PEDS GI/GU SHERPATH

A parent is reporting that the child has redness and pus around the gastrostomy tube site. Which statement indicates that the parent has an adequate understanding of gastrostomy tubes? "The tube site is just irritated." "The tube site is properly healed by now." "I should apply antibiotics to the gastrostomy tube." "The skin is breaking down, and my child will need surgery."

"I should apply antibiotics to the gastrostomy tube." If the child has redness and pus around the site, an infection may be present. The parent's indication that antibiotics are necessary demonstrates an adequate understanding of gastrostomy tubes and how to manage them.

The nurse is giving discharge instructions to the parents of a 6-month-old boy who has been diagnosed with gastroesophageal reflux disease (GERD). Which statement by one of the parents shows a correct understanding of how to care for the infant? "I will raise his head when he sleeps so he won't choke." "I will put him to sleep on his stomach to ease the pain from GERD." "I will lay him on his back and give him a pacifier to help him sleep." "I will lay him on his right side when he sleeps to ease the gastrointestinal pain."

"I will lay him on his back and give him a pacifier to help him sleep." The infant should be placed supine, flat on the back, to prevent sudden infant death syndrome (SIDS) A pacifier will help the infant with GERD sleep and learn how to swallow properly swallow.

A child presents with anorexia, right lower quadrant pain, and nausea. Which instruction can the nurse give to the child to enhance comfort? "Lie on your back." "Lie on your abdomen." "Lie on your left side with knees bent." "Sit up straight in the chair with your legs dangling."

"Lie on your left side with knees bent."

The nurse is teaching the parents of a child with encopresis about potential symptoms. Which statement by the parents indicates teaching was effective? "We need to buy special lotion to combat the dry skin." "Our child's feces will have a very foul odor most of the time." "My child will have a lot of pain from straining to pass stools." "We can expect our child to vomit some blood after overeating."

"Our child's feces will have a very foul odor most of the time." Encopresis occurs when stool collects in the colon and rectum as a result of the child holding in bowel movements. This stool may leak out and produce an unpleasant odor without the child necessarily being aware of it.

A nurse is providing patient teaching to a couple whose infant has just had surgery for cleft lip. What information does the nurse provide regarding feeding to ensure the child receives adequate nutrition? Select all that apply. "Feed the infant with a straw." "Stop feeding frequently to burp." "Feed the infant in an upright position." "Use a syringe with a rubber tip for feedings." Withhold feeding for 12 hours after the surgery.

"Stop feeding frequently to burp." Burping the infant frequently will help eliminate excess air that is swallowed and enhance the feeding. "Feed the infant in an upright position." Feeding the infant in the upright position will allow gravity to assist in the feeding and decrease the likelihood that the child might choke. "Use a syringe with a rubber tip for feedings." A syringe with a rubber tip can be used to feed the child after surgery.

The caregivers of a child with cleft lip ask the nurse how to decrease feeding difficulties associated with the condition. Which is the best response from the nurse regarding optimizing feeding of the child? "Stop breastfeeding." "Use a nipple with small hole." "Use a long nipple for feeding your child." "Make sure your child is lying flat during feedings."

"Use a long nipple for feeding your child." Using unique nipples and feeders specially designed for infants with cleft lip will assist the parents in decreasing feeding difficulties for infants with cleft lip.

After surgery to create a colostomy, a child who is still on NPO (nothing by mouth) status requests a meal. Which response is appropriate for the nurse? "Let me check with the surgeon." "The surgeon said you still can't eat anything." "I will ask your parents to bring you some food." "You cannot eat until I can hear your belly gurgle when I listen to it or when you pass gas."

"You cannot eat until I can hear your belly gurgle when I listen to it or when you pass gas." This would an appropriate response by the nurse. They explained to the patient not only that they would not be able to eat but why.

The nurse is caring for an infant with gastroesophageal reflux disease (GERD). Which assessment findings indicate potential complications? Select all that apply. Blood pressure of 80/66 10th percentile on the growth chart Two teeth erupting from the top gums Crackles heard in the lungs on auscultation Elevated axillary temperature of 103.6° F

10th percentile on the growth chart Being in the 10th percentile can indicate poor weight gain and failure to thrive, which is a complication of GERD. Crackles heard in the lungs on auscultation Crackles in the lungs can indicate aspiration, a complication of GERD. Elevated axillary temperature of 103.6° F A fever indicates infection and may be related to aspiration pneumonia, a complication of GERD.

A child with celiac disease presents with severe diarrhea, a thready pulse, and low blood pressure. Which actions should the nurse take? Select all that apply. Insert a Foley catheter Administer intravenous saline Administer oral pain medication Obtain serum electrolyte levels Administer a nebulizer treatment

Administer intravenous saline The child exhibits signs of celiac crisis. The nurse should begin fluid resuscitation. Obtain serum electrolyte levels Metabolic acidosis is a symptom of celiac disease. The nurse should monitor the child's electrolyte levels.

A child is experiencing a fever, rigid abdomen, and is bending over, holding his right lower abdomen. What does the nurse suspect is the likely cause of this? Peptic ulcer Appendicitis Dehydration Pyloric stenosis

Appendicitis Fever, rigid abdomen, and bending over, holding the right lower abdomen are symptoms of appendicitis. Peptic ulcer is associated with epigastric pain and generalized abdominal pain but the patient should not have a rigid abdomen. Dehydration could be caused by excessive fever but the severe pain does not indicate dehydration. Pyloric stenosis is usually associated with projectile vomiting and an olive-shaped mass in the right epigastrium.

A young teen with a fever and a history of constipation who has been experiencing 10/10 right-sided abdominal pain, suddenly stops crying because "I feel better." What is the nurse's best action? A young teen with a fever and a history of constipation who has been experiencing 10/10 right-sided abdominal pain, suddenly stops crying because "I feel better." What is the nurses best action? Give an enema Assess the abdomen Prepare for discharge Assess for bowel movement

Assess the abdomen A young teen with a fever and history of constipation who has been experiencing 10/10 right-sided abdominal pain and who suddenly stops crying because "I feel better" may be experiencing perforation of the appendix that will lead to peritonitis. Careful assessment of the abdomen is appropriate for the nurse to do. Giving an enema is contraindicated for severe abdominal pain. Preparing for discharge and assessing for bowel movement are not appropriate inventions.

The nurse is caring for a child who has inflammatory bowel disease with severe malabsorption and anemia who can no longer attend school because of the condition. Which nursing actions are appropriate? Select all that apply. Administer oral pain medication as needed. Assess electrolyte and albumin levels regularly. Question the child about feelings related to body image. Assess the child's height and weight and plot these values on a growth chart. Encourage the parents and child to establish a regular bowel elimination regimen.

Assess the child's height and weight and plot these values on a growth chart. Encourage the parents and child to establish a regular bowel elimination regimen. Assess electrolyte and albumin levels regularly.

A 4-year-old has one accident a week at night. She has not gone more than 6 months without an accident. She really wants to fix the problem so she can feel "normal." What type of management should be suggested in this case? Reward systems Behavioral conditioning Pharmacological medications Diet modification to include more carbohydrates

Behavioral conditioning Behavioral conditioning, such as use of an alarm, would be helpful. The child would awaken in the night in response to alarm and use the bathroom.

