When explaining dietary guidelines to a client with acute glomerulonephritis (AGN), which instruction should the nurse include in the dietary teaching?
- A. Restrict sodium intake
- B. Encourage high-protein foods.
- C. Increase potassium intake.
- D. Decrease fluid intake.
Correct Answer: A
Rationale: Sodium restriction helps manage fluid retention and hypertension, which are common in AGN.
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A child aged 10 days has ambiguous genitalia:
- A. If a buccal smear is chromatin negative, there is a serious risk of an Addisonian crisis
- B. A raised urinary output of pregnanetriol would confirm a diagnosis of CAR
- C. The finding of the genotype 45 XO would reliably explain the anomaly
- D. If testicles were present in the 'labia', an acceptable explanation would be Klinefelter's syndrome
Correct Answer: B
Rationale: A raised urinary pregnanetriol indicates congenital adrenal hyperplasia (CAR). Chromatin-negative buccal smear suggests male genotype, and 45 XO is Turner syndrome, not related to ambiguous genitalia. Klinefelter's syndrome does not explain testicles in the labia.
An infant with trisomy 21 has a complete AV canal defect. Which finding associated with both conditions will the primary care pediatric nurse practitioner expect?
- A. Crackles in both lungs
- B. Hepatomegaly
- C. Oxygen desaturation
- D. Peripheral edema
Correct Answer: C
Rationale: Because infants with trisomy 21 maintain neonatal high pulmonary vascular resistance, they often do not show signs of CHF but instead will have signs of pulmonary hypertension with loud single S2 and desaturation with agitation or effort.
Which of the following skills would be expected of a 7-month-old infant but not of a 5-month-old infant?
- A. Crawls
- B. Smiles socially
- C. Controls bowel and bladder
- D. Sits unsupported
Correct Answer: D
Rationale: A 7-month-old can typically sit unsupported, while a 5-month-old cannot. Crawling and social smiling develop earlier, and bowel control is not expected at this age.
How much bilirubin can be bound to 1 gm of albumin?
- A. 8.5 mg
- B. 9.8 mg
- C. 10.5 mg
- D. 13.6 mg
Correct Answer: A
Rationale: 1 gram of albumin can bind approximately 8.5 mg of bilirubin, which is important in managing neonatal jaundice.
A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _______ beats/min.
- A. 60
- B. 70
- C. 90 to 110
- D. 110 to 120
Correct Answer: C
Rationale: If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a 6-month-old. Sixty beats/min is the cut-off for holding the digoxin dose in an adult; 70 beats/min is the determining heart rate to hold a dose of digoxin for an older child; 110 to 120 beats/min is an acceptable heart rate to administer digoxin to a 6-month-old.