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Which is instituted for the therapeutic management of minimal change nephrotic syndrome?
- A. Corticosteroids
- B. Antihypertensive agents
- C. Long-term diuretics
- D. Increased fluids to promote diuresis
Correct Answer: A
Rationale: Corticosteroids are the mainstay of therapy for minimal change nephrotic syndrome. Minimal change disease is the most common cause of nephrotic syndrome in children, and corticosteroids are highly effective in inducing remission in these patients. They work by reducing inflammation and decreasing the permeability of the glomerular filtration barrier in the kidneys, thereby reducing proteinuria. Antihypertensive agents are used to control blood pressure in patients with renal involvement, and long-term diuretics are not typically recommended in nephrotic syndrome due to the risk of worsening kidney function. Increased fluids to promote diuresis are also not indicated as the primary treatment for minimal change nephrotic syndrome.
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Appropriate intervention is vital for many children with heart disease in order to go on to live active, full lives. Which of the following outlines an effective nursing intervention to decrease cardiac demands and minimize cardiac workload?
- A. Feeding the infant over long periods
- B. Allowing the infant to have her way to avoid conflict
- C. Scheduling care to provide for uninterrupted rest periods
- D. Developing and implementing a consistent care plan
Correct Answer: C
Rationale: The most appropriate intervention to decrease cardiac demands and minimize cardiac workload in children with heart disease is to schedule care to provide uninterrupted rest periods. By allowing the child to rest without interruptions, their heart will not have to work as hard, promoting better overall cardiac function. This intervention focuses on promoting rest and recovery, which is crucial for children with heart disease to maintain optimal cardiac health. Feeding the infant over long periods may not necessarily decrease cardiac demands, and allowing the infant to have her way to avoid conflict is not related to cardiac workload. Developing and implementing a consistent care plan is important but may not directly decrease cardiac demands as effectively as scheduling care for uninterrupted rest periods.
24 hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:
- A. Removal of the transplanted kidney
- B. High-dose IV cyclosporine (Sandimmune) therapy
- C. Bone marrow transplant
- D. Intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol)
Correct Answer: A
Rationale: Hyperacute rejection occurs immediately after transplantation, within minutes to up to 24 hours. It is a rapid and severe rejection reaction that is usually irreversible. It occurs due to pre-existing antibodies against the donor organ. In hyperacute rejection, the transplanted kidney must be removed to prevent further complications and ensure the safety of the patient. Treatment with immunosuppressive medications like cyclosporine or corticosteroids is not effective in this situation. Bone marrow transplant is not indicated in the treatment of hyperacute rejection.
Which organ(s) is/are most at risk for dysfunction in a patient with a potassium level of 6.3 mEq/L?
- A. Lungs
- B. Liver
- C. Kidneys
- D. Heart
Correct Answer: D
Rationale: A potassium level of 6.3 mEq/L indicates hyperkalemia, which can have significant effects on the heart. The heart is one of the most sensitive organs to changes in potassium levels. In hyperkalemia, elevated serum potassium levels can lead to various cardiac manifestations, including dysrhythmias, conduction abnormalities, and eventually cardiac arrest. Monitoring and managing potassium levels are crucial in preventing life-threatening cardiac complications in patients with hyperkalemia. While the kidneys and other organs can also be affected by high potassium levels, the heart is the most critical organ to consider in this scenario.
A 9mo-old infant develops a left adrenal mass; histological examination with genetic characteristics confirms neuroblastoma. Which of the following carries a better outcome?
- A. amplification of the MYCN (N-myc) proto-oncogene
- B. hyperdiploidy
- C. loss of heterozygosity of 17q chromosome
- D. loss of 1p chromosome
Correct Answer: B
Rationale: Hyperdiploidy is associated with a better prognosis in neuroblastoma.
A nurse is teaching parents about prevention and treatment of colic. Which should the nurse include in the teaching plan?
- A. Avoid use of pacifiers.
- B. Eliminate all second-hand smoke contact.
- C. Lay infant flat after feeding.
- D. Avoid swaddling the infant.
Correct Answer: B
Rationale: Second-hand smoke exposure has been linked to an increased risk of colic in infants. Colic is a condition characterized by excessive, inconsolable crying in otherwise healthy infants. By eliminating all second-hand smoke contact, the nurse is helping to reduce potential triggers for colic and promoting a healthier environment for the infant. This is an important aspect of prevention and treatment that should be emphasized in the teaching plan for parents.