A nurse is caring for a child who has acute glomerulonephritis.
Which of the following actions is the nurse's priority?
Check the child's daily weight.
Educate the parents about potential complications.
Place the child on a no-salt-added diet.
Maintain a saline lock.
The Correct Answer is A
Nursing care planning goals for a child with acute glomerulonephritis are directed toward the excretion of excess fluid through urination.
Monitoring fluid status is very important and daily weights are an effective way to monitor fluid retention, as weight gain is the earliest sign of fluid retention.
Choice B, Educating the parents about potential complications, is important but not the nurse’s priority.
Choice C, Place the child on a no-salt-added diet, which may be part of the treatment
plan but is not the nurse’s priority.
Choice D, Maintaining a saline lock, may be necessary for administering medications but is not the nurse’s priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer ischoice C.
Choice A rationale:
A lead level of 10 mcg/dL is above the CDC’s reference value of 3.5 mcg/dL and would require more immediate follow-up and intervention, not just rescreening in one year.
Choice B rationale:
A lead level of 18 mcg/dL is significantly elevated and would necessitate immediate medical intervention and frequent monitoring, rather than waiting a year for rescreening.
Choice C rationale:
A lead level of 4 mcg/dL is slightly above the CDC’s reference value of 3.5 mcg/dL.While it is concerning, it may be appropriate to rescreen in one year if no other risk factors are present.
Choice D rationale:
A lead level of 44 mcg/dL is dangerously high and requires urgent medical treatment and frequent follow-up, not just rescreening in one year.
Correct Answer is A
Explanation
Adolescents affected by scoliosis often experience body image dissatisfaction.
Therefore, the nurse should anticipate body image changes as the most common reaction.
Choice B is not correct because loss of privacy is not the most common reaction
when dealing with scoliosis surgery.
Choice C is not correct because feelings of displacement are not the most
common reaction when dealing with scoliosis surgery.
Choice D is not correct because identity crisis is not the most common reaction
when dealing with scoliosis surgery.
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