A child with HUS is very pale and lethargic. Stools have progressed from watery to bloody diarrhea; blood work indicates low hemoglobin and hematocrit; there has been no urine output for 24 hours. In addition to blood products, what else is added to the plan of care?

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Initiation of dialysis. Hemolytic Uremic Syndrome (HUS) is a condition characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury. When a child with HUS presents with severe anemia, low hemoglobin and hematocrit, bloody diarrhea, and decreased urine output, it indicates severe kidney damage requiring urgent intervention like dialysis. Dialysis helps in removing waste products, excess fluids, and electrolytes from the blood when the kidneys are unable to perform this function adequately. Option B) Close observation of hemodynamic status is not the priority in this case. While hemodynamic status is important, addressing the acute kidney injury with dialysis takes precedence due to the life-threatening nature of the condition. Option C) Diuretic therapy to force urinary output is contraindicated in HUS as it can worsen the kidney injury and electrolyte imbalances. Option D) Monitoring of urinary output is essential but does not address the underlying cause of the symptoms. Immediate intervention with dialysis is necessary to support kidney function and prevent further complications. In an educational context, understanding the pathophysiology of HUS, recognizing the clinical manifestations, and prioritizing interventions based on the severity of the condition are crucial skills for pediatric genitourinary nursing. This case underscores the importance of timely and appropriate interventions in managing pediatric patients with acute kidney injury.

Correct Answer: D

Rationale: The correct answer is D) 5 fl. oz. for the bladder capacity of a 3-year-old. Understanding pediatric genitourinary nursing interventions is crucial when caring for pediatric patients. In this case, the bladder capacity of a 3-year-old is approximately 5 fl. oz. due to the child's age-related growth and development. Option A) 1.5 fl. oz. is incorrect because it is too low for a 3-year-old's bladder capacity. Option B) 3 fl. oz. is also too low for a 3-year-old. Option C) 4 fl. oz. is closer but still underestimates the bladder capacity of a 3-year-old compared to the correct answer. Educationally, knowing the bladder capacity of pediatric patients is essential for nurses to monitor urinary output, assess for urinary retention, and provide appropriate interventions. Understanding age-specific norms helps in delivering safe and effective care to pediatric patients. In this case, recognizing the appropriate bladder capacity for a 3-year-old informs nursing interventions and assessment strategies in pediatric genitourinary care.

Correct Answer: D

Rationale: The best response is option D: "I will ensure he learns testicular self-examination monthly to monitor his health." This response promotes patient education and empowerment in monitoring his health post-operatively. Testicular self-examination is crucial in detecting any changes or abnormalities early, which is particularly important after testicular torsion repair to monitor for recurrence or other issues. Option A is incorrect as it does not address the importance of testicular self-examination and wrongly emphasizes a timeline for returning to sports. Option B is also incorrect as it focuses solely on physical activity rather than long-term monitoring of testicular health. Option C is incorrect and misleading as testicular torsion repair does not automatically lead to infertility, and seeking therapy based on this assumption is inappropriate. In an educational context, it is essential for nurses to emphasize the importance of self-care practices such as testicular self-examination to pediatric patients and their parents. By teaching them how to monitor for changes and abnormalities, nurses empower patients to take an active role in their health management, promoting early detection and intervention when needed. This approach fosters a sense of autonomy and responsibility for one's health, leading to better health outcomes.

Correct Answer: C

Rationale: In this scenario, the correct answer is option C: Record the urine output in the chart. Rationale: The nurse should record the urine output in the chart because it is within the expected range for a 4-year-old weighing 15 kg. The average urine output for children is 1-2 mL/kg/hour, and in this case, the child has produced 150 mL in a 10-hour period, which falls within this range. Why other options are wrong: A) Option A is incorrect because the urine output is not too low for a child of this age and weight. B) Option B may not be necessary as the urine output is within the expected range, and increasing oral intake may not be indicated. D) Option D is unnecessary as there is no indication of dehydration or need for IV fluids based on the provided information. Educational context: Understanding normal pediatric urine output ranges is crucial for pediatric nurses to assess hydration status accurately. By documenting the urine output, the nurse can monitor the child's renal function and fluid balance, which is essential in pediatric care. This scenario highlights the importance of applying knowledge of pediatric genitourinary norms in clinical practice to provide safe and effective care for pediatric patients.

Correct Answer: C

Rationale: The correct response, option C, is the most appropriate choice for the parent of a 7-year-old experiencing persistent bed-wetting. Limiting fluids in the evening can help reduce the likelihood of bed-wetting episodes by decreasing urine production overnight. Additionally, implementing a reward system for dry nights can positively reinforce the child's efforts and progress, promoting a sense of achievement and motivation to stay dry. Option A, suggesting the use of DDAVP, may be a viable treatment in some cases of bed-wetting, but it is typically reserved for specific situations and should be prescribed by a healthcare provider after a thorough evaluation. Option B, advocating a punitive approach by showing the child the work involved in changing sheets, is not recommended as it can lead to emotional distress and does not address the underlying cause of bed-wetting. Option D, mentioning bed-wetting alarms, is a valid intervention that can be effective in helping children recognize and respond to the sensation of a full bladder during sleep. However, in this scenario, focusing on fluid management and positive reinforcement through a reward system aligns better with addressing the issue of persistent bed-wetting in a 7-year-old. In an educational context, it is essential to emphasize a holistic approach to managing pediatric genitourinary issues, including bed-wetting. Educating parents about practical strategies like fluid restriction and positive reinforcement can empower them to support their child effectively while also promoting a positive and nurturing environment for the child to address this common concern.