NCLEX PEDIATRIC NURSING TEST BANK LATEST UPDATE EXAM WITH COMPLETE 100 Q&A’S WITH RATIONALES GUARANTEED PASS | RATED A+

1. Molly, with suspected rheumatic fever, is admitted to the pediatric unit. When obtaining the
child’s history, the nurse considers which information to be most important?
o A. A fever that started 3 days ago
o B. Lack of interest in food
o C. A recent episode of pharyngitis
o D. Vomiting for 2 days
Correct Answer: C. A recent episode of pharyngitis
A recent episode of pharyngitis is the most important factor in establishing the diagnosis of
rheumatic fever. Activation of the innate immune system begins with a pharyngeal infection that
leads to the presentation of S. pyogenes antigens to T and B cells. CD4+ T cells are activated and
production of specific IgG and IgM antibodies by B cells ensues (Cunningham, Pathogenesis of
group A streptococcal infections, 2000).
 Option A: The most common presenting features of ARF are fever (>90% of
patients) and arthritis (75% of patients). The most serious manifestation is carditis
(>50% of patients) because it can lead to chronic rheumatic heart disease—while
all other clinical features fully resolve, often within weeks.
 Option B: The child with ARF may exhibit a lack of interest in food, but this
cannot be specific only to ARF. The main clinical manifestation of ARF carditis
reflects the involvement of the endocardium, which presents as valvulitis of the
mitral valve (mitral regurgitation) and, less frequently, of the aortic valve (aortic
regurgitation).
 Option D: Although the child may have a history of vomiting, this finding is not
specific to rheumatic fever. A number of other clinical features are often observed
in patients with ARF but are not included as manifestations in the Jones Criteria,
including lethargy, abdominal pain, and epistaxis, as well as rapid sleeping pulse
rate and tachycardia out of proportion to fever