PEDs ch.16 Renal Disorders

The nurse caring for a child with nephrotic syndrome expects the following assessment findings or lab values. Select all that apply.

-Edema of 4+ in lower legs -Protein in the urine when checked with a urine dipstick -Weight gain -Anorexia

The nurse is calculating intake and output values for a 4-year-old who weighs 20 kg. The nurse recognizes that the normal urine output for this child is approximately:

40mL/hr

The nurse is assessing a newborn boy and notes on exam that one testicle is in the scrotum and the other can be pushed into the scrotum but immediately retracts. The placement of this testicle should be described as:

A gliding testicle

The clinic nurse suspects a child may have acute postinfectious glomerulonephritis (APIGN) when the child displays which symptoms? Select all that apply.

A history of strep throat 2wks ago, hypertension, oliguria, anorexia

The nurse is preparing a child who is suspected of having nephrolithiasis for diagnostic testing for the disorder. Which diagnostic test does the nurse anticipate being ordered?

Abdominal radiograph

The parents of a child hospitalized with acute post-infectious glomerulonephritis (APIGN) ask the nurse why blood pressure readings are being taken so often. The nurse's reply should be based on knowledge of which of the following?

Acute hypertension must be identified and treated

The emergency department nurse is reviewing the lab report and notes the child's blood urea nitrogen (BUN) and creatinine are markedly elevated. The nurse correctly suspects the child has:

Acute kidney injury

The nurse is analyzing the lab results for a child admitted to the emergency department. The following results are noted: Blood urea nitrogen (BUN): 60 mg/deciliter Creatinine: 3.1Sodium: 141 mEq/literPotassium: 4.7 mEq/literChloride: 102 mEq/literBased on these laboratory findings, the nurse will further assess the child for:

Acute kidney injury

The emergency department nurse is assessing a child with nephrotic syndrome who is hemodynamically unstable. The child is tachycardic, hypotensive, and has poor perfusion. The nurse understands that the priority intervention is to:

Administer an intravenous normal saline fluid bolus

The nurse is caring for a 1-month-old infant who was admitted to the hospital with urosepsis. The priority intervention when caring for this child is to:

Administer antibiotics as ordered on the infant's medication record

A child has been diagnosed with a mild acute kidney injury secondary to an infectious organism. The nurse would question a prescription for which medication?

Aminoglycosides

The nurse is reviewing a 6-year-old child's lab report and notes that the child's glomerular filtration rate (GFR) is 10%. The nurse correctly interprets this finding as:

An indication that the child needs dialysis

The emergency department nurse is assessing a child who is known to have one kidney. The child reports flank pain, vomiting, and decreased urine output. The nurse understands that the priority intervention is to:

Consult the surgical team to evaluate the child

The nurse is performing discharge teaching for a family whose infant has been diagnosed with mild vesicoureteral reflux (VUR). Further teaching is needed when the parents state:

Daily antibiotics have been shown to be helpful in decreasing kidney damage

The nurse is assessing a child suspected of having a urinary tract infection (UTI). The following assessment findings could indicate the presence of a UTI. Select all that apply.

Flank pain, abdominal pain, urinary frequency

The nurse is performing teaching with a family whose child has been diagnosed with nephrotic syndrome. Which part of the nephron is affected with this disease?

Glomerulus

The nurse is teaching the parents of an infant born with hypospadias about the infant's condition. The nurse knows teaching has been successful when the parents state:

He will need surgery sometime between 6 and 12months of age

The nurse is assessing a child and notes the presence of a raised, port-wine colored, non-blanching rash on the extremities. The child should be further assessed for signs and symptoms of:

Henoch- Schönlein purpura

The nurse is providing teaching to a family whose infant has cryptorchidism. The family understands this condition when they state:

If the testicles are descended by puberty, he will have a lower chance of testicular cancer

The nurse is working with a student nurse who asks how the symptoms of urinary tract infections (UTIs) in infants differ from those in adults. The nurse correctly replies:

Infants may present with subtle UTI symptoms, such as fever alone

The nurse is working with a student nurse who is caring for a child with nephrotic syndrome. The nurse knows that the student nurse understands the clinical manifestations of nephrotic syndrome when the student states that the manifestations are:

Massive proteinuria, hypoalbuminemia, and edema

The nurse is creating a plan of care for a child newly admitted with hemolytic uremic syndrome (HUS). Which interventions should be included on the plan of care? Select all that apply.

Monitor intake and output, assess for edema, monitor for anemia, monitor for seizure activity

The clinic nurse is taking a family history for a child with a suspected renal disorder. Which statements made by the parents could indicate an increased risk of the child having a renal disorder? Select all that apply.

My mother had polycystic kidney disease, my father was deaf, my aunt had gout

The nurse who is caring for a child with acute post-infectious glomerulonephritis (APIGN) expects the child to have an order for which medication?

Nifedipine (Adalat)

The nurse caring for a child diagnosed with acute post-infectious glomerulonephritis would ensure the child has a diet consisting of:

No added salt

The nurse is caring for a child on telemetry with acute kidney injury. The nurse correctly suspects the child has hyperkalemia upon noting that the electrocardiogram has:

Peaked Twaves

The nurse is reviewing the medication record for a teenager with nephrotic syndrome. What medications would the child would be expected to receive? Select all that apply.

