A nurse is assessing a toddler during a well-child visit. Which of the following findings should the nurse identify as an indication of nephrotic syndrome?

Choice A reason: This is not the correct instruction to include in the discharge teaching. Perform clean intermittent catheterization every 8 hours is a possible intervention for infants who have neurogenic bladder dysfunction due to spinal cord injury or spina bifida. However, not all infants who have myelomeningocele repair require catheterization. The nurse should assess the infant’s bladder function and teach the guardian how to perform catheterization if needed.

Choice B reason: This is not the correct instruction to include in the discharge teaching. Use a rectal thermometer to stimulate the passage of stool twice per day is a possible intervention for infants who have neurogenic bowel dysfunction due to spinal cord injury or spina bifida. However, not all infants who have myelomeningocele repair require rectal stimulation. The nurse should assess the infant’s bowel function and teach the guardian how to manage constipation or fecal incontinence if needed.

Choice C reason: This is not the correct instruction to include in the discharge teaching. Anticipate gradual loss of function in the lower extremities is a possible outcome for infants who have myelomeningocele repair, depending on the location and severity of the defect. However, the nurse should not assume that the infant will lose function in the lower extremities. The nurse should monitor the infant’s motor and sensory development and provide appropriate interventions to promote mobility and prevent complications.

Choice D reason: This is the correct instruction to include in the discharge teaching. Check toys and pacifiers for the presence of latex is an important precaution for infants who have myelomeningocele repair, as they are at risk of developing latex allergy due to repeated exposure to latex products during surgery and medical procedures. The nurse should teach the guardian how to identify and avoid latex-containing items and how to recognize and treat signs of allergic reaction.

Choice A reason: Hemoglobin (Hgb) of 12 g/dL is within the normal range for school-age children and is not specifically indicative of nephrotic syndrome.

Choice B reason: A serum protein level of 4.2 g/dL is lower than the normal range, which is typically between 6 and 8 g/dL. This finding is consistent with nephrotic syndrome, as the condition is characterized by proteinuria and hypoalbuminemia, leading to low serum protein levels.

Choice C reason: A BUN (Blood Urea Nitrogen) level of 15 mg/dL is within the normal range for children and does not specifically indicate nephrotic syndrome. Nephrotic syndrome is characterized by protein loss, not necessarily changes in BUN levels.

Choice D reason: A serum sodium level of 144 mEq/L is within the normal range for children. While electrolyte imbalances can occur in nephrotic syndrome, this value does not specifically indicate the condition.