One week after kidney transplant, a child complains of abdominal pain, is very irritable, has gained 10% of body weight, and has elevated BUN and creatinine levels. Which medication is most likely being taken?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Corticosteroids. Rationale: 1. Corticosteroids are commonly prescribed post-kidney transplant to suppress the immune system and prevent rejection of the new organ. This medication can lead to fluid retention, weight gain, and elevated BUN and creatinine levels due to its impact on renal function. 2. A) Codeine tablets are unlikely to cause these specific symptoms and are not typically used in the immediate post-transplant period. 3. B) Furosemide is a diuretic that would typically be used to reduce fluid retention, the opposite effect seen in this case. 4. C) MiraLAX powder is a laxative and would not explain the symptoms of abdominal pain, irritability, weight gain, and elevated BUN and creatinine levels. Educational context: Understanding the pharmacological management post-kidney transplant is crucial for healthcare professionals caring for pediatric patients. Corticosteroids are a cornerstone of immunosuppressive therapy in transplant recipients, but their side effects must be carefully monitored and managed to ensure the success of the transplant. Recognizing the signs and symptoms of corticosteroid-related adverse effects is essential for early intervention and optimal patient outcomes.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) We will likely add antibiotics to the dialysis fluid at the next dwell to treat peritonitis. This is the most appropriate course of action for a 12-year-old on peritoneal dialysis experiencing cloudy return fluid and abdominal pain. Peritonitis, an infection of the peritoneum lining the abdominal cavity, is a common complication in patients undergoing peritoneal dialysis. Prompt diagnosis and treatment with antibiotics directly into the dialysis fluid are crucial to prevent further complications and to manage the infection effectively. Option B) Cloudy returns are common and not concerning is incorrect because cloudy return fluid in a patient on peritoneal dialysis can indicate peritonitis, especially when accompanied by symptoms like abdominal pain. This should not be dismissed as normal. Option C) We will give your child oral antibiotics as a precaution is incorrect because peritonitis in peritoneal dialysis patients requires intraperitoneal antibiotics for effective treatment. Oral antibiotics would not provide adequate concentration at the site of infection. Option D) We will increase the rate of fluid administration to relieve the pain is incorrect because while pain relief is important, the priority in this case is to address the potential peritonitis with appropriate antibiotics to prevent further complications. Educationally, understanding the management of complications in pediatric patients on peritoneal dialysis is crucial for healthcare professionals caring for these vulnerable populations. Recognizing the signs of peritonitis and knowing the appropriate interventions can significantly impact patient outcomes and quality of life.

Correct Answer: D

Rationale: The best response for the nurse in this scenario is option D) "This tumor grows very rapidly, so it may not have been noticeable just a few days ago." This response is the most accurate and informative as it educates the parent about the nature of Wilms tumor, which is known to have rapid growth. This reassures the parent that missing the lump initially is understandable due to its sudden appearance. Option A is incorrect because it could potentially minimize the parent's feelings of guilt or responsibility. Option B, although empathetic, does not provide the educational context about the rapid growth of Wilms tumor. Option C is incorrect as it does not address the parent's concerns and may come off as dismissive. In an educational context, this scenario highlights the importance of effective communication with parents of pediatric patients. Nurses should provide not only emotional support but also valuable information to help parents understand the medical condition, its characteristics, and the reasoning behind missed symptoms. This approach fosters trust, empowers parents with knowledge, and promotes a collaborative relationship in the child's healthcare journey.

Correct Answer: B

Rationale: In pediatric oncology, staging of tumors is crucial for determining prognosis and guiding treatment decisions. In this case, option B is correct because it accurately describes a stage III tumor as being confined to the abdomen but having spread to lymph nodes or the peritoneal area, with a very good prognosis. This information is important for the parents to understand the extent of the disease and the likely outcomes. Option A is incorrect because it inaccurately states that the prognosis is poor for a stage III tumor, which is not typically the case. Option C is also incorrect as it describes a more advanced stage of tumor spread than stage III. Option D is incorrect because it implies a poor prognosis for a stage III tumor, which is not accurate. Educationally, understanding tumor staging in pediatric oncology is crucial for healthcare providers and families to make informed decisions about treatment options and to have realistic expectations about the prognosis. It is important for healthcare providers to effectively communicate this information to families in a clear and compassionate manner to support them through this challenging time.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) A 3-year-old who had impetigo 1 week ago. Glomerulonephritis is often associated with post-streptococcal infection, such as impetigo, due to the deposition of immune complexes in the glomeruli. This triggers an inflammatory response that can lead to glomerulonephritis. Option B) A 5-year-old with five UTIs in the previous year is not at a particularly high risk for developing glomerulonephritis. UTIs, while they can lead to kidney infections, do not typically directly cause glomerulonephritis. Option C) A 6-year-old with new-onset type 1 diabetes is at risk for diabetic nephropathy, a different kidney condition associated with diabetes, rather than glomerulonephritis. Option D) A 10-year-old recovering from viral pneumonia is not directly linked to an increased risk of developing glomerulonephritis. Viral pneumonia affects the respiratory system primarily and does not directly impact the kidneys in a way that would lead to glomerulonephritis. Educationally, understanding the risk factors for glomerulonephritis in pediatrics is crucial for healthcare providers to recognize and manage this condition effectively. It emphasizes the importance of recognizing the connection between certain infections, like impetigo, and kidney complications in children, aiding in prompt diagnosis and treatment.