RNSG-1412 Pedi Genitourinary Renal and Urinary

Which is a priority problem for a child with severe edema caused from nephrotic syndrome? A. Risk for constipation B. Risk for skin breakdown C. Inability to regulate body temperature D. Consumption of more calories or nutrients than the body requires

B Rationale:Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia (hypoproteinemia), and edema. A child with edema from nephrotic syndrome is at high risk for skin breakdown. Skin surfaces need to be cleaned and separated with clothing to prevent irritation and resultant skin breakdown. The child will be anorexic, so "taking in more calories or nutrients than the body requires" is not a concern. A risk for constipation or inability to regulate body temperature is not a concern with nephrotic syndrome.

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse would plan which intervention? A.Cover the bladder with petroleum jelly gauze. B. Cover the bladder with a nonadhering plastic wrap. C. Apply sterile distilled water dressings over the bladder mucosa. D.Keep the bladder tissue dry by covering it with dry sterile gauze.

B Rationale:In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The use of petroleum jelly gauze needs to be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucosa when removed.

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which would the nurse most likely expect to note? A. Hematuria B. Glucosuria C. Bacteriuria D. Proteinuria

C Rationale:Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic facilitates entry of bacteria into the urine. Hematuria, proteinuria, and glucosuria are not characteristically noted in this condition.

A 4-year-old child with acute glomerulonephritis is admitted to the hospital. The nurse identifies which client problem in the plan of care as the priority? A. Infection related to hypertension B. Injury related to loss of blood in urine C. Excessive fluid volume related to decreased plasma filtration D. Retarded growth and development related to a chronic disease

C Rationale:Glomerulonephritis is a term that refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. The child with acute glomerulonephritis will have an excessive accumulation of water and retention of sodium, leading to circulatory congestion and edema. Excessive fluid volume would be a focus for this disease process. No risk for infection is associated with this disease; it is a postinfectious process, usually from a pneumococcal, streptococcal, or viral infection. Hematuria is present, but the loss of blood is not enough to constitute a risk for injury. The disease is acute as opposed to chronic, and almost all children recover completely.

The nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which question to the mother would elicit data associated with the cause of this disease? A. "Has your child had any nausea or diarrhea? B. Have you noticed any rashes on your child? C. Did your child recently complain of a sore throat? D. "Did your child sustain any injuries to the kidney area?"

C Rationale: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 the remaining options are unrelated to a diagnosis of glomerulonephritis.

The nurse has provided discharge instructions to the parents of a 2-year-old child who underwent an orchiopexy to correct cryptorchidism. Which statement by the parents indicates that further teaching is necessary? A."I'll check my child's temperature. B. I'll give my child medication so that my child will be comfortable. C. I'll check my child's voiding to be sure there's no problem. D. I'll let my child decide when to return to play activities."

D Cryptorchidism is a condition in which one or both testes fail to descend through the inguinal canal into the scrotal sac. Surgical correction may be necessary. All vigorous activities would be restricted for 2 weeks after surgery to promote healing and prevent injury. This prevents dislodging of the suture, which is internal. Normally, 2-year-olds want to be active; allowing the child to decide when to return to play activities may prevent healing and cause injury. The parents need to be taught to monitor the temperature, provide analgesics as needed, and monitor the urine output.

The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan? A. "Caution needs to be used when straddling the infant on a hip. B. Vital signs need to be taken daily to check for bladder infection. C. Catheterization will be necessary when the infant does not void. D. Circumcision has been delayed to save tissue for surgical repair."

D Rationale:Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant would not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. Options 1, 2, and 3 are unrelated to this disorder.

A 7-year-old child is seen in a clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. The nurse would provide which information to the parents? A. Primary nocturnal enuresis does not respond to treatment. B. Primary nocturnal enuresis is caused by a psychiatric problem. C. Primary nocturnal enuresis requires surgical intervention to improve the problem. D. Primary nocturnal enuresis is usually outgrown without therapeutic intervention.

D Rationale:Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and although in some cases nocturnal enuresis can continue into adolescence and adulthood, most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.

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 explanation, given by the parents, indicates understanding of this condition? A. "It's a hereditary disorder that occurs in every other generation. B. "It is caused by the use of medications taken by the parent during pregnancy. C. "It is a condition in which the urinary bladder is abnormally located in the pelvic cavity. D. "It's an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall."

