PEDs Chapt 21 Nursing Care of the Child with a Genitourinary Disorder

The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? a) "Let's meet with the dietitian and plan some meals." b) "Here is some written information from the dietitian." c) "She must severely restrict her sodium intake." d) "She should try to avoid protein."

"Let's meet with the dietitian and plan some meals." Correct Explanation: Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.

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) "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." b) "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive." c) "That must be hard on you, especially because you are raising her by yourself." d) "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it."

"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." Correct Explanation: 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 nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child? a) Sacrum b) Abdomen c) Eyes d) Fingers

Eyes Correct Explanation: Edema is usually the presenting symptom in nephrotic syndrome, appearing first around the eyes and ankles.

You are counseling a couple about sexually transmitted diseases. The male partner has genital herpes. To prevent spread of the infection to the female partner, you advise the couple that a) intercourse should be avoided until a Pap test is negative. b) acyclovir should be applied topically prior to intercourse. c) a condom should be used during intercourse. d) coitus should be delayed until 10 days after penicillin is begun.

a condom should be used during intercourse. Correct Explanation: Condoms provide protection against the spread of sexually transmitted diseases as well as conception.

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration you would want to prepare his parents for is a) the need for maintaining a semi-Fowler's position. b) the need for complete bed rest for 10 days. c) some discomfort at the surgery site. d) a liquid diet for 3 days.

some discomfort at the surgery site. Correct Explanation: After they are returned to the scrotum, testes may be sutured there to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation.

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, you would want to prepare her to a) drink three glasses of water during the procedure. b) have a local anesthetic injected prior to the procedure. c) anticipate a headache afterward. d) void during the procedure.

void during the procedure. Correct Explanation: A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.

A child needs to collect urine for 24 hours and the nurse explains that this test assesses glomerular filtration rate and how the kidneys are functioning. Which of the following would be indicative of this type of test? a) Urinalysis for casts and bacteria b) Creatinine clearance c) Microscopic studies for RBC casts d) Urine culture and sensitivity

Creatinine clearance Correct Explanation: A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate.

A child is being evaluated for renal and urinary tract disease. Which of the following would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? a) Kidneys, ureter, and bladder x-ray b) Urinalysis c) Creatinine clearance rate d) Computed tomography scan

Creatinine clearance rate Correct Explanation: The glomerular filtration rate is measured by creatinine clearance rate or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.

You obtain a history from the mother of a child with glomerulonephritis about how he became ill. Which of the following would you expect her to tell you she noticed? a) Headache, loss of appetite b) Dark brown urine c) Loss of weight, oliguria d) Diuresis and pallor

Dark brown urine Correct Explanation: Acute glomerulonephritis often presents with glomeruli bleeding, which is revealed as black or brown urine from old blood.

A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point? a) Toxic shock syndrome b) Amenorrhea c) Mittelschmerz d) Endometriosis

Endometriosis Correct Explanation: If dysmenorrhea does not improve within 6 months with the use of NSAIDs and COCs, a laparoscopy is indicated to look for endometriosis, the most common reason for secondary dysmenorrhea. The other conditions listed are not associated with dysmenorrhea.

A nurse is assessing a child that may have peritonitis. Which of the following would be signs of this problem? a) Increased red blood cell count of dialysate outflow b) Diarrhea c) Syncope d) Increased white blood cell count of dialysate outflow

Increased white blood cell count of dialysate outflow Correct Explanation: Increased white blood cell count of dialysate outflow is one of the signs of peritonitis. Vomiting, fever, and abdominal pain are also signs of peritonitis.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? a) Risk for infection b) Activity intolerance c) Imbalanced nutrition, less than body requirements d) Excess fluid volume

Risk for infection Correct Explanation: When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

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) Strawberry red tongue b) Smoky colored urine c) Jaundiced skin d) Loose, dark stools

Smoky colored urine Correct Explanation: 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.

To prevent further urinary tract infections in a preschooler, what measures would you teach her mother? a) Teach her to take frequent tub baths to clean her perineal area. b) Teach her to wipe her perineum front to back after voiding. c) Suggest she drink less fluid daily to concentrate urine. d) Encourage her to be more ambulatory to increase urine output.

