Oligoarthritis predominantly affects the joints of the lower extremities rather than upper extremity joints. Which of the following joints is never a presenting sign of oligoarthritis?

Correct Answer: D

Rationale: In pediatric nursing, understanding the manifestations of different conditions is crucial for accurate diagnosis and management. In the case of oligoarthritis, which typically presents with inflammation in a few joints, it is important to recognize the pattern of joint involvement to differentiate it from other conditions. The correct answer is D) interphalangeal joints. Oligoarthritis predominantly affects larger joints such as the knees and ankles, sparing the smaller joints like interphalangeal joints. This is a key characteristic used in diagnosing oligoarthritis. Option A) hip is incorrect because the hip joint can be affected in oligoarthritis, though less commonly than the lower extremity joints mentioned in the question. Option B) knee and Option C) ankle are incorrect as these are commonly involved in oligoarthritis, aligning with the typical pattern of joint involvement in this condition. Educationally, this question highlights the importance of recognizing typical joint patterns in oligoarthritis, aiding in its differentiation from other conditions. Understanding such distinctions is vital for nurses caring for pediatric patients with rheumatologic conditions, enabling timely interventions and improved outcomes.

Correct Answer: C

Rationale: The correct answer is C) it usually presents before 5 years of age. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect people of all ages, including children. However, childhood-onset SLE typically presents in older children and adolescents, with the peak onset around puberty. SLE in young children, especially before the age of 5, is extremely rare. Option A) it has a more severe course is incorrect because childhood SLE generally has a milder course compared to adult-onset SLE. Children tend to have fewer organ complications and a better prognosis. Option B) there is more widespread organ involvement is incorrect as childhood SLE often involves fewer organs compared to adult SLE. Organ involvement in children is typically milder and less extensive. Option D) fever, fatigue, hematologic abnormalities, and arthritis are common clinical manifestations is incorrect because these are indeed common clinical manifestations of childhood SLE. Children with SLE commonly present with symptoms like fever, fatigue, blood disorders, and arthritis. Educationally, understanding the differences in the presentation and course of SLE in children compared to adults is crucial for healthcare providers working with pediatric populations. Recognizing the unique features of childhood SLE can aid in early diagnosis, appropriate management, and improved outcomes for pediatric patients with this condition.

Correct Answer: D

Rationale: In this question, the correct answer is D) en coup de sabre. Juvenile localized scleroderma (LS) is a chronic autoimmune disorder that primarily affects the skin and underlying tissues. En coup de sabre is a subtype of LS that typically presents with a linear sclerotic band on the forehead or scalp. This subtype is most commonly associated with neurological manifestations such as seizures, headaches, and cognitive abnormalities due to the involvement of underlying brain tissue. Option A) plaque morphea is a subtype of LS characterized by thickened plaques of skin without systemic involvement. It is not typically associated with neurological manifestations. Option B) eosinophilic fasciitis is a distinct disorder characterized by inflammation of the fascia and not typically associated with LS or neurological symptoms. Option C) generalized morphea is a subtype of LS that involves widespread areas of the skin without systemic involvement. It is not commonly associated with neurological manifestations. Educationally, understanding the different subtypes of juvenile LS and their associated extracutaneous manifestations is crucial for healthcare providers caring for pediatric patients with this condition. Recognizing the subtype most commonly linked to neurological symptoms, such as en coup de sabre, can aid in early detection, appropriate management, and improved outcomes for affected children.

Correct Answer: A

Rationale: In Kawasaki disease (KD), predictors of poor outcomes are essential to recognize for effective management. In this scenario, option A, "old age," is the correct answer. This is because KD primarily affects children under 5 years old, and older age is not typically associated with poor outcomes in KD. Male gender (option B) is a known risk factor for KD but not a predictor of poor outcomes. Persistent fever (option C) is a common symptom in KD and is associated with the acute phase of the disease but not necessarily with poor outcomes. Poor response to intravenous immunoglobulin (IVIG) (option D) is a crucial predictor of poor outcome in KD as it indicates resistance to the primary treatment modality for the disease. Educationally, understanding predictors of poor outcomes in KD is crucial for nurses caring for pediatric patients. Recognizing these predictors can aid in early identification of high-risk patients, prompt intervention, and improved patient outcomes. Nurses must be adept at recognizing and interpreting clinical indicators to provide optimal care for children with KD.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D) cyberbullying. Witnessing violence, community violence, and media violence can indeed have detrimental effects on children, such as poor school performance, symptoms of anxiety and depression, and lower self-esteem. However, cyberbullying does not necessarily directly result from an increased impact of violence in the same way as the other effects mentioned. Children exposed to violence can experience difficulties in academic performance due to trauma and emotional distress. They may also develop symptoms of anxiety and depression as a result of the exposure to violence, affecting their mental health and overall well-being. Furthermore, witnessing violence can lower a child's self-esteem and sense of self-worth, impacting their confidence and social interactions. In an educational context, understanding the effects of violence on children is crucial for pediatric nurses to provide holistic care. By recognizing these potential impacts, healthcare professionals can better support children and families dealing with the consequences of violence exposure. It is important to address these issues proactively to promote the health and well-being of children in their care.