NCLEX Child Health- Renal and Urinary

The nurse is assisting with gathering admission assessment data on a 2-year-old child who has been diagnosed with nephrotic syndrome. The nurse collects data knowing that which is a common characteristic associated with nephrotic syndrome? 1.Hypotension 2.Generalized edema 3.Increased urinary output 4.Frank, bright red blood in the urine

2.Generalized edema Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, and edema. The urine is dark, foamy, and frothy, but microscopic hematuria may be present. Frank, bright red blood in the urine does not occur. Urine output is decreased and the blood pressure is normal or slightly decreased

The nurse is assisting with preparing a plan of care for a 4-year-old child hospitalized with nephrotic syndrome. Which intervention is most appropriate for this child? 1.Provide a high-salt diet. 2.Provide a high-protein diet. 3.Discourage visitors at mealtimes. 4.Encourage the child to eat in the playroom.

4.Encourage the child to eat in the playroom. Mealtimes should center on pleasurable socialization. The child should be encouraged to eat meals with other children on the unit. A diet that is normal in protein with a sodium restriction is normally prescribed for a child with nephrotic syndrome. Parents or other family members should be encouraged to be present at mealtimes with a hospitalized child.

Which assessment finding should the nurse expect to note in the child hospitalized with a diagnosis of nephrotic syndrome?

Abdominal pain

The nurse should recognize which laboratory value as being abnormal? A) pH: 4B) Specific gravity: 1.020C) Protein level: absentD) Glucose level: absent

a

Laboratory tests for nephrotic syndrome

Urinalysis 24/hr-urine collectionProteinuria: present; up to 15 grams of protein in a 24/h4 specimenhyaline castsFew RBCsOval fat bodiesIncreased specific gravity

The nurse is reviewing the record of a child admitted to the hospital with nephrotic syndrome. Which finding should the nurse expect to note documented in the record? 1.Proteinuria 2.Weight loss 3.Increased appetite 4.Hyperalbuminemia

1.Proteinuria The term nephrotic syndrome refers to a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema. The child experiences fatigue, anorexia, increased weight, abdominal pain, and a normal blood pressure.

What should the nurse recommend to prevent urinary tract infections in young girls? A)Wearing cotton underpants B)Increasing fluids; decreasing salt intake C)Cleansing the perineum with water after voiding D)Limiting bathing as much as possible

A

A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply.) A) VomitingB) Jaundice C) Swelling of the face D) Persistent diaper rash E) Failure to gain weight

A) VomitingD) Persistent diaper rashE) Failure to gain weight

An objective of care for the child with nephrosis is what desired outcome? A)Reduced blood pressure B)Reduced excretion of urinary protein C)Increased ability of tissues to retain fluid D)Increased excretion of urinary protein

b

bladder exstrophy nursing interventions

protect the tissue-sterile towels w sterile water-keep skin dry but bladder moist (careful bc urine is coming out)-pain mang.-nutrtional status-may need to collect urine-support bc it is a long processs

A nurse caring for a 2-month-old febrile infant is asked to collect a urine specimen for a culture and sensitivity. The nurse collects the specimen by performing which action? 1.Catheterizing the infant using the smallest available straight catheter 2.Attaching a urinary collection device to the infant's perineum for collection 3.Place cotton balls in the diaper and then after the infant voids aspirating the urine with a syringe 4.Noting the time of the next expected voiding and preparing to collect the specimen into a cup when the infant voids

1.Catheterizing the infant using the smallest available straight catheter In young infants less than 3 months of age who are febrile, urine specimens should be collected by bladder catheterization with a straight catheter. A urine collection bag would not get a sterile specimen and may take too long. For some types of urine testing, such as specific gravity, ketones, glucose, and protein, the nurse can aspirate urine directly from the cotton balls in the diaper. But would not be appropriate for a culture and sensitivity urine specimen. It is not reasonable to try to identify the time of the next voiding to attempt to collect the specimen

The nurse is assisting in developing a plan of care for a child diagnosed with acute glomerulonephritis. The nurse should include which intervention in the plan of care? 1.Encourage limited activity and provide safety measures. 2.Force intake of oral fluids to prevent hypovolemic shock. 3.Catheterize the child to strictly monitor intake and output. 4.Encourage classmates to visit and to keep the child informed of school events.

1.Encourage limited activity and provide safety measures. Activity is limited and most children, because of fatigue, voluntarily restrict their activities during the active phase of the disease. Catheterization may cause a risk of infection. Fluids should not be forced. Visitors should be limited to allow for adequate rest.

The nurse is assisting in developing a plan of care for a 10-year-old child diagnosed with acute glomerulonephritis. Following review of the plan of care, the nurse determines that which intervention is the priority for the child? 1.Promoting bed rest 2.Restricting oral fluids 3.Encouraging visits from friends 4.Allowing the child to play with the other children in the playroom

1.Promoting bed rest ed rest is required during the acute phase, and activity is gradually increased as the condition improves. Providing for quiet play according to the developmental stage of the child is important. Fluids should not be forced or restricted. Visitors should be limited to allow for adequate rest.