Which combined clinical evidence should best warrant dialysis in the AKI patient? Select all that apply. BUN >120 mg/dL Severe hypertension Estimated GFR of 95% Patient has fluid overload Pulmonary crackles that do not clear with a cough Blood pH is low and not responsive to intervention

BUN >120 mg/dL Increasing BUN >120 mg/dL suggests renal insufficiency and dialysis is required. Severe hypertension Hypertension, together with other indicators, leads to the requirement for dialysis. Patient has fluid overload Edema can be caused by fluid overload. Kidneys cannot compensate and fluid needs to be removed by other methods. Pulmonary crackles that do not clear with a cough Pulmonary crackles that do not clear with a cough indicate pulmonary edema. Pulmonary edema can form from fluid overload and congestive heart failure. Blood pH is low and not responsive to intervention Metabolic acidosis that does not respond to treatment is an indication for dialysis.

The nurse is caring for a child with Hirschsprung disease who has been diagnosed with colon inflammation. Which provider orders would the nurse anticipate? Select all that apply. Administer a suppository as needed. Provide oral fluids as desired. Begin preoperative checklist. Increase dietary fiber and fluids. Initiate intravenous administration of normal saline.

Begin preoperative checklist. Complications from Hirschsprung disease may indicate the need for surgery. Initiate intravenous administration of normal saline. A patient with an inflamed colon is at risk for deficient fluid volume and should be given IV fluid resuscitation.

What is necessary for absorption of vitamins A, D, E, and K? Bile Chyme Insulin Amylase

Bile Bile is necessary for absorption of vitamins A, D, E, and K. Insulin is a hormone that allows the body to use sugar (glucose) from carbohydrates. Amylase is the enzyme used to help break down carbohydrates. Chyme is the partially digested food and water secretions that are delivered to the small intestines.

Immediately after delivery, the nurse notices signs of possible UTI in the neonate. What is the likely bacterial route of the infection? Blood Bladder Vaginal canal Fecal material

Blood Sepsis, bacteria in the blood, is the most likely source as bacteria can seed in the kidney and can cause UTI.

A parent of a 6-month-old infant calls the nurse hotline and reports that an infant has had loose stools for the past 12 hours. Which question is most pertinent in the nurse's assessment? Can you describe the number and character of the stools? How much fluid has the infant consumed in the past 24 hours? Do you think the infant caught a bug from a family member? Has the infant consumed a new or different food recently?

Can you describe the number and character of the stools? Asking the parent to describe the number and character of the stools is the most pertinent question, as it will help characterize the infant's current symptoms.

The nurse walks into a patient's room shortly after surgical correction of intussusception and notices that the patient is very lethargic. Which nursing action is a priority? Assess pain Check vital signs Check urine output Call the rapid response team

Call the rapid response team The patient is exhibiting signs of possible sepsis or peritonitis. The nurse should call the rapid response team and to stay with the patient and initiate cardiopulmonary resuscitation (CPR) if indicated.

A nurse is working at a urology clinic and arrives at work to an assignment caring for four young children: Child A: A 3-year-old with urethritis Child B: A 15-year-old with cystitis Child C: A newborn with suspected VUR Child D: A 7-year-old with pyelonephritis Which patient should she see first? Child A Child B Child C Child D

Child D A child with pyelonephritis should be seen first. Urinary infections are more serious the further up the urinary tract they are. Pyelonephritis can cause kidney damage if not treated promptly.

Which patient findings indicate to the nurse that treatment of encopresis complications has been effective? Select all that apply. The child does not attend school events. Child talks about the condition with the nurse. The child's skin is clean, dry, and free of excoriation. Child chooses a cheeseburger, soda, and a sugar cookie for lunch. Parents report the child has a bowel movement every 6 to 8 hours.

Child talks about the condition with the nurse. Verbalizing positive, realistic feelings about self and verbalizing appropriate ways to achieve control over bowel incontinence are indications that treatment has been effective. The child's skin is clean, dry, and free of excoriation. Maintenance of skin integrity is an indication that treatment has been effective. Parents report the child has a bowel movement every 6 to 8 hours. Following a regular bowel schedule is one effective treatment for children with encopresis

Which agent is associated with alteration of normal intestinal flora by antibiotics? Rotavirus Salmonella Escherichia coli Clostridium difficile

Clostridium difficile Clostridium difficile is associated with alteration of normal intestinal flora by antibiotics. The most common causes of diarrhea in children are Salmonella and Escherichia coli; they are often food-borne.

An 11-year-old boy acquired a testicular malignancy at the age of 10 years. An abdominal x-ray at the age of 6 months may have revealed which disorder? Phimosis Hydrocele Hypospadias Cryptorchidism

Cryptorchidism Cryptorchidism increases the risk for testicular malignancy.

Which genitourinary assessment should be used prior to the removal of renal stones or tumors from the urinary bladder? CT Scan Cystoscopy Voiding cystourethrogram (VCUG) Dimercaptosuccinic acid (DMSA) renal scan

Cystoscopy Cystoscopy would provide an examination of the bladder and lower urinary tract. This study is anatomical, not functional. Visualization and removal of tumors and stones are possible.

A patient with inflammatory bowel disease (IBD) presents with weight loss, dehydration, and anemia. The patient is at the 15th percentile for weight and has been experiencing severe and frequent diarrhea and vomiting. What will the nurse teach the child's parents about dietary management of the condition? Give the child daily vitamins. Administer total parenteral nutrition. Provide the child with a high-fiber diet. Include high-fat dairy products in the child's diet.

Daily vitamins

Why do children with chronic renal failure have anemia? Diet Fluid intake Recurrent infection Decreased erythropoietin

Decreased erythropoietin Anemia in children with chronic renal failure is related to decreased production of erythropoietin. Recombinant human erythropoietin is offered to these children to eliminate the need for frequent blood transfusions. Diet, fluid intake, and recurrent infection are not related to anemia and chronic renal failure.

A child is diagnosed with esophageal atresia and is not gaining weight as expected. Which finding on a follow-up examination indicates that the expected outcomes for this patient have not been met? Child crying Good skin turgor Elevated heart rate Decreased urinary output

Decreased urinary output The nurse should note intake and output to determine whether the expected outcome of adequate hydration is being achieved. A decreased urinary output suggests that the patient is dehydrated and the outcome has not been met.

After eating hamburgers at the state fair, a patient develops bloody diarrhea. At the emergency department they are given IV antibiotics and fluids. During hospitalization, the nurse notes the patient is oliguric. Within a few days, the patient has copious amounts of dilute urine. Which is the most important complication for the nurse to assess for? Reactivation of HUS caused by dormant bacteria Edema caused by excessive loss of electrolytes in urine Dehydration caused by the inability to respond to antidiuretic hormone Dehydration and electrolyte imbalance due to slow nephron tubule recovery

Dehydration and electrolyte imbalance due to slow nephron tubule recovery The increase in GFR exceeds the tubular recovery and therefore copious, dilute urine is produced. When reabsorption and secretion do not occur normally, electrolyte imbalance is a concern.

The nurse is preparing a 3-year-old child for the examination of the urethra and taking a urine sample. What strategy should the nurse use while preparing the child? Demonstrate and explain the procedure on a doll. Explain the urinary system and procedure to the child. Show pictures of the urinary system and the procedure. Ask the parents to explain the procedure to the child.

Demonstrate and explain the procedure on a doll A 3-year-old child is too young to understand the procedure of examining the urinary system. The nurse should explain the procedure by demonstrating it on a doll. This should be done to eliminate fear in the child's mind before the examination. The child will not be able to understand the anatomy of the urinary system; thus, the nurse should not give a verbal explanation or show pictures of the urinary system. It is the nurse's responsibility to prepare the child for the examination. The nurse should not ask the parents to explain about the examination and the process of procuring the urine sample to the child.

