Nokea
A 12-year-old girl has recently begun menstruating and is well into puberty. The child is visiting the health care provider today for a routine physical examination. Which finding should cause concern in the nurse?
- A. Breasts of slightly different sizes
- B. Irregular periods
- C. Vulvar irritation
- D. Supernumerary nipple
Correct Answer: C
Rationale: Vulvar irritation may indicate an infection or other issues and should be further evaluated. In a pubescent girl, breasts of slightly different sizes and irregular periods are common variations of normal development. Supernumerary nipple, an extra nipple, is a benign condition that is not typically concerning during puberty.
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The nurse is caring for a child with a urinary tract infection who is on intravenous gentamicin (Garamycin). What interventions should the nurse plan for this child with regard to this medication? (Select all that apply.)
- A. Encourage fluids.
- B. Monitor urinary output.
- C. Monitor sodium serum levels.
- D. All above
Correct Answer: D
Rationale: Gentamicin is an aminoglycoside antibiotic that requires monitoring of serum peak and trough levels to avoid toxicity, particularly nephrotoxicity and ototoxicity. Encouraging fluids and monitoring urinary output are also crucial to minimize the risk of kidney damage.
The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching?
- A. My child needs to stay home from school for at least 1 more month.
- B. I should not add additional salt to any of my child's meals.
- C. My child will not be able to participate in contact sports while receiving corticosteroid therapy.
- D. I should measure my child's urine after each void and report the 24-hour amount to the healthcare provider.
Correct Answer: B
Rationale: Avoiding additional salt is crucial to help manage edema in children with MCNS. While monitoring urine output is important, the other statements either misinterpret the need for prolonged school absence or misunderstand the risk associated with contact sports during steroid therapy.
What do the clinical manifestations of minimal change nephrotic syndrome include?
- A. Hematuria, bacteriuria, and weight gain
- B. Gross hematuria, albuminuria, and fever
- C. Hypertension, weight loss, and proteinuria
- D. Massive proteinuria, hypoalbuminemia, and edema
Correct Answer: D
Rationale: Minimal change nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema due to the loss of protein in the urine. Hematuria, bacteriuria, and weight loss are not typical features of this condition.
What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.)
- A. Fever
- B. Hypotension
- C. All are applicable
- D. Swelling and tenderness of graft area
Correct Answer: B
Rationale: Signs of kidney transplant rejection include fever, diminished urinary output, and swelling/tenderness in the graft area. These symptoms indicate that the body may be rejecting the transplanted organ, requiring immediate medical attention.
What measure of fluid balance status is most useful in a child with acute glomerulonephritis?
- A. Proteinuria
- B. Daily weight
- C. Specific gravity
- D. Intake and output
Correct Answer: B
Rationale: Daily weight is the most accurate measure of fluid balance in children with acute glomerulonephritis, as it reflects changes in body fluid status more reliably than other measures like proteinuria or specific gravity.