Chapter 39 - The Child With a Genitourinary Disorder

The nurse is discussing genitourinary conditions with a group of 16-year-old girls. One of the girls says she has heard about girls who have stopped taking birth control pills and now don't have periods. The condition the girl is referring to is which of the following? A) Oliguria B) Amenorrhea C) Pyelonephritis D) Ascites

Ans: B Feedback: Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Ascites is edema in the peritoneal cavity.

The nurse is collecting data on a 6-year-old child admitted with a possible urinary tract infection. Which of the following vital signs might indicate the possibility of an infection? A) Pulse rate 135 bpm B) Pulse oximetry 93% on room air C) Respirations 22 per minute D) Blood Pressure 100/70

Ans: A Feedback: Data to collect regarding the child includes temperature, pulse (be alert for tachycardia) and respiration rates; normal vital signs for a 6-year-old would be a pulse rate of 70 to 115 beats per minute, so this rate shows tachycardia,. The other vital signs are all within normal limits for this age child.

A child who has been diagnosed with minimal change nephrotic syndrome (MCNS) is being discharged after a 3-week hospitalization. Her edema has been greatly reduced and her appetite is beginning to return. Her caregivers have promised to have a family party to celebrate her return. The child has requested the following food for the party. Which of the following foods would the nurse suggest would be appropriate for the diet this child is on? A) Banana splits B) Popcorn C) Potato chips D) Orange soda

Ans: A Feedback: For the child with nephrotic syndrome, the addition of salt is discouraged, and sometimes the child is put on a low sodium diet. In ad dition the child may be placed on a high protein diet. Popcorn, potato chips and orange soda all have higher sodium content than do banana splits. In addition the banana split would have higher protein content.

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTI's). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which of the following statements would be accurate for the nurse to tell this mother? A) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." B) "The position of the urethra in girls makes girls more susceptible than boys to UTI's." C) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." D) "It is unlikely that your daughter is practicing good cleaning habits after she voids."

Ans: A Feedback: Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

The nurse is caring for an 8-year-old hospitalized child with nephrotic syndrome. Which of the following nursing interventions would be appropriate for this child? A) Measure the abdominal girth daily. B) Weigh the child once a week. C) Test the urine for ketones twice a day D) Administer antipyretics as needed.

Ans: A Feedback: Measure the child's abdomen daily at the level of the um bilicus, and make certain that all staff personnel measure at the same level. Weigh the child at the same time every day on the same scale in the same clothing. Test the urine regularly for albumin and specific gravity. Elevated temperature is not an issue with nephrotic syndrome.

The nurse is teaching a group of nursing students about acute glomerulonephritis genitourinary conditions. A student asks the about a condition that occurs when there is a decreased volume of urine output. The condition the student is referring to is which of the following? A) Oliguria B) Amenorrhea C) Pyelonephritis D) Ascites

Ans: A Feedback: Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis. Ascites is edema in the peritoneal cavity.

A 12-year-old girl who has not yet reached menarche comes to the pediatrician's office for her annual well-child check. As the nurse is weighing and measuring her, the child says emphatically that she does not want to get her period. Which of the following responses would be most appropriate for the nurse to make to this child? A) "What have you heard about it that makes you worried?" B) "But it's a good thing, having a period is a part of growing up." C) "Are you afraid of getting pregnant?" D) "Do you think it will hurt?"

Ans: A Feedback: The beginning of menstruation, called menarche, normally occurs between the ages of 9 and 16 years. For many girls this is a joyous affirmation of their womanhood, but others may have negative feelings about the event depending on how they have been prepared for menarche and for their roles as women. The nurse would need to explore the child's understanding of the implications of menarche.

The LPN is working with the RN to develop a plan of care for a child with nephrotic syndrome. Which of the following would be appropriate goals of treatment for this child? (Select all that apply) A) Conserving energy B) Encouraging a high salt diet C) Preventing infection D) Restricting protein intake E) Promoting coping

Ans: A, C, E Feedback: The major goals for the child with nephrotic syndrome are relieving edema, improving nutritional status, maintaining skin integrity, conserving energy, and pre venting infection. The family goals include learning about the disease and treatments, as well as learning ways to cope with the child's long-term care. The child may be on a no-added-salt or low salt diet, but there are usually no food restrictions.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with acute glomerulonephritis. In which of the following age ranges is the peak incidence of this disorder noted? A) 2 to 4 years of age B) 6 to 7 years of age C) 12 to 13 years of age D) 15 to 17 years of age

Ans: B Feedback: Acute glomerulonephritis has a peak incidence in children 6 to 7 years of age and occurs twice as often in boys.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to do which of the following actions? A) Weigh the child in the same clothes she had been weighed in the day before and report the two weighs to the nurse while the nurse is on the phone. B) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. C) Give the child a diuretic and report back to the nurse in a few hours. D) Give the child fluids and report back to the nurse in a few hours.

