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. "Palliative care should be given separately from curative care." B. "Clinicians should participate in the discussion with the family about the child's prognosis." C. "Parents who express hope of their child surviving are less accepting of palliative care." D. "Palliative care should be offered once a child has less than 6 months to live."

Correct Answer is B

Explanation

A. "Palliative care should be given separately from curative care." Palliative care can be provided alongside curative treatments to enhance comfort and quality of life. It is not limited to end-of-life care but focuses on symptom management and emotional support throughout the illness.

B. "Clinicians should participate in the discussion with the family about the child's prognosis." Open, honest, and compassionate communication between healthcare providers and families is crucial. Clinicians help families understand the prognosis, treatment options, and goals of care, ensuring informed decision-making.

C. "Parents who express hope of their child surviving are less accepting of palliative care." Parents can hope for a cure while still accepting palliative care to improve their child's comfort and quality of life. Hope and palliative care are not mutually exclusive.

D. "Palliative care should be offered once a child has less than 6 months to live." Palliative care is not limited to a specific timeframe. It can begin at diagnosis of a serious illness and continue throughout treatment, rather than being restricted to end-of-life care.

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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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