Pediatric Nursing

Rheumatic Fever

MCQ questions:
1) Rheumatic fever is primarily caused by which type of bacteria?

a. Staphylococcus aureus
b. Group A Streptococcus
c. Escherichia coli
d. Clostridium difficile

2) What is the most common cardiac complication associated with rheumatic fever?

a. Myocardial infarction
b. Rheumatic heart disease
c. Congestive heart failure
d. Atrial fibrillation

3) Which of the following is a major clinical manifestation of rheumatic fever?

a. Fever
b. Arthralgia
c. Migratory polyarthritis
d. Cough

4) Which age group is most at risk of developing rheumatic fever?

a. Infants under 2 years

b. Children aged 5–15 years
c. Adults over 30 years
d. The elderly

5) The main diagnostic criteria used for diagnosing rheumatic fever are known as:

a. Lewis criteria
b. Jones criteria
c. Rochester criteria
d. Boston criteria

6) A child diagnosed with rheumatic fever presents with Sydenham chorea. Which
description best fits this symptom?

a. Inflammation of the joints

b. Painless red skin lesions on the trunk
c. Involuntary, jerky movements of the face and limbs
d. Heart murmur due to valve involvement

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7) What is the best initial treatment to reduce inflammation in a child with acute
rheumatic fever?

a. Prednisone
b. Aspirin
c. Ibuprofen
d. Acetaminophen

8) For which of the following would you monitor closely in a patient with severe
carditis related to rheumatic fever?

a. Increased appetite
b. Skin rash
c. Cardiomegaly on imaging
d. Stable vital signs

9) Which nursing intervention is most appropriate for a child with Sydenham chorea
related to rheumatic fever?

a. Restrict all physical activities

b. Provide a quiet, safe environment
c. Encourage regular exercise to prevent stiffness
d. Administer anticoagulants

10) A child with a history of rheumatic fever needs long-term antibiotic prophylaxis.
The purpose of this treatment is to:

a. Prevent recurrence of rheumatic fever

b. Treat existing heart valve damage
c. Cure rheumatic heart disease
d. Manage Sydenham chorea

11) What is the typical incubation period between a Group A Streptococcus infection
and the onset of rheumatic fever symptoms?

a. 1–3 days
b. 2–4 weeks
c. 4–6 months
d. 6–12 hours

12) Which of the following is a minor manifestation of rheumatic fever?

a. Erythema marginatum
b. Subcutaneous nodules
c. Arthralgia
d. Chorea

13) A patient with rheumatic fever shows elevated C-reactive protein (CRP) and
erythrocyte sedimentation rate (ESR). This elevation suggests:

a. A bacterial infection is present

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 b. Inflammation due to an autoimmune response
c. Viral infection
d. Heart failure

14) Which heart valve is most commonly affected by rheumatic fever?

a. Tricuspid valve
b. Mitral valve
c. Pulmonary valve
d. Aortic valve

15) The main route of transmission for Group A Streptococcus that can lead to
rheumatic fever is through:

a. Airborne dust
b. Direct contact with respiratory secretions
c. Bloodborne transmission
d. Contaminated food

16) Which laboratory test is commonly used to confirm a past Group A Streptococcus
infection in a patient presenting with rheumatic fever?

a. Throat culture
b. C-reactive protein
c. Rapid antigen detection test
d. Antistreptolysin O (ASO) titer

17) Which of the following is a primary goal in managing a patient with acute rheumatic
fever?

a. Reducing pain with narcotics

b. Restricting fluid intake
c. Preventing further Group A Streptococcus infections
d. Administering diuretics immediately

18) In children with rheumatic fever, which nursing intervention would you prioritize to
prevent injury?

a. Encourage self-care independence

b. Apply side rail padding and keep the child’s room quiet
c. Encourage high-protein diet
d. Use splints to immobilize joints

19) When administering corticosteroids to a patient with rheumatic fever and severe
carditis, the nurse should monitor for:

a. Bradycardia
b. Hyperglycemia
c. Hypotension
d. Muscle weakness

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20) For a child with a history of rheumatic fever, which of the following lifestyle
modifications is recommended to help prevent recurrence?