The nurse is preparing a 2-year-old child with suspected nephrotic syndrome for a renal biopsy to confirm the diagnosis. The mother asks the nurse, "Will my child ever look thin again?" The nurse should respond by giving which statement? 1."Do you feel guilty about your child's weight gain?" 2."In most cases, medication and diet will control fluid retention." 3."Wearing loose-fitting clothing should help conceal the extra weight." 4."When children are little, it's expected that they'll look a little chubby."

2."In most cases, medication and diet will control fluid retention." It is important to give the mother information that addresses the issue that is the parent's concern. Most children experience remission with treatment. Options 1 and 3 are nontherapeutic and may add to the mother's guilt. Option 4 does not acknowledge the concern and is a stereotypical response.

A urinalysis has been prescribed for an infant and the nurse plans to collect the specimen. The nurse implements which appropriate method to collect the specimen? 1.Catheterizes the infant, using a No. 5 French Foley 2.Attaches a urinary collection device to the infant's perineum 3.Obtains the specimen from the diaper, using a syringe, after the infant voids 4.Monitors the urinary patterns and prepares to collect the specimen into a cup when the infant voids

2.Attaches a urinary collection device to the infant's perineum 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. Urine for certain tests, such as specific gravity, may be obtained from a diaper. Urinary catheterization is not to be done unless specifically prescribed because of the risk of infection. It is not reasonable to monitor urinary patterns and attempt to collect the specimen in a cup when the infant voids.

The nurse is providing information to the mother of a child with nephrotic syndrome regarding the edematous appearance of the child. Which statement should the nurse make to the mother? 1."Children always look a little bit fat, so don't be concerned." 2."Dress the child in loose-fitting clothing to hide the extra weight." 3."The fluid retention should be controlled by medication and diet." 4."The child will always have this appearance, and preparing the child for the body image change is important."

3."The fluid retention should be controlled by medication and diet." Most children experience remission with treatment and corticosteroids. Diuretics also may be a component of the treatment plan, and a restricted sodium diet is recommended. It is important to give the parent information in a matter-of-fact manner and address the issue that is the parent's concern. Options 1, 2, and 4 are inaccurate and inappropriate statements to the mother.

A 2-year-old child is admitted to the hospital with a diagnosis of nephrotic syndrome. In planning care for this child, which nursing intervention should be of highest priority? 1.Weigh morning and afternoon. 2.Maintain a strict intake and output. 3.Dipstick the urine for protein every 4 hours. 4.Take vital signs with blood pressure every 2 hours.

3.Dipstick the urine for protein every 4 hours. Continuous monitoring of fluid retention and excretion is an important nursing intervention in the care of the child with nephrotic syndrome. Although it is important to maintain a strict intake and output in monitoring fluid retention and excretion, the goal of treatment with this child is to decrease the amount of protein lost in the urine. Because this is the goal, option 3 has the highest priority. Although weight is monitored, it is not necessary to check the weight morning and evening. Taking vital signs with blood pressure is important but is not the priority in this situation and does not have to be monitored every 2 hours.

The nurse assists in preparing a plan of care for the infant with bladder exstrophy. The nurse identifies which immediate problem as the priority for the infant? 1.Infection 2.Elimination 3.Skin disruption 4.Lack of parental understanding

3.Skin disruption In bladder exstrophy, the bladder is exposed and external to the body. The highest priority is skin disruption related to the exposed bladder mucosa. Although the infant needs to be monitored for elimination patterns and kidney function, this is not the priority concern for this condition. Lack of parental understanding related to the diagnosis and treatment of the condition will need to be addressed, but again, is not the priority. Although infection related to the anatomically located defect can be a problem, it is not the immediate one.

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 response should the nurse give to the parents about bladder exstrophy? 1."It is a hereditary disorder that occurs in every other generation." 2."It is caused by the use of medications taken by the mother during pregnancy." 3."It is a condition in which the urinary bladder is abnormally located in the pelvic cavity." 4."It is an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall."

4."It is an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall." Bladder exstrophy is a congenital anomaly that is characterized by the extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause is unknown and there is a higher incidence among males. Options 1, 2, and 3 are not characteristics of this disorder.

A nursing instructor is observing a nursing student caring for an infant with a diagnosis of bladder exstrophy. The nursing student provides appropriate care to the infant by performing which action? 1.Covering the bladder with a dry sterile dressing 2.Covering the bladder with a wet-to-dry dressing 3.Applying sterile water soaks to the bladder mucosa 4.Covering the bladder with a nonadhering plastic wrap

4.Covering the bladder with a nonadhering plastic wrap Care should be taken to protect the exposed bladder tissue from drying while allowing drainage of urine. This is best accomplished by covering the bladder with a nonadhering plastic wrap. The use of wet-to-dry dressings should be avoided because this type of dressing adheres to the mucosa and may damage the delicate tissue when removed. Sterile dressings and dressings soaked in solutions can also dry out and damage the mucosa when removed.

A 5-year-old female child has been sent to the school nurse for urinary incontinence 3 times in the past 2 days. The nurse should recommend to her parent that the FIRST action is to have the child evaluated for: A) school phobia. B) causes. C) possible urinary tract infection. C) possible structural defects of the urinary tract.

