A medical student asks you about the main factor which affects plasma creatinine level. The correct answer is the

Correct Answer: C

Rationale: In the context of pediatric genitourinary disorders, the main factor affecting plasma creatinine level is muscle mass (Option C). This is because creatinine is a byproduct of muscle metabolism and is produced at a relatively constant rate proportional to muscle mass. In pediatric patients, especially in those with varying degrees of muscle development, the creatinine level can be influenced by changes in muscle mass. Option A, the degree of dehydration, is incorrect because while dehydration can lead to a transient increase in plasma creatinine due to decreased renal perfusion, it is not the main factor affecting creatinine levels in the long term. Option B, nutritional state, is incorrect because although muscle mass is influenced by nutrition, it is the muscle mass itself that directly impacts creatinine levels, not just the general nutritional status. Option D, presence of catabolism, is incorrect because catabolism can lead to breakdown of muscle tissue, which may affect creatinine levels indirectly by altering muscle mass, but it is not the primary factor affecting creatinine levels. Educationally, understanding the factors influencing plasma creatinine levels is crucial for healthcare professionals when interpreting lab results in pediatric patients with genitourinary disorders. It highlights the importance of considering muscle mass when assessing kidney function and can guide clinical decision-making in managing renal health in children.

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: A

Rationale: In the context of pediatric genitourinary disorders, understanding the prevalence and impact of Verotoxin (VT)-producing Escherichia coli is crucial. The correct answer is A) 5% to 15% of affected children. This bacterium can cause hemorrhagic enterocolitis and progress to hemolytic uremic syndrome in a subset of affected individuals. Option B) 25% to 35% is incorrect because the prevalence of hemolytic uremic syndrome is lower than this range. Option C) 45% to 55% is also incorrect as it overestimates the proportion of affected children who develop hemolytic uremic syndrome. Option D) 65% to 75% is the furthest from the actual prevalence. Educationally, this question highlights the importance of recognizing the potential complications of VT-producing E. coli infections in pediatric patients. By understanding the epidemiology and clinical manifestations, healthcare providers can promptly diagnose and manage these conditions to prevent serious complications like hemolytic uremic syndrome.

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.