Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 4-year-old child is diagnosed with nephrotic syndrome. Which of the following findings would the nurse expect to observe?
A. Massive proteinuria and generalized edema
Massive proteinuria and generalized edema is correct because nephrotic syndrome results from increased permeability of the glomerular membrane. This allows large amounts of protein, especially albumin, to be lost in the urine (proteinuria). The loss of albumin leads to hypoalbuminemia, which reduces plasma oncotic pressure. As a result, fluid shifts from the intravascular space into the interstitial tissues, causing generalized edema. Edema is often most noticeable around the eyes (periorbital edema), abdomen (ascites), and lower extremities. Additional associated findings may include hyperlipidemia and lipiduria due to the liver’s increased production of lipids in response to protein loss.
B. Hematuria and flank pain
Hematuria and flank pain is incorrect because these findings are more characteristic of nephritic syndromes such as acute poststreptococcal glomerulonephritis. Nephrotic syndrome typically does not present with significant hematuria or flank pain; instead, protein loss and edema are the dominant features.
C. Polyuria and polydipsia
Polyuria and polydipsia is incorrect because these symptoms are commonly associated with endocrine disorders such as diabetes mellitus or diabetes insipidus. In nephrotic syndrome, urine output may actually decrease due to fluid shifting into tissues and activation of fluid-retaining mechanisms.
D. Hyperactive reflexes and muscle spasms
Hyperactive reflexes and muscle spasms is incorrect because these signs are indicative of electrolyte imbalances such as hypocalcemia. While electrolyte disturbances can occur in kidney disorders, they are not defining or expected hallmark findings of nephrotic syndrome.
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Full Explanation
A. Massive proteinuria and generalized edema is correct because nephrotic syndrome results from increased permeability of the glomerular membrane. This allows large amounts of protein, especially albumin, to be lost in the urine (proteinuria). The loss of albumin leads to hypoalbuminemia, which reduces plasma oncotic pressure. As a result, fluid shifts from the intravascular space into the interstitial tissues, causing generalized edema. Edema is often most noticeable around the eyes (periorbital edema), abdomen (ascites), and lower extremities. Additional associated findings may include hyperlipidemia and lipiduria due to the liver’s increased production of lipids in response to protein loss.
B. Hematuria and flank pain is incorrect because these findings are more characteristic of nephritic syndromes such as acute poststreptococcal glomerulonephritis. Nephrotic syndrome typically does not present with significant hematuria or flank pain; instead, protein loss and edema are the dominant features.
C. Polyuria and polydipsia is incorrect because these symptoms are commonly associated with endocrine disorders such as diabetes mellitus or diabetes insipidus. In nephrotic syndrome, urine output may actually decrease due to fluid shifting into tissues and activation of fluid-retaining mechanisms.
D. Hyperactive reflexes and muscle spasms is incorrect because these signs are indicative of electrolyte imbalances such as hypocalcemia. While electrolyte disturbances can occur in kidney disorders, they are not defining or expected hallmark findings of nephrotic syndrome.
Similar Questions
A nurse is providing anticipatory guidance to the parents of a toddler. Which of the following should the nurse include? (Select all that apply.)
A. Expression of bedtime fears is common.
Expression of bedtime fears is common is correct because toddlers commonly experience fears related to separation, darkness, or unfamiliar situations. These fears are a normal part of emotional and cognitive development and should be addressed with reassurance and consistent routines.
B. Importance of annual screenings for phenylketonuria.
Importance of annual screenings for phenylketonuria is incorrect because PKU screening is performed at birth through newborn screening. Routine annual screening is not part of anticipatory guidance for toddlers.
C. Develop food habits that will prevent dental caries.
Develop food habits that will prevent dental caries is correct because toddlers are at increased risk for dental caries. Guidance should include limiting sugary foods and drinks, avoiding bedtime bottles with milk or juice, and promoting good oral hygiene habits.
D. Significance of potty training by 18 months.
Significance of potty training by 18 months is incorrect because readiness for toilet training varies widely. Most toddlers are not developmentally ready until 18–24 months or later, and forcing early training can lead to frustration and setbacks.
E. Behaviors associated with negativism and ritualism.
Full Explanation
A. Expression of bedtime fears is common is correct because toddlers commonly experience fears related to separation, darkness, or unfamiliar situations. These fears are a normal part of emotional and cognitive development and should be addressed with reassurance and consistent routines.
B. Importance of annual screenings for phenylketonuria is incorrect because PKU screening is performed at birth through newborn screening. Routine annual screening is not part of anticipatory guidance for toddlers.
