A couple comes into the clinic for genetic counseling. Both parents are heterozygous for sickle cell trait. What is the chance each of their children will have sickle cell anemia?

Choice A reason:

Bacteriuria, or the presence of bacteria in the urine, is not a primary clinical manifestation of acute renal failure. While facial edema can occur due to fluid retention, bacteriuria is more commonly associated with urinary tract infections. Acute renal failure primarily affects the kidneys’ ability to filter waste and regulate fluid and electrolytes, leading to symptoms such as oliguria and hypertension.

Choice B reason:

Hematuria, or blood in the urine, can be a symptom of various kidney conditions, but it is not a primary manifestation of acute renal failure1. Pallor, or paleness, can occur due to anemia, which may be a secondary complication of chronic kidney disease rather than acute renal failure. The primary symptoms of acute renal failure are related to the sudden decline in kidney function, such as oliguria and hypertension.

Choice C reason:

Proteinuria, or the presence of excess protein in the urine, is more commonly associated with chronic kidney disease or nephrotic syndrome rather than acute renal failure. Muscle cramps can occur due to electrolyte imbalances, but they are not primary manifestations of acute renal failure. The primary symptoms of acute renal failure include oliguria and hypertension.

Choice D reason:

Oliguria, or reduced urine output, and hypertension, or high blood pressure, are primary clinical manifestations of acute renal failure. Acute renal failure results in a sudden decline in kidney function, leading to the retention of waste products and fluids, which can cause oliguria and hypertension. These symptoms are key indicators of acute renal failure and require prompt medical attention.

Choice A reason:

Performing an ultrasound to determine if there is urinary retention is not the immediate priority action. While an ultrasound can help assess urinary retention, the presence of edema, redness, and the foreskin being behind the glans penis suggests a condition known as paraphimosis. Paraphimosis is a medical emergency that requires prompt attention to prevent complications such as tissue damage. Therefore, alerting the ER physician is the priority action.

Choice B reason:

Asking the parents specifically how long the infant has not voided is important for gathering information, but it is not the immediate priority action. The clinical signs of edema, redness, and the foreskin being behind the glans penis indicate a potential emergency that requires immediate medical intervention. While obtaining a detailed history is important, the nurse should first alert the ER physician to ensure timely management.

Choice C reason:

Alerting the ER physician to the patient’s condition is the correct priority action. The presence of edema, redness, and the foreskin being behind the glans penis suggests paraphimosis, which is a urological emergency. Prompt intervention is necessary to reduce the foreskin and restore normal blood flow to prevent tissue damage3. The ER physician can provide the necessary treatment and management for this condition.

Choice D reason:

Continuing to monitor the patient in the ER setting is not appropriate without first addressing the potential emergency. The signs of edema, redness, and the foreskin being behind the glans penis indicate a condition that requires immediate medical attention. Monitoring alone is insufficient; the nurse must alert the ER physician to ensure prompt intervention.