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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.
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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.
The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. What knowledge should influence the nurses reply?
- A. The antibiotic therapy contributes to labile blood pressure values.
- B. Hypotension leading to sudden shock can develop at any time.
- C. Acute hypertension is a concern that requires monitoring.
- D. Blood pressure fluctuations indicate that the condition has become chronic.
Correct Answer: C
Rationale: Frequent blood pressure monitoring is critical in acute glomerulonephritis to detect acute hypertension, which requires aggressive management to prevent renal damage. Antibiotics aren?t typically used, hypotension is not a primary concern, and fluctuations don?t indicate chronicity.
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.
A girl, age 5 1/2 years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for what condition?
- A. School phobia
- B. Glomerulonephritis
- C. Urinary tract infection (UTI)
- D. Attention deficit hyperactivity disorder (ADHD)
Correct Answer: C
Rationale: Incontinence in a toilet-trained 5½-year-old girl suggests a UTI, common in this age group. UTI evaluation precedes psychosocial causes like school phobia or ADHD, and glomerulonephritis typically presents with reduced urine output and fluid retention, not incontinence.
What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)?
- A. Reduce blood pressure.
- B. Lower serum protein levels.
- C. Minimize excretion of urinary protein.
- D. Increase the ability of tissue to retain fluid.
Correct Answer: C
Rationale: The primary goal in MCNS is to minimize urinary protein excretion, reducing edema and complications. Blood pressure is typically normal, serum protein levels need to increase, and fluid retention (edema) is a problem to be reduced, not increased.