Teach her to wipe her perineum front to back after voiding. Correct Explanation: Escherichia coli can be easily spread from the rectum to the urinary meatus and cause infection if girls do not take precautions against this.

A parent asks if their newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? a) There is a chance the testicles will descend on their own. b) If the infant is having swelling or pain, then surgery will be performed. c) This problem needs to be corrected immediately in the newborn period. d) Surgery is not needed for this type of problem.

There is a chance the testicles will descend on their own. Correct Explanation: The AAP recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year old. This problem does not cause pain or swelling.

An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, which of the following would lead the nurse to suspect that the adolescent has candidiasis? a) Thick, white cheese-like discharge b) Yellow-green discharge c) Milky, gray, fishy-odor discharge d) Frothy, gray-green discharge

Thick, white cheese-like discharge Correct Explanation: With candidiasis, the vaginal discharge is thick, white, and cheese-like. A frothy, gray-green discharge is noted with trichomoniasis. A milky, gray discharge with a fishy odor suggests gardnerella. A yellow-green vaginal discharge suggests gonorrhea.

The nurse is assessing a child diagnosed with nephritic syndrome and observes generalized edema. The nurse documents this as which of the following? a) Phimosis b) Hydronephrosis c) Anasarca d) Enuresis

Anasarca Correct Explanation: Anasarca refers to generalized edema. Enuresis refers to continued incontinence of urine past the age of toilet training. Hydronephrosis refers to a condition in which the pelvis and calyces of the kidney are dilated. Phimosis refers to a condition in which the foreskin of the penis cannot be retracted.

A child is having their urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate? a) This determines the presence of sugar in the urine. b) This may indicate a urinary tract infection. c) This determines the presence of RBCs in the urine. d) This indicates renal disease.

This may indicate a urinary tract infection. Correct Explanation: Positive leukocytes may indicate a urinary tract infection. The urine would also need to be cultured to determine the type and amount of bacteria growth.

The nurse is conducting a presentation for a group of nurses who work with adolescents. The group of nurses discusses dysmenorrhea. Which of the following statements is most accurate related to dysmenorrhea? a) Dysmenorrhea can result from diaphragms or tampons being left in place too long. b) Genetic abnormalities are the most common cause of dysmenorrhea. c) A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. d) Common symptoms of dysmenorrhea are weight gain and mood swings.

A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. Correct Explanation: The increased secretion of prostaglandins, which occurs in the last few days of the menstrual cycle, is thought to be a contributing factor in primary dysmenorrhea.

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 medication given to treat dysmenorrhea b) A dull, aching abdominal pain at ovulation c) A symptom of premenstrual syndrome d) The beginning of menstruation

A dull, aching abdominal pain at ovulation Correct Explanation: 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.

Most urinary tract infections seen in children are caused by which of the following? a) Hereditary causes b) Intestinal bacteria c) Dietary insufficiencies d) Fungal infections

Intestinal bacteria Correct Explanation: 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 acute glomerulonephritis. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Smoky colored urine b) Jaundiced skin c) Strawberry red tongue d) Loose, dark stools

Smoky colored urine Explanation: 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.

A newborn is diagnosed with hypospadias and the parents want him to be circumcised. What would be the best response by the nurse? a) Circumcision is usually performed after 1 year old. b) The circumcision may predispose the child to renal failure. c) Circumcision with a hypospadias will cause meatal stenosis. d) The foreskin is needed for repair.

The foreskin is needed for repair. Correct Explanation: A child's foreskin is not removed since it is needed to help repair a hypospadias. Once the hypospadias is repaired, a circumcision can be performed at the same time. Meatal stenosis has to do with the urethral opening diameter, not the placement.

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 recently had an ear infection. c) The child had a congenital heart defect. d) The child is being treated for asthma.

The child recently had an ear infection. Correct Explanation: 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.

