A 10-kg toddler is diagnosed with acute renal failure (ARF), is afebrile, and has a 24-hour urine output of 110 mL. After calculating daily fluid maintenance, which would the nurse expect the toddler’s daily allotment of fluids to be?

Correct Answer: B

Rationale: In this scenario, the correct answer is B) 350 mL of oral and intravenous fluids. For a 10-kg toddler with acute renal failure, the daily fluid maintenance requirement is typically calculated as 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, and 20 mL/kg for each kg above 20. Therefore, for a 10-kg toddler, the total daily fluid requirement would be 1000 mL + 0 (as there are no additional kgs) = 1000 mL. Since the toddler already has a 24-hour urine output of 110 mL, the nurse would expect the toddler's daily allotment of fluids to be 1000 mL - 110 mL = 890 mL. Option B) providing 350 mL of oral and intravenous fluids is appropriate to ensure hydration without overwhelming the compromised kidneys. Option A) Sips of clear fluids and ice chips only would not provide an adequate amount of fluids to meet the toddler's daily maintenance requirements and could lead to dehydration. Option C) 1000 mL of oral and intravenous fluids would exceed the toddler's calculated daily allotment by 110 mL, potentially causing fluid overload and worsening the renal condition. Option D) 2000 mL of oral and intravenous fluids would significantly exceed the toddler's calculated daily allotment, posing a risk of fluid overload and further compromising renal function. In an educational context, understanding the principles of calculating fluid requirements based on weight and condition is crucial in pediatric pharmacology and nursing practice. It is essential for nurses to accurately assess and manage fluid balance in pediatric patients, especially those with renal issues, to prevent complications and promote optimal outcomes.

Correct Answer: D

Rationale: The correct answer is D) Try to keep your child away from sick children because relapses have been associated with infections. Explanation: Children with Minimal Change Nephrotic Syndrome (MCNS) are at risk for relapses, and infections are a known trigger for relapses in these patients. Keeping the child away from sick individuals can help reduce the likelihood of infections, thereby decreasing the risk of relapse. This preventive measure is crucial in managing MCNS effectively. Option A is incorrect because relapses in MCNS are not as rare as stated. Option B is also incorrect as there are strategies, like infection prevention, that can help in preventing relapses. Option C, while reducing dietary sodium can be beneficial in some cases of nephrotic syndrome, it is not the primary preventive measure for relapse in MCNS. Educational Context: Understanding the triggers and preventive measures for relapse in MCNS is essential for pediatric nurses and healthcare providers. This knowledge allows for comprehensive patient education and empowers parents to take active steps in managing their child's condition effectively. By emphasizing the role of infection prevention, healthcare providers can improve outcomes and quality of life for children with MCNS.

Correct Answer: A

Rationale: The correct answer is A) Slowing the rate of solute removal during dialysis. During hemodialysis, especially in pediatric patients, rapid removal of solutes can lead to a condition known as dialysis disequilibrium syndrome. This syndrome presents with symptoms such as confusion, restlessness, headache, nausea, and muscle twitching due to rapid changes in electrolyte concentrations and osmolality in the brain. Slowing the rate of solute removal allows the body more time to adjust to these changes, reducing the risk of dialysis disequilibrium syndrome. This is a crucial intervention to ensure the safety and well-being of pediatric patients undergoing hemodialysis. Option B) Ensuring the patient is warm during dialysis is incorrect as it does not directly address the underlying cause of the symptoms described. Option C) Administering antibiotics before dialysis is irrelevant to the scenario provided. Option D) Obtaining an accurate weight the night before dialysis is important for fluid management but does not directly address the acute symptoms experienced during dialysis. Understanding the potential complications of hemodialysis in pediatric patients is essential for nurses and healthcare providers caring for this population. Proper management and monitoring during dialysis can help prevent adverse events and improve patient outcomes.

Correct Answer: C

Rationale: In the context of pediatric chronic renal failure (CRF), it is crucial to provide a diet that supports proper growth and development while managing the condition. The correct answer, option C, states that the diet should be high in protein and calcium while being low in potassium and phosphorus. High protein intake is important in CRF to prevent malnutrition and support growth, but it should be carefully controlled to avoid excess waste products that the kidneys may struggle to eliminate. Calcium is essential for bone health, which can be compromised in children with CRF. Limiting potassium and phosphorus is necessary in CRF to prevent electrolyte imbalances and further stress on the kidneys. Option A is incorrect because it suggests excluding all minerals and electrolytes, which would be harmful to a child with CRF. Option B is incorrect as it suggests low protein intake, which is not ideal for ensuring proper growth and development in these children. Option D is incorrect as it recommends high intake of phosphorus and sodium, which can be detrimental in CRF due to difficulties in filtering these electrolytes by the compromised kidneys. Educationally, understanding the specific dietary needs of children with CRF is crucial for nurses and healthcare providers caring for these patients. It is essential to balance nutritional requirements with the limitations imposed by the renal condition to optimize the child's health outcomes. By grasping these principles, healthcare professionals can effectively manage the dietary aspect of pediatric CRF and contribute to improved patient outcomes.

Correct Answer: C

Rationale: Educational Rationale: The correct answer is C) Diurnal enuresis. Diurnal enuresis refers to involuntary voiding of urine during waking hours, which can occur in children with conditions like diabetes. In this case, the child's newly diagnosed diabetes may be affecting their bladder control, leading to daytime accidents. A) Primary enuresis typically refers to children who have never been consistently dry at night. It is not the appropriate term for daytime accidents in a child who previously had control. B) Secondary enuresis is the term used when a child who has been previously dry for a significant period of time starts to experience bedwetting again. This does not apply to daytime accidents in a child with diabetes. D) Nocturnal enuresis refers to bedwetting during the night, which is not the same as daytime accidents. Educational Context: Understanding different types of enuresis is essential for healthcare providers, especially in pediatrics. Recognizing diurnal enuresis in a child with diabetes can prompt further evaluation and management to address any underlying issues affecting bladder control. It is crucial for nurses, nurse practitioners, and other healthcare professionals to be able to differentiate between different types of enuresis to provide appropriate care and support to pediatric patients.