A patient with glomerulonephritis is receiving intravenous fluids to regulate hydration but begins to experience pulmonary edema and worsening hypertension. Blood serum analysis shows hyperkalemia and increased BUN. The hyperkalemia does not respond to interventions. These clinical data should be an indication for the nurse to prepare for which steps in the management of acute renal failure? Dialysis Antibiotics Kidney transplant Update vaccinations

Dialysis In patients with acute renal failure, unresponsive hyperkalemia and increasing BUN, pulmonary edema and worsening hypertension are indications for dialysis.

What is the current treatment for end-stage renal disease? Dialysis and transplantation Limited sodium and water intake None available Restriction of protein intake

Dialysis and transplantation Dialysis and transplantation are the only treatments currently available for end-stage renal disease. Sodium and water intake are not usually limited unless there is evidence of edema or hypertension. Protein restriction is not recommended because it may negatively affect a child's growth and neurodevelopment. Treatment is available in the form of dialysis and transplantation.

The pediatric nurse is reviewing the record of a child scheduled for an office visit. Prior to assessing the child, the nurse notes documentation that the child has diurnal enuresis. Based on this diagnosis finding, the nurse plans to include which question during the assessment? "Do you wet the bed at night?" "Do you have a hard time using the bathroom?" "Do you use the bathroom frequently throughout the night?" "Do you wet yourself during the day while you're awake?"

Do you wet yourself during the day while you're awake?" Diurnal enuresis does indicate the child has urinary control ("wets" self) problems during wakeful times in the day.

An infant who presents with suspected celiac crisis would have which assessment findings? Select all that apply. Drowsiness Supple elastic skin Metabolic acidosis Sweet-smelling stool Hardened black stools

Drowsiness Unusual drowsiness or fatigue can be an indication of metabolic acidosis, which is a sign of celiac crisis. Metabolic acidosis An infant with suspected celiac crisis will present with metabolic acidosis.

Which dietary modification should be made for a child with encopresis? Select all that apply. Eat granola bars Increase water intake Eat whole-grain cereals Decrease vegetable intake Decrease milk and sugar intake

Eat granola bars Eating granola bars helps a child with encopresis by increasing fiber in the diet. Increase water intake Increasing fluid intake helps with softening stool. Eat whole-grain cereals Eating whole-grain cereals helps a child with encopresis by increasing fiber in the diet.

The nurse notices that the parents of a child admitted with congenital diaphragmatic hernia are not holding the child. Which nursing intervention is appropriate to assist in resolution of the problem? Explain to the parents that no child is perfect. Tell the parents that they must bond with the child. Encourage to the parents to spend time away from the child. Educate the parents about the condition and the treatment.

Educate the parents about the condition and the treatment. The parents are exhibiting signs of anxiety. The nurse should provide clear and truthful information about the condition, treatment plan, and prognosis to encourage participation of the parents in the treatment plan.

Which statements help to clarify the main differences between peritoneal dialysis and hemodialysis? Select all that apply. Efficiency of dialysis Time required for dialysis Types of products removed Location of catheterization Caregiver involvement in dialysis treatment

Efficiency of dialysis Hemodialysis is more efficient than peritoneal dialysis. Time required for dialysis Hemodialysis requires less time than peritoneal dialysis. Location of catheterization Hemodialysis requires direct vascular access. Peritoneal dialysis requires catheterization of the abdomen. The risk for infection at access site in hemodialysis is higher. Caregiver involvement in dialysis treatment Peritoneal dialysis typically requires parents/caregivers to be actively involved in the dialysis treatment. Hemodialysis is performed in hospital or clinical settings.

During feeding, an infant with pyloric stenosis begins to cough and wheeze. Which is the priority nursing action? Elevate the infant's head Provide supplemental oxygen Obtain a STAT chest radiograph Place the infant in the supine position

Elevate the infant's head The head of the bed is elevated to promote lung expansion and swallowing and assist in clearing the aspiration. This option addresses patient safety.

A patient has returned for a follow-up appointment for pharyngitis. The child now has altered electrolytes and an elevated ASO titer. The nurse notes facial edema and hypertension. Which finding confirms a diagnosis of acute poststreptococcal glomerulonephritis? Facial edema Hypertension Elevated ASO titer Altered electrolytes

Elevated ASO titer Elevated ASO titer provides evidence for acute poststreptococcal glomerulonephritis as it indicates a confirmation for strep infection.

A five-year-old boy presents to the emergency department with severe pain and scrotal swelling and is diagnosed with testicular torsion. The nurse should expect to prepare this patient for which treatment? Ultrasonography Ice and analgesics Emergency surgery High dose antibiotics

Emergency surgery Testicular torsion is a rotation of the testicle that interrupts blood supply and can cause permanent testicular damage. This is a medical emergency and will therefore require emergency surgery.

Which condition in the child brought to the emergency department is the likely cause of the symptoms of vomiting, fever, and diarrhea? Infection Bowel obstruction Poor gastric emptying Central nervous system disorder

Infection When vomiting is accompanied by fever and diarrhea, the underlying cause may be an infection. When vomiting is green and bilious, the underlying cause may be bowel obstruction. When vomiting has curdled stomach contents, mucus or fatty foods, and occurs many hours after ingestion, the underlying cause may be poor gastric emptying. When vomiting is associated with change in the level of consciousness or a headache, the underlying cause may be a central nervous system disorder.

A child presents with diarrhea after eating at a local restaurant. Which intervention should the nurse implement first? Restrict fluid Encourage diet restriction Inform the health department Prepare droplet precaution PPE

Inform the health department This is a public health concern. A dietary recall of possibly contaminated foods can be important in establishing the cause and minimizing the risk of spread to the public.

The nurse is providing discharge teaching to the parents of the child who had a urinary tract infection (UTI). The nurse tells the parents, "Always ask the child if he needs to use the bathroom. You should not let your child hold it for a long time." What is the reason for the nurse to give this advice to the parents? It would reduce the blood supply of the kidneys. It would cause severe abdominal pain in the child. It would inhibit the process of urine formation. It would increase the chances of another infection.

It would increase the chances of another infection Urinary stasis is the most important factor influencing the occurrence of UTI. Children at times may tend to hold urine for long periods of time, even when their parents repeatedly ask whether they feel the need to urinate. This is very important to prevent infections. Holding urine does not reduce the blood supply to the kidneys significantly. Abdominal pain is associated with UTIs and is not caused by holding urine. A child holding his or her urine does not impact urine formation.

When assessing a child treated for intussusception, which behavioral finding would indicate the expected outcomes had been met for that child? Guarding Flexing the legs Crying while standing Knocking over blocks

Knocking over blocks

A child has been diagnosed with cleft palate, and the nurse is meeting with the caregivers. What are appropriate interventions by the nurse? Select all that apply. Listen to the caregivers' questions. Teach the effectiveness of verbalizing concerns. Ensure consent forms for surgery have been signed. Assure the parents that they have nothing to worry about. Encourage the parents to leave the hospital for the night, as the child will be sedated.

Listen to the caregivers' questions. Listening will help caregivers cope with a cleft palate diagnosis. Family members should be allowed to work through what has happened to their child. Correct Teach the effectiveness of verbalizing concerns. The nurse should encourage and help the caregivers to verbalize their feelings, perceptions, and fears to aid in the coping process. Correct Ensure consent forms for surgery have been signed. The nurse should ensure all consent forms for surgery have been signed by the caregivers.

The nurse is evaluating a patient with cleft lip to determine whether collaborative care was able to achieve the expected outcome. Which action should the nurse take to determine whether a child with cleft lip and palate is achieving adequate nutrition? Monitor feeding technique. Measure height and weight. Measure head circumference. Make sure the child is burped after each feeding.

Measure height and weight. Measuring height and weight will help the nurse to determine whether a child with cleft lip and palate is achieving adequate nutrition.

