Davis Pediatric Success GU Disorders

The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which questions would be appropriate for the nurse to ask to obtain more information? Select all that apply. 1. "Has there been a stressful event in the child ' s life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more fussy, and does your child seem to be in pain when urinating?" 5. "Is your child having difficulties at preschool

1, 2, 3, 4 1. Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. 2. A pattern of enuresis can often be seen in families. 3. Increased thirst and incontinence can be associated with diabetes. 4. Fussiness and incontinence can be associated with UTIs.

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse ' s best responses? Select all that apply. 1. "Your child ' s urine output will increase, and the urine will become less tea-colored." 2. "Your child will have more energy as lab tests become more normal." 3. "Your child ' s appetite will decrease as urine output increases." 4. "Your child ' s laboratory values will become more normal." 5. "Your child ' s weight will increase as the urine becomes less tea-colored."

1, 5 1. When glomerulonephritis is improving, urine output increases, and the urine becomes less tea-colored. These are signs that can be monitored at home by the child ' s parents. 5. The child ' s weight will increase as the urine resumes a more normal color, indicating lab values are returning to normal and the child is better.

Which statement by a parent is most consistent with minimal change nephrotic syndrome (MCNS)? 1. "My child missed 2 days of school last week because of a really bad cold." 2. "After camping last week, my child ' s legs were covered in bug bites." 3. "My child came home from school a week ago because of vomiting and stomach cramps." 4. "We have a pet turtle, but no one washes their hands after playing with the turtle."

1. An upper respiratory infection often precedes MCNS by a few days.

A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? 1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." 2. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." 3. "We will make sure the dressing is loosely applied to increase the toddler ' s comfort." 4. "If we notice any yellow drainage, we will know that everything is healing well."

1. Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system.

A child with hemolytic uremic syndrome (HUS) is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects administration of blood products and what else to be added to the plan of care? 1. Initiation of dialysis. 2. Close observation of the child ' s hemodynamic status. 3. Diuretic therapy to force urinary output. 4. Monitoring of urinary output.

1. Because the child is symptomatic, dialysis is the treatment of choice.

The nurse is caring for a 12-year-old receiving peritoneal dialysis. The nurse notes the return to be cloudy, and the child is complaining of abdominal pain. The child ' s parents ask what the next step will likely be. Which is the nurse ' s best response? 1. "We will probably place antibiotics in the dialysis fl uid before the next dwell time." 2. "Many children experience cloudy returns. We do not usually worry about it." 3. "We will probably give your child some oral antibiotics just to make sure nothing else develops." 4. "The abdominal pain is likely due to the fl uid going in too slowly. We will increase the rate of administration with the next fi ll."

1. Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fl uid.

The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The child ' s parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

1. Fluid status is monitored to ensure adequate urinary output. Assessing blood pressure monitors kidney function.

Which should be included in the plan of care for a child diagnosed with hydronephrosis? 1. Intake and output as well as vital signs should be strictly monitored. 2. Fluids and sodium in the diet should be limited. 3. Steroids should be administered as ordered. 4. Limited contact with other people to avoid infection.

1. Fluid status is monitored to ensure adequate urinary output. Assessing blood pressure monitors kidney function.

Which child is at risk for developing glomerulonephritis? 1. A 3-year-old who had impetigo 1 week ago. 2. A 5-year-old with a history of fi ve UTIs in the previous year. 3. A 6-year-old with new-onset type 1 diabetes. 4. A 10-year-old recovering from viral pneumonia.

1. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis.

A child receiving peritoneal dialysis has not been having adequate volume in the return. The child is currently edematous and hypertensive. Which would the nurse anticipate the health-care provider to do? 1. Increase the glucose concentration of the dialysate. 2. Decrease the glucose concentration of the dialysate. 3. Administer antihypertensives and diuretics but not change the dialysate concentration. 4. Decrease the dwell time of the dialysate.

1. Increasing the concentration of glucose will pull more fl uid into the return.

Which is a care priority for a newborn diagnosed with bladder exstrophy and a malformed pelvis? 1. Change the diaper frequently and assess for skin breakdown. 2. Keep the exposed bladder open in a warm and dry environment to avoid any heat loss. 3. Offer formula for infant growth and fl uid management. 4. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair.

