A 12-year-old child is injured in a bicycle accident. When considering the possibility of renal trauma, the nurse should consider what factor?

Correct Answer: D

Rationale: In this scenario, option D is the correct answer because it highlights an important concept in pediatric renal trauma assessment. The amount of hematuria is not always a reliable indicator of the seriousness of renal injury in children. This is crucial to understand because children's bodies can respond differently to trauma compared to adults. Hematuria alone may not accurately reflect the extent of renal damage in pediatric patients, making it essential for healthcare providers to consider other clinical signs and diagnostic tests when assessing for renal trauma. Now, let's analyze why the other options are incorrect: A) Flank pain rarely occurs in children with renal injuries: This statement is inaccurate as flank pain can indeed be a symptom of renal trauma in children. Dismissing this can lead to overlooking a potential renal injury. B) Few nonpenetrating injuries cause renal trauma in children: This statement is misleading as nonpenetrating injuries can still result in renal trauma in pediatric patients. It is crucial not to underestimate the possibility of renal injury in such cases. C) Kidneys are immobile, well protected, and rarely injured in children: This statement is incorrect as children's kidneys, despite being somewhat protected, can still sustain injury due to their anatomical position and vulnerability during traumatic events. It is important not to assume complete immunity to renal trauma based on the kidneys' location. Educational Context: Understanding the nuances of assessing renal trauma in children is vital for nurses caring for pediatric patients. Recognizing the limitations of relying solely on hematuria as an indicator of renal injury can prevent overlooking potentially serious conditions. Nurses must be vigilant in assessing all clinical manifestations and considering further diagnostic evaluations to ensure prompt and accurate management of pediatric renal trauma.

Correct Answer: C

Rationale: In the case of a child admitted with acute renal failure (ARF), the therapeutic management to rapidly provoke a flow of urine involves the administration of mannitol (Osmitrol) or furosemide (Lasix), which are both diuretics. Mannitol and furosemide help increase urine output by promoting the excretion of excess fluids and electrolytes from the body, thereby aiding in the management of ARF. Option A, Propranolol (Inderal), is a beta-blocker used for conditions like hypertension and arrhythmias, not for increasing urine output. Option B, Calcium gluconate, is a calcium supplement used to treat low calcium levels or as an antidote for calcium channel blocker toxicity; it does not promote diuresis. Option D, Sodium, chloride, and potassium, are electrolytes that may need to be corrected in ARF, but administering them does not directly provoke a flow of urine. In an educational context, understanding the appropriate medications for managing ARF is crucial for nursing care of children. Administering the correct diuretics can help prevent complications associated with fluid overload in ARF, ensuring proper fluid balance and renal function in pediatric patients.

Correct Answer: C

Rationale: In a child with chronic renal failure, water and sodium retention is a major complication due to the kidney's inability to effectively regulate fluid and electrolyte balance. This retention can lead to edema, hypertension, and further kidney damage. Option A, Hypokalemia, is incorrect because chronic renal failure often leads to hyperkalemia due to the impaired excretion of potassium by the kidneys. Option B, Metabolic alkalosis, is incorrect as chronic renal failure typically causes metabolic acidosis due to the kidneys' inability to excrete acid effectively. Option D, Excessive excretion of blood urea nitrogen, is incorrect because in chronic renal failure, there is a decrease in the excretion of waste products like urea nitrogen, leading to its accumulation in the blood. Understanding the complications of chronic renal failure in children is crucial for nurses caring for these patients. It is essential to monitor and manage fluid and electrolyte balance closely to prevent further complications and maintain the child's overall health.

Correct Answer: C

Rationale: In children with chronic renal failure (CRF), the most appropriate diet is one that is low in phosphorus (Option C). This is because in CRF, the kidneys are unable to excrete phosphorus effectively, leading to its accumulation in the blood. High levels of phosphorus can result in mineral and bone disorders, cardiovascular complications, and other health issues in these patients. Therefore, limiting dietary phosphorus intake is crucial in managing CRF. Option A, a diet low in protein, is not the most appropriate choice for a child with CRF. While protein restriction may be necessary in advanced stages of CRF to reduce uremic symptoms, it is not the primary dietary consideration. Protein is important for growth and development in children, so it should not be overly restricted unless medically indicated. Option B, a diet low in vitamin D, is not specifically indicated for CRF. In fact, children with CRF often have low levels of vitamin D due to impaired kidney function, so they may require supplementation. Restricting vitamin D in these patients can exacerbate bone health issues. Option D, a diet supplemented with vitamins A, E, and K, is not the most appropriate choice for a child with CRF. While these vitamins are important for overall health, they are not the primary focus of dietary management in CRF. The key is to focus on limiting phosphorus intake while ensuring adequate nutrition for growth and development. Educationally, it is important for nurses caring for children with CRF to understand the rationale behind dietary recommendations. By knowing the impact of different nutrients on the child's condition, nurses can provide holistic care that supports the child's health and well-being. This knowledge allows nurses to collaborate effectively with dietitians and other healthcare providers to optimize the child's nutritional status and overall outcomes.

Correct Answer: D

Rationale: When caring for a child with end-stage renal disease (ESRD), the most important nursing consideration is option D: Multiple stresses are placed on children with ESRD and their families because children's lives are maintained by drugs and artificial means. This is the correct answer because children with ESRD require complex medical management including medications, dialysis, and potentially kidney transplantation to sustain life. The stress on the child and family is significant due to the constant need for medical interventions and the emotional toll of dealing with a chronic illness. Option A is incorrect because while children may be resilient, ESRD is a serious condition that goes beyond minor inconveniences. Option B is incorrect as ESRD is a lifelong condition that often requires ongoing support even into adulthood. Option C is incorrect as ESRD is generally not curable but can be managed with medical interventions. In an educational context, understanding the unique challenges faced by children with ESRD and their families is crucial for nurses caring for these patients. Nurses need to provide holistic care that addresses not only the physical needs of the child but also the emotional and psychological impact of living with a chronic illness. By recognizing and addressing the stresses placed on children with ESRD and their families, nurses can provide more effective and compassionate care.