A newborn with a repaired gastroschisis is transferred to the pediatric unit after several days in the pediatric intensive care unit. The infant is receiving parenteral nutrition and continuous enteral feedings. To maintain normal growth and development of the infant, which action should the nurse include in plan of care?

For this client with a history of Wilms tumor, a radical nephrectomy, chronic kidney disease, and ongoing follow-up by oncology and nephrology services, the nurse should prioritize the following three care needs:

B. Identifying cardiac arrhythmias: Given the history of chronic kidney disease and potential electrolyte imbalances, cardiac arrhythmias are a significant concern that should be assessed and monitored for.

F. Monitoring fluid status: Fluid balance is crucial in clients with chronic kidney disease, and monitoring for fluid overload or dehydration is essential. This is especially important because of the potential need for fluid restrictions.

H. Assessing for worsening respiratory status: Assessing respiratory status is important, as clients with chronic kidney disease may be at risk for respiratory complications, including fluid overload, pulmonary edema, or other issues that can impact their respiratory status.

The other options are not the top priorities based on the client's history and current condition:

A. Collaborating with a dietitian to prepare a low-protein diet is important but may not be the immediate priority.

C. Performing diagnostic testing to determine the cause of a fever is necessary, but it does not take precedence over the immediate concerns of cardiac arrhythmias, fluid status, and respiratory status.

D. Educating the client and family on the importance of fluid restrictions is important, but it is related to monitoring fluid status and may be part of ongoing care.

E. Administering antipyretic medication as needed is relevant for fever management but not a top priority until the cause of the fever is determined.

G. Reassessing vital signs is part of ongoing care but may not be the immediate priority over identifying cardiac arrhythmias and assessing for worsening respiratory status.

I. Investigating acid/base complications is important but may not be the immediate priority when cardiac, fluid, and respiratory status are concerns.

The correct answers are A, D, E.

Before the cardiac catheterization for a 3-year-old with a history of ventricular septal defect, the nurse's focused assessment should include the following:

A. Determine when the child last ate: Knowing when the child last ate is important because the procedure may require fasting, and the nurse needs to ensure that the child has adhered to the fasting guidelines.

D. Locate and mark the pedal pulses: Locating and marking the pedal pulses is essential to establish a baseline for assessing peripheral circulation, especially given the history of ventricular septal defect.

E. Obtain a history of allergic reactions: Obtaining a history of allergic reactions is important to ensure that there are no allergies or sensitivities that could impact the procedure or the use of any contrast materials during the cardiac catheterization.

The other options are not necessary components of the focused assessment in preparation for the cardiac catheterization:

B. Measure the child's height and weight: Measuring height and weight may be done at some point but is not a priority in the immediate pre-procedural assessment.

C. Perform a mini-mental exam on the child: A mini-mental exam may not be applicable or necessary in the pre-catheterization assessment of a 3-year-old.

F. Document lying, sitting, and standing blood pressures: Blood pressure variations in different positions are typically not relevant for this type of procedure, and it may not be practical or necessary for a 3-year-old.