Chapter 43

A The first dose of muromonab-CD3 can cause fever, chills, chest tightness, wheezing, nausea, and vomiting. Cough and hyperkalemia are associated with angiotensin-converting enzyme inhibitors. Photosensitivity and GI upset are often associated with diuretics. Urinary retention and decreased appetite are associated with imipramine.

1. The nurse is caring for a child who is experiencing an acute renal transplant rejection and is to receive muromonab-CD3. What would the nurse most likely expect to assess after the first dose is administered? A. Fever with chills, chest tightness B. Cough, hyperkalemia C. Photosensitivity, gastrointestinal (GI) upset D. Urinary retention, decreased appetite

B Caffeine is an irritant to the bladder and should be avoided. Liberal fluid intake and cranberry juice should be encouraged. The child should wear cotton underwear to avoid perineal irritation.

10. The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). In educating the parents, the nurse would recommend that the child avoid: A. a liberal fluid intake. B. caffeine. C. cranberry juice. D. cotton underwear.

C Erythropoietin is given to stimulate red blood cell growth. Vitamin D and calcium are used to correct hypocalcemia. Growth hormone is used to stimulate growth in stature. Citric acid and sodium citrate (or sodium bicarbonate tablets) are used to correct acidosis.

11. The mother of a child with end-stage renal disease asks the nurse why her son is getting an injection of erythropoietin. When responding to the mother, the nurse explains that the rationale is: A. to treat low calcium levels. B. to stimulate growth in stature. C. to stimulate red blood cell growth. D. to correct acidosis.

B The child with HUS typically exhibits severe thrombocytopenia (decreased platelets) and leukocytosis. BUN and creatinine are elevated. Hyponatremia, hyperkalemia, metabolic acidosis, and proteinuria also may be noted.

12. A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding? A. Decreased blood urea nitrogen (BUN) and creatinine B. Decreased platelets and leukocytosis C. Hypernatremia and hypokalemia D. Respiratory acidosis and proteinuria

B Hydrocele requires watchful waiting because it will usually resolve spontaneously on its own. Hydrocele is not associated with the development of infertility; a varicocele, if left untreated, can lead to infertility. Immediate surgery is warranted for testicular torsion. Ice packs to the scrotum are helpful in relieving pain associated with epididymitis.

13. After teaching the parents of a child with a hydrocele about this condition, which statement indicates that the teaching was successful? A. "If this gets worse and we don't treat it, our son could become infertile." B. "This condition should gradually go away on its own." C. "The surgeon is going to operate on him immediately." D. "It's going to be difficult putting ice packs on his scrotum."

C With nephrotic syndrome, proteinuria, hyperlipidemia, decreased serum protein levels (hypoproteinemia), and decreased serum albumin levels (hypoalbuminemia) are present. BUN typically becomes elevated.

14. The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find? A. Hyperlipidemia B. Hypoalbuminemia C. Decreased blood urea nitrogen (BUN) D. Hypoproteinemia

C When applying a urine bag, the nurse would first cleanse the perineal area well and pat it dry. If a culture was to be obtained, the nurse would cleanse the genital area with povidone-iodine or according to institutional protocol. Next the nurse would apply benzoin around the scrotum and allow it to dry. Then the nurse would apply the urine bag, making sure that the penis is fully inside the bag, tucking it downward inside the diaper to discourage leaking.

15. The nurse is applying a urine bag to a 15-month-old boy to collect a urine specimen. Which action would the nurse take first? A. Apply benzoin to the scrotal area. B. Tuck the bag downward inside the diaper. C. Pat the perineal area dry after cleaning. D. Apply the narrow portion of the bag on the perineal space.

D Amoxicillin is a penicillin and is not associated with nephrotoxicity leading to renal failure. Vancomycin, gentamicin (an aminoglycoside), and co-trimoxazole (a sulfonamide) are nephrotoxic.

16. A group of students are reviewing information about renal failure in children. The students demonstrate a need for additional teaching when they identify which agent as a potential contributor to renal failure? A. Vancomycin B. Gentamicin C. Co-trimoxazole D. Amoxicillin

B E. coli most commonly causes UTI. Other less common causative organisms include Klebsiella, S. aureus, and Pseudomonas.

