The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness?

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Strep throat. This child is presenting with symptoms suggestive of Sydenham chorea, a complication of untreated streptococcal infection. Sydenham chorea is characterized by spastic movements, facial grimaces, and speech disturbances, worsened by anxiety and relieved by sleep. Understanding this association between streptococcal infection and Sydenham chorea is crucial for nurses to provide appropriate care and education to patients and families. A) Kawasaki disease (KD) is unlikely in this case as it presents with symptoms like fever, rash, conjunctivitis, strawberry tongue, and swollen hands/feet. These symptoms do not align with the clinical presentation described in the question. C) Malignant hypertension typically presents with severe hypertension, headache, blurred vision, and can lead to end-organ damage. The symptoms described do not match those of malignant hypertension. D) Atrial fibrillation is an abnormal heart rhythm that can present with palpitations, chest discomfort, dizziness, and fatigue. The symptoms described in the question are not indicative of atrial fibrillation. Nurses need to be knowledgeable about the various manifestations of different conditions, especially in pediatrics, to provide timely and effective care. Understanding the link between streptococcal infection and Sydenham chorea can prompt early intervention and prevent long-term complications.

Correct Answer: B

Rationale: In the context of pediatric cardiovascular conditions, the correct answer to the question, "Which patient could require feeding by gavage?" is option B) Toddler with repair of transposition of the great vessels. Gavage feeding, also known as tube feeding, may be necessary in this case due to the postoperative recovery period following a major cardiac surgery like the repair of transposition of the great vessels. In this scenario, the correct answer is right because after undergoing such a complex surgical procedure, the toddler may have temporary difficulty with oral feeding due to factors like intubation, prolonged anesthesia, or decreased appetite. Gavage feeding ensures adequate nutrition and hydration during this critical recovery phase when oral intake may be insufficient. Now, let's explore why the other options are incorrect: - Option A) Infant with congestive heart failure (CHF): While infants with CHF may have feeding difficulties, gavage feeding is not typically the first-line intervention in managing CHF unless there are severe complications affecting oral intake. - Option C) Toddler with Kawasaki disease (KD) in the acute phase: Children with KD may have fever and inflammation, but gavage feeding is not typically a primary intervention for this condition unless there are specific complications impacting oral feeding. - Option D) School-age child with rheumatic fever (RF) and chorea: Chorea, a movement disorder associated with RF, does not directly indicate the need for gavage feeding. Nutritional support in RF is generally managed through standard oral intake unless there are specific complications. Educationally, understanding the rationale behind the need for gavage feeding in pediatric patients with complex cardiovascular conditions is crucial for nurses and healthcare providers. It highlights the importance of individualized care and appropriate nutrition support strategies in addressing the unique needs of children recovering from cardiac surgeries. This knowledge enhances patient safety, promotes optimal recovery outcomes, and underscores the significance of comprehensive care in pediatric pharmacology and nursing practice.

Correct Answer: C

Rationale: In the context of caring for a child with rheumatic fever (RF), option C, "I will give him the aspirin that is ordered for pain and inflammation," is the correct choice. This statement demonstrates a good understanding because aspirin is commonly prescribed to manage pain and inflammation in RF due to its anti-inflammatory and analgesic properties. Aspirin also helps prevent complications like rheumatic heart disease in RF patients. Option A suggesting applying heat to swollen joints is incorrect because heat can exacerbate inflammation and should be avoided in RF. Option B recommending gentle stretching exercises is also incorrect as aggressive exercise can lead to further joint damage in RF. Option D suggesting cold packs for reducing pain is not ideal as cold therapy can worsen vasoconstriction and pain in RF. Educationally, understanding the rationale behind the use of aspirin in RF is crucial for nursing students to provide safe and effective care to pediatric patients with this condition. It is essential for nurses to be aware of the appropriate pharmacological interventions and their implications in managing RF symptoms to promote optimal outcomes for these young patients.

Correct Answer: C

Rationale: In pediatric patients presenting with chest pain, pneumonia is the most common cause. This is due to the high prevalence of respiratory infections in children, leading to inflammation of the lung tissue and subsequent chest pain. Pneumonia can trigger pleuritic chest pain, which worsens with coughing or deep breathing. Myocarditis (option A) is less common in pediatric patients and is typically characterized by symptoms like fatigue, shortness of breath, and arrhythmias rather than isolated chest pain. Pericarditis (option B) is rare in children and is more commonly associated with viral infections or autoimmune conditions. Pleurisy (option D) refers to inflammation of the pleura, the lining around the lungs, and is less common than pneumonia in causing chest pain in pediatric patients. Educationally, understanding the differential diagnosis of chest pain in pediatric patients is crucial for nursing professionals. Recognizing pneumonia as a common cause can help in prompt evaluation, treatment, and alleviating parental anxiety. It also underscores the importance of thorough assessment and knowledge of age-specific conditions in pediatric pharmacology and nursing practice.

Correct Answer: B

Rationale: In this question, the correct answer is B) coarctation of aorta, as it is not a common cause of heart failure in full-term neonates. Coarctation of the aorta typically presents with symptoms related to decreased lower extremity pulses rather than heart failure in neonates. Option A) asphyxial can lead to hypoxia and subsequent heart failure in neonates due to inadequate oxygen supply. Option C) hypoplastic left heart syndrome and option D) transposition of great arteries are congenital heart defects that can result in heart failure in full-term neonates due to structural abnormalities affecting the heart's ability to pump effectively. In an educational context, understanding the various causes of heart failure in neonates is crucial for nurses caring for pediatric patients. Recognizing these conditions early can lead to prompt intervention and improved outcomes for neonates with cardiovascular conditions. Nurses should be knowledgeable about common cardiac defects and their associated presentations to provide optimal care and support to neonates and their families.