1. Preventing infection from stool contamination and skin breakdown is the top priority of care.

Which would the nurse expect to hear the parents of an infant with an incarcerated hernia report? 1. Acute onset of pain, abdominal distention, and a mass that cannot be reduced. 2. Gradual onset of pain, abdominal distention, and a mass that cannot be reduced. 3. Acute onset of pain, abdominal distention, and a mass that is easily reduced. 4. Gradual onset of pain, abdominal distention, and a mass that is easily reduced.

1. Signs of an incarcerated hernia include an acute onset of pain, abdominal distention, and a mass that cannot be reduced. Other signs are bloody stools, edema of the scrotum, and a history of poor feeding.

Which causes the symptoms in testicular torsion? 1. Twisting of the spermatic cord interrupts the blood supply. 2. Swelling of the scrotal sac leads to testicular displacement. 3. Unmanaged undescended testes cause testicular displacement. 4. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

1. Testicular torsion is caused by an interruption of the blood supply due to twisting of the spermatic cord.

During hemodialysis, the nurse notes that a 10-year-old becomes confused and restless. The child complains of a headache and nausea and has generalized muscle twitching. This can be prevented by which of the following? 1. Slowing the rate of solute removal during dialysis. 2. Ensuring the patient is warm during dialysis. 3. Administering antibiotics before dialysis. 4. Obtaining an accurate weight the night before dialysis.

1. The child is experiencing signs of disequilibrium syndrome, which is caused by free water shifting from intravascular spaces and can be prevented by slowing the rate of dialysis.

Chronic hypertension in the child who has CKD is due to which of the following? 1. Retention of sodium and water. 2. Obstruction of the urinary system. 3. Accumulation of waste products in the body. 4. Generalized metabolic alkalosis.

1. The retention of sodium and water leads to hypertension.

The manifestations of hemolytic uremic syndrome (HUS) are due primarily to which event? 1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia. 2. There is a disturbance of the glomerular basement membrane, allowing large proteins to pass through. 3. The red blood cell changes shape, causing it to obstruct microcirculation. 4. There is a depression in the production of all formed elements of the blood.

1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen.

The nurse is caring for a child due for surgery on a Wilms tumor. The child ' s procedure will consist of which of the following? 1. Only the affected kidney will be removed. 2. Both the affected kidney and the other kidney will be removed in case of recurrence. 3. The mass will be removed from the affected kidney. 4. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done.

1. The treatment of a Wilms tumor involves removal of the affected kidney.

A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? 1. Obtain urinalysis and urine culture. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Send home on an antibiotic. 5. Schedule a VCUG.

1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a renal ultrasound shows scaring or possible refl ux. If the child has a UTI related to bubble baths, constipation, or wiping back to front, a VCUG would not be ordered.

Which causes the clinical manifestations of hydronephrosis? 1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. 2. A structural abnormality causes urine to fl ow too freely through the urinary system, leading to fl uid and electrolyte imbalances. 3. Decreased production of urine in one or both kidneys results in an electrolyte imbalance. 4. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular fi ltration rate.

1. Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death.

Which is true of a Wilms tumor? Select all that apply. 1. It is also referred to as neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a slow-growing tumor. 5. It is associated with a poor prognosis.

2, 3 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies.

Which would the nurse most likely fi nd in the history of a child with hemolytic uremic syndrome (HUS)? Select all that apply. 1. Frequent UTIs and possible vesicoureteral refl ux (VUR). 2. Vomiting and diarrhea before admission. 3. Bee sting and localized edema of the site for 3 days. 4. Previously healthy with no signs of illness. 5. Anorexia and bruising.

2, 5 2. HUS is often preceded by diarrhea that may be caused by E. coli present in undercooked meat. 5. Anorexia and bruising (purura and/ or petechiae) are common clinical manifestations.

A 10-kg toddler is diagnosed with AKI, is afebrile, and has a 24-hour urine output of 110 mL. After calculating daily fl uid maintenance, which would the nurse expect the toddler ' s daily allotment of fl uids to be? 1. Sips of clear fl uids and ice chips only. 2. 350 mL of oral and intravenous fl uids. 3. 1000 mL of oral and intravenous fl uids. 4. 2000 mL of oral and intravenous fl uids.

