A nurse is caring for a school-age child in the pediatric unit.

Exhibits

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.

Answer and Explanation

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.

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Correct Answer is D

Explanation

Rationale:

A. Encourage physical activity prior to bedtime: Stimulating activity close to bedtime can increase agitation and make it harder for clients with Alzheimer’s disease to settle for sleep. Calming routines in the evening are more appropriate to reduce nighttime confusion and restlessness.

B. Wear clothing with zippers instead of buttons: Although zippers are often easier than buttons, clients with Alzheimer’s may have difficulty with any fasteners. Simple clothing with Velcro or elastic waists is typically more suitable to promote independence.

C. Replace the carpet with hardwood floors: Carpets provide traction and cushioning, which can help prevent injuries from falls. Hardwood floors may be slippery or cause confusion due to glare or unfamiliar patterns, increasing fall risk.

D. Place locks at the tops of exterior doors: Clients with Alzheimer’s are at risk for wandering. Installing locks at the tops of doors—out of the client's usual line of sight—helps prevent elopement while preserving safety in the home environment.

A. Use an incentive spirometer every 4 hours B. Remain on bed rest for 24 hours following the procedure C. Place a pillow under your knees while in bed D. Participate in range of motion exercises.

Correct Answer is D

Explanation

Rationale:

A. Use an incentive spirometer every 4 hours: Incentive spirometry is primarily used to promote lung expansion and prevent atelectasis postoperatively. While important, it is aimed at respiratory function, not directly at promoting circulation.

B. Remain on bed rest for 24 hours following the procedure: Prolonged bed rest can lead to venous stasis and increase the risk of thromboembolic events. Early ambulation or movement is encouraged to improve circulation and prevent complications like deep vein thrombosis (DVT).

C. Place a pillow under your knees while in bed: Placing a pillow under the knees can cause venous stasis by compressing the popliteal vessels and should be avoided. It may also contribute to joint stiffness and increase the risk of DVT.

D. Participate in range of motion exercises: Range of motion exercises encourage venous return and stimulate blood flow in the extremities. This helps prevent postoperative complications such as DVT and promotes overall circulatory health.

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