Prednisone, Albumin, Furosemide

The nurse notes that a child with a suspected urinary disorder has frothy urine. The nurse recognizes that this is a sign of:

Proteinuria, which could indicate nephrotic syndrome

An infant has been diagnosed with grade IV vesicoureteral reflux. The nurse knows that this condition usually results in:

Recurrent urinary tract infections and renal scarring

The nurse is taking a history of a child with a suspected renal disorder. The following statement made by the parent could indicate that the child's diet contributes to the child's renal disorder:

She is on a ketogenic diet for seizure control

The clinic nurse is teaching a family whose child has chronic urinary tract infections (UTIs). The nurse understands that further teaching is needed when the parent states:

She needs to eat a low fiber diet in order to prevent her from getting more UTIs

The emergency department nurse is performing discharge teaching for a family whose child has been diagnosed with symptoms of nephrolithiasis. The nurse knows that teaching has been successful when the parents state:

She should avoid foods that are high in oxalates for now

A child with acute kidney injury (AKI) presents to the emergency department with seizures. The nurse understands that all of the following laboratory values or assessment findings could be causing seizures in this child. Select all that apply.

Sodium level 125, Glucose level 50, Calcium level 7.0

The pediatric renal nurse is assessing an infant who has a renal disorder with the student nurse. The renal nurse assesses the infant's ears for anomalies, and the student nurse asks why that is necessary. The renal nurse replies:

The auditory and renal systems develop at the same time, so the two may have associated anomalies

The nurse is explaining to a child's parent what a voiding cystourethrogram (VCUG) test is. The nurse's most accurate description of this test is:

The bladder is filled with dye that can be seen on Xray and an Xray is done to see if the fluid stays in the bladder

The nurse and student nurse are discussing the normal urinary system development for the 2-month-old infant they are caring for. Given the infant's age, the student nurse correctly states that:

This infant's kidneys are immature

The nurse is reviewing the laboratory report for a febrile infant and notes that the infant's urine contains a colony count of 60,000 cells per milliliter. Based on this information, the nurse recognizes that:

This is a finding that indicates the presence of infection

The nurse who is caring for a child with nephrotic syndrome monitors for complications of the disease. Which are complications of this disease? Select all that apply.

Thromboembolism, infection

The nurse is preparing to administer vaccines to a child with chronic kidney disease (CKD). The nurse knows that the following vaccines are contraindicated for this child? Select all that apply.

Varicella, MMR

The nurse is reviewing the medication record for a teenager with a history of nephrolithiasis. The nurse knows that the following medications are contraindicated for this child. Select all that apply.

Vitamin D and C, Ceftriaxone, Calcium supplements

The nurse is preparing to collect a urine specimen for culture from an infant who is suspected of having a urinary tract infection (UTI). The most reliable method to use in order to decrease the chance of the urine specimen being contaminated is:

catheterization

The nurse is assessing a child with chronic kidney disease who has fluid retention. The nurse correctly notes that the most sensitive indicator of fluid change is:

changes in weight

The emergency department nurse is assessing a child who has chronic kidney disease (CKD). The nurse understands that most concerning assessment finding is

cough and pulse oximetry reading of 90% on room air

The nurse is working with a child admitted to the emergency department who needs to have a CT scan with IV contrast. Upon reviewing the child's lab results, the nurse understands that the child should not have the test done when her:

creatinine is 2.1

The school nurse is assessing a child with a kidney disorder who reports muscle cramping during the school day. The nurse suspects that the child may have:

hypocalcemia

The nurse is preparing a child to have a DMSA scan when the parent asks about the purpose of the scan. Which part of the urinary system that a DMSA scan would detect damage or injury?

kidney

A 12-year-old boy who is on the school soccer team is admitted to the hospital following an ulnar fracture and a concussion. His blood pressure is 112/72 and his heart rate is 115. His urine output is 0.5 ml/kg/hour for the last 4 hours. He has been taking ibuprofen 800 mg three to four times a day for several weeks now to treat cramps and pain from playing soccer. The nurse understands that the most likely explanation for his poor urine output is

kidney injury from the ibuprofen use

A child is being treated for chronic kidney disease (CKD) at home. The nurse would teach the family to provide a:

low potassium diet

The nurse is reviewing the growth chart of a child with a history of chronic kidney disease (CKD). Based on knowledge about this child's disease, the nurse expects the child's growth to be:

lower than normal

The nurse understands that the most common cause of acute kidney injury in children is:

poor renal perfusion

The nurse is analyzing a lab report for a child with end-stage renal disease (ESRD). Which of the following lab alterations would be expected for a child with end-stage renal disease?

potassium 6mEq/liter

The nurse is reviewing a child's medical history and notes that the child has had repeated urinary tract infections (UTIs). The nurse recognizes that repeated UTIs can result in:

renal scarring

The nurse is teaching the parents of a child who will go home on peritoneal dialysis how the dialysis works. The nurse knows that further teaching is needed when the parents state:

the fluid goes in and out of her with a pump

A child has been diagnosed with chronic urinary tract infections. The nurse would question an order for which test?

urine glucose test

The nurse is performing discharge teaching for a family whose child has Henoch-Schonlein purpura (HSP). The nurse knows that further teaching is needed when the parents state:

we will check her urine for nitrates each day

The nurse is performing discharge teaching with a family whose child has chronic kidney disease. The child has been receiving hemodialysis in the hospital. The nurse recognizes that further teaching is needed when the parents state:

we will give him a Fleet enema if he gets constipated