A nurse is assessing a toddler who has acute nephrotic syndrome. Which of the following findings should the nurse report to the provider?
Yellow nasal discharge.
Poor appetite.
Facial edema.
Irritability.
None
None
The Correct Answer is A
Choice A rationale: Yellow nasal discharge in a toddler with acute nephrotic syndrome signifies a potential upper respiratory tract infection, which is critically important. Children with nephrotic syndrome are highly susceptible to infections due to significant urinary loss of immunoglobulins, leading to an immunocompromised state. Furthermore, corticosteroid treatments, often prescribed for nephrotic syndrome, suppress the immune system. An infection can precipitate a relapse of the syndrome, lead to severe complications like peritonitis or sepsis, and requires prompt evaluation and potentially antibiotic therapy to prevent life-threatening outcomes.
Choice B rationale: Poor appetite is a non-specific symptom in toddlers with nephrotic syndrome and does not typically indicate an immediate, life-threatening complication. It can be attributed to generalized malaise, abdominal discomfort due to ascites, or even side effects of medications such as corticosteroids. While important to monitor for nutritional status and overall well-being, it does not carry the same urgency as signs of infection, which can rapidly lead to severe health deterioration in an immunocompromised child.
Choice C rationale: Facial edema is a cardinal clinical manifestation of acute nephrotic syndrome, resulting from profound hypoalbuminemia. Reduced plasma oncotic pressure causes fluid to shift from the intravascular space into the interstitial space, leading to generalized edema, often prominently in the face. This finding is expected and indicates the disease process itself, rather than an acute, unexpected complication requiring immediate reporting, unless there is a sudden, significant worsening or associated respiratory compromise.
Choice D rationale: Irritability in a toddler can be a manifestation of general discomfort, illness, or even a side effect of corticosteroid therapy, which can cause mood disturbances and behavioral changes. While it warrants assessment to identify the underlying cause, irritability is a non-specific symptom and does not directly indicate an urgent, life-threatening complication of nephrotic syndrome requiring immediate medical intervention, unlike the signs of an acute infection in an immunocompromised child.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
“Our baby will sleep in our bed because I am breastfeeding.” Sharing a bed with a baby increases the risk of SIDS1.
Choice B is not the answer because removing blankets and toys from the crib is a recommended way to reduce the risk of SIDS2.
Choice C is not the answer because giving a baby a pacifier during naps and at bedtime can help reduce the risk of SIDS.
Choice D is not the answer because placing a baby on their back when sleeping is one of the most important measures to help protect against SIDS1.
Correct Answer is A
Explanation
The correct answer is Choice A.
Choice A rationale: The initial step in assessing unexplained bruising in a toddler is to gather information directly from the caregivers. This establishes a clinical baseline and allows the nurse to evaluate consistency, plausibility, and emotional responses. Bruising in toddlers can be developmental due to increased mobility, but patterns, location, and frequency matter. Normal platelet count ranges from 150,000 to 450,000/mm³; abnormal bruising may suggest thrombocytopenia, coagulopathy, or trauma. Early dialogue supports accurate documentation and escalation if needed.
Choice B rationale: While engaging the toddler may seem appropriate, their developmental stage limits reliable verbal communication. Toddlers typically lack the cognitive and linguistic capacity to describe events accurately, especially those involving trauma or abuse. Their responses may be influenced by fear, confusion, or limited vocabulary. Relying on their account prematurely risks misinterpretation and emotional distress. Assessment should prioritize adult sources first, followed by observational and clinical data to guide further action.
Choice C rationale: Notifying social services is a critical step in suspected abuse but must follow preliminary assessment and documentation. Premature reporting without context may lead to unnecessary distress for the family and compromise the integrity of the investigation. The nurse must first gather objective findings, caregiver explanations, and clinical indicators. Social services involvement is warranted when findings suggest non-accidental trauma, inconsistent histories, or high-risk environments. The decision must be evidence-informed and procedurally sound.
Choice D rationale: Notifying the provider is essential for collaborative care but should follow initial data collection. The provider relies on the nurse’s observations and caregiver input to determine next steps, including diagnostic testing or referral. Immediate escalation without context may delay appropriate triage or misdirect resources. The nurse’s role includes thorough documentation, pattern recognition, and initiating dialogue with caregivers to inform the provider’s clinical judgment. This ensures a coordinated, evidence-based response.
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