Which of the following is a hallmark feature of dermatomyositis?

Correct Answer: D

Rationale: In pediatric nursing, understanding the hallmark features of dermatomyositis is crucial for accurate diagnosis and effective management. The correct answer is D) All of the above. Dermatomyositis is characterized by a combination of muscle weakness and skin rash, making it a unique condition. Muscle weakness is a significant feature of dermatomyositis, often involving proximal muscles such as the shoulders and hips. This weakness can lead to difficulties with mobility and activities of daily living in affected children. The presence of a rash is another key feature of dermatomyositis. The rash typically appears on the face, elbows, knees, and knuckles, with a characteristic reddish or purplish discoloration. This rash is often described as a heliotrope rash and can help differentiate dermatomyositis from other conditions. Joint pain, on the other hand, is not a hallmark feature of dermatomyositis. While children with dermatomyositis may experience muscle pain and discomfort, joint pain is not a primary characteristic of this condition. Educationally, understanding the unique clinical presentation of dermatomyositis is essential for nurses caring for pediatric patients. Recognizing the triad of muscle weakness, rash, and other associated symptoms can prompt timely intervention and appropriate referrals to specialists for further evaluation and treatment. This knowledge enhances the quality of care provided to children with dermatomyositis and contributes to better outcomes.

Correct Answer: A

Rationale: Renewable energy sources, such as solar and wind power, offer numerous benefits. The correct answer, option A, highlights the reduction in greenhouse gas emissions as a key advantage of renewable energy. This is because these sources do not produce the same levels of carbon dioxide and other pollutants as fossil fuels, thus helping mitigate climate change and its associated health risks. Option B, increased reliance on fossil fuels, is incorrect because the whole point of renewable energy is to move away from dependence on non-renewable resources like coal and oil. Option C, higher air pollution, is also incorrect as renewable energy sources actually contribute to cleaner air quality by reducing harmful emissions. Option D, greater water usage, is not a typical issue associated with renewable energy, as these sources generally require minimal water compared to traditional power plants. From an educational standpoint, understanding the benefits of renewable energy is crucial for healthcare professionals, including pediatric nurses. Climate change has significant implications for children's health, with effects ranging from increased respiratory illnesses due to air pollution to the spread of vector-borne diseases. By promoting awareness of renewable energy benefits, nurses can advocate for sustainable practices that support a healthier environment for children and future generations.

Correct Answer: C

Rationale: The correct answer is C) indomethacin. Indomethacin belongs to a class of NSAIDs known to cause a unique skin reaction called "fixed drug eruption." This reaction presents as small, hypopigmented, depressed scars after resolution of the initial rash. The mechanism is thought to involve immune-mediated cytotoxicity resulting in localized tissue damage. Celecoxib (A) and meloxicam (B) are selective COX-2 inhibitors and are not typically associated with fixed drug eruptions. Ibuprofen (D) is a non-selective NSAID, but it is less commonly linked to this specific skin reaction compared to indomethacin. In a pediatric nursing context, understanding the potential adverse effects of medications like NSAIDs is crucial for safe and effective patient care. Recognizing unique drug reactions can aid in prompt identification, management, and prevention of similar occurrences in the future. This question highlights the importance of pharmacovigilance and critical thinking in pediatric nursing practice.

Correct Answer: D

Rationale: In the case presented, the correct answer is D) hypertriglyceridemia. Explanation: Macrophage activation syndrome (MAS) is a severe, potentially life-threatening complication of various rheumatic diseases in children, characterized by excessive immune system activation and cytokine release. One of the key distinguishing features of MAS is the presence of hypertriglyceridemia, which is a result of the dysregulated immune response leading to abnormal lipid metabolism. Why the other options are incorrect: A) Leucopenia: While leucopenia can be seen in MAS, it is not a specific enough marker to definitively distinguish MAS from a flare of the primary disease as it can also occur in various inflammatory conditions. B) ESR (erythrocyte sedimentation rate): ESR is a non-specific marker of inflammation and can be elevated in both MAS and a flare of the primary disease, making it less useful for differentiation. C) Failing hypofibrinogenemia: Hypofibrinogenemia is a common finding in MAS, but it is not as specific or sensitive as hypertriglyceridemia in distinguishing MAS from a flare of the primary disease. Educational context: Understanding the clinical manifestations and diagnostic criteria for MAS is crucial for pediatric nurses caring for children with rheumatic diseases. Recognizing the key laboratory findings such as hypertriglyceridemia can aid in early identification and prompt management of MAS, which is essential for improving patient outcomes. Nurses play a vital role in monitoring and assessing these patients, making knowledge of MAS and its diagnostic markers essential in pediatric nursing practice.

Correct Answer: A

Rationale: In pediatric nursing, understanding reactive arthritis is crucial as it can have significant implications for patient care. In this case, the least likely microorganism to cause reactive arthritis is Clostridium difficile (Option A). The correct answer is A because Clostridium difficile is primarily associated with gastrointestinal infections and is not a common causative agent of reactive arthritis. On the other hand, Salmonella paratyphi, Shigella, and Yersinia enterocolitica are known to be linked with reactive arthritis due to their ability to trigger an inflammatory response in the joints following an infection. Educationally, this question highlights the importance of recognizing the diverse range of microorganisms that can lead to reactive arthritis in pediatric patients. By understanding the specific pathogens involved, nurses can better assess, diagnose, and manage patients presenting with joint inflammation post-infection. This knowledge is essential for providing effective and targeted care to pediatric patients with reactive arthritis.