17. A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause? A. Klebsiella B. Escherichia coli C. Staphylococcus aureus D. Pseudomonas

C Risk factors associated with obstructive uropathy include prune belly syndrome, chromosome abnormalities, anorectal malformations, and ear defects. The statement about surgery to repair an anal problem suggests an anorectal malformation. Constipation is a risk factor for urinary tract infections. Bedwetting suggests enuresis. A bacterial skin infection is associated with acute glomerulonephritis.

18. A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant? A. "She's been constipated quite a few times." B. "We've noticed that her bed is wet in the morning." C. "She had surgery to repair a problem with her anus." D. "She had a bacterial skin infection about a week ago."

C The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action.

19. A nurse identifies a nursing diagnosis of Impaired urinary elimination related to infection in the urinary tract as manifested by dysuria for a preschooler. When developing the plan of care, what would be most important for the nurse to do first? A. Develop a schedule for bladder emptying. B. Encourage fluid intake. C. Assess usual voiding patterns. D. Monitor intake and output.

B Gross hematuria causes the urine to appear tea, cola, or even dirty green colored. Cloudy urine is typically a sign of infection. Normal urine ranges from moderately yellow to pale or almost clear. Orange-colored urine can occur because of medication.

2. The nurse is visually inspecting a urine specimen from a 12-year-old boy. The nurse documents gross hematuria with a specimen of which color? A. Cloudy yellow B. Cola colored C. Pale to almost clear urine D. Light orange to moderately yellow colored

B In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination. Bladder size does not differ between boys and girls. The kidneys are less well protected in the abdomen, increasing the risk for injury but not UTIs.

20. While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate? A. "Girls have a smaller bladder size than boys do." B. "A girl's urethra is closer to the rectal opening." C. "A girl's urethra is longer than a boy's urethra." D. "Her kidneys are less well protected."

A A vesicostomy refers to a stoma created in the abdominal wall to the bladder. A ureteral stent is a thin catheter temporarily placed in the ureter to drain urine. A continent urinary diversion uses a piece of the intestine to create a bladder that can be catheterized. Bladder augmentation involves the use of a piece of the stomach or intestine to enlarge bladder capacity.

21. A child returns from surgery in which a stoma was created in the abdominal wall to the bladder. The nurse identifies this as a: A. vesicostomy. B. ureteral stent. C. continent urinary diversion. D. bladder augmentation.

B Cystoscopy is an endoscopic visualization of the urethra and bladder. The nurse would instruct the child that she might experience some burning when she voids after the procedure. A full bladder is needed for urodynamic studies. Putting a tube into the bladder describes a catheterization. Putting a thick tight rubber band suggests a tourniquet, which is used to obtain blood specimens.

22. The nurse is preparing an 8-year-old girl for a cystoscopy. Which instruction would be most appropriate to give to the child? A. "You need to make sure that you don't go to the bathroom before the test." B. "You might feel some burning when you go to the bathroom afterward." C. "I'm going to have to put a tube into your bladder to empty it." D. "I have to put a thick tight rubber band around your arm to get a blood specimen."

B C D Normal findings include a round abdomen, positive bowel sounds, dullness over the spleen, and descended testicles. Labial fusion, a distended abdomen, and undescended testicles are abnormal findings.

23. The nurse is assessing a 5-year-old child's genitourinary system. Which findings would the nurse document as normal? Select all that apply. A. Labial fusion B. Round abdomen C. Positive bowel sounds D. Dullness over the spleen E. Undescended testicles

C D E The newborn's foreskin does not normally retract. This may not be possible until later in infancy. If the foreskin does not retract do not force it. If the foreskin is able to be retracted, do so gently. Return the foreskin to place prior to applying the diaper. Soap and water should be used several times per day to clean the penis and perineal area.

