A nurse is caring for a school-age child in the pediatric unit.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing. 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
The Correct Answer is []
Rationale for correct choices:
- Nephrotic syndrome: The child shows hallmark signs of nephrotic syndrome—periorbital edema, fatigue, frothy urine, hypoalbuminemia (1.4 g/dL), hyperlipidemia (cholesterol 465 mg/dL), massive proteinuria (24 mg/dL), and specific gravity of 2.066. The elevated platelets and ESR also support an inflammatory renal process.
- Administer oral corticosteroids: Corticosteroids like prednisone are the first-line treatment for nephrotic syndrome as they reduce proteinuria by suppressing immune-mediated damage to the glomeruli.
- Encourage a low-sodium diet: A low-sodium diet helps control edema by minimizing fluid retention, which is especially important in children presenting with ascites and periorbital swelling.
- Abdominal girth: Measuring abdominal girth helps track changes in ascites and monitor the effectiveness of fluid management interventions like diet and medication.
- Urine specific gravity: Monitoring urine specific gravity assesses kidney concentration ability and fluid balance. Persistently elevated values may indicate worsening proteinuria or fluid imbalance
Rationale for incorrect choices:
- Acute glomerulonephritis: Although this condition can cause hematuria and edema, it typically follows a streptococcal infection and presents with hypertension, gross hematuria, and low urine output not massive proteinuria or hyperlipidemia.
- Chronic kidney disease: CKD develops over time and is characterized by progressive decline in renal function. This child’s symptoms and labs point more toward an acute or relapsing condition like nephrotic syndrome.
- Hemolytic uremic syndrome: HUS is associated with recent diarrheal illness, thrombocytopenia, anemia, and acute kidney injury—not heavy proteinuria or hypoalbuminemia. Platelet count here is high, not low as seen in HUS.
- Initiate contact precautions: Contact precautions are not routinely required for nephrotic syndrome unless there’s an active infection or immunosuppressive therapy risk—neither of which is indicated in the current scenario.
- Initiate peritoneal dialysis: Dialysis is reserved for end-stage renal disease or severe fluid overload unresponsive to other treatments. The child’s kidney function here, while abnormal, does not yet warrant dialysis.
- Administer antibiotics: There’s no evidence of bacterial infection—no fever, elevated WBC count, or infectious focus. Antibiotics are not appropriate without signs of infection.
- Head circumference: Head circumference is useful in infants for monitoring brain growth but irrelevant in school-age children with kidney disorders.
- Bilirubin: Bilirubin levels assess liver function and jaundice; they’re not relevant in evaluating nephrotic syndrome progression.
- HbA1c: HbA1c measures long-term glucose control in diabetes, not kidney function or protein loss. It's unrelated to the child’s current presentation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Report the incident to the nurse manager: While reporting the error is necessary for institutional accountability and improvement, it should not take priority over assessing the client's immediate physiological response to the error.
B. Measure the client's vital signs: The nurse's first priority after a medication error is to assess the client for any adverse effects. Vital signs provide essential information about the client's condition and guide further actions to ensure safety.
C. Fill out an incident report: An incident report is a key part of documenting medication errors but is done after the client's condition has been assessed and stabilized. It is for internal use and not part of the medical record.
D. Notify the provider: The provider must be informed promptly, especially if corrective treatment is needed. However, this step comes after assessing the client's status to provide relevant clinical information during the report.
Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}
Explanation
Rationale for Correct Choices:
- Compartment syndrome: The client shows hallmark signs: pain unrelieved by medication (rated 9/10), cool foot, 2+ edema, numbness, absent pedal pulses, delayed capillary refill, and inability to move the foot. These findings indicate increased pressure within a muscle compartment that compromises circulation and nerve function, requiring emergency intervention to prevent tissue necrosis or amputation.
- Osteomyelitis: A rapidly rising temperature (up to 38.9°C), elevated WBC count (28,000/mm³), and presence of drainage from the splint site suggest a localized bone infection. Osteomyelitis can develop from an open fracture, especially post-surgery, and early detection is critical for avoiding systemic infection or bone destruction.
Rationale for Incorrect Choices:
- Deep vein thrombosis (DVT): While immobilization increases DVT risk, the scenario lacks classic signs like unilateral calf swelling, warmth, erythema, or a positive Homan's sign. Additionally, pulses are absent in the foot, not consistent with a DVT presentation, which typically does not affect distal pulses.
- Fat embolism: The client does not exhibit hallmark signs such as acute respiratory distress, petechial rash, or altered mental status. Although long bone fractures pose a fat embolism risk, no findings suggest embolic movement or pulmonary compromise in this case.
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