Ans: B Feedback: Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. When interviewing the caregivers, which of the following questions would be most important for the nurse to ask? A) "Is your child potty trained?" B) "Has your child complained of pain?" C) "How often do you bathe your child?" D) "Do any of your other children have a temperature?"

Ans: B Feedback: Gather information about the current illness: when the fever started and its course thus far, signs of pain or discomfort on voiding, recent change in feeding pattern, presence of vomiting or diarrhea, irritability, lethargy, abdominal pain, unusual odor to urine, chronic diaper rash, and signs of febrile convulsions. Toilet training and bathing habits would be of importance, but they are not the most important to ask. Temperatures in other children in the family would not be related to this child's current situation.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with nephrotic syndrome. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of nephrotic syndrome? A) "These children have such a big appetite and are always hungry." B) "The child may look chubby, but they really are malnourished." C) "When you look at the urine of these children it is smoky and bloody." D) "Their lab work shows a decreased level of cholesterol."

Ans: B Feedback: In children with nephrotic syndrome, malnutrition may become severe. The generalized edema masks the loss of body tissue, causing the child to present a chubby appearance and to double his or her weight. After diuresis, the malnutrition becomes quite apparent. Anorexia, irritability, and loss of appetite develop. Hematuria is not usually present, although a few red blood cells may appear in the urine. There is an increase in the level of cholesterol in the blood.

The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. The nurse tells the caregiver that the most important reason the child needs increased fluids is for which of the following reasons? A) To fill the bladder so a specimen can be obtained. B) To dilute the urine and flush the bladder. C) To prevent the child from developing a fever. D) To decrease the pain of urination.

Ans: B Feedback: Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder. An increase in fluid intake also helps decrease the pain experienced in urination, but this is not the most important reason the child needs increased fluids. Fluids may help decrease the chance of the child developing a fever, but this is not the most important reason fluids are given.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent complains of severe abdominal pain. A diagnosis of pelvic inflammatory disease is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to A) Contact the necessary authorities to report a suspected case of sexual abuse B) Take the child to a private room and interview her regarding her sexual history and partners C) Take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity D) Talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted disease and discuss the importance of safe sex practices

Ans: B Feedback: Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.

The location of the kidneys in the child in relationship to the location of the kidneys in the adult makes which of the following a greater likelihood in the child? A) The adult has less fat to cushion the kidney B) The child has a greater risk for trauma to the kidney C) The child has more frequent urges to empty the bladder. D) The adult has a greater chance of retaining fluids than the child.

Ans: B Feedback: The kidneys in children are located lower in relationship to the ribs than in adults. This placement and the fact that the child has less of a fat cushion around the kidneys cause the child to be at greater risk for trauma to the kidneys. The location of the kidneys does not affect the urges to empty the bladder nor the retaining of fluids.

The nurse is caring for a child admitted with acute glomerulonephritis. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? A) Loose, dark stools B) Smoky colored urine C) Strawberry red tongue D) Jaundiced skin

Ans: B Feedback: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in Hepatitis.

Urinary tract infections are usually successfully treated by which of the following? A) Increasing fluids, such as cranberry juice B) Administering antibiotics C) Performing bladder irrigations D) Administering diuretics

Ans: B Feedback: UTIs may be treated with antibiotics (usually sulfisoxazole or ampicillin) at home. Fluids are encouraged, but they do not treat the infection. Bladder irrigations and diuretics are not used in the treatment of urinary tract infections.

The nurse is discussing urinary tract infections (UTI's) in children with a group of peers. Which of the following is the most accurate regarding urinary tract infection seen in children? A) Urinary tract infections are rarely seen after toilet training. B) The most common age for UTI's in children is 2 to 6 years of age. C) Males between the ages of 10 to 12 years of age commonly get UTI's. D) Girls who have gone through puberty most commonly get UTI's.

Ans: B Feedback: Urinary tract infections (UTIs) are fairly common in the "diaper age," in infancy, and again between the ages of 2 and 6 years. Older school-age and adolescent girls are not as prone to UTI's.

