Chapter 24, The Child with Renal Dysfunction

Which reason is appropriate when external defects of the genitourinary tract, such as hypospadias, are repaired early? 1 Acceptance of hospitalization 2 Prevention of separation anxiety 3 Development of normal body image 4 Prevention of urinary tract complications

3 Promotion of a normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Surgical intervention for external defects of the genitourinary system should be done as soon as possible. Prevention of urinary tract complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible. Proper preprocedure preparation can help prevent or at least reduce separation anxiety. Acceptance of hospitalization is important but not the reason for early surgical intervention of external defects of the genitourinary system.

Vesicoureteral reflux is associated with which condition? 1 Hypotension 2 Incontinence 3 Recurrent kidney infections 4 Increased renal arterial perfusion

3 Vesicoureteral reflux is associated with recurrent kidney infections, not hypotension, incontinence, or increased renal arterial perfusion.

Why do children with chronic renal failure have anemia? 1 Diet 2 Fluid intake 3 Recurrent infection 4 Decreased erythropoietin

4 Anemia in children with chronic renal failure is related to decreased production of erythropoietin. Recombinant human erythropoietin is offered to these children to eliminate the need for frequent blood transfusions. Diet, fluid intake, and recurrent infection are not related to anemia and chronic renal failure. p. 807

Which reason is appropriate as to why a child should not hold or wait to urinate who has been diagnosed with a urinary tract infection (UTI)? 1 Inhibits the process of urine formation 2 Reduces the blood supply of the kidneys 3 Causes severe abdominal pain in the child 4 Increases the chances of another infection

4 Urinary stasis is the most important factor influencing the occurrence of UTI. Children at times may tend to hold urine for long periods of time, even when their parents repeatedly ask whether they feel the need to urinate. This is very important to prevent infections. Holding urine does not reduce the blood supply to the kidneys significantly. Abdominal pain is associated with UTIs and is not caused by holding urine. A child holding urine does not impact urine formation.

The estimated blood volume of a child scheduled for hemodialysis is 1200 ml. The total dialysis circuit volume should not exceed 10% of the child's estimated blood volume. Which maximum total dialysis circuit volume is safe for dialysis? Record your answer as a whole number. _________ ml

For safe pediatric dialysis, the total dialysis circuit volume should not exceed 10% of the child's estimated blood volume. Therefore, the maximum total dialysis circuit volume for a safe dialysis in the child is 10% of 1200 ml, that is, 120 ml.

Which is the current treatment for end-stage renal disease? 1 None available 2 Dialysis and transplantation 3 Restriction of protein intake 4 Limited sodium and water intake

2 Dialysis and transplantation are the only treatments currently available for end-stage renal disease. Sodium and water intake are not usually limited unless there is evidence of edema or hypertension. Protein restriction is not recommended because it may negatively affect a child's growth and neurodevelopment. Treatment is available in the form of dialysis and transplantation.

Which nursing intervention is appropriate for a child with nephrotic syndrome on bed rest? 1 Restraining the child as necessary 2 Adjusting activities to the child's tolerance level 3 Discouraging the parents from holding the child 4 Performing passive range-of-motion exercises once a day

2 The child will have a variable level of tolerance for activity. Activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child so they are age appropriate. Restraints would not be used to confine a child to bed unless the child is a threat to self or others. Parents would be encouraged to hold the child. The child would be encouraged to move all extremities while in bed to prevent the complications of immobility.

Which clinical manifestations are appropriate when an infant has a suspected urinary tract infection (UTI)? Select all that apply. 1 Jaundice 2 Vomiting 3 Swelling of the face 4 Persistent diaper rash 5 Failure to gain weight

2,4,5 Vomiting is a clinical manifestation observed in an infant with a urinary tract infection (UTI) and can be related to poor feeding. Persistent diaper rash is a clinical manifestation of UTI in an infant. Failure to gain weight is a clinical manifestation of UTI in an infant related to poor feeding and vomiting. Jaundice is not a clinical manifestation of UTI in an infant. Swelling of the face is not a clinical manifestation of UTI in an infant.

Which condition is appropriate when a child presents to the pediatric office with incontinence and strong-smelling urine? 1 Sexual abuse 2 Nephritic syndrome 3 Urinary tract infection 4 Structural defect of the urinary tract

3 A child who exhibits clinical symptoms of incontinence and strong-smelling urine should be evaluated for a urinary tract infection. Incontinence and strong-smelling urine are not associated with sexual abuse, nephritic syndrome, or structural defects of the urinary tract.

