An eight-year-old with nephrotic syndrome is pale, lethargic, and has ascites. To determine if the ascites is increasing, the nurse should (chose one best answer):
assess the bowel sounds
Frequently ambulate child
Weigh child weekly
monitor and measure the abdominal girth
The Correct Answer is D
A. Assess the bowel sounds:
Bowel sounds are not directly related to the assessment of ascites. Bowel sounds are more relevant in assessing gastrointestinal function and peristalsis. While bowel changes could potentially be a sign of complications, monitoring abdominal girth is more specific to tracking ascites.
B. Frequently ambulate child:
While ambulation is important for overall health, it's not a direct assessment method for monitoring ascites. Ambulating a child might have benefits, but it won't provide specific information about the presence or progression of ascites.
C. Weigh child weekly:
Weekly weighing can provide some information about overall fluid balance, but it might not be as sensitive as measuring abdominal girth when it comes to detecting changes in ascites. Additionally, monitoring weight alone might not give insight into the distribution of fluid in the abdominal cavity.
D. Monitor and measure the abdominal girth.
Explanation: The presence of ascites (accumulation of fluid in the abdominal cavity) in a child with nephrotic syndrome could indicate worsening kidney function and fluid balance. Monitoring and measuring the abdominal girth is a reliable way to assess changes in the amount of fluid accumulation over time. An increase in abdominal girth could suggest a worsening condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Kidneys are very small and irregular.
Explanation: This statement is not the primary reason for instructing caregivers about preventing kidney injury in babies or children under 2 years old. While it is true that infant and toddler kidneys are relatively smaller and have a slightly different shape compared to adult kidneys, the main concern for kidney injury prevention in this age group is related to other factors.
B) The occurrence of Hirsutism.
Explanation: Hirsutism refers to excessive hair growth, typically in a male pattern, in women and children. It is not directly related to kidney injury prevention in babies or children under 2 years old. Hirsutism is usually caused by hormonal imbalances and is not a primary consideration when instructing caregivers about preventing kidney injury.
C) Diaper rashes.
Explanation: Diaper rashes are skin irritations that occur in the diaper area of infants and young children. While diaper rashes can be uncomfortable and require proper care, they are not a major concern when instructing caregivers about preventing kidney injury. Diaper rashes are typically a result of prolonged exposure to moisture and can be managed with good hygiene practices and appropriate diaper-changing routines.
D) Children under two years old are more vulnerable to kidney trauma from compression force to abdomen.
Explanation: This statement is true and is the main reason for instructing caregivers about preventing kidney injury in babies or children under 2 years old. Children in this age group have relatively larger abdomens and less developed abdominal muscles, which makes their kidneys more susceptible to injury from compression forces to the abdomen. This is why caregivers are advised to handle young children carefully, avoid rough play, and ensure that they are securely fastened in car seats and other safety devices to prevent potential kidney trauma.
Correct Answer is ["C","D"]
Explanation
A. The fact that the patient is male
Incorrect Explanation: The patient's gender does not directly provide important information about the history of reflux.
Explanation: Vesicoureteral reflux (VUR), which is the retrograde flow of urine from the bladder into the ureters, can affect individuals of any gender. While gender might have some implications for certain conditions, it is not a critical factor in understanding the history of reflux.
B. The fact that the patient is female.
Incorrect Explanation: The patient's gender does not directly provide important information about the history of reflux.
Explanation: Just like with the previous option, the patient's gender does not play a significant role in the history of vesicoureteral reflux. The condition can affect both males and females.
C. Developmental milestones
Correct Explanation: Developmental milestones are important in understanding the history of reflux.
Explanation: Developmental milestones are significant because VUR is more common in infants and young children. Infants and young children have a higher likelihood of developing reflux due to the immaturity of their urinary tract systems. Knowing about the patient's developmental milestones can help assess the risk and potential severity of reflux.
D. The number of urinary tract infections the patient has had
Correct Explanation: The number of urinary tract infections (UTIs) is important in understanding the history of reflux.
Explanation: Repeated urinary tract infections can be a sign of vesicoureteral reflux. The backflow of urine from the bladder into the ureters can contribute to UTIs. Monitoring the frequency of UTIs can provide insights into the presence and severity of reflux.
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