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

NORCET 8 Prelims-2025

Child Health Nursing (Pediatrics)

Hard

Appeared in: NORCET 8 Prelims-2025

Explanation

The highest priority is monitoring for infection, as corticosteroids suppress the immune system in a child who is already immunocompromised from losing immunoglobulins due to nephrotic syndrome. Sepsis is a life-threatening risk.
Corticosteroids also have significant metabolic effects, including causing hyperglycemia (high blood sugar) by increasing glucose production and inducing insulin resistance.
Addressing these two acute, drug-induced complications is a greater priority than monitoring the disease's primary symptom (edema) or long-term side effects.

Option B: Assessing for fluid retention is a crucial part of monitoring the disease and the effectiveness of the treatment, but it is not the priority for assessing a new, life-threatening adverse effect of the corticosteroid medication itself.
Option C: While a possible side effect, gastrointestinal bleeding is less common and typically less immediately life-threatening than a systemic infection in a severely immunocompromised child.
Option D: Skin thinning and bruising are Cushingoid features that develop as a result of long-term corticosteroid use. They are not an acute assessment priority.

Visual 1: Flowchart: Priority Assessments for a Child on Corticosteroids - Shows a decision tree starting with the most life-threatening risks (Infection, Hyperglycemia) and branching to other important assessments.
Visual 2: Infographic: Side Effects of Corticosteroids - Visually separates acute/priority side effects (immunosuppression, hyperglycemia, hypertension) from long-term/Cushingoid effects (moon face, skin thinning, osteoporosis).

Clinical Relevance

Nursing practice connection: Use the key finding related to Priority nursing assessment for a pediatric patient with nephrotic syndrome on corticosteroid therapy to guide bedside assessment, documentation, and the next nursing action.
A key nursing responsibility is educating the family that steroids can mask fever, so any subtle sign of illness (e.g., lethargy, poor feeding, irritability) must be reported immediately.
Nurses must teach families strict hand hygiene and to avoid crowds or contact with sick individuals to minimize infection risk.
Patient safety is paramount. A missed or delayed diagnosis of infection in a child on high-dose steroids can rapidly progress to sepsis and death.

How to Approach the Question

First, identify the core components of the question: a child with nephrotic syndrome receiving corticosteroid therapy.
Recognize this is a priority-setting question. You must determine the most immediate, life-threatening risk.
Analyze the effects of the disease (nephrotic syndrome causes immunocompromise) and the drug (corticosteroids are immunosuppressants). The combined effect points to a severe risk.
Evaluate each option based on acuity. Differentiate between acute, life-threatening side effects of the drug (infection, hyperglycemia) versus signs of the underlying disease (edema) or long-term drug side effects (skin changes).
Select the option that addresses the most critical and immediate potential harm. The risk of a fatal infection is the highest priority.

Concept Tested & Keywords

Concept Tested: Priority nursing assessment for a pediatric patient with nephrotic syndrome on corticosteroid therapy.
Stem keywords: 9-year-old child, nephrotic syndrome, corticosteroid therapy, assessment
Lead-in keywords: first priority
Clinical cues: The combination of nephrotic syndrome (immunocompromised state) and corticosteroid therapy (immunosuppressant) exponentially increases infection risk.
Negative lead-in flag: false

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