a. Participate in strenuous sports

b. Avoid crowded public places during cold and flu season
c. Drink high-sugar beverages
d. Discontinue antibiotics after symptoms improve

21) Which of the following is NOT considered a major criterion for diagnosing
rheumatic fever according to the Jones criteria?

a. Carditis
b. Fever
c. Chorea
d. Erythema marginatum

22) What is the purpose of long-term antibiotic prophylaxis in patients with a history of
rheumatic fever?

a. To treat current heart infections

b. To prevent recurrence of rheumatic fever
c. To reduce inflammation in joints
d. To cure rheumatic heart disease

23) Which of the following symptoms may indicate the development of carditis in a child
with rheumatic fever?

a. Enlarged liver
b. New or changing heart murmur
c. Swollen lymph nodes
d. Nasal congestion

24) Migratory polyarthritis, a symptom of rheumatic fever, is best described as:

a. Joint pain that occurs only in the ankles

b. Inflammation that moves from one joint to another
c. Persistent pain in one joint
d. Red, scaly patches on the skin

25) In rheumatic fever, which of the following signs is characterized by painless, flat or
slightly raised lesions on the skin, usually found on the trunk?

a. Subcutaneous nodules
b. Erythema marginatum
c. Petechiae
d. Ecchymosis

26) When assessing a child with suspected rheumatic fever, which finding would the
nurse recognize as a minor criterion?

a. Erythema marginatum

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 b. Chorea
c. Fever
d. Subcutaneous nodules

27) A nurse knows that chorea, a major manifestation of rheumatic fever, typically
presents as:

a. Constant high fever

b. Joint swelling and tenderness
c. Sudden, purposeless jerky movements
d. Increased appetite and weight gain

28) Which medication class is most commonly prescribed to reduce inflammation in

acute rheumatic fever?

a. Antibiotics
b. Nonsteroidal anti-inflammatory drugs (NSAIDs)
c. Anticoagulants
d. Antihypertensives

29) For a child recovering from rheumatic fever, the nurse educates the parents on
limiting activity. This intervention is necessary to:

a. Prevent respiratory infection

b. Avoid worsening cardiac inflammation
c. Increase muscle strength
d. Prevent joint deformities

30) A nurse is caring for a child with rheumatic fever and carditis. Which dietary
recommendation is appropriate if the child also has congestive heart failure?

a. High-sodium diet
b. Sodium- and fluid-restricted diet
c. High-protein diet
d. Low-calorie diet

31) Rheumatic fever is primarily triggered by an infection with which organism?

a. Staphylococcus aureus
b. Streptococcus pneumoniae
c. Group A beta-hemolytic Streptococcus
d. Escherichia coli

32) A minor criterion for diagnosing rheumatic fever is:

a. Subcutaneous nodules
b. Migratory polyarthritis
c. Fever
d. Carditis

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33) Which of the following clinical manifestations is classified as a major criterion for
rheumatic fever?

a. Arthralgia
b. Erythema marginatum
c. High blood pressure
d. Enlarged lymph nodes

34) Which test can help confirm a recent Group A Streptococcus infection in a patient
suspected of having rheumatic fever?

a. Blood culture
b. Throat culture
c. Chest X-ray
d. C-reactive protein test

35) Subcutaneous nodules, a sign of rheumatic fever, are most commonly found:

a. On the lower back

b. Attached to tendon sheaths and bony prominences
c. On the scalp
d. In the abdomen

36) When caring for a patient with rheumatic fever, which of the following would be the
priority nursing intervention?

a. Encourage vigorous exercise

b. Promote adequate rest and gradual return to activities
c. Increase sodium intake
d. Provide high-sugar fluids

37) A child with acute rheumatic fever is prescribed aspirin. Which laboratory value
should the nurse monitor due to this medication?

a. Blood glucose
b. Platelet count
c. White blood cell count
d. Serum potassium

38) A patient with a history of rheumatic fever presents with joint pain and fever. The
nurse suspects:

a. Recurrence of rheumatic fever

b. Osteoarthritis
c. Viral infection
d. Rheumatoid arthritis

39) Which statement by the parent of a child with rheumatic fever indicates a need for
further teaching?

a. “I will make sure my child takes antibiotics as prescribed.”

