In evaluation of 3-year-old boy with minimal change nephrotic syndrome (MCNS)

Correct Answer: B

Rationale: In evaluating a 3-year-old boy with minimal change nephrotic syndrome (MCNS), the correct answer is B) microscopic hematuria may be present in up to 15%. In MCNS, the hallmark features are massive proteinuria and hypoalbuminemia, but it can also present with microscopic hematuria in up to 15% of cases. Option A is incorrect because the presence of albuminuria and hematuria in the urine is more indicative of a glomerular disease like IgA nephropathy rather than MCNS. Option C and D are also incorrect percentages as they do not accurately reflect the prevalence of microscopic hematuria in MCNS. Educationally, understanding the clinical manifestations of MCNS in pediatric patients is crucial for nurses working in genitourinary settings. Recognizing the presence of microscopic hematuria alongside proteinuria in MCNS can aid in timely diagnosis and appropriate nursing interventions for these young patients.

Correct Answer: D

Rationale: In the case of a 9-month-old patient diagnosed with hemolytic uremic syndrome (HUS) without active hemorrhage, the correct treatment option among the given choices is D) platelet transfusion. Platelet transfusion is not indicated in the treatment of HUS without active hemorrhage because this condition is not primarily characterized by thrombocytopenia or platelet dysfunction. A) Volume repletion is a common intervention in HUS to maintain adequate hydration and renal perfusion. B) Control of hypertension is crucial in managing HUS to prevent further kidney damage. C) Dialysis may be necessary in severe cases of HUS with renal failure to support kidney function and remove waste products. Educationally, understanding the appropriate treatment options for pediatric genitourinary conditions like HUS is essential for pediatric nurses to provide safe and effective care. Knowing when to implement specific interventions based on the patient's condition can significantly impact outcomes. In this scenario, recognizing that platelet transfusion is not indicated in HUS without active hemorrhage demonstrates a sound understanding of pediatric pharmacology and genitourinary nursing interventions.

Correct Answer: A

Rationale: In pediatric genitourinary nursing interventions, understanding the appropriate management of children with end-stage renal disease (ESRD) is crucial. The correct answer is A) 15 ml/min/1.73 m2. This is because children with ESRD typically require intervention when their glomerular filtration rate drops below this level, indicating severe kidney dysfunction. Option B) 25 ml/min/1.73 m2 is incorrect as waiting for the GFR to drop to this level may delay necessary interventions and jeopardize the child's health. Option C) 35 ml/min/1.73 m2 is also incorrect as it is above the threshold at which intervention is usually recommended for ESRD in children. Option D) 45 ml/min/1.73 m2 is well above the critical level at which renal replacement therapy is typically initiated in children with ESRD. Educationally, this question highlights the importance of early recognition and intervention in pediatric patients with ESRD to prevent complications and improve outcomes. Nurses and healthcare providers must be aware of the appropriate thresholds for dialysis or renal transplantation in children to provide timely and effective care for this vulnerable population.

Correct Answer: D

Rationale: In pediatric genitourinary nursing interventions, understanding the implications of kidney transplant in children is crucial. The correct answer, option D, "increased risk for certain malignancies," is right because children who undergo kidney transplants are at a higher risk for developing certain types of cancers due to long-term immunosuppressive therapy. This therapy suppresses the immune system to prevent rejection of the transplanted kidney, making the child more susceptible to malignancies. Option A, "but have to take immunosuppressive medications associated with a variety of side effects which include all the following EXCEPT," is incorrect because immunosuppressive medications do have a range of side effects, including nephrotoxicity, cardiovascular complications, and increased risk for certain malignancies. It is important for nurses to monitor and manage these side effects in pediatric kidney transplant recipients. Option B, "nephrotoxicity," and option C, "cardiovascular complications," are incorrect because these are common side effects associated with immunosuppressive medications in children with kidney transplants. Nephrotoxicity can lead to kidney damage, while cardiovascular complications may include hypertension, dyslipidemia, and increased risk of cardiovascular events. Educationally, this question highlights the importance of understanding the long-term implications of kidney transplant in children, including the need for immunosuppressive therapy and the associated risks. Nurses caring for pediatric kidney transplant recipients must be vigilant in monitoring for side effects and collaborating with the healthcare team to optimize outcomes for these vulnerable patients.

Correct Answer: A

Rationale: The correct answer is A) ureteropelvic junction obstruction. In a 3-week-old neonate with an abdominal mass, ureteropelvic junction obstruction is the most common cause. This condition occurs when there is a blockage at the junction where the ureter meets the renal pelvis, leading to dilation of the renal pelvis and calyces, resulting in an abdominal mass. Obstructive megaureter (option B) refers to the dilation of the ureter, which is less common in neonates compared to ureteropelvic junction obstruction. Posterior urethral valves (option C) are more commonly seen in male infants and typically present with hydronephrosis rather than an abdominal mass. Multicystic renal dysplasia (option D) is a congenital condition characterized by non-functional cysts in the kidney, usually presenting as a palpable flank mass rather than an abdominal mass in neonates. In an educational context, understanding the differential diagnosis of abdominal masses in neonates is crucial for pediatric genitourinary nursing interventions. Recognizing the most common causes, such as ureteropelvic junction obstruction in this case, can guide appropriate diagnostic workup and treatment strategies to ensure optimal patient outcomes.