Online Nursing Practice Test about Renal Disorders (8-11)

2:37 PM    No comments









CHEAP BUY ! ! !  
NCLEX E-Book with FREE Saunders and KAPLAN ($4)


Situation: Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome.

8. The diagnosis of Idiopathic Nephrotic Syndrome has been confirmed. Which unexpected finding would the nurse report?

a) proteinuria
b) distended abdomen
c) blood in the urine
d) elevated serum lipid levels

9. Carlo's potential for impairment of skin integrity is related to:

a) joint inflammation
b) drug therapy
c) edema
d) generalized body rash

10. Prednisone is prescribed for Carlo. The nurse evaluate its effectiveness by

a) checking his BP every 4 hours
b) checking his urine for protein
c) weighing him each morning before breakfast
d) observing him for behavioral changes

11. At Carlo's last check-up when he was 2 1/2 years old, his BP was 95/60, PR was 110/min and weight was 15 kg. Which unexpected assessment today would the nurse report to help the diagnosis?

a) BP: 95/60
b) weight: 20 kg
c) PR: 110
d) temp: 37 C


ANSWERS AND RATIONALE

8) C
- hematuria is rare in nephrotic syndrome but it is profuse is acute glomerulonephritis.

The manifestations of nephrotic syndrome are:

  • Proteinuria - nephrosis is believed to be due to immunologic response that results in increased permeability of glomerular membrane to proteins resulting in massive protein losses in the urine -- proteinuria and albuminuria (+3 +4), the child losses 50-100 mg/kg weight/day from proteinuria.
  • Hypoalbuminemia - loss of protein in blood results in hypoalbumenimia
  • Edema - cardinal sign and appears first in the periorbital region followed by dependent edema and accompanied by pallor, fatigue and lethargy. Hypoalbuminemia leads to decreased oncotic pressure resulting in fluid shift from intravascular to interstitial causing generalized edema or anasarca.The child has lost appetite but gained weight -- puffiness of the eyes on awakening decreases during the day but appears on the legs and abdomen. Fluid shift causes decreased blood volume that leads to decreased blood supply to kidney. Decreased blood supply to kidney initiates release of aldosterone. Aldosterone causes sodium retention (in interstitial spaces so child will have hyponatremia) and water retention contributing to edema.
  • Hypocholesteronemia and hyperlipidemia - triglycerides and fats are released by the liver in the blood to make up for the protein loss
9) C
- management: reduce protein excretion
Prevention of Skin Breakdown from Edema
  • frequent turning
  • keep nails short to prevent scratching
  • meticulous skin care to dependent and edematous areas - sacrum, scrotum, labia, abdomen, legs
  • loose clothing
Monitor Edema
  • weigh daily and monitor I and O
  • check for pulmonary edema manifested by crackles on auscultation
  • ascites - measure abdominal girth
Prevention of Infection - pulmonary edema predisposes to respiratory infection and generalized edema predisposes to skin breakdown. Avoid contact with persons who have infection.

Diet - usually anorexic because of GI edema
  • high protein diet
  • sodium restriction if with severe edema
  • fluid intake equal to output and insensible loss
  • vitamin and iron supplements
  • small feedings, give favorite foods
10) B
- prednisone is prescribed for CArlo to decrease protein excretion. Proteinuria disappears in one week after intiating treatment. The child is responding favorably to treatment if there is no proteinuria for 2 consecutive days. Steroid therapy is continued until urine is negative for protein and gradually reduced over a period of 1 to 3 weeks

Monitor side effect of prolonged steroid therapy
  • Hyperglycemia - test urine
  • monitor growth of child by checking height because steroid has growth suppressing effect by preventing calcium deposition in the bones
  • Gastric Irritation - give milk or meals, test for occult blood, administer with antacids
  • Avoid exposure to infection because child is immunosuppressed
11) B
- during the toddler period, the child gains 2.5 kg a year. Carlo has gained 5 kg in only 6 months. In nephrotic syndrome, this excessive weight gain is due to edema.


Related Topics:

0 comments:

Post a Comment

Subscribe to: Post Comments (Atom)