A nurse is providing peritoneal dialysis to a child and observes there is minimal dialysate outflow at the end of the outflow time. Which of the following actions should the nurse take?
Increase the dwell time during the next dialysis infusion.
Instruct the child to change position.
Increase oral fluid intake.
Assess for a bruit at the site of the peritoneal catheter.
The Correct Answer is B
Choice A rationale
Increasing the dwell time during the next dialysis infusion is not appropriate. The issue is with the outflow, not the dwell time. Increasing the dwell time could exacerbate the problem.
Choice B rationale
Instructing the child to change position is correct. Changing position can help facilitate the drainage of dialysate by allowing gravity to assist in the outflow process.
Choice C rationale
Increasing oral fluid intake is not relevant to the issue of minimal dialysate outflow. The problem lies with the mechanical process of dialysis, not fluid intake.
Choice D rationale
Assessing for a bruit at the site of the peritoneal catheter is not directly related to resolving minimal dialysate outflow. A bruit indicates blood flow through a vascular access, not the peritoneal catheter.
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Correct Answer is A
Explanation
Choice A rationale
The tumbling E chart is used for visual acuity assessment in children who cannot read letters, such as those who are too young or have language barriers. It involves identifying the direction of the letter “E” in various orientations.
Choice B rationale
Testing the child without glasses before testing with glasses is not the standard procedure for visual acuity assessment. The correct approach is to test with the child’s usual corrective lenses if they have them.
Choice C rationale
The standard distance for visual acuity testing using a chart is 3 meters (10 feet) for children, not 4.6 meters (15 feet).
Choice D rationale
Assessing each eye separately first, then both eyes together, is the correct procedure for visual acuity testing. This ensures accurate measurement of each eye’s visual acuity.
Correct Answer is A
Explanation
Choice A rationale
Weighing the child once per day is crucial in the acute stage of nephrotic syndrome to monitor fluid retention and the effectiveness of treatment. Daily weight monitoring helps in assessing the child’s fluid balance and detecting any sudden weight gain, which could indicate worsening edema.
Choice B rationale
Increasing fluid intake to 2 L/day is not recommended for a child in the acute stage of nephrotic syndrome. This condition is characterized by significant protein loss leading to edema, and increasing fluid intake would exacerbate the problem. Fluid restriction is often necessary to manage edema.
Choice C rationale
Positioning the child supine at bedtime is not beneficial for managing nephrotic syndrome. Elevating the child’s head and legs can help reduce edema, while supine positioning might worsen it by allowing fluid to accumulate in dependent areas.
Choice D rationale
Limiting calorie intake to 45 cal/kg/day is not appropriate for a child with nephrotic syndrome. Adequate nutrition is essential for healing and recovery, and restricting calories could be harmful. The focus should be on providing a balanced diet to support the child’s overall health.