Chapter 29: The Child with a Genitourinary Condition

The nurse is measuring output on an infant on the pediatric unit. When weighing the diaper and subtracting the weight of the dry diaper, the nurse records 30 g and documents this as _________ mL.

ANS: 30 Diapers may be weighed on a gram scale before application and after removal (1 g = 1 mL).

A 7-year-old child with acute glomerulonephritis has gross hematuria and has been confined to bed. What is the most appropriate nursing intervention for this child? a. Providing activities for the child on restricted activity b. Feeding the child a protein-restricted diet c. Carefully handling edematous extremities d. Observing the child for evidence of hypotension

ANS: A Although children may feel well, activity is limited until hematuria resolves.

What will the nurse caution the parents of a child who has had a nephrectomy that he will have to avoid? a. Contact sports b. Horseback riding c. Alcohol d. Diuretic medications

ANS: A Children who have only one kidney should avoid contact sports to prevent injury to that remaining organ.

The nurse is aware that genitourinary surgery is especially stressful for preschool children. What factor(s) lend to this stress? (Select all that apply.) a. They may perceive the treatment as punishment. b. They are especially prone to separation anxiety. c. They are sexually curious and developmentally fixated on their genitals. d. They have a fear of castration. e. They fear death.

ANS: A, B, C, D All options, except fear of death, are especially stressful for preschool children undergoing genitourinary surgery. Children in this age group do not have an understanding of the concept of death.

The nurse discussed strategies with a parent to prevent a recurrence of urinary tract infection in the child. Which statement made by the parent indicates a need for further teaching? a. "My daughter should wash and wipe the perineal area from front to back." b. "I am only going to have my daughter wear cotton underwear." c. "It is acceptable to take frequent bubble baths." d. "She needs to drink lots of fluids and void frequently."

ANS: C Oils in bubble bath and similar products are known to irritate the urethra.

What foods does the nurse recommend the child with acute glomerulonephritis avoid to prevent hyperkalemia? a. Dairy products b. Whole-grain cereals c. Organ meats d. Bananas

ANS: D Bananas are very high in potassium and should be avoided.

The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone? a. Can interfere with the treatment for nephrosis. b. Require that the child have antibiotic coverage. c. Can be given in smaller, divided doses. d. Should be delayed.

ANS: D No vaccinations or immunizations should be administered while the disease is active and during immunosuppressive therapy.

A 6-year-old child with daytime enuresis complains of dysuria and urgency. What does the nurse recognize these signs and symptoms indicate? a. Urinary tract infection b. Nephrotic syndrome c. Acute glomerulonephritis d. Vesicoureteral reflux

ANS: A Urinary frequency and pain during micturition are symptoms of acute urinary tract infection.

The nurse caring for a child with nephrotic syndrome is alert to which classic symptoms of this disorder? (Select all that apply.) a. Proteinuria b. Grossly bloody urine c. Hyperalbuminemia d. Fatigue e. Generalized edema

ANS: A, B, D, E All options listed are those of nephrotic syndrome with the exception of hyperalbuminemia. The nephrotic child has hypoalbuminemia, as most of the protein has been spilled in the urine.

What special considerations are related to long-term prednisone therapy in preschoolers? (Select all that apply.) a. Delayed immunization b. Hypertension c. Enlargement of the sex organs d. Alteration in nutrition e. Increased risk for infection

ANS: A, E Delayed immunization and greater risk for infection are concerns relative to long-term prednisone therapy.

Which physical assessment technique will the nurse omit when caring for a 2-year-old child diagnosed with Wilms' tumor? a. Performing range-of-motion exercises on lower extremities b. Palpating the abdomen c. Assessing for bowel sounds d. Percussing ankle and knee reflexes

ANS: B Palpation of the abdomen could disturb the tumor and cause the malignancy to spread.

What is an appropriate intervention for the edematous child with reduced mobility related to nephrotic syndrome? a. Reach the child to minimize body movements. b. Change the child's position frequently. c. Keep the head of the child's bed flat. d. Keep edematous areas moist and covered.

ANS: B The child should be turned frequently to prevent respiratory tract infection and to prevent pressure on delicate skin.

What is an initial sign of nephrosis that the nurse might note in a child? a. Raspberry-like rash b. Periorbital edema c. Temperature elevation d. Abdominal pain

ANS: B The edema of nephrotic syndrome is generalized and not readily noticed, even by the parents, but an early sign that can be assessed is periorbital edema.

The nurse is explaining to a 17-year-old female the actions to prevent urinary tract infection. Which is the best beverage for the nurse to recommend to keep urine acidic? a. Milk b. Grape juice c. Apple juice d. Orange juice

ANS: C Juices such as apple or cranberry help maintain acidity of urine.

Which statement made by a parent of a child with nephrotic syndrome indicates an understanding of discharge teaching? a. "I will make sure he gets his measles vaccine as soon as he gets home." b. "He can stop taking his medication next week." c. "I should check his urine for protein when he goes to the bathroom." d. "He should eat a low-protein diet for the next few weeks."

ANS: C The parents should be instructed to keep a daily record of the child's urinary proteins.

An adolescent male is admitted to the ED with severe acute scrotal pain. When documenting medical history the nurse notes cryptorchidism at birth. What diagnosis does the nurse expect? a. Urinary tract infection b. Nephrosis c. Torsion d. Phimosis

ANS: C When one or both testes fail to lower into the scrotum, the condition is termed cryptorchidism. Acute scrotal pain may indicate a testicular torsion (twisting), which necessitates immediate surgery to preserve testicular function.