24. The nurse is providing instruction to the parents of a newborn boy. The parents have decided not to circumcise the child. What information should be included in the discussion? Select all answers that apply. A. The foreskin should be pulled back for cleaning at least once per day. B. The foreskin should be pulled back gently with each diaper change. C. Clean the penis gently with soap and water. D. If the foreskin is not retractable do not force it. E. When the foreskin is retracted, gently replace it prior to completing diapering.

C Oliguria is the result of acute renal failure associated with HUS. The BUN and creatinine level are indications of kidney function and are elevated with acute renal failure. Hypertension is associated with HUS. Output is decreased with renal failure, as is GFR.

25. The nurse is caring for a client with hemolytic-uremic syndrome (HUS). The cilent is demonstrating oliguria. What does the nurse expect to find when reviewing the client's records? A. A pattern of below-normal blood pressure B. Higher fluid output than fluid intake C. Elevated BUN and creatinine levels D. Increased glomerular filtration rate (GFR)

C The nurse would suspect testicular torsion, which is a surgical emergency that necessitates immediate surgical correction to prevent testicular necrosis and possible gangrene. Therefore, the nurse would notify the health care provider immediately. The nurse would then have the client rate the pain, complete a head-to-toe assessment, and monitor urine output.

26. A 15-year-old client presents to the emergency room reporting an abrupt onset of severe, sudden pain on the right side of the scrotum while playing football. The nurse notes a blue-black swelling of the affected scrotum. Which action will the nurse complete next? A. Complete a head-to-toe assessment B. Have the client rate the pain C. Notify the primary health care provider D. Monitor the client's urine output

B Rationale: Known risk factors include a recent episode of pharyngitis or other streptococcal infection, decreased urine output, rust or cola colored urine, and swelling around the eyes. Edema may occur in the abdomen, face, eyes, feet, ankles, hands, or generally.

27. The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response by the client's parent will the nurse highlight for the primary health care provider as an indicator for this condition? A. "My child's has recently reported urinary frequency." B. "My child just got over a head cold with laryngitis." C. "My child's urine is pale yellow in color." D. "My child's eyes appear sunken to me."

A Many children with nephrotic syndrome develop hypoalbuminemia and require the administration of albumin. Albumin increases the intravascular pressure, causing the movement of fluid from the interstitial space to the intravascular space. As a result, fluid overload can occur. The treatment is to administer furosemide after the albumin infusion is complete. Furosemide is a diuretic that will help excrete the extra fluid from the vascular space, thus preventing fluid overload. Electrolyte imbalances would occur if the low albumin was not treated. The blood pressure and urine output should be assessed during the medication administration to determine renal function.

28. The nurse is administering an IV infusion of albumin to a child with nephrotic syndrome. What is the primary concern for the nurse when administering this medication to the child? A. Fluid overload B. Electrolyte imbalance C. Increased blood pressure D. Urine output

B C D E Acute poststreptococcal glomerulonephritis (APSGN) is an immune process that injures the renal glomeruli. Children come to the healthcare provider with fever, anorexia, headaches and abdominal pain. The focus of care is primarily on fluid volume and managing hypertension.The child would have edema so the nurse should assess thoroughly the lung sounds for crackles, and the work of breathing. Hypertension occurs from the damaged kidneys so the blood pressure should be assessed often and hypertension treated. Assessment of pain is necessary. The pain is abdominal in nature and should be treated appropriately. The urine will have proteinuria and hematuria. It is tea colored from the gross blood in the urine. The level of consciousness is not affected by APSGN.

29. A child is hospitalized with acute poststreptococcal glomerulonephritis. What assessments should the nurse include in the plan of care for this child?? Select all that apply. A. Assess level of consciousness B. Assess pain C. Monitor blood pressure D. Auscultate lung sounds E. Inspect the urine

B The nurse needs to use familiar terms to explain to the child what is needed and to gain cooperation. The most positive approach would be to let the child's mother help rather than demanding that he tinkle right now. Using the terms "urine sample" or "void" is not appropriate for a 4-year-old.

3. The nurse is caring for a 4-year-old with a suspected urinary tract infection. What would be most appropriate to say to the child when obtaining a urine specimen from him? A. "I will need a urine sample." B. "Let your mom help you tinkle in this cup." C. "Please tinkle in this cup right now." D. "Please void in this cup instead of the toilet."

