An infant is admitted to the hospital because of vomiting and lethargy. The child shows evidence of failure to thrive, and physical examination reveals an abdominal mass. Blood and urinary cultures grow Escherichia coli. The most likely cause of this disorder is

Correct Answer: D

Rationale: The correct answer is D) obstruction at the ureteropelvic junction. In this scenario, the infant's presentation of vomiting, lethargy, failure to thrive, abdominal mass, and positive blood and urinary cultures for Escherichia coli suggests a urinary tract infection (UTI) secondary to obstruction at the ureteropelvic junction. This obstruction can lead to stasis of urine, providing a medium for bacterial growth, hence the positive cultures. Option A) mesenteric cyst is incorrect because it typically presents with abdominal pain, not the symptoms described in the case. Option B) Wilms tumor is unlikely in this case as it usually presents with painless abdominal swelling, not the symptoms of UTI. Option C) adrenal hemorrhage would present with different symptoms such as shock or abdominal pain, not consistent with the infant's presentation. Understanding genitourinary disorders in pediatric patients is crucial for nurses and healthcare professionals. Recognizing the signs and symptoms of UTIs, obstructive uropathy, and other genitourinary conditions in children is vital for prompt diagnosis and treatment to prevent complications. This case highlights the importance of clinical assessment, diagnostic reasoning, and knowledge of pediatric genitourinary disorders in providing optimal care for pediatric patients.

Correct Answer: B

Rationale: In this scenario, the most likely diagnosis for the 7-year-old with periorbital edema, tea-colored urine, high blood pressure, and low serum complement level is Poststreptococcal glomerulonephritis (PSGN). The rationale for choosing B) Poststreptococcal glomerulonephritis: - PSGN often presents with these symptoms 1-3 weeks after a streptococcal infection. - Edema, tea-colored urine (hematuria), hypertension, and low complement levels are characteristic of PSGN. - The history of a sore throat 10 days ago fits the timeline for a post-streptococcal complication. Explanation for why the other options are incorrect: - A) Lupus nephritis: Unlikely in the absence of other systemic symptoms typical of lupus. - C) Berger syndrome: Typically presents with episodes of visible blood in the urine (hematuria) rather than tea-colored urine and periorbital edema. - D) Thin basement membrane disease: Presents with microscopic hematuria without other systemic symptoms like edema, hypertension, or low complement levels. Educational context: Understanding the unique clinical manifestations and timelines of different pediatric genitourinary conditions is crucial for nurses and healthcare professionals. Recognizing the signs and symptoms of PSGN can lead to prompt diagnosis and appropriate management to prevent complications and promote positive outcomes for pediatric patients.

Correct Answer: C

Rationale: In nephrotic syndrome, the correct answer is C) reduced sodium reabsorption by the kidney. This is because nephrotic syndrome is characterized by increased glomerular permeability leading to proteinuria, hypoalbuminemia, edema, and hyperlipidemia. The reduced sodium reabsorption is not a typical feature of nephrotic syndrome. Option A) elevated serum cholesterol is true because nephrotic syndrome leads to increased synthesis of lipoproteins due to loss of proteins in the urine. Option B) 85% experience minimal change in disease is true as most cases of nephrotic syndrome in children are due to minimal change disease. Option D) elevated serum triglycerides is also true as hypertriglyceridemia is commonly seen in nephrotic syndrome. Educationally, understanding the pathophysiology of nephrotic syndrome is crucial for nurses and healthcare professionals caring for pediatric patients. Recognizing the characteristic features of the syndrome, such as the lipid abnormalities and proteinuria, is essential for accurate diagnosis and management. This knowledge also helps in providing appropriate patient education and family support regarding the condition and its treatment.

Correct Answer: C

Rationale: In the context of pediatric genitourinary pharmacology, the use of erythropoietin in chronic renal failure is crucial to address anemia by stimulating red blood cell production. The correct answer, C) Improved sleep, is associated with an incorrect outcome because erythropoietin therapy does not directly impact sleep patterns. Option A) iron deficiency is a possible side effect of erythropoietin therapy as increased red blood cell production may require more iron. Option B) reduced need for blood transfusions is a positive outcome of erythropoietin therapy as it aims to improve anemia and decrease the need for transfusions. Option D) hyperkalemia is a potential adverse effect of erythropoietin therapy, as increased red blood cell production can lead to elevated potassium levels due to the release of potassium from red blood cells. Educationally, it is important for nurses and healthcare providers to understand the effects and side effects of medications used in pediatric patients with renal conditions. By grasping these principles, healthcare professionals can provide safe and effective care to pediatric patients undergoing treatment for chronic renal failure.