The nurse is caring for a school aged child with glomerulonephritis. Which of the following findings requires IMMEDIATE attention?

The child's urine output is 190mL in an 8-hour period and their urine is dark brown

The child is lethargic, confused and complains of a headache and double vision

The child's BUN, creatinine, and erythrocyte sedimentation rate are elevated

The child sleeps most of the day, is irritable when awake, and the BP is 138/80

Answer and Explanation

The Correct Answer is B

A. Decreased urine output and dark brown urine are concerning but not immediately life-threatening.
B. Lethargy, confusion, headache, and double vision are signs of severe hypertension and possibly hypertensive encephalopathy, which require immediate attention.
C. Elevated BUN, creatinine, and ESR are indicative of kidney dysfunction but are not as immediately concerning as neurological symptoms.
D. While elevated BP and irritability are concerning, they are not as immediately critical as the neurological symptoms in option B.

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Correct Answer is C

Explanation

A. While appropriate clothing is important, it is not the priority for reducing child abuse.
B. Skin and nail care are necessary for infant hygiene but are not directly related to preventing child abuse.
C. Recognizing that increased crying is normal during the first month and ensuring parents have emotional support can significantly reduce the risk of frustration that may lead to child abuse.
D. Understanding normal feeding patterns is important but less critical for the immediate goal of preventing child abuse.

A. Vomiting B. Poor Feeding C. Weak cry D. Sunken Fontanels E. Irritability

Correct Answer is ["A","B","E"]

Explanation

A. Vomiting can be a sign of increased intracranial pressure (ICP).
B. Poor feeding is a concerning symptom of increased ICP.
C. A weak cry may indicate general illness but is not specifically indicative of increased ICP.
D. Sunken fontanels suggest dehydration, not increased ICP. Bulging fontanels would be concerning for increased ICP.
E. Irritability can be a sign of increased ICP in infants.

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The nurse is caring for a school aged child with glomerulonephritis. Which of the following findings requires IMMEDIATE attention?

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