NCLEX - PN Pediatrics Renal & Urinary

The nurse is assisting with preparing a plan of care for a 4-year-old child hospitalized with nephrotic syndrome. Which intervention is most appropriate for this child? 1.Provide a high-salt diet. 2.Provide a high-protein diet. 3.Discourage visitors at mealtimes. 4.Encourage the child to eat in the playroom.

4.Encourage the child to eat in the playroom. Mealtimes should center on pleasurable socialization. The child should be encouraged to eat meals with other children on the unit. A diet that is normal in protein with a sodium restriction is normally prescribed for a child with nephrotic syndrome. Parents or other family members should be encouraged to be present at mealtimes with a hospitalized child.

The nurse is assigned to care for an infant with cryptorchidism. One testis cannot be palpated. The nurse anticipates that which diagnostic study will be prescribed to determine where the undescended testis is located in the body? 1.Cystocopy 2.Abdominal x-ray 3.Urodynamic study 4.Computed tomography scan

4.Computed tomography scan If the testis is not palpable, an ultrasonography, computed tomography scan, or magnetic resonance imaging can determine its location. The missing testis may be found at any point along the process vaginalis, may be located in the abdomen, or may follow an aberrant course and come to lie in the inguinal area, base of the penis, or perineum. A cystoscopy is an examination of the bladder and lower urinary tract. An abdominal x-ray would not show the presence of the testis in the abdominal cavity. A urodynamic study is done to determine voiding dysfunction and an abnormal urinary tract.

The nurse is assisting in planning discharge instructions to the mother of a child following orchiopexy, which was performed on an outpatient basis. Which is the priority in the plan of care? 1.Wound care 2.Pain control measures 3.Measurement of intake 4.Cold and heat applications

1.Wound care The most common complications associated with orchiopexy are bleeding and infection. Discharge instruction should include demonstration of proper wound cleansing and dressing and teaching parents to identify signs of infection such as redness, warmth, swelling, or discharge. Testicles will be held in a position to prevent movement, and great care should be taken to prevent contamination of the suture line. Analgesics may be prescribed but are not the priority, considering the options presented. Option 2 is not necessary. Option 4 is not a prescribed treatment measure

A child is seen in the clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. The mother asks the nurse about the diagnosis. Which should the nurse relay to the mother about primary nocturnal enuresis? 1.Primary nocturnal enuresis does not respond to treatment. 2.Primary nocturnal enuresis is caused by a psychiatric problem. 3.Primary nocturnal enuresis requires surgical intervention to improve the problem. 4.Primary nocturnal enuresis is common, and most children will outgrow bed-wetting without therapeutic intervention.

4.Primary nocturnal enuresis is common, and most children will outgrow bed-wetting without therapeutic intervention. HomeHelpCalculator Study Mode Question 19 of 33 ID: 1232 | file: Pediatric PreviousGoNext StopBookmark Rationale Strategy Reference Submit A child is seen in the clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. The mother asks the nurse about the diagnosis. Which should the nurse relay to the mother about primary nocturnal enuresis? Rationale:Primary nocturnal enuresis is bed-wetting and is described as occurring in a child that has never been dry at night for extended periods. It is common in children, most of whom will outgrow bed-wetting without therapeutic intervention. The child is not able to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system (CNS). It is not caused by a psychiatric problem. Behavioral conditioning with use of alarms has been used for treatment in the older child with nocturnal enuresis. A device that contains a moisture-sensitive alarm is worn on the child's pajamas. As the child starts to void, the alarm goes off, awakening the child. The alarm system may need to be used consistently over 15 weeks for resolution.

The nurse is administering medications to a 6-year-old child with nephrotic syndrome. To reduce proteinuria, the nurse would expect which medication to be prescribed? 1.Enalapril 2.Prednisone 3.Furosemide 4.Cyclophosphamide

3.Furosemide The child is usually placed on diuretic therapy with furosemide until protein loss is controlled. Enalapril is most commonly used to control hypertension. Corticosteroids, such as prednisone, may be prescribed to decrease inflammation. Corticosteroids also suppress the autoimmune response and stimulate vascular reabsorption of edema. Cyclophosphamide is an alkylating agent.

A 1-year-old child with hypospadias is scheduled for surgery to correct this condition. The nurse is asked to assist in preparing a plan of care for this child. During this developmental time period, which factor should the nurse take into account? 1.Sibling rivalry will cause regression to occur. 2.Fears of separation and mutilation are present. 3.Embarrassment of voiding irregularities is common. 4.Concern over size and function of the penis is present.

