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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A"}
Explanation
Rationale for Correct Choices:
• Weak: Weak pedal pulses are typical because the narrowed aortic segment reduces blood flow to the lower extremities. This is a key clinical finding that often leads to suspicion of coarctation in children.
• Strong: Brachial pulses are typically strong or bounding because the narrowing occurs after the vessels to the upper body branch off, allowing normal or increased perfusion to the arms.
Rationale for Incorrect Choices:
• Absent: Completely absent pedal pulses are uncommon in coarctation of the aorta unless the narrowing is extremely severe or there is complete arterial obstruction. Most clients will have diminished but still palpable pedal pulses.
• Bounding: Bounding pedal pulses would indicate increased blood flow to the lower extremities, which is not seen in coarctation of the aorta. Instead, bounding pulses are usually found in the upper extremities in this condition.
• Weak: Weak brachial pulses would suggest reduced blood flow to the upper extremities, which is inconsistent with the anatomy of coarctation where the narrowing is distal to these branches.
• Thready: Thready pulses indicate low stroke volume or shock states, which are not characteristic of compensated coarctation. In coarctation, upper extremity pulses remain strong unless severe heart failure develops.
Correct Answer is ["A","B","D"]
Explanation
Rationale:
A. "It is so scary to think that our child will likely develop epilepsy now.": While febrile seizures can be frightening, most children who experience them do not go on to develop epilepsy. This misconception needs to be addressed to reduce parental anxiety.
B. "We have never had anyone in our family have a febrile seizure so I was so surprised when this happened.": Although family history can increase risk, febrile seizures can occur in children without a family history. Parents may benefit from education about the unpredictability and prevalence of febrile seizures.
C. "I am thankful that our child won't have to be on anti-seizure medication.": This reflects an accurate understanding, as most febrile seizures do not require ongoing anti-seizure medication, so no further teaching is necessary.
D. “I am afraid that our 10-year-old will start having febrile seizures.": Febrile seizures typically occur between 6 months and 5 years of age, so it is unlikely that a 10-year-old would develop them.
E. "It's important to manage fevers in the future in order to decrease the risk of febrile seizures.": While it is true that managing a fever does not always prevent a febrile seizure, it is a crucial and appropriate part of the management plan.
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