The home health nurse is monitoring an 8-month-old child with hypothyroidism taking levothyroxine (Synthroid). Which symptoms does the nurse recognize as signs of overdose? (Select all that apply)

Choice A reason: A positive antistreptolysin titer suggests post-streptococcal glomerulonephritis, not nephrosis (minimal change disease). Nephrosis is typically idiopathic, not infection-related, and lacks streptococcal association. Edema and proteinuria are hallmark features due to hypoalbuminemia, making this an incorrect characteristic for nephrosis, as it reflects a different renal pathology.

Choice B reason: Bacteriuria indicates urinary tract infection, not a characteristic of nephrosis, which involves sterile proteinuria and hypoalbuminemia. Infections may occur as complications due to immunosuppression, but bacteriuria is not a primary feature. Edema and proteinuria define nephrosis, making bacteriuria an incorrect symptom for this condition.

Choice C reason: Edema is a hallmark of nephrosis, resulting from massive proteinuria causing hypoalbuminemia, reducing plasma oncotic pressure. Fluid leaks into interstitial spaces, causing periorbital or generalized edema. This is a primary symptom, reflecting the pathophysiological fluid shift, making it a key characteristic in children with nephrosis.

Choice D reason: Massive proteinuria is a defining feature of nephrosis, particularly minimal change disease, where glomerular damage allows excessive protein filtration. This leads to hypoalbuminemia, edema, and hyperlipidemia. Proteinuria is a core diagnostic criterion, making it a characteristic symptom essential for identifying and managing nephrosis in children.

Choice A reason: Acute appendicitis typically causes right lower quadrant pain due to inflammation of the appendix, often at McBurney’s point. Left lower quadrant pain is associated with conditions like diverticulitis, not appendicitis. The anatomical location of the appendix makes this an incorrect expected finding in a child with appendicitis.

Choice B reason: Bradycardia is not typical in acute appendicitis, which often causes tachycardia due to pain, inflammation, or fever from infection. The body’s stress response increases heart rate to meet metabolic demands. Leukocytosis is a more specific sign, making bradycardia an incorrect expected finding in this condition.

Choice C reason: Hyperactive bowel sounds occur early in appendicitis but progress to hypoactive sounds as inflammation worsens, causing ileus. By the time of acute presentation, bowel sounds are typically diminished. Elevated WBC is a more consistent finding, reflecting infection, making hyperactive sounds less likely in advanced appendicitis.

Choice D reason: A WBC of 17,000/mm³ indicates leukocytosis, a hallmark of acute appendicitis due to bacterial infection and inflammation of the appendix. Neutrophil elevation reflects the body’s immune response to localized peritonitis. This is an expected finding, as it confirms the infectious process, requiring urgent surgical evaluation in children.