Which condition is appropriate when considering common postinfectious renal diseases in childhood? 1 Wilms tumor 2 Nephrotic syndrome 3 Acute glomerulonephritis 4 Hemolytic uremic syndrome

3 Acute glomerulonephritis is the most common postinfectious renal diseases in childhood and the one for which a cause can be established in most cases. Wilms tumor is a common malignant renal and intra-abdominal tumor of childhood. Nephrotic syndrome is a clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Hemolytic uremic syndrome is an uncommon acute renal disease.

Which finding is appropriate regarding a newborn child whose urine specific gravity is 1.030? 1 The child is producing normal urine. 2 The specific gravity of the urine is low. 3 The urine possibly contains protein or glucose. 4 The child possibly has distal tubular dysfunction

3 If a newborn child's urine has a specific gravity of 1.030, it is a high value. It suggests that the urine possibly contains protein or glucose. The normal range for a newborn child is 1.001 to 1.020. Hence, a specific gravity of 1.030 is not normal; it is a high value for this age group. A child with distal tubular dysfunction is likely to produce urine that has a low specific gravity rather than a high specific gravity.

Which objectives are appropriate in the therapeutic management of a 10-year-old boy with nephrotic syndrome? 1 Decreasing intravascular fluid volume, preventing infection, and minimizing complications related to therapies 2 Reducing excretion of urinary protein, enhancing fluid retention in the tissues, treating infection, and minimizing complications related to therapies 3 Reducing excretion of urinary protein, reducing fluid retention in the tissues, preventing infection, and minimizing complications related to therapies 4 Increasing excretion of urinary protein, reducing fluid retention in the tissues, preventing infection, and minimizing complications related to therapies

3 Objectives for therapeutic management of the child with nephrotic syndrome include reducing (not increasing) excretion of urinary protein, reducing fluid retention in the tissues, preventing (rather than treating) infection, and minimizing complications related to therapies.

Which laboratory test is used to visualize the renal vascular system in the diagnosis of renal arterial stenosis? 1 Renal biopsy 2 Urodynamics 3 Renal angiography 4 Retrograde pyelography

3 Renal angiography is used to visualize the renal vascular system in the diagnosis of renal arterial stenosis. Renal biopsy yields histologic and microscopic information about renal structures. Urodynamics reveals characteristics of voiding dysfunction. Retrograde pyelography is used to visualize the pelvic calyces, ureters, and bladder.

Which urine test of urinary system function is appropriate to visualize the renal vascular system? 1 Urodynamics 2 Specific gravity 3 Renal angiography 4 Retrograde pyelography

3 Renal angiography is used to visualize the renal vascular system, especially for renal arterial stenosis. Urodynamics is a set of tests designed to measure bladder filling and storage and evaluate function. Specific gravity is used to determine the specific gravity of the urine and is helpful in determining dehydration status. Retrograde pyelography is used to visualize the pelvic calyces, ureters, and bladder.

Which strategy is appropriate when preparing a 3-year-old child for the examination of the urethra and taking a urine sample? 1 Demonstrate and explain the procedure on a doll. 2 Ask the parents to explain the procedure to the child. 3 Explain the urinary system and procedure to the child. 4 Show pictures of the urinary system and the procedure

1 A 3-year-old child is too young to understand the procedure of examining the urinary system. The nurse would explain the procedure by demonstrating it on a doll. This should be done to eliminate fear in the child's mind before the examination. The child will not be able to understand the anatomy of the urinary system; thus, the nurse would not give a verbal explanation or show pictures of the urinary system. It is the nurse's responsibility to prepare the child for the examination. The nurse would not ask the parents to explain the examination and the process of procuring the urine sample to the child.