Diuresis has not occurred on a child with nephrotic syndrome after a month on corticosteroids. What protocol can the nurse encourage to bring about diuresis? a. Ibuprofen, an anti-inflammatory agent b. Furosemide (Lasix), a diuretic c. Ciprofloxacin (Cipro), an antibiotic d. Cyclophosphamide (Cytoxan), an antisuppressant

ANS: D A potent antisuppressant such as Cytoxan can bring about diuresis when corticosteroids have proven ineffective.

Which urinary diversion procedure is the least damaging to the body image of the adolescent? a. Urostomy b. Ileal conduit c. Nephrostomy d. Suprapubic placement

ANS: B The ileal conduit diverts urine to the colon, and the urine is excreted with the feces. There is no external appliance, as is needed with the other diversion methods.

When asked about correcting the hypospadias of a newborn, what does the nurse explain about this condition? a. No intervention is necessary as the defect will correct itself over time. b. Surgical repair of the hypospadias is done before 18 months of age. c. Corrective surgery is usually delayed until the preschool age. d. Repairing the defect will increase the risk of testicular cancer.

ANS: B Treatment of hypospadias consists of surgical repair and is usually performed before 18 months of age.

What will the nurse caring for a newborn with exstrophy of the bladder include in the care? (Select all that apply.) a. Diaper infant tightly. b. Protect skin around bladder. c. Position infant on back. d. Prepare for surgical closure. e. Cover exposed bladder with shield.

ANS: B, C, D, E The infant is kept on his back or side with special attention to the skin around the exposed bladder, which is constantly bathed with urine. These infants are diapered loosely, if at all. Surgical closure is done as quickly as possible.

A parent tells the nurse that her child is scheduled for an x-ray of the bladder and urethra that is done while the child is urinating. What is this test known as? a. Cystometrogram b. Cystoscopy c. Voiding cystourethrogram d. Intravenous pyelogram

ANS: C An x-ray examination of the bladder and urethra before and during micturition is called a voiding cystourethrogram

Parents are speaking with the urologist about their son's undescended testicle. Which statement by the child's father causes the nurse to determine he understands the information presented? a. "An undescended testicle can reduce fertility." b. "The testicle usually descends spontaneously during the first month of life." c. "Surgical correction reduces the risk for testicular tumors." d. "The optimal time to surgically correct the condition is at diagnosis."

ANS: A Although orchiopexy improves the condition, the fertility rate among patients may be reduced even when only one testis is undescended.

What is it important to assess in a child receiving prednisone to treat nephrotic syndrome? a. Infection b. Urinary retention c. Easy bruising d. Hypoglycemia

ANS: A Prednisone depresses the immune response and increases susceptibility to infection. Because steroids mask signs of infection, the child must be assessed for more subtle symptoms of illness.

A 7-year-old child has a BUN of 25 mg/dL. What is the nurse aware this lab value might indicate? (Select all that apply.) a. Dehydration b. Renal disease c. Need for steroid therapy d. Diabetes e. Pituitary malfunction

ANS: A, B, C Increased BUN can indicate dehydration, renal disease, and/or need for steroid therapy.

The 6-year-old child scheduled for an orchiopexy shyly asks the nurse, "What are they going to do to me 'down there'?" What is the nurse's best response? a. "They are going to fix you up 'down there'." b. "They will move your testicle from your abdomen to your scrotum." c. "What do you think your doctor is going to do?" d. "You shouldn't worry. Your doctor knows exactly what to do."

ANS: C Encourage the patient to talk about what he knows and what feelings he has about the surgery. School-age children have a fear of bodily harm.

During a physical assessment of a hospitalized 5-year-old child, the nurse notes that the foreskin has been retracted and is very tight on the shaft of the penis; the nurse is unable to return it over the head of the penis. What action should the nurse implement? a. Forcibly push the foreskin down over the head of the penis. b. Place a warm compress on the penis. c. Notify the charge nurse. d. Wait a few hours and try again.

ANS: C Notify the charge nurse of this occurrence of paraphimosis. The tight foreskin can impede blood flow to the penis; this should be remedied immediately.

The parents of a newborn are concerned that their son's scrotum is enlarged and swollen on one side. What is the nurse's best response? a. "It is very common in the newborn that one gonad is larger than the other." b. "Birth trauma caused bruising to the scrotum. It will reduce in size in a few days." c. "It is a collection of fluid that will most likely correct itself in a year." d. "The doctor will drain this collection of blood before your baby is discharged."

ANS: C These signs are indicative of a hydrocele, a collection of fluid in the scrotum that usually corrects itself in a year.

A 5-year-old boy is admitted to the hospital with acute glomerulonephritis. In taking the child's history, what does the nurse recognize as the probable cause? a. Recovery from German measles 2 months ago b. Dysuria since the previous night c. A history of allergy d. A sore throat 2 weeks ago

ANS: D Acute glomerulonephritis develops from 1 to 3 weeks after a streptococcal infection, which causes an allergic-type response that alters the effectiveness of the glomeruli.

The nurse is providing information to parents of a child born with bilateral cryptorchidism. What information is accurate to include? a. This is the most common form. b. Fertility will be unaffected. c. Surgical intervention is not recommended. d. An inguinal hernia may be present.

ANS: D When one or both testes fail to lower into the scrotum, the condition is termed cryptorchidism. The unilateral form is more common. Because the testes are warmer in the abdomen than in the scrotum, the sperm cells begin to deteriorate. If both testes are affected, sterility results. Inguinal hernia often accompanies this condition. Occasionally, a testis or the testes spontaneously descend during the first year of life. An operation called an orchiopexy may be performed.