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Chemotherapeutic agents such as methotrexate and cyclophosphamide are sometimes used to treat JRA. Why are these medications used?
- A. Effective against cancer, like JRA.
- B. Affect the immune system.
- C. Are similar to NSAIDs.
- D. Are absorbed into the synovial fluid.
Correct Answer: B
Rationale: Chemotherapeutic agents like methotrexate and cyclophosphamide are used to treat Juvenile Rheumatoid Arthritis (JRA) because they work by suppressing the immune system. In JRA, the immune system is overactive and attacks the body's own tissues, leading to inflammation and joint damage. By suppressing immune system activity, these medications can help reduce inflammation and prevent further joint damage in patients with JRA.
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An adolescent patient, who has pelvic inflammatory disease (PID), inquires about the effects of the disease on their ability to bear children. What is the pediatric nurse's best response?
- A. The occurrence of spontaneous abortion during pregnancy increases with PID.
- B. There is an increased risk for ectopic pregnancy or infertility.
- C. There is an increased risk of placenta previa.
- D. There should be no problems with your ability to conceive.
Correct Answer: B
Rationale: PID can lead to scarring of the fallopian tubes, increasing the risk of ectopic pregnancy or infertility.
A 5-year-old child, recently diagnosed with ileocecal Burkitt lymphoma; lab investigations reveal: serum uric acid 12 mg/dl, serum sodium, 145 meq/dl; serum potassium, 4.5 meq/dl; serum phosphate 4.4 meq/dl; serum calcium, 8.9 mg/dl; blood urea, 22 mg/dl; serum creatinine, 0.8 mg/dl. Of the following, the MOST effective treatment is
- A. excessive hydration
- B. sodium bicarbonate
- C. xanthine oxidase inhibitor
- D. recombinant urate oxidase
Correct Answer: D
Rationale: Recombinant urate oxidase (rasburicase) effectively lowers uric acid levels in cases of tumor lysis syndrome.
A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first?
- A. Heart rate, respiratory rate, and bloodpressure
- B. Recent exposure to communicable diseases
- C. Number of immunizations received
- D. Height and weight
Correct Answer: A
Rationale: In this situation, the priority data the nurse should obtain first is the vital signs including heart rate, respiratory rate, and blood pressure of the child. This information will help assess the child's current physiological status and potential effects of ingesting the aspirin. Aspirin overdose in children can lead to serious complications such as metabolic acidosis, respiratory distress, and cardiovascular instability. Monitoring the vital signs will provide crucial information to guide appropriate interventions and determine the severity of the child's condition. Height and weight (option D) are important for routine assessments but not the priority in this urgent situation. Recent exposure to communicable diseases (option B) and number of immunizations received (option C) are not relevant to the immediate management of the child's aspirin ingestion.
The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?
- A. Actinic
- B. Arcus
- C. Asymmetry
- D. Assessment
Correct Answer: C
Rationale: In the ABCD method used to assess skin lesions for possible skin cancer, the letter A stands for Asymmetry. Asymmetry refers to the irregular shape of the lesion when one half of the lesion does not match the other half. Lesions that are symmetrical are less likely to be concerning for skin cancer, while asymmetrical lesions should be further evaluated by a healthcare professional. This characteristic helps in identifying potentially worrisome skin lesions early on for appropriate management.
A client with autoimmune thrombocytopenia and a platelet count of 8,000/ul develops epistaxis and melena. Treatment with corticosteroids and immunoglobulins has been unsuccessful, and the physician recommends a splenectomy. The client states, "I don't need surgery-this will go away on its own". In considering her response to the client, the nurse must depend on the ethical principle of:
- A. Beneficence
- B. Advocacy
- C. Autonomy
- D. Justice
Correct Answer: C
Rationale: The ethical principle most relevant in this situation is autonomy. Autonomy refers to a person's right to make decisions about their own care and treatment. In this case, the client is expressing her wish to avoid surgery and believes her condition will improve on its own. It is important for the nurse to respect the client's autonomy and involve her in the decision-making process regarding her treatment. The nurse should provide information, support, and guidance to help the client make an informed decision that aligns with her values and preferences. While the nurse can provide education and encourage the client to consider the physician's recommendation, ultimately the decision should respect the client's autonomy.