2. 350 mL is approximately a third of the daily fl uid requirement and is recommended for the child in the oliguric phase of AKI. If the child were febrile, the fl uid intake would be increased.

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse ' s best response? 1. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." 2. "There is blood in your child ' s urine that causes it to be tea-colored." 3. "Your child ' s urine is very concentrated, so it appears to be discolored." 4. "A ketogenic diet often causes the urine to be tea-colored."

2. Blood in the child's urine causes it to be tea-colored.

A child had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago because of postoperative hemorrhage. The parent noted that her child was "swallowing a lot and fi nally began vomiting large amounts of blood." The child ' s vital signs are as follows: T 99.5°F (37.5°C), HR 124, BP 84/48, and RR 26. The nurse knows that this child is at risk for which type of renal problem? 1. CKD due to advanced disease process. 2. Prerenal failure due to dehydration. 3. Primary kidney damage due to a lack of urine fl owing through the system. 4. Postrenal failure due to a hypotensive state.

2. Examples of causes of prerenal failure include dehydration and hemorrhage.

Which protrusion into the groin of a female most likely causes inguinal hernias? 1. Bowel. 2. Fallopian tube. 3. Large thrombus formation. 4. Muscle tissue.

2. Fallopian tube or an ovary is the most common tissue to protrude into the groin in females.

The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due to which of the following? 1. Chemical changes in the composition of albumin. 2. Increased permeability of the glomeruli. 3. Obstruction of the capillaries of the glomeruli. 4. Loss of the kidneys ' ability to excrete waste and concentrate urine.

2. Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine.

The nurse is providing discharge instructions to the parents of an infant born with bladder exstrophy who had a continent urinary reservoir placed. Which statement should be included? 1. "Allow your child to sleep on the abdomen to provide comfort during the immediate post-operative period." 2. "As your child grows, be cautious around playgrounds because the surface could be a health hazard." 3. "As your child grows, be sure to encourage many different foods because it is not likely that food allergies will develop." 4. "Encourage your child ' s development, by having brightly colored objects around, such as balloons."

2. Many children with urological malformations are prone to latex allergies. The surfaces of playgrounds are often made of rubber, which contains latex.

Which best describes the electrolyte imbalance that occurs in CKD? 1. Decreased serum phosphorus and calcium levels. 2. Depletion of phosphorus and calcium stores from the bones. 3. Change in the structure of the bones, causing calcium to remain in the bones. 4. Nutritional needs are poorly met, leading to a decrease in many electrolytes such as calcium and phosphorus.

2. The calcium and phosphorus levels are drawn from the bones in response to low calcium levels.

The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. Which is the nurse ' s best response? 1. "The terms are used interchangeably and mean the same thing." 2. "The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, whereas a hydrocele is a fl uid-fi lled mass in the scrotum." 3. " 'Hydrocele' is the term used when an inguinal hernia occurs in females." 4. "A hydrocele presents in a manner similar to that of an inguinal hernia but causes increased concern because it is often malignant."

2. The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin; a hydrocele is a fluid-filled mass in the scrotum.

Which needs to be present to diagnose hemolytic uremic syndrome (HUS)? 1. Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure. 2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure. 3. Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure. 4. Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure.

2. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure.

The parents overhear the health-care team refer to their child ' s disease as in stage III. The parents ask the nurse what this means. Which is the nurse ' s best response? 1. "The tumor is confi ned to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is poor." 2. "The tumor is confi ned to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is very good." 3. "The tumor has been found in three other organs beyond the peritoneal area; the prognosis is good." 4. "The tumor has spread to other organs beyond the peritoneal area; the prognosis is poor."

2. The tumor is confi ned to the abdomen but has spread to the lymph nodes or peritoneal area. The prognosis is still very good.

The nurse anticipates that the child who has had a kidney removed will have a high level of pain and will require invasive and noninvasive measures for pain relief. The nurse anticipates that the child will have pain because of which of the following? 1. The kidney is removed laparoscopically, and there will be residual pain from accumulated air in the abdomen. 2. There is a postoperative shift of fl uids and organs in the abdominal cavity, leading to increased discomfort. 3. The chemotherapy makes the child more sensitive to pain. 4. The radiation therapy makes the child less sensitive to pain.

