CAQ: Pediatric GU
A 3-year-old child is hospitalized with nephrotic syndrome. The child has oliguria and generalized edema. What factor does the nurse identify that will have the greatest effect on the child's adjustment to hospitalization? 1 Lack of parental visits 2 Inability to select a variety of foods 3 Response of peers to the edematous appearance 4 Willingness to participate in cooperative play activities
1- Lack of parental visits Hospitalization is traumatic to the preschooler because of separation from significant family members. When parents are unable to visit, the nurse should arrange for daily contact with them by other means such as internet webcam technology. Preschoolers are not interested in food; children with nephrotic syndrome often have decreased appetites. Preschoolers are not concerned about attitudes of peers; it is too early in their social development to have this concern. Massive edema results in easy fatigability and a lack of interest in play.
A toddler who lacks toilet training is admitted to a hospital. What does the nurse need to do when collecting urine samples from the toddler? Select all that apply. 1 Squeeze urine from the diaper. 2 Place a hat under the toilet seat. 3 Convince the child to void in the unfamiliar receptacle. 4 Attach single-use bags over the child's urethral meatus. 5 Use the terms for urination that the child can understand.
4- Attach single-use bags over the child's urethral meatus. 5- Use the terms for urination that the child can understand. The nurse should use special collection devices for infants or toddlers who are not toilet trained. A single-use bag with self-adhering material over the child's urethral meatus can be used in toddlers to collect urine. The nurse needs to use terms for urination such as "pee pee" that the child is able to understand. Urine should not be collected by squeezing urine from the diaper because the results may be inaccurate. A young child is often reluctant to void in unfamiliar receptacles. A potty chair or specimen hat placed under the toilet seat is usually effective for young children rather than toddlers. A young child is often reluctant to void in unfamiliar receptacles. They should not forced to void.
A mother brings her 6-year-old child to the pediatric clinic, stating that the child has not been feeling well, is weak and lethargic, and has a poor appetite, headaches, and smoky-colored urine. What additional information should the nurse obtain that will aid diagnosis? 1 Rash on palms and feet 2 Shoulder and knee pain 3 Recent weight loss of 2 lb (0.9 kg) 4 Strep throat in the past two weeks
4- Strep throat in the past two weeks The smoky urine and the stated symptoms should lead the nurse to suspect glomerulonephritis, which usually occurs after a recent streptococcal infection. A rash on the hands and feet is associated with scarlet fever, not glomerulonephritis. Shoulder and knee pain is associated with rheumatic fever, not glomerulonephritis. Weight loss generally occurs in children who have type 1 diabetes, not in those with glomerulonephritis.
A nurse anticipates that dialysis will be necessary for a 12-year-old child with chronic kidney disease when the child begins to exhibit which symptom? 1 Hypotension 2 Hypokalemia 3 Hypervolemia 4 Hypercalcemia
3 -Hypervolemia Hypervolemia results when the kidneys have failed and are no longer able to maintain homeostasis, the blood pressure is high, and cardiac overload is imminent. Hypertension, not hypotension, is present when kidney failure occurs. Hyperkalemia, not hypokalemia, occurs with kidney failure. Hypocalcemia, not hypercalcemia, is present when kidney failure occurs.
Which between-meal snack should a nurse tell the parents of a preschooler with a urinary tract infection to offer their child? 1 Skim milk 2 Fresh fruit 3 Hard candy 4 Cream soup
1- Skim milk A high-protein, high-carbohydrate snack provides additional nutrients to combat an infection and a fever. Also, fluid helps flush the urinary tract. Fruit does not provide the protein needed for the healing process. Candy provides empty calories. A cream soup is too heavy for a between-meal snack and does not provide the needed protein.
A 6-year-old child is admitted to the pediatric unit with a diagnosis of nephrotic syndrome. What should the plan of care include during the acute phase? 1 Offering a low-protein diet 2 Encouraging fluids every hour 3 Promoting frequent position changes 4 Providing time for active play periods
3- Promoting frequent position changes Severe edema is usually present, and changes of position are necessary to prevent skin breakdown. A high-protein diet should be offered, although there is no evidence that it alters the outcome of the disorder. A low-protein diet is used for children with azotemia resulting from renal failure. Fluids are not encouraged and may even be curtailed during periods of edema. Active play periods are permitted during remission but not during the acute phase; these children tend to self-limit energy expenditure.
