The Point chapter 43

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? a. Thin gray vaginal discharge with fishy odor b. Irritation of labia and vaginal opening c. Foul yellow-gray discharge d. White cottage cheese-like discharge

d. White cottage cheese-like discharge Rationale:White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene.

Imipramine

•Tricyclic antidepressant •Used to treat bed wetting.

Oxybutynin

Ditropan. Bladder relaxant. It can treat overactive bladder.

When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply. a. Proteinuria b. Intermittent hematuria c. Flank pain d. Abdominal mass e. Foul-smelling urine

B,D Rationale: Intermittent hematuria is a common symptom of hydronephrosis. An abdominal mass may be palpated with hydronephrosis. Foul-smelling urine is associated with obstructive uropathy. Flank pain is associated with obstructive uropathy and vesicoureteral reflux. Proteinuria is associated with nephritic syndrome.

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? a. Venous varicosity detected along the spermatic cord b. Testis cannot be "milked" down inguinal canal c. Fluid detected in scrotal sac d. Testis can briefly be brought into scrotum

b. Testis cannot be "milked" down inguinal canal Rationale: With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present? a. Enlarged inguinal glands b. Swollen testes c. Abdominal mass d. Purulent drainage from the penis

c. Abdominal mass Rationale: An abdominal mass indicates hydronephrosis. Enlarged inguinal glands are not associated with hydronephrosis. Purulent drainage from the penis is not associated with hydronephrosis. Swollen testes are not associated with hydronephrosis.

The nurse is educating the parents of a child requiring renal replacement. The parents express concern because they live in a remote, rural area with no access to pediatric specialty dialysis units. Which would the nurse recommend to the parents? a. In home hemodialysis b. Renal transplant c. Hemodialysis d. Peritoneal dialysis

d. Peritoneal dialysis Rationale:Peritoneal dialysis is performed in the home setting after proper training. Hemodialysis is completed several times a week at a dialysis center. Renal transplant would be a discussion if the child needed a kidney transplant.

The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them.

1) Cuts a hole in the front of the smaller diaper 2) Unfolds both diapers, placing smaller diaper inside larger diaper 3) Places both diapers under the infant 4) Brings the penis and catheter/stent through the hole in the smaller diaper 5) Closes the smaller diaper 6) Closes the larger diaper

The nurse is caring for a child diagnosed with acute post-streptococcal glomerulonephritis. When assessing the child, what findings does the nurse anticipate? Select all that apply. a. Generalized edema b. A recent gastrointestinal infection resulting in severe diarrhea c. Headache d. Weight gain e. Clear, straw colored urine

A,C,D Rationale: Acute post-streptococcal glomerulonephritis often follows a respiratory infection caused by one of the strains of group A beta-hemolytic streptococcus. With kidney function being decreased the nurse expects to assess signs and symptoms such as weight gain from edema and headache. Urine will likely be concentrated causing it to be dark in color.

Desmopressin

ADH agonist, used to treat bedwetting.

21 of 25 The nurse is reviewing the health history of a client suspected of having vesicoureteral reflux. What findings in the health history are consistent with this disorder? Select all that apply. a. Pyuria b. Hematuria c. Flank pain d. Urinary frequency e. History or repeated urinary tract infections.

B,C,D,E Rationale: Vesicoureteral reflux (VUR) is a condition in which urine from the bladder flows back up the ureters. Primary VUR results from a congenital abnormality at the vesicoureteral junction that results in incompetence of the valve. Secondary VUR is related to other structural or functional problems such as neurogenic bladder, bladder dysfunction, or bladder outlet obstruction. Symptoms consistent with this condition include dysuria, urinary frequency, hematuria, back or flank pain, previous urinary tract infections, Pus in the urine is not associated with this condition.

The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply. a. Albumin b. Prednisone c. Oxybutynin d. Desmopressin e. Imipramine

C,D,E Rationale: Medication therapy for treatment of nocturnal enuresis may include oxybutynin, imipramine, and desmopressin. These agents are prescribed only if behavioral and motivational therapies have been ineffective. Prednisone, a corticosteroid, would be ordered to induce remission and promote dieresis in children with nephritic syndrome. Albumin would be used to treat nephritic syndrome.

