NORCET 8 Prelims-2025: A 9-year-old child with nephrotic syndrome is on corticosteroid therapy. What should be the first priority in…

NORCET 8 Prelims-2025

Child Health Nursing (Pediatrics)

Hard

Appeared in: NORCET 8 Prelims-2025

Explanation

Corticosteroids suppress the immune system, which is a critical risk for children with nephrotic syndrome who are already immunocompromised due to urinary loss of immunoglobulins.
Infection is a leading cause of morbidity and mortality in these patients, and steroids can mask typical signs like fever, making vigilant monitoring the top priority.
Corticosteroids are known to alter glucose metabolism, frequently causing hyperglycemia, which is a significant metabolic side effect that requires routine assessment.

Option B: Assessing for fluid retention is monitoring a primary symptom of the disease itself, not a priority adverse effect of the medication. The medication is intended to reduce fluid retention.
Option C: While corticosteroids can cause gastric irritation and bleeding, it is a less common and less immediately life-threatening risk compared to a systemic infection in an immunocompromised child.
Option D: Skin thinning and bruising are characteristic Cushingoid features that result from long-term corticosteroid use. They are not an acute concern and therefore not a first priority in assessment.

Clinical Relevance

Nursing practice connection: Use the key finding related to Priority nursing assessment for a pediatric patient on corticosteroid therapy for nephrotic syndrome to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role is patient safety. Recognizing that steroids mask fever means a nurse must be vigilant for subtle signs of infection, such as lethargy, irritability, or poor feeding, and report them immediately.
Patient and family education is critical. The nurse must teach the family to prevent infections by practicing good hand hygiene and avoiding crowds, and to understand the importance of regular blood glucose checks.
What if? If a child on corticosteroids develops a new, low-grade fever of 99.5°F (37.5°C), the priority action is to notify the healthcare provider immediately. This seemingly minor fever could be the only sign of a serious, life-threatening infection due to the suppressed immune response.

How to Approach the Question

First, identify the question type. This is a priority-setting question, indicated by the phrase 'first priority'.
Next, analyze the clinical scenario: a child with nephrotic syndrome (already at risk for infection) is receiving corticosteroid therapy.
Recall the major adverse effects of the medication (corticosteroids). Key effects include immunosuppression, hyperglycemia, fluid retention, GI irritation, and long-term Cushingoid changes.
Differentiate between the symptoms of the disease (fluid retention) and the side effects of the treatment.
Apply a safety and risk framework. Ask yourself: Which of these potential problems is most common and could harm the patient most quickly? A systemic infection in an immunocompromised child is the most immediate life-threatening risk.
Evaluate each option based on this framework. Monitoring for infection and the common metabolic effect of hyperglycemia addresses the most critical, acute safety risks of the therapy.

Concept Tested & Keywords

Concept Tested: Priority nursing assessment for a pediatric patient on corticosteroid therapy for nephrotic syndrome.
Stem keywords: nephrotic syndrome, corticosteroid therapy, 9-year-old child, first priority, assessment
Lead-in keywords: first priority
Clinical cues: Patient is a child, which can affect drug metabolism and immune response.
Clinical cues: Patient has nephrotic syndrome, which already confers a risk of infection.

QHC8KfDhByJRFcp2SWhgq2

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 42-44

E6 Pharmacology Nursing Lilley 11e Part 2 p. 226-228

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 199-201