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LPN Nursing · GI and Renal Disorders in Children · Practice question

A nurse is assisting in the care of a 10-year-old child. Select from the choices below to specify what condition the child is most likely experiencing ____, 2 actions the nurse should take to address that condition ____ and ____, and 2 parameters the nurse should monitor to assess the child's progress ____ and ____.

Nurses' Notes

Guardian reports child has been less active, has lost weight recently, and has a decreased appetite. Guardian reports child's urine has been dark brown in color lately. Child appears weak, but responsive to verbal stimuli and follows commands. Denies pain. Skin warm and dry. Slight swelling noted around eyes and face. Respirations even and nonlabored.

Lungs scattered, wheezes bilateral. Occasional nonproductive cough. Heart rate regular. Abdomen soft, nondistended. Pedal pulses +2 bilaterally.

Vital Signs

Temperature 37.2° C (99° F)

Heart rate 110/min

Respiratory rate 20/min

Blood pressure 128/90 mm Hg

SaO2 96% on room air

Medical History

Tonsillectomy at age 5

Asthma

Streptococcal pharyngitis 2 weeks ago

Diagnostic Results

Hgb 10.2 g/dL (10 to 15.5 g/dL)

Hct 30% (32% to 44%)

WBC count 8,500/mm3 (5,000 to 10,000/mm3)

BUN 24 mg/dL (10 to 20 mg/dL)

Creatinine 1.2 mg/dL (0.5 to 1.0 mg/dL)

Urinalysis:

Appearance Dark brown color (clear, amber yellow) RBC 4 (less than 2)

Specific gravity 1.2 (1.010 to 1.025)

Ketones None (None)

WBC 1 (0 to 4) WBC casts None (None)

Protein 12 mg/dL (0 to 8 mg/dL)

Other:

Antistreptolysin O titer 280 Todd units/mL (170 to 330 Todd units/mL)

Answer & explanation

Correct:

The clinical picture points clearly to acute glomerulonephritis (AGN): the child has dark brown urine (hematuria), periorbital and facial edema, hypertension (128/90 mm Hg), elevated BUN and creatinine, proteinuria, elevated RBCs on urinalysis, and an antistreptolysin O (ASO) titer elevated within the normal-high range — all following a recent streptococcal pharyngitis two weeks prior. This post-streptococcal immune-complex mechanism rules out nephrotic syndrome (which features massive proteinuria and hyperlipidemia but not hematuria) and UTI (which would show nitrites and leukocyte esterase without the post-strep history or edema pattern). For blank 1, the condition is acute glomerulonephritis. The two nursing actions are to administer prescribed antibiotics (to eradicate any residual streptococcal infection, blank 2) and to monitor fluid balance including intake and output (to manage fluid retention and prevent worsening edema and hypertension, blank 3). Corticosteroids are not a primary treatment for AGN. The two monitoring parameters are urine output and color (to track hematuria resolution and fluid status, blank 4) and blood pressure (because hypertension is a major complication of AGN and a leading cause of morbidity, blank 5).

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