A nurse is performing an assessment for a 5-year-old child who has celiac disease. Which of the following findings should the nurse expect?

A. Inform the client to contact the pharmacy regarding any questions related to the medication. While pharmacists can provide additional information, the nurse should ensure the adolescent understands the medication instructions and has immediate answers to any questions during the teaching session.

B. Provide instructions to the client's parent with the client present. Adolescents may be more comfortable discussing sensitive topics such as STIs privately. The primary teaching should be directed to the adolescent to respect their autonomy and privacy.

C. Instruct the client's parents to write down the information that is being provided. This is not appropriate for an adolescent who is capable of understanding their own medical information. The focus should be on ensuring the adolescent comprehends the information.

D. Ask how the client prefers to learn new information. Correct. Asking the adolescent how they prefer to learn new information helps tailor the education to their learning style, making it more effective and respectful of their preferences.

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.