The caregivers of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine “looks funny.” He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100 °F (37.8 °C). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:

Choice A reason: Rheumatic fever follows streptococcal infections but typically presents with joint pain or carditis, not puffy eyes or abnormal urine. Glomerulonephritis matches the post-infectious symptoms, making this incorrect, as it does not align with the child’s clinical presentation after ear infections. Choice B reason: Lipoid nephrosis causes edema but lacks a clear link to recent infections or hematuria. Acute glomerulonephritis better explains the symptoms post-ear infection, making this less fitting and incorrect for the suspected condition based on the child’s reported signs and history. Choice C reason: Urinary tract infections cause dysuria or frequency, not typically puffy eyes or hematuria post-infection. Glomerulonephritis aligns with the streptococcal history and symptoms, making this incorrect compared to the condition suspected based on the child’s clinical presentation to the nurse. Choice D reason: Acute glomerulonephritis, often post-streptococcal from ear infections, causes hematuria (“funny” urine), periorbital edema (puffy eyes), and headache. This aligns with pediatric nephrology evidence, making it the correct condition the nurse suspects, prompting immediate evaluation by a care provider for the child.