Which of the following clinical scenarios would most increase your degree of suspicion for bacterial endocarditis in a child?

Correct Answer: A

Rationale: The correct answer is option A: Fever, new cardiac murmur, splenomegaly. This clinical scenario raises suspicion for bacterial endocarditis in a child because bacterial endocarditis often presents with nonspecific symptoms like fever and can lead to the development of new cardiac murmurs due to valvular damage. Splenomegaly can also be a common finding in bacterial endocarditis due to embolic phenomena affecting the spleen. Option B (Tachypnea, tachycardia, cardiac murmur, sudden onset leg swelling) is less indicative of bacterial endocarditis as sudden onset leg swelling is more commonly associated with conditions like deep vein thrombosis or heart failure. Option C (Positive CRP, skin lesion, hepatomegaly) does not strongly suggest bacterial endocarditis as the presence of skin lesions and hepatomegaly are not specific to this condition. Option D (Positive ASO titre, progressively louder heart murmur, marked hepatomegaly) is more suggestive of acute rheumatic fever rather than bacterial endocarditis due to the positive ASO titre and the association with a progressively louder heart murmur. In an educational context, understanding the clinical manifestations and diagnostic indicators of bacterial endocarditis in children is crucial for timely identification and treatment of this serious condition. This knowledge helps pediatric nurses provide comprehensive care and support to children at risk for or diagnosed with bacterial endocarditis.

Correct Answer: D

Rationale: The correct answer is D) Chlamydia trachomatis. In pediatric nursing, it is crucial to understand the common causative organisms for different conditions to provide accurate care. Afebrile pneumonia in infancy is often caused by Chlamydia trachomatis, a bacteria commonly associated with respiratory infections in newborns. Staphylococcus (option A) is more commonly known for causing skin infections rather than afebrile pneumonia in infants. Hemophilus influenza (option B) is a common cause of respiratory infections in children but is not the most common causative organism for afebrile pneumonia in infancy. Streptococcus pneumoniae (option C) is a leading cause of bacterial pneumonia in children but is not typically associated with afebrile pneumonia in infants. Educationally, understanding the specific pathogens associated with different conditions helps nurses and healthcare providers make accurate clinical decisions, prescribe appropriate treatments, and provide targeted care. It also emphasizes the importance of early detection and appropriate management to prevent complications in pediatric patients.

Correct Answer: B

Rationale: The correct answer is B) T-ALL by immunophenotyping. In pediatric acute lymphoblastic leukemia (ALL), T-cell ALL (T-ALL) is considered an unfavorable prognostic factor due to its aggressive nature and poorer response to treatment compared to B-cell ALL. T-ALL is associated with a higher risk of relapse and lower overall survival rates. Option A) Age <10 years old is actually a favorable prognostic factor in pediatric ALL, as younger age is associated with better outcomes and response to therapy. Option C) Initial WBCs <50,000/mm³ is also a favorable prognostic factor, as lower white blood cell counts at diagnosis are associated with better outcomes. Option D) CSF free from blast cells is important for staging and treatment planning, but it is not a prognostic factor for ALL. In an educational context, understanding prognostic factors in pediatric ALL is crucial for nurses caring for pediatric oncology patients. Recognizing these factors helps in anticipating patient outcomes, guiding treatment decisions, and providing appropriate support to patients and families throughout the challenging treatment process. Nurses play a significant role in monitoring for signs of relapse, managing treatment side effects, and promoting adherence to therapy in pediatric ALL patients.

Correct Answer: B

Rationale: The correct answer is B) Bacterial Meningitis. In a 5-year-old girl with altered mental status and cerebrospinal fluid (CSF) findings of high white blood cells (WBCs) with predominantly neutrophils, low sugar, and high protein, the most likely diagnosis is bacterial meningitis. Bacterial meningitis is characterized by a high neutrophil count in the CSF, low glucose levels, and high protein levels. This is due to the acute inflammatory response caused by bacterial pathogens. The altered mental status is also a common symptom seen in bacterial meningitis due to the infection affecting the brain. Option A) Normal is incorrect as the clinical presentation and CSF findings are indicative of an abnormal, inflammatory process. Option C) Viral encephalitis typically presents with lymphocytic predominance in the CSF, as well as other specific clinical findings such as seizures and focal neurological deficits, which are not mentioned in the question stem. Option D) TB Meningitis would show a lymphocytic predominance in the CSF, and TB Meningitis is less common in this age group compared to bacterial meningitis. In an educational context, understanding the typical CSF findings and clinical presentations of different types of meningitis is crucial for pediatric nurses to provide timely and appropriate care. Recognizing the signs and symptoms of bacterial meningitis in children is vital as it is a medical emergency requiring prompt treatment to prevent serious complications.

Correct Answer: C

Rationale: In hemophilia A, which is a genetic disorder caused by deficiency of clotting factor VIII, the correct answer is C) Prolonged APTT (activated partial thromboplastin time). This is because hemophilia A specifically affects the intrinsic pathway of the coagulation cascade, leading to a prolonged APTT due to the deficiency of factor VIII. Option A) Prolonged bleeding time is incorrect because hemophilia A primarily affects clotting factors, not platelet function, which is assessed by bleeding time. Option B) Prolonged prothrombin time is incorrect because prothrombin time primarily evaluates the extrinsic pathway of the coagulation cascade, which is not primarily affected in hemophilia A. Option D) Prolonged thrombin time is incorrect because thrombin time evaluates the conversion of fibrinogen to fibrin, which is not directly impacted by factor VIII deficiency in hemophilia A. Educationally, understanding the specific clotting factors involved in hemophilia A and how they affect different parts of the coagulation cascade is crucial for accurate diagnosis and management of patients with this condition. Nurses caring for pediatric patients with hemophilia A need to recognize the importance of monitoring APTT levels and administering factor replacement therapy to prevent and treat bleeding episodes effectively.