The condition where diagnosis of acute rheumatic fever needs adherence to Jones criteria is:

Correct Answer: D

Rationale: In this question, the correct answer is D) Acute rheumatic fever recurrence. The Jones criteria are a set of guidelines used to help diagnose acute rheumatic fever, a condition that can follow an untreated streptococcal infection. One of the major criteria in the Jones criteria is the history of acute rheumatic fever or its recurrence. Therefore, adherence to the Jones criteria is necessary to diagnose acute rheumatic fever recurrence accurately. Now, let's analyze why the other options are incorrect: A) Chorea: While chorea is one of the major manifestations of acute rheumatic fever, it is not specifically mentioned in the Jones criteria for diagnosis. B) Indolent carditis: Carditis is indeed a major criterion in the Jones criteria, but the term "indolent" does not align with the acute nature of rheumatic fever. C) Subcutaneous nodules: Subcutaneous nodules are also a major criterion in the Jones criteria, but they are not directly linked to the need for adherence specifically in diagnosing acute rheumatic fever recurrence. Educational Context: Understanding the Jones criteria is crucial for healthcare professionals, especially those working with pediatric patients. By knowing the criteria and the significance of each component, nurses can accurately assess and diagnose acute rheumatic fever in children. This knowledge helps in providing timely and appropriate treatment to prevent complications and long-term sequelae associated with the condition. Regular review and application of the Jones criteria in clinical practice can improve patient outcomes and reduce the burden of rheumatic heart disease in pediatric populations.

Correct Answer: C

Rationale: In the initial treatment of rheumatic fever with severe carditis and congestive heart failure, the correct answer is C) Acetylsalicylic acid 100 mg/kg/day in 4 divided doses. This is because acetylsalicylic acid is contraindicated in the presence of viral infections, especially in children due to the risk of Reye's syndrome. Option A, Benzathine benzyl penicillin 1.2 mega unit, is commonly used to treat streptococcal infections associated with rheumatic fever. Option B, complete bed rest, is also a standard recommendation to reduce cardiac workload and prevent further complications. Option D, Prednisolone 2 mg/kg/day in 3 divided doses, is used in the presence of severe carditis but should be carefully monitored due to potential side effects such as immunosuppression. Educationally, understanding the rationale behind each treatment option is crucial for pediatric nurses to provide safe and effective care to children with rheumatic fever. It is essential to consider contraindications, appropriate dosages, and potential adverse effects when managing these complex cases.

Correct Answer: B

Rationale: In the management of newly diagnosed bronchial asthma with occasional symptoms, the most appropriate treatment is a low dose inhaled corticosteroid (ICS), which is option B. The rationale behind this is that ICS is recommended as first-line therapy for asthma due to its anti-inflammatory effects, which help to reduce airway inflammation and prevent symptoms. It is effective in controlling asthma symptoms and reducing the frequency and severity of asthma attacks. Inhaled short-acting B2 agonists (option A) are used for quick relief of acute symptoms but are not recommended as monotherapy for long-term asthma control. Anti-leukotrienes (option C) are typically used as adjunctive therapy for asthma and not as first-line treatment. Slow-release theophylline (option D) is less commonly used now due to its narrow therapeutic window and potential for toxicity. From an educational perspective, understanding the rationale behind the choice of treatment is crucial for nursing students to provide safe and effective care to pediatric patients with asthma. It is important for students to grasp the principles of asthma management, including the use of ICS as a cornerstone of treatment, to ensure optimal outcomes for their patients. By explaining the reasons why certain options are correct or incorrect, students can develop a deeper understanding of the pharmacological management of asthma and make informed clinical decisions in their practice.

Correct Answer: B

Rationale: In neonates, apnea of prematurity is primarily due to an immature central respiratory control system. This means that the brainstem, responsible for regulating breathing, is not fully developed in premature infants, leading to periods of apnea where breathing ceases temporarily. Option A) Airway obstruction is not the primary cause of apnea in premature infants. While airway issues can contribute to breathing difficulties, it is not the main reason for apnea of prematurity. Option C) Congenital heart disease may present with respiratory symptoms, but it is not the underlying cause of apnea in premature infants. Heart defects can impact circulation and oxygenation but are not directly linked to the immature respiratory control seen in apnea of prematurity. Option D) Neuromuscular disorders can also lead to breathing difficulties, but in the case of apnea of prematurity, the main issue lies in the immaturity of the central respiratory control system rather than a specific neuromuscular disorder. Educationally, understanding the specific etiology of apnea in premature infants is crucial for pediatric nurses to provide appropriate care and interventions. Recognizing that it is the immature central respiratory control system that is primarily responsible helps guide nursing assessments and interventions to support respiratory function in these vulnerable patients.

Correct Answer: C

Rationale: In this scenario, the most concerning diagnosis for a newborn presenting with delayed meconium passage, abdominal distension, and bilious vomiting is Hirschsprung disease (Option C). Hirschsprung disease is a congenital condition where there is a lack of ganglion cells in the distal colon, leading to functional obstruction. The rationale for why Hirschsprung disease is the correct answer lies in the classic presentation of symptoms such as delayed passage of meconium, abdominal distension due to the blocked colon, and bilious vomiting, which are indicative of a significant obstruction in the bowel. Regarding the other options: - A) Meconium plug syndrome: While it can cause bowel obstruction in newborns, it typically presents with a different clinical picture and does not involve the absence of ganglion cells. - B) Cystic fibrosis: Although it can present with gastrointestinal symptoms, it is less likely to cause the specific combination of symptoms described in the question. - D) Malrotation with volvulus: This condition involves a twisting of the bowel, which can lead to similar symptoms, but the absence of ganglion cells, as seen in Hirschsprung disease, is not a feature of malrotation. Educationally, understanding the differentiation between these conditions is crucial for pediatric nurses as it guides their clinical reasoning and decision-making in assessing and managing newborns with gastrointestinal symptoms. Recognizing the red flags for Hirschsprung disease can prompt timely interventions and prevent complications associated with this condition.