2.Fears of separation and mutilation are present. At the age of 1 year, a child's fears of separation and mutilation are present because the child is facing the developmental task of trusting others. As the child gets older, fears about virility and reproductive ability may surface. The question does not provide enough data to determine that siblings exist. Options 3 and 4 may be issues if the child were older.

The nurse is reviewing the record of a child admitted to the hospital with nephrotic syndrome. Which finding should the nurse expect to note documented in the record? 1.Proteinuria 2.Weight loss 3.Increased appetite 4.Hyperalbuminemia

1.Proteinuria The term nephrotic syndrome refers to a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema. The child experiences fatigue, anorexia, increased weight, abdominal pain, and a normal blood pressure.

A male child who had surgery to correct hypospadias is seen in a primary health care provider's office for a well-baby checkup. The nurse provides instructions to the mother, knowing that which long-term complication is associated with hypospadias? 1.Infertility 2.Renal anomalies 3.Erectile dysfunction 4.Decreased urinary output

2.Renal anomalies The nurse should ask the child's parents about the child's kidney function because hypospadias may be associated with renal anomalies. The incorrect options are not associated with a long-term effect of hypospadias.

A parent with a 6-year-old child diagnosed with enuresis discusses with the nurse the measures that are being taken to help her child. Which statement by the parent indicates a need for further teaching? 1."I make sure that my child goes potty before going to bed." 2."I have my child help with changing the wet sheets in the morning." 3."I take away privileges such as TV time when the bed is wet in the morning." 4."I make sure that my child does not have anything to drink 2 hours before bedtime."

3."I take away privileges such as TV time when the bed is wet in the morning." Providing a reward system appropriate for the child is more effective than a punitive system to treat enuresis. Interventions for treatment of enuresis include involving the child in caring for the wet sheets and changing the bed, to assist with the child taking ownership of the problem. Limiting fluid intake at night and encouraging the child to void just before going to bed is another effective intervention.

An infant, weighing 12 kg, is receiving diuretic therapy, and the nurse is closely monitoring the intake and output. Which is the amount of hourly urine output should the nurse expect as adequate? 1.5 to 11 mL/hour 2.12 to 24 mL/hour 3.25 to 30 mL/hour 4.32 to 40 mL/hour

2.12 to 24 mL/hour Normal urinary output for an infant is 1 to 2 mL/kg/hr. Therefore for an infant weighing 12 kg, 12 to 24 mL/hour would be the expected amount as adequate.

A child is admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which findings should the nurse expect to observe? Select all that apply. 1.Ascites 2.Anorexia 3.Weight loss 4.Proteinuria 5.Decreased serum lipids 6.Periorbital and facial edema

1.Ascites 2.Anorexia 4.Proteinuria 6.Periorbital and facial edema Nephrotic syndrome is a kidney disorder that is characterized by massive proteinuria, hypoalbuminemia, periorbital and facial edema, ascites, elevated serum lipids, and anorexia. The urine volume is decreased and the urine is dark and frothy in appearance. The child with this condition gains weight.

The nurse is assisting in developing a plan of care for a child diagnosed with acute glomerulonephritis. The nurse should include which intervention in the plan of care? 1.Encourage limited activity and provide safety measures. 2.Force intake of oral fluids to prevent hypovolemic shock. 3.Catheterize the child to strictly monitor intake and output. 4.Encourage classmates to visit and to keep the child informed of school events.

1.Encourage limited activity and provide safety measures. Activity is limited and most children, because of fatigue, voluntarily restrict their activities during the active phase of the disease. Catheterization may cause a risk of infection. Fluids should not be forced. Visitors should be limited to allow for adequate rest.

The nurse is assisting with gathering admission assessment data on a 2-year-old child who has been diagnosed with nephrotic syndrome. The nurse collects data knowing that which is a common characteristic associated with nephrotic syndrome? 1.Hypotension 2.Generalized edema 3.Increased urinary output 4.Frank, bright red blood in the urine

2.Generalized edema Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, and edema. The urine is dark, foamy, and frothy, but microscopic hematuria may be present. Frank, bright red blood in the urine does not occur. Urine output is decreased and the blood pressure is normal or slightly decreased

The nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which question to the mother should elicit information about the cause of this disease? 1."Has your child had any diarrhea?" 2."Have you noticed any rashes on your child?" 3."Did your child recently complain of a sore throat?" 4."Did your child sustain any injuries to the kidney area?"

3."Did your child recently complain of a sore throat?" Group A beta-hemolytic streptococcal infection is a cause of glomerulonephritis. Often the child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The questions to the mother in options 1, 2, and 4 are unrelated to a diagnosis of glomerulonephritis.

