The nurse is caring for a toddler during a follow-up visit after corticosteroid treatment for minimal change nephrotic syndrome (MCNS). Which finding should the nurse recognize as an early sign of relapse?

Increased thirst.

Tachypnea.

Rounded face.

Albuminuria.

Answer and Explanation

The Correct Answer is D

Minimal change nephrotic syndrome involves an idiopathic increase in glomerular permeability, specifically targeting the podocytes of the basement membrane. This pathology results in massive protein loss, leading to systemic hypoalbuminemia, which shifts fluid from the intravascular space into the interstitium, causing generalized edema. Early detection of a relapse relies on identifying the recurrence of basement membrane dysfunction before significant clinical symptoms such as severe anasarca or weight gain manifest.

Rationale:

A. Increased thirst is not a recognized early clinical indicator of a recurrence in nephrotic syndrome. While fluid shifts can affect perceived hydration, thirst is more commonly associated with diabetes mellitus or electrolyte imbalances. The primary monitoring focus for MCNS remains the urinary protein status rather than oral intake patterns.

B. Tachypnea may occur in late-stage relapse if pleural effusions or massive ascites develop, causing respiratory compromise. It is considered a secondary complication of severe fluid overload rather than a primary diagnostic sign of early disease activity. Monitoring should focus on the kidneys rather than respiratory rate during the initial stages of relapse.

C. A rounded face, often termed moon face, is a classic side effect of prolonged corticosteroid therapy used to treat the condition. This finding indicates a physiological response to the medication rather than a return of the disease process itself. It can mask the development of edema, making objective laboratory testing more critical.

D. Albuminuria is the most significant and early indicator that the nephrotic process has returned. Parents are often taught to monitor the child's urine daily using dipsticks to detect protein excretion before visible edema occurs. Identifying protein in the urine allows for prompt intervention with steroids to prevent a full-blown clinical relapse.

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Correct Answer is ["A","B","D","E","F","G"]

Explanation

Pulmonary embolism management transitions from acute anticoagulation to long-term prevention and risk factor modification. A pulmonary embolism occurs when a thrombus, often from a deep vein, obstructs pulmonary arterial flow, leading to ventilation-perfusion mismatch and potential right heart strain. Discharge education focuses on hemorrhage prevention while on anticoagulants, enhancing peripheral venous return to prevent stasis, and addressing modifiable factors like nicotine use that promote a prothrombotic state.

Rationale:

A. Avoiding aspirin is essential because it is an antiplatelet agent that increases the risk of bleeding when combined with anticoagulants. The concurrent use of multiple blood-thinning medications significantly elevates the potential for gastrointestinal hemorrhage or intracranial bleeding. Clients must be taught to screen over-the-counter medications for hidden salicylates to maintain pharmacological safety during the recovery period.

B. Moving and stretching the lower extremities prevents venous stasis, a primary component of Virchow’s triad. Frequent movement facilitates the skeletal muscle pump, which assists in pushing venous blood back toward the heart and prevents the formation of new thrombi. This is especially critical for a client with a recent lower extremity fracture and cast who has reduced mobility.

C. Keeping legs in a dependent position is contraindicated because it promotes venous pooling and increases the risk of deep vein thrombosis. The client should be encouraged to elevate the legs above the level of the heart to facilitate venous drainage and reduce generalized edema. Dependent positioning worsens stasis and creates an environment conducive to further clot formation.

D. Smoking cessation is highly encouraged because nicotine causes vasoconstriction and hypercoagulability, increasing the risk of recurrent thromboembolic events. This client has a significant smoking history, which likely contributed to the development of the pulmonary embolism post-surgery. Quitting smoking is a vital lifestyle modification to improve vascular health and prevent future life-threatening complications.

E. Reporting shortness of breath is a priority instruction as it may indicate a recurrent embolism or worsening pulmonary function. Since the client already experienced an acute event characterized by respiratory distress, he must be vigilant in recognizing early symptoms. Prompt reporting allows for immediate clinical evaluation and prevents the progression of potential pulmonary infarction or failure.

F. Performing range of motion exercises maintains joint flexibility and promotes circulation while the client is convalescing. These exercises help prevent the complications of immobility-induced stasis, which is a high risk given his recent ankle fracture and surgery. Consistent movement ensures that blood flow remains active in the unaffected and partially affected limbs to support recovery.

G. Avoiding anal intercourse is a specific safety precaution to prevent mucosal trauma and subsequent rectal bleeding while on anticoagulation therapy. The rectal mucosa is highly vascular and easily injured, leading to significant blood loss if the client's clotting ability is pharmacologically suppressed. This instruction is a necessary component of comprehensive education regarding the prevention of internal bleeding.

H. Applying warm moist heat to fresh bruising is contraindicated as it causes vasodilation and can worsen local bleeding and hematoma expansion. Instead, clients should apply cold compresses to new bruises to promote vasoconstriction and limit the size of the hemorrhage. Heat should only be used in later stages of healing once the initial clot has stabilized.

A. Eliminate or reduce intake of fatty and gas forming foods. B. Chew food slowly and thoroughly before attempting to swallow. C. Sip fluids slowly with each meal and between meals. D. Plan volume-controlled, evenly-spaced meals throughout the day.

Correct Answer is D

Explanation

Gastric bypass procedures involve creating a small gastric pouch and bypassing a significant portion of the small intestine. This anatomical alteration significantly reduces the stomach's holding capacity and alters nutrient absorption. Effective postoperative management focuses on preventing dumping syndrome, a condition where hyperosmolar chyme enters the jejunum too rapidly, causing systemic symptoms.

Rationale:

A. While reducing fats and gas-forming foods can prevent gastrointestinal distress, it is not the most critical instructional priority. These dietary modifications focus on comfort and minor flatulence rather than the fundamental structural limitations of the new stomach. They are secondary to volume and timing constraints.

B. Mastication is essential to prevent stomal obstruction and facilitate easier digestion within the smaller pouch. While important for safety and preventing esophageal discomfort, it does not address the systemic risks associated with rapid gastric emptying or the volume-related complications of the bypass.

C. Instructing a client to sip fluids with meals is actually contraindicated because it can cause the gastric pouch to empty too quickly. Fluids should be consumed between meals to avoid the rapid transit of food, which triggers vasomotor symptoms like tachycardia, sweating, and severe abdominal cramping.

D. Consuming 6 small, volume-controlled meals is the most important instruction to ensure nutritional adequacy while preventing pouch distension. This strategy minimizes the risk of dumping syndrome by regulating the osmotic load entering the small intestine. Maintaining a strict schedule prevents overeating and promotes stable blood glucose.

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The nurse is caring for a toddler during a follow-up visit after corticosteroid treatment for minimal change nephrotic syndrome (MCNS). Which finding should the nurse recognize as an early sign of relapse?

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Explanation

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Explanation

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