NORCET-7 Mains-2024: What is the priority nursing action for a child with nephrotic syndrome?

NORCET-7 Mains-2024

Child Health Nursing (Pediatrics)

Medium

Appeared in: NORCET-7 Mains-2024

Explanation

The nursing process (Assess, Diagnose, Plan, Implement, Evaluate) prioritizes assessment as the first step.
Measuring daily weight and abdominal girth are key assessment activities to monitor fluid status, the primary problem in nephrotic syndrome.
Daily weight is the most sensitive indicator of fluid retention or loss.
Abdominal girth measurement specifically tracks ascites, a common and significant complication.
This assessment data is crucial for evaluating the effectiveness of treatments like diuretics and corticosteroids and for detecting complications early.

Option A: Fluid restriction is generally contraindicated because children with nephrotic syndrome can have low intravascular volume, and restriction can lead to hypovolemic shock or thrombosis.
Option B: Encouraging a high-protein diet can increase the metabolic load on the kidneys and potentially worsen glomerular damage and proteinuria.
Option D: This is an implementation step (carrying out a doctor's order), not an assessment. According to the nursing process, assessment is the priority and must be done first to establish a baseline and monitor response to treatment.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Priority nursing actions for pediatric nephrotic syndrome in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Accurate fluid balance monitoring is a core nursing competency and is critical for patient safety in nephrotic syndrome to prevent life-threatening complications.
Nurses are responsible for educating the family on how to monitor for signs of fluid overload, infection, and other complications at home.
What if? If the child with nephrotic syndrome suddenly develops shortness of breath and coughing, the priority action would shift immediately to assessing airway, breathing, and circulation (ABCs). This could indicate pulmonary edema, a medical emergency requiring immediate intervention and physician notification.

How to Approach the Question

First, identify the question type. This is a 'priority' question, which requires you to determine the most important action among several correct or plausible options.
Apply the nursing process framework: Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE). Assessment is almost always the first and most critical step.
Analyze the options based on the nursing process. 'Measure daily weight and abdominal girth' is an assessment action.
'Restrict fluid intake,' 'Encourage protein intake,' and 'Administer corticosteroids' are implementation actions.
Since assessment precedes implementation, the assessment action (measuring weight and girth) is the priority.
Consider the pathophysiology. The core problem in nephrotic syndrome is massive fluid shift and edema. Therefore, assessing and monitoring this fluid status is the top priority.

Concept Tested & Keywords

Concept Tested: Priority nursing actions for pediatric nephrotic syndrome
Stem keywords: priority nursing action, child, nephrotic syndrome
Lead-in keywords: priority
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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