An 8-year-old child with a stomach ulcer passes a dark-colored, tarry stool. As what does the nurse document this? Melena Meconium Hematemesis Hematochezia

Melena Melena is dark-colored, tarry stool that suggests upper GI bleeding such as from the stomach. Meconium is the first stool of a newborn. Hematemesis is vomiting bright red blood and hematochezia is passage of bright red blood per rectum, usually indicating lower GI tract bleeding.

The nurse is caring for a patient diagnosed with a hiatal hernia. Which assessments should be performed to determine that treatment has been effective? Select all that apply. Palpate the abdomen. Monitor intake and output. Monitor intravenous (IV) fluids. Assess the patient for vomiting. Assess patient adherence to use of medication.

Monitor intake and output. Patients with hiatal hernia often present with vomiting, putting them at risk for inadequate nutrition. Monitoring intake and output will allow the nurse to determine whether treatment is improving the nutritional status of the patient. Assess the patient for vomiting. Patients with hiatal hernia often present with vomiting, putting them at risk for inadequate nutrition. By assessing for vomiting, the nurse can determine whether the treatment is reducing the symptoms.

Which nursing actions are important in the care of a patient with cirrhosis after a liver biopsy? Placing the patient in a prone position Palpating for an olive shaped mass Monitoring hemoglobin and hematocrit Assessing for red currant jelly-like stools

Monitoring hemoglobin and hematocrit Monitoring hemoglobin and hematocrit is important after a liver biopsy, because the most common complication is internal bleeding. Placing the patient prone is not appropriate, because it doesn't promote breathing. Right side positioning is best. Pyloric stenosis is associated with an olive shaped mass. This would not be an expected nursing action. Red currant jelly-like stools are associated with intussusception, not cirrhosis or an expected complication of a liver biopsy.

What is an important nursing consideration when caring for a child with end-stage renal disease (ESRD)? SATA The child with ESRD usually adapts well to the minor inconveniences of treatment. The child with ESRD requires extensive support until they outgrow the condition. Multiple stresses are placed on the child and family with ESRD until the illness is cured. Multiple stresses are placed on the child and family with ESRD because the child's life is maintained by drugs and artificial means.

Multiple stresses are placed on the child and family with ESRD because the child's life is maintained by drugs and artificial means. ESRD is a chronic, progressive disease with dependence on technology. Families need to arrange for continuing examinations and procedures that are painful and may require hospitalization. ESRD is a complex disease process that requires substantial medical intervention. ESRD cannot be outgrown or cured. Dialysis is necessary until renal transplantation is performed.

The nurse is caring for a child with gastroesophageal reflux disease (GERD). Which medications would the nurse anticipate being ordered? Albuterol Omeprazole Erythromycin Acetaminophen

Omeprazole Omeprazole is a proton pump inhibitor that is given to patients with GERD to decrease the amount of stomach acid and prevent symptoms.

The nurse is evaluating how a couple is coping with their young child's diagnosis of cleft lip. For which signs does the nurse look to determine whether effective coping is taking place? Parents do not voice fears. Parents will not hold the child. Parents plan and organize all special care appointments. Parents sit quietly in the room without looking at the child.

Parents plan and organize all special care appointments. Taking control over the special care needs of the child indicates that parents are coping effectively with their child's cleft lip diagnosis.

Which symptom does the nurse identify as the most common clinical manifestation of gastroesophageal reflux (GER) in an infant? Gagging Coughing Excessive crying Passive regurgitation

Passive regurgitation Passive regurgitation is the most common clinical manifestation of GER in an infant. Gagging, coughing, and excessive crying are some other clinical manifestations of GER in an infant; however, passive regurgitation is the most common one.

The nurse is assessing a child with a tracheoesophageal fistula who has been coughing and choking during feeding. The child is in the 45th percentile for weight, and vital signs are normal. Which nursing intervention is appropriate to ensure that the expected outcome is achieved for this patient? Administer intravenous fluids. Place child in prone position. Provide the child with a pacifier. Place child on a chalasia board.

Place child on a chalasia board. Management of a child with a tracheoesophageal fistula focuses on preventing aspiration. Placing the child in a chalasia board at a 30-degree angle would help minimize the risk of aspiration.

Which intervention should the nurse use to reduce anxiety in parents of a child with congenital diaphragmatic hernia? Select all that apply. Provide discharge teaching. Refer parents to a support group. Inform the parents about the procedure. Teach the parents standardized feeding techniques. Allow the parents to yell in order to express emotions.

Provide discharge teaching. Providing discharge teaching will help reduce the parents' anxiety by providing an explanation of how to care for their child at home. Refer parents to a support group. Providing referral to support groups will help reduce the parents' anxiety by allowing them to meet other parents whose child is like theirs. Inform the parents about the procedure. Providing clear, truthful information will help reduce the parents' anxiety. They will have an idea on how to care for the child at home. Teach the parents standardized feeding techniques. Teaching the parents prescribed feeding techniques will help reduce their anxiety because they will know how to effectively feed their child at home.

Which urine test of urinary system function is used to visualize the renal vascular system? Urodynamics Specific gravity Renal angiography Retrograde pyelography

Renal angiography Renal angiography is used to visualize the renal vascular system, especially for renal arterial stenosis. Urodynamics is a set of tests designed to measure bladder filling and storage and evaluate function. Specific gravity is used to determine the specific gravity of the urine and is helpful in determining dehydration status. Retrograde pyelography is used to visualize the pelvic calyces, ureters, and bladder.

Which is the most common cause of diarrhea in children under 5? Rotavirus Salmonella Escherichia coli Clostridium difficile

Rotavirus The most common cause of diarrhea in children under 5 is rotavirus. There is a high incidence of Salmonella and Escherichia coli in the summer months but rotavirus is the most common cause of diarrhea in children under 5. Clostridium difficile is associated with alteration of normal intestinal flora by antibiotics.

A 9-year old boy is brought into the health care provider's office with concerns about his reaction to his parent's divorce. The child has been unusually withdrawn and stays in his room, refusing to see anyone, often not even coming out to go to the bathroom. On assessment the nurse notes a foul fecal odor coming from the child. Which complication of constipation would the nurse suspect? Tenesmus Depression Primary encopresis Secondary encopresis

Secondary encopresis The child is showing signs of secondary encopresis: he has lost continence he previously had. The encopresis is probably in reaction to the stress of his parent's divorce and will most likely resolve as the stress of the situation wanes.

A child with gastroenteritis is receiving treatment for dehydration. Which assessment findings indicate treatment has been effective? Serum sodium 158 mEq/L Serum potassium 3.9 mEq/L Urine output of 100 mL in 4 hours Absence of skin breakdown on anus

Serum potassium 3.9 mEq/L A normal serum potassium level is between 3.5 and 5.0 mEq/L. A serum potassium of 3.9 is considered normal and would indicate effective treatment.

Which are common causes of functional constipation among school-age children? SATA Stresses Hypothyroidism Environmental changes Change in toileting pattern Increased sporting activities

Stresses, environmental changes, change in toileting patterns Common causes of functional constipation among school-age children include stress, environmental changes, and change in toileting pattern. Hypothyroidism is an organic cause of constipation. Increased activity associated with sporting activities would promote normal stooling.

The nurse is caring for a child with celiac disease who requires fluid resuscitation. Which assessment findings would the nurse anticipate after treatment has begun? Select all that apply. Drowsiness Sunken eyes Supple skin Skin elasticity Crying without tears

Supple skin Supple skin is a sign of adequate hydration. Good skin turgor and moist mucous membranes indicate the fluid resuscitation is successful. Skin elasticity Skin elasticity is a sign of adequate hydration. Good skin turgor indicates that the fluid resuscitation is successful.

