Which discharge instruction for a child with encopresis should the nurse question?

Correct Answer: D

Rationale: Encopresis is a condition characterized by repeated involuntary defecation in inappropriate places by a child over the age of 4 years. The correct answer to the question, "Which discharge instruction for a child with encopresis should the nurse question?" is D) Offer a diet high in protein. This answer is incorrect because a diet high in protein can actually exacerbate encopresis. Protein can be constipating, leading to harder stools and increased difficulty with bowel movements, which is counterproductive in managing encopresis. Option A) Limit milk intake is a recommended step because milk and dairy products can contribute to constipation in some children. Encouraging a balanced diet with adequate fiber intake is crucial in managing encopresis, making option B) Obtain a complete dietary log important. Option C) Follow up with a child psychologist is also essential as encopresis can have psychological components that may require professional intervention. Children with encopresis may experience emotional distress and may benefit from therapy or counseling. In an educational context, understanding the impact of diet on bowel function in children with encopresis is crucial for nursing practice. By selecting the appropriate dietary interventions and seeking psychological support when needed, nurses can provide comprehensive care to children with encopresis.

Correct Answer: D

Rationale: In the case of a toddler with acute hepatitis, it is important to consider activities that are low impact and do not put additional stress on the liver. Playing with puzzles in bed is the most appropriate choice among the options provided. This activity allows the child to engage in cognitive and fine motor skills development while being in a restful position, which is crucial for recovery from hepatitis. Option A, climbing on a playscape, involves physical exertion and could strain the liver, which needs rest during the healing process. Option B, kicking a ball, also involves physical activity that may not be suitable for a toddler with acute hepatitis as it can lead to fatigue. Option C, playing video games in bed, although sedentary, may overstimulate the child and cause fatigue or agitation, which can hinder the healing process. Educationally, this question highlights the importance of considering the specific health condition of a pediatric patient when selecting appropriate activities. Understanding the impact of different activities on a child's health, especially in cases of acute illness, is crucial for nurses and healthcare providers caring for pediatric patients. By choosing the most suitable activity, healthcare providers can support the child's recovery and overall well-being.

Correct Answer: A

Rationale: The correct answer is A) 1 to 2 years. The glomerular filtration rate (GFR) is a crucial indicator of kidney function, representing the rate at which blood is filtered by the glomeruli in the kidneys. In infants, the GFR is significantly lower compared to adults due to immature renal function. By the age of 1 to 2 years, the GFR in children reaches adult levels as their kidneys mature, allowing for efficient filtration of waste and maintenance of fluid balance. Option B) 3 to 4 years is incorrect as the GFR actually reaches adult levels earlier, by 1 to 2 years of age. Option C) 5 to 6 years and Option D) 7 to 8 years are also incorrect as the GFR typically reaches adult levels well before these ages, demonstrating the rapid maturation of renal function in children. Understanding the timeline of GFR development is essential for pediatric healthcare providers as it impacts how medications are dosed and metabolized in children. It also informs the assessment and management of renal function in pediatric patients, highlighting the importance of age-appropriate care and monitoring.

Correct Answer: D

Rationale: The correct answer is option D) GFR = 0.413 × Ht / Cr serum in the revised Schwartz formula for estimating glomerular filtration rate (GFR) in pediatric patients. This formula takes into account the child's height (Ht) and serum creatinine (Cr) levels to estimate kidney function accurately. The height adjustment in the formula is crucial as it helps in normalizing GFR values for pediatric patients, who have varying body sizes compared to adults. Option A) GFR = 0.134 × Ht / Cr serum is incorrect because the coefficient value is different from the revised Schwartz formula. Option B) GFR = 0.413 × Cr serum / Ht is incorrect because the ratio of serum creatinine to height is inverted compared to the correct formula. Option C) GFR = 0.134 × Cr serum / Ht is also incorrect due to the same reasons as option B. Understanding the correct formula for estimating GFR in pediatric patients is essential for healthcare providers, especially those working in pediatric nephrology or general pediatrics. Proper assessment of kidney function is critical in managing pediatric patients with renal conditions or those receiving potentially nephrotoxic medications. Mastery of pharmacology calculations like the Schwartz formula is crucial for safe medication dosing and monitoring in pediatric patients.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) membranous nephropathy. Membranous nephropathy is the most common cause of nephrotic syndrome in adults but can also occur in children. In this case, the 12-year-old girl with nephrotic syndrome secondary to hepatitis B infection is likely to have membranous nephropathy as it is a known complication of hepatitis B infection. Regarding the incorrect options: A) Membranoproliferative glomerulonephritis is characterized by mesangial cell proliferation and thickening of the glomerular capillary wall, which is not typically associated with hepatitis B infection-related nephrotic syndrome. C) Focal segmental glomerulosclerosis is more commonly seen in African American children and is not directly linked to hepatitis B infection. D) Minimal change nephrotic syndrome is often seen in children and is characterized by foot process effacement on electron microscopy, but it is not specifically associated with hepatitis B infection-related nephrotic syndrome. Educationally, understanding the different types of glomerulonephritis and their associations with specific conditions is crucial for nurses and healthcare providers caring for pediatric patients with renal disorders. This knowledge helps in accurate diagnosis, appropriate management, and better patient outcomes. It also highlights the importance of considering underlying etiologies in nephrotic syndrome cases to provide targeted treatment and supportive care.