CHP 26: Genitourinary

Which symptoms are characteristic of a preschool-age client who is diagnosed with a urinary tract infection? 1. Foul-smelling urine, elevated blood pressure, and hematuria 2. Severe flank pain, nausea, headache 3. Headache, hematuria, vertigo 4. Urgency, dysuria, fever

Correct Answer: 4 Rationale 1: Clinical manifestations of a urinary tract infection (UTI) in a preschool-age client include fever, urgency, and dysuria. While hematuria may be present, there is no elevated blood pressure, headache, or vertigo.

A school-age client diagnosed with nephrotic syndrome is severely edematous. The primary healthcare provider has placed the child on bed rest. Which nursing intervention is a priority for this client? 1. Reposition the child every two hours. 2. Monitor BP every 30 minutes. 3. Encourage fluids. 4. Limit visitors.

Correct Answer: 1 Rationale 1: A child with severe edema, on bed rest, is at risk for altered skin integrity. To prevent skin breakdown, the child should be repositioned every two hours. Vital signs are taken every four hours, fluids need to be monitored and should not be encouraged, and the child needs social interaction, so visitors should not be limited.

17) A 10-year-old diagnosed with chronic renal failure is seen at the dialysis center for dialysis treatment three times a week. The child weighs 35 pounds after dialysis. Physician's order: Epogen 50 U/kg three times weekly after dialysis. Medication on hand: Epogen 2000 U/mL Calculate how many ml of Epogen the child should receive three times a week.

Answer: 0.38 mL Explanation: 0.38 mL

18) The child is diagnosed with an upper urinary tract infection (UTI). The family asks the nurse what is the difference in the symptoms of an upper versus a lower urinary tract infection? Match each symptom (1-8 below) with the appropriate infection. A. Lower UTI B. Upper UTI 1. High fever 2. Diarrhea 3. Chills 4. Hematuria 5. Costovertebral angle tenderness 6. Cloudy urine 7. Suprapubic or flank pain 8. Moderate/severe dehydration

Answer: 1/B, 2/A, 3/B, 4/A, 5/B, 6/A, 7/A, 8/B 1. Upper UTI 2. Lower UTI 3. Upper UTI 4. Lower UTI 5. Upper UTI 6. Lower UTI 7. Lower UTI 8. Upper UTI Explanation: Lower UTI: Fever, diarrhea, vomiting, irritability, lethargy, foul smelling and cloudy urine, dehydration, abdominal pain, enuresis, suprapubic or flank pain, and urgency. Upper UTI: high fever, chills abdominal pain, nausea, vomiting, flak pain, costo-vertebral angle tenderness, moderate to severe dehydration.

A child, in renal failure, is diagnosed with hyperkalemia. Which food choices will the nurse teach the parents and child to avoid? 1. Carrots and green, leafy vegetables 2. Chips, cold cuts, and canned foods 3. Spaghetti and meat sauce, breadsticks 4. Hamburger on a bun, cherry gelatin

Correct Answer: 1 Rationale 1: Carrots and green, leafy vegetables are high in potassium. Chips, cold cuts, and canned foods are high in sodium but not necessarily potassium. Spaghetti and meat sauce with breadsticks and a hamburger on a bun with cherry gelatin would be acceptable choices for a low-potassium diet.

The nurse is providing care to a male infant who is diagnosed with hypospadias. Which clinical manifestation does the nurse anticipate when assessing this infant? 1. A urethral meatus that is located on the ventral surface of the penis 2. The presence of foreskin 3. A small opening or a fissure that extends the entire length of the penis 4. An opening on the dorsal surface of the penis

Correct Answer: 1 Rationale 1: For an infant diagnosed with hypospadias, the nurse would anticipate a urethral meatus that is located on the ventral surface of the penis. Infants diagnosed with hypospadias may also have a partial absence of the foreskin. A small opening or a fissure that extends the entire length of the penis or an opening on the dorsal side of the penis would be expected for an infant diagnosed with epispadias.

A child is scheduled for a kidney transplant. The nurse completes the preoperative teaching to prepare the child and parents for the surgery and postoperative considerations. Which statement by the parents indicates understanding of the teaching session? 1. "We know it's important to see that our child takes prescribed medications after the transplant." 2. "We'll be glad we won't have to bring our child in to see the doctor again." 3. "We're happy our child won't have to take any more medicine after the transplant." 4. "We understand our child won't be at risk anymore for catching colds from other children at school."

