Nurse Kai is evaluating a female child with acute post-streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement?

Correct Answer: A

Rationale: In a female child with acute post-streptococcal glomerulonephritis, the earliest sign of improvement is often seen as an increase in urine output. This occurs as the kidneys start to recover and normal functioning is restored. Increased urine output indicates improved glomerular filtration and clearance of waste products from the body. It is an essential indicator of renal function and overall improvement in the condition of the child. Other signs such as increased appetite and energy levels may follow but increased urine output is typically the first noticeable sign of improvement in cases of glomerulonephritis.

Correct Answer: B

Rationale: In a patient with Hirschsprung's disease presenting with fever and watery explosive diarrhea, these symptoms could indicate enterocolitis, which is a serious complication of the disease. Enterocolitis is characterized by inflammation of the intestines and can lead to significant complications if not promptly addressed. Therefore, the priority action for Nurse Joyce would be to immediately notify the physician so that appropriate interventions can be initiated promptly to manage the child's condition. Administering an antidiarrheal or monitoring the child would not be appropriate initial actions given the seriousness of the symptoms described.Ignoring these symptoms and doing nothing is also not advisable as prompt medical attention is necessary in this situation.

Correct Answer: D

Rationale: Tetralogy of Fallot is a congenital heart defect characterized by four primary abnormalities: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. Due to the pulmonary stenosis, less blood reaches the lungs to be oxygenated, resulting in deoxygenated blood entering the systemic arterial circulation. This leads to cyanosis, which is often referred to as "Tet spells" in these patients. Cyanosis is the bluish discoloration of the skin and mucous membranes caused by the presence of deoxygenated hemoglobin. The other conditions listed do not typically result in deoxygenated blood entering the systemic arterial circulation and causing cyanosis.

Correct Answer: C

Rationale: In status asthmaticus, a severe and prolonged asthma attack can lead to inadequate ventilation due to airway obstruction. This results in retention of carbon dioxide (CO2) in the blood, leading to respiratory acidosis. As the CO2 levels rise, it combines with water in the blood to form carbonic acid, lowering the blood pH levels. Symptoms of respiratory acidosis can include shortness of breath, confusion, lethargy, and potentially life-threatening complications. Treatment for status asthmaticus aims to improve ventilation and restore normal blood gas levels to alleviate respiratory acidosis.

Correct Answer: C

Rationale: Infants with congenital heart disease who have been admitted with heart failure may have difficulty feeding due to increased work of breathing and poor energy reserves. Offering small, frequent feedings can help prevent fatigue and provide adequate nutrition to support the infant's growth and recovery. It also helps to prevent overloading the heart with a large volume of fluids at once. This approach allows the infant to receive enough calories while reducing the risk of aspiration and conserving energy for feeding and breathing. Positioning the infant flat on the back may worsen respiratory distress, encouraging nutritional fluids alone may not address the feeding challenges faced by the infant, and measuring the head circumference is important for growth monitoring but may not be the priority when managing heart failure in this case.