In caring for a child with nephrotic syndrome, which nursing intervention is most important?
Assessing for edema.
Providing a high-calorie diet.
Monitoring for signs of infection.
Encouraging high protein snacks.
The Correct Answer is C
Choice A rationale
Assessing for edema is an important nursing intervention in nephrotic syndrome because fluid retention due to decreased oncotic pressure is a common manifestation. However, preventing and monitoring for infection is a higher priority due to the immunosuppressed state of these children.
Choice B rationale
Providing a high-calorie diet is important to meet the increased metabolic needs associated with nephrotic syndrome and to compensate for energy loss. However, preventing infection takes precedence in nursing care.
Choice C rationale
Monitoring for signs of infection is the most important nursing intervention in a child with nephrotic syndrome. These children are at increased risk of infection due to protein loss (including immunoglobulins), edema compromising skin integrity, and potential immunosuppressive medications. Early detection and management of infection are critical to prevent serious complications. Normal temperature range is 97°F to 100.4°F (36.1°C to 38°C).
Choice D rationale
Encouraging high-protein snacks was a traditional recommendation but is now understood to potentially worsen proteinuria and is not the most important intervention. A moderate protein intake is generally recommended for children with nephrotic syndrome.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice D rationale
Same-sex peer group activity becomes increasingly important during the school-aged years (approximately 6 to 12 years). Children in this stage develop a strong sense of belonging and identity within these groups, engaging in cooperative play, sharing interests, and establishing social norms.
Correct Answer is B
Explanation
Choice A rationale
Myoclonic seizures are characterized by brief, sudden, involuntary muscle jerks or twitches. These movements are typically not associated with a complete loss of postural tone leading to a fall. The child's presentation of suddenly dropping to the floor without warning indicates a loss of muscle strength.
Choice B rationale
Atonic seizures, also known as drop attacks, involve a sudden loss of muscle tone, causing the individual to fall abruptly. This loss of tone can be localized or generalized, affecting the entire body, which aligns with the description of the child suddenly dropping to the floor.
Choice C rationale
Absence seizures are characterized by brief lapses of consciousness, often appearing as a staring spell. Individuals usually do not fall during an absence seizure; instead, they may have subtle motor movements like eye blinking or lip smacking.
Choice D rationale
Tonic seizures involve a sudden increase in muscle tone, causing stiffening of the body, arms, or legs. While a person might fall due to the rigidity, the primary characteristic is muscle stiffening, not a sudden loss of tone.
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