A child is admitted with nephrotic syndrome. What is the nurse's priority action?

RML MAINS 2025

Child Health Nursing (Pediatrics)

Medium

Appeared in: RML MAINS 2025

Explanation

Nephrotic syndrome's core feature is massive proteinuria, leading to low blood albumin (hypoalbuminemia).
Low albumin decreases plasma oncotic pressure, causing a major fluid shift from the vascular space into the interstitial tissues, resulting in severe, generalized edema.
The immediate priority is to monitor this fluid status to assess the severity of edema, detect complications like intravascular volume depletion (hypovolemia), and evaluate the effectiveness of treatments like diuretics.
Daily weight is the most accurate indicator of total body fluid changes.
Strict intake and output records are essential for tracking kidney function and response to therapy.

Option B: This is contraindicated. Children with nephrotic syndrome lose significant amounts of protein in their urine, which worsens hypoalbuminemia and edema.
Option C: This is not the primary dietary intervention. The first and most important dietary change is sodium restriction to help control edema.
Option D: This is not a routine priority action for nephrotic syndrome itself. It is a treatment for a potential complication.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Priority nursing management for pediatric nephrotic syndrome in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Accurate daily weight measurement is the gold standard for monitoring fluid status. It must be performed at the same time each day, on the same scale, with the child wearing similar clothing.
Patient and family education is crucial, focusing on the 'no added salt' diet, signs of infection, and the importance of monitoring urine for protein at home.
What if? If the child with nephrotic syndrome suddenly develops a fever and severe abdominal pain, the priority action shifts. The nurse must immediately assess for signs of spontaneous bacterial peritonitis (a life-threatening complication) and notify the healthcare provider.

How to Approach the Question

First, identify that the question is asking for the 'priority action'. This requires you to determine the most immediate and critical need of the patient.
Recall the pathophysiology of nephrotic syndrome: the primary problem is massive protein loss leading to severe fluid shifts and edema.
Analyze the options in the context of this core problem. The most urgent issue to manage is the unstable fluid balance.
Evaluate each option's relevance: Monitoring intake, output, and weight directly assesses the fluid balance problem.
Eliminate the other options: Reducing protein is harmful. Reducing water is a secondary, not primary, intervention. Giving antibiotics treats a potential complication, not the underlying process.
Conclude that assessing and monitoring the patient's fluid status is the highest priority to ensure safety and track the disease course.

Concept Tested & Keywords

Concept Tested: Priority nursing management for pediatric nephrotic syndrome
Stem keywords: child, nephrotic syndrome, admitted, nurse's priority action
Lead-in keywords: priority action
Clinical cues: A diagnosis of nephrotic syndrome implies significant fluid shifts and edema, making fluid balance a central concern.

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E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) pp. 199-201, 200-202