Rheumatoid factor (RF)-positive polyarthritis usually accounts for <10% of all juvenile idiopathic arthritis (JIA) cases. The articular manifestation pattern is characterized by involvement of 25 joints in both upper and lower extremities. Of the following, the LEAST effective drug to induce remission for this subtype of JIA is

Correct Answer: A

Rationale: In the case of RF-positive polyarthritis in juvenile idiopathic arthritis (JIA) with involvement of 25 joints in both upper and lower extremities, the least effective drug to induce remission is NSAIDs (Option A). The rationale behind this is that NSAIDs primarily target symptoms like pain and inflammation, but they do not address the underlying autoimmune process causing JIA. In contrast, methotrexate (Option B), TNF-a antagonists (Option C), and IL-6 inhibitors (Option D) are disease-modifying anti-rheumatic drugs (DMARDs) that target the underlying autoimmune response in JIA, leading to remission and preventing joint damage. Methotrexate is a first-line DMARD commonly used in JIA treatment. TNF-a antagonists and IL-6 inhibitors are biologic DMARDs that specifically target key inflammatory pathways involved in JIA pathogenesis. Educationally, understanding the mechanisms of action of different drug classes in treating JIA is crucial for healthcare providers managing pediatric patients with arthritis. It is essential to differentiate between symptomatic relief (NSAIDs) and disease-modifying treatment (DMARDs) to provide optimal care and improve long-term outcomes for children with JIA.

Correct Answer: D

Rationale: In the context of pediatric nursing and neonatal lupus, it is crucial to understand the therapeutic options available for managing cardiac complications associated with this condition. In this scenario, the correct answer is D) methotrexate. Methotrexate is not typically used in the treatment of cardiac complications in neonatal lupus. Methotrexate is a cytotoxic medication that is more commonly used in conditions such as cancer, rheumatoid arthritis, and psoriasis due to its immunosuppressive properties. Option A) fluorinated corticosteroids are often used to reduce inflammation and immune responses in conditions like neonatal lupus, making it a therapeutic option. Option B) intravenous immunoglobulin is used to modulate the immune system and may be beneficial in treating cardiac manifestations of neonatal lupus. Option C) plasmapheresis is a procedure that involves removing and replacing blood plasma and can be helpful in removing autoantibodies in conditions like neonatal lupus. Understanding the appropriate therapeutic options for neonatal lupus is essential for pediatric nurses to provide optimal care for infants with this condition. It is important to be familiar with the mechanisms of action, indications, and contraindications of various treatment modalities to ensure safe and effective patient care.

Correct Answer: A

Rationale: In Familial Mediterranean fever (FMF), the hallmark cutaneous finding is an erysipelas-like rash (Option A). This rash presents as painful, red, raised patches on the skin, resembling the appearance of erysipelas. This characteristic rash helps differentiate FMF from other conditions. Morbilliform rash (Option B) is a diffuse maculopapular rash resembling measles, commonly seen in viral infections like measles or certain drug reactions. Migratory rash (Option C) refers to a rash that moves from one location to another and is not specific to FMF. Pustulosis (Option D) is characterized by the presence of pustules on the skin, typically seen in conditions like psoriasis. Educationally, understanding the unique cutaneous manifestations of diseases like FMF is crucial for accurate diagnosis and appropriate management in pediatric nursing practice. Recognizing the erysipelas-like rash in FMF aids in early intervention and prevention of complications. This knowledge enhances the quality of care provided to pediatric patients with FMF and improves outcomes.

Correct Answer: A

Rationale: In the context of pediatric nursing and the treatment of chronic renal disease in children with Henoch-Schonlein purpura (HSP), the correct answer, A) prednisolone, is the least effective option among the listed medications. Prednisolone is a corticosteroid commonly used to reduce inflammation and suppress the immune system's response. While it may be effective in managing acute symptoms of HSP, it is less effective in treating chronic renal disease associated with HSP. Option B) azathioprine is an immunosuppressive medication that is sometimes used in the treatment of autoimmune conditions but may have potential side effects on the kidneys, making it a less preferable choice for chronic renal disease in this context. Option C) cyclophosphamide is a potent immunosuppressive and cytotoxic agent that can have severe side effects, including renal toxicity, which would make it a risky choice for treating renal disease in children with HSP. Option D) cyclosporine is another immunosuppressive drug that can be used in various autoimmune conditions, but it also has potential nephrotoxic effects, which could worsen the renal condition in children with HSP. In an educational context, it is crucial for pediatric nurses to understand the appropriate pharmacological management of chronic renal disease in children with underlying conditions like HSP. Prednisolone, while commonly used in HSP treatment, may not be the most effective option for managing chronic renal complications. Nurses need to be aware of the potential side effects and limitations of different medications to provide safe and effective care to pediatric patients with complex conditions like HSP.

Correct Answer: B

Rationale: In cases of physical abuse in children with burn injuries, the presence of patterned burns is the most suggestive of intentional harm. Patterned burns indicate that the injury was caused by a specific object or instrument, pointing towards inflicted trauma rather than accidental injury. This is crucial in identifying cases of abuse and taking appropriate actions to protect the child. The other options are incorrect because: A) Presence of splash marks is more indicative of accidental burns, like scalds from hot liquids. C) Unclear borders of burns are more likely to be seen in accidental burns where the heat distribution is uneven. D) Stocking/glove distribution is characteristic of immersion burns, which can be accidental in nature. Educationally, understanding the specific indicators of intentional burns in children is vital for healthcare professionals working with pediatric patients. Recognizing these signs can lead to early intervention and protection of vulnerable children from further harm. It is essential to be thorough in assessing and differentiating accidental from inflicted injuries to ensure the safety and well-being of pediatric patients.