The parents of a 14-month-old boy with bilateral cryptorchidism ask the nurse in the pediatric clinic why it is important for him to have surgery before he is 2 years old. Before responding, the nurse takes into consideration the fact that uncorrected cryptorchidism can result in what? 1 Infertility 2 Hydrocele 3 Varicocele 4 Epididymitis
1- Infertility Undescended testes (cryptorchidism) is the failure of the testes to move down the inguinal canal into the scrotum; this migration begins around the 25th to 30th week of gestation. Undescended testes are exposed to body heat that can destroy the sperm-producing ability of the testes, resulting in sterility. A hydrocele is an enlargement of the scrotum with fluid; it is not related to cryptorchidism. A varicocele is a dilation and tortuosity of the scrotal veins; it is not caused by undescended testicles. Inflammation of the epididymis may occur whether or not cryptorchidism is corrected.
The mother of a 5-year-old girl child reports to a nurse that her daughter has a genital discharge and recurrent urinary tract infections. What should the nurse suspect from the mother's statement? 1 The child may be a victim of sexual abuse. 2 The child may be a victim of physical abuse. 3 The child may be a victim of physical neglect. 4 The child may be a victim of emotional neglect.
1- The child may be a victim of sexual abuse. Genital discharge and recurrent urinary tract infections are signs of sexual abuse. Bruises, burns, fractures, or dislocation may indicate physical abuse. Malnutrition and poor hygiene may indicate physical neglect. Enuresis and sleep disorders may indicate emotional neglect.
A nurse is reviewing the laboratory report of an adolescent child with nephrotic syndrome. What does the nurse expect analysis of the child's urine to reveal? 1 High protein level 2 Low specific gravity 3 Numerous red blood cells 4 Several crystalline particles
1-High protein level Protein (albumin) is present in the urine of children with nephrotic syndrome; it is evidence of kidney damage. Proteinuria, combined with oliguria, results in an increased urine specific gravity. Only rarely do red blood cells (RBCs) or RBC casts filter through the glomerular basement membrane. Crystals are not found in the urine of children with nephrotic syndrome.
What should a nurse include in the plan of care for a 9-year-old child with nephrotic syndrome? 1 Providing meticulous skin care 2 Restricting fluids to 4 oz (120 mL) each shift 3 Offering a diet low in carbohydrates and protein 4 Sending blood to the laboratory for typing and crossmatching
1-Providing meticulous skin care Massive edema, typical of nephrotic syndrome, predisposes the child to skin breakdown. The child requires more fluid than 4 oz (120 mL) each shift to maintain hydration. Carbohydrates and proteins are not restricted. Children with nephrotic syndrome usually do not receive blood transfusions.
The nurse is providing discharge instructions to the parents of a child who has undergone surgical correction of hypospadias. What is the priority information for the nurse to include? 1 Ensuring that the child's privacy is maintained 2 Increasing the time that the catheter is clamped 3 Maintaining the surgically implanted tension device 4 Teaching parents how to care for the catheterization system
4- Teaching parents how to care for the catheterization system Parents should know how to empty the urine bag and how to prevent kinking of the tubing. Although the child's privacy is important, the priority is maintaining the flow of urine through the indwelling catheter. The indwelling catheter is never clamped because backup pressure could disturb the suture line. There is no tension device.
A nurse is caring for a 6-year-old child who is admitted to the pediatric unit with recently diagnosed nephrotic syndrome. The parents ask the nurse why their child is retaining so much fluid. What should the nurse consider before telling the parents about the changes in body fluid distribution in language that they can understand? 1 Loss of sodium and water through an impaired basement membrane of the glomerulus results in hypovolemia. 2 Loss of body protein reduces oncotic pressure, and fluid moves from the intravascular to the interstitial space. 3 Hyperproteinemia results in increased oncotic pressure, and fluid moves from the intravascular to interstitial space. 4 Basement membranes of the glomeruli become selectively impermeable to water, and fluid is retained in the tissues.
2- Loss of body protein reduces oncotic pressure, and fluid moves from the intravascular to the interstitial space. The basement membrane of the glomerulus becomes permeable to protein that is lost in the urine; decreased serum protein reduces the oncotic pressure in the capillaries, which normally helps hold fluid within the vascular system. Hypoproteinemia causes decreased oncotic pressure, which results in hypovolemia; sodium and water are retained to counter the hypovolemia. Increased oncotic pressure pulls fluid from the interstitial space into the intravascular compartment; nephrotic syndrome is characterized by hypoproteinemia, and therefore the opposite is true. The basement membrane becomes permeable to protein, not impermeable to water.
