A nurse is caring for a 7-year-old male client in a pediatrician's office.
Complete the following sentence by using the list of options. The nurse recognizes that the client is most likely experiencing
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
? Rationale for correct answers
Post-streptococcal glomerulonephritis (PSGN) is a renal complication following Group A Streptococcus infection, commonly pharyngitis. It typically develops 1–2 weeks after the initial illness, fitting this timeline.
- Tea-colored urine and proteinuria (2+) reflect glomerular damage.
- Hypertension (141/88 mm Hg) in a previously normotensive child signals fluid overload due to reduced renal clearance.
- Periorbital edema and increased weight further support fluid retention. Urinalysis shows blood (1+) and absence of infection markers, confirming nephritic pathology rather than a urinary tract infection.
❌ Rationale for incorrect Response 1 options
- Nephrotic syndrome: Presents with massive proteinuria (>3+), hypoalbuminemia, and generalized edema—typically without hematuria or hypertension.
- Urinary tract infection: Would show positive leukocyte esterase and nitrites, which are absent here.
- Rheumatic fever: Occurs post-strep but is characterized by carditis, migratory joint pain, and erythema marginatum, not renal manifestations.
❌ Rationale for incorrect Response 2 options
- Sandpaper-like rash and joint pain: May relate to scarlet fever or rheumatic fever—not PSGN.
- Positive leukocyte esterase and nitrites: Indicate bacterial urinary infection, not present here.
- Fever and elevated white count: Were present previously, but current afebrile status and fatigue point to PSGN.
✅ Take-home points
- PSGN should be suspected post-streptococcal infection with hematuria, proteinuria, and hypertension.
- Urinalysis helps differentiate nephritic vs nephrotic syndromes and infection.
- Edema in PSGN is often periorbital and related to sodium/water retention.
- Rheumatic fever and UTI must be excluded based on systemic and lab findings.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is []
Explanation
Rationale for correct condition The client’s leg and abdominal pain following exertion and potential dehydration are classic triggers of sickle cell crisis, specifically a vaso-occlusive episode. Hemoglobin 7.6 g/dL and hematocrit 22% reflect anemia from sickled erythrocytes impairing oxygen delivery. Mucosal pallor and pain without respiratory distress or splenic signs further support vaso-occlusion rather than other complications. Elevated ferritin indicates chronic hemolysis and iron overload.
Rationale for correct actions IV fluids restore plasma volume, reducing blood viscosity and decreasing red cell sickling. Hydration improves microvascular perfusion and minimizes further occlusion. Blood transfusion increases oxygen-carrying capacity and reduces sickled hemoglobin percentage, alleviating tissue ischemia and systemic anemia. Transfusion also mitigates risk of organ damage by improving oxygenation.
Rationale for correct parameters Pain scale monitoring assesses therapy efficacy, crucial as pain is a primary symptom of vaso-occlusion. Frequent evaluation enables titration of analgesics and guides supportive interventions. Urine output reflects hydration status and renal perfusion—key concerns as hypovolemia and renal ischemia may occur in sickle cell crisis. Output <0.5 mL/kg/hr may signal renal compromise.
Rationale for incorrect conditions Acute chest syndrome presents with cough, hypoxia, and pulmonary infiltrates—absent in this client. Aplastic crisis shows extreme anemia without pain, often post-viral. Sequestration crisis involves sudden splenomegaly and hypovolemia, not evident in this case.
Rationale for incorrect actions Oxygen therapy isn’t necessary with SpO₂ at 98%; it doesn’t relieve vaso-occlusion. Ibuprofen is suboptimal for severe pain in sickle crisis. Warm compresses may assist pain but are not core interventions for systemic pathology.
Rationale for incorrect parameters Oxygen saturation is stable and not primary for vaso-occlusive monitoring. Spleen palpation assesses sequestration, irrelevant here. Temperature is modestly elevated but not the primary marker of crisis progression.
Take-home points • Sickle cell crisis manifests as severe pain from microvascular occlusion after dehydration or exertion • Treatment focuses on hydration and oxygen-carrying capacity via fluids and transfusion • Pain and urine output are direct indicators of response to vaso-occlusive management • Differentiating crisis types ensures targeted and effective care strategies
Correct Answer is D
Explanation
Choice A rationale
Acute kidney injury leads to a buildup of metabolic waste products, including hydrogen ions, resulting in metabolic acidosis. The body compensates for this acidosis by increasing the respiratory rate and depth to blow off carbon dioxide, a form of carbonic acid. Therefore, a decreased respiratory rate is an unexpected finding.
Choice B rationale
Acute kidney injury is characterized by the inability of the kidneys to filter waste and regulate fluid balance. The most common manifestation in the initial phase is oliguria, which is a significant decrease in urine output, not polyuria (excessive urination). Polyuria may occur during the recovery phase, but not acutely.
Choice C rationale
An acute kidney injury can lead to the retention of nitrogenous wastes like urea and creatinine, a condition known as uremia. This can cause neurological symptoms such as lethargy, seizures, and altered mental status. Hyperactivity is not a typical manifestation and would be an unusual finding.
Choice D rationale
Edema is a hallmark sign of acute kidney injury. The kidneys fail to excrete excess sodium and water, leading to fluid retention. This fluid accumulates in the interstitial spaces, causing generalized swelling, especially in the face, hands, and feet. This is a direct consequence of the kidney's impaired regulatory function.
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