The nurse is conducting an admission assessment on a school-age ...

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The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition?
 
  a. Oliguria and hypertension
  b. Hematuria and pallor
  c. Proteinuria and muscle cramps
  d. Bacteriuria and facial edema

Question 2

Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis?
 
  a. Risk for Injury related to malignant process and treatment
  b. Fluid Volume Deficit related to excessive losses
  c. Fluid Volume Excess related to decreased plasma filtration
  d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces

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Answer to Question 1

ANS: A
The principal feature of acute renal failure is oliguria; hypertension is a nonspecific clinical manifestation. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure.

Answer to Question 2

ANS: C
Glomerulonephritis has a decreased filtration of plasma, which results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration.

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TYSM

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