The nurse is caring for an adolescent who has just started dialysis. The child always seems angry, hostile, or depressed. The nurse should recognize that this is most likely related to what underlying cause?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Resentment of the control and enforced dependence imposed by dialysis. Adolescents undergoing dialysis often struggle with feelings of resentment, anger, and hostility due to the loss of control over their health and the enforced dependence on a machine for survival. This emotional response is a common reaction to the significant lifestyle changes and restrictions imposed by dialysis treatment. Option A) Physiologic manifestations of renal disease is incorrect because while renal disease can certainly impact a patient's emotional well-being, the specific emotional response described in the question is more directly related to the psychological implications of undergoing dialysis. Option B) The fact that adolescents have few coping mechanisms is incorrect as well because adolescents, like individuals of any age, have coping mechanisms; however, the issue here lies more in the specific challenges and adjustments required when starting dialysis treatment. Option C) Neurologic manifestations that occur with dialysis is also incorrect as the symptoms described in the question are more likely to be related to emotional and psychological responses rather than direct neurologic manifestations. Educationally, understanding the psychological impact of chronic illness and treatments like dialysis on adolescents is crucial for nurses caring for this population. By recognizing and addressing the emotional struggles that adolescents may face during dialysis, nurses can provide holistic care that supports both the physical and emotional well-being of their patients.

Correct Answer: C

Rationale: The correct answer is C) It is the preferred means of renal replacement therapy in children. Renal transplantation is considered the preferred means of renal replacement therapy in children because it offers the best chance for a child to lead a near-normal, healthy life. Transplantation provides the opportunity for improved quality of life, growth, and development compared to long-term dialysis. It allows children to have more freedom in terms of diet, fluid intake, and physical activity, enhancing their overall well-being. Option A is incorrect because there is no specific age limit for renal transplantation in children. The decision for transplantation is based on individual medical considerations rather than a set age requirement. Option B is incorrect as children can receive kidneys from both pediatric and adult donors, depending on compatibility and availability. There is no restriction that kidneys must come only from other children. Option D is incorrect because while there are challenges and considerations in deciding on transplantation, such as immunosuppressive therapy and the need for ongoing medical care, many children who undergo successful renal transplants can indeed lead relatively normal and active lives. Educationally, understanding the significance of renal transplantation in children is crucial for nurses caring for pediatric patients with renal disorders. By recognizing the benefits and considerations of transplantation, nurses can provide holistic care, support families through the decision-making process, and promote positive outcomes for children undergoing this procedure.

Correct Answer: B

Rationale: The correct answer is B) "I should not add additional salt to any of my child's meals." Explanation: In minimal change nephrotic syndrome (MCNS), managing salt intake is crucial to prevent fluid retention and swelling. Excessive salt can worsen edema, which is a common symptom of MCNS. By reducing salt intake, the parent helps to control fluid balance and reduce the child's symptoms. Why the other options are wrong: A) "My child needs to stay home from school for at least 1 more month." This statement is incorrect because children with MCNS can usually attend school as long as they are feeling well and their condition is stable. There is no need for a prolonged absence from school unless there are specific complications. C) "My child will not be able to participate in contact sports while receiving corticosteroid therapy." While it is true that corticosteroid therapy can weaken the immune system and increase the risk of infections, there is no blanket restriction on participating in contact sports. It would depend on the individual child's condition and the healthcare provider's recommendations. D) "I should measure my child's urine after each void and report the 24-hour amount to the healthcare provider." While monitoring urine output is important in some kidney conditions, in MCNS, the hallmark symptom is proteinuria rather than changes in urine volume. Monitoring urine output in this case would not provide relevant information for managing the condition. Educational context: This question highlights the importance of patient education in managing chronic conditions like MCNS. By understanding dietary modifications such as reducing salt intake, parents can actively participate in their child's care and help improve outcomes. Providing accurate information empowers parents to support their child's health effectively.

Correct Answer: B

Rationale: In the context of pediatric nursing, understanding common conditions related to genitalia is essential. The correct answer to the question, "What is the narrowing of the preputial opening of the foreskin called?" is B) Phimosis. Phimosis is the narrowing of the opening of the foreskin, which can lead to difficulty retracting the foreskin over the glans. This condition can cause issues with hygiene and lead to complications if not addressed. Option A) Chordee is incorrect because it refers to a downward curvature of the penis, not related to the foreskin's narrowing. Option C) Epispadias is a congenital malformation where the urethra opens on the upper surface of the penis, unrelated to foreskin narrowing. Option D) Hypospadias is a condition where the urethral opening is on the underside of the penis, also not related to foreskin narrowing. Educationally, nurses must be able to recognize and differentiate between various genital conditions in children to provide appropriate care and education to families. Understanding the terminology and characteristics of each condition is crucial in pediatric nursing practice.

Correct Answer: B

Rationale: The correct answer is B) Treatment is necessary to maintain the ability to be fertile when older. Explanation: Cryptorchidism, the condition of undescended testes, should be identified and treated by age 2 to prevent potential complications like infertility and testicular cancer in the future. Timely treatment is crucial for the affected individual to retain fertility as the testes need to descend into the scrotum to function properly. Why other options are incorrect: A) Medical therapy is not effective after this age: This is incorrect because medical therapy can still be effective after age 2, but surgical intervention is usually recommended for cryptorchidism. C) The younger child can tolerate the extensive surgery needed: This is incorrect as surgery for cryptorchidism is not necessarily more tolerable for younger children, and the timing of the surgery is more essential than the age of the child. D) Sexual reassignment may be necessary if treatment is not successful: This is incorrect and an extreme option that is not typically associated with cryptorchidism. Educational context: Understanding the importance of timely identification and treatment of cryptorchidism is crucial for nurses caring for children. This knowledge helps in advocating for early intervention to prevent long-term complications and promote the overall health and well-being of the child. Nurses play a vital role in educating parents about the significance of addressing cryptorchidism early to ensure optimal outcomes for the child's reproductive health.