The mother of a child diagnosed with pyelonephritis asks if the kidneys were damaged because of this. What is the best response by the nurse? a) Yes, all children who get pyelonephritis have renal scarring. b) The child's risk for renal scarring is increased with pyelonephritis. c) As long as IV antibiotics are started, there is no risk of renal damage. d) No, if the child is urinating normally, the kidneys were not damaged.

The child's risk for renal scarring is increased with pyelonephritis. Correct Explanation: It would not be possible to determine if the child has renal scarring with pyelonephritis until more testing is performed. It can result in renal scarring with this type of problem, but that does not mean there will definitely be complications. Antibiotics are usually the treatment of choice in this situation, but it cannot be determined when the damage had occurred.

A nurse is providing education to parents of a child diagnosed with vesicoureteral reflux (VUR). Which of the following would be included in the education? a) This is typically treated with a kidney transplant. b) This occurs when there is backflow of urine into the bladder and sometimes kidneys. c) This occurs only when there is an obstruction of the ureteropelvic junction. d) This is diagnosed by abdominal x-ray.

This occurs when there is backflow of urine into the bladder and sometimes kidneys. Correct Explanation: The cause of VUR is a backflow of urine into the bladder and possibly kidneys. This disorder can occur if there is an obstruction, but not always. The way to determine if a child has VUR is typically by a VCUG diagnostic test. There are five different grades to VUR and it is treated according to the cause and degree of VUR.

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) "It is unlikely that your daughter is practicing good cleaning habits after she voids." b) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." c) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." d) "The position of the urethra in girls makes girls more susceptible than boys to UTI's."

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." Correct Explanation: 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 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) "Emotional stress can be a cause of this disorder." b) "This is what happens if a 16-year-old girl has never had any periods at all." c) "This disorder is usually seen after a girl has had a spontaneous abortion." d) "It is caused from taking birth control pills when a girl is younger than 13 years old."

"Emotional stress can be a cause of this disorder." Correct Explanation: 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) "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do." d) "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."

"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." Correct Explanation: 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 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) Rheumatic fever b) A urinary tract infection c) Acute glomerulonephritis d) Lipoid nephrosis (idiopathic nephrotic syndrome)

Acute glomerulonephritis Correct Explanation: 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.

A 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child? a) Make sure the IV fluid contains potassium b) Increase oral intake of fluid c) Administer the IV fluid slowly d) Provide a diet high in protein and sodium

Administer the IV fluid slowly Correct Explanation: If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to replace plasma volume. Administer such fluid slowly, however, to avoid heart failure as extra fluid cannot be removed by the nonfunctioning kidneys. Be certain the fluid prescribed does not contain potassium until it is established kidney function is adequate; otherwise, the buildup of potassium could cause heart block. The child's diet should be low in protein, potassium, and sodium and high in carbohydrate to supply enough calories for metabolism yet limit urea production and control serum potassium levels. Oral fluid intake may be limited to prevent heart failure due to accumulating fluid that cannot be excreted.

A 13-year-old girl tells the nurse during a gynecological visit that a friend of hers developed toxic shock syndrome from tampon use. The client says that tampons work well for her, but she wonders whether they are safe. Which of the following recommendations should the nurse give this client to help prevent toxic shock syndrome? a) Insert two tampons at a time b) Use the highest absorbency tampon possible c) Alternate use of tampons with sanitary pads d) Use feminine hygiene sprays in conjunction with tampons

Alternate use of tampons with sanitary pads Correct Explanation: To help prevent toxics shock syndrome, the nurse should recommend that the client alternate use of tampons with use of sanitary pads; change tampons at least every 4 hours; use the lowest absorbency tampon possible that is still adequate for her individual flow; avoid handling the portion of the tampon that will be inserted vaginally; not use tampons near the end of a menstrual flow, when excessive vaginal dryness can result from scant flow; not insert more than one tampon at a time, to avoid abrasions and to keep the vaginal walls from becoming too dry; and avoid deodorant tampons, deodorant sanitary pads, and feminine hygiene sprays as these products can irritate the vulvar-vaginal lining.