Which cause is appropriate when diagnosing acute renal failure in children? 1 Severe dehydration 2 Glomerular disease 3 Renal artery stenosis 4 Obstructive uropathy

1 Acute renal failure may be due to prerenal, intrarenal, or postrenal causes. Prerenal causes are usually associated with diminished blood flow; intrarenal causes are associated with medication; and postrenal causes are related to obstruction of the outflow of urine. In children, viral or bacterial illness that leads to severe diarrhea and/or vomiting poses a risk of dehydration. When dehydration becomes severe, there is a decrease in renal perfusion leading to acute tubular necrosis, or acute renal failure. Illnesses with profuse diarrhea are considered to be the most common cause of acute renal failure in children. Glomerular disease is the most common cause of glomerular damage, which is an intrinsic renal cause of acute renal failure. However, in children, prerenal causes such as dehydration due to diarrheal diseases and persistent vomiting are the most common causes of acute renal failure. Renal artery stenosis is also a prerenal cause of acute renal failure in children, but it is a less common cause than diarrheal disease. Obstructive uropathy can lead to acute renal failure too, but it is an uncommon cause in children except during infancy.

Which test is appropriate when confirming the diagnosis of renal calculi? 1 Scout film 2 Renal biopsy 3 Urine culture 4 Renal angiography

1 Scout film in this case refers to the abdominal x-rays which specifically focus on the kidney, ureters, and bladder. This film is useful to detect the presence of calculi, or opaque foreign bodies in the bladder. Therefore, the child should be prepared for a scout film of the abdomen. Renal biopsy is done in cases in which histologic and microscopic information about glomeruli and renal tubules is needed. Urine culture is done for a patient with a urinary tract infection to find the pathogen. Renal angiography is done to visualize the renal vascular system, especially when the patient is suspected to have renal arterial stenosis.

Which urine test result is appropriate to report to the health care provider? 1 pH of 4 2 Absence of protein 3 Absence of glucose 4 Specific gravity of 1.020

1 The expected pH of urine is 4.8 to 7.8. A specific gravity of 1.020 is within the normal range of 1.015 to 1.030. Protein should not be present in the urine; it indicates an abnormality in glomerular filtration. Glucose should not be present in the urine; it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

Which finding is appropriate for the increased incidence of bacteriuria in females? 1 Lower urinary tract 2 Higher urinary tract 3 Higher intake of fluids 4 Frequent emptying of the bladder

1 The lower urinary tract accounts for the increased incidence of bacteriuria in females. Females have a lower, not a higher, urinary tract, which increases the incidence for bacteriuria. Frequent emptying of the bladder and a higher intake of fluids help to prevent infections and are therefore not associated with an increased incidence of bacteriuria in females.

Which nursing response is appropriate when asked by the parent of a child hospitalized with acute glomerulonephritis (AGN) why blood pressure readings are taken often? 1 Acute hypertension must be anticipated and identified. 2 Hypotension leading to sudden shock can develop at any time. 3 Blood pressure fluctuations are a common side effect of antibiotic therapy. 4 Blood pressure fluctuations are a sign that the condition has become chronic.

1 Vital signs, in particular the blood pressure, provide information about the severity of AGN and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations are not indicative of chronic disease. Most children with AGN fully recover. Hypertension, not hypotension, is more likely with AGN.

Which laboratory finding with clinical symptoms indicates nephrosis? 1 Hypoalbuminemia 2 Low specific gravity 3 Decreased hematocrit 4 Decreased hemoglobin

1 Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into the urine in a child with nephrosis. The specific gravity is increased by the large amount of protein in the urine of a child with nephrosis. The hematocrit would be elevated as a result of nephrosis. The hemoglobin would be increased as a result of hypovolemia in a child with nephrosis.

Which nursing information is appropriate when teaching the parents of a child who is referred for radioisotope imaging of the renal system using the diethylenetriamine pentaacetic acid (DTPA) radioisotope? Select all that apply. 1 "The child may need to be catheterized for this procedure." 2 "A contrast dye would be injected into the arteries of the child." 3 "This test will help to locate any obstruction in the urinary tract." 4 "This test would help determine the filtering ability of the kidney." 5 "This test would determine whether the renal blood vessels are obstructed."

1,3,4 DTPA isotope imaging may involve urethral catheterization of the child. This investigation is used to locate the presence of any obstruction in the urinary tract and also determine the glomerular filtration rate (GFR). The GFR is a reliable indicator of renal function. In this procedure, the contrast dye is injected intravenously for analysis of renal function. This test does not determine whether the renal blood vessels are obstructed; a renal angiogram helps to determine the presence of renal stenosis.

