A nurse is caring for a preschooler who has a new diagnosis of celiac disease. Which of the following findings should the nurse expect?

A. Bradycardia: Bradycardia (a slow heart rate) is not typically associated with heart failure. Heart failure usually leads to increased heart rate (tachycardia) as the heart attempts to compensate for poor cardiac output.

B. Increased appetite: Increased appetite is not commonly seen in heart failure. In fact, children with heart failure often have poor appetite and may experience difficulty eating due to fatigue and shortness of breath.

C. Tachypnea: Correct. Tachypnea is a common manifestation of heart failure as the body attempts to increase oxygen intake due to decreased cardiac output and poor perfusion.

D. Tremors: Tremors are not typically associated with heart failure. They are more commonly related to neurological or metabolic conditions.

Given the clinical presentation and the context, the most appropriate words to fill in the blanks are "pyelonephritis" and "renal scarring."

So, the sentence should read: "The child is at risk for developing pyelonephritis and renal scarring."

Rationale for each choice:

1. Pyelonephritis: The child presents with a fever and lethargy, which are common signs of a urinary tract infection (UTI). The use of a sterile straight catheter to obtain a urine sample suggests that the healthcare provider is investigating a potential UTI, which in children can progress to pyelonephritis if not promptly treated. Pyelonephritis is an infection of the kidneys and is more severe than a simple bladder infection, requiring careful management to prevent complications.

2. Renal scarring: If pyelonephritis occurs, it can lead to renal scarring, especially in young children. Renal scarring is a long-term complication of recurrent or severe kidney infections, which can affect kidney function and lead to chronic kidney disease. Early diagnosis and treatment of UTIs are crucial to prevent renal scarring.

Rationale against other choices:

Nephrotic syndrome: This condition is characterized by proteinuria, hypoalbuminemia, hyperlipidemia, and edema. While it is a serious kidney disorder, the child's symptoms (fever, lethargy, decreased appetite) are more indicative of an acute infection rather than nephrotic syndrome.

Acute glomerulonephritis: This condition typically presents with hematuria, proteinuria, hypertension, and edema. It is often a post-infectious condition (e.g., following a streptococcal infection) and less likely to present with just fever and lethargy in isolation. The current presentation suggests an acute infection rather than glomerulonephritis.

Polycystic kidney: This is a genetic disorder characterized by the growth of numerous cysts in the kidneys. It typically presents with signs of chronic kidney disease over time, rather than acute symptoms like fever and lethargy.