A nurse is collecting data from the chart of a child who has streptococcal pharyngitis after being admitted for suspected rheumatic fever. Which of the following findings should the nurse identify as an indication of possible rheumatic fever? (Select All that Apply)
Atrial fibrillation on the cardiac monitor
Elevated BUN and creatinine on morning laboratory results
Involuntary movements of extremities
Alopecia
Report of chest pain
Oliguria
Correct Answer : C,E
A. Atrial fibrillation on the cardiac monitor. Rheumatic fever can cause carditis, but atrial fibrillation is not a typical finding. Instead, valvular damage, tachycardia, or murmurs are more commonly observed.
B. Elevated BUN and creatinine on morning laboratory results. Rheumatic fever primarily affects the heart, joints, skin, and brain, not the kidneys. Elevated BUN and creatinine are more indicative of post-streptococcal glomerulonephritis, a separate complication of streptococcal infection.
C. Involuntary movements of extremities. Sydenham’s chorea, characterized by involuntary, jerky movements, is a classic neurologic manifestation of rheumatic fever. It results from inflammation affecting the basal ganglia of the brain.
D. Alopecia. Rheumatic fever does not cause alopecia. Hair loss is more commonly associated with autoimmune diseases such as lupus, not post-streptococcal complications.
E. Report of chest pain. Chest pain can indicate carditis, a major criterion for rheumatic fever. Inflammation of the heart's endocardium, myocardium, or pericardium may lead to pain, murmurs, or heart failure symptoms.
F. Oliguria. Decreased urine output is more commonly seen in post-streptococcal glomerulonephritis rather than rheumatic fever, as rheumatic fever primarily affects the heart, joints, and nervous system.
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Related Questions
Correct Answer is C
Explanation
A. Aspirin. Aspirin should never be given to a child with chickenpox due to the risk of Reye's syndrome, a rare but serious condition that can cause liver and brain damage when aspirin is used during viral infections.
B. Corticosteroid cream. While corticosteroids reduce inflammation, they are not recommended for chickenpox because they can suppress the immune response and potentially worsen the infection.
C. Oral antihistamine. Antihistamines such as diphenhydramine help relieve severe itching, which is a common symptom of chickenpox. Reducing itchiness can also help prevent scratching that may lead to skin infections and scarring.
D. Oral antibiotics. Chickenpox is caused by the varicella-zoster virus, so antibiotics are not needed unless a secondary bacterial infection (such as impetigo) develops from scratching the lesions.
Correct Answer is D
Explanation
A. Pyloric stenosis. Pyloric stenosis is a condition that affects infants, causing projectile vomiting due to the narrowing of the pyloric sphincter. It is not a complication of appendicitis and is unrelated to this child's condition.
B. Celiac disease. Celiac disease is an autoimmune disorder triggered by gluten consumption, leading to malabsorption and gastrointestinal symptoms. It is a chronic condition and is not associated with appendicitis or its complications.
C. Gastroenteritis. Gastroenteritis involves inflammation of the stomach and intestines, usually due to viral or bacterial infection. While it can cause abdominal pain, it is not a direct complication of appendicitis but rather a separate condition with similar symptoms.
D. Peritonitis. Peritonitis is the most serious complication of appendicitis and occurs when the inflamed appendix ruptures, leading to infection of the peritoneal cavity. It presents with severe abdominal pain, fever, rigidity, and signs of systemic infection, requiring urgent medical intervention.
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