A child needs to collect urine for 24 hours. The nurse explains to the parents and child that this test assesses glomerular filtration rate and how the kidneys are functioning. What results would be expected in this type of test? a. Creatinine clearance b. Culture and sensitivity c. Red blood cell (RBC) casts d. Casts and bacteria

a. Creatinine clearance Rationale:A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate. Urine is collected and kept on ice for a 24-hour period. During that time a serum creatinine is obtained. The presence of creatinine in the urine is compared with the serum to determine the amount of creatinine clearance. Casts, bacteria, and a culture and sensitivity are used to evaluate for infection and the antibiotics needed to treat the infection. RBCs are used to look for bleeding in the urine.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? a. Risk for infection b, Excess fluid volume c. Activity intolerance d. Imbalanced nutrition less than body requirements

a. Risk for infection When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? a. "She must severely restrict her sodium intake." b. "Let's meet with the dietitian and plan some meals." c. "Here is some written information from the dietitian." d. "She should try to avoid protein."

b. "Let's meet with the dietitian and plan some meals." Rationale: Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.

The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they state that they need to report what to the physician? a. Bleeding that stops without pressure b. The infant does not urinate within 6 to 8 hours c. Appearance of granulation tissue d. Small spots of blood on diaper

b. The infant does not urinate within 6 to 8 hours. Rationale: The parents should immediately notify the physician or nurse practitioner if the infant does not urinate within 6 to 8 hours after the procedure. Small spots of blood on the diaper, bleeding that stops without pressure, and granulation tissue are normal findings.

The nurse is assessing a hospitalized child diagnosed with nephrotic syndrome. What assessment(s) is most important for the nurse to complete to help identify hypoalbuminemia in this child? a. The blood pressure and oxygen saturation b. The heart and lung sounds c. The respiratory rate and heart rate d. The heart rate and blood pressure

d. The heart rate and blood pressure Rationale: In nephrotic syndrome hyperalbuminemia occurs with a loss of protein and albumin in the blood stream. This causes many fluid shifts from the blood stream (intravascular) to the interstitial tissues. The result is edema as the fluid in the interstitial spaces increases. This leaves the intravascular fluid decreased or depleted causing hypovolemia. The best assessment for this condition is to assess the heart rate and the blood pressure. These will indicate hypovolemia from the fluid shifts occurring. The respiratory rate and the work of breathing are assessed for fluid overload in the lungs. The heart sounds and the lungs sounds are assessed for fluid overload, not decreased. Assessing the oxygen saturation is only necessary if there are adventitious lung sounds or increased work of breathing.

The nurse is caring for a child on a pediatric unit who has hemodialysis 3 times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child? a. Cheeseburger, French fries, and lemonade b. Three egg omelet, bacon, and orange juice c. Grilled chicken, half of a banana, and flavored water d. Tomato soup, crackers, and diet soda

c. Grilled chicken, half of a banana, and flavored water Rationale: Since hemodialysis is usually performed only every other day, larger amounts of waste products build up in the child's blood; therefore, the child must follow a stricter diet between hemodialysis treatments, though dietary restrictions are usually lifted while the child is actually undergoing the treatment. Since the kidneys are not functioning, foods high in sodium, protein, and potassium must be avoided.

The nurse is triaging clients as they come in to an express care facility. Which assessment finding is clinically significant for early nephrotic syndrome? a. Sacral edema b. Facial puffiness c. Periorbital edema d. Edema in the hands

c. Periorbital edema Rationale: Periorbital edema and edema in the ankles are the initial presenting symptoms. As the swelling advances, the edema becomes generalized with a pendulous abdomen full of fluid. Edema in the scrotum also appears. Edema in the hands, sacrum and facial puffiness can be a progression of the disease.

The nurse is caring for an infant with grade II vesicoureteral reflux (VUR). The parent is very fearful that the infant will have progressive renal damage. Which response by the nurse would be appropriate? a. "You can expect recurrent urinary tract infections along with progressive renal damage." b. "Your infant will most likely need surgical intervention." c. "This problem must be carefully managed to avoid permanent damage." d. "This condition usually resolves spontaneously with no symptoms."

d. "This condition usually resolves spontaneously with no symptoms." Rationale: Grades I and II VUR usually resolves spontaneously. Grades III to V are generally associated with recurrent urinary tract infections, hydronephrosis, and renal damage. Typically, only grades III to V need surgical intervention.

The nurse is caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis. What would the nurse expect to administer if ordered? a. Ferrous sulfate b. Erythropoietin c. Vitamin D d. Sodium bicarbonate tablets

d. Sodium bicarbonate tablets Rationale: Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth.