A group of nursing students are reviewing the variations in the genitourinary system in children as compared with adults. The students demonstrate understanding of this information when they identify which of the following? a) Glomerular filtration rate is faster in infants than in adults. b) Bladder capacity reaches adult capacity by age 1 year. c) The renal system usually reaches functional maturity by age 5 years. d) A child's kidneys are surrounded by more fat padding than an adult's kidneys.

Bladder capacity reaches adult capacity by age 1 year. Correct Explanation: Bladder capacity is about 30 mL in the newborn and increases to the usual adult capacity of about 270 mL by 1 year of age. Glomerular filtration rate is slower in the infant and young toddler compared with the adult. The renal system usually reaches functional maturity by 2 years of age. The kidneys of a child are less well protected from injury by the ribs and fat padding than they are in the adult.

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) Blood Pressure 136/84 c) Pulse oximetry 93% on room air d) Respirations 24 per minute

Blood Pressure 136/84 Correct Explanation: 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 condition in which one or both of the testes does not descend in the male infant is referred to as which of the following? a) Cryptorchidism b) Orchiopexy c) Enuresis d) Hydrocele

Cryptorchidism Correct Explanation: When one or both of the testes do not descend, the condition is called cryptorchidism.

A nurse is performing postoperative care on a child with a ureteral stent. Which of the following interventions will help manage bladder spasms? a) Apply antibiotic ointment to tube site. b) Encourage high fluid intake. c) Increase low-fat foods. d) Allow tubes to dangle freely to encourage flow.

Encourage high fluid intake. Correct Explanation: Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.

A child is born with ambiguous genitalia. Which of the following assessments establishes whether the child is genetically male or female? a) DNA analysis b) Laparoscopy c) Ultrasound d) Pyelography

DNA analysis Correct Explanation: If there is any question about a child's gender, karyotyping or DNA analysis establishes whether the child is genetically male or female. Laparoscopy (introduction of a narrow laparoscope into the abdominal cavity through a half-inch incision under the umbilicus) or possibly exploratory surgery may be necessary to determine if ovaries or undescended testes are present. Intravenous pyelography or ultrasound can be used to establish whether a complete urinary tract is present.

A parent is asking how she can help her son deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? a) Take away a toy every time the child urinates in their pants. b) Demonstrate how to urinate in the bathroom every time. c) Demonstrate love and acceptance at home. d) Discuss how child can continue to go to the bathroom instead of in the underwear.

Demonstrate love and acceptance at home. Correct Explanation: Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. Which of the following would be the best way to prevent this? a) Prophylactic antibiotics after strep throat are important. b) Tell parents to give ibuprofen if their child has a sore throat. c) All children in the child's class should be tested for strep throat if there is a positive. d) Encourage the child to take all the antibiotics if diagnosed with strep throat.

Encourage the child to take all the antibiotics if diagnosed with strep throat. Correct Explanation: Encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community that the child came in contact with unless they are symptomatic. Ibuprofen does not cure strep throat and that is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.

A nurse is developing a teaching plan for the parents of an 8 year old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify which of the following as an appropriate measure? a) Engaging the child in stress reduction measures b) Giving desmopressin intranasally c) Encouraging fluid intake after dinner d) Practicing bladder-stretching exercises

Encouraging fluid intake after dinner Correct Explanation: In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.

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) Sacrum b) Eyes c) Hands d) Ankles

Eyes Correct Explanation: 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.

Peritoneal dialysis is so effective that 3 hours of peritoneal dialysis accomplishes as much as 12 hours of hemodialysis. a) True b) False

False Correct Explanation: Hemodialysis can be done as a continuous process, but it is so effective 3 hours of hemodialysis accomplishes as much as 12 hours of peritoneal dialysis.

The human papillomavirus (HPV) is commonly passed on from a pregnant woman to her fetus. a) False b) True

False Correct Explanation: The presence of vulvar HPV lesions appears to have no effect on the fetus during pregnancy, but if they are so large they obstruct the birth canal for birth, a cesarean birth may be scheduled.