C) possible urinary tract infection.

A 2-year-old child is admitted to the hospital with a diagnosis of nephrotic syndrome. In planning care for this child, which nursing intervention should be of highest priority in the care of this child?

Checking the urine for protein every 4 hours

The nursing instructor is observing a nursing student caring for an infant with a diagnosis of bladder exstrophy. The nursing student provides appropriate care to the infant if which intervention is performed?

Covering the bladder with a sterile, non adhering moist dressing

The nurse develops a plan of care for an infant with bladder exstrophy. The nurse prioritizes the plan of care and selects which as the priority?

Diminished tissue integrity

The nurse provides home care instructions to the mother of a child with glomerulonephritis. Which statement by the mother indicates a need for further instructions?

I need to be sure to increase my child's intake of fluids

The clinic nurse is providing instructions to the parents of a child with a urinary tract infection. The nurse determines that the parents need additional teaching if which statement is made?

I need to encourage my child to hold the urine and to urinate no more than 4 times a day

The nurse has completed discharge teaching with the parents of a child with glomerulonephritis. Which statement by the parents indicates that further teaching is necessary?

It'll be so good to have our child back in tap-dancing classes next week.

-passing a thin biopsy needle into the kidney through the skin over the kidney, is used to diagnose the extent of renal disease and thereby predict disease outcome or progress or beginning rejection of a transplanted kidney.Renal biopsy may be done in the older child under a local anesthetic, general anesthesia will be necessary for the younger child who cannot cooperate easily.-After the biopsy, a sterile gauze square is pressed against the site for approximately 15 minutes to halt bleeding, followed by a large pressure dressing. Urine voided after renal biopsy is blood-tinged. Children are kept on bedrest for 24 hours or until no more hematuria is present. Vital signs should be done and the biopsy site observed q15min for the first hour. Encourage children to drink fluids during the first 24 hours to keep urine freely flowing and prevent blood clotting during this time. A hematocrit is usually ordered 24 hours after the procedure to provide another assessment that bleeding is not occurring.

Renal bipsy

a study of the lower urinary tract. The urethra and bladder and the presence of reflux into the ureters are revealed. On the x-ray table, the child's bladder is catheterized, then radiopaque dye is injected into the bladder. The child is then asked to void while serial x-ray films are taken. Although the catherization is unpleasant, , being asked to void while they are observed on the x-ray table is the most stressful part of the procedure for children.--Children need to be told in advance that they will be asked to do this, that it is a necessary part of the study. Being certain that children are aware their parents approve of voiding on a table is helpful to some children (they have just been taught that the only proper place for voiding is a bathroom). Caution children that a first voiding after catherization may be painful. A few children have difficulty voiding a second time after they return to their hospital room, because they worry that the second voiding will also sting. Sitting in a bathtub of warm water and voiding into the water may help relieve pain.

Voiding Cystourethrogram (VCUG)

The nurse is teaching parents about prevention of urinary tract infections in children. Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

b

What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis? a. Infarction of renal vessels b. Immune complex formation and glomerular deposition c. Bacterial endotoxin deposition on and destruction of glomeruli d. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation

b

A nurse is teaching a parent of a child who has a urinary tract infection. Which of the following should the nurse include in the teaching? (SATA) A) Wear nylon underpants B) Avoid bubble baths C) Empty bladder completely with each void D) Watch for manifestations of infection E) Wipe perineal area back to front

bcd

The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause?a. Poor hygiene b. Constipation c. Urinary stasis d. Congenital anomalies

c

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? A)"You will need to decrease the number of calories in your child's diet." B)"Your child's diet will need an increased amount of protein." C)"You will need to avoid adding salt to your child's food." D) "Your child's diet will consist of low-fat, low-carbohydrate foods."

c

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. "You will need to decrease the number of calories in your child's diet." b. "Your child's diet will need an increased amount of protein." c. "You will need to avoid adding salt to your child's food." d. "Your child's diet will consist of low-fat, low-carbohydrate foods."

c

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. The nurse's BEST reply is: A) "Blood pressure changes are a common side effect of antibiotic therapy." B) "Blood pressure changes are a sign that the condition has become chronic." C) "Acute hypertension, or high blood pressure, must be anticipated and identified." D) "Hypotension, or low blood pressure, leading to sudden shock can develop at any time."

c

What is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? A)Risk for Injury related to malignant process and treatment. B)Deficient Fluid Volume related to excessive losses. C)Excess Fluid Volume related to decreased plasma filtration. D) Excess Fluid Volume related to fluid accumulation in tissues and third spaces.

c

Which diagnostic finding is present when a child has primary nephrotic syndrome? A)Positive ASO titer B)Hyperalbuminemia C)Proteinuria D)Leukocytosis

c

A nurse is planning care of a child who has a urinary tract infection. Which of the following interventions should the nurse include? A) Administer an antidiuretic B) Restrict fluids C) Evaluate the child's self-esteem D) Encourage frequent voiding

d

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed?A) Restraining child as necessaryB) Discouraging parents from holding childC) Doing passive range-of-motion exercises once a dayD) Adjusting activities to child's tolerance level

d