The preliminary management of a 6-year-old diagnosed with nocturnal enuresis (bedwetting) focused on behavioral modifications and positive reinforcement. Follow-up evaluation determines no significant improvement. The nurse practitioner should change the plan to include:
bowel cleansing.
urine analysis.
a bedwetting alarm.
a referral to a pediatric urologist.
The Correct Answer is C
Rationale:
A. Bowel cleansing may be considered if constipation is contributing, but it is not the standard next step when behavioral strategies alone fail.
B. Urinalysis is useful for ruling out underlying urinary tract infections or diabetes but is typically performed earlier in the evaluation process.
C. A bedwetting alarm is a first-line second-step intervention after behavioral modifications have not produced improvement. It conditions the child to wake in response to bladder fullness and has demonstrated efficacy in reducing nocturnal enuresis.
D. Referral to a pediatric urologist is generally reserved for refractory cases, underlying anatomic abnormalities, or complicated presentations, not as the immediate next step after failed behavioral therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Bowel cleansing may be considered if constipation is contributing, but it is not the standard next step when behavioral strategies alone fail.
B. Urinalysis is useful for ruling out underlying urinary tract infections or diabetes but is typically performed earlier in the evaluation process.
C. A bedwetting alarm is a first-line second-step intervention after behavioral modifications have not produced improvement. It conditions the child to wake in response to bladder fullness and has demonstrated efficacy in reducing nocturnal enuresis.
D. Referral to a pediatric urologist is generally reserved for refractory cases, underlying anatomic abnormalities, or complicated presentations, not as the immediate next step after failed behavioral therapy.
Correct Answer is D
Explanation
Rationale:
A. Hematocrit and hemoglobin can indicate anemia but do not reliably reflect ongoing purging behaviors.
B. Serum albumin levels assess nutritional status but are not specific for detecting purging.
C. Bicarbonate and sodium levels may be affected by purging, but they are less sensitive indicators than electrolyte disturbances.
D. Serum potassium, chloride, and magnesium levels are commonly depleted in adolescents who continue purging through vomiting or laxative use. Monitoring these electrolytes helps detect ongoing purging behavior and prevent potentially life-threatening complications such as cardiac arrhythmias.
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