2. There is a postoperative shift of fl uids and organs in the abdominal cavity, leading to increased discomfort.

Which fi nding requires immediate attention in a child with glomerulonephritis? 1. Sleeping most of the day and being very "cranky" when awake; blood pressure is 170/90. 2. Urine output is 190 mL in an 8-hour period and is the color of Coca-Cola. 3. Complaining of a severe headache and photophobia. 4. Refusing breakfast and lunch and stating he "just is not hungry."

3. A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention.

Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)? 1. A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats per minute. 2. A 4-year-old female who states, "It hurts when I pee"; she has been urinating every 30 minutes; vital signs are within normal range. 3. An 8-year-old male presenting with a fi nger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. 4. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; oral temperature of 101.5°F (38.6°C).

3. Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time.

A child diagnosed with acute kidney injury (AKI) complains of "not feeling well," having "butterfl ies in the chest," and arms and legs "feeling like Jell-O." The cardiac monitor shows that the QRS complex is wider than it was and that an occasional premature ventricular contraction (PVC) is seen. Which would the nurse expect to administer? 1. An isotonic saline solution with 20 mEq KCl/L. 2. Sodium bicarbonate via slow intravenous push. 3. Calcium gluconate via slow intravenous push. 4. Oral potassium supplements.

3. Calcium gluconate is the drug of choice for cardiac irritability secondary to hyperkalemia.

Which laboratory results besides hematuria are most consistent with hemolytic uremic syndrome (HUS)? 1. Massive proteinuria, elevated blood urea nitrogen and creatinine. 2. Mild proteinuria, decreased blood urea nitrogen and creatinine. 3. Mild proteinuria, increased blood urea nitrogen and creatinine. 4. Massive proteinuria, decreased blood urea nitrogen and creatinine.

3. Hematuria, mild proteinuria, and increased BUN and creatinine are all present in HUS.

The parents of a child hospitalized with minimal change nephrotic syndrome (MCNS) ask why the last blood test revealed elevated lipids. Which is the nurse ' s best response? 1. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated." 2. "It ' s not unusual to see elevated lipids in children because of the dietary habits of today." 3. "Because your child is losing so much protein, the liver is stimulated and makes more lipids." 4. "Your child ' s blood is very concentrated because of the edema, so the lipids are falsely elevated."

3. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver caused by hypoalbuminemia

A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving furosemide (Lasix) twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema? 1. An increase in the amount and frequency of furosemide (Lasix). 2. Addition of a second diuretic, such as mannitol. 3. Administration of intravenous albumin. 4. Elimination of all fl uids and sodium from the child ' s diet.

3. In cases of severe edema, albumin is used to help return the fl uid to the bloodstream from the subcutaneous tissue.

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse ' s best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

The parent of a 7-year-old voices concern over the child ' s continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. Which is the nurse ' s best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very fi rm and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fl uids in the evening and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

3. Limiting the child's fl uids in the evening will help decrease the nocturnal urge to void. Providing positive reinforcement and allowing the child to choose a reward will increase the child ' s sense of control.

Which combination of signs is commonly associated with glomerulonephritis? 1. Massive proteinuria, hematuria, decreased urinary output, and lethargy. 2. Mild proteinuria, increased urinary output, and lethargy. 3. Mild proteinuria, hematuria, decreased urinary output, and lethargy. 4. Massive proteinuria, decreased urinary output, and hypotension.

3. Mild-to-moderate proteinuria, hematuria, decreased urinary output, and lethargy are common fi ndings in glomerulonephritis.

The parent of a child diagnosed with AKI asks the nurse why peritoneal dialysis was selected instead of hemodialysis. Which is the nurse ' s best response? 1. "Hemodialysis is not used in the pediatric population." 2. "Peritoneal dialysis has no complications, so it is a treatment used without hesitation." 3. "Peritoneal dialysis removes fl uid at a slower rate than hemodialysis, so many complications are avoided." 4. "Peritoneal dialysis is much more effi cient than hemodialysis."