C. Develop food habits that will prevent dental caries is correct because toddlers are at increased risk for dental caries. Guidance should include limiting sugary foods and drinks, avoiding bedtime bottles with milk or juice, and promoting good oral hygiene habits.
D. Significance of potty training by 18 months is incorrect because readiness for toilet training varies widely. Most toddlers are not developmentally ready until 18–24 months or later, and forcing early training can lead to frustration and setbacks.
Before administering methylergonovine (Methergine), what priority assessment finding would lead the nurse to hold the medication?
A. Pulse is 90 beats per minute
Pulse is 90 beats per minute is incorrect because a normal heart rate does not contraindicate methylergonovine. The medication’s primary cardiovascular effect is on vascular smooth muscle, not directly on heart rate.
B. Pulse is 110 beats per minutes
Pulse is 110 beats per minute is incorrect because mild tachycardia alone is not a contraindication. However, the nurse should monitor heart rate during administration, especially if hypotension or other complications arise.
C. Blood pressure of 120/70
Blood pressure of 120/70 is incorrect because this is a normal blood pressure and indicates it is safe to give the medication.
D. Blood pressure of 150/90
Blood pressure of 150/90 is correct because hypertension is a contraindication for methylergonovine. Administering the drug to a hypertensive patient can precipitate severe hypertension, stroke, myocardial infarction, or other cardiovascular complications. The nurse must hold the medication, notify the healthcare provider, and implement alternative measures for postpartum bleeding management.
Full Explanation
A. Pulse is 90 beats per minute is incorrect because a normal heart rate does not contraindicate methylergonovine. The medication’s primary cardiovascular effect is on vascular smooth muscle, not directly on heart rate.
B. Pulse is 110 beats per minute is incorrect because mild tachycardia alone is not a contraindication. However, the nurse should monitor heart rate during administration, especially if hypotension or other complications arise.
C. Blood pressure of 120/70 is incorrect because this is a normal blood pressure and indicates it is safe to give the medication.
D. Blood pressure of 150/90 is correct because hypertension is a contraindication for methylergonovine. Administering the drug to a hypertensive patient can precipitate severe hypertension, stroke, myocardial infarction, or other cardiovascular complications. The nurse must hold the medication, notify the healthcare provider, and implement alternative measures for postpartum bleeding management.
A 2-year-old child presents to the emergency department with a barking cough, stridor, and a hoarse voice that worsens at night. The child is afebrile but appears anxious and has labored breathing. The nurse suspects croup as the diagnosis. Which of the following interventions should the nurse prioritize to manage the child's symptoms and prevent further respiratory distress?
A. Administer a dose of oral antibiotics to treat the infection
Administer a dose of oral antibiotics to treat the infection is incorrect because most cases of croup are viral in origin (commonly parainfluenza virus). Antibiotics are not indicated unless there is a secondary bacterial infection.
B. Place the child in a supine position to facilitate airflow to the lungs
Place the child in a supine position to facilitate airflow to the lungs is incorrect because lying flat may worsen respiratory distress in a child with croup. Upright positioning is preferred to ease breathing.
C. Encourage the child to lie down to conserve energy
Encourage the child to lie down to conserve energy is incorrect because supine positioning can increase airway obstruction and worsen stridor. Allowing the child to remain upright and calm is safer.
D. Provide a cool mist humidifier or take the child outside into cool night air
Provide a cool mist humidifier or take the child outside into cool night air is correct because cool, moist air helps reduce laryngeal inflammation and edema, which can relieve stridor and improve breathing. This is a first-line, noninvasive intervention to manage mild to moderate croup symptoms while minimizing respiratory distress.
Full Explanation
A. Administer a dose of oral antibiotics to treat the infection is incorrect because most cases of croup are viral in origin (commonly parainfluenza virus). Antibiotics are not indicated unless there is a secondary bacterial infection.
B. Place the child in a supine position to facilitate airflow to the lungs is incorrect because lying flat may worsen respiratory distress in a child with croup. Upright positioning is preferred to ease breathing.
C. Encourage the child to lie down to conserve energy is incorrect because supine positioning can increase airway obstruction and worsen stridor. Allowing the child to remain upright and calm is safer.
D. Provide a cool mist humidifier or take the child outside into cool night air is correct because cool, moist air helps reduce laryngeal inflammation and edema, which can relieve stridor and improve breathing. This is a first-line, noninvasive intervention to manage mild to moderate croup symptoms while minimizing respiratory distress.