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Parents of a child who will need hemodialysis ask the nurse, What are the advantages of a fistula over a graft or external access device for hemodialysis? (Select all that apply.)
- A. It is ready to be used immediately.
- B. All below
- C. There is less restriction of activity with a fistula.
- D. It produces dilation and thickening of the superficial vessels.
Correct Answer: A
Rationale: A fistula typically has fewer complications, allows for greater freedom of movement, and involves natural vessel changes that improve dialysis efficiency. However, it is not ready for immediate use, which is why it may take weeks to mature before it can be used.
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A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include?
- A. Bowel cleansing
- B. Dietary modification
- C. Structured toilet training
- D. Behavior modification
Correct Answer: B
Rationale: Dietary modification is often the first step in managing chronic constipation in children, focusing on increasing fiber and fluid intake. Other interventions like bowel cleansing and toilet training may follow if dietary changes are insufficient.
What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema?
- A. Place an ice pack on the scrotal area.
- B. Place the child in an upright sitting position.
- C. Elevate the scrotum with a rolled washcloth.
- D. Place a warm moist pack to the scrotal area.
Correct Answer: C
Rationale: Elevating the scrotum with a rolled washcloth helps reduce edema by promoting fluid drainage. Ice packs are not recommended due to the risk of frostbite, and warm moist packs are not typically used for this purpose. An upright position does not specifically address the edema.
Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what?
- A. Minimize separation anxiety
- B. Prevent urinary complications.
- C. Increase acceptance of hospitalization.
- D. Promote development of normal body image.
Correct Answer: D
Rationale: Early repair of congenital genitourinary defects like hypospadias is important to promote a normal body image and avoid psychological issues as the child grows. It also helps prevent urinary complications and allows for normal development.
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.
What is an important consideration in understanding the reactions of parents when their infant is born with physical defects?
- A. Grief lasts until the defects are repaired.
- B. Denial is a common adaptive reaction.
- C. The psychologic reaction is similar to that with the death of an infant.
- D. Reactions of health professionals to the birth of an infant can affect parents' reactions.
Correct Answer: C
Rationale: When a parent's infant is born with physical defects, understanding the psychological reactions is crucial. The reaction is often similar to the grief experienced when facing the death of a child. Parents need to grieve for the loss of the expected child and adapt to the needs of a child with physical defects. The grief process typically involves stages like shock, frustration, and anger, which can last for years. Denial during the shock phase is not maladaptive but can help parents cope initially. Additionally, parents are sensitive to the behavior of health professionals, whose interactions can significantly influence the parents' reactions to the infant. Therefore, recognizing the similarity of the psychological reaction to grief is an important consideration in understanding how parents cope with their infant's physical defects.