A child is receiving a combination of prednisone, tacrolimus, and mycophenolate for a kidney transplant. The child's parents ask the nurse the reason for these medications. What is the nurse's best explanation? Decrease pain Boost immunity Suppress rejection Improve circulation to the kidney

Suppress rejection A combination of prednisone, tacrolimus, and mycophenolate is given to suppress rejection. Prednisone, tacrolimus, and mycophenolate do not decrease pain, boost immunity, or improve circulation.

The nurse is speaking with the family of a pediatric patient with celiac disease. Which patient symptom, reported by the parents, requires immediate action? Flaky skin Formed stools Tearless crying Abdominal distention

Tearless crying Tearless crying is an indication of dehydration and should be addressed immediately to prevent further exacerbation of the problem.

The nurse is preparing a child and the parents for a colostomy. Which situations, facilitated by the nurse, are most appropriate? Select all that apply. The child and parents should be allowed to eat lunch together. The child and parents should be allowed to witness another colostomy. The child and the parents should not be allowed to interact before the surgery. The child and parents are given the opportunity to see the equipment before surgery. The child and parents are given the opportunity to manipulate the equipment before surgery.

The child and parents are given the opportunity to see the equipment before surgery. The nurse would allow the child and parents to see the equipment before surgery. This helps to relieve some anxiety about the surgical process. Correct The child and parents are given the opportunity to manipulate the equipment before surgery. The nurse would allow the child and parents to manipulate the equipment before surgery. This helps to relieve some anxiety about the surgical process.

A 4-year-old patient is diagnosed with congenital diaphragmatic hernia. What are appropriate nursing outcomes for this patient? Select all that apply. The patient's mucosa will appear pink. The patient will play outside for 3 hours. The patient will have minimal wheezing. The patient will have regular breath sounds. The patient will sit quietly while tests are run.

The patient's mucosa will appear pink. It is important that the patient not experience cyanosis, which may accompany a hernia. The patient will have regular breath sounds. An expected complication of hernia is diminished or absent breath sounds. Regular breath sounds on auscultation are an appropriate outcome.

Why does a nurse administer antipyretics to a child with acute diarrhea? To reduce a high temperature To treat severe dehydration and vomiting To treat pathogens causing gastrointestinal losses To rehydrate and replace fluid lost through the stools

To reduce a high temperature Children with diarrhea may also have fever. Antipyretics are administered to reduce the high temperature. Intravenous fluids are administered to treat severe dehydration and vomiting. Antimicrobial agents are administered to treat specific pathogens causing gastrointestinal losses. Oral rehydration solutions are administered to rehydrate and replace stool losses.

A child presents to the pediatric office with incontinence and strong-smelling urine. For what condition should the child be evaluated? Sexual abuse Nephritic syndrome Urinary tract infection Structural defect of the urinary tract

UTI A child who exhibits clinical symptoms of incontinence and strong-smelling urine should be evaluated for a urinary tract infection. Incontinence and strong-smelling urine are not associated with sexual abuse, nephritic syndrome, or structural defects of the urinary tract.

The nurse is demonstrating appropriate oral hygiene for a repaired cleft lip before patient discharge. Which actions does the nurse demonstrate to protect the repair site from complications or infection while it is healing? Brush the child's teeth. Use a cotton swab to clean the mouth. Use alcohol to clean the cleft lip repair site. Clean using a rolling motion horizontally along the suture line.

Use a cotton swab to clean the mouth. The nurse should demonstrate how to use a cotton swab or saline to clean the area after a feeding to remove debris.

Which action can exacerbate respiratory distress in a patient with congenital diaphragmatic hernia? Using a nasogastric (NG) tube Elevating the head of the bed Using a facemask or bag valve mask for ventilatory support Using a high-frequency ventilation system for ventilatory support

Using a facemask or bag valve mask for ventilatory support Air can enter the stomach and further impair respiratory function.

A nurse is concerned that a child with an upper gastrointestinal hernia is experiencing an imbalance in nutrition. Which symptom should the nurse document? Bleeding Vomiting Diarrhea Constipation

Vomiting Vomiting is the clinical manifestation of hernias that can contribute to an imbalance in nutrition.

The nurse is caring for a child with celiac disease. The mother reports that the child attended a birthday party and ate cake. Which assessment finding would the nurse anticipate? Watery stools Peripheral edema Pronounced tachypnea More frequent eructation

Watery stools Loose stools are a result of failure to eliminate gluten from the diet by a child with celiac disease.

The nurse should report which urine test result to the healthcare provider? pH of 4 Absence of protein Absence of glucose Specific gravity of 1.020

pH of 4 The expected pH of urine is 4.8 to 7.8.A specific gravity of 1.020 is within the normal range of 1.015 to 1.030. Protein should not be present in the urine; it indicates an abnormality in glomerular filtration. Glucose should not be present in the urine; it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

The nurse is providing discharge teaching to the parents of a child with pyloric stenosis. Which statements, made by the parents, indicate that teaching was effective? Select all that apply. "After surgery, I will be allowed to change my child's diapers." "This condition will affect the way my child absorbs my breast milk." "I can't talk with my friends about my child's condition because they don't understand." "We will have to get a second job to afford the medication that will cure him." "I have the number for the support group the social worker gave me this morning, and I will call today."

"After surgery, I will be allowed to change my child's diapers." Parents should be allowed to participate in the care of their child when appropriate. "This condition will affect the way my child absorbs my breast milk." Parents should understand that malabsorption is a possibility for children with pyloric stenosis. "I have the number for the support group the social worker gave me this morning, and I will call today." Having a viable support system provides comfort while caring for the child and helps to reduce anxiety.

The nurse is teaching a parent how to care for a child's gastrostomy tube. Which statement, made by the parent, indicates successful patient teaching? Select all that apply. "I will clean the area with alcohol." "I will apply antimicrobial ointment if indicated." "It is not necessary to clean new gastrostomy-tube." "I will make sure the tube remains closed after surgery." "If crusty drainage appears, I will use half-strength hydrogen peroxide."

"I will apply antimicrobial ointment if indicated." Applying antimicrobial ointment if indicated is an appropriate care method for a new gastrostomy. "If crusty drainage appears, I will use half-strength hydrogen peroxide." Using hydrogen peroxide is an appropriate care method for a new gastrostomy.

A nurse is preparing the family of an infant who has undergone a pyloromyotomy for discharge. The infant is currently receiving electrolyte solution during feedings. Which statements by the parent suggest successful patient teaching to ensure an optimum outcome for the infant after surgery? SATA "A yellow discharge from the surgical site is normal." "I will offer my baby full-strength breast milk in a few days." "I will report gastrointestinal issues to the primary health care provider." "We do not breastfeed, so I will offer my baby full-strength formula in a few days." "A fever of less than 102° F is not cause for concern and can be treated with antipyretics."

"I will offer my baby full-strength breast milk in a few days." If the infant is breast fed, full-strength breast milk may be introduced after electrolyte solution has been given. "I will report gastrointestinal issues to the primary health care provider." The parent must report excessive vomiting or abdominal tenderness to the health care provider, as it may indicate infection. Moreover, excessive vomiting may lead to dehydration and malnutrition.

A nurse is caring for the parents of an infant who is discovered to have hydronephrosis. The parents ask why the infant will need to be tested for a urinary tract infection (UTI) at birth. Which is the best response by the nurse? "Hydronephrosis is an infection of the kidneys making UTIs likely." "This is a routine testing. We screen all neonates for a UTI at birth." "Hydronephrosis is a malformation of the bladder and urethra, causing urine retention and infection." "Infants with hydronephrosis can have urine flow back into the kidneys from the bladder, causing bacterial growth."