Correct Answer: 1 Rationale 1: It is important that the nurse emphasize compliance with treatments that will need to be followed after the transplant. Follow-up appointments will be necessary, as well as medications and general health promotion.

A preschool-age client diagnosed with with nephrotic syndrome is placed on prednisone for several weeks. Which teaching point is appropriate for the nurse to include in the teaching plan for this client? 1. Never stop the medication suddenly. 2. This drug is taken once a week on Sunday. 3. The child should always take the medication at night before bed. 4. This drug should be taken with meals.

Correct Answer: 1 Rationale 1: Prednisone, a corticosteroid with anti-inflammatory action, is frequently used to treat nephrotic syndrome. It should never be stopped suddenly. The drug is taken more than once a week and can be taken any time during the day, but should remain on a constant schedule. Taking with food is always appropriate for most medications, but it does not have to be with a meal.

A child is prescribed hemodialysis for the treatment of kidney failure. When providing care for this child, what will the nurse monitor for during the assessment? Select all that apply. 1. Shock 2. Hypotension 3. Infections 4. Migraines 5. Fluid overload

Correct Answer: 1,2,3 Rationale 1: Rapid changes in fluid and electrolyte balance during hemodialysis may lead to shock and hypotension. Other complications to watch for are thromboses and infection. Migraines and fluid overload are not clinical manifestations associated with hemodialysis.

The nurse is preparing an educational session for sexually active adolescents. Which statements are appropriate for the nurse to include when educating about sexually transmitted infections (STIs)? Select all that apply. 1. "Frequently diagnosed STIs include chlamydia, genital herpes, gonorrhea, human papillomavirus, trichomoniasis, and syphilis." 2. "Your risk for contracting an STI can be decreased by using a condom when having sex." 3. "Birth control pills are useful in decreasing your risk of contracting an STI." 4. "Risk factors for pelvic inflammatory disease (PID) include multiple sexual partners, lack of barrier protection during intercourse, and history of an STI.' 5. "Pelvic inflammatory disease (PID) is an infection of the lower genital tract."

Correct Answer: 1,2,4 Rationale 1: It is appropriate for the nurse to include the frequently diagnosed STIs, the fact that the risk is decreased by using a condom, and the risk factors for pelvic inflammatory disease. Birth control pills are useful in decreasing the risk of pregnancy but are not useful for decreasing the risk of contracting an STI. PID is an infection of the upper genital tract, not the lower genital tract.

A child diagnosed with acute glomerulonephritis is in the playroom and experiences blurred vision and headache. Which action by the nurse is the most appropriate? 1. Check the urine to see if hematuria has increased. 2. Obtain a blood pressure on the child; notify the healthcare provider. 3. Reassure the child, and encourage bed rest until the headache improves. 4. Obtain serum electrolytes, and send a urinalysis to the lab.

Correct Answer: 2 Rationale 1: Blurred vision and headache may be signs of encephalopathy, a complication of acute glomerulonephritis. A blood pressure (BP) should be obtained and the healthcare provider notified. The healthcare provider may decide to order an antihypertensive to bring down the BP. This is a serious complication, and delay in treatment could mean lethargy and seizures. Therefore, the other options (checking urine for hematuria, encouraging bed rest, and obtaining serum electrolytes) do not directly address the potential problem of encephalopathy.

A child recently had a kidney transplant and is prescribed cyclosporine. The parents ask the nurse about the reason for the cyclosporine. Which reason will the nurse include in the response for why this medication is prescribed? 1. To boost immunity 2. To suppress rejection 3. To decrease pain 4. To improve circulation

Correct Answer: 2 Rationale 1: Cyclosporine is given to suppress rejection. It doesn't boost immunity, decrease pain, or improve circulation.

The nurse teaches parents that the anticholinergic drug oxybutynin is used to treat enuresis. The parents ask the nurse why the medication is being prescribed. Which response by the nurse is the most appropriate? 1. "It's an antidepressant that is used to help the child relax." 2. "It will help decrease the spasms sometimes associated with enuresis." 3. "It has an antidiuretic effect, so your child can attend sleepovers." 4. "It will slow the production of urine, so your child does not have to urinate as frequently."

