A 10-year-old boy he is a known case of steroid dependent nephrotic syndrome presented to the ER with severe generalized edema.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D, frusemide (furosemide). Frusemide is a loop diuretic commonly used to manage edema associated with nephrotic syndrome due to its potent diuretic effect on the loop of Henle in the kidney. It helps to reduce fluid overload and alleviate symptoms of edema in patients with nephrotic syndrome. Option A, aldactone (spironolactone), is a potassium-sparing diuretic and is not the first-line treatment for acute severe edema due to its slower onset of action compared to loop diuretics like frusemide. Option B, mannitol, is an osmotic diuretic used for conditions such as cerebral edema and intraocular pressure reduction, not typically indicated for generalized edema in nephrotic syndrome. Option C, acetazolamide, is a carbonic anhydrase inhibitor that primarily works in the proximal convoluted tubule of the kidney. It is not as effective as loop diuretics like frusemide in managing severe edema in nephrotic syndrome. Educationally, it is crucial for nursing students to understand the pharmacological management of pediatric genitourinary disorders like nephrotic syndrome. This knowledge is vital for safe and effective patient care, especially in emergency situations where quick decision-making is essential. Understanding the mechanisms of action and appropriate use of diuretics in pediatric patients is critical for NCLEX exam preparation and real-life nursing practice.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) increased echogenicity in renal ultrasound. Explanation: The presentation of severe dehydration with high renal indices suggests acute kidney injury (AKI) in this pediatric patient. Increased echogenicity in the renal ultrasound is indicative of renal parenchymal disease, which can be seen in conditions like acute tubular necrosis or obstructive uropathy, contributing to the AKI. This finding helps in diagnosing the underlying cause of the renal dysfunction in this case. Option A) urine sodium (mEq/L) <15 is incorrect because in cases of dehydration, the urine sodium concentration is typically elevated due to the kidneys conserving sodium to maintain fluid balance. Option B) fractional excretion of sodium (%) >2 is incorrect because in prerenal conditions like dehydration, the fractional excretion of sodium is usually low as the kidneys try to retain sodium. Option C) urine osmolality ∼ 300 is incorrect as in cases of severe dehydration, the urine osmolality is typically high (>500) due to the kidneys concentrating the urine to conserve water. Educational Context: Understanding the interpretation of renal indices and diagnostic tests is crucial in managing pediatric patients with genitourinary disorders. In this case, recognizing the significance of increased echogenicity in renal ultrasound aids in identifying the underlying cause of AKI, guiding appropriate treatment interventions. This question highlights the importance of clinical correlation and diagnostic reasoning in pediatric pharmacology and reinforces the need for a comprehensive understanding of pediatric genitourinary disorders for nursing practice and NCLEX preparation.

Correct Answer: C

Rationale: In pediatric pharmacology, understanding renal function and its impact on medication dosing is crucial. The correct answer is C) 3, which corresponds to a moderate reduction of glomerular filtration rate (GFR) ranging from 30–59 ml/min/1.73 m2 in the staging of chronic kidney disease (CKD) in children. At this stage, there is a noticeable decrease in kidney function, requiring close monitoring and potential adjustments in medication dosages to prevent drug accumulation and toxicity. Option A) 1 is incorrect because stage 1 CKD is defined by normal or high GFR (>90 ml/min/1.73 m2) with evidence of kidney damage present for three months or more but without any significant reduction in kidney function. Option B) 2 is incorrect as stage 2 CKD is characterized by mild reduction in GFR (60–89 ml/min/1.73 m2) with evidence of kidney damage for three months or more. Option D) 4 is incorrect as stage 4 CKD represents a severe reduction in GFR (15–29 ml/min/1.73 m2) necessitating advanced interventions like renal replacement therapy. Educationally, this question highlights the importance of assessing renal function in pediatric patients when prescribing medications to ensure optimal dosing and avoid adverse effects. Understanding the staging of CKD in children is essential for pediatric healthcare providers to deliver safe and effective pharmacological interventions tailored to individual renal function.

Correct Answer: B

Rationale: In this case, the correct answer is B) renal disorders. The elevated blood pressure in a 9-year-old male presenting with a severe headache is concerning for a renal disorder, specifically a condition known as pediatric hypertension. Pediatric hypertension is often associated with underlying renal disorders such as renal artery stenosis, chronic kidney disease, or other renal abnormalities. The kidneys play a crucial role in regulating blood pressure through the renin-angiotensin-aldosterone system, and dysfunction in this system can lead to hypertension. Option A) endocrine disorders is incorrect in this context because while certain endocrine disorders can lead to hypertension, the presentation of a severe headache and high blood pressure in a pediatric patient is more suggestive of a renal etiology. Option C) neurologic disorders is also not the most likely cause in this scenario. While neurologic conditions can sometimes be associated with elevated blood pressure, they are less commonly the primary cause in a pediatric patient with this presentation. Option D) vascular diseases may contribute to hypertension, but in a pediatric patient presenting with severe headache and elevated blood pressure, renal disorders are a more common and likely cause. Educationally, understanding the relationship between pediatric genitourinary disorders and hypertension is crucial for nursing students preparing for the NCLEX exam. Recognizing the signs and symptoms of pediatric hypertension and its association with renal disorders is essential for providing safe and effective care to pediatric patients.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) posterior urethral valves. Posterior urethral valves are a congenital anomaly in male infants where there is an obstruction in the urethra, leading to urinary tract obstruction. This condition often presents with abdominal distention due to bladder distention and can lead to hydronephrosis and kidney damage if not promptly treated. Option A) ureteropelvic junction obstruction involves a blockage at the junction of the ureter and the renal pelvis, usually causing hydronephrosis, but this typically presents later in childhood and not in a 3-week-old neonate. Option B) obstructive megaureter refers to an enlarged ureter due to an obstruction, but it is less likely in a 3-week-old neonate and is usually less symptomatic compared to posterior urethral valves. Option D) multicystic renal dysplasia is a condition where the kidney develops cysts and fails to function properly, but it usually presents with a non-functional kidney rather than an abdominal mass in a neonate. Educationally, understanding pediatric genitourinary disorders is crucial for nurses and healthcare providers working with pediatric populations. Recognizing the signs and symptoms of conditions like posterior urethral valves early on can lead to timely interventions and prevent long-term complications for the child. This question highlights the importance of early assessment and intervention in pediatric patients with genitourinary issues.