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 b. “It’s safe for my child to resume sports after a week of rest.”
c. “We will complete the full course of antibiotic prophylaxis.”
d. “I will limit contact with anyone who has a sore throat.”

40) For a patient with rheumatic fever and confirmed carditis, the nurse would expect to
administer which of the following medications?

a. Diuretics only
b. Aspirin and corticosteroids
c. Antibiotics alone
d. Antihypertensives

41) In a child diagnosed with rheumatic fever, which heart valve is most commonly
affected by inflammation?

a. Pulmonary valve
b. Tricuspid valve
c. Mitral valve
d. Aortic valve

42) The purpose of using salicylates in the treatment of acute rheumatic fever is to:

a. Destroy Group A streptococci bacteria

b. Treat chorea symptoms
c. Reduce inflammation and pain
d. Prevent future infections

43) Which of the following is a recommended nursing intervention for a child with
rheumatic fever who has chorea?

a. Encourage high levels of physical activity

b. Provide a safe, supportive environment
c. Increase the child’s salt intake
d. Restrict all social interaction

44) To prevent complications in a child with rheumatic fever, it is important to:

a. Administer antipyretics only if fever is present

b. Encourage the child to exercise regularly
c. Promote strict adherence to antibiotic therapy
d. Increase protein intake

45) Which of the following statements about erythema marginatum is correct?

a. It is a major manifestation of acute rheumatic fever

b. It is painful and red with raised edges
c. It typically occurs on the face and neck
d. It is a symptom that lasts for several months

46) Which of the following interventions is most appropriate for a child with rheumatic
fever and moderate carditis?

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 a. Strict bed rest during the acute phase
b. Regular physical exercise to increase heart strength
c. Discontinuing salicylate therapy after symptoms resolve
d. Administering a high-salt diet

47) When teaching parents about antibiotic prophylaxis for their child after rheumatic
fever, the nurse should emphasize:

a. Antibiotics are only necessary if symptoms return

b. Prophylaxis should continue until the age of 21 or longer
c. Antibiotics are no longer needed after the first year
d. Prophylaxis can be discontinued after two weeks

48) In rheumatic fever, which lab result would likely be elevated due to inflammation?

a. Serum sodium
b. C-reactive protein (CRP)
c. Blood glucose
d. Serum potassium

49) Which of the following assessments is most critical to detect progression to

rheumatic heart disease in a child with rheumatic fever?

a. Monitoring for skin rashes

b. Checking for joint pain and swelling
c. Auscultating for new or worsening heart murmurs
d. Assessing for muscle weakness

50) A child with rheumatic fever is prescribed a corticosteroid. Which side effect should
the nurse monitor for?

a. Weight loss
b. Hyperglycemia
c. Hypotension
d. Increased appetite

10-year-old child presents to the clinic with a history of sore throat two weeks ago. The child
is now experiencing joint pain, fever, and a skin rash. Upon examination, a new heart
murmur is detected.

51) Based on this clinical presentation, the nurse suspects rheumatic fever. Which of the
following would be the most appropriate initial diagnostic approach?

a. A) Conduct a throat culture

b. B) Order an ECG
c. C) Test for antistreptococcal antibodies
d. D) Perform a chest X-ray

52) The child with suspected rheumatic fever has a rash that appears as red, painless
patches on the trunk. This finding is known as:

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 a. A) Erythema marginatum
b. B) Petechiae
c. C) Purpura
d. D) Urticaria

A 9-year-old child has been diagnosed with acute rheumatic fever following an untreated
strep throat infection. The nurse observes involuntary, jerking movements of the child’s arms
and legs, making it difficult for the child to walk.