The nurse is assessing a newborn and anticipates that the newborn has renal impairment. Which finding supports the nurse's conclusion? 1 The newborn has odorless urine. 2 The newborn has colorless urine. 3 The newborn first voids after 76 hours. 4 The newborn's urine has a specific gravity of 1.020.
3- The newborn first voids after 76 hours. A newborn should void within 24 hours. However, in this case, the newborn first voids after 76 hours, indicating renal impairment. The urine should be colorless and odorless. This indicates that the urine is normal and the child has normal renal function. The normal specific gravity of urine is 1.020.
What should a nurse incorporate into the plan of care for a school-aged child hospitalized with acute glomerulonephritis (AGN)? Select all that apply. 1 Weighing daily 2 Restricting fluids 3 Monitoring intravenous therapy 4 Instituting isolation precautions 5 Checking the blood pressure hourly
1-Weighing daily 2-Restricting fluids Comparing daily weights is an objective measure of fluid balance and response to diuretic therapy. Fluids, as well as sodium, are restricted in the presence of oliguria. Intravenous therapy is not needed unless there is an emergency. Isolation is unnecessary because the illness is not communicable. Although the blood pressure is closely monitored, it need not be taken hourly.
Which finding in the urinalysis of a 5½-year-old child will alert the nurse to consider the possibility of lead-induced kidney damage? 1 Protein 2 Calcium 3 Potassium 4 Phosphate
1- Protein is usually not excreted in urine because it is a large molecule. When found, it indicates kidney disease. Excess calcium is excreted in urine. Potassium is excreted by the kidneys to maintain electrolyte balance. Excess phosphate is excreted in urine.
The urinary output of a 9-year-old child with acute glomerulonephritis decreases to 250 mL/24 hr. A diet low in sodium and potassium is prescribed. What should the nurse encourage the child to have for lunch? 1 Baked chicken, green beans, and lemonade 2 Cream of tomato soup, salami sandwich, and cola 3 Grilled cheese sandwich, sliced tomatoes, and milk 4 Peanut butter and jelly sandwich, celery, and orangeade
1- Baked chicken, green beans, and lemonade The foods in this grouping have the least sodium and potassium. Cream of tomato soup, a salami sandwich, and cola are high in sodium; some colas also have a high potassium content. A grilled cheese sandwich, sliced tomatoes, and milk are high in sodium. Celery is high in sodium; the sodium content is moderately high in bread and peanut butter.
A nurse is caring for a school-aged child with nephrotic syndrome who has massive edema. The nurse teaches the parents about the low-sodium diet that has been ordered. Which food group has the lowest level of sodium compared with the other food groups? 1 Meat 2 Dairy 3 Fresh fruit 4 Fresh vegetables
3- Fresh fruit Fresh fruit has the overall lowest sodium content compared with the other food groups. Meat is higher in sodium than fruit. Dairy products are higher in sodium than fruit is. Fresh vegetables are higher in sodium than fruit is.
A nurse is assessing a toddler with vesicoureteral reflux. What clinical finding does the nurse expect to identify? 1 Dysuria 2 Oliguria 3 Glycosuria 4 Proteinuria
1- Dysuria Discomfort during urination (dysuria) is a symptom of a urinary tract infection (UTI), which is common with vesicoureteral reflux. During voiding, urine is swept up the ureters and then flows back to the bladder, resulting in a residual volume that provides a medium for the development of a UTI. Oliguria, glycosuria, and proteinuria usually do not occur with vesicoureteral reflux.
A 9-year-old child is found to have acute glomerulonephritis after a recent infection. What microorganism should the nurse suspect as the cause of the child's current health problem? 1 Haemophilus 2 Streptococcus 3 Pseudomonas 4 Staphylococcus
2- Streptococcus Acute glomerulonephritis, an immune complex disease, is a reaction that occurs as a sequela of streptococcal infection; it is known as acute poststreptococcal glomerulonephritis. Haemophilus is associated with conjunctivitis and meningitis, not with glomerulonephritis. Pseudomonas is associated with many diseases of human beings but not with glomerulonephritis in children. Staphylococcus is associated with localized suppurating infections, not with glomerulonephritis.
