Nokea
A child is admitted for minimal change nephrotic syndrome (MCNS). The nurse recognizes that the childs 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: Response to steroid therapy within 28 days predicts prognosis in MCNS; non-response reduces likelihood of remission. Blood pressure is typically normal, creatinine clearance isn?t prognostic, and proteinuria confirms diagnosis but doesn?t predict outcome.
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A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child?
- A. Stimulate appetite.
- B. Detect evidence of edema.
- C. Minimize risk of infection.
- D. Promote adherence to the antibiotic regimen.
Correct Answer: C
Rationale: High-dose prednisone causes immunosuppression, making infection prevention a priority in MCNS. Appetite is naturally increased by steroids, edema monitoring is part of disease management, and antibiotics are not used prophylactically in this condition.
What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls?
- A. Avoid public toilet facilities.
- B. Limit long baths as much as possible.
- C. Cleanse the perineum with water after voiding.
- D. Ensure clear liquid intake of 2 L/day.
Correct Answer: D
Rationale: Adequate fluid intake (e.g., 2 L/day for a 5-6-year-old) minimizes urinary stasis, reducing UTI risk. Public toilets and long baths aren?t directly linked to UTIs, and perineal cleansing with water lacks evidence as a primary preventive measure.
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 results from immune complexes formed after streptococcal infection, depositing in glomerular capillaries. Renal vessel infarction occurs in sickle cell disease, bacterial endotoxins aren?t involved, and embolization is linked to bacterial endocarditis.
The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss?
- A. Poor appetite
- B. Reduction of edema
- C. Restriction to bed rest
- D. Increased potassium intake
Correct Answer: B
Rationale: Rapid weight loss of 8 lb in 4 days in acute glomerulonephritis is due to improved renal function and mobilization of edema fluid. Poor appetite and bed rest don?t cause such significant loss, and potassium is restricted, not increased, until renal function normalizes.
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: Hematuria is common in renal trauma but doesn?t correlate with injury severity. Flank pain often occurs due to bleeding, most renal trauma in children is from blunt injuries like accidents, and children?s kidneys are more mobile and less protected, increasing injury risk.