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

Answer and Explanation

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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Correct Answer is C

Explanation

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects communication, social interaction, and behavior. When planning care for a child with ASD, it's important to consider their individual needs and strengths.

A) Allow for adjustment of rules to correlate with the child's behavior:

Children with ASD often benefit from consistent routines and clear expectations. Adjusting rules based on behavior might confuse the child and undermine the structure they rely on for understanding their environment.

B) Allow for imaginative play with peers without supervision:

Children with ASD can struggle with social interactions and may need guidance to engage in play with peers successfully. Unsupervised imaginative play might lead to challenges or misunderstandings, making supervision and support important.

C) Provide a flexible schedule that adjusts to the child's interests:

This is a crucial intervention. Many children with ASD find comfort in routines, but rigidity can be detrimental. A flexible schedule that incorporates the child's interests can enhance engagement, motivation, and learning. It provides structure while accommodating the child's preferences.

D) Establish a reward system for positive behavior:

Reward systems can be effective for motivating positive behaviors in children with ASD. Visual cues and rewards are often helpful in reinforcing desired behaviors. This intervention can encourage appropriate social interactions and communication.

A. Low-protein, low-potassium diet B. Low-sodium fluid-restricted C. Low carbohydrate, low-protein diet D. Regular diet, no added salt

Correct Answer is B

Explanation

A) Low-protein, low-potassium diet:

While low-protein and low-potassium diets can be appropriate for certain kidney conditions, such as chronic kidney disease, they are not typically the primary focus in the acute phase of glomerulonephritis. Protein restriction might be considered if there is significant kidney damage, and potassium levels are elevated.

B) Low-sodium fluid-restricted diet:

This is the most appropriate option. In acute glomerulonephritis, the kidneys' ability to regulate sodium and fluid balance may be impaired due to inflammation and decreased glomerular filtration. Fluid retention and peripheral edema are common. A low-sodium diet helps reduce fluid retention and manage edema.

C) Low carbohydrate, low-protein diet:

Low-carbohydrate and low-protein diets are not the main dietary considerations for acute glomerulonephritis. The primary focus is on managing sodium and fluid intake due to impaired kidney function.

D) Regular diet, no added salt:

A regular diet without added salt might exacerbate the fluid retention and edema associated with acute glomerulonephritis. Sodium intake needs to be controlled to prevent further fluid buildup.

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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?

Nursing Test Bank

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