Nokea
A nurse is caring for a 2-year-old child who has been diagnosed with nephrotic syndrome. The nurse collects data knowing that a common characteristic associated with nephrotic syndrome is:
- A. Hypotension
- B. Generalized edema
- C. Increased urinary output
- D. Bright red blood in urine
Correct Answer: B
Rationale: Hypotension, or low blood pressure, is not typically associated with nephrotic syndrome. In fact, some patients with nephrotic syndrome may experience high blood pressure. Generalized edema, or swelling, is a common characteristic of nephrotic syndrome. It occurs due to the loss of proteins in the urine, which leads to a decrease in the amount of protein in the blood. This decrease in blood protein levels causes fluid to move from the blood vessels into the tissues, leading to swelling. Increased urinary output is not typically associated with nephrotic syndrome. In fact, some patients may experience decreased urine output. Bright red blood in the urine is not a typical symptom of nephrotic syndrome. Hematuria, or blood in the urine, when present in nephrotic syndrome, is usually microscopic and not visible to the naked eye.
You may also like to solve these questions
A nurse is caring for a child who has acute glomerulonephritis. Which of the following actions is the nurse's priority?
- A. Maintain a saline-lock.
- B. Place the child on a no-salt-added diet.
- C. Check the child's weight daily.
- D. Educate the parents about potential complications.
Correct Answer: C
Rationale: While maintaining a saline-lock can be important for administering medications or fluids, it is not the priority action. The nurse's priority should be to assess the child's condition and intervene to prevent complications. A no-salt-added diet may be recommended for some children with acute glomerulonephritis to help manage fluid balance and blood pressure. However, this is not the priority action. The nurse's priority should be to assess the child's condition and intervene to prevent complications. This is the correct answer. Checking the child's weight daily is a priority action because weight changes can indicate fluid retention or loss, which can affect kidney function. Regular weight checks can help guide treatment decisions and monitor the effectiveness of interventions. Educating the parents about potential complications is important, but it is not the priority action. The nurse's priority should be to assess the child's condition and intervene to prevent complications.
A nurse is collecting data from an infant who has otitis media. Which of the following findings should the nurse expect?
- A. Bluish-green discharge from the ear canal
- B. Erythema and edema of the affected auricle
- C. Increase in appetite
- D. Tugging on the affected ear lobe
Correct Answer: D
Rationale: Bluish-green discharge from the ear canal is not a typical finding in otitis media. This could suggest a different condition, such as an external ear infection or a ruptured eardrum. Erythema and edema of the affected auricle (outer part of the ear) are not typical findings in otitis media. These symptoms are more commonly associated with conditions affecting the external ear, such as otitis externa. An increase in appetite is not typically associated with otitis media. In fact, children with otitis media may have a decreased appetite due to discomfort or pain while swallowing. Tugging on the affected ear lobe is a common sign of otitis media in infants and young children. This is often due to the pain and discomfort caused by the infection.
A nurse is contributing to the plan of care of an unconscious adolescent who ingested a non-corrosive substance that has no recommended antidote. The nurse should recommend performing gastric lavage with which of the following substances?
- A. Activated charcoal
- B. Osmotic diarrheal agents
- C. Syrup of ipecac
- D. 0.9% sodium chloride
Correct Answer: A
Rationale: Activated charcoal is often used in the management of poisoning. It works by binding to the poison in the stomach and preventing it from being absorbed into the body. Osmotic diarrheal agents are not typically used in gastric lavage. These agents work by increasing the amount of water in the intestinal tract, which can stimulate bowel movements. Syrup of ipecac was once used to induce vomiting in cases of poisoning, but it is no longer recommended for use in poisoning cases. 0.9% sodium chloride, or normal saline, is a type of fluid that's often used in medical treatments, but it's not typically used in gastric lavage for poisoning.
A nurse is preparing to administer acetaminophen 10mg/kg PO to a preschool child for fever. The child weighs 22 lb. Available is acetaminophen liquid 160 mg/5 mL. How many mL should the nurse administer?
- A. 3.125 mL
Correct Answer: A
Rationale: The child weighs 22 lb, which is approximately 10 kg (since 1 kg is approximately 2.2 lb). The prescribed dose of acetaminophen is 10 mg/kg. Step 1 is: Calculate the total dose of acetaminophen for the child. This is done by multiplying the child's weight in kg by the prescribed dose in mg/kg. 10 kg×10 mg/kg=100 mg The available acetaminophen liquid is 160 mg/5 mL. Step 2 is: Calculate the volume of acetaminophen liquid to administer. This is done by setting up a proportion with the total dose of acetaminophen and the concentration of the available liquid. x mL100 mg=5 mL160 mg Solving for x gives: x=160 mg mg×5 mL=3.125 mL Therefore, the nurse should administer approximately 3.125 mL of the acetaminophen liquid.
A nurse is providing guidance to a toddler's parent about the types of food that are part of a clear liquid diet. Which food, if suggested by the parent, would indicate that they have understood the instructions?
- A. Yogurt
- B. Gelatin
- C. Strained soup
- D. Pureed fruit
Correct Answer: B
Rationale: Yogurt is not part of a clear liquid diet. It is a dairy product and is not clear or liquid at room temperature. Gelatin is part of a clear liquid diet. This type of diet is often prescribed before medical procedures or tests, or for patients with certain digestive issues. It consists of liquids and foods that are clear and liquid at room temperature. Strained soup might be allowed on a full liquid diet, but it is not part of a clear liquid diet. Only the broth of the soup, which is clear and liquid at room temperature, would be allowed. Pureed fruit is not part of a clear liquid diet. While it is a liquid at room temperature, it is not clear.