53) The nurse recognizes these movements as Sydenham chorea. Which of the following
is the best nursing intervention to address this manifestation?

a. A) Encourage physical activity to strengthen muscles

b. B) Provide a safe environment with padded side rails
c. C) Apply a heating pad to reduce joint pain
d. D) Limit the child’s fluid intake

54) To manage Sydenham chorea in this patient, which medication might the physician
prescribe?

a. A) Penicillin
b. B) Aspirin
c. C) Prednisone
d. D) Valproic acid

A 12-year-old child is brought to the emergency department with fever, chest pain, and a
history of a sore throat two weeks prior. Upon assessment, the nurse notes swelling in the
child’s knee and ankle joints, as well as a heart murmur.

55) Considering this presentation, which condition should be prioritized in the nurse's
assessment?

a. A) Rheumatoid arthritis
b. B) Rheumatic fever with carditis
c. C) Viral infection
d. D) Juvenile idiopathic arthritis

56) The child’s echocardiogram shows mitral valve insufficiency. Which of the following
is the priority intervention?

a. A) Encourage bed rest and limited physical activity

b. B) Start a high-protein diet to promote healing
c. C) Discharge the child for home care
d. D) Administer antihypertensive medication

A child with a known history of rheumatic fever is seen for a routine follow-up visit. The
parents report the child has had no new symptoms but has missed several doses of their
monthly penicillin injection.

57) The nurse explains that missing doses of penicillin can lead to which complication?

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 a. A) Increased risk of another sore throat infection
b. B) Recurrence of rheumatic fever
c. C) Elevated blood sugar levels
d. D) Increased risk of joint pain only

58) The parents ask why long-term antibiotic prophylaxis is necessary for their child.
Which is the best response by the nurse?

a. A) "The antibiotics help prevent joint pain."

b. B) "Long-term antibiotics reduce the risk of a heart infection from another strep infection."
c. C) "It helps the immune system become stronger."
d. D) "It stops the fever from returning."

A 7-year-old boy presents with fever, joint pain, and swelling in his wrists and knees. His
mother mentions he had a sore throat about a month ago, which wasn’t treated with
antibiotics.

59) Based on this history, what other symptoms should the nurse assess for that are
commonly associated with rheumatic fever?

a. A) Petechiae and swollen lymph nodes

b. B) Red spots on the trunk and involuntary movements
c. C) Muscle twitching and hyperactivity
d. D) High blood pressure and weight loss

60) The nurse observes a red, painless rash on the child’s trunk, which matches a
symptom of rheumatic fever. This rash is called:

a. A) Erythema nodosum
b. B) Erythema migrans
c. C) Erythema marginatum
d. D) Purpura

An 8-year-old child diagnosed with rheumatic fever is hospitalized with severe joint pain and
swelling, as well as a fever. The doctor prescribes aspirin for anti-inflammatory management.

61) What side effect should the nurse monitor for when administering aspirin to this
child?

a. A) Hypertension
b. B) Tinnitus
c. C) Nausea
d. D) Bradycardia

62) In addition to aspirin, the physician prescribes a corticosteroid for this child. Which
complication would most likely require corticosteroid treatment in rheumatic fever?

a. A) Arthralgia
b. B) Mild fever
c. C) Carditis with heart enlargement
d. D) Sydenham chorea

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A 14-year-old girl with a history of untreated strep throat is admitted with a diagnosis of
rheumatic fever. She has developed signs of heart failure, including shortness of breath and
ankle swelling.

63) Which diagnostic test would be most helpful in assessing heart involvement in this
patient?

a. A) Complete blood count (CBC)

b. B) Chest X-ray
c. C) Electrocardiogram (ECG)
d. D) Echocardiogram

64) The child’s echocardiogram reveals severe mitral valve insufficiency. Which
medication might be prescribed to manage symptoms of heart failure?

a. A) Ibuprofen
b. B) Furosemide
c. C) Acetaminophen
d. D) Amoxicillin

A 10-year-old boy with acute rheumatic fever is being treated for migratory polyarthritis,
which is causing significant pain in his knees, elbows, and wrists. He has no other major
symptoms at this time.

