Identify the nursing action that takes the highest priority in the care of a 2-year-old boy in the edematous phase of nephrotic syndrome.
A)Increase fluid intake to 1000 mL per day.
B)Encourage the child to play actively for 10 minutes each hour.
C)Clean and powder the skin folds every 2 hours.
D)Monitor intake and output every 24 hours.

Question

Quizplus · Accepted Answer

The highest priority nursing action in the edematous phase of nephrotic syndrome for a 2-year-old boy is to clean and powder the skin folds every 2 hours to prevent skin breakdown and potential infection due to excess fluid and edema in the body. While monitoring intake and output is important, it is not the highest priority in this phase of nephrotic syndrome. Increasing fluid intake may exacerbate edema and encourage fluid retention, and encouraging active play may not be appropriate or feasible for a child experiencing edema.

Identify the Nursing Action That Takes the Highest Priority in the Care