The practical nurse (PN) is monitoring a 5-year-old following a fracture of the ulna. For which situation should the PN seek immediate intervention by the registered nurse (RN)?

A. Hematuria is the classic clinical hallmark of acute glomerulonephritis that typically prompts parents to seek medical consultation. The presence of red blood cells in the urine often results in a "cola-colored" or smoky appearance due to the leakage of erythrocytes through the inflamed glomerular basement membrane. This visual change is sudden and alarming to caregivers, serving as a primary reason for acute healthcare visits.

B. Weight loss is an unlikely finding in the initial presentation of acute glomerulonephritis. Instead, these children typically experience rapid weight gain and edema due to sodium and water retention caused by a decreased glomerular filtration rate. The clinical manifestation of fluid overload, including periorbital edema and hypertension, is much more characteristic of the acute inflammatory phase than any nutritional or fluid deficit.

C. Polydipsia, or excessive thirst, is not a typical symptom of acute glomerulonephritis and is more commonly associated with diabetes mellitus or diabetes insipidus. In glomerulonephritis, the renal system is struggling to filter and excrete fluid, often leading to oliguria rather than the polyuria that drives thirst. Consequently, parents would be more likely to report a decrease in urinary frequency and volume rather than increased intake.

D. A sore throat is a precursor to post-streptococcal glomerulonephritis but is usually no longer present by the time the renal symptoms manifest. The typical latency period between a Group A beta-hemolytic streptococcal infection and the onset of kidney inflammation is approximately 1 to 3 weeks. While the history of a sore throat is diagnostically significant, the active renal symptoms like hematuria are what usually motivate the immediate visit.

One of the most important interventions in caring for clients with major depressive disorder is building a therapeutic relationship. Scheduling regular periods of time for interaction with the client demonstrates support and provides an opportunity for the client to express their feelings and concerns. Journaling and self-reflection can be helpful interventions for some clients, but they do not necessarily demonstrate support.

Assisting the client to identify symptoms of depression is important for assessment and care planning, but it is not a way to demonstrate support.

Incorporating animated communication techniques may be appropriate for certain clients, but it is not a universal intervention for supporting clients with major depressive disorder.