"Infants with hydronephrosis can have urine flow back into the kidneys from the bladder, causing bacterial growth." Infants with hydronephrosis are prone to having VUR (vesicoureteral reflux), which causes urine to back up into the kidneys causing urinary stasis and bacterial growth.

A nurse is caring for a 7-year-old male who is not circumcised. The child has had recurrent UTIs. What information should the nurse share with the child to help reduce the likelihood of repeat UTIs? "You may need to take an antibiotic every day to keep from getting UTIs." "Make sure to empty your bladder completely when you go to the bathroom." "Make sure to clean your foreskin carefully each time you go to the bathroom." "Boys are more likely to get UTIs than girls due to the length of their urethra. There is nothing you can do to change that risk factor."

"Make sure to clean your foreskin carefully each time you go to the bathroom." Uncircumcised boys are at risk for having UTIs due to the potential for collection of stool under the foreskin of the penis. They should be advised to clean their penis carefully after having a bowel movement.

The nurse is caring for an infant with gastroesophageal reflux disease (GERD). Which action by a parent, observed by the nurse, indicates teaching was effective? The infant is fed every 1 to 2 hours. A pacifier is clipped to the infant's car seat. The infant is placed on the stomach to sleep. The parent administers acetaminophen when the infant cries.

A pacifier is clipped to the infant's car seat. Using a pacifier reduces crying and encourages swallowing in infants with GERD.

The parents of a 2-month-old girl bring her in for treatment. The infant has had infrequent bowel movements since birth, and the parents describe the recent appearance of ribbon-like-foul smelling stools when changing her diaper. What other clinical manifestation might the nurse observe? Abdominal bruising Abdominal distention Appropriate weight gain Relaxing internal sphincter

Abdominal distention Abdominal distention is a clinical manifestation of Hirschsprung disease that the nurse might observe. Increased gas can contribute to abdominal distention.

The nurse is caring for a child with intussusception who presented with vomiting and diarrhea. Laboratory values reveal elevated serum sodium and elevated hematocrit. Which priority action should the nurse take to achieve the expected outcomes for this patient? Asses the child's A1c Increase dietary iron Notify the provider immediately Encourage the child to sit up in a chair Administer intravenous (IV) normal saline

Administer intravenous (IV) normal saline

A child with irritable bowel disease presents with complaints of severe intestinal cramping, diarrhea, and bloating. Which intervention is most important in achieving the desired outcome for this patient? Administer oral prednisone. Administer IV pain medication. Administer oral metronidazole. Administer intravenous (IV) normal saline bolus.

Administer intravenous (IV) normal saline bolus.

Which structure can dilate to increase blood flow to the nephron? Renal artery Afferent arteriole Efferent arteriole Peritubular capillaries

Afferent arteriole The afferent arteriole is the vessel leading into the glomerulus. If this vessel is dilated, there is an increase in blood flow to the nephron.

A child with inflammatory bowel disease (IBD) is experiencing an acute flare-up. Which type of diet will the nurse recommend to help the child maintain adequate nutrition during this episode? An elemental diet A high-fiber, high-residue diet A diet high in folate and vitamin C Total parenteral nutrition (TPN) and lipids

An elemental diet

During abdominal assessment, the nurse notes hypoactive bowel sounds, abdominal distention, vomiting, and currant jelly stools. Which interventions would the nurse expect to provide for this patient? Antipyretic Barium enema IV normal saline Intravenous antiemetic Abdominal ultrasonography

Barium enema A definitive diagnosis can be made and treatment provided simultaneously with a barium enema, which allows hydrostatic reduction of the intussusception to be done. Correct IV normal saline IV normal saline is given to prevent dehydration from vomiting. Correct Intravenous antiemetic An antiemetic would be administered to treat vomiting. Correct Abdominal ultrasonography Abdominal ultrasonography is useful in identifying the location of the intussusception and the amount of edema in the area.

The nurse is providing diet teaching to a patient with impaired renal function. The nurse reviews the lunch menu and instructs the patient to avoid which food item? Select all that apply. Brown rice with baked chicken Chicken nuggets, french fries, and whole milk Broiled fish, garden salad, and vinaigrette dressing Canned beef and noodle soup, toast, and a sports drink Vegetable wrap on whole grain, baby carrots, and apple juice

Chicken nuggets, french fries, and whole milk Due to risk for fluid overload and fluid retention, the patient with renal impairment should avoid foods high in sodium, as these will exacerbate the issue. This meal is high in sodium. Canned beef and noodle soup, toast, and a sports drink Because the patient with renal impairment is at risk for fluid overload and fluid retention, they should avoid foods high in sodium, as these will exacerbate the issue. This meal is high in sodium.

A nurse is caring for a child recently diagnosed with celiac disease. Which lunch selections are most appropriate? Select all that apply. Roast beef sandwich on pumpernickel toast with fruit salad. Apples and cream oatmeal with dried pineapples and pecans. Chicken stir-fry with white rice, carrots, onions, and broccoli. Roasted turkey sandwich on multigrain bread with potato chips. Fresh ham on a corn tortilla with mashed potatoes and mandarin oranges.

Chicken stir-fry with white rice, carrots, onions, and broccoli. Children with celiac disease do not need to eliminate white rice from their diet. Rice of any kind can be used as a substitute for grains that contain gluten. Fresh ham on a corn tortilla with mashed potatoes and mandarin oranges. Children with celiac disease do not need to eliminate corn from their diet. Corn should be used as a substitute.

The nurse is evaluating a patient with encopresis. Which findings would the nurse expect on assessment after taking patient history? Select all that apply. Child has fecal stains in the underwear. Child plays video games for hours alone. The child is captain of the middle school soccer team. Child spends weekends having sleepovers with friends. Urinalysis reveals the child's fourth urinary tract infection in 16 months.

Child has fecal stains in the underwear. Having soiled clothing is indicative of encopresis. Child plays video games for hours alone. Social withdrawal is indicative of encopresis. Urinalysis reveals the child's fourth urinary tract infection in 16 months. Frequent urinary tract infections and urinary incontinence are indicative of encopresis.

When at home, which intervention is the most important for a child with gastroenteritis? Encouraging a proper diet Showering at least twice each day Washing hands with alcohol-based sanitizer Encouraging frequent sips of water every few minutes

Encouraging frequent sips of water every few minutes Proper rehydration to prevent the need for hospitalization is the priority for a child with gastroenteritis.

Which action should the nurse take to decrease the spread of infection from a patient with Clostridium difficile infection? Select all that apply. Enforce hand washing Monitor urine output Provide acetaminophen Enforce contact precautions Check temperature every 4 hours

Enforce hand washing Hand hygiene will help to decrease the spread of infection from a patient with Clostridium difficile infection. Enforce contact precautions Contact precautions must be strictly enforced for all staff and family members to minimize the risk of spreading the infection.

A 4-year-old female child has had several UTIs during the school year. The nurse knows that which bacteria is most likely causing the young girl's UTIs? Group B Strep K. pneumoniae Proteus species Escherichica coli (E. coli)

Escherichica coli (E. coli) Young girls tend to get UTIs associated with E. coli due to the proximity of the urethra to the rectum and stool. All young girls should be instructed to wipe from front to back to minimize the risk of infections.