Which condition is appropriate for an 8-year-old girl with dehydration who has demonstrated diminished urine output and lethargy since shortly after undergoing surgery? 1 Wilms tumor 2 Acute kidney injury 3 Acute glomerulonephritis 4 Hemolytic uremic syndrome

2 A child with dehydration who experiences diminished urine output and lethargy within a short time (especially if in shock or after surgery) is at risk for acute kidney injury. Common signs of Wilms tumor include weight loss, abdominal swelling, and fever. Some common signs of acute glomerulonephritis include edema, anorexia, cloudy urine, oliguria, pallor, lethargy, and headaches. Signs of hemolytic uremic syndrome include vomiting, irritability, lethargy, pallor, bruising, and signs of neurologic involvement. Wilms tumor, hemolytic uremic syndrome, and acute glomerulonephritis are not the most common complications seen after surgery. Dehydration with decreased perfusion to the kidneys is the most likely cause of this patient's symptoms, considering that the patient has just undergone surgery.

Which nursing intervention is appropriate when collecting and storing a urine specimen for culture for a young girl who needs to be evaluated for a urinary tract infection (UTI)? 1 The specimen should be stored in a refrigerator for a maximum of 6 hours after voiding. 2 The child should be seated on the toilet facing the tank to easily collect clean-catch urine. 3 The child should be encouraged to drink large volumes of water to obtain specimen quickly. 4 The specimen should be stored at room temperature for a maximum of 2 hours after voiding.

2 Collection of clean-catch urine in a young girl is easier when the child is made to sit on the toilet facing the tank. In this position, the labia are naturally separated. There is less chance of contamination of urine. The child is also more stable and relaxed in this position. A fresh urine specimen is needed for sensitivity and specificity of the urinalysis and to prevent growth of organisms. Urine specimens would be stored in a refrigerator for a maximum of 4 hours after voiding. The child would not be encouraged to drink large volumes of water to obtain a specimen quickly, because a recent high fluid intake can lead to a falsely low organism count. A urine specimen should be stored at room temperature for a maximum of 1 hour after voiding.

In what defect of the genitourinary tract is the meatal opening located on the dorsal surface of the penis? 1 Hydrocele 2 Epispadias 3 Hypospadias 4 Cryptorchidism

2 Location of the urethral meatal opening on the dorsal surface of the penis is called epispadias. A hydrocele is a fluid-filled sack in the scrotum. Hypospadias is when the urethral opening is located behind the glans penis or along the ventral surface of the penile shaft. Cryptorchidism is the failure of one or both testes to descend normally through inguinal canal.

Which nursing collection method is appropriate when obtaining a urine sample for culture? 1 Avoid taking the urine sample from a catheter. 2 Use aseptic techniques while collecting the sample. 3 Store the sample for 2 hours before sending it to the laboratory. 4 Obtain the parents' consent before collecting the sample.

2 The nurse would take aseptic measures while collecting the urine sample of the child. This would be done to prevent contamination of the sample. The nurse can take the urine sample from a catheter if required. The nurse would send the urine sample for testing immediately after it is collected. The nurse need not obtain the consent of the parents before collecting the sample of urine.

Which findings are appropriate when observing the child in the acute phase of acute glomerulonephritis? 1 Hematuria and ketosis 2 Hematuria and proteinuria 3 Increased serum complement 4 Positive cultures of the pharynx for streptococci

2 Urinalysis during the acute phase of acute glomerulonephritis reveals hematuria and proteinuria. Urinalysis during the acute phase of acute glomerulonephritis shows hematuria and proteinuria, not hematuria and ketosis. Serum complement (C3) is decreased, not increased. Streptococci are not typically found on culture.

Which structure is appropriately visualized by both cystoscopy and retrograde pyelography tests? 1 Ureters 2 Bladder 3 Renal arteries 4 Urethral openings

2 Visualization of the bladder is possible by both cystoscopy and retrograde pyelography. During cystoscopy, the bladder is visualized directly through a scope inserted via the urethra. In retrograde pyelography, a contrast medium injected through a urethral catheter helps visualize the bladder. Visualization of the ureters can be done through retrograde pyelography but not through cystoscopy, which helps visualize the bladder and lower urinary tract. Visualization of renal arteries is done through renal angiography. Cystoscopy, not retrograde pyelography, helps visualize the urethral openings.

