A nurse is preparing to reposition a client who had a stroke. Which of the following actions should the nurse take?

Rationale:

A. Use Leopold maneuvers to determine the fetal position: Leopold maneuvers are not appropriate as an immediate response to sudden nausea. The priority is to relieve the symptom, which may be related to positional compression of major blood vessels.

B. Position the client on her side: At 36 weeks gestation, the gravid uterus can compress the inferior vena cava when lying supine, leading to supine hypotensive syndrome. Symptoms like nausea, dizziness, and hypotension can occur. Side-lying positioning relieves the pressure and restores venous return and cardiac output.

C. Administer propranolol IV to the client: Propranolol is not indicated for treating pregnancy-related nausea or hypotension. Using it without a cardiovascular diagnosis would be inappropriate and could worsen hypotensive symptoms.

D. Ask the client to increase her daily calcium intake: While calcium is essential in pregnancy, especially for fetal bone development, increasing calcium intake has no immediate impact on sudden nausea or circulatory symptoms linked to maternal positioning.

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.