Which patient scenarios should the nurse anticipate care for dialysis or kidney transplant? Select all that apply. Estimated GFR of ≤10%, hypertensive, anemic. Estimated GFR of 100% with hypertension and UTI. Severe hypertension and edema that are unresponsive to interventions. Resolving hyperkalemia, estimated GFR >50%, moderate hypertension. Severe edema and congestive heart failure. Hypertension and increasing BUN levels.

Estimated GFR of ≤10%, hypertensive, anemic. Once GFR has fallen below 10%, the patient is in ESRD and requires dialysis or kidney transplant. Severe hypertension and edema that are unresponsive to interventions. All of the listed manifestations, when present together, indicate the requirement for dialysis. Severe edema and congestive heart failure. Hypertension and increasing BUN levels. The severe edema, congestive heart failure, and hypertension may all be related to fluid overload. The increasing BUN levels are suggestive of renal insufficiency and dialysis may be indicated.

A 6-month-old infant has dysuria, poor weight gain, and is irritable. The infant is nonfebrile. During the check-up you notice a foul smell from the urine in the diaper. A urinary tract infection (UTI) is suspected and a urine culture (UCS) is ordered. What evidence is used to differentiate UTI from pyelonephritis? Fever Dysuria Irritability Poor weight gain

Fever Infants and young children (>24 months) are presumed to have pyelonephritis if they have symptoms of fever.

Which 3 factors need to be considered when planning care for a patient diagnosed with ESRD? Select all that apply. GFR Quality of life Blood pressure Hydration status Serum creatinine and BUN levels

GFR GFR ≤10% indicates significant reduction in nephron functionality. Quality of life A child's quality of life is considered in the diagnosis of ESRD. Once a child is diagnosed with ESRD, dialysis or kidney transplant is required. Serum creatinine and BUN levels Increasing creatinine and BUN levels are indications of declining renal function.

When assessing an infant with a tracheoesophageal fistula, which findings would be expected? Select all that apply. Crying when not being held Gagging during bottle feeding Blue discoloration around the mouth Coughing after latching onto breast for feeding Abnormally high platelet count and thrombin level

Gagging during bottle feeding Choking is considered one of the 3Cs of tracheoesophageal fistula. Blue discoloration around the mouth Cyanosis, or blue discoloration, is considered one of the 3Cs of tracheoesophageal fistula. Coughing after latching onto breast for feeding Coughing is considered one of the 3Cs of tracheoesophageal fistula.

The nurse is caring for a child with Hirschsprung disease who has abdominal distention and hard, dry stools. Which food choices would be most appropriate? Select all that apply. Macaroni and cheese Grapes and apple slices Boiled cabbage and broccoli Cinnamon raisin granola bars Fried chicken tenders and fries

Grapes and apple slices Grapes and apple slices are high in fiber and would be included in the diet selection for a child with constipation. Boiled cabbage and broccoli Vegetables should be included in the diet selection for the child with constipation, but fresh vegetables are preferred over boiled for their nutritional value. Cinnamon raisin granola bars Granola and raisins are both high in dietary fiber and would be included in the diet selection for a child with constipation.

The nurse is caring for a child who presents with abdominal distention and currant jelly stools. Since admission, the patient's blood pressure has decreased and the patient has become lethargic. Which is the priority nursing action for this patient? Notify the health care provider Administer intravenous (IV) pain medication Prepare the patient for abdominal ultrasonography Prepare the patient for magnetic resonance imaging (MRI) of the chest and abdomen

HCP

Which manifestations should the nurse likely anticipate for a patient diagnosed with HUS? Select all that apply. Hematuria Hemolytic anemia Thrombocytopenia Stool culture that is positive for E. coli Stool culture that is positive for Staph aureus

Hematuria Hematuria is a symptom often associated with HUS, and therefore the nurse will need to manage this symptom. Hemolytic anemia This is a symptom that is expected in a patient with HUS, therefore the nurse will need to treat this symptom. Thrombocytopenia Thrombocytopenia is expected in this patient with HUS, and therefore the nurse will need to implement care to manage this patient. Stool culture that is positive for E. coli This is a finding that will often appear in patients with HUS, and therefore this symptom will need to be managed by the nurse.

Which set of clinical evidence will prompt a nurse to prepare for managing a patient with glomerulonephritis over nephrotic syndrome? Select all that apply. Hematuria Hypotensive Hypertensive Frothy urine Pallor & fatigue Abrupt onset edema

Hematuria Hypertensive Abrupt onset edema

Both nephrotic syndrome and glomerulonephritis have similar clinical manifestations. What evidence can be used to distinguish between the two disease states? Select all that apply. Hypertension Gross hematuria Glomerular dysfunction Normal serum albumin levels Normal serum electrolyte levels

Hypertension In glomerulonephritis the patient is hypertensive. In nephrotic syndrome the patient may be normo- or hypo-tensive. Gross hematuria Gross hematuria is evident in glomerulonephritis. Microscopic hematuria may be present in nephrotic syndrome Normal serum albumin levels Normal serum albumin levels are found in glomerulonephritis. Hypoalbuminemia is a symptom of nephrotic syndrome. Normal serum electrolyte levels Normal serum electrolyte levels are seen in nephrotic syndrome. Altered electrolyte levels are found in glomerulonephritis.

Which explanation describes the rationale for immunizing children prior to receiving a kidney transplant? Immunosuppression that is required after transplant increases the risk for infections. After transplant, immunizations should be updated to provide specific protection for the new organ. The transplanted organ may harbor microbes, including viruses, to which the recipient was not previously exposed. Immunizations facilitate the systemic immunosuppression. Other immunosuppressive treatments only target functions of the kidney.

Immunosuppression that is required after transplant increases the risk for infections. Immunizations will initiate an immune response that is specific for the antigens of the inoculation. This will provide future protection.

A family brings their toddler to the clinic because of frothy urine and a swollen face. Serum analysis confirms hypoalbuminemia and elevated hematocrit levels. The child is normotensive. Based on this clinical data, what care measure should the nurse anticipate in managing this patient? Hemodialysis to decrease edema Immunosuppression with corticosteroids Give normal saline IV to decrease hematocrit Decrease protein in diet to compensate for hypoalbuminemia

Immunosuppression with corticosteroids For the child with nephrotic syndrome, corticosteroids are continued until child is in remission—defined as <1+ urine protein for 3-7 consecutive days. Steroids are typically continued at the same daily dose for 4-6 weeks.

A 3-year-old, uncircumcised male is seen in the emergency department for emesis that started 4 hours ago. His mother states he has grade IV vesicoureureteral reflux (VUR). Urinalysis was positive for ketones and urine culture was negative. PO challenge was tolerated with no further emesis. What information would be important to help the family prevent UTI in this patient? Select all that apply. Increase frequency of voiding Proper cleaning of the prepuce Decrease the volume of fluid intake Significantly increase volume intake Antibiotic prophylaxis would be beneficial

Increase frequency of voiding Using timed voiding (urinating at scheduled times), before the child has the urge to urinate, can increase elimination and decrease urine stasis. Proper cleaning of the prepuce In the uncircumcised male, it is important that the caregivers or child learn to properly clean the prepuce to decrease bacteria. Antibiotic prophylaxis would be beneficial UTI is the most common clinical manifestation of VUR, therefore, it is appropriate to use antibiotic prophylaxis.

A renal parenchymal histological report of a 2-year-old patient confirms evidence of rare bilateral Wilms tumors affecting the kidneys. As the surgeon prepares for surgery, why is palpating or putting pressure on the abdomen avoided? Increased pressure on the tumor may cause a significant rise in blood pressure. Palpation or pressure near the tumor may cause it to shift and increase the difficulty of removal. Only with bilateral Wilms tumors will the surgeon use extra precautions to prevent the tumors from colliding. Increased pressure may cause the tumor to rupture and cancer cells may spread throughout the abdominal cavity.

