A nurse is assessing a 9-year-old child whose parents report that the child had a sudden onset of sore throat, fever, with white exudate and petechiae on the soft palate about 2 weeks ago but has now resolved. The child now presents with puffiness around the eyes, tea-colored urine, and decreased urine output. Which of the following conditions should the nurse suspect?

Urinary tract infection

Nephrotic syndrome

Acute tubular necrosis

Acute post-streptococcal glomerulonephritis (APSGN)

Answer and Explanation

The Correct Answer is D

A. Urinary tract infection is incorrect because while UTIs can cause dysuria, urgency, and sometimes hematuria, they rarely follow a strep throat infection and do not typically cause periorbital edema or tea-colored urine in otherwise healthy children.

B. Nephrotic syndrome is incorrect because nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and generalized edema, rather than the hematuria, mild periorbital edema, and tea-colored urine seen here.

C. Acute tubular necrosis is incorrect because ATN is usually associated with ischemic or nephrotoxic injury and presents with oliguria and elevated creatinine, not a history of recent streptococcal infection or classic tea-colored urine.

D. Acute post-streptococcal glomerulonephritis (APSGN) is correct because APSGN typically occurs 1–2 weeks after a streptococcal pharyngitis or skin infection. Classic manifestations include periorbital edema, hematuria (tea- or cola-colored urine), mild proteinuria, decreased urine output, and hypertension. This child’s history of recent strep throat followed by these renal symptoms is highly indicative of APSGN.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. "Sweating can occur with hyperglycemia" is incorrect because sweating is a symptom of hypoglycemia, not hyperglycemia. Hyperglycemia typically presents with polyuria, polydipsia, dehydration, and fatigue.

B. "My son might have nausea and vomiting with hypoglycemia" is incorrect because nausea and vomiting are more commonly associated with hyperglycemia or diabetic ketoacidosis (DKA), not low blood glucose.

C. "My son might complain of feeling shaky when he has a low blood glucose level" is correct. Symptoms of hypoglycemia include shakiness, sweating, irritability, palpitations, hunger, and sometimes confusion. These signs reflect the body’s response to low circulating glucose, primarily mediated by adrenergic stimulation. Recognizing these early signs allows for prompt intervention, such as administering fast-acting glucose.

D. "The onset of low blood glucose usually occurs slowly" is incorrect because hypoglycemia can develop rapidly, often within minutes, especially in children who are active, miss a meal, or take insulin. Slow onset is more characteristic of chronic hyperglycemia, not acute hypoglycemia.

A. Ensure the weights hang freely and do not touch the floor to maintain proper traction force. B. Remove the traction weights every 6 hours to prevent skin breakdown, C. Limit monitoring of pin sites to once every 24 hours to reduce patient discomfort. D. Place the rope knot in contact with the pulley to stabilize the traction system.

Correct Answer is A

Explanation

A. Ensure the weights hang freely and do not touch the floor to maintain proper traction force is correct. Proper skeletal traction depends on continuous, consistent force applied through the weights. If the weights touch the floor or are obstructed, the traction is disrupted, which can result in malalignment, delayed healing, increased pain, or neurovascular compromise. Maintaining correct traction mechanics is the highest priority to prevent serious complications.

B. Remove the traction weights every 6 hours is incorrect because weights should never be removed unless prescribed. Interrupting traction can cause muscle spasm, malalignment, or delayed fracture healing. Skin breakdown is addressed through regular skin care and positioning, not by removing weights.

C. Limit monitoring of pin sites to once every 24 hours is incorrect because pin sites require frequent assessment (at least every 4–8 hours) for signs of infection, inflammation, or loosening. Infrequent monitoring increases the risk of osteomyelitis or local infection.

D. Place the rope knot in contact with the pulley is incorrect because this would interfere with the smooth functioning of the traction system. The rope must move freely through the pulley to maintain proper tension and alignment.

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Naxlex Comprehensive Predictor Exams

A nurse is providing discharge teaching to the parents of a child who has a new diagnosis of diabetes mellitus. Which statement made by the parents indicates an understanding of the teaching?

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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