As the nurse cares for four postpartum patients, which patient is at highest risk for hemorrhage?

A. Urinary tract infection is incorrect because while UTIs can cause dysuria, urgency, and sometimes hematuria, they rarely follow a strep throat infection and do not typically cause periorbital edema or tea-colored urine in otherwise healthy children.

B. Nephrotic syndrome is incorrect because nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and generalized edema, rather than the hematuria, mild periorbital edema, and tea-colored urine seen here.

C. Acute tubular necrosis is incorrect because ATN is usually associated with ischemic or nephrotoxic injury and presents with oliguria and elevated creatinine, not a history of recent streptococcal infection or classic tea-colored urine.

D. Acute post-streptococcal glomerulonephritis (APSGN) is correct because APSGN typically occurs 1–2 weeks after a streptococcal pharyngitis or skin infection. Classic manifestations include periorbital edema, hematuria (tea- or cola-colored urine), mild proteinuria, decreased urine output, and hypertension. This child’s history of recent strep throat followed by these renal symptoms is highly indicative of APSGN.

A. Cataract is incorrect because although cataracts can cause a cloudy or white appearance of the lens, they are less commonly associated with leukocoria (white pupillary reflex) seen in photographs and are not typically linked with intermittent eye crossing in toddlers.

B. Retinoblastoma is correct because leukocoria (white reflection in the pupil) is the classic and most common presenting sign of this malignant eye tumor in young children. Strabismus or eye crossing often occurs because the tumor interferes with normal vision. Retinoblastoma is a medical emergency, and early detection is critical to preserve vision and life.

C. Strabismus is incorrect because while it involves misalignment of the eyes, it does not cause a white pupillary reflex. Strabismus may be a symptom of an underlying condition, such as retinoblastoma, but it is not the primary diagnosis given these findings.

D. Glaucoma is incorrect because pediatric glaucoma typically presents with tearing, photophobia, corneal cloudiness, and enlarged eyes, not leukocoria. Eye crossing is also not a primary feature of glaucoma.