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: D

Rationale: Preoperative teaching for Jose, a 4-year-old child, scheduled for a cardiac catheterization should be adapted to his level of development so that he can understand. Children at this age have limited cognitive and emotional understanding, so using simple language, visuals, and play-based strategies is essential. It is important to provide age-appropriate information to reduce anxiety and improve cooperation during the procedure. Preoperative teaching should focus on preparing Jose for what he will see, hear, and experience in a way that is tailored to his developmental stage. Involving play tools such as medical play dolls or child-friendly illustrations can help Jose grasp the concept of the procedure and alleviate fears. It is important to involve both Jose and his parents in the teaching process to ensure they understand how to support and prepare him for the procedure.

Correct Answer: A

Rationale: The nurse's reply should be based on the statement that "the child needs opportunities to play with peers." It is important for children to engage in play and social interactions with their peers for their overall development, including social, emotional, cognitive, and physical growth. By allowing the child with congenital heart disease to play with other children, under appropriate supervision, the child can still have enriching experiences while ensuring their safety and well-being. It is essential to strike a balance between enabling the child to participate in activities and managing any potential risks associated with their condition. A supportive environment that encourages play and socialization with peers can contribute positively to the child's development and quality of life.

Correct Answer: C

Rationale: In the management of anaphylaxis, the immediate medication of choice for administration is epinephrine. Epinephrine is a potent vasoconstrictor and bronchodilator which helps restore blood pressure and open up the airways during an anaphylactic reaction. It is the first-line treatment to reverse the potentially life-threatening effects of an allergic reaction. Other medications, like diphenhydramine or dobutamine, may be used as adjuncts later in the treatment, but epinephrine is crucial for immediate administration to stabilize the child's condition.

Correct Answer: C

Rationale: The most appropriate response by the nurse is option C, "This type of surgery rarely affects the ability to have an erection or ejaculation." This response is accurate and provides reassurance to the patient while acknowledging his concerns. Transurethral resection of the prostate (TURP) is a common procedure for managing benign prostatic hyperplasia (BPH), and it typically does not have a significant impact on sexual function. By providing this information, the nurse can help alleviate the patient's fears and encourage him to proceed with the necessary treatment.