The child with nephrotic syndrome who has ascites and difficulty breathing is probably most comfortable sleeping in which position? a) Supine b) Sims' position c) Prone d) Fowler's

Fowler's Correct Explanation: A Fowler's position (sitting upright) allows ascites fluid to settle downward and not press against the diaphragm, compromising breathing.

A nurse is performing an assessment on a child. Which of the following would be indicative of a potential for a urinary tract infection? a) Holding urine while at school. b) Not using cleansing towelettes routinely. c) Washing the genital area with water daily. d) Not using soap when cleaning the urethral area.

Holding urine while at school. Correct Explanation: UTIs are often caused by children who do not urinate frequently at school. It is important for a child to avoid using towelettes and soap in the genital area because this can increase the chance of a UTI. Washing the genital area with water daily does not increase the chance of a UTI.

The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. The nurse documents this finding as which of the following? a) Bladder exstrophy b) Patent urachus c) Epispadias d) Hypospadias

Hypospadias Correct Explanation: Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Epispadias is present when the urethral opening is on the dorsal surface of the penis. Patent urachus refers to a fistula between the bladder and umbilicus. Bladder exstrophy involves the bladder lying open and exposed on the abdomen.

A child in kidney failure has had a kidney transplantation. You would prepare the child for which of the following to occur postoperatively? a) A transient rash from T-cell suppression b) Full-body irradiation that will leave him nauseated c) Burning on urination from high uric acid content d) Infection-control precautions that may cause him to be lonely

Infection-control precautions that may cause him to be lonely Correct Explanation: Children may be isolated following a transplant to help them resist infection during the time their immune system response is lowered to help them avoid transplant rejection.

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) Test the urine for ketones twice a day b) Weigh the child once a week. c) Administer antipyretics as needed. d) Measure the abdominal girth daily.

Measure the abdominal girth daily. Correct Explanation: 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 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 an indwelling urinary catherter c) Placing a cotton ball in the underwear to catch urine d) Obtaining a clean catch voided urine

Obtaining a clean catch voided urine Correct Explanation: 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 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) Respirations 22 per minute b) Blood Pressure 100/70 c) Pulse rate 135 bpm d) Pulse oximetry 93% on room air

Pulse rate 135 bpm Correct Explanation: 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.

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) Ascites b) Oliguria c) Pyelonephritis d) Amenorrhea

Pyelonephritis Correct Explanation: 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.

A child diagnosed acute glomerulonephritis will most likely have a history of which of the following? a) Recent illness such as strep throat b) Hemorrhage or history of bruising easily c) Sibling diagnosed with the same disease d) Hearing loss with impaired speech development

Recent illness such as strep throat Correct Explanation: Symptoms of acute glomerulonephritis often appear one to three weeks after the onset of a streptococcal infection such as strep throat.

Which of the following nursing diagnoses would be the priority when caring for a child in renal failure following a kidney transplant? a) Constipation related to effects of administered drugs b) Deficient fluid volume related to fluid intake restrictions postoperatively c) Pain related to tissue rejection d) Risk for infection related to immunocompromised state

Risk for infection related to immunocompromised state Correct Explanation: Children are administered anti-immune therapies to lower immune system response and help prevent transplant rejection following a transplant; this leaves them susceptible to infection.

A 16-year-old girl has had several cases of cystitis in the past year. Which of the following should the nurse suspect as the cause, based on this finding? a) Sexual activity b) Frequent voiding c) Wiping from front to back after voiding d) Regular participation in a strenuous sport

Sexual activity Correct Explanation: When cystitis is seen in adolescent girls, it is an alert a girl may be sexually active. Wiping from front to back after voiding helps prevent urinary tract infections, not cause them. Frequent voiding does not cause cystitis, nor does regular participation in a strenuous sport.

Which measure would help an adolescent relax best during a pelvic examination? a) Advise her to keep one hand on her abdomen. b) Show her a speculum prior to the exam. c) Help her hold her breath during the exam. d) Assure her that no part of the exam will hurt.

