Of the following, the MOST common intrinsic cause of acute kidney injury (AKI) in childhood is

Correct Answer: D

Rationale: The correct answer is D) Acute tubular necrosis. Acute tubular necrosis is the most common intrinsic cause of acute kidney injury in children. This condition is characterized by damage to the renal tubules due to ischemia, nephrotoxic medications, or sepsis. In children, factors such as dehydration, sepsis, and exposure to nephrotoxic medications can contribute to the development of acute tubular necrosis. Option A) Acute interstitial nephritis is more commonly seen in adults and is characterized by inflammation of the renal interstitium due to medications or infections. Option B) Rhabdomyolysis can lead to kidney injury due to the release of myoglobin into the bloodstream, but it is not the most common cause of AKI in children. Option C) Glomerulonephritis involves inflammation of the glomeruli in the kidney and is more commonly seen in chronic kidney disease rather than acute kidney injury in children. Educationally, it is important for healthcare providers to be able to differentiate between the various causes of acute kidney injury in children to provide prompt and appropriate management. Understanding the etiology of AKI helps in implementing preventive strategies and tailored treatment plans to improve patient outcomes.

Correct Answer: D

Rationale: In the context of pediatric kidney transplant patients, it is crucial for nurses and healthcare professionals to have a comprehensive understanding of the medications and potential side effects associated with post-transplant care. In this scenario, the correct answer is option D) sudden death. The rationale behind sudden death not being associated with immunosuppressive medications is that while these medications have a range of potential side effects, sudden death is not a common or direct side effect linked to their use. Instead, sudden death in pediatric kidney transplant patients is more likely to be related to other factors such as rejection episodes, infections, or underlying medical conditions. Option A) nephrotoxicity is a potential side effect of immunosuppressive medications, as these drugs can put additional strain on the kidneys over time. Option B) cardiovascular complications can also be a concern due to the impact of these medications on the cardiovascular system. Option C) increased risk for certain malignancies is another known side effect, as immunosuppression can make patients more susceptible to developing certain types of cancers. In an educational context, understanding the side effects of immunosuppressive medications in pediatric kidney transplant patients is vital for providing safe and effective care. Nurses need to be able to recognize and manage potential complications, monitor for signs of adverse effects, and educate patients and families on the importance of adherence to medication regimens while being vigilant for any concerning symptoms that may arise.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) torsion of the testis. Testicular torsion is a medical emergency that occurs when the spermatic cord twists, cutting off blood flow to the testicle, leading to severe scrotal pain. In a 5-year-old boy presenting with sudden and severe scrotal pain, testicular torsion should be suspected and promptly addressed to prevent testicular damage. Option A) retractile testes is a normal variation where the testes move in and out of the scrotum but do not cause pain. Option C) epididymitis is inflammation of the epididymis and is more common in older boys and adolescents, usually accompanied by symptoms like swelling and fever. Option D) incarcerated hernia presents with a visible bulge that may or may not cause pain, but it is not typically associated with severe scrotal pain as described in the case. Educationally, this question highlights the importance of recognizing and promptly managing testicular torsion in pediatric patients to prevent complications like testicular infarction. Understanding the unique clinical presentations of genitourinary emergencies in children is crucial for healthcare providers working in pediatric settings.

Correct Answer: B

Rationale: In the context of pharmacology and pediatric genitourinary function, understanding active hydrogen ion secretion is crucial. The correct answer, Option B, "occurs in the," is right because active hydrogen ion secretion predominantly occurs in the distal convoluted tubule and the collecting ducts in the nephron. This process is vital for maintaining the acid-base balance in the body by regulating urine pH. Option A, "which is responsible for the final acidification of the urine," is incorrect because while active hydrogen ion secretion does contribute to urine acidification, it is not solely responsible for the final acidification. Other processes such as passive reabsorption of bicarbonate also play a role. Option C, "distal convoluted tubule," is incorrect as this is the site where active sodium reabsorption occurs rather than active hydrogen ion secretion. Option D, "collecting ducts," is incorrect because while some hydrogen ion secretion does occur in the collecting ducts, the primary site for this process is in the distal convoluted tubule. Educationally, understanding the mechanisms of active hydrogen ion secretion in the pediatric genitourinary system is essential for nurses and healthcare professionals caring for pediatric patients with renal issues. It helps in managing conditions like acid-base imbalances and guiding appropriate pharmacological interventions to maintain renal function and overall health in pediatric patients.

Correct Answer: B

Rationale: In pediatric pharmacology, understanding renal disorders in children is crucial for nursing practice. In this context, recognizing systemic causes of renal disease is important for accurate diagnosis and treatment. The correct answer, B) cystinosis, is a systemic cause of renal disease in children. Cystinosis is a rare genetic disorder that leads to the accumulation of cystine within cells, including in the kidneys, causing renal damage over time. A) Polycystic kidney disease is a primary renal disorder characterized by the formation of fluid-filled cysts in the kidneys, rather than being a systemic cause of renal disease. C) Alport syndrome is a genetic condition affecting the glomerular basement membrane of the kidneys, leading to renal failure. While it is a primary renal disorder, it is not a systemic cause of renal disease in the same way as cystinosis. D) Focal segmental glomerulosclerosis is a primary renal disease involving scarring of the glomeruli in the kidney, not a systemic cause of renal disease like cystinosis. Educationally, understanding the distinction between primary and systemic causes of renal disease in children is essential for nurses preparing for the NCLEX exam and for providing quality care to pediatric patients with renal disorders. Recognizing the systemic effects of conditions like cystinosis can help nurses intervene early and appropriately in the care of these children.