The nurse is caring for a child who is being evaluated for a possible nephroblastoma. Which of the following nursing interventions would be important for this child? The nurse should A) Monitor for protein in the urine at each voiding. B) Protect the child from having the abdomen palpated. C) Check blood pressure every 2 hours. D) Measure the child's intake and output every hour.

Ans: B Feedback: When the child is being evaluated and treated, abdominal palpation should be avoided because cells may break loose and spread the tumor.

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." Of the following statements, which would be the most appropriate response by the nurse? A) "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it." B) "There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." C) "That must be hard on you, especially because you are raising her by yourself." D) "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive."

Ans: B Feedback: Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally oral contraceptive pills are prescribed to prevent ovulation.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also complains of a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100 degrees Fahrenheit. The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have A) A urinary tract infection B) Lipoid nephrosis (idiopathic nephrotic syndrome) C) Acute glomerulonephritis D) Rheumatic fever

Ans: C Feedback: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear one to three weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103 to 104 degrees Fahrenheit at the onset but decreases in a few days to about 100 degrees Fahrenheit. Slight headache and malaise are usual, and vomiting may occur.

Most urinary tract infections seen in children are caused by which of the following? A) Hereditary causes B) Fungal infections C) Intestinal bacteria D) Dietary insufficiencies

Ans: C Feedback: Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections.

The nurse is caring for a child admitted with a urinary tract infection. In addition to foul smelling urine, which of the following clinical manifestations would likely have been noted in the child with this diagnosis? A) Weight gain. B) Decreased urination C) Vomiting D) Increased appetite

Ans: C Feedback: In children, the symptoms or a urinary tract infection may be fever, nausea, vomiting, foul-smelling urine, weight loss, and increased urination. Occasionally there is little or no fever. Vomiting is common, and diarrhea may occur.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. Which of the following would the nurse likely find in this child's history? A) The child has a sibling with the same diagnosis. B) The child had a congenital heart defect. C) The child recently had an ear infection. D) The child is being treated for asthma.

Ans: C Feedback: In the child with acute glomerulonephritis presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.

If the newborn is following a normal development process, the child will most likely void when which of the following amounts of urine is in the bladder? A) 3 mL B) 6 mL C) 15 mL D) 25 mL

Ans: C Feedback: In the newborn, the bladder empties when about 15 mL of urine is present.

A group of nursing students is discussing terminology related to the genitourinary system during a post-conference setting. One of the students asks what mittelschmerz is or what it means. A classmate of this student correctly answers that mittelschmerz is which of the following? A) A symptom of premenstrual syndrome B) The beginning of menstruation C) A dull, aching abdominal pain at ovulation D) A medication given to treat dysmenorrhea

Ans: C Feedback: Mittelschmerz is a dull, aching abdominal pain at the time of ovulation (hence the name, which means "midcycle"). The beginning of menstruation is called menarche. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Nonsteroidal, anti-inflammatory drugs (NSAIDs), such as ibuprofen (advil, motrin) inhibit prostaglandins and are the treatment of choice for primary dysmenorrhea, which is painful menstruation.

A symptom often seen in acute glomerulonephritis is edema. The most common site the edema is first noted is in which area of the body? A) Ankles B) Hands C) Eyes D) Sacrum

Ans: C Feedback: Periorbital edema may accompany or precede hematuria in children with acute glomerulonephritis. Edema in the ankles, hands and sacrum are not noted in acute glomerulonephritis.

The nurse is teaching a group of nursing students about genitourinary conditions. The nurse tells these students about a condition that occurs when there is an inflammation of the kidney and renal pelvis. The condition the nurse is referring to is which of the following? A) Oliguria B) Amenorrhea C) Pyelonephritis D) Ascites

Ans: C Feedback: Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Ascites is edema in the peritoneal cavity.

The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea? A) "It is caused from taking birth control pills when a girl is younger than 13 years old." B) "This disorder is usually seen after a girl has had a spontaneous abortion." C) "Emotional stress can be a cause of this disorder." D) "This is what happens if a 16-year-old girl has never had any periods at all."

Ans: C Feedback: Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.

The caregiver of a 1-year-old son calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which of the following statements regarding the son's treatment? A) "Without the hormone your son will have fluid that will collect in his scrotum." B) "Without the treatment your child's gonads will not reach normal size." C) "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." D) "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do."

Ans: C Feedback: Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processus does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.