The nurse is assigned to care for a 2-year-old child who has been admitted to the hospital for surgical correction of cryptorchidism. What is the highest priority in the postoperative plan of care for this child? 1.Force oral fluids. 2.Encourage coughing. 3.Test the urine for glucose. 4.Prevent tension on the suture.

4.Prevent tension on the suture. When a child returns from surgery, the testicle is held in position by an internal suture that passes through the testes and scrotum and is attached to the thigh. It is important not to dislodge this suture. Depending on the type of anesthesia used, option 2 may be appropriate but is not the priority in this surgery. Although adequate hydration is important to maintain, fluids should not be forced. Testing urine for glucose is not related to this type of surgery.

The nurse is reviewing the record of a child scheduled for a primary health care provider's visit. Before data collection, the nurse notes documentation that the child has enuresis. Based on this diagnosis, the nurse plans to focus on which factor when collecting data? 1. Bowel function 2. Bladder function 3. Motor development 4. Nutritional status and weight gain

2. Bladder function Enuresis refers to a condition in which the child is unable to control bladder function, although he or she has reached an age at which control of voiding is expected. Nocturnal enuresis, or bed-wetting, is common in children.

The nurse has reinforced discharge instructions to the mother of an 18-month-old child following surgical repair of hypospadias. Which statement by the mother indicates a need for further teaching? 1."I should encourage fluid intake." 2."I should avoid toilet training right now." 3."I should carry my child by straddling the child on my hip." 4."I should use double diapers to hold the surgery site in place."

3."I should carry my child by straddling the child on my hip." Parent teaching following hypospadias repair includes restricting the child from activities that put pressure on the surgical site. Straddling the child on the hip will cause pressure on the surgical site. The parents should be instructed to use double diapers to hold the stent in place and should be instructed how to hold the child during the postoperative period. Fluids should be encouraged to maintain hydration. Toilet training should not be an issue during this stressful period.

The nurse is assigned to care for a child who is suspected of having glomerulonephritis. The nurse reviews the child's record and notes that which findings are associated with the diagnosis of glomerulonephritis? Select all that apply. 1.Headache 2.Hypotension 3.Red-brown urine 4.Periorbital edema 5.Increased urine output 6.A low blood urea nitrogen (BUN) level

1.Headache 3.Red-brown urine 4.Periorbital edema Signs of glomerulonephritis include headache, abdominal or flank pain, gross hematuria resulting in dark, smoky, cola-colored or red-brown urine and periorbital edema or facial edema. Clients are hypertensive and have decreased urine output. BUN levels may be elevated.

The nurse is assisting in developing a plan of care for a 10-year-old child diagnosed with acute glomerulonephritis. Following review of the plan of care, the nurse determines that which intervention is the priority for the child? 1.Promoting bed rest 2.Restricting oral fluids 3.Encouraging visits from friends 4.Allowing the child to play with the other children in the playroom

1.Promoting bed rest ed rest is required during the acute phase, and activity is gradually increased as the condition improves. Providing for quiet play according to the developmental stage of the child is important. Fluids should not be forced or restricted. Visitors should be limited to allow for adequate rest.

The nurse is planning care for a child with hemolytic-uremic syndrome (HUS). The child has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to include which interventions in the care of the child? Select all that apply. 1.Provide adequate nutrition. 2.Restrict fluids, as prescribed. 3.Institute measures to prevent infection. 4.Monitor the arteriovenous (AV) fistula. 5.Administer blood products to treat severe anemia. 6.Anticipate the child will have central nervous system involvement.

1.Provide adequate nutrition. 2.Restrict fluids, as prescribed. 3.Institute measures to prevent infection. 5.Administer blood products to treat severe anemia. 6.Anticipate the child will have central nervous system involvement. HUS is thought to be associated with bacterial toxins, chemicals, and viruses that cause acute kidney injury in children. A child with HUS who is undergoing peritoneal dialysis for the treatment of anuria will be prescribed fluid restrictions. The treatment also involves providing adequate nutrition, preventing infection and anticipating CNS involvement which may include seizure, stupor, and coma. Peritoneal dialysis does not require an AV fistula (only hemodialysis does).