Correct Answer: 2 Rationale 1: Oxybutynin (Ditropan) is an anticholinergic that relaxes the smooth muscle of the bladder and decreases spasms. Oxybutynin is not an antidepressant or an antidiuretic, and does not slow urine production.

A nurse is preparing to admit a child with possible obstructive uropathy. Which laboratory test should the nurse expect to draw on this child? 1. Platelet count 2. Blood urea nitrogen (BUN) and creatinine 3. Partial thromboplastin time (PTT) 4. Blood culture

Correct Answer: 2 Rationale 1: The blood urea nitrogen (BUN) and creatinine are serum lab tests for kidney function. Obstructive uropathy is a structural or functional abnormality of the urinary system that interferes with urine flow and results in urine backflow into the kidneys; therefore, the BUN and creatinine will be elevated. Platelet count and partial thromboplastin time (PTT) are drawn when a bleeding disorder is suspected. A blood culture is done when an infectious process is suspected.

A preschool-age client is diagnosed with acute glomerulonephritis and is admitted to the hospital. Which nursing diagnosis is most appropriate for this client? 1. Risk for Injury Related to Loss of Blood in Urine 2. Fluid-Volume Excess Related to Decreased Plasma Filtration 3. Risk for Infection Related to Hypertension 4. Altered Growth and Development Related to a Chronic Disease

Correct Answer: 2 Rationale 1: The fluid is excessive, and fluid and electrolyte balance should be monitored. There is no risk for injury because the blood loss in the urine is not such that it causes anemia. While a risk for infection may be present, it is not related to the hypertension. Growth and development is not normally affected because this is an acute process, not a chronic one.

A child is admitted to the hospital unit with a diagnosis of minimal-change nephrotic syndrome (MCNS). Which clinical manifestations does the nurse anticipate when conducting the admission assessment? 1. Hematuria, bacteriuria, weight gain 2. Gross hematuria, albuminuria, fever 3. Massive proteinuria, hypoalbuminemia, edema 4. Hypertension, weight loss, proteinuria

Correct Answer: 3 Rationale 1: Nephrotic syndrome is an alteration in kidney function secondary to increased glomerular basement membrane permeability to plasma protein. It is characterized by massive proteinuria, hypoalbuminemia, and edema. While hematuria and hypertension may be present, they are not pronounced. Gross hematuria and hypertension are associated with glomerulonephritis. Bacteriuria and fever are associated with a urinary tract infection. Because of the edema, a weight gain, not a weight loss, would be seen.

The nurse is preparing to discharge a toddler-age client who just had an orchiopexy. Which discharge instruction is appropriate for this client? 1. Information to the parents about the child's resuming normal vigorous activities 2. Discussion with the parents about the low incidence of testicular malignancy and no further need for any follow-up 3. Explanation to the parents about the need for loose, nonrestrictive clothing 4. Reassurance to the parents that infertility is not a future risk

Correct Answer: 3 Rationale 1: Orchiopexy is the surgical correction of cryptorchidism (failure of the testes to descend into the scrotal sac). Discharge instructions should include information about the need for loose, nonrestrictive clothing to avoid pressure on the postoperative site. The risk of testicular cancer is 35 to 50 times greater in men with a history of cryptorchidism. Long-term planning includes teaching the child to perform monthly testicular examinations once puberty has been reached. Vigorous activities such as straddling toys, riding bicycles, or rough play should be avoided for up to two weeks following surgery to promote healing and prevent injury. A discussion of fertility and the possible need for fertility testing is important, since cryptorchidism increases the risk of infertility.

The nurse educator is teaching a group of nursing students the pathophysiologic reasons related to genitourinary (GU) disorders in the pediatric population. Which statements are appropriate for the nurse educator to include in the teaching session? Select all that apply. 1. "Incomplete organ development during fetal development is the cause of many GU disorders." 2. "Improper placement of the urethra in vagina is one cause of GU disorders." 3. "GU disorders in the pediatric population can be caused by hydronephrosis." 4. "GU disorders in the pediatric population are not caused by infections." 5. "Anatomic obstruction or incomplete nerve innervation can cause GU disorders."

Correct Answers: 1,3,5 Rationale 1: Pathophysiologic causes of GU disorders in the pediatric population include incomplete organ development during fetal development; hydronephrosis; and anatomic obstruction or incomplete nerve innervations. Improper placement of the urethra in the penis, not the vagina, is another pathophysiologic cause of GU disorders. GU disorders can also be caused by infection.