A 7-year-old child must remain quietly in bed while undergoing peritoneal dialysis. What activity is most appropriate for the nurse to plan for this child? 1 Learning to play chess 2 Constructing a model airplane 3 Working multiple-piece puzzles with another child 4 Using a large sponge ball to play catch with a roommate
3- Working multiple-piece puzzles with another child Working puzzles is a quiet activity that will not jeopardize placement of the peritoneal catheter and is appropriate for the child's cognitive level and allows social interaction with a peer. Chess requires cognitive abilities beyond the scope of a 7-year-old child. Although constructing a model airplane is a quiet activity, it is probably too difficult for a 7-year-old to do without help from an adult. Playing catch could result in displacement of the peritoneal catheter.
A nurse is caring for a 6-year-old child with a diagnosis of glomerulonephritis. The child's urine output decreases to less than 100 mL/24 hr, the creatinine clearance is 60 mL/min, and there is an irregular apical pulse. A diagnosis of acute renal failure is made. Blood is drawn for testing. Which serum level requires immediate intervention? 1 Sodium 126 mEq/L (126 mmol/L) 2 Bilirubin 0.3 mg/dL (5.1 mcmol/L) 3 Creatinine 1.3 mg/dL (114.4 mcmol/L) 4 Potassium 6.1 mEq/L (6.1 mmol/L)
4- Potassium 6.1 mEq/L (6.1 mmol/L) A high potassium level can cause cardiac dysrhythmias; the expected range for serum potassium in a child is 3.4 to 4.7 mEq/L (3.4 to 4.7 mmol/L). The expected range for serum sodium is 136 to 146 mEq/L (136 to 146 mmol/L). Hyponatremia is expected with acute renal failure. In a child the expected range for both total and direct bilirubin is 0.2 to 0.8 mg/dL (3.4 to 12.0 mcmol/L); indirect bilirubin is expected to be 0.1 to 1.0 mg/dL (1.7 to 17 mcmol/L). The bilirubin level is not related to renal failure. The expected range for serum creatinine is 0.3 to 0.7 mg/dL (26 to 62 mcmol/L). An increase is expected with acute renal failure.
The parents of a boy with hypospadias with chordee ask a nurse why their child should undergo corrective surgery. What problem that may develop eventually should the nurse discuss with the parents? 1 Renal failure 2 Testicular cancer 3 Testicular torsion 4 Sexual difficulties
4- Sexual difficulties Chordee can affect the child's future reproductive capabilities, which are related to the inability to inseminate directly. Kidney function is not affected by hypospadias with chordee. The incidence of testicular cancer is not increased; nor is the risk for testicular torsion.
A 2-year-old boy born with cryptorchidism is to undergo orchiopexy. What should the nurse tell the parents about the anticipated outcome of this surgery? 1 The urine stream will be directed downward. 2 Damage to the undescended testicle will be prevented. 3 Fluid that has collected in the scrotum will be removed. 4 The fibrous tissue that has caused the penile deformity will be released.
2- Damage to the undescended testicle will be prevented. Cryptorchidism is the failure of one or more testes to descend into the scrotal sac; orchiopexy surgically pulls the testicle downward into the scrotum. Downward direction of the urine is the goal if the child has hypospadias. Removal of scrotal fluid is the goal if the child has a hydrocele. Release of fibrous tissue is the goal if the child has chordee.
A nurse is assessing the condition of a school-aged child with acute glomerulonephritis. What clinical finding does the nurse anticipate? 1 Ketonuria 2 Periorbital edema 3 Increased appetite 4 Decreased blood pressure
2- Periorbital edema The glomerular filtration rate is reduced; this results in sodium retention, protein loss, and fluid accumulation, producing edema that is most noticeable around the eyes. Ketonuria is not a manifestation of glomerulonephritis. Usually the appetite decreases because of general malaise, and the blood pressure is increased because of kidney involvement.
A 9-year-old child is admitted to the pediatric unit with a diagnosis of acute glomerulonephritis. What does the nurse expect the admission urinalysis to reveal? 1 Polyuria 2 Ketonuria 3 Hematuria 4 Bacteriuria
3- Hematuria The urine is cloudy, smoky, or the color of tea because of the presence of erythrocytes and casts from the affected kidney tissue. Oliguria and increased blood pressure occur as a result of kidney impairment. Excessive metabolism of fats does not occur in glomerulonephritis. At this time there is no infection in the urinary tract.
