Treatment of juvenile dermatomyositis (JDM) includes pharmacological and non-pharmacological therapy. The mainstay of pharmacological therapy is corticosteroids that should be integrated with non-pharmacological therapy. Of the following, the recommendation that is LEAST part of non-pharmacological treatment program in JDM is

Correct Answer: D

Rationale: In the treatment of juvenile dermatomyositis (JDM), a comprehensive approach involving both pharmacological and non-pharmacological therapies is essential. The correct answer, D) bed rest, is the least appropriate non-pharmacological treatment program for JDM because maintaining mobility and activity is crucial in managing the condition. Physical therapy (option A) is an essential component of the non-pharmacological treatment program for JDM as it helps improve muscle strength, flexibility, and function. Occupational therapy (option B) is also important in helping children with JDM participate in daily activities and maintain independence. Avoidance of sun exposure (option C) is crucial in managing JDM as sunlight can exacerbate skin rashes and muscle weakness in these patients. On the other hand, bed rest can lead to muscle weakness, joint stiffness, and a decline in overall physical function, which are counterproductive in the management of JDM. Educationally, understanding the rationale behind each treatment option is crucial for healthcare providers caring for children with JDM. By knowing the appropriate non-pharmacological interventions, providers can offer comprehensive care that addresses both the physical and functional aspects of the condition, ultimately improving the quality of life for these patients.

Correct Answer: D

Rationale: The rationale is that tuberculin skin tests (TST) may give false-negative results immediately after arrival due to factors like recent travel stress or malnutrition. Therefore, repeating the test after 3-6 months ensures more accurate results. The other tests are generally required to be repeated for ongoing monitoring.

Correct Answer: D

Rationale: In the case of suspected child abuse in a 3-month-old with a severe head injury, the most helpful study to support this suspicion is a radionuclide bone scan (Option D). This is because a radionuclide bone scan can detect skeletal injuries that may not be visible on X-rays, especially in infants where their bones are still developing and may not show fractures easily. Choosing Option A, an infantogram, is not the best choice as it provides an overall body image but may miss specific bone injuries. Option B, X-rays of the spine, and Option C, X-rays of the skull, are limited in their ability to detect subtle fractures or injuries in other parts of the body. Educationally, understanding the importance of choosing the most appropriate diagnostic study in cases of suspected child abuse is crucial for healthcare providers working with pediatric patients. It highlights the need for thorough evaluation and consideration of imaging modalities that can provide the most comprehensive information to support a diagnosis and ensure the safety and well-being of the child.

Correct Answer: A

Rationale: In this scenario, the correct Apgar score for the infant is 7. The Apgar score is a quick assessment tool used to evaluate a newborn's physical condition at one minute and five minutes after birth. It consists of five components: heart rate, respiratory effort, muscle tone, reflex irritability, and color. For the given infant: - Pulse rate: at least 100 beats per minute (2 points) - Cyanotic hands and feet indicate some central cyanosis (1 point) - Good muscle tone and a strong cry and grimace suggest good reflex irritability (2 points) - However, the infant may lose 1 point for color if they are cyanotic (blue) in the extremities. So, the Apgar score calculation would be 2 + 1 + 2 - 1 = 4 + 3 = 7. Option B) 8 would be incorrect because cyanosis in the extremities would lead to a deduction in the color component, resulting in a score of 7, not 8. Option C) 9 would also be incorrect as the presence of cyanosis in the extremities would still lead to a slight deduction in the color component, making the score 7, not 9. Educationally, understanding the Apgar score is crucial for healthcare providers working with newborns to quickly assess their well-being and determine if immediate interventions are needed. It helps in identifying infants who may require additional support or monitoring after birth. Interpreting Apgar scores correctly is essential for providing appropriate care and support to newborns during a critical period of transition.

Correct Answer: C

Rationale: The correct answer is C) Renal ultrasonography. In this case, the patient presents with multiple congenital anomalies including a ventricular septal defect, cleft lip and palate, and imperforate anus. Renal ultrasonography is not necessary in the initial workup of these specific conditions. A) A karyotype analysis would be appropriate to check for any chromosomal abnormalities that may be associated with multiple congenital anomalies. B) TORCH titer is important to rule out infections such as toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus which can cause congenital defects. D) Ultrasonography of the brain can help in assessing for any structural abnormalities in the brain that could be associated with the other congenital anomalies present. Educationally, understanding the rationale behind selecting appropriate laboratory tests based on the clinical presentation is crucial in pediatric nursing practice. It helps in providing comprehensive care and early interventions for newborns with complex medical conditions.