A 12-year-old girl with nephrotic syndrome (NS) secondary to hepatitis B infection. Of the following

Correct Answer: B

Rationale: In this scenario, the correct answer is B) membranoproliferative glomerulonephritis. Nephrotic syndrome (NS) in pediatric patients can have various underlying causes, one of which is hepatitis B infection. Membranoproliferative glomerulonephritis is the most common type of secondary NS associated with hepatitis B infection in pediatric patients. Membranoproliferative glomerulonephritis is characterized by thickening of the glomerular basement membrane, mesangial cell proliferation, and hypercellularity. This results in impaired filtration and protein loss, leading to the clinical presentation of nephrotic syndrome. The other options (A, C, D) are less likely in this specific case. Membranous nephropathy is more commonly associated with hepatitis B infection in adults rather than children. Focal segmental glomerulosclerosis is more commonly seen in primary nephrotic syndrome rather than secondary causes. While these conditions can occur in pediatric patients, membranoproliferative glomerulonephritis is the most common type in this particular scenario. Educationally, understanding the specific associations of nephrotic syndrome in pediatric patients is crucial for healthcare providers to provide accurate diagnosis and appropriate management. This knowledge helps in tailoring treatment plans and improving patient outcomes.

Correct Answer: A

Rationale: In pediatric genitourinary disorders, understanding the impact of Verotoxin (VT)-producing Escherichia coli is crucial. The correct answer is A) 5% to 15% of affected children. This bacterium can lead to hemolytic uremic syndrome in a subset of affected individuals. Hemolytic uremic syndrome is a severe condition characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury. Option B) 25% to 35% of affected children is incorrect because the incidence of hemolytic uremic syndrome caused by VT-producing E. coli is lower than this range. Option C) 45% to 55% and Option D) 65% to 75% are also incorrect as they overestimate the percentage of affected children who develop hemolytic uremic syndrome. Educationally, this question highlights the importance of recognizing the potential complications of VT-producing E. coli infections in pediatric patients. Understanding the prevalence of hemolytic uremic syndrome in affected children is crucial for accurate diagnosis and management in clinical practice. This knowledge is essential for nurses, nurse practitioners, and other healthcare professionals caring for pediatric patients with genitourinary disorders.

Correct Answer: A

Rationale: In this scenario, the correct option is A) urine sodium (mEq/L) <15. The reason this is the correct answer is that in a 9-month-old patient presenting with severe dehydration, the urine sodium concentration is expected to be low (<15 mEq/L). This finding indicates the kidneys' ability to conserve sodium in response to dehydration, a physiological response to maintain fluid balance. Option B) fractional excretion of sodium (%) >2 would not be appropriate in this case as a high fractional excretion of sodium would suggest inappropriate renal sodium loss, which is not characteristic of dehydration. Option C) urine osmolality ∼ 300 may not be as helpful in this context as it is a more general measure of urine concentration and may not specifically indicate dehydration. Option D) increased echogenicity in renal ultrasound is not typically used as a primary diagnostic tool for evaluating dehydration and renal function in pediatric patients. Educationally, understanding how to interpret urine sodium levels in pediatric patients with dehydration is crucial for nurses and healthcare providers to make appropriate clinical decisions and provide effective treatment. This rationale highlights the importance of considering specific laboratory values in the context of a patient's clinical presentation to guide proper management.

Correct Answer: D

Rationale: In pediatric patients with end-stage renal disease (ESRD), managing bone health is crucial due to the risk of renal osteodystrophy. The correct answer, option D - calcium supplementation, is not recommended in this scenario. In ESRD, the kidneys cannot activate vitamin D effectively, leading to decreased calcium absorption. Administering calcium supplements without adequate activated vitamin D can result in hypercalcemia and worsen secondary hyperparathyroidism, common in ESRD. Option A is incorrect because it mentions starting treatment for short stature and bony deformities, which are common in renal osteodystrophy and require management. Option B does not provide any relevant information. Option C, 1,25-dihydroxy vitamin D supplementation, is essential in ESRD to help maintain calcium balance and bone health as the active form of vitamin D cannot be adequately produced by the kidneys. Educationally, understanding the intricacies of managing pediatric patients with ESRD is vital for nurses and healthcare providers. This scenario highlights the importance of comprehensive care and the potential complications of inappropriate interventions, emphasizing the need for a multidisciplinary approach in managing pediatric genitourinary disorders.

Correct Answer: D

Rationale: Potter syndrome, also known as Potter sequence or oligohydramnios sequence, is a rare condition characterized by a set of physical characteristics that arise from lack of amniotic fluid in utero. The correct answer, Option D, pulmonary hypoplasia, is the exception among the given options as it is a common feature of Potter syndrome. Pulmonary hypoplasia occurs due to the compression of the developing lungs in the absence of amniotic fluid, leading to underdeveloped or incomplete lungs. Option A, flat face, is a characteristic feature of Potter syndrome due to the decreased volume of the amniotic fluid causing the fetus's face to appear flattened. Clubfeet, Option B, are also commonly associated with Potter syndrome, as the lack of amniotic fluid can restrict normal movement and positioning of the limbs during fetal development, leading to this deformity. Option C, cardiac abnormalities, can also be present in Potter syndrome due to the impact of oligohydramnios on the developing cardiovascular system. In an educational context, understanding the clinical manifestations of Potter syndrome is crucial for healthcare professionals, especially those working in pediatrics or neonatology. By recognizing the physical features associated with this condition, healthcare providers can promptly diagnose and manage affected infants to improve outcomes. Additionally, knowledge of the pathophysiology of Potter syndrome aids in providing comprehensive care and support to both the infant and their family.