Nokea
A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication?
- A. Propranolol (Inderal)
- B. Calcium gluconate
- C. Mannitol (Osmitrol) or furosemide (Lasix) (or both)
- D. Sodium, chloride, and potassium
Correct Answer: C
Rationale: Mannitol or furosemide promotes urine flow in ARF if glomerular function is intact, inducing osmotic diuresis. Propranolol doesn?t affect diuresis, calcium gluconate addresses hyperkalemia, and electrolytes like sodium, chloride, and potassium are avoided to prevent complications.
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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.
In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information?
- A. Limit fluids to reduce reflux.
- B. Give cranberry juice twice a day.
- C. Have siblings examined for VUR.
- D. Surgery is indicated to reverse scarring.
Correct Answer: C
Rationale: VUR has a 36% incidence in siblings, necessitating screening to detect and prevent scarring. Fluid restriction is not advised, cranberry juice lacks proven efficacy in children, and surgery may be needed for severe VUR but doesn?t reverse existing scarring.
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.
The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause?
- A. Poor hygiene
- B. Constipation
- C. Urinary stasis
- D. Congenital anomalies
Correct Answer: C
Rationale: Urinary stasis is the primary host factor promoting UTIs by providing a bacterial growth medium. Poor hygiene and constipation contribute by facilitating bacterial entry or causing stasis via rectal pressure, but stasis is the key driver. Congenital anomalies are less common causes.
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 acute glomerulonephritis, reflecting edema changes. Proteinuria indicates disease severity, specific gravity is unreliable due to proteinuria and hematuria, and intake/output is less accurate, especially in non-toilet-trained children.