Nokea
A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say:
- A. She will need to take the antibiotics until she is 18 years old.
- B. She will need to take the antibiotics for 5 years after the last attack.
- C. She will need to take the antibiotics for 10 years after the last attack.
- D. She will need to take the antibiotics for the rest of her life.
Correct Answer: D
Rationale: Valvular involvement indicates significant damage; therefore, lifelong prophylactic antibiotics are required.
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In the electrocardiogram of a 40-year old male, the QRS amplitude in lead I and aVF measured (+) 10 and (-)10mV respectively. The frontal QRS axis is
- A. (+) 15°
- B. (-) 45°
- C. (-) 75°
- D. (-) 90°
Correct Answer: B
Rationale: The frontal QRS axis is (-) 45° given the QRS amplitudes in leads I and aVF.
Which vaccines must be delayed for 11 months after the administration of gamma globulin? (Select all that apply.)
- A. Diphtheria, tetanus, and pertussis
- B. Hepatitis B
- C. Inactivated polio virus
- D. Measles, mumps, and rubella
Correct Answer: D
Rationale: Live virus vaccines (MMR and Varicella) should be delayed for 11 months after gamma globulin infusion because the passive antibodies can interfere with vaccine efficacy.
Recurrent headaches in childhood are seen with:
- A. Tension headaches
- B. Migraine
- C. Sinusitis
- D. Hypermetropia
Correct Answer: B
Rationale: The correct answer is B because migraine is a common cause of recurrent headaches in children. The other options (a, c, d, e) are less common or present differently.
A psychiatric referral is warranted in a preschool child with the following:
- A. Night terrors
- B. Separation anxiety
- C. Scared of ghosts
- D. Masturbation
Correct Answer: B
Rationale: Separation anxiety in a preschool child, especially if it is severe and persistent, may warrant a psychiatric referral to assess for anxiety disorders.
Deafness can develop due to:
- A. Unconjugated hyperbilirubinaemia in the newborn
- B. Pneumococcal meningitis
- C. Alport syndrome
- D. Cleft palate
Correct Answer: B
Rationale: Pneumococcal meningitis is a known cause of sensorineural hearing loss due to inflammation and damage to the cochlea.