D447 Women and Children - Set 3 - Part 3

Correct Answer: Swimming for resistance exercise without joint impact

Option d is correct because swimming provides muscle-strengthening resistance exercise and cardiovascular benefit while the buoyancy of water eliminates joint impact, making it particularly recommended for children with juvenile arthritis who need activity without joint stress. Option a is incorrect because competitive high-impact sports like basketball involve repetitive jumping and jarring movements that place excessive stress on inflamed joints, potentially worsening damage and pain rather than providing the low-impact exercise this child needs. Option b is incorrect because prolonged bed rest and activity restriction leads to muscle weakness, joint stiffness, and deconditioning that actually worsens arthritis outcomes, as regular appropriate exercise is essential for maintaining joint function and overall health. Option c is incorrect because long-distance running creates repetitive high-impact loading on weight-bearing joints that can exacerbate inflammation and accelerate joint d

Correct Answer: Warm baths or heat application before getting dressed

Option a is correct because warm baths and heat application are specifically recommended to reduce morning stiffness in juvenile arthritis by increasing blood flow and joint flexibility, helping the child transition into daily activities more comfortably each morning. Option b is incorrect because cold therapy is used for acute inflammation and swelling rather than chronic morning stiffness, and applying cold packs to stiff joints upon waking would likely increase discomfort and further restrict the joint mobility the child needs to start the day. Option c is incorrect because vigorous stretching on stiff joints immediately upon waking can cause pain and potential injury, while gentle movement after warming the joints with heat is the recommended approach to safely reducing morning stiffness in juvenile arthritis. Option d is incorrect because remaining in bed until stiffness resolves passively can take hours and reinforces inactivity, while active interventions like warm baths followe

Correct Answer: Explaining that abruptly stopping corticosteroids is dangerous

Option b is correct because abrupt discontinuation of long-term corticosteroid therapy can cause adrenal crisis, a potentially life-threatening condition, and the nurse's priority is ensuring the child understands the medication cannot be stopped suddenly without provider-guided tapering. Option a is incorrect because while validating the child's frustration is therapeutically appropriate, the immediate safety priority when a child expresses intent to stop long-term corticosteroids independently is educating about the serious danger of abrupt discontinuation before addressing dose modifications. Option c is incorrect because agreeing to stop corticosteroids based on bothersome side effects without provider consultation ignores the life-threatening risk of adrenal crisis from abrupt discontinuation and is outside the nurse's scope of practice to recommend. Option d is incorrect because corticosteroid side effects from long-term therapy do not resolve within days, and prov

Correct Answer: Flexible scheduling with movement breaks and activity modification

Option c is correct because children with juvenile arthritis benefit from flexible scheduling that allows movement breaks to reduce stiffness and modified activities that enable participation, supporting both physical health and normal school engagement without unnecessary restriction. Option a is incorrect because permanent exemption from physical education removes beneficial exercise opportunities and socially isolates the child, while activity modification within physical education allows safe participation and maintains the therapeutic benefits of regular movement. Option b is incorrect because shortened school days unnecessarily limit academic and social opportunities when flexible scheduling and accommodations within the full school day can effectively manage symptoms while maintaining normal educational participation and peer interaction. Option d is incorrect because a full-time aide is excessive for most children with juvenile arthritis whose needs can be met through environme

Correct Answer: Increased infection susceptibility from immunosuppression

Option d is correct because biologic disease-modifying agents suppress components of the immune system to control autoimmune inflammation, significantly increasing infection susceptibility, and new fever with respiratory symptoms requires urgent evaluation for serious infection in this immunosuppressed child. Option a is incorrect because while biologic infusion reactions can occur, they typically present during or shortly after administration with symptoms like flushing and itching rather than delayed onset fever and cough developing a full week after treatment. Option b is incorrect because while a coincidental viral illness is possible, the nurse must prioritize the concern that biologic immunosuppression increases infection risk, and assuming the illness is unrelated without thorough evaluation could miss a serious opportunistic infection. Option c is incorrect because allergic hypersensitivity to biologics typically manifests as urticaria, angioedema, or anaphylaxis during or shor

