A 10-year-old child presents with joint pain, low-grade fever, and a history of untreated strep throat 3 weeks ago. The nurse recalls that rheumatic fever is an autoimmune reaction following Group A Streptococcus infection. Which of the following complications should the nurse prioritize monitoring for?

Pulmonary hypertension leading to increased peripheral resistance

Pancarditis leading to long-term valve damage, especially the mitral valve

Acute kidney injury leading to bladder insufficiency

Coronary artery aneurysms arising from hypertension

Answer and Explanation

The Correct Answer is B

A. Pulmonary hypertension is not a primary complication of rheumatic fever. While pulmonary vascular changes can occur secondary to left-sided heart dysfunction, this is not the main concern in acute rheumatic fever.

B. Rheumatic fever is an autoimmune response to Group A Streptococcus. It can involve the heart (carditis), joints (polyarthritis), skin (erythema marginatum), and central nervous system (Sydenham chorea). Cardiac involvement is the most serious complication. Pancarditis may affect the endocardium, myocardium, and pericardium, but valvular damage, especially to the mitral valve, can persist long-term, potentially leading to rheumatic heart disease. Monitoring for heart murmurs, arrhythmias, and signs of heart failure is critical.

C. While post-streptococcal glomerulonephritis can follow strep infection, rheumatic fever does not primarily affect the kidneys, and bladder insufficiency is unrelated.

D. Coronary artery aneurysms are associated with Kawasaki disease, not rheumatic fever. Hypertension is not a direct feature of rheumatic fever, and coronary involvement is not typical.

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Free Nursing Study Resources

Correct Answer is D

Explanation

A. This scale requires the child to understand numbers and quantify pain. A 5-year-old who has difficulty with numbers cannot reliably use this scale, making it inappropriate.

B. While FLACC is excellent for observational assessment of nonverbal or pre-verbal children, it does not allow the child to self-report pain. Since the nurse wants the child to self-report, this is not the best choice.

C. This scale requires the child to mark a point on a line representing their pain intensity. It also requires abstract thinking and fine motor skills, which may be challenging for a 5-year-old, especially if they can’t reliably understand numbers or gradients.

D. The Oucher scale uses pictures of faces showing increasing pain intensity along with a numeric scale. For children who understand pictures but struggle with numbers, this scale allows them to self-report pain by pointing to the face that matches their discomfort. It is validated for children aged 3–12 years, making it the most appropriate choice for a 5-year-old who can use pictorial cues.

A. Lymphoid tissue, including tonsils, normally enlarges in early childhood and may exceed adult size before gradually shrinking in adolescence. B. This finding is abnormal and warrants an urgent referral to an ENT specialist. C. The enlarged tonsils suggest the child's immune system is underdeveloped. D. The enlarged tonsils indicate a chronic infection that requires immediate antibiotic treatment.

Correct Answer is A

Explanation

A. Tonsils are part of the lymphatic system, which is most active in early childhood to help the body respond to infections and build immunity. It is common for tonsils to appear large in healthy children between ages 3 and 6. This is a normal physiological finding and usually does not indicate illness unless accompanied by symptoms such as fever, difficulty breathing, or recurrent infections.

B. While significantly enlarged tonsils causing airway obstruction, sleep apnea, or recurrent infections may require evaluation, tonsillar enlargement alone in an otherwise healthy child is typically normal and does not require urgent referral.

C. Enlarged tonsils in this age group indicate a normally active immune system, not underdevelopment. They help the body recognize and respond to antigens, supporting healthy immune function.

D. Chronic or acute infections may cause tonsillar enlargement, but in the absence of symptoms such as fever, redness, or exudate, there is no evidence of infection, and antibiotics are not indicated.

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Naxlex Comprehensive Predictor Exams

A 5-year-old child is scheduled for a vaccination. The nurse wants the child to self-report pain. The child can understand pictures but has difficulty with numbers. Which pain assessment tool is MOST appropriate?

Correct Answer is D

Explanation

During a routine checkup, a nurse observes that a 4-year-old child has noticeably enlarged tonsils but is otherwise healthy with no signs of infection. The child's parents express concern. Which statement BEST explains this finding?

Correct Answer is A

Explanation

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