Which condition is appropriate for a previously healthy 10-year-old boy who is hospitalized for weight gain over the past several days, generalized edema, and irritability? 1 Wilms tumor 2 Nephrotic syndrome 3 Acute glomerulonephritis 4 Hemolytic uremic syndrome

2 Weight gain over the several days preceding presentation, generalized edema, and irritability are associated with nephrotic syndrome. Common signs of Wilms tumor include weight loss, abdominal swelling, and fever. Some common signs of acute glomerulonephritis include edema, anorexia, cloudy urine, oliguria, pallor, lethargy, and headaches. Signs of hemolytic uremic syndrome include vomiting, irritability, lethargy, pallor, bruising, and signs of neurologic involvement.

Which manifestations are appropriate for both acute poststreptococcal glomerulonephritis (APSGN) and minimal-change nephrotic syndrome (MCNS)? Select all that apply. 1 Generalized edema 2 Microscopic hematuria 3 Elevated blood pressure 4 Elevated serum protein level 5 Normal serum potassium level

2,5 Microscopic hematuria may be seen in both APSGN and MCNS. In APSGN, hematuria is present and may be either gross or microscopic. In MCNS, there may be microscopic or no hematuria. Serum potassium level remains normal in MCNS. It may be either normal or elevated in APSGN. Children with MCNS have severe, generalized edema. Those with APSGN have primarily periorbital and peripheral edema. Blood pressure is elevated in APSGN and normal or decreased in MCNS. Serum protein levels are decreased in both conditions though marked decrease is seen only in MCNS.

Which nursing explanation is appropriate when parents ask the reasoning for the child's medications of prednisone, tacrolimus, and mycophenolate for a kidney transplant? 1 Decrease pain 2 Boost immunity 3 Suppress rejection 4 Improve circulation to the kidney

3 A combination of prednisone, tacrolimus, and mycophenolate is given to suppress rejection. Prednisone, tacrolimus, and mycophenolate do not decrease pain, boost immunity, or improve circulation.

Which clinical manifestations are appropriate with the diagnosis of acute poststreptococcal glomerulonephritis? 1 Edema, increased urine volume, hypotension 2 Edema, decreased urine volume, hypotension 3 Edema, decreased urine volume, hypertension 4 Edema, increased urine volume, hypertension

3 Edema, decreased urine volume, and hypertension are common clinical manifestations of acute poststreptococcal glomerulonephritis. Pallor; cloudy, brown urine; irritability; lethargy; and vomiting are other signs. Increased urine volume and hypotension are not clinical manifestations of acute poststreptococcal glomerulonephritis.

Which clinical manifestation is appropriate with a persistent urinary tract infection (UTI)? 1 The infection has spread in the blood. 2 There is pain in the lower abdominal area and a fever. 3 Problem continues despite taking antibiotics prescribed earlier. 4 The child is cured and symptoms begin again within a month's time.

3 Persistent UTIs are characterized by an infection that persists despite antibiotic treatment. The statement that the child has had an infection in spite of taking antibiotic therapy indicates that the child has persistent UTIs. If the patient with a UTI infection has lower abdominal pain and fever, then the type of UTI would be a symptomatic UTI. If the parents report that the child gets cured and gets the symptoms of infection again within a month's time, then the child has recurrent UTI. If the blood reports reveal the pathogen causing UTI, then the child has urosepsis.

Which finding indicates the need for a radionuclide (nuclear) cystogram in the child with recurrent urinary tract infections? 1 Severe abdominal pain 2 Symptoms of renal calculi 3 Allergy to intravenous contrast medium 4 Child unwilling to undergo catheterization

3 Voiding cystourethrography is used to visualize the bladder outline and urethra and check for reflux of urine into the ureters. It uses a contrast medium to visualize the bladder. If the child has an allergy to contrast material, then a radionuclide cystogram is used to evaluate for vesicoureteral reflux. A radionuclide cystogram does not give clear anatomic details of the urinary system and thus cannot be used to detect renal calculi. These investigations do not aggravate abdominal pain. These investigations could be done once the pain is under control. Both these procedures involve catheterizing the patient.

