A child is hospitalized with a diagnosis of nephrotic syndrome. Which assessment finding would the nurse expect to note in the child?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Abdominal pain is a common clinical manifestation in children with nephrotic syndrome.
The pain is caused by the accumulation of fluid in the peritoneal cavity, a condition known as ascites.
Ascites develops due to a significant fluid shift from the bloodstream into the interstitial spaces, driven by low blood albumin levels (hypoalbuminemia).
Edema of the intestinal wall can also contribute to abdominal discomfort and pain.

Option A: Children with nephrotic syndrome experience significant weight GAIN, not loss. This is due to massive fluid retention causing generalized edema (anasarca).
Option B: Edema of the bowel wall, a common feature of nephrotic syndrome, typically leads to diarrhea and malabsorption, not constipation.
Option C: While the fluid shift in nephrotic syndrome causes decreased intravascular volume (hypovolemia), which can lead to hypotension, blood pressure is often normal. Hypotension is considered a sign of severe volume depletion, not a universal expected finding. Abdominal pain from ascites is more common.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of nephrotic syndrome in children to guide bedside assessment, documentation, and the next nursing action.
A key nursing responsibility is to monitor for and manage edema. This includes daily weight checks, measuring abdominal girth, and assessing for signs of respiratory distress from pleural effusions.
While abdominal pain is expected, a sudden increase in severity could indicate spontaneous bacterial peritonitis, a serious complication of ascites in nephrotic syndrome, which requires immediate medical attention.
What if? If the child presented with high blood pressure (hypertension) and tea-colored urine instead, the diagnosis would more likely be acute glomerulonephritis, not nephrotic syndrome. The underlying pathophysiology and management would be different, focusing on controlling blood pressure and fluid overload.

How to Approach the Question

First, identify the core condition in the question: nephrotic syndrome in a child.
Next, recall the classic pathophysiology: massive proteinuria -> hypoalbuminemia -> decreased oncotic pressure -> fluid shift into interstitial spaces.
Think about the direct consequences of this massive fluid shift. It causes generalized edema, which includes fluid in the abdomen (ascites).
Evaluate each option based on this core process:
Does it cause weight loss? No, fluid retention causes weight gain.
Does it cause constipation? No, bowel edema usually causes diarrhea.

Concept Tested & Keywords

Concept Tested: Clinical manifestations of nephrotic syndrome in children.
Stem keywords: child, hospitalized, nephrotic syndrome, assessment finding
Lead-in keywords: expect to note
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: NOT changes the reasoning strategy; look for the exception or incorrect statement rather than the true statement.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1031-1033

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.