The nurse is reviewing the blood urea nitrogen (BUN) results of an assigned client. The test is elevated. What factors may be associated with this result? Select all that apply. a. There may be an infectious process in the child. b. The child has type 1 diabetes mellitus. c. The child's diet contains high levels of protein. d. The child may be dehydrated. e. The child may be experiencing water intoxication.

A,C,D Rationale: Blood urea nitrogen may be elevated with a high-protein diet or dehydration, and may be decreased with overhydration or water intoxication. There is no direct link between this test and the presence of diabetes mellitus. BUN levels may be increased with an infectious process such as glomerulonephritis.

While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication? a. Metabolic acidosis b. Uremia c. Hypocalcemia d. Immunosuppression

b. Uremia Rationale: Uremia may result in depression of the central nervous system leading to symptoms such as headache or coma or gastrointestinal or neuromuscular disturbances. Metabolic acidosis causes lethargy, dull headache, and confusion. Immunosuppression is not involved with end-stage kidney disease. Hypocalcemia is manifested by muscle twitching, or tetany.

The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia? a. Abdominal pain b. The blood pressure c. Pulse rate and rhythm d. Increased muscle tone

c. Pulse rate and rhythm Rationale: Hyperkalemia occurs when the potassium levels rise above normal lab values. Although it may be different for different laboratories a normal potassium range is generally between 3.5 and 5 mmol/L. When the potassium levels rise the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm since potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmias occur or the heart starts to fail.

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? a. Enlarged inguinal glands and fever. b. Hardened and tender epididymitis with edema and erythema of scrotum c. Sudden onset of severe scrotal pain with significant hemorrhagic swelling d. Fever, scrotal swelling, and urethral discharge

c. Sudden onset of severe scrotal pain with significant hemorrhagic swelling Rationale: Testicular torsion is characterized by a testicle that is abnormally attached to the scrotum and twisted. Signs and symptoms include sudden onset of severe scrotal pain with significant hemorrhagic swelling. Enlarged glands and fever point to infection. A hardened and tender epididymis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.

The home care nurse is conducting an in-home visit for a child who had corrective surgery for hypospadias 3 days prior. What would alert the home care nurse to provide additional teaching? a. The parent states, "I cannot wait until I can bath him the tub again...he enjoys it so much." b. The parent expresses relief that the child was not also diagnosed with cryptorchidism at birth. c. The parent indicates the child is fussy, but calms down when held on the parent's hip. d. The parent states, "I have had to buy more diapers since having to double diaper him."

c. The parent indicates the child is fussy, but calms down when held on the parent's hip. Rationale: Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Surgical repair involves a catheter or stent left in place for 3 to 7 days postoperatively. Activities or play that involves straddling (such a being carried on the parent's hip) are discouraged to prevent trauma to the surgical site and catheter or stent. The child should be double diapered to prevent stool from contaminating the catheter or stent and operative site and causing an infection. The child should not be bathed in a tub until the catheter or stent is removed. Cryptorchidism is a common diagnosis along with hypospadias.

The nurse is caring for a 10-year-old child experiencing nocturnal enuresis with no physiologic cause. The child states, "I am embarrassed and I wish I could stop this right now!" How will the nurse respond? a. "You can wear pull-ups to bed and, since they look like underwear, no one will know." b. "You will grow out of this eventually; you just need to be patient." c. "You are not alone. There are almost 5 million people that have enuresis." d. "There are several things we can do to help you achieve this goal."

d. "There are several things we can do to help you achieve this goal." Rationale: The child wants to stop this problem immediately, so the nurse's most therapeutic response is to assure the child that enuresis is indeed solvable. For some children, learning about the high prevalence of the problem may provide consolation. However, this may not alleviate the child's embarrassment and it does not address the desire for solutions. Telling the child that he or she will "grow out of this" downplays the embarrassment and does not address the desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.

A group of nursing students are reviewing the variations in the genitourinary system in children as compared with adults. The students demonstrate understanding of this information when they state: a. A child's kidneys are surrounded by more fat padding than an adult's kidneys. b. The renal system usually reaches functional maturity by age 5 years. c. Glomerular filtration rate is faster in infants than in adults. d. Bladder capacity reaches adult capacity by age 1 year.

d. Bladder capacity reaches adult capacity by age 1 year. Rationale: Bladder capacity is about 30 mL in the newborn and increases to the usual adult capacity of about 270 mL by 1 year of age. Glomerular filtration rate is slower in the infant and young toddler compared with the adult. The renal system usually reaches functional maturity by 2 years of age. The kidneys of a child are less well protected from injury by the ribs and fat padding than they are in the adult.