3. Peritoneal dialysis removes fl uid at a slower rate that is more easily controlled than that of hemodialysis.

The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take? 1. Notifies the health-care provider because this urine output is too low. 2. Encourages the child to increase oral intake to increase urine output. 3. Records the child ' s urine output in the chart. 4. Administers isotonic fl uid intravenously to help with rehydration.

3. Recording the child ' s urine output in the chart is the appropriate action because the urine output is within the expected range of 0.5-1 mL/kg/hr, or 75-150 mL for the 10-hour period.

An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fi x the chordee as well?" Which is the nurse ' s best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize sexual functioning when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

3. Releasing the chordee surgically is necessary for future sexual function.

A renal transplantation is which of the following? 1. A curative procedure that will free the child from any more treatment modalities. 2. An ideal treatment option for families with a history of dialysis noncompliance. 3. A treatment option that will free the child from dialysis. 4. A treatment option that is very new to the pediatric population.

3. Renal transplantation frees the patient from dialysis

Which would the nurse expect to fi nd on assessment in a child with Wilms tumor? 1. Decreased blood pressure, increased temperature, and a fi rm mass located in one fl ank area. 2. Increased blood pressure, normal temperature, and a fi rm mass located in one fl ank area. 3. Increased blood pressure, normal temperature, and a fi rm mass located on one side of the midline of the abdomen. 4. Decreased blood pressure, normal temperature, and a fi rm mass located on one side or the other of the midline of the abdomen.

3. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child ' s temperature to be affected.

An adolescent woke up complaining of intense pain and swelling of the scrotal area and abdominal pain. He has vomited twice. Which should the nurse suggest? 1. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the emergency room. 2. Bring him to the health-care provider ' s offi ce for evaluation. 3. Take him to the emergency department immediately. 4. Encourage him to rest; apply ice to the scrotal area and go to the emergency department if the pain does not improve.

3. The child is having symptoms of testicular torsion, which is a surgical emergency and needs immediate attention.

The diet for a child with CKD should be high in calories and include: 1. Low protein and all minerals and electrolytes. 2. Low protein and minerals. 3. High protein and calcium and low potassium and phosphorus. 4. High protein, phosphorus, and calcium and low potassium and sodium.

3. The child with CKD needs a diet high in calories, protein, and calcium and low in potassium and phosphorus.

A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs. The parent asks the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. Which is the nurse ' s best response? 1. "I ' m not sure why your child is going for this test. I will check and get back to you." 2. "It sounds like we made a mistake. I will check and get back to you." 3. "The test is done to check to see if the disease has spread to the lungs." 4. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery."

3. The test is done to see if the disease has spread to the lungs.

A 5-year-old is discharged from the hospital following the diagnosis of hemolytic uremic syndrome (HUS). The child has been free of diarrhea for 1 week, and renal function has returned. The parent asks the nurse when the child can return to school. Which is the nurse ' s best response? 1. "Immediately, as your child is no longer contagious." 2. "It would be best to keep your child home for a few more weeks because the immune system is weak, and there could be a relapse of HUS." 3. "Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet." 4. "It would be best to keep your child home to monitor urinary output."

3. Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation.

The parents of a 7-year-old tell the nurse they do not understand the difference between CKD and AKI. Which is the nurse ' s best response? 1. "There really is not much difference because the terms are used interchangeably." 2. "Most children experience AKI. It is highly unusual for a child to experience CKD." 3. "CKD tends to occur suddenly and is irreversible." 4. "AKI is often reversible, whereas CKD results in permanent deterioration of kidney function."

4. AKI is often reversible, whereas CKD results in permanent deterioration of kidney function.

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)? 1. Carefully cleanse the perineum from front to back and apply a self-adhesive urine collection bag to the perineum. 2. Insert an indwelling Foley catheter, obtain the sample, and wait for results. 3. Place a sterile cotton ball in the diaper and immediately obtain the sample with a syringe after the fi rst void. 4. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample.

4. An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained.

One week after kidney transplant, a child complains about abdominal pain, and the parents note that the child has been very fussy. The nurse notes a 10% weight gain as well as elevated BUN and creatinine levels. Which of the following medications would the child most likely be taking? 1. Codeine tablets. 2. Furosemide (Lasix). 3. Polyethylene glycol 3350 (MiraLAX). 4. Corticosteroids.

