The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate?

Correct Answer: C

Rationale: Creatinine is a waste product produced by muscle metabolism that is normally filtered by the glomerulus in the kidneys and excreted in urine. The level of creatinine in the urine is a direct reflection of the glomerular filtration rate (GFR). As GFR decreases in conditions such as acute renal failure, the amount of creatinine excreted in the urine also decreases. Therefore, measuring creatinine levels in the urine is a useful clinical indication of the glomerular filtration rate and kidney function. pH, osmolality, and protein level may provide additional information but are not as directly linked to GFR as creatinine levels.

Correct Answer: A

Rationale: Imipramine (Tofranil) is a tricyclic antidepressant (TCA) that is commonly used to treat enuresis in children. Enuresis is a condition characterized by involuntary urination, especially observed during sleep in children who are old enough to have bladder control. Imipramine works by affecting the balance of certain neurotransmitters in the brain, which helps regulate the bladder and reduce involuntary urination. While imipramine has antidepressant properties, it is also effective in treating enuresis by reducing the frequency of bedwetting episodes.

Correct Answer: A

Rationale: Following a splenectomy (spleen removal), patients are at an increased risk of developing infections, particularly those caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. The spleen plays a vital role in the immune system by filtering and clearing bacteria and viruses from the bloodstream. Without a functioning spleen, patients are more vulnerable to bacterial infections. Therefore, the nurse should be aware of the potential for infection and provide appropriate education to the client regarding infection prevention strategies, such as vaccinations and prompt medical treatment for any signs of infection.

Correct Answer: A

Rationale: Given that the 16-year-old girl has been diagnosed with genital herpes and is concerned about preventing complications of the disease, the most appropriate nursing diagnosis would be "Risk for transmission of infection." Genital herpes is a highly contagious sexually transmitted infection, and individuals with the infection can transmit it to their partners through sexual contact. Therefore, it is crucial to educate the girl on ways to prevent the transmission of the infection to others. By addressing this nursing diagnosis, the healthcare team can provide guidance on safer sexual practices, including the use of condoms, abstinence during outbreaks, and communication with partners to prevent the spread of the infection. This nursing diagnosis focuses on promoting the girl's health and preventing further complications related to the transmission of genital herpes.

Correct Answer: D

Rationale: Children with Down syndrome often have better outcomes when treated with specific regimens, contrary to this option.