Which of the following instructions should Nurse Cheryl include in her teaching plan for the parents of Reggie with otitis media?

Correct Answer: D

Rationale: Nurse Cheryl should include in her teaching plan for Reggie's parents to avoid contact with people who have upper respiratory tract infections. Otitis media is often caused by upper respiratory infections, and exposure to individuals with such infections can increase the risk of exacerbating Reggie's condition or causing recurrent infections. Implementing measures to minimize exposure can help prevent further complications and promote faster recovery for Reggie. Placing the child in the supine position to bottle-feed may increase the likelihood of fluid entering the middle ear, worsening the otitis media. Giving amoxicillin on an empty stomach is not recommended as it can cause gastrointestinal upset and reduce absorption; instead, it should be given with food to enhance efficacy. Cleaning the inside of the ear canals with cotton swabs can be harmful and may cause damage or introduce infection, making it an inappropriate practice in managing otitis media.

Correct Answer: D

Rationale: When assessing a newborn and noticing a wide perineum and unequal gluteal and thigh folds, it may signal the possibility of developmental dysplasia of the hip (DDH), also known as hip dysplasia. DDH is a condition where the hip joint does not properly form in newborns, leading to instability and potential dislocation. The wide perineum and unequal gluteal and thigh folds are physical signs that can be indicative of hip dysplasia. It is essential to diagnose and treat hip dysplasia early to prevent long-term complications like difficulty walking and osteoarthritis. Regular screening of newborns for hip dysplasia risk factors and physical exam findings is crucial for early detection and intervention.

Correct Answer: C

Rationale: In Juvenile Rheumatoid Arthritis (JRA), which is now referred to as Juvenile Idiopathic Arthritis (JIA), the autoimmune reaction primarily occurs in the synovial tissue of the joints. The synovial tissue lines the inside of the joint capsule and produces synovial fluid, which helps to lubricate and nourish the joint. In JIA, the immune system mistakenly targets the synovial tissue, leading to inflammation, pain, and damage to the joints. This inflammatory process can result in swelling, warmth, stiffness, and eventual joint destruction if left untreated. Therefore, the synovial tissue is the primary site of the autoimmune reaction in JRA/JIA.

Correct Answer: D

Rationale: Hyporeflexia (reduced deep tendon reflexes) and bradycardia (slow heart rate) are not typical signs of diabetes mellitus (DM). The major signs of DM are the classic "3 Ps": polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive hunger). These symptoms are usually due to elevated blood glucose levels leading to increased thirst, frequent urination, and hunger. Additionally, unexplained weight loss can also be a common symptom of DM. Other complications related to DM, such as neuropathy, can lead to issues like hyporeflexia, but they are not considered major signs of DM itself.

Correct Answer: D

Rationale: A definitive diagnosis of sickle cell disease is based on hemoglobin electrophoresis. This test separates the different types of hemoglobin based on their electrical charge, allowing for the detection of abnormal hemoglobin variants such as hemoglobin S, which is characteristic of sickle cell disease. A complete blood count (CBC) can show various abnormalities seen in sickle cell disease, but it is not specific for confirming the diagnosis. Bone marrow aspiration is not routinely used for diagnosing sickle cell disease. Blood chemistry tests may reveal some complications associated with sickle cell disease but do not confirm the condition itself. Hemoglobin electrophoresis is the gold standard for diagnosing sickle cell disease by identifying the specific hemoglobin variant characteristic of the disorder.