Show her a speculum prior to the exam. Correct Explanation: Distraction and information about the procedure are effective measures to promote relaxation. Holding her breath tenses the abdomen; a pelvic exam is not necessarily pain-free.

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? a) Hardened and tender epididymitis with edema and erythema of scrotum b) Enlarged inguinal glands and fever c) Sudden onset of severe scrotal pain with significant hemorrhagic swelling d) Fever, scrotal swelling, and urethral discharge

Sudden onset of severe scrotal pain with significant hemorrhagic swelling Correct Explanation: Testicular torsion is characterized by a testicle that is abnormally attached to the scrotum and twisted. Signs and symptoms include sudden onset of severe scrotal pain with significant hemorrhagic swelling. Enlarged glands and fever point to infection. A hardened and tender epididymitis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.

A 16-year-old tells you she has terrible dysmenorrhea. Which of the following actions would be the best health teaching measure regarding this? a) Take over-the-counter ibuprofen for its prostaglandin action. b) Take acetaminophen beginning with the first day of a menstrual flow. c) Drink a minimum of fluid if having pain. d) Use ice to help in reducing inflammation and pain.

Take over-the-counter ibuprofen for its prostaglandin action. Correct Explanation: An anti-inflammatory medication is most helpful in reducing the discomfort of dysmenorrhea.

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) Give the child fluids and report back to the nurse in a few hours. 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) 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.

Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Correct Explanation: 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 caring for a 5-month-old boy with an undescended left testis. Which of the following would the nurse identify as indicative of true cryptorchidism? a) Testis can briefly be brought into scrotum b) Venous varicosity detected along the spermatic cord c) Fluid detected in scrotal sac d) Testis cannot be "milked" down inguinal canal

Testis cannot be "milked" down inguinal canal Correct Explanation: With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.

A 5-year-old boy occasionally wets his bed at night and his pants during the day. Which of the following findings would indicate an organic as opposed to a functional cause of this enuresis? a) The boy only wets his bed on the nights his father forgets to taken him to the bathroom to void before going to bed b) The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained c) The boy only wets his pants when he is absorbed in playing video games d) The boy only wets the bed on nights that he is exceptionally tired

The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained Correct Explanation: Enuresis is primary, or functional, if bladder training was never achieved, acquired or secondary or organic if control was established but has now been lost. Enuresis when exceptionally tired, while absorbed in some activity, or when a parent forgets to remind the child is more likely to be primary rather than organic.

The nurse knows which of the following is a description of peritoneal dialysis when compared to hemodialysis? a) The child must go into a facility to get peritoneal dialysis. b) There are strict diet and fluid restrictions. c) The child can live a more normal lifestyle. d) Therapy is only 3 to 4 days per week.

The child can live a more normal lifestyle. Correct Explanation: The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

A 12-year-old girl reports pain and a burning sensation on urination. The nurse suspects a urinary tract infection. Which of the following diagnostic tests would be most appropriate for confirming this condition? a) Urinalysis b) Radioisotope scanning c) Urine culture d) Renal biopsy

Urine culture Explanation: A urinary tract infection (UTI), or the presence of bacteria in urine, is diagnosed by urine culture. Urinalysis involves use of a chemical reagent strip to detect glucose, protein, and occult blood and to measure pH, as well as use of a refractometer to measure specific gravity. Radioisotope scanning is used to assess glomeruli filtration ability. Renal biopsy involves passing a thin biopsy needle into the kidney through the skin over the kidney and is used to diagnose the extent of renal disease and thereby predict disease outcome or progress or reveal beginning rejection of a transplanted kidney.

The nurse is working with a child with altered genitourinary status. Which of the following interventions would be included in the plan of care with excess fluid volume? a) Avoid administering IVs. b) Hold all medication until the fluid retention is improving. c) Weigh the child twice a day on the same scale. d) Measure the amount of nitrates present in the urine.

Weigh the child twice a day on the same scale. Correct Explanation: A child with a renal problem needs to be weighed on the same scale for accurate weights. The frequency is important to ensure the child is not retaining fluid.

