A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child?

Correct Answer: C

Rationale: In caring for a child with minimal change nephrotic syndrome receiving high doses of prednisone, the appropriate nursing goal is to minimize the risk of infection (Option C). This is because prednisone, a corticosteroid, suppresses the immune system and increases the child's susceptibility to infections. By prioritizing infection prevention, nurses can help protect the child from potentially serious complications. Option A (Stimulate appetite) is not the most appropriate goal in this scenario. While prednisone can affect appetite, the primary concern in this case is the risk of infection due to immunosuppression. Option B (Detect evidence of edema) is important in managing nephrotic syndrome but is not the most immediate goal when the child is on high doses of prednisone. Monitoring for edema is more focused on the disease process itself rather than the effects of prednisone therapy. Option D (Promote adherence to the antibiotic regimen) is not directly relevant to the situation described in the question. Antibiotics are not typically indicated for nephrotic syndrome unless there is a specific infection present. The main focus should be on preventing infections rather than promoting antibiotic adherence. By selecting the correct nursing goal of minimizing the risk of infection, nurses demonstrate their understanding of the potential complications associated with high-dose prednisone therapy in children with nephrotic syndrome. This decision reflects a patient-centered approach that prioritizes the child's safety and well-being.

Correct Answer: D

Rationale: In the case of a child admitted for minimal change nephrotic syndrome (MCNS), the nurse must understand that the child's prognosis is closely related to their response to steroid therapy. This is the correct answer because MCNS is known to respond well to corticosteroid treatment, which helps reduce proteinuria and edema, leading to a positive outcome. Regarding the incorrect options: - Admission blood pressure (Option A) is not directly correlated with the prognosis of MCNS. While blood pressure management is important in nephrotic syndrome, it is not the primary factor determining prognosis. - Creatinine clearance (Option B) is more indicative of renal function rather than the prognosis of MCNS specifically. - Amount of protein in urine (Option C) is a characteristic feature of MCNS but does not solely determine the child's prognosis. It is more of a diagnostic indicator than a prognostic factor. Educationally, it is crucial for nurses to grasp the significance of different factors influencing the prognosis of pediatric nephrotic syndrome. Understanding the importance of prompt recognition and appropriate management, such as administering steroid therapy in MCNS, is vital in providing effective care and improving patient outcomes.

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 context of pediatric acute renal failure, the most common cause is severe dehydration (Option C). Dehydration leads to decreased blood flow to the kidneys, resulting in reduced urine output and impaired kidney function. This condition can rapidly progress to acute renal failure if not promptly treated. Option A, Pyelonephritis, is a common renal infection in children but is not the most common cause of acute renal failure. While tubular destruction (Option B) can contribute to renal failure, severe dehydration is more prevalent in causing acute renal failure in children. Upper tract obstruction (Option D) can also lead to acute renal failure by obstructing urine flow, but severe dehydration is more frequently encountered in pediatric patients, making it the primary cause in this scenario. Educationally, understanding the pathophysiology of acute renal failure in children is crucial for nurses caring for pediatric patients. Recognizing the signs of dehydration and promptly initiating appropriate interventions can help prevent the progression to acute renal failure and improve patient outcomes.

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.