Question

A telephone advice RN receives a call from a parent regarding her 6-year-old child. The mother reports that the child developed a sore throat, fever, and lethargy that morning. The child also reports pain upon swallowing.

1. The RN advises the mother to assess the child's oral cavity. The observation of which clinical sign would be most significant in the diagnosis of pharyngitis caused by a streptococcal organism?

White pockets of exudate

Red oral mucosa

Swollen tonsils

Foul-smelling breath

2. Based upon the mother's response to the appearance of the oral cavity, the RN advises the mother to seek medical attention for her child. In educating the mother about potential complications for untreated streptococcal throat infections, she indicates that all of the following are potential complications except:

Glomerulonephritis

Rheumatic fever

Scarlet fever

Hemolytic uremic syndrome

3. The RN advises the mother to observe for symptoms in the other children in the household. When can she expect to see symptoms emerge if the other children become infected?

5–7 days

24–48 hours

12–24 hours

2–5 days

4. To confirm the diagnosis and begin appropriate treatment, the RN expects all of the following to be ordered except ________.

pharyngeal culture

rapid pharyngeal swab test

bed rest

penicillin

5. The patient's rapid strep A test comes back positive in 1 hour. How would the RN best communicate to the mother that the medical team may be wary of confirming the diagnosis of strep throat based upon this information alone?

The rapid strep test requires 24 hours to be conclusively diagnostic.

The rapid strep test has a high risk of contamination.

The rapid strep test requires 12 hours to be conclusively diagnostic.

The rapid strep test has a high risk of false-negative results.

Answer 1

Pharyngitis is classified under inflammatory medical condition. Development and pathophysiology of pharyngitis is host-specific. It can be caused by bacterial or viral species. In the given context the child exhibits sore throat, fever, and lethargy. Pharyngitis is orally observed as the characteristic swelling of the tonsils with bright red coloration, due to inflammatory reactions by complement cascade activation. Streptococcus pharyngitis is known to be the primary agent infecting the pharyngeal apparatus. This specific inflammation is caused by group-A beat hemolytic streptococcus. The activated complement cascade exemplifies the formation pus as a scary white-lesion like on the swollen tonsils. The pus contains the dead bacterial cells. Leukocytes and the pharmacological substances-released by the different classes of leukocytes. White pockets of exudate are the striking oral clinical sign, along with the swollen tonsils. Hence option A is correct and best justifies the statement. Rheumatic fever is the prolonged consequence of pharyngitis when proper medical assistance is not procured by the individual. This condition involves a damage to heart valves and affects the dynamics of blood pumping. Glomerulonephritis is the extended form of ailment of strep throat caused the group-A streptococcus, which involves the inflammation of glomerulus in the kidney. Scarlet fever is another potential complication of pharyngitis and is caused by Streptococcus pyogens. Hemolytic uremic syndrome is direct consequence of the gastrointestinal infections caused by E. coli O157:H7 strain, shigella and salmonella. Hence, option D is correct and best justifies the statement. Pharyngitis is contagious and it spreads when healthy individuals pertain direct contact with the infected one wiz kissing or shaking sneezed hands. It can also spread by consuming the food or drinks contaminated by the droplets from the infected person. The incubation time of the bacteria is around 1 or 2-5 days, after being exposed. Hence, option D is the correct answer and best justifies the statement.

The pharyngeal culture is composed of bacterial or viral strains along with mucus. This culture is subjected to various Streptococcal specific test to detect the underlying streptococcal species. Rapid pharyngeal test has 93-98% sensitivity and is primarily carried out before proceeding to pharyngeal culture test. Doctors might prescribe penicillin and amoxicillin to subside other secondary infections, that might emerge during pharyngitis. Bed rest is not ordered by the RN until and unless the complication extend to scarlet or rheumatic fever. Hence, option-Cis correct and best describe the statement. The rapid strep test gives the result in 5 minutes. A sterile cotton swab is rubbed at tonsils and posterior pharynx, which lasts less than 6 sec. Later, the swab is subjected to test container and the swab is analyzed for the presence of group-A streptococci. The rapid swab test produces false positive with a count of 2 out of 100 results, whereas the other 98 are positive results. This test does not discriminate between the actual infective organism and other similar genera. The test is based on the detection of surface protein on bacteria, which are similar among the genera of streptococcus. The rapid strep test has a high risk of false-negative results. A third of false- negative as the rapid test comes negative even though the individual has sore throat infection. The doctors go for pharyngeal or throat culture assessment during false-negative results which are obtained from rapid strep test. Hence, option D is the correct answer and best justifies the statement.