D. Rationale:Bladder exstrophy is a congenital anomaly characterized by extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause is not known, and a higher incidence is seen in male newborns. The explanations in the remaining options reflect inaccurate understanding.

Which question would the nurse ask the parents of a child suspected of having glomerulonephritis? A. "Did your child fall off a bike onto the handlebars? B. Has the child had persistent nausea and vomiting? C. Has the child been itching or had a rash anytime in the last week? D. Has the child had a sore throat or a throat infection in the last few weeks?"

D. Rationale:Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a 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 assessment data in options 1, 2, and 3 are unrelated to a diagnosis of glomerulonephritis.

The nurse recognizes that clinical manifestations of nephrotic syndrome include which findings? A. Hematuria, bacteriuria, weight gain B. Gross hematuria, albuminuria, fever C. Hypertension, weight loss, proteinuria D. Massive proteinuria, hypoalbuminemia, edema

D. Rationale:Nephrotic syndrome is a kidney disorder. Clinical manifestations of nephrotic syndrome include edema, proteinuria, hypoalbuminemia, and hypercholesterolemia in the absence of hematuria and hypertension. No fever, bacteriuria, or weight loss would be noted with this syndrome

A 7-year-old child is seen in a clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. Which statement made by the parents indicates understanding of this condition? A. "Primary nocturnal enuresis does not respond to treatment. B. Primary nocturnal enuresis is caused by a psychiatric problem. C. Primary nocturnal enuresis requires surgical intervention to improve the problem." D. Most children outgrow the bed-wetting problem without therapeutic intervention."

D. Rationale:Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.

The nurse is providing discharge instructions to the parents of an infant who underwent surgical repair of bladder exstrophy. The parents ask whether their child will be able to control the bladder as the child gets older. How would the nurse respond? A. "Your child will need catheterization until bladder control is gained. B. "Your child will be able to control the bladder like other children. C. "You need to potty train your child starting at the same time you normally would. D. "Your child will not have a sphincter mechanism for the first 3 to 5 years, so urine will drain freely."

D. Rationale:Bladder exstrophy is a defect in which the infant is born with the bladder on the outside of the body. This defect requires surgical repair, which takes place within the first 1 to 2 days of life. During the next 3 to 5 years, urine drains freely from the urethra as there is no sphincter mechanism. This time period allows the bladder to gain capacity while the child grows. Then, subsequent surgical repair is done to create a sphincter mechanism. Therefore, options 1, 2, and 3 are incorrect.

When collecting the history about a child who presents with signs of glomerulonephritis, the nurse would report which most important finding to the primary health care provider? A. Child fell off a bike onto the handlebars B. Nausea and vomiting for the last 24 hours C. Urticaria and itching for 1 week before diagnosis D. Streptococcal throat infection 2 weeks before diagnosis

D. Rationale:Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a 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 assessment data in the remaining options are unrelated to a diagnosis of glomerulonephritis.

The nurse is reviewing the primary health care provider's prescriptions for a child hospitalized with nephrotic syndrome. Which food would the nurse tell the assistive personnel to remove from the child's food tray? A. Pickle B. Wheat toast C. Baked chicken D. Steamed vegetables

A Rationale:A no-added-salt diet is indicated. High-sodium foods such as pickles, chips, and cured meats need to be avoided. The items in the remaining options can be consumed.

After performing an assessment of an infant with bladder exstrophy, the nurse prepares a plan of care. The nurse identifies which problem as the priority for the infant? A. Urinary incontinence B. Impaired tissue integrity C. Inability to suck and swallow D. Lack of knowledge about the disease (parents)

B Rationale:In bladder exstrophy, the bladder is exposed and external to the body. The highest priority is impaired tissue integrity related to the exposed bladder mucosa. Although the infant needs to be monitored for elimination patterns and kidney function, urinary incontinence is not a concern for this condition, as the infant is not yet toilet trained. Inability to suck and swallow is unrelated to the disorder. Lack of knowledge about the diagnosis and treatment of the condition will need to be addressed but again is not the priority.

The nurse is reviewing the record of a child diagnosed with nephrotic syndrome. The nurse would expect to note which finding documented in the child's record? A. Polyuria B. Weight gain C. Hypotension D. Grossly bloody urine

B Rationale:Massive edema resulting in dramatic weight gain is a characteristic finding in nephrotic syndrome. Urine is dark, foamy, and frothy, but only microscopic hematuria is present; frank bleeding does not occur. Urine output is decreased, and hypertension is likely to be present.

