A child with nephrotic syndrome is prescribed a corticosteroid. The nurse should ensure the child is:

Taken off the medication after 1 week

Monitored closely for signs of infection

Administered the medication with milk

Given the medication at bedtime

Answer and Explanation

The Correct Answer is B

Choice A reason: Discontinuing corticosteroids after one week in nephrotic syndrome is inappropriate, as treatment requires a prolonged course (weeks to months) to reduce proteinuria and edema. Abrupt cessation risks adrenal insufficiency and disease relapse due to persistent glomerular inflammation, making this an incorrect approach for managing the immune-mediated pathology effectively.

Choice B reason: Corticosteroids in nephrotic syndrome suppress the immune system, increasing infection risk due to reduced immunoglobulin production and impaired immune response. Children are particularly vulnerable to bacterial infections like peritonitis. Close monitoring for fever, leukocytosis, or other infection signs is critical to detect and treat complications early, ensuring safe management.

Choice C reason: Administering corticosteroids with milk may reduce gastrointestinal irritation but is not the priority in nephrotic syndrome. The primary concern is immunosuppression, increasing infection risk. While milk may aid tolerability, it does not address the significant risk of sepsis or other infections, making monitoring for infection the more critical nursing action.

Choice D reason: Giving corticosteroids at bedtime may align with diurnal cortisol rhythms but is not the priority in nephrotic syndrome. Timing does not mitigate the immunosuppression that increases infection risk. Monitoring for infection signs like fever or malaise is essential, as corticosteroids heighten susceptibility, making bedtime administration a less critical consideration.

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Correct Answer is C

Explanation

Choice A reason: NPH insulin has an onset of 1-2 hours, peaking at 4-12 hours. At 0900, 2 hours post-administration, the effect is minimal, with low hypoglycemia risk. Peak action, when hypoglycemia is most likely due to maximum glucose-lowering effect, occurs later, making this time less critical for monitoring.

Choice B reason: At 0730, only 30 minutes post-NPH insulin, the medication’s onset has not occurred, as it takes 1-2 hours to begin lowering glucose. Hypoglycemia is unlikely this early, as insulin levels are not yet significant. Peak effect at 4-12 hours is when monitoring is critical, making 0730 incorrect.

Choice C reason: NPH insulin peaks at 4-12 hours, with significant glucose-lowering effects by 1100 (4 hours post-0700 injection). Hypoglycemia risk is highest during this period due to insulin’s maximum activity, reducing blood glucose. Monitoring at 1100 is critical to detect and treat low glucose, preventing symptoms like tremors or seizures.

Choice D reason: At 0715, only 15 minutes post-NPH insulin, the medication has not reached its onset (1-2 hours). Hypoglycemia is unlikely, as insulin has not significantly lowered glucose. The peak effect at 4-12 hours is when hypoglycemia risk is highest, making 0715 an incorrect time for monitoring.

A. Right side B. Prone C. Left side D. Upright

Correct Answer is D

Explanation

Choice A reason: Right-side positioning after feeding may reduce reflux in some infants but is less effective than upright positioning, which uses gravity to keep stomach contents down. Right-side lying also poses a sudden infant death syndrome risk, making it less ideal than upright positioning for managing gastroesophageal reflux in infants.

Choice B reason: Prone positioning is contraindicated for infants due to increased sudden infant death syndrome risk. It does not effectively reduce gastroesophageal reflux compared to upright positioning, which leverages gravity to prevent regurgitation. Prone positioning is unsafe and not recommended, making it an incorrect choice for reflux management.

Choice C reason: Left-side positioning is not optimal for gastroesophageal reflux, as it may not prevent stomach contents from refluxing into the esophagus. Upright positioning is more effective, using gravity to minimize regurgitation and esophagitis. Left-side lying also carries sleep-related risks, making it less appropriate than upright positioning.

Choice D reason: Upright positioning after feeding is optimal for gastroesophageal reflux, as gravity keeps stomach contents from refluxing into the esophagus, reducing regurgitation and esophageal irritation. This position minimizes aspiration risk and promotes comfort, making it the recommended choice for infants with reflux to prevent complications like esophagitis.

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A child with nephrotic syndrome is prescribed a corticosteroid. The nurse should ensure the child is:

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

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