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    Ati Rn Paediatrics Nursing 2023 Proctored Exam

    A nurse is caring for an adolescent who has acute glomerulonephritis. Which of the following actions should the nurse take?

    Explanation & Rationale

    A. Weigh the client daily: Acute glomerulonephritis commonly causes fluid retention due to impaired renal filtration. Daily weights provide the most accurate assessment of fluid balance and help detect subtle increases in fluid volume that may indicate worsening edema or renal function. B. Increase the client’s dietary protein intake: Protein intake is often restricted in acute glomerulonephritis to reduce the workload on the kidneys and limit nitrogenous waste production. Increasing protein could worsen azotemia and place additional stress on renal function. C. Assess the client’s blood pressure every 8 hr: Blood pressure monitoring is important because hypertension is common in acute glomerulonephritis. However, daily weights are a more sensitive and priority measure for detecting fluid overload, which directly contributes to hypertension and edema. D. Avoid palpating the client’s abdomen: Abdominal palpation is not contraindicated in acute glomerulonephritis. While care should be gentle, avoiding abdominal assessment is unnecessary and does not directly address the primary concerns of fluid balance and renal function.

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