a child with a diagnosis of acute glomerulonephritis is admitted to the hospital what is the priority nursing intervention
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Nursing Elites

HESI LPN

Pediatric Practice Exam HESI

1. What is the priority nursing intervention for a child admitted to the hospital with a diagnosis of acute glomerulonephritis?

Correct answer: A

Rationale: The priority nursing intervention for a child with acute glomerulonephritis is monitoring for hypertension. Acute glomerulonephritis involves inflammation of the kidney's glomeruli, leading to impaired kidney function. Hypertension is a common complication due to fluid retention and increased renin-angiotensin system activity. Monitoring for hypertension is crucial for early detection and management to prevent further kidney damage and complications. Providing pain relief (Choice B) may be required for discomfort but is not the priority. Restricting fluid intake (Choice C) may be necessary in some kidney diseases, but in acute glomerulonephritis, the focus is on monitoring and managing hypertension. Encouraging fluid intake (Choice D) is inappropriate as it can exacerbate fluid overload and hypertension in acute glomerulonephritis.

2. What should be the focus of nursing activity for the mother of an 8-year-old girl with a broken arm, who is the nurturer in the family?

Correct answer: A

Rationale: The correct answer is A: Teaching proper care procedures. In this scenario, focusing on teaching the mother proper care procedures is crucial as she is the nurturer in the family and will likely be the primary caregiver for the child. This will empower her to provide appropriate care and support for her daughter during the recovery process. Choices B, C, and D are not the most appropriate activities for the mother in this situation. Dealing with insurance coverage, determining treatment success, and transmitting information to family members are important but not as directly relevant to the immediate care needs of the child's broken arm.

3. What behavior does a toddler subjected to prolonged hospitalization with limited parental visits typically exhibit?

Correct answer: D

Rationale: Toddlers subjected to prolonged hospitalization with limited parental visits often exhibit a limited emotional response to the environment. This behavior is a common coping mechanism in young children facing such situations. While cheerful interactions with staff members (choice A) may occur occasionally, the overall response tends to be subdued. Indications of sadness throughout the day (choice B) and excessive crying when parents are not present (choice C) are less typical in this scenario, as the child may have learned to suppress emotions due to the challenging circumstances.

4. After the nurse has completed an oral examination of a healthy 2-year-old child, the parent asks when the child should first be taken to the dentist. When is the most appropriate time in the child’s life for the nurse to suggest?

Correct answer: B

Rationale: The most appropriate time for a child to first visit the dentist is within the next few months after turning two years old. This visit allows the dentist to assess the child's oral health, provide guidance on proper oral hygiene practices, and establish a positive relationship with dental care. Choice A (Before starting school) is not as specific and timely as the recommended age of 2 years. Choice C (When the first deciduous teeth are lost) is not ideal as preventive dental visits should start earlier to establish good oral health habits. Choice D (At the next dental check-up for a family member) may delay the child's first dental visit, missing the opportunity for early preventive care and guidance.

5. The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury?

Correct answer: D

Rationale: For a child with muscular dystrophy who fell out of bed, it is important to prevent further injuries. Using bed side rails when a caregiver is not present can help provide a safety measure and prevent falls. While continuous caregiver presence (choice B) may be ideal, it may not always be feasible. Recommending raising the bed's side rails throughout the day and night (choice A) may limit the child's mobility unnecessarily. Encouraging the use of a loose restraint (choice C) can be dangerous and may increase the risk of injury in case of a fall.

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