A Hypospadias occurs when the urethral opening is on the ventral side of the penis. It needs to be repaired because the male cannot aim a urinary stream while standing and it causes rectile dysfunction when the child is older. The penile dressing following surgery is usually a compression type to decrease edema and bruising. The easiest way to accomplish this type of dressing is through double diapering. Double diapering also prevents the stool from getting to the penis and surgical site causing an infection. The penis is generally taped to the abdomen to prevent the catheter or stent from casuing stress on the urethral sutures, not to keep the site clean or prevent swelling. Gauze is not used over the surgical site. Double diapering provides a compression dressing and the soiled diaper should be changed with every bowel movement.

30. An infant has undergone a hypospadias repair. What intervention will the nurse teach the parents to keep the site clean and to reduce swelling? A. "It is important to use double diapering to keep stool off the site." B. "The compression dressing should be changed if it becomes soiled." C. "Keep the penis taped to the abdomen so stool cannot get to surgical site." D. "You can use a gauze dressing to cover the urethral stent."

D Double diapering is a method used to protect a child's urethra and stent or catheter after surgery and additionally helps to keep the area clean and free from infection. Keeping the drainage tube taped in an upright position, administering antibiotics, and administering analgesics are also important, but double diapering keeps the area clean and helps prevent infection.

4. The nurse is providing postsurgical care for an infant who has undergone a hypospadias repair. Which action by the nurse would be most important to help keep the area clean while maintaining proper position of the drainage tubing? A. Keeping the drainage tube taped in an upright position B. Administering antibiotics as ordered C. Administering analgesics as prescribed D. Using a double-diapering technique

A At the age of 4, the mother should not assume that the girl will wipe properly. The mother will need to supervise her wiping in order to train her properly. Making sure the child changes her underwear daily, avoiding bubble baths, and supervising her wiping after bowel movements indicate that the mother has understood the instructions.

5. The nurse is caring for a 4-year-old girl with vulvovaginitis. After instructing the girl's mother on how to help prevent subsequent episodes, which statement by the mother indicates a need for additional teaching? A. "She tells me she wipes from front to back." B. "I will make sure she changes her underwear every day." C. "She should avoid bubble baths." D. "I will help supervise her wiping after bowel movements."

A It is important to double-check whether the girl has any allergies. The test is contraindicated in children allergic to shellfish or iodine. Adequate hydration is also important, but the check for allergies is a priority. Only females of reproductive age must be screened for pregnancy. An enema is not necessary at all institutions.

6. A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test? A. Checking with the parents for any allergies B. Ensuring adequate hydration C. Giving the girl an enema D. Screening her for pregnancy

C The parents should be especially alert for signs of infection as cyclosporine is an immunosuppressant drug. Weight gain instead of weight loss, hypertension instead of hypotension, and increased facial hair instead of hair loss are some other potential side effects.

7. A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication? A. Weight loss B. Hypotension C. Signs of infection D. Hair loss

A It is important to introduce the girl to other youngsters with chronic renal conditions so she does not feel so isolated. Adolescents need interaction with peers. Telling the girl that this is a temporary condition, her real friends don't care about her appearance, and she is beautiful in her own way dismisses the girl's concerns and does not offer solutions. Nephrotic syndrome is a chronic condition, so telling her the condition is temporary also is inaccurate.

8. The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A. "Let's put you in touch with some other girls who are also having the same body changes." B. "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C. "Your real friends do not care about your appearance and just want you to get well." D. "You are beautiful in your own way; what matters is what is on the inside."

D The nurse should inform the child that she should feel no discomfort during the test. No fasting is required and no dye is used, so allergies are not a concern. A full bladder is needed for urodynamic studies.

9. An 8-year-old girl is scheduled for a renal ultrasound. What would the nurse include in the plan of care when preparing the child for this test? A. Withholding food and fluids after midnight B. Checking the child for allergies to shellfish C. Ensuring the child has a full bladder D. Informing the child she should feel no discomfort