The health care provider orders Prenisolone 2 mg/kg/day to be given every 8 hours for a child diagnosed with nephrotic syndrome. The child weighs 42 lb. The medication is available in a solution of 3mg/mL. What is the amount per dosage in mL for this child? A) 1.2 mL B) 3.8 mL C) 4.2 mL D) 12.6 mL

Ans: C Feedback: The child weighs 19 kg. The total daily dose would be 38 mg of medication per day or 12.6 mg per dose. (Every 8 hours would be 3 doses in one day). One dose would be 4.2 mL.

If the child follows a normal development process, the child's kidneys will most likely have reached their full size and function by which of the following ages? A) 5 years of age B) 8 years of age C) 12 years of age D) 17 years of age

Ans: C Feedback: The kidneys reach their full size and function by the time the child is an adolescent.

When caring for a child who has a diagnosis of acute glomerulohephritis which of the following nursing interventions would most likely be included in the child's plan of care. (select all that apply) A) The nurse encourages ambulation several times a day. B) The nurse promotes increased fluid intake. C) The nurse administers diuretics. D) The nurse administers antihypertensives. E) The nurse weighs the child every day using the same scale. F) The nurse dipsticks the child's urine to test for protein.

Ans: C, D, E, F Feedback: Fluid intake and urinary output should be carefully monitored and recorded. Special attention is needed to keep the intake within prescribed limits. The amount of fluid the child is allowed may be based on output, as well as on evidence of continued hypertension and oliguria. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. Weigh the child daily, at the same time, on the same scale, and in the same clothes. The urine must be tested regularly for protein and hematuria using dipstick tests. Bed rest should be maintained until acute symptoms and gross hematuria disappear.

When caring for a child who has a urinary tract infection, which of the following nursing interventions would be most appropriate. (select all that apply) A) The nurse encourages the child to void every 30 minutes. B) The nurse positions the child on a bedpan rather than on the toilet. C) The nurse observes for signs of pain or burning on urination. D) The nurse monitors intake and output. E) The nurse administers pain medications each time the child voids. F) The nurse administers antipyretics as needed.

Ans: C, D, F Feedback: Because of pain and burning on urination, the toilet-trained child may try to hold urine and not void. Encourage the child to void every 3 or 4 hours to prevent recurrent infection. Observe the child for signs of burning and pain when he or she is urinating. Monitor and measure urine output. Antipyretic medications may be ordered to reduce body temperature. A bedpan would not be necessary in most children with a UTI. Pain medications following each voiding would not be indicated.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a one week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out which of the following? A) The child has a urinary tract infection due to not bathing while on the fishing trip B) The child is out of the habit of waking himself up during the night to void C) The child did not want to go on the fishing trip and is now retaliating against being made to go D) The child has been sexually abused, maybe on the fishing trip

Ans: D Feedback: Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse and should be further explored.

The nurse is doing an in-service training with a group of peers on the topic of the genitourinary system. Which of the following is a major function of the kidneys? A) Produce white blood cells B) Remove carbon dixoide C) Circulate cerebrospinal fluid D) Regulate blood pressure

Ans: D Feedback: Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acid-base. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli. Cerebrospinal fluid circulates through the brain and spinal cord.

The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which of the following vital signs would the nurse anticipate with this child's diagnosis? A) Pulse rate 112 bpm B) Pulse oximetry 93% on room air C) Respirations 24 per minute D) Blood Pressure 136/84

Ans: D Feedback: Hypertension appears in 60% to 70% of patients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for this age child, but not a concern with this diagnosis. The other vital signs are within normal limits for this age child.

The nurse is caring for a child admitted with nephrotic syndrome. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? A) Oliguria B) Amenorrhea C) Pyelonephritis D) Ascites

Ans: D Feedback: In the child with nephrotic syndrome the abdomen may be greatly enlarged with ascites, which is edema in the peritoneal cavity. Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is which of the following? A) Performing a suprapubic aspiration B) Placing a cotton ball in the underwear to catch urine C) Placing an indwelling urinary catherter D) Obtaining a clean catch voided urine

Ans: D Feedback: In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet trained child, using a cotton ball to collect the urine would not be appropriate.

The nurse recognizes that which of the following would be a likely physiologic cause for a child to have enuresis? A) Regression to get attention B) Stress and stressful situations C) Sexual abuse D) Sleeping too soundly

Ans: D Feedback: Physiologic causes may include a small bladder capacity, urinary tract infection, and lack of awareness of the signal to empty the bladder because of sleeping too soundly. Psychological causes might include rigorous toilet training, resentment toward family caregivers or a desire to regress to an earlier level of development to receive more care and attention or emotional stress and stressful situations. Enuresis can be a symptom of sexual abuse.