Nokea
The nurse is caring for a child with acute renal failure. What laboratory findings should the nurse expect to find? (Select all that apply.)
- A. Hyponatremia
- B. Hyperkalemia
- C. All are applicable
- D. Elevated blood urea nitrogen level
Correct Answer: C
Rationale: In acute renal failure, laboratory findings typically include hyperkalemia, hyponatremia, and elevated blood urea nitrogen (BUN) levels due to the kidneys' inability to excrete waste and balance electrolytes. Metabolic alkalosis is less common, with metabolic acidosis being more typical.
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Why are neonates predisposed to problems with thermoregulation?
- A. Renal function is not fully developed.
- B. Flexed posture favors heat loss.
- C. A large body surface area favors heat loss to the environment.
- D. A thick layer of subcutaneous fat provides excellent insulation.
Correct Answer: C
Rationale: Neonates have a large surface area relative to their weight, which makes them prone to heat loss to the environment, leading to thermoregulation issues. The underdeveloped kidney affecting urine concentration (Choice A) is unrelated to the thermal regulation process. While a flexed posture can help retain heat (Choice B), it does not outweigh the impact of the large body surface area in neonates. Although subcutaneous fat (Choice D) provides insulation, in neonates, the large body surface area is more significant in contributing to heat loss than the fat's insulating properties.
What statement best describes Hirschsprung disease?
- A. The colon has an aganglionic segment.
- B. It results in frequent evacuation of solids, liquid, and gas.
- C. The neonate passes excessive amounts of meconium.
- D. It results in excessive peristaltic movements within the gastrointestinal tract.
Correct Answer: A
Rationale: Hirschsprung disease is characterized by the absence of ganglion cells in a segment of the colon, leading to a lack of peristalsis and obstruction. The other options do not accurately describe this condition.
When assessing a child with leukemia, which clinical manifestations should the nurse anticipate?
- A. Petechiae, fever, fatigue
- B. Headache, papilledema, irritability
- C. Muscle wasting, weight loss, fatigue
- D. Decreased intracranial pressure, psychosis, confusion
Correct Answer: A
Rationale: The correct answer is A: Petechiae, fever, fatigue. Children with leukemia commonly present with petechiae (due to low platelet count), fever (due to infection), and fatigue (due to anemia), which are classic manifestations of the disease. Option B is incorrect because headache, papilledema, and irritability are more indicative of increased intracranial pressure, not leukemia. Option C is incorrect as muscle wasting and weight loss are not typical initial manifestations of leukemia in children. Option D is incorrect as decreased intracranial pressure, psychosis, and confusion are not commonly associated with leukemia.
A 12-year-old child is injured in a bicycle accident. When considering the possibility of renal trauma, the nurse should consider what factor?
- A. Flank pain rarely occurs in children with renal injuries.
- B. Few nonpenetrating injuries cause renal trauma in children.
- C. Kidneys are immobile, well protected, and rarely injured in children.
- D. The amount of hematuria is not a reliable indicator of the seriousness of renal injury.
Correct Answer: D
Rationale: The amount of hematuria is not a reliable indicator of the severity of renal trauma, as even minor injuries can cause significant bleeding, while severe injuries may result in little or no visible blood. Renal trauma should be evaluated through imaging and clinical assessment.
What findings on physical assessment of a neonate would indicate the need for further evaluation?
- A. Nystagmus
- B. Epstein pearls
- C. Low-set ears
- D. Positive Babinski reflex
Correct Answer: C
Rationale: Low-set ears in a neonate suggest major abnormalities and should prompt further evaluation. The correct alignment of the top of the pinnae of the ear with the outer canthus of the eye is crucial. Nystagmus, an involuntary eye movement, is common in newborns and often resolves on its own. Epstein pearls, small cysts on the hard palate, are insignificant and disappear over time. A positive Babinski reflex is normal in infants up to 1 year of age. Therefore, the presence of low-set ears is the most concerning finding that requires immediate attention.