Nokea
A child is admitted for minimal change nephrotic syndrome (MCNS). The nurse recognizes that the child's prognosis is related to what factor?
- A. Admission blood pressure
- B. Creatinine clearance
- C. Amount of protein in urine
- D. Response to steroid therapy
Correct Answer: D
Rationale: The prognosis for children with MCNS is closely related to their response to steroid therapy. A favorable response to steroids usually indicates a better prognosis, while poor response may require alternative treatments and can indicate a more complicated disease course.
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The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son. The nurse replies based on what knowledge?
- A. Most boys in the United States can be toilet trained at age 3 years.
- B. Training can begin when he has sufficient bladder capacity.
- C. Additional surgery may be necessary to achieve continence.
- D. They should begin now because he will require additional time.
Correct Answer: B
Rationale: Toilet training should begin when the child has sufficient bladder capacity and control, which may be delayed in children who have undergone surgical repairs for conditions like bladder exstrophy. Premature training can lead to frustration and setbacks.
What procedure is most appropriate for the assessment of an abdominal circumference related to a bowel obstruction?
- A. Measuring the abdomen after feedings
- B. Marking the point of measurement with a pen
- C. Measuring the circumference at the symphysis pubis
- D. Using a new tape measure with each assessment to ensure accuracy
Correct Answer: B
Rationale: Marking the point of measurement ensures consistent and accurate assessments of abdominal circumference, especially important in conditions like bowel obstruction where changes need to be monitored closely.
What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis?
- A. Infarction of renal vessels
- B. Immune complex formation and glomerular deposition
- C. Bacterial endotoxin deposition on and destruction of glomeruli
- D. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation
Correct Answer: B
Rationale: Postinfectious glomerulonephritis is typically caused by immune complex deposition in the glomeruli following a streptococcal infection. This immune response leads to inflammation and impaired kidney function.
The nurse is caring for a child with a urinary tract infection who is on trimethoprim-sulfamethoxazole (Bactrim). What side effects of this medication should the nurse teach to the parents and the child? (Select all that apply.)
- A. Rash
- B. Urticaria
- C. All are applicable
- D. Photosensitivity
Correct Answer: C
Rationale: Trimethoprim-sulfamethoxazole (Bactrim) can cause side effects like rash, urticaria, and photosensitivity. Parents and the child should be educated on these potential side effects to ensure prompt recognition and management.
When should a child receive the first dose of the hepatitis B virus (HBV) vaccine if the mother is hepatitis B surface antigen (HBsAg) negative?
- A. 2 months of age, before hospital discharge.
- B. Birth before discharge from the hospital.
- C. 6 months of age, at the third well-child visit.
- D. No time (this vaccine is not currently recommended).
Correct Answer: B
Rationale: If the mother is HBsAg negative, it is recommended that the child receives the first dose of the hepatitis B vaccine at birth before discharge from the hospital. This is to provide early protection against the hepatitis B virus. The second dose of the vaccine is typically given at the first well-child visit, and the third dose is usually administered at a later date. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, including the hepatitis B virus vaccine. Choice A is incorrect as the first dose should ideally be given at birth. Choice C is incorrect as waiting until 6 months of age may leave the child vulnerable to infection during the early months of life. Choice D is incorrect as the hepatitis B vaccine is recommended for all newborns, especially if the mother is HBsAg negative, to prevent transmission of the virus.