Which of the following findings by the nurse are considered Major Characteristics of Rheumatic Fever as determined by the Jones Criteria? Select the FIVE that apply.
Jaundice
Subcutaneous Nodules
Polyarthritis
Chorea
Carditis
Erythema Marginatum
Decreased urine output
Correct Answer : B,C,D,E,F
Rationale:
A. Jaundice: This is not part of the Jones Criteria for rheumatic fever. While jaundice may occur with certain liver or hemolytic conditions, it is unrelated to the pathophysiologic features of rheumatic fever.
B. Subcutaneous Nodules: These are firm, painless nodules typically found over bony prominences or near joints and are a recognized major criterion for rheumatic fever. They are associated with severe carditis and indicate inflammation of connective tissue.
C. Polyarthritis: This is one of the most common major criteria. It involves migratory inflammation affecting large joints, with swelling, redness, and pain that shifts from one joint to another over several days.
D. Chorea: Also called Sydenham chorea or “St. Vitus dance,” this involves involuntary, purposeless movements and is a major neurological manifestation of rheumatic fever. It can appear weeks to months after the initial streptococcal infection.
E. Carditis: This includes inflammation of the heart’s endocardium, myocardium, and/or pericardium. Carditis is a major criterion and can present with new murmurs, cardiomegaly, or signs of heart failure.
F. Erythema Marginatum: This is a distinctive, non-pruritic, pink rash with a clear center and wavy margins that spreads outward. It is one of the major cutaneous manifestations in the Jones Criteria.
G. Decreased urine output: This is not part of the Jones Criteria and is more indicative of renal involvement, such as in acute glomerulonephritis, which can occur after streptococcal infections but is a separate condition from rheumatic fever.
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Related Questions
Correct Answer is D
Explanation
Rationale:
A. The infant's eye appears to be protruding: Protrusion of the eye, or proptosis, is more often linked to orbital tumors, severe infections, or trauma rather than retinoblastoma. Retinoblastoma primarily affects the retina inside the eye, not surrounding orbital structures.
B. The infant tugs and pulls at one ear: Ear pulling is more commonly associated with otitis media or ear discomfort. This behavior is not connected to retinoblastoma and would not be expected in a history related to an intraocular tumor.
C. The infant always keeps her eyes tightly closed: Persistent eye closure could be a sign of photophobia, eye irritation, or pain from corneal abrasions or infections, but it is not the hallmark presentation of retinoblastoma.
D. One pupil appears white: A white reflex in the pupil, known as leukocoria, is a classic finding in retinoblastoma. Parents may notice this when light shines in the child’s eye, where one pupil appears white instead of the normal red reflex.
Correct Answer is C
Explanation
Rationale:
A. The child withdraws and attempts to hide because they think the pain is a form of punishment: This is more typical of toddlers who have limited understanding and may associate pain with punishment, rather than preschoolers who have a better grasp of cause and effect.
B. The child denies being scared about pain in an attempt to seem brave, and withdraws to a game on mom's phone: While distraction techniques are effective, preschoolers are more likely to show visible signs of distress rather than denying fear completely, as their emotional expression is more open.
C. The child makes facial expressions such as brow contracting and chin quivering in anticipation of the pain: Preschool-aged children often express fear and anxiety about painful procedures through facial cues and body language, showing clear anticipation and emotional response.
D. The child kicks, hits and cries due to lack of control over the situation: This aggressive and oppositional behavior is more characteristic of toddlers or children with less developed coping skills, rather than preschoolers who generally have more emotional regulation.
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