Correct Answer: Albumin loss causing decreased plasma oncotic pressure

Option b is correct because massive urinary protein loss in nephrotic syndrome depletes serum albumin, which reduces plasma oncotic pressure and allows fluid to shift from the intravascular space into the interstitial tissues, producing the characteristic generalized edema. Option a is incorrect because while sodium and water retention occur secondarily in nephrotic syndrome, the primary pathophysiologic driver of edema is the loss of albumin through damaged glomeruli, which decreases oncotic pressure and initiates the fluid shift into tissues. Option c is incorrect because nephrotic syndrome involves glomerular permeability to proteins rather than widespread inflammatory capillary damage, and the edema results from albumin depletion and oncotic pressure loss rather than a generalized vascular inflammatory process. Option d is incorrect because the edema in nephrotic syndrome is driven by protein loss through the kidneys and resulting oncotic pressure changes, not cardiac failure, thou

Correct Answer: Increased susceptibility to infections and weight gain

Option a is correct because corticosteroids suppress immune function increasing infection risk and cause weight gain through increased appetite and fluid retention, both being common and clinically significant side effects families must understand and monitor throughout treatment. Option b is incorrect because while prolonged corticosteroid use can affect bone density, the bone effects in children are generally monitored and managed rather than being immediate or universally permanent, and infection risk and weight gain are more immediately relevant teaching priorities. Option c is incorrect because hair loss is not a typical side effect of corticosteroid therapy, and describing it as immediate and beginning within the first week is inaccurate, potentially causing unnecessary anxiety about a symptom that is not expected with this medication class. Option d is incorrect because corticosteroids typically cause sodium and water retention leading to fluid overload and potentially elevated

Correct Answer: Untreated deficiency causing irreversible brain development delay

Option c is correct because thyroid hormone is essential for normal brain development in infancy, and untreated congenital hypothyroidism leads to irreversible cognitive and developmental delays, making prompt initiation of levothyroxine replacement therapy critically urgent despite initial normal appearance. Option a is incorrect because while thyroid dysfunction can eventually affect cardiovascular function, the primary urgency for treating congenital hypothyroidism in newborns is preventing irreversible brain damage rather than immediate cardiac failure, which is not the typical early presentation. Option b is incorrect because while prolonged neonatal jaundice is an early sign of congenital hypothyroidism, the primary treatment urgency is not preventing liver damage from jaundice but rather protecting the developing brain from the irreversible cognitive effects of thyroid hormone deficiency. Option d is incorrect because congenital hypothyroidism does not typically cause rapid seve

Correct Answer: Providing fast-acting carbohydrates to raise blood glucose

Option b is correct because sweating, trembling, and confusion after increased physical activity in a child with type one diabetes are classic signs of hypoglycemia, and the immediate priority is providing fast-acting carbohydrates like juice or glucose tablets to rapidly raise blood sugar. Option a is incorrect because glucagon injection is reserved for severe hypoglycemia when the child is unconscious or unable to swallow safely, and this student is still conscious and able to take oral carbohydrates, making fast-acting oral glucose the appropriate first intervention. Option c is incorrect because hypoglycemia requires immediate treatment with fast-acting carbohydrates rather than waiting thirty minutes, as untreated hypoglycemia can rapidly progress to seizures, loss of consciousness, and potentially life-threatening complications in a child with diabetes. Option d is incorrect because administering insulin to a child showing signs of hypoglycemia would dangerously lower blood gluco

Correct Answer: Pyelonephritis requiring monitoring for signs of systemic sepsis

Option d is correct because high fever, flank pain, vomiting, and urinalysis showing bacteria with white blood cells indicate kidney infection, and pyelonephritis can progress to sepsis, making vigilant monitoring for systemic deterioration the nursing priority throughout treatment. Option a is incorrect because lower urinary tract infection typically presents with dysuria, frequency, and urgency without the high fever, flank pain, and systemic symptoms seen in this child, whose presentation clearly indicates upper tract kidney involvement requiring more intensive monitoring. Option b is incorrect because while appendicitis can cause right-sided pain and vomiting, the presence of significant urinary findings including bacteria, white blood cells, and nitrites on urinalysis points to a urinary tract source rather than an appendiceal process. Option c is incorrect because while renal calculi can cause flank pain, the combination of high fever, positive urinalysis with bacteria and white