The nurse is reviewing the Provider Prescriptions from week 1 at 1200.
Drag words from the choices below to fill in each blank in the following sentence.
The greatest concerns to the nurse are
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
MCNS causes increased permeability of the glomerular membrane, leading to massive protein loss in the urine, hypoalbuminemia, edema, and hyperlipidemia. The major nursing concerns involve maintaining fluid balance and preventing progression of renal complications. Because children with nephrotic syndrome can rapidly develop severe edema, intravascular volume depletion, and long-term renal impairment if complications occur, these findings require close monitoring and prompt intervention.
Rationale for correct choices:
• Fluid imbalance is a major concern because severe protein loss decreases plasma oncotic pressure, causing fluid to shift from the intravascular space into the interstitial tissues. This leads to edema, periorbital swelling, ascites, and decreased circulating blood volume despite visible swelling. The child already shows pitting edema, delayed capillary refill, and poor skin turgor, indicating altered fluid distribution. Strict intake and output, daily weights, and abdominal girth monitoring are prescribed to assess and manage this complication.
• Although MCNS often responds well to corticosteroid therapy, repeated relapses or complications can lead to progressive renal damage and increase the risk for chronic kidney disease. Persistent proteinuria and prolonged glomerular dysfunction may impair long-term kidney function if not effectively managed. Monitoring renal status and preventing complications are important nursing priorities.
Rationale for incorrect choices:
• Growth restriction can occur in children with chronic illness, especially with prolonged corticosteroid therapy such as prednisone, but it is not the greatest immediate concern during the acute phase of nephrotic syndrome. The priority is stabilizing fluid status and preventing renal complications first. Growth changes are usually a longer-term concern that develops over time rather than an urgent complication.
• Mood changes may occur as a side effect of corticosteroid therapy, particularly with prednisone, and children may become irritable, restless, or emotionally labile. However, this is not considered a life-threatening complication and does not take priority over fluid shifts or renal dysfunction. While psychosocial monitoring is important, it is secondary to preventing hypovolemia and kidney damage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Gentamicin is an aminoglycoside antibiotic commonly used to treat severe bacterial infections, such as meningitis, in pediatric patients. Although highly effective, it has a narrow therapeutic window and is well-known for its potential to cause nephrotoxicity (kidney damage) and ototoxicity (hearing loss). Because the drug is primarily excreted by the kidneys, the nurse must meticulously monitor renal function markers, as an elevation in these values often indicates the onset of drug-induced acute kidney injury.
Rationale:
A. A creatinine level of 1.4 mg/dL is significantly higher than the expected reference range for a 4-year-old child and must be reported immediately. Creatinine is a byproduct of muscle metabolism that is filtered almost entirely by the kidneys; an elevation indicates a decrease in the glomerular filtration rate. This rise strongly suggests nephrotoxicity, requiring a possible dose adjustment or discontinuation of the medication to prevent permanent renal damage.
B. A blood urea nitrogen (BUN) level of 12 mg/dL falls within the normal reference range for a child (5 to 18 mg/dL). Although BUN is used to assess kidney function, it is also influenced by other factors such as hydration status, protein intake, and liver function. Since this value is stable and within the expected limits, it does not suggest a complication of the gentamicin therapy.
C. A BUN level of 6 mg/dL is at the lower end of the normal reference range for a 4-year-old child. A low BUN is generally not a cause for concern in this clinical setting and may simply reflect the child's small muscle mass or adequate hydration. It does not indicate the presence of drug-induced nephrotoxicity.
D. A creatinine level of 0.3 mg/dL is within the expected reference range of 0.2 to 0.5 mg/dL for a preschool-age child. This finding suggests that the kidneys are effectively filtering waste products and that the gentamicin is not currently causing detectable nephrotoxic damage. The nurse should continue to monitor this value alongside serum drug levels (trough and peak) to ensure the medication remains at a safe and therapeutic concentration.
Correct Answer is A
Explanation
A peripherally inserted central catheter (PICC) is a long-term intravenous access device used to administer medications, fluids, or nutrition directly into the central circulation. In pediatric clients, PICC lines are typically inserted into large peripheral veins in the upper extremities and advanced toward the superior vena cava. Proper vein selection is essential to ensure safe catheter advancement, reduce complications, and maintain long-term patency. Nurses must understand appropriate anatomical sites used for PICC insertion.
Rationale:
A. The cephalic vein is a suitable site for PICC insertion because it is a large, superficial vein in the upper extremity that allows safe advancement of the catheter toward central circulation. It provides good accessibility and reduces the risk of complications compared to smaller or less stable veins. This makes it a commonly selected site for PICC placement.
B. The femoral vein is not typically used for PICC insertion because it is located in the lower extremity and has a higher risk of infection and thrombosis. Central lines placed in the femoral region are generally avoided for long-term use due to mobility issues and increased complication rates. Therefore, it is not preferred for PICC placement.
C. Scalp veins are sometimes used for peripheral IV access in infants but are not appropriate for PICC insertion. These veins are too small and superficial to accommodate the advancement of a catheter into central circulation. They are only suitable for short-term peripheral access in neonates or infants.
D. The radial vein is not commonly used for PICC insertion because it is a smaller distal vein in the forearm/wrist area and does not provide an optimal pathway for central catheter advancement. PICC lines require larger proximal veins to safely guide the catheter toward central veins. Radial veins are typically used for peripheral IV access or arterial sampling, not central catheter placement.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.