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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Correct Answer is B

Explanation

A. Directional trends describe the general patterns of growth, such as cephalocaudal (head-to-toe) or proximodistal (center-to-periphery) development. The scenario focuses on differences in the rate of skill acquisition, not the direction of development.

B. Developmental pace refers to the rate at which different skills or abilities emerge, which can vary among domains. In this scenario, the toddler’s language skills are advancing rapidly, while gross motor skills like running show little change, illustrating that different areas of development progress at different rates.

C. Sensitive periods refer to specific windows of time during which a child is particularly responsive to certain types of learning or stimuli, such as language acquisition. The scenario does not specify a critical timing for development, but rather differences in progression across skills, so sensitive periods are not the primary principle illustrated.

D. Sequential trends refer to the orderly and predictable progression of developmental milestones, such as crawling before walking. While the toddler is developing language, the scenario emphasizes rate differences, not the order in which skills emerge.

A. Collapse of alveoli due to surfactant deficiency and impaired gas exchange B. Bronchial smooth muscle relaxation and increased surfactant production C. Chronic airway inflammation, bronchoconstriction, and increased mucus production D. Acute upper airway infection leading to mucus obstruction in the sinuses

Correct Answer is C

Explanation

A. Alveolar collapse (atelectasis) due to surfactant deficiency is typically seen in neonatal respiratory distress syndrome, not asthma. Asthma primarily affects the airways, not alveolar surfactant production.

B. In asthma, bronchial smooth muscle constriction occurs, not relaxation. Surfactant production is not a central factor in asthma pathophysiology.

C. These features lead to edema and hyperresponsiveness, contraction of smooth muscle around the bronchi and bronchioles, and mucus accumulation, all contributing to the child’s symptoms.

D. While upper respiratory infections can trigger asthma exacerbations, sinus obstruction itself is not the primary pathophysiologic process in asthma. The key changes occur in the lower airways.

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Naxlex Comprehensive Predictor Exams

During a well-child visit, a nurse notes that a toddler has recently started speaking in short sentences, but gross motor skills such as running have shown little change. Which principle does this BEST illustrate?

Correct Answer is B

Explanation

Correct Answer is C

Explanation

A pregnant client completes the 1-hour glucose tolerance test (GTT) at 26 weeks' gestation. The nurse explains that if the blood glucose result is above ____ to ____mg/dL. It is considered a positive screening and the client will need a 3-hour oral glucose tolerance test.

A nurse is caring for a client who has preeclampsia and is being treated with magnesium sulfate IV. The client's urine output for the past hour is 25 mL and deep-tendon reflexes are absent. Which of the following actions should the nurse take? (Select all that apply)

A pregnant client has a history of opioid dependence. Which of the following are appropriate nursing interventions for managing her care? Select all that apply.

During a well-child visit, a parent asks why their 7-month-old has started to reach for objects with one hand before picking up smaller items with the fingers. Which explanation should the nurse give?

A 30-year-old Rh-negative pregnant woman is at 17 weeks gestation and has an Rh-positive partner. She has had no prior sensitization. She asks the nurse when she will receive Rho(D) immune globulin. Which of the following is the best response?

The nurse is performing an assessment on a pregnant patient with a diagnosis of severe preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis?