Final Exam: Renal Dysfunction NCLEX Questions

d

A nurse is planning care of a child who has a UTI. Which of the following interventions should the nurse include? a. administer an antidiuretic b. restrict fluids c. evaluate the child's self-esteem d. encourage frequent voiding

a

What is included in the therapeutic management of nephrotic syndrome? a. Corticosteroids b. Long-term diuretics c. Antihypertensive agents d. Fluid and salt restrictions

c

What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)? a. Reduce blood pressure. b. Lower serum protein levels. c. Minimize excretion of urinary protein. d. Increase the ability of tissue to retain fluid.

d

What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome? a. Low specific gravity b. Decreased hemoglobin c. Normal platelet count d. Reduced serum albumin

b

What measure of fluid balance status is most useful in a child with acute glomerulonephritis? a. Proteinuria b. Daily weight c. Specific gravity d. Intake and output

b c d

A nurse is teaching a parent of a child who has a UTI. Which of the following should the nurse include in the teaching? Select all that apply a. wear nylon underpants b. avoid bubble baths c. empty bladder completely with each void d. watch for manifestations of infection e. wipe perineal area back to front

a

A nurse is teaching the parents of a child diagnosed with a UTI secondary to vesicoureteral reflux. How should the nurse explain how the reflux contributes to the infection? a. "it prevents complete emptying of the bladder" b. "it causes urine backflow into the kidney" c. "it results in painful bladder spasms" d. "it causes painful urination"

c

A child with minimal change nephrotic syndrome 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? a. an increase in the amount and frequency of furosemide b. addition of a second diuretic, such as mannitol c. administration of IV albumin d. elimination of all fluids and sodium from the child's diet

a

A 6 month old child is discharged with a urinary stent after a procedure to repair a hypospadias. The nurse should tell the parents to a. avoid tub baths until the stent is removed b. measure output in the urinary bag c. avoid giving fruit juice d. clean the tip of the penis three time a day with soap and water

a

A child had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has bad no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? a. obtain urinalysis and urine culture b. evaluate for renal failure c. admit to the pediatric unit d. send home on an antibiotic

b

A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

b

A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take? a. Check the urine to see if hematuria has increased. b. Obtain the childs blood pressure and notify the health care provider. c. Obtain serum electrolytes and send urinalysis to the laboratory. d. Reassure the child and encourage bed rest until the headache improves.

a b d

A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerular nephritis. Which of the following nursing measures should be considered? Select all that apply a. on examination there is usually a mild to moderate elevated in BP compared with normal values for age, although severe hypertension may be present b. urinalysis during the acute phase characteristically shows hematura, proteinuria, and increased specific gravity c. the primary objective is to reduce the excretion of urinary protein and maintain protein-free urine d. assessment of the child's appearance for signs of cerebral complications is an important function because the severity of the acute phase is variable and unpredictable e. because these children are particularly vulnerable to upper respiratory infection, protect them from contact with infected roommates, family, or visitors

b c e

A nurse is caring for a child who has acute poststreptococcal glomerulonephritis. Which of the following manifestations should the nurse expect? Select all that apply a. pale urine b. periorbital edema c. ill appearance d. decreased creatinine e. hypertension

d

A father brings his 4 week old son to the clinic for a checkup, stating that he believes his son's testicle is missing. Which explanation would be most appropriate? a. "although the testes should have descended by now, it is not a cause for worry" b. "it does appear that one of his testes has not descended. I will palpate his scrotum to check whether both testes are present" c. "the testes are present in the scrotal sac at birth, but surgery can remedy the situation" d. "although the testes normally descend by 1 year of age, I can understand your concern"

c

A girl, age 5 1/2 years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for what condition? a. School phobia b. Glomerulonephritis c. Urinary tract infection (UTI) d. Attention deficit hyperactivity disorder (ADHD)

c

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child? a. Stimulate appetite. b. Detect evidence of edema. c. Minimize risk of infection. d. Promote adherence to the antibiotic regimen.

b c e

A nurse is assessing a child who has a urinary tract infection. Which of the following are manifestations of UTIs? Select all that apply a. night sweats b. swelling of the face c. pallor d. pale-colored urine e. fatigue

a b c e

A nurse is assessing a child who has nephrotic syndrome. Which of the following findings should the nurse expect? Select all that apply a. urine dipstick +2 protein b. edema in the ankles c. hyperlipidemia d. polyuria e. anorexia

b d e

A nurse is assessing an infant who has a suspected UTI. Which of the following are expected findings? Select all that apply a. increase in hunger b. irritability c. decrease in urination d. vomiting e. fever

d

A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurses best response? a. Blood pressure will stabilize. b. Your child will have more energy. c. Urine will be free of protein. d. Urine output will increase.

a

A recent history of which problem should alert the nurse to gather additional information about the possibility of a UTI in a 2 year old child who is exhibiting fever and fussiness? a. abdominal pain b. swollen lymph glands c. skin rash d. back pain

c

A teenage girl has been diagnosed with a UTI. The nurse recognizes the need for teaching when the teenager states a. "I will not take bubble baths" b. "I will drink plenty of water" c. "I can drink coffee" d. "I can drink cranberry juice"

d

A toddler diagnosed with nephrotic syndrome has a fluid volume excess related to fluid accumulation in the tissues. Which measure should the nurse anticipate including in the child's plan of care? a. limit visitors to 2-3 hours a day b. maintain strict bed rest c. test urine specific gravity every shift d. weight the child before breakfast

c

A young child is diagnosed with vesicoureteral reflux. What is a common recurrent complication in a child with this diagnosis? a. Incontinence b. Urinary obstruction c. Recurrent urinary tract infections d. Infarction of renal vessels

b

After teaching the parents about the urethral catheter placed after surgical repair of their son's hypospadias, the nurse determines that the teaching was successful when the mother states that the catheter in her child's penis accomplishes which goal? a. decreases the pain at the surgical site b. keeps the new urethra from closing c. measures his urine correctly d. prevents bladder spasms

c

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 fix the chordee as well?" Which is the nurse's best response? a. "I understand your concern. Parents do not want their children to undergo extra surgery" b. "the chordee repair is done strictly for cosmetic reasons that may affect your son as he ages" c. "the repair is done to optimize sexual functioning when he is older" d. "this is the best time to repair the chordee because he will be having surgery anyway"

d

What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls? a. Avoid public toilet facilities. b. Limit long baths as much as possible. c. Cleanse the perineum with water after voiding. d. Ensure clear liquid intake of 2 L/day.

a b d e

What signs and symptoms are indicative of a urinary tract disorder in the infancy period (1-4 months)? (Select all that apply) a. Pallor b. Poor feeding c. Hypothermia d. Excessive thirst e. Frequent urination

a

Clinical manifestations of nephrotic syndrome include a. hyperlipidemia, hypoalbuminemia, edema, and proteinuria b. hematuria, hypertension, periorbital edema, flank pain c. oliguria, hypolipidemia, and hyperalbuminemia d. hematuria, generalized edema, hypertension, and proteinuria

d

Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what? a. Minimize separation anxiety. b. Prevent urinary complications. c. Increase acceptance of hospitalization. d. Promote development of normal body image.

c

During a clinic visit, the mother of an infant with hydrocele states that the infant's scrotum is smaller now than when he was born. After teaching the mother about the infant's condition, which statement by the mother indicates that teaching has been effective? a. "I guess keeping his bottom up has helped" b. "massaging his groin area is working" c. "it seems like the fluid is being reabsorbed" d. "keeping him quiet and in an infant seat has helped"

d

For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs? a. Appetite increases and blood pressure is normal b. Urinary tract infection is gone and edema subsides c. Generalized edema subsides and blood pressure is normal d. Diuresis occurs as urinary protein excretion diminishes

c

In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information? a. Limit fluids to reduce reflux. b. Give cranberry juice twice a day. c. Have siblings examined for VUR. d. Surgery is indicated to reverse scarring.

c

When assessing an infant with an undescended testis, the nurse should be alert for which symptom? a. abnormal lower extremity reflexes b. a history of frequent emesis c. a bulging in the inguinal area d. poor weight gain

d

Ms. Sanford, age 8 years, has been diagnosed with pyelonephritis. The nurse would expect medical management to include all of the following except a. admission to the hospital with IV antibiotics administered for the first 48 hours b. blood and urine cultures obtained on admission c. urine cultures repeated after therapy d. administration of nitrofurantoin

b

Nursing interventions in caring for the child with acute glomerulonephritis includes a. enforced bed rest b. daily weights c. keeping the child NPO d. a high-sodium diet

d

Shortly after an infant is returned to his room following a hydrocele repair, the infant's parent approaches the nurse in the hall to report that the child's scrotum looks swollen and bruised. Which response by the nurse would be most appropriate? a. "let me see if the surgeon has prescribed aspirin for him. If he did, I will get it right away" b. "can you wait in his room? Then you can ask me any questions when I get there" c. "what you are describing is unusual after this type of surgery. I will let the surgeon know" d. "this is normal after this type of surgery. Let us look at it together just to be sure"

a

The charge nurse is reviewing the laboratory results of a child admitted with nephrotic syndrome with a nurse new to the pediatric unit. The nurse is aware that teaching is required when the new nurse states than an expected finding in nephrotic syndrome is a. hyperalbuminemia b. elevated triglycerides c. elevated cholesterol d. proteinuria

b

The clinical manifestations of minimal change nephrotic syndrome are due to which of the following? a. chemical changes in the composition of albumin b. increased permeability of the glomeruli c. obstruction of the capillaries of the glomeruli d. loss of the kidneys' ability to excrete waste and concentrate urine

c

The diet requirement for minimal-change nephrotic syndrome includes a. water restriction b. low-protein diet in both acute and remission stages c. salt restriction during periods of edema and while on corticosteroid therapy d. high-protein diet during both acute and remission stages

d

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

d

The nurse is asked to obtain a urine specimen from 5 year old Gary Berringer. Which of the following is the correct procedure? a. place a urine bag on Gary to collect the next specimen b. obtain a catheterized specimen c. encourage Gary to drink large volumes of water in an attempt to obtain a specimen d. obtain a midstream specimen, preferable the first morning specimen

a c e

The nurse is caring for a 4 year old girl with a history of frequent UTIs. What should the nurse be aware of before obtaining a urine sample? Select all that apply a. to obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank b. since children who have a UTI will have painful urination, have the child drink a large amount of fluid before obtaining the sample c. the specimen must be fresh, less than 1 hour after voiding with a storage at room temperature or less than 4 hours after voiding with refrigeration d. if a urinalysis obtained by a bag specimen is negative, a specimen still needs to be obtained by catheterization or suprapubic aspiration e. the key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria

c

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

b

The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching? a. My child needs to stay home from school for at least 1 more month. b. I should not add additional salt to any of my childs meals. c. My child will not be able to participate in contact sports while receiving corticosteroid therapy. d. I should measure my childs urine after each void and report the 24-hour amount to the health care provider.

a

The nurse is planning interventions for a school-age child hospitalized with acute poststreptococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include? a. playing a card game with someone the same age b. putting together a puzzle with mother c. playing video games with a 4 year old d. watching a movie with a younger brother

c

The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need? a. Consuming a regular diet b. Increasing protein c. Restricting fluids d. Decreasing calories

c

The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause? a. Poor hygiene b. Constipation c. Urinary stasis d. Congenital anomalies

b

The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss? a. Poor appetite b. Reduction of edema c. Restriction to bed rest d. Increased potassium intake

b

The parents of a neonate with hypospadias and chordee wish to have him circumcised. Which explanation should the nurse incorporate into the discussion with the parents concerning the recommendation to delay circumcision? a. the associated chordee is difficult to remove during circumcision b. the foreskin is used to repair the deformity surgically c. the meatus can become stenosed, leading to urinary obstruction d. the infant is too small to have a circumcision

c

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. What knowledge should influence the nurses reply? a. The antibiotic therapy contributes to labile blood pressure values. b. Hypotension leading to sudden shock can develop at any time. c. Acute hypertension is a concern that requires monitoring. d. Blood pressure fluctuations indicate that the condition has become chronic.

b

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? a. "it is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications" b. "there is blood in your child's urine that causes it to be tea-colored" c. "your child's urine is very concentrated, so its appears to be discolored" d. "a ketogenic diet often causes the urine to be tea-colored"

b

The parent of a toddler with nephrotic syndrome asks the nurse what can be done about the child's swollen eyes. Which measure should the nurse suggest? a. apply cool compresses to the child's eyes b. elevate the head of the child's bed c. apply eyedrops every 8 hours d. limit the child's television watching

c

The parents of a child hospitalzied with minimal change nephrotic syndrome ask why the last blood test reveal elevated lipids. Which is the nurse's best response? a. "if your child has just eaten a fatty meal, the lipids may have been falsely elevated" b. "it's not unusual to see elevated lipids in children because of the dietary habits of today" c. "because your child is losing so much protein, the liver is stimulated and makes more lipids" d. "your child's blood level is very concentrated because of the edema, so the lipids are falsely elevated"

a e

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 a. "your child's urine output will increase, and the urine will become less tea-colored" b. "your child will have more energy as lab tests become more normal" c. "your child's appetite will decrease as urine output increases" d. "your child's laboratory values will become more normal" e. "your child's weight will increase as the urine becomes less tea-colored"

b

The single most important host factor influencing the occurrence of a urinary tract infection is? a. Urethra b. Urinary stasis c. Uric acid d. Urination

b

The toddler with nephrotic syndrome responds to treatment and is ready to go home. When helping the family plan for home care, which instruction should the nurse include in the teaching? a. administer pain medication as needed b. keep the child away from others with an infection c. notify the HCP if there is an increase in the child's urine output d. administer acetaminophen daily

c

Vesicoureteral reflux is closely associated with which of the following? a. acute glomerulonephritis b. nephrotic syndrome c. renal scarring and kidney damage d. high alkaline content in the urine

d

What are the common clinical manifestations of nephrotic syndrome? a. Hematuria, bacteriuria, and weight gain b. Gross hematuria, albuminuria, and fever c. Hypertension, weight loss, and proteinuria d. Proteinuria, hypoalbuminemia, and edema

d e

What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply) a. Soft diet b. High protein c. Fluid restricted d. No salt added at the table e. Restriction of foods high in sodium

d

What do the clinical manifestations of minimal change nephrotic syndrome include? a. Hematuria, bacteriuria, and weight gain b. Gross hematuria, albuminuria, and fever c. Hypertension, weight loss, and proteinuria d. Massive proteinuria, hypoalbuminemia, and edema

b

What factors predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in girls c. Ingestion of highly acidic juices d. Frequent emptying of the bladder

c

When developing the discharge plan for a school age child diagnosed with acute poststreptococcal glomerulonephritis, which instruction should the nurse plan to discuss? a. restrict dietary protein b. monitor pulse rate and rhythm c. prevent respiratory infections d. restrict foods high in potassium

b

When developing the preoperative teaching plan for a 14 month old child with an undescended testis who is scheduled to have surgery, which method is appropriate? a. tell the child that his penis and scrotum will be "fixed" b. explain to the parents how the defect will be corrected c. tell the child that he will not see any incisions after surgery d. use an anatomically correct doll to show the child what will be "fixed"

a b c e f

When observing manifestations of a urinary tract infection in the 24-month old, what might the student nurse expect to see? Select all that apply a. Painful urination b. Poor feedings c. Frequent urination d. Not thirsty e. Fever f. Foul-smelling urine

c

Which combination of signs is commonly associated with glomerulonephritis? a. massive proteinuria, hematuria, decreased urinary output, and lethargy b. mild proteinuria, increased urinary output, and lethargy c. mild proteinuria, hematuria, decreased urinary output, and lethargy d. massive proteinuria, decreased urinary output, and hypotension

c

Which meal would be most appropriate for a 15 year old with glomerulonephritis with severe hypertension? a. egg noodles, hamburger, canned peas, milk b. baked ham and potato, peak, canned carrots, milk c. baked chicken, rice, beans, orange juice d. hot dog on a bun, corn chips, pickle, cookie, milk

b

Which of the following clinical manifestations are associated with acute glomerulonephritis? a. normal blood pressure, generalized edema, oliguria b. periorbital edema, hypertension, dark-colored urine c. fatigue, elevated serum lipid levels, elevated serum protein levels d. temperature elevation, circulatory congestion, normal BUN and creatinine serum levels

b

Which of the following discharge instructions should not be included for the child who is post hypospadias repair and still has a catheter or stent? a. position the urine bag below the waist b. the child is allowed to take a tub bath daily c. an antibacterial ointment may be applied to the penis d. avoid straddle toys, sandboxes, and rough activities

c

Which question should the nurse ask first when obtaining a history from the mother of a 10 year old with a fever, malaise, and swelling around the eyes? a. "has the child had a sore throat recently?" b. "is the child playing with friends as usual?" c. "does the child urinate as much as usual?" d. "is the urine pale in color?"

a

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

a

Which symptom suggests pyelonephritis in a 3 year old? a. flank pain and tenderness b. foul-smelling urine c. dysuria or urgency d. enuresis or daytime incontinence

a

Which would the nurse expect to hear the parents of an infant with an incarcerated hernia report? a. acute onset of pain, abdominal distention, and a mass that cannot be reduced b. gradual onset of pain, abdominal distention, and a mass that cannot be reduced c. acute onset of pain, abdominal distention, and a mass that is easily reduced d. gradual onset of pain, abdominal distention, and a mass that is easily reduced

b

While assessing the penis of a child who has had surgery for repair of a hypospadias, the nurse observes the appearance of the penis. The nurse should report which aspect to the surgeon? a. swollen b. dusky blue at the tip c. somewhat misshapen d. pink

c

While preparing to examine a 6 week old infant's scrotal sac and testes for possible undescended testes, which would be the most important for the nurse to do? a. check the diaper for recent urination b. give the infant a pacifier c. ensure that the room is kept warm d. tap lightly on the left inguinal ring