4. Corticosteroids are considered part of the antirejection regimen that is essential after a kidney transplant.

A parent asks the nurse how to prevent the child from having minimal change nephrotic syndrome (MCNS) again. Which is the nurse ' s best response? 1. "It is very rare for a child to have a relapse after having fully recovered." 2. "Unfortunately, many children have cycles of relapse, and there is very little that can be done to prevent it." 3. "Your child is much less likely to get sick again if sodium is decreased in the diet." 4. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

4. Exposure to infectious illness has been linked to the relapse of minimal change nephrotic syndrome.

Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)? 1. Avoiding constipation has no effect on the occurrence of UTIs. 2. After urinating, always wipe from back to front to prevent fecal contamination. 3. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. 4. Increasing fl uids will help prevent and treat UTIs.

4. Increasing fl uids will help fl ush the bladder of any organisms, encourage urination, and prevent stasis of urine.

In addition to increased blood pressure, which fi ndings would most likely be found in a child with hydronephrosis? 1. Metabolic alkalosis and positive renal ultrasound. 2. Metabolic acidosis and negative renal ultrasound. 3. Metabolic alkalosis and bacterial growth in the urine. 4. Metabolic acidosis, polydipsia, and polyuria.

4. Metabolic acidosis is caused by a reduction in hydrogen ion secretion from the distal nephron. Polydipsia and polyuria occur as the kidney ' s ability to concentrate urine decreases. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction.

Which medication would most likely be included in the postoperative care of a child with repair of bladder exstrophy? 1. Furosemide (Lasix). 2. Mannitol. 3. Meperidine (Demerol). 4. Oxybutynin (Ditropan).

4. Oxybutynin (Ditropan) is used to help control bladder spasms.

The nurse is caring for a 1-year-old diagnosed with AKI. Edema is noted throughout the child ' s body, and the liver is enlarged. The child ' s urine output is less than 0.5 mL/kg/hr, and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is noted to have nasal fl aring and retractions with inspiration. The lung sounds are coarse throughout. Despite receiving oral sodium polystyrene sulfonate (Kayexalate), the child ' s serum potassium continues to rise. Which treatment will provide the most benefi t to the child? 1. Additional rectal sodium polystyrene sulfonate (Kayexalate). 2. Intravenous furosemide (Lasix). 3. Endotracheal intubation and ventilatory assistance. 4. Placement of a Tenckhoff catheter for peritoneal dialysis.

4. Placement of a Tenckhoff catheter for peritoneal dialysis is needed when the child ' s condition deteriorates despite medical treatment.

The bladder capacity of a 3-year-old is approximately how much? 1. 1.5 fl . oz. 2. 3 fl . oz. 3. 4 fl . oz. 4. 5 fl . oz.

4. The capacity of the bladder in fl uid ounces can be estimated by adding 2 to the child ' s age in years.

The nurse evaluates postoperative teaching for repair of testicular torsion as successful when the parent of an adolescent says which the following? 1. "I will encourage him to rest for a few days, but he can return to football practice in a week." 2. "I will keep him in bed for 4 days and let him gradually increase his activity after that." 3. "I will seek therapy as he ages because he is now infertile." 4. "I will make sure he does testicular self-examination monthly."

4. The child and family should be taught the importance of testicular self-examination.

The nurse evaluates the parents ' understanding of the teaching about an inguinal hernia as successful when they say which of the following? 1. "There are no risks associated with waiting to have the hernia reduced; surgery is done for cosmetic reasons." 2. "It is normal to see the bulge in the baby ' s groin decrease with a bowel movement." 3. "We will wait for surgery until the baby is older because narcotics for pain control will be required for several days." 4. "It is normal for the bulge in the baby ' s groin to look smaller when the baby is asleep."

4. The hernia often appears smaller when the child is asleep.

The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" Which is the nurse ' s best response? 1. "Do not be hard on yourself. It ' s easy to overlook something that has probably been growing for months when we see our children on a regular basis." 2. "I understand you must be very upset. Your child would have had a better prognosis had you caught it earlier." 3. "It really takes a trained professional to recognize something like this." 4. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

4. The tumor is fast-growing and could very easily not have been evident a few days earlier.