A nurse caring for a 2-month-old febrile infant is asked to collect a urine specimen for a culture and sensitivity. The nurse collects the specimen by performing which action? 1.Catheterizing the infant using the smallest available straight catheter 2.Attaching a urinary collection device to the infant's perineum for collection 3.Place cotton balls in the diaper and then after the infant voids aspirating the urine with a syringe 4.Noting the time of the next expected voiding and preparing to collect the specimen into a cup when the infant voids

1.Catheterizing the infant using the smallest available straight catheter In young infants less than 3 months of age who are febrile, urine specimens should be collected by bladder catheterization with a straight catheter. A urine collection bag would not get a sterile specimen and may take too long. For some types of urine testing, such as specific gravity, ketones, glucose, and protein, the nurse can aspirate urine directly from the cotton balls in the diaper. But would not be appropriate for a culture and sensitivity urine specimen. It is not reasonable to try to identify the time of the next voiding to attempt to collect the specimen

The nurse is preparing a 2-year-old child with suspected nephrotic syndrome for a renal biopsy to confirm the diagnosis. The mother asks the nurse, "Will my child ever look thin again?" The nurse should respond by giving which statement? 1."Do you feel guilty about your child's weight gain?" 2."In most cases, medication and diet will control fluid retention." 3."Wearing loose-fitting clothing should help conceal the extra weight." 4."When children are little, it's expected that they'll look a little chubby."

2."In most cases, medication and diet will control fluid retention." It is important to give the mother information that addresses the issue that is the parent's concern. Most children experience remission with treatment. Options 1 and 3 are nontherapeutic and may add to the mother's guilt. Option 4 does not acknowledge the concern and is a stereotypical response.

A urinalysis has been prescribed for an infant and the nurse plans to collect the specimen. The nurse implements which appropriate method to collect the specimen? 1.Catheterizes the infant, using a No. 5 French Foley 2.Attaches a urinary collection device to the infant's perineum 3.Obtains the specimen from the diaper, using a syringe, after the infant voids 4.Monitors the urinary patterns and prepares to collect the specimen into a cup when the infant voids

2.Attaches a urinary collection device to the infant's perineum Although many methods have been used to collect urine from an infant, the most reliable method is the urine collection device. This device is a plastic bag that has an opening lined with adhesive so that it may be attached to the perineum. Urine for certain tests, such as specific gravity, may be obtained from a diaper. Urinary catheterization is not to be done unless specifically prescribed because of the risk of infection. It is not reasonable to monitor urinary patterns and attempt to collect the specimen in a cup when the infant voids.

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. The nurse reviews the child's record for the laboratory results of the urine test and would most likely expect to note which finding? 1.Hematuria 2.Bacteriuria 3.Glucosuria 4.Proteinuria

2.Bacteriuria Epispadias is a congenital defect that involves the abnormal placement of the urethral orifice of the penis. In clients with this condition, the urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic leads to the easy access of bacterial entry into the urine. Options 1, 3, and 4 are not characteristically noted with this condition.

The nurse is reinforcing discharge instructions to the parent of a 2-year-old child who has had an orchiopexy to correct cryptorchidism. Which statement by the parent indicates a need for further teaching? 1."I'll check his temperature." 2."I'll give him medication so he'll be comfortable." 3."I'll let him decide when to return to his play activities." 4."I'll check his voiding to be sure there are no problems."

3."I'll let him decide when to return to his play activities." All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury. This will prevent dislodging of the suture, which is internal. Normally, 2-year-old children will want to be very active. Therefore, allowing the child to decide when to return to his play activities may prevent healing and cause injury. The parents should be taught to monitor the child's temperature; provide analgesics, as needed; and monitor the urine output

An 18-month-old child is being discharged after surgical repair of hypospadias. Which postoperative nursing care measure should the nurse stress to the parents as they prepare to take this child home? 1.Leave diapers off to allow the site to heal. 2.Avoid tub baths until the stent has been removed. 3.Encourage toilet training to ensure that the flow of urine is normal. 4.Restrict the fluid intake to reduce urinary output for the first few days.

2.Avoid tub baths until the stent has been removed. After hypospadias repair, the parents are instructed to avoid giving the child a tub bath until the stent has been removed to prevent infection. Diapers are placed on the child to prevent the contamination of the surgical site. Toilet training should not be an issue during this stressful period. Fluids should be encouraged to maintain hydration.

The nurse caring for a child with nephrotic syndrome reviews the medication record. The nurse notes that prazosin hydrochloride is prescribed for the child. The nurse determines that this medication has been prescribed to achieve which result? 1.Reduce proteinuria. 2.Control hypertension. 3.Decrease inflammation. 4.Suppress the autoimmune response.

