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

Answer and Explanation

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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Correct Answer is B

Explanation

A. "Since ADHD is genetic, we need to know if other family members have been diagnosed to determine if your child has it." While ADHD has a genetic component, a family history alone is not sufficient to diagnose the condition. A proper diagnosis requires a comprehensive evaluation, not just genetic predisposition.

B. "Your child will need a comprehensive evaluation, based on specific criteria including a detailed history and behavior assessment." ADHD diagnosis is based on clinical criteria from the DSM-5, which includes a thorough history, observation of symptoms in multiple settings, and standardized behavior assessments. This ensures an accurate and well-supported diagnosis.

C. "If your child shows symptoms of ADHD at home but not at school, they can still be diagnosed with ADHD." ADHD symptoms must be present in at least two different settings, such as home and school, to meet diagnostic criteria. If symptoms are only seen in one setting, another cause may be responsible for the child’s behavior.

D. "ADHD can be confirmed with a blood test, so we should schedule one for your child." There is no laboratory test, imaging, or biomarker that can diagnose ADHD. Diagnosis is based on behavioral criteria and clinical evaluation rather than medical testing.

A. Ask the parents to escort the child's sibling to the family lounge so they are not in the child's room. B. Consult the child life specialist to provide age-appropriate activities and emotional support to the sibling. C. Provide the sibling with coloring pages and crayons to keep them occupied in the child's room. D. Offer the sibling a tour of the hospital unit to help them become more familiar with the environment.

Correct Answer is B

Explanation

A. Ask the parents to escort the child's sibling to the family lounge so they are not in the child's room. Removing the sibling from the room does not address their distress or emotional needs. Siblings of hospitalized children may experience fear, anxiety, or feelings of exclusion, and they need support, not isolation.

B. Consult the child life specialist to provide age-appropriate activities and emotional support to the sibling. Child life specialists are trained to help children understand and cope with hospitalization through play, education, and emotional support. They can help the sibling process their emotions in an age-appropriate way.

C. Provide the sibling with coloring pages and crayons to keep them occupied in the child's room. While coloring can be a helpful distraction, it does not address the sibling’s distress or provide the emotional support they may need to understand their sibling’s condition.

D. Offer the sibling a tour of the hospital unit to help them become more familiar with the environment. A tour may help the child feel more comfortable, but it does not directly address their distress or emotions regarding their sibling’s hospitalization.

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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)

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