65) Which intervention should the nurse prioritize for managing this patient’s joint
pain?

a. A) Apply warm compresses to affected joints and administer NSAIDs as prescribed

b. B) Restrict all physical activity until joint pain completely resolves
c. C) Place the patient on a strict low-sodium diet
d. D) Monitor blood pressure closely

66) If the child’s joint pain improves but he begins to show signs of Sydenham chorea,
such as uncoordinated movements, which medication might the physician add to the
treatment plan?

a. A) Salicylates
b. B) Carbamazepine
c. C) Prednisone
d. D) Digitalis

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Answers:-
1) Answer: B) Group A Streptococcus
2) Answer: B) Rheumatic heart disease
3) Answer: C) Migratory polyarthritis
4) Answer: B) Children aged 5–15 years
5) Answer: B) Jones criteria
6) Answer: C) Involuntary, jerky movements of the face and limbs
7) Answer: B) Aspirin
8) Answer: C) Cardiomegaly on imaging
9) Answer: B) Provide a quiet, safe environment
10) Answer: A) Prevent recurrence of rheumatic fever
11) Answer: B) 2–4 weeks
12) Answer: C) Arthralgia
13) Answer: B) Inflammation due to an autoimmune response
14) Answer: B) Mitral valve
15) Answer: B) Direct contact with respiratory secretions
16) Answer: D) Antistreptolysin O (ASO) titer
17) Answer: C) Preventing further Group A Streptococcus infections
18) Answer: B) Apply side rail padding and keep the child’s room quiet
19) Answer: B) Hyperglycemia
20) Answer: B) Avoid crowded public places during cold and flu season
21) Answer: B) Fever
22) Answer: B) To prevent recurrence of rheumatic fever
23) Answer: B) New or changing heart murmur
24) Answer: B) Inflammation that moves from one joint to another
25) Answer: B) Erythema marginatum
26) Answer: C) Fever
27) Answer: C) Sudden, purposeless jerky movements
28) Answer: B) Nonsteroidal anti-inflammatory drugs (NSAIDs)
29) Answer: B) Avoid worsening cardiac inflammation
30) Answer: B) Sodium- and fluid-restricted diet
31) Answer: C) Group A beta-hemolytic Streptococcus
32) Answer: C) Fever
33) Answer: B) Erythema marginatum
34) Answer: B) Throat culture
35) Answer: B) Attached to tendon sheaths and bony prominences
36) Answer: B) Promote adequate rest and gradual return to activities
37) Answer: B) Platelet count
38) Answer: A) Recurrence of rheumatic fever
39) Answer: B) “It’s safe for my child to resume sports after a week of rest.”
40) Answer: B) Aspirin and corticosteroids
41) Answer: C) Mitral valve
42) Answer: C) Reduce inflammation and pain
43) Answer: B) Provide a safe, supportive environment
44) Answer: C) Promote strict adherence to antibiotic therapy
45) Answer: A) It is a major manifestation of acute rheumatic fever
46) Answer: A) Strict bed rest during the acute phase

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47) Answer: B) Prophylaxis should continue until the age of 21 or longer
48) Answer: B) C-reactive protein (CRP)
49) Answer: C) Auscultating for new or worsening heart murmurs
50) Answer: B) Hyperglycemia
51) Answer: C) Test for antistreptococcal antibodies
52) Answer: A) Erythema marginatum
53) Answer: B) Provide a safe environment with padded side rails
54) Answer: D) Valproic acid
55) Answer: B) Rheumatic fever with carditis
56) Answer: A) Encourage bed rest and limited physical activity
57) Answer: B) Recurrence of rheumatic fever
58) Answer: B) "Long-term antibiotics reduce the risk of a heart infection from another
strep infection."
59) Answer: B) Red spots on the trunk and involuntary movements
60) Answer: C) Erythema marginatum
61) Answer: B) Tinnitus
62) Answer: C) Carditis with heart enlargement
63) Answer: D) Echocardiogram
64) Answer: B) Furosemide
65) Answer: A) Apply warm compresses to affected joints and administer NSAIDs as
prescribed
66) Answer: B) Carbamazepine

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