A nurse is caring for a school-age child in the pediatric unit.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

Nephrotic Syndrome: The child presents with periorbital and abdominal edema, foamy dark-colored urine, significant proteinuria (24 mg/dL), hypoalbuminemia (1.4 g/dL), and hyperlipidemia (cholesterol 465 mg/dL), all of which are classic indicators of nephrotic syndrome. The elevated ESR and low sodium further support an inflammatory renal process with fluid retention.
Chronic Kidney Disease: CKD is a long-term progressive decline in kidney function. This child shows acute findings with severe proteinuria and low albumin, consistent with nephrotic syndrome, not CKD.
Acute Glomerulonephritis: Usually presents with hematuria (cola-colored urine), hypertension, and mild proteinuria. This client has severe proteinuria, hypoalbuminemia, and edema, which are more typical of nephrotic syndrome.
Hemolytic Uremic Syndrome: Commonly follows a gastrointestinal illness and includes anemia, thrombocytopenia, and acute kidney injury. This child’s platelets are elevated, not low, and there's no history of diarrheal illness, making HUS unlikely.
Encourage a low sodium diet: Sodium restriction helps manage fluid retention and edema which are key concerns in nephrotic syndrome. It also prevents worsening of ascites and periorbital swelling.
Administer oral corticosteroids: This is the first-line treatment for idiopathic nephrotic syndrome, especially in children. Corticosteroids reduce glomerular permeability, limiting protein loss in the urine and promoting remission.
Initiate peritoneal dialysis: Dialysis is only indicated in severe renal failure, which this child does not have. There’s no indication of uremia or electrolyte crisis, so dialysis is not appropriate at this stage.

Intake and output: Essential for assessing fluid balance. Children with nephrotic syndrome may retain fluid or have decreased urine output, making I&O a crucial measure.
Daily weight: This is the most accurate way to track fluid retention or loss. Daily weight is important for evaluating response to treatment, especially as edema resolves.

Head circumference: This is monitored in infants and toddlers, especially to assess for hydrocephalus or growth delays. It is not relevant for a school-age child with kidney issues.

HbA1C: A measure of long-term blood glucose control, used for diagnosing and managing diabetes. Has no relevance in the diagnosis or management of nephrotic syndrome.
Urine specific gravity: While useful in initial diagnosis (and already elevated), it is not the best indicator of ongoing progress. Daily weight and I&O are more practical and reliable for assessing edema and treatment response.

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Correct Answer is B

Explanation

A. Soy. While soy can have mild estrogen-like effects and may influence thyroid function or interact with certain medications, it is not typically associated with hypotension or increased surgical bleeding risk.
B. Black cohosh. Black cohosh is often used to manage menopausal symptoms but is known to cause vasodilation and hypotension in some individuals. Its use can increase the risk of low blood pressure during anesthesia and surgery.
C. Flaxseed. Flaxseed is commonly used for digestive health and cardiovascular support. It may have mild blood pressure–lowering effects but is not strongly linked to significant hypotension during surgery.
D. Probiotics. Probiotics support gut flora and immunity but do not affect blood pressure significantly. They are not associated with intraoperative complications like hypotension.

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"D"}

Explanation

Panic disorder: Typically presents with intense fear, chest pain, shortness of breath, dizziness, and a sense of doom. It is episodic, not sustained like mania, and does not include symptoms like euphoria, grandiosity, or hallucinations.
Catatonia: Involves motor immobility, stupor, rigidity, or excessive purposeless movement. While this client is very active, their activity is goal-directed but disorganized, consistent with mania, not catatonia.
Mania: Characterized by euphoric or irritable mood, increased energy, racing thoughts, pressured speech, poor judgment, impulsivity, and decreased need for sleep. The client displays grandiosity, impulsive spending, hyperactivity, pressured speech, insomnia, and hallucinations, all pointing to mania.
Major depressive disorder: Involves symptoms like anhedonia, depressed mood, fatigue, and decreased energy. This is inconsistent with the client's overactivity and euphoric behavior.
Delirium: Usually presents with acute confusion, fluctuating consciousness, and disorientation, often due to a medical condition or substance use. This client is consistently manic and does not show signs of fluctuating alertness or disorientation to time and person.
Anhedonia: Inability to feel pleasure, commonly seen in depression, not in mania.
Alogia: Poverty of speech or reduced speech output, often associated with schizophrenia, not consistent with this client’s pressured and loud speech.
Magical thinking: Believing that one's thoughts can influence reality, often seen in schizotypal personality disorder, not prominent here.
Euphoric mood: A classic symptom of mania, where the individual may feel overly joyful, energetic, and invincible, as reflected in the client's excessive confidence, impulsivity, and erratic behavior.
Hypervigilance: Commonly linked with anxiety disorders or PTSD, and not the most fitting descriptor for this client’s presentation.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing preoperative teaching to an older adult female client who is scheduled for a laminectomy and uses supplements. Which of the following supplements should the nurse identify as increasing the client's risk for hypotension during surgery?

Correct Answer is B

Explanation

The nurse continues to care for the client. Exhibits Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The client is most likely experiencing dropdownas evidenced by the client'sdropdown

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"D"}

Explanation

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