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? A. Hypertension B. Generalized edema C. Increased urinary output D. Frank, bright red blood in the urine

B. Rationale:Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

The nurse is caring for a 7-year-old child with glomerulonephritis and is preparing to discuss the plan of care with the parents. In anticipating this encounter, the nurse recognizes that which is a common reaction of parents to the diagnosis of glomerulonephritis? A. Fear of the complicated treatment regimen B. Anger at the child for requiring hospitalization C. Guilt that they did not seek treatment more quickly D. Depression that the child may not be able to play sports

C Rationale:Guilt is a common reaction of the parents of a child diagnosed with glomerulonephritis. Parents blame themselves for not responding more quickly to the child's initial symptoms, or they may believe they could have prevented the development of glomerular damage. The remaining options may be associated with the parents' reaction to the diagnosis, but they are not common parental reactions.

The parent of a newborn infant with hypospadias asks the nurse why circumcision cannot be performed. Which is the most appropriate response by the nurse? A."Circumcision will cause an infection. B. "Circumcision is not performed in a newborn. C. "Circumcision will cause difficulty with urination. D. "Circumcision has been delayed to save tissue for surgical repair."

D. Rationale:The infant would not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. This defect will most likely be corrected during the first year of life to limit the psychological effects on the child. The remaining options are inaccurate statements.

The nurse is developing a plan of care for a 6-year-old child diagnosed with acute glomerulonephritis. The nurse would include which priority intervention in the plan of care? A. Encourage limited activity and provide safety measures. B. Catheterize the child to monitor intake and output strictly. C. Encourage the child to talk about feelings related to illness. D. Encourage classmates to visit and to keep the child informed of school events.

A. Rationale:Glomerulonephritis is a term that refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. In glomerulonephritis, activity is limited, and most children, because of fatigue, voluntarily restrict their activities during the active phase of the disease. Catheterization may cause infection. A 6-year-old would not be encouraged to talk about feelings related to the illness because the child may not understand the illness. The child would be allowed to express feelings in other ways, such as play. Visitors need to be limited to allow for adequate rest.

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

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

The nurse reviews the record of a child who is suspected to have glomerulonephritis and expects to note which finding that is associated with this diagnosis? A. Hypotension B. Brown-colored urine C. Low urinary specific gravity D. Low blood urea nitrogen level

B. Rationale:Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria resulting in dark, smoky, cola-colored, or brown-colored urine is a classic symptom of glomerulonephritis. Hypertension is also common. Blood urea nitrogen levels may be elevated. A moderately elevated to high urinary specific gravity is associated with glomerulonephritis.

The nurse is caring for an infant with cryptorchidism. The nurse anticipates that the most likely diagnostic study to be prescribed would be the one that assesses which item? A. Babinski reflex B. DNA synthesis C. Urinary function D. Chromosomal analysis

C Rationale:Cryptorchidism (undescended testes) may occur as a result of hormone deficiency, intrinsic abnormality of a testis, or a structural problem. Diagnostic tests for this disorder are performed to assess urinary and kidney function because the kidneys and testes arise from the same germ tissue. Babinski reflex reflects neurological function. Assessing DNA synthesis and a chromosomal analysis are unrelated to this disorder.

The nurse is creating a plan of care for a 10-year-old child diagnosed with acute glomerulonephritis. What is the priority nursing intervention? A. Promoting bed rest B. Restricting oral fluids C. Allowing the child to play D. Encouraging visits from friends

A Rationale:Bed rest is required during the acute phase, and activity is gradually increased as the condition improves. Fluids would not be forced or restricted. Providing for quiet play according to the developmental stage of the child is important. Visitors need to be limited to allow for adequate rest.

A nursing student caring for a 6-month-old infant is asked to collect a sample for urinalysis from the infant. How would the student collect the specimen? A. Catheterizing the infant using the smallest available Foley catheter B. Attaching a urinary collection device to the infant's perineum for collection C. Obtaining the specimen from the diaper by squeezing the diaper after the infant voids D. Noting the time of the next expected voiding and then preparing a specimen cup for the

C Rationale, Strategy, Tip Rationale: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. Urinary catheterization is not to be done unless specifically prescribed because of the risk of infection. Urine for certain tests, such as specific gravity, may be obtained from a diaper by collection of the urine with a syringe. It is not reasonable to try to identify the time of the next voiding to attempt to collect the specimen.