2.Control hypertension. Prazosin hydrochloride may be used to control hypertension. The child also may be placed on diuretic therapy until protein loss is controlled. Corticosteroids, such as prednisone, may be prescribed to decrease inflammation. Corticosteroids also suppress the autoimmune response and stimulate vascular reabsorption of edema. Cyclophosphamide is an alkylating agent.

A 2-year-old child is admitted to the hospital with a diagnosis of nephrotic syndrome. In planning care for this child, which nursing intervention should be of highest priority? 1.Weigh morning and afternoon. 2.Maintain a strict intake and output. 3.Dipstick the urine for protein every 4 hours. 4.Take vital signs with blood pressure every 2 hours.

3.Dipstick the urine for protein every 4 hours. Continuous monitoring of fluid retention and excretion is an important nursing intervention in the care of the child with nephrotic syndrome. Although it is important to maintain a strict intake and output in monitoring fluid retention and excretion, the goal of treatment with this child is to decrease the amount of protein lost in the urine. Because this is the goal, option 3 has the highest priority. Although weight is monitored, it is not necessary to check the weight morning and evening. Taking vital signs with blood pressure is important but is not the priority in this situation and does not have to be monitored every 2 hours.

The nurse assists in preparing a plan of care for the infant with bladder exstrophy. The nurse identifies which immediate problem as the priority for the infant? 1.Infection 2.Elimination 3.Skin disruption 4.Lack of parental understanding

3.Skin disruption In bladder exstrophy, the bladder is exposed and external to the body. The highest priority is skin disruption related to the exposed bladder mucosa. Although the infant needs to be monitored for elimination patterns and kidney function, this is not the priority concern for this condition. Lack of parental understanding related to the diagnosis and treatment of the condition will need to be addressed, but again, is not the priority. Although infection related to the anatomically located defect can be a problem, it is not the immediate one.

The nurse is providing information to the mother of a child with nephrotic syndrome regarding the edematous appearance of the child. Which statement should the nurse make to the mother? 1."Children always look a little bit fat, so don't be concerned." 2."Dress the child in loose-fitting clothing to hide the extra weight." 3."The fluid retention should be controlled by medication and diet." 4."The child will always have this appearance, and preparing the child for the body image change is important."

3."The fluid retention should be controlled by medication and diet." Most children experience remission with treatment and corticosteroids. Diuretics also may be a component of the treatment plan, and a restricted sodium diet is recommended. It is important to give the parent information in a matter-of-fact manner and address the issue that is the parent's concern. Options 1, 2, and 4 are inaccurate and inappropriate statements to the mother.

The child with cryptorchidism is being discharged after orchiopexy, which was performed on an outpatient basis. The nurse should reinforce instructions to the parents about which priority care measure? 1.Measuring intake and output 2.Administering anticholinergics 3.Preventing infection at the surgical site 4.Applying cold, wet compresses to the surgical site

3.Preventing infection at the surgical site The most common complications associated with orchiopexy are bleeding and infection. The parents are instructed in postoperative homecare measures, including the prevention of infection, pain control, and activity restrictions. The measurement of intake and output is not required. Anticholinergics are prescribed for the relief of bladder spasms; they are not necessary after orchiopexy. Cold, wet compresses are not prescribed. The moisture from a wet compress presents a potential for infection

The parents of a newborn have been told that their child was born with bladder exstrophy and the parents ask the nurse about this condition. Which response should the nurse give to the parents about bladder exstrophy? 1."It is a hereditary disorder that occurs in every other generation." 2."It is caused by the use of medications taken by the mother during pregnancy." 3."It is a condition in which the urinary bladder is abnormally located in the pelvic cavity." 4."It is an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall."

4."It is an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall." Bladder exstrophy is a congenital anomaly that is characterized by the extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause is unknown and there is a higher incidence among males. Options 1, 2, and 3 are not characteristics of this disorder.

A nursing instructor is observing a nursing student caring for an infant with a diagnosis of bladder exstrophy. The nursing student provides appropriate care to the infant by performing which action? 1.Covering the bladder with a dry sterile dressing 2.Covering the bladder with a wet-to-dry dressing 3.Applying sterile water soaks to the bladder mucosa 4.Covering the bladder with a nonadhering plastic wrap

4.Covering the bladder with a nonadhering plastic wrap Care should be taken to protect the exposed bladder tissue from drying while allowing drainage of urine. This is best accomplished by covering the bladder with a nonadhering plastic wrap. The use of wet-to-dry dressings should be avoided because this type of dressing adheres to the mucosa and may damage the delicate tissue when removed. Sterile dressings and dressings soaked in solutions can also dry out and damage the mucosa when removed.