In caring for a child with nephrotic syndrome, which of the following interventions will be included in the child's plan of care? a) Ambulating three to four times a day b) Testing the urine for glucose levels regularly c) Increasing fluid intake by 50 cc an hour d) Weighing on the same scale each day

Weighing on the same scale each day Correct Explanation: The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss.

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? a) Foul yellow-gray discharge b) Irritation of labia and vaginal opening c) Thin gray vaginal discharge with fishy odor d) White cottage cheese-like discharge

White cottage cheese-like discharge Correct Explanation: White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene.

A mother is distraught that her 7-year-old daughter has begun puberty early. She worries about both the physical and social implications of this change for her daughter. Which of the following should the nurse say to the mother to address these concerns? (Select all that apply.) a) "Your daughter can start on oral contraceptives to alleviate any concerns about possible pregnancies." b) "Medication is available that can halt sexual maturation at this point." c) "After reaching the age of normal puberty, your daughter will maintain normal growth, development and appearance." d) "Your daughter is not only sexually precocious but also emotionally and psychologically precocious, so she should be able to handle this change."

• "After reaching the age of normal puberty, your daughter will maintain normal growth, development and appearance." • "Medication is available that can halt sexual maturation at this point." Explanation: Both parents and children need reassurance that, after reaching the age of normal puberty, the child with precocious puberty will maintain normal growth and development and appearance. Administration of a synthetic analog desensitizes GnRH receptors, making stimulation by GnRH ineffective and halting sexual maturation at the point to which it has advanced. Oral contraceptives are not advisable for girls this young, because the estrogen in them also causes early closure of epiphyseal lines, possibly stunting the child's growth further. Parents may need to be reminded also, that, although their child appears to be much older, the changes are only in sexual characteristics. Household tasks, responsibility, and expectations must be geared to the child's chronologic age, not to outward appearance.

When assessing a child with hydronephrosis, which of the following would the nurse expect to find? Select all that apply. a) Abdominal mass b) Foul-smelling urine c) Flank pain d) Intermittent hematuria e) Proteinuria

• Intermittent hematuria • Abdominal mass Explanation: Intermittent hematuria is a common symptom of hydronephrosis. An abdominal mass may be palpated with hydronephrosis. Foul-smelling urine is associated with obstructive uropathy. Flank pain is associated with obstructive uropathy and vesicoureteral reflux. Proteinuria is associated with nephritic syndrome.

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) Take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity b) Contact the necessary authorities to report a suspected case of sexual abuse c) Take the child to a private room and interview her regarding her sexual history and partners 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

Take the child to a private room and interview her regarding her sexual history and partners Correct Explanation: 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.

A 16-year-old girl visits her gynecologist with a complaint of metrorrhagia, or bleeding between menstrual periods, since her last visit, 3 months ago. On consulting the patient's chart, the nurse learns that she was prescribed an oral contraceptive at her last visit. Which of the following interventions should the nurse implement in this situation? a) Recommend that she ask the gynecologist about endometrium ablation to halt the metrorrhagia b) Refer the client to her primary care physician for examination for possible uterine or cervical cancer c) Recommend that she ask the gynecologist to change her prescription to a different oral contraceptive d) Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that

Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that Correct Explanation: Metrorrhagia is bleeding between menstrual periods. This may occur in teenagers taking oral contraceptives (breakthrough bleeding) during the first 3 or 4 months of use. If metrorrhagia occurs for more than one menstrual cycle in a teenager who is not taking oral contraceptives (which is not the case here), she be referred to her primary care provider for examination, because abnormal vaginal bleeding is an early sign of uterine or cervical carcinoma or an ovarian cyst. Endometrium ablation, used with premenopausal women to halt metrorrhagia, is not recommended for adolescents. There is no need at this point for the client to change prescriptions, as the bleeding will likely go away in the next month or so as the client's body adapts to the current contraceptive.

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 did not want to go on the fishing trip and is now retaliating against being made to go c) The child has been sexually abused, maybe on the fishing trip d) The child is out of the habit of waking himself up during the night to void

The child has been sexually abused, maybe on the fishing trip Correct Explanation: 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.