A child with a history of strep throat presents with fever, shortness of breath, abdominal pain, and a very painful and swollen shoulder joint. Based on this history and presentation, what medical condition should be suspected?
Kawasaki disease
Rheumatoid heart disease
Coarctation of the Aorta
Dextro-transposition of the great arteries
The Correct Answer is B
A. Kawasaki disease typically presents with fever, conjunctivitis, rash, swollen hands/feet, and lymphadenopathy, not following strep throat or with joint pain as a primary feature.
B. Rheumatic heart disease is a complication of rheumatic fever, which can follow an untreated or inadequately treated streptococcal throat infection. The child’s symptoms—fever, shortness of breath (carditis), abdominal pain, and painful swollen joint (arthritis)—are classic signs of rheumatic fever, which can lead to long-term cardiac damage.
C. Coarctation of the aorta is a congenital condition involving narrowing of the aorta and typically presents with differential blood pressure between extremities, not joint swelling or post-streptococcal symptoms.
D. Dextro-transposition of the great arteries is a cyanotic congenital heart defect that presents in newborns, not older children with post-infectious symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Physical abuse typically presents with visible signs of injury, inconsistent explanations for trauma, or fearfulness around caregivers. While abuse may coexist, the pattern here involves medical fabrication rather than physical harm.
B. Munchausen by proxy (also known as factitious disorder imposed on another) occurs when a caregiver—usually a parent—exaggerates, fabricates, or induces illness in a child to gain attention or sympathy. The repeated vague complaints, specialist seeking, and now unconscious presentation strongly raise this concern.
C. Severe organic failure to thrive results from an underlying physical condition affecting growth and development, not from caregiver behavior. It also doesn't typically include extensive medical seeking behavior for vague, shifting symptoms.
D. Ingestion of a toxin is possible in any unconscious child, but in this context, without clear evidence of accidental exposure, it may actually be a result of the caregiver's actions in Munchausen by proxy. Thus, it is a potential symptom, not the root concern.
Correct Answer is A
Explanation
A. This response is clear, professional, and factual. Nurses are mandated reporters and are legally obligated to report any suspicion of child abuse, regardless of confirmation. This statement provides an appropriate explanation without placing blame or making accusations.
B. While involving a supervisor can be helpful, avoiding the question may increase tension and does not clarify the nurse’s legal duty.
C. Deflecting to the provider fails to acknowledge the nurse’s role and responsibility in mandated reporting.
D. This response shifts responsibility and may imply blame or avoid accountability, which is not appropriate or professional.
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