Which clinical manifestation is appropriate when assessing a child for possible nephrotic syndrome? 1 Cola- or tea-colored urine 2 Excessive loss of body weight 3 Appearance of white lines on the nails 4 Swelling of the genitalia in the morning

3 When assessing for nephrotic syndrome, the nurse would look for the appearance of white lines on the child's nails. These lines, called Muehrcke lines, appear parallel to the lunula and are caused by prolonged hypoalbuminemia. Cola- or tea-colored urine indicates gross hematuria. In nephrotic syndrome, hematuria is either absent or microscopic. Due to poor appetite and loss of protein, there may be some weight loss. However, it is obscured by the generalized severe edema. Hence, excessive loss of body weight is not seen. Swelling of the genitalia is usually more prominent later in the day.

The nurse is teaching the parents of preschoolers about preventing urinary tract infections (UTIs). Which strategies are appropriate when teaching the parents how to prevent UTIs? Select all that apply. 1 "Put a diaper on your child overnight." 2 "Do not allow your children to urinate in public toilets." 3 "Give cranberry juice to your children on a regular basis." 4 "Ensure that your children evacuate their bowels regularly." 5 "Encourage your children to drink 6 to 8 glasses of water each day."

3,4,5 Research has proven that cranberry juice increases the acidity of the urine and thus helps prevent recurrence of symptomatic UTIs. If the child has recurrent UTIs, then the parents should be encouraged to give cranberry juice to their child on a regular basis. Drinking adequate amounts of water promotes flushing of the normal bladder and lowers the concentration of pathogens in the bladder. It also helps enhance the antibacterial properties of the renal medulla. Constipation can cause bladder obstruction and increase the risk of UTI. Thus, the parents must ensure that the children clear their bowels regularly. Diapers would not be recommended in preschool-age children because these children have adequate bladder control, and extended use of diapers is known to increase the risk of developing UTI. If the child is outside the home and has a desire to void, the child should be allowed to use public toilets, because holding the bladder for a long time can increase the risk of UTI.

Which finding indicates the child with acute glomerulonephritis has progressed to renal failure? 1 Pleural effusion 2 Gross hematuria 3 Moderate proteinuria 4 Elevated serum potassium levels

4 Acute glomerulonephritis may be characterized by normal or elevated serum potassium levels. However, unless the disease has progressed to renal failure, the blood examination reveals normal potassium levels rather than elevated levels. Pleural effusion occurs during the edematous phase of glomerulonephritis. Gross hematuria occurs during the acute phase of glomerulonephritis. With disease improvement, the gross hematuria diminishes. Mild to moderate proteinuria is common in acute glomerulonephritis. Massive proteinuria occurs with nephrotic syndrome.

Which nursing consideration is appropriate when caring for a child with end-stage renal disease (ESRD)? 1 The child with ESRD usually adapts well to the minor inconveniences of treatment. 2 The child with ESRD requires extensive support until the child has outgrown the condition. 3 Multiple stresses are placed on the child and family with ESRD until the illness is ultimately cured. 4 Multiple stresses are placed on the child and family with ESRD because the child's life is maintained by drugs and artificial means.

4 ESRD is a chronic, progressive disease with dependence on technology. Families need to arrange for continuing examinations and procedures that are painful and may require hospitalization. ESRD is a complex disease process that requires substantial medical intervention. ESRD cannot be outgrown or cured. Dialysis is necessary until renal transplantation is performed.

Which clinical manifestations are appropriate when diagnosing nephrotic syndrome? 1 Uric acid, edema, hypolipidemia 2 Creatinine, edema, proteinuria, hyperalbuminemia 3 Blood urea nitrogen, proteinuria, hypoalbuminemia 4 Proteinuria, edema, hyperlipidemia, hypoalbuminemia

4 Nephrotic syndrome is a clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema.

Which causes primary reflux? 1 Trauma 2 Acquired infection 3 Acquired condition 4 Congenitally abnormal insertion of ureters into the bladder

4 Primary reflux occurs when a congenitally abnormal insertion of ureters into the bladder occurs. It is not caused by an acquired infection, acquired condition, or trauma.

Which complication is appropriate when assessing a toddler with acute kidney injury resulting from severe dehydration? 1 Hypotension 2 Hypokalemia 3 Hypernatremia 4 Water intoxication

4 The child with acute renal failure is at risk for water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes. The child needs to be monitored for hypertension, not hypotension, when hospitalized with acute renal failure. Hyperkalemia, not hypokalemia, is a concern in acute renal failure. Hyponatremia, not hypernatremia, may develop in acute renal failure, because the sodium is diluted in large amounts of water.