12-year-old Caroline has recurring nephrotic syndrome; which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care?

Correct Answer: A

Rationale: For 12-year-old Caroline with recurring nephrotic syndrome, body image should be a prime consideration when planning ongoing nursing care. Nephrotic syndrome can cause physical changes such as weight gain, swelling, and changes in appearance due to the disease process and treatment side effects like corticosteroids. These physical changes can impact a child's self-esteem and body image, especially during the sensitive pre-adolescent period. As a result, addressing Caroline's body image concerns through open communication, providing support, promoting self-acceptance, and involving her in decision-making regarding her care can significantly impact her emotional well-being and overall quality of life.

Correct Answer: C

Rationale: Idiopathic thrombocytopenic purpura (ITP) is a condition characterized by a low platelet count, which can lead to an increased risk of bleeding. Steroids are often prescribed to help increase platelet production in patients with ITP. Therefore, the nurse should monitor the child for signs of bleeding, such as petechiae, ecchymosis, gum bleeding, and other unusual bleeding manifestations. Monitoring for bleeding is crucial to assess the effectiveness of the steroid treatment and to prevent complications associated with ITP.

Correct Answer: C

Rationale: The most appropriate intervention to decrease cardiac demands and minimize cardiac workload in children with heart disease is to schedule care to provide uninterrupted rest periods. By allowing the child to rest without interruptions, their heart will not have to work as hard, promoting better overall cardiac function. This intervention focuses on promoting rest and recovery, which is crucial for children with heart disease to maintain optimal cardiac health. Feeding the infant over long periods may not necessarily decrease cardiac demands, and allowing the infant to have her way to avoid conflict is not related to cardiac workload. Developing and implementing a consistent care plan is important but may not directly decrease cardiac demands as effectively as scheduling care for uninterrupted rest periods.

Correct Answer: A

Rationale: The presence of a chronic cough, along with diffuse wheezing during the expiratory phase of respiration, suggests asthma. Asthma is a chronic condition characterized by inflammation and narrowing of the airways, causing symptoms such as coughing, wheezing, and difficulty breathing. The wheezing sound typically occurs during expiration due to air trapping in the narrowed airways. In this case, the absence of retractions (which could indicate increased work of breathing) and the nature of the wheezing pattern are more consistent with asthma rather than other conditions such as pneumonia, croup, or foreign body aspiration. While these other conditions may also present with respiratory symptoms, the specific combination of chronic cough and expiratory wheezing is most indicative of asthma in this scenario.

Correct Answer: A

Rationale: Clubbing of fingers is a common physiologic adaptation seen in children with tetralogy of Fallot. Clubbing is the result of chronic hypoxia and decreased oxygen levels in the blood. In children with tetralogy of Fallot, there is a structural defect in the heart that leads to mixing of oxygenated and deoxygenated blood in the heart and decreased oxygenation of the blood circulating to the body. This chronic hypoxia can cause clubbing of the fingers, where the tips of the fingers appear enlarged and the nails are rounded. Therefore, clubbing of fingers is a key sign to monitor in children with tetralogy of Fallot.