A nurse is assessing a toddler who has acute nephrotic syndrome. Which of the following findings should the nurse report to the provider?
Facial edema
Irritability
Poor appetite
Yellow nasal discharge
The Correct Answer is D
Rationale:
A. Facial edema is a common finding in nephrotic syndrome due to hypoalbuminemia and fluid retention.
B. Irritability can occur due to discomfort or malaise associated with the condition but is not immediately concerning.
C. Poor appetite is a common symptom in children with nephrotic syndrome and is expected.
D. Yellow nasal discharge may indicate an infection, which is a concern in children with nephrotic syndrome because they are at increased risk for infections due to their condition and the potential use of immunosuppressive therapies.
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Correct Answer is B
Explanation
Rationale:
A. Assessing the erythematous rash is important, as it can indicate the presence of erythema marginatum, a common symptom of rheumatic fever, but it is not the priority.
B. Auscultating the rate and characteristics of the child's heart sounds is the priority assessment because acute rheumatic fever can cause carditis, which affects the heart valves and can lead to serious complications. Early detection of any cardiac involvement is crucial for timely intervention and management.
C. Assessing joint pain is necessary for comfort and symptom management but does not take precedence over potential cardiac complications.
D. Identifying parental anxiety is important for providing emotional support but is not the immediate priority in managing the child's acute condition.
Correct Answer is A
Explanation
Rationale:
A. The knee-chest position increases systemic vascular resistance, which helps to divert more blood to the pulmonary circulation, improving oxygenation in a child experiencing a "tet spell" or hypercyanotic episode.
B. The prone position does not help in relieving cyanosis and dyspnea in Tetralogy of Fallot.
C. The supine position with the head turned does not assist in improving oxygenation during a cyanotic episode.
D. The semi-Fowler's position may aid breathing but is less effective than the knee-chest position in managing cyanotic spells.