A toddler diagnosed with nephrotic syndrome has a nursing diagnosis of excess fluid related to fluid accumulation (generalized edema). Which nursing intervention would be the priority to include in the nursing plan of care?
Seizure Precautions
Ambulation
Daily weight
Keep bed position flat
The Correct Answer is C
A) Seizure Precautions:
While seizure precautions are important in certain clinical situations, they are not directly related to the excess fluid and generalized edema associated with nephrotic syndrome. Nephrotic syndrome is primarily characterized by proteinuria, hypoalbuminemia, and fluid retention, which can lead to edema. Seizure precautions would not directly address the fluid imbalance in this context.
B) Ambulation:
Ambulation involves walking or movement and is not a priority intervention for addressing excess fluid and generalized edema. The primary concern in nephrotic syndrome with fluid accumulation is to manage the fluid balance and prevent further complications related to edema, such as respiratory distress or compromised circulation.
C) Daily weight:
This is the correct priority intervention. Daily weight monitoring is crucial in managing fluid balance and assessing the effectiveness of treatment in a child with nephrotic syndrome and fluid accumulation. Sudden weight gain can indicate worsening edema, while weight loss might indicate a response to treatment. Daily weight monitoring provides essential information to adjust fluid and medication management accordingly.
D) Keep bed position flat:
While maintaining a flat bed position may help improve venous return and fluid distribution, it is not the priority intervention for managing excess fluid and generalized edema in a child with nephrotic syndrome. Monitoring daily weight and adjusting treatment based on weight changes are more directly related to addressing the fluid imbalance.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Inattention, Hyperactivity, Impulsivity
Explanation: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. These symptoms can significantly impact an individual's ability to function in various areas of their life, such as school, work, and social interactions.
The other options are not accurate descriptions of ADHD:
B. "Can never be well treated" is not correct. ADHD can be effectively managed and treated through a combination of strategies, which may include behavioral interventions, psychoeducation, counseling, and in some cases, medication.
C. "Inability to learn" is not a defining characteristic of ADHD. While individuals with ADHD might face challenges in learning due to their symptoms, they are certainly capable of learning and can benefit from tailored strategies to support their learning process.
D. "Excess tiredness, impulsivity, and hyperactivity" describes a combination of symptoms, but ADHD is specifically characterized by inattention, hyperactivity, and impulsivity. Tiredness, while not a primary symptom of ADHD, can be a secondary effect of difficulties in focusing and maintaining attention.
Correct Answer is B
Explanation
A. Dizziness is always a sign of a concussion.
This statement is incorrect. While dizziness can be a symptom of a concussion, it is not always indicative of a concussion. There can be various causes of dizziness, and it is essential to consider other symptoms as well when assessing for a concussion.
B. Bike Helmet Safety
Explanation:
The correct answer to include as part of concussion/head injury prevention teaching to children and parents is "Bike helmet safety." This is because wearing a helmet while riding a bike or participating in other activities that involve head injury risks is crucial to prevent head injuries and concussions. Helmets provide protection to the head by absorbing impact energy and reducing the risk of skull fractures or traumatic brain injuries.
C. Normal fluid intake.
While staying hydrated is important for overall health, it is not directly related to concussion or head injury prevention teaching. This choice is unrelated to the topic.
D. Signs of autism.
Signs of autism are unrelated to concussion or head injury prevention teaching. This choice is not relevant to the topic at hand.
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