A child with acute glomerulonephritis is in the playroom and experiences blurred vision and headache. Which of the following actions should be taken by the nurse?
1. Check the urine to see if hematuriahas increased.
2. Obtain a BP on the child;notify thephysician.
3. Reassure the child,and encouragebed rest until the headache improves.
4. Obtain serum electrolytes,and send aurinalysis to the lab.
Answer:2
Rationale:Blurred vision and headache may be signs of encephalopathy,a complication of acute glomerulonephritis. A B/P should be obtained and the physician notified. The physician may decide to order an antihypertensive to bring down the B/P. This is a serious complication,and delay in treatment could mean lethargy and seizures. Therefore,the other options (checking urine for hematuria,encouraging bed rest,and obtaining serum electrolytes) do not directly address the potential problem of encephalopathy.
You might also like to view...
The role of the nurse in the school setting can include:
1. Providing medical diagnoses for children with illnesses. 2. Providing health assessment of infants of mothers enrolled in school. 3. Providing medication to children when requested without prescription. 4. Providing mental health therapy upon request.
If you are supporting the steps in the AHRQ document "Five Steps to Safer Health Care," you would ensure that:
a. Patients are actively encouraged to make decisions related to care. b. Rules and decisions are made through centralized processes. c. You monitor the performance of each staff member closely. d. Preference is given to increasing staff numbers rather than staff credentials.
If the dosage is inappropriate for a client, who is responsible?
A) Physician B) Pharmacist C) Nurse D) Medical technician
The trait approach focuses on
a. Follower-leader interaction b. Role of the leader c. Role of the follower d. Role of the organization