providers managing pediatric patients with rheumatologic conditions. It highlights the importance of individualized treatment plans in pediatric care to optimize outcomes while minimizing potential risks and side effects.

Correct Answer: A

Rationale: In treating a 16-year-old female adolescent with Behcet disease involving oral and genital ulcers and erythema nodosum, the BEST treatment is colchicine (Option A). Colchicine is effective in managing the symptoms of Behcet disease by reducing inflammation and preventing flare-ups. It is particularly useful in treating oral and genital ulcers, which are common manifestations of the disease in adolescents. Azathioprine (Option B) and cyclophosphamide (Option C) are immunosuppressants that are usually reserved for more severe cases of Behcet disease or when colchicine is not effective. These medications have more significant side effects and risks compared to colchicine, making them less suitable as the first-line treatment for this adolescent. Steroids (Option D) are not the preferred choice for long-term management of Behcet disease due to their side effects, especially in growing adolescents. While steroids may be used for acute flare-ups, they are not recommended as a primary treatment option in this case. Educationally, understanding the rationale behind choosing colchicine for this adolescent with Behcet disease is crucial for nursing students. It highlights the importance of selecting appropriate treatments based on the patient's age, disease severity, and potential side effects. This knowledge empowers nurses to provide safe and effective care to pediatric patients with complex conditions like Behcet disease.

Correct Answer: A

Rationale: In Henoch-Schonlein purpura (HSP), the most common gastrointestinal manifestation occurring in up to 80% of affected children is abdominal pain and ileus. This is because HSP is a systemic vasculitis that affects small blood vessels, including those in the gastrointestinal tract. Abdominal pain and ileus result from the inflammation and damage to these blood vessels, leading to bowel wall edema and impaired peristalsis. Option B, diarrhea, is less common in HSP compared to abdominal pain and ileus. While gastrointestinal symptoms like vomiting (Option C) may occur in some cases of HSP, they are not as prevalent as abdominal pain and ileus. Paralytic ileus (Option D) is a severe form of ileus that involves a lack of bowel motility due to nerve or muscle damage, which is not a typical manifestation of HSP. Educationally, understanding the common gastrointestinal manifestations of HSP is crucial for pediatric nurses to recognize and manage symptoms promptly. This knowledge helps in providing appropriate care, monitoring for complications like bowel obstruction, and educating both the child and their caregivers about the condition. By grasping these nuances, healthcare professionals can enhance the quality of care provided to children with HSP.