A 1-year-old with ARF is edematous with minimal urine output. The vital signs include HR 146, BP 176/92, and RR 42; the child has nasal flaring and retractions. Despite oral Kayexalate, serum potassium continues to rise. Which treatment will most benefit the child?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Placement of a Tenckhoff catheter for peritoneal dialysis. Peritoneal dialysis is the most suitable treatment for the 1-year-old with acute renal failure (ARF) who is edematous, has minimal urine output, and is experiencing a rise in serum potassium levels despite oral Kayexalate. Peritoneal dialysis helps remove waste, excess fluids, and electrolytes from the body when the kidneys are not functioning properly. Option A) Additional rectal Kayexalate is not the best choice because the child is not responding to oral Kayexalate, which indicates the need for a more aggressive intervention like dialysis. Option B) Intravenous furosemide may exacerbate the child's fluid and electrolyte imbalance, leading to further complications. Option C) Endotracheal intubation and ventilatory assistance are not directly addressing the underlying cause of the ARF and high potassium levels. Educationally, understanding the appropriate management of pediatric genitourinary disorders is crucial for nurses, especially when caring for critically ill children. Recognizing the signs and symptoms of renal failure, understanding the principles of dialysis, and knowing when to escalate treatment are essential skills for pediatric nurses to ensure safe and effective care for their patients.

Correct Answer: A

Rationale: The correct answer is A) Your child’s urine output will increase, and the urine will become less tea-colored. Rationale: - In glomerulonephritis, the kidneys' filtering units are inflamed, leading to decreased urine output and tea-colored urine due to the presence of blood. As the child improves, increased urine output and clearer urine indicate better kidney function and resolution of inflammation. - Option B is incorrect as resting comfortably does not directly correlate with improvement in glomerulonephritis. Improvement in labs is a better indicator. - Option C is incorrect as increased urine output is typically associated with increased thirst and appetite in pediatric patients. - Option D is partially correct but lacks specificity. Improving lab values are an essential part of monitoring, but changes in urine output and color are more direct indicators of kidney function improvement. Educational Context: Understanding how to monitor a child's improvement in glomerulonephritis is crucial for parents to manage the condition effectively at home. Educating parents on these signs helps them recognize improvement and seek medical assistance if necessary. Monitoring urine output and color provides valuable insight into the child's kidney function and overall health status.

Correct Answer: C

Rationale: The correct answer is C) An 8-year-old male with a finger laceration and a history of ureteral reimplantation 2 years ago. This child does not need a urinalysis to evaluate for a UTI because the symptoms presented are not related to genitourinary issues but rather to a finger laceration. It is essential to focus on the chief complaint to guide diagnostic testing. Option A, a 4-month-old female with fever, fussiness, and poor appetite, presents with classic UTI symptoms and requires evaluation with a urinalysis. Option B, a 4-year-old female with dysuria and frequent urination, also needs a urinalysis to assess for a UTI. Option D, a 12-year-old female with back pain and fever, presents with symptoms concerning for a possible kidney infection, necessitating a urinalysis. In an educational context, understanding the appropriate indications for diagnostic tests like urinalysis is crucial in pediatric pharmacology. By analyzing symptoms and medical history, healthcare providers can make informed decisions about the necessity of specific tests to guide diagnosis and treatment effectively.

Correct Answer: D

Rationale: In pediatric patients, obtaining a urine sample for evaluation of a UTI can be challenging due to their age and limited ability to cooperate. The best method to obtain a urine sample in an 8-month-old being evaluated for a UTI is option D, which is performing an in-and-out (straight) catheterization. Rationale for choosing option D: Performing an in-and-out catheterization ensures a sterile collection of urine directly from the bladder, minimizing the risk of contamination and providing an accurate sample for analysis. This method is considered the most reliable in infants who are not toilet trained and can't provide a clean-catch sample. Rationales for why other options are incorrect: A) Using a urine collection bag may lead to contamination from the perineal area and may not provide a sterile sample for accurate diagnosis. B) Inserting an indwelling Foley catheter is invasive and not necessary for a simple urine sample collection in this scenario, increasing the risk of complications. C) Placing a sterile cotton ball in the diaper and using a syringe is not a recommended method for obtaining a sterile urine sample in infants, as it is prone to contamination from the diaper and surrounding environment. Educational context: Understanding the appropriate methods for obtaining a urine sample in pediatric patients is crucial for accurate diagnosis and treatment of UTIs. In-and-out catheterization is a common and effective technique used in infants and young children when a sterile urine sample is required. It is important for healthcare providers to be knowledgeable about the most appropriate methods to ensure patient safety and accurate test results.

Correct Answer: B

Rationale: In pediatric patients with hepatitis, it is crucial to provide foods that are easily digestible, gentle on the liver, and rich in nutrients. Option B, offering clear liquids such as broth and Jell-O, is the correct choice. Clear liquids are easy on the digestive system, help maintain hydration, and provide some essential nutrients without overloading the liver. Option A, a tuna sandwich on whole wheat bread and skim milk, may be too heavy and fatty for a child with hepatitis, potentially putting strain on the liver. Option C, a hamburger, French fries, and a diet soda, contains high amounts of unhealthy fats and sugars that can be challenging for the liver to process. Option D, a peanut butter sandwich and a milkshake, while high in calories, may also be too heavy and fatty for a child with hepatitis. Educationally, understanding appropriate dietary choices for pediatric patients with hepatitis is essential for nurses and healthcare providers. By selecting the correct foods, we can support the child's recovery, prevent complications, and promote overall well-being. It is important to prioritize nutrition that is gentle on the liver and easy to digest to aid in the healing process.