Increased pressure may cause the tumor to rupture and cancer cells may spread throughout the abdominal cavity. Nurses often post signs to warn against palpation or pressure on the abdomen or tumor to prevent the rupture and spillage of tumor cells into the peritoneum. Family members should be aware of this precaution as well.

The nurse understands that a patient with hydronephrosis will be most predisposed to UTIs because of which change? Increases urine stasis Increases renal perfusion Increases urine production Increases urinary elimination

Increases urine stasis Hydronephrosis is the swelling of the kidney due to a build-up of urine, which can lead to urine stagnation and increase the possibility of pathogen multiplication and the development of infection.

In which situation should peritoneal dialysis be favored over hemodialysis? Infants who are hemodynamically unstable Adolescents with chronic kidney disease (CKD) Infants with severe urinary tract infection (UTI) Adolescents with end-stage renal disease (ESRD)

Infants who are hemodynamically unstable Peritoneal dialysis is a slower process and therefore prevents dramatic shifts in fluid and electrolytes.

What questions should help the nurse identify an underlying cause of enuresis? Select all that apply. Is your child losing weight? Does your child currently have a fever? Has your child grown in height recently? Has your child been dry at night until recently? Does your child complain of pain during urination?

Is your child losing weight? If the child is losing weight, the cause may be diabetes. The increased urine production due to glucose diuresis may cause the enuresis. Does your child currently have a fever? If the child has a fever, this may indicate infection. The child may have a UTI that is causing the enuresis. Has your child been dry at night until recently? Determining how long the child has been dry at night can specify primary or secondary enuresis.

Urine culture results show >100,000 colonies/mL of urine, indicating an infection. What is the next best step in the assessment? Isolate and identify the pathogenic bacteria. Renal ultrasonography can be used to examine the bladder. Insert a urinary catheter to facilitate voiding and determine urine output. Complete serum studies to determine BUN, serum creatinine, and serum osmolality.

Isolate and identify the pathogenic bacteria. Isolation and identification of the pathogenic bacteria is required. After identification of antibiotic sensitivity, the patient can be given the appropriate antibiotic.

Which elements of a dietary regime are helpful in the therapeutic management of a child with CKD? Select all that apply. Include foods with sodium. Limit (regulate) fluid intake. Include foods the child enjoys. Allow the child to consume fluids freely. Individualize plan within restrictive parameters.

Limit (regulate) fluid intake. Regulating fluid intake will prevent exacerbation of edema and hypertension. Include foods the child enjoys. Including foods the child enjoys will be helpful for maintaining positive attitude in the child and may facilitate consumption of less favored foods. Individualize plan within restrictive parameters. Plans need to be individualized to ensure each child receives the nutrition needed without exacerbating symptoms of CKD.

A child is diagnosed with and treated for inflammatory bowel disease (IBD). Which action by the child best indicates that the desired outcomes have been met? Decrease in crying Drinking milk with dinner Playing a game with a sibling Decrease in bowel movements to 6 per day

Playing a game with a sibling

The nurse is caring for a 6-year-old patient with a UTI. The nurse should anticipate which items may be included in treatment? Select all that apply. Qinolones Tetracyclines Nitrofurantoin Cephalosporins Trimethoprim-sulfamethoxazole

Nitrofurantoin This antibiotic medication is used to treat UTI caused by E. coli and S. saprophyticus (both found in feces). Cephalosporins Cephalosporins are used to treat UTI, though not as effectively as oral antibiotics, and are best used for parenteral treatment against more resistant strains. Trimethoprim-sulfamethoxazole This antibiotic medication has been shown to be effective against most of the bacterial species that cause UTI.

The nurse is caring for a child diagnosed with Crohn's disease. Which assessment findings would be concerning? Select all that apply. Nocturnal diarrhea Loss of 5 pounds in 1 week Gain of 2 pounds in 3 days Decreased albumin and hemoglobin levels Rapid recoil when skin of the sternum is pinched

Nocturnal diarrhea Loss of 5 pounds in 1 week Decreased albumin and hemoglobin levels

A common cause of HUS is the bacteria E.coli. Upon infection of the upper gastrointestinal tract, the bacteria secrete a toxin (Shiga toxin) which damages the endothelial walls of the capillaries and causes inflammation. How does this relate to renal function? Occlusion of the glomeruli by inflammation can decrease GFR. The toxins damage the lining of the ureters and prevent peristalsis into the bladder. Occlusion of the glomeruli increases glomerular pressure and increases GFR causing diuresis. Damage to the endothelium can result in proteinuria due to decreased size permeability and decreased GFR.

Occlusion of the glomeruli by inflammation can decrease GFR. Damage to the endothelium leads to inflammation that can occlude or decrease flow in the glomerulus. This leads to a decrease in GFR.

A child with right lower quadrant pain and anorexia has begun vomiting. Which assessments are necessary to evaluate the outcome of nursing care for this patient? Select all that apply. Palpate the skin Auscultate the chest Measure urine output Obtain a food diary Measure arterial blood gases (ABGs)

Palpate the skin Measure urine output

Patient 1: Born with grade V VUR that is unresolved; has received conservative treatments to correct the reflux. Patient has developed a GFR of 10% over the past two months. Patient 2: Born with grade V VUR that is unresolved; has received conservative treatments to correct the reflux. Patient has a GFR of 50%. How should the nurse classify each patient based on the information provided? Select all that apply. Patient 1: Acute kidney injury Patient 1: Chronic kidney disease Patient 1: End-stage renal disease Patient 2: Acute kidney injury Patient 2: Chronic kidney disease Patient 2: End-stage renal disease

Patient 1: End-stage renal disease Patients with end-stage renal disease have irreversible kidney damage, as indicated by significant decrease in estimated GFR ≤10%. Patient 2: Chronic kidney disease Patients with chronic kidney disease have irreversible kidney damage, as indicated by estimated GFR 50%.

A 16-year-old female returns to the clinic with symptoms of UTI. This is her second UTI in 6 months since she has become sexually active. What is the most important information the nurse should provide to aid in the prevention of future UTIs? Increase fluid intake Urinate after sexual intercourse Increase the frequency of urination Urinate when first urge to void is sensed

Urinate after sexual intercourse The UTIs developed after patient became sexually active. This indicates she may need education related to urination after intercourse to flush the urethra.

What is the correct series of events for the progression from acute to end stage renal disease? Patient develops osteodystrophy (rickets) and anemia. The patient has rising serum creatinine & BUN levels and hypertension. Patient has a GFR of less than 10%. Dialysis is continued. Kidney transplant is indicated. Patient is not responding to treatments for hyperkalemia, GFR is estimated at 50%. Dialysis included in treatment plan. Patient has irreversible loss of kidney function. GFR is estimated to have fallen below 50% and patient has hypertension. Patient has edema, is hypertensive & hyperkalemic, and GFR is estimated at 50%. Optimistic regarding the ability to regain renal function.

Patient has edema, is hypertensive & hyperkalemic, and GFR is estimated at 50%. Optimistic regarding the ability to regain renal function. Patient is not responding to treatments for hyperkalemia, GFR is estimated at 50%. Dialysis included in treatment plan. Patient has irreversible loss of kidney function. GFR is estimated to have fallen below 50% and patient has hypertension. Patient develops osteodystrophy (rickets) and anemia. The patient has rising serum creatinine & BUN levels and hypertension. Patient has a GFR of less than 10%. Dialysis is continued. Kidney transplant is indicated.

After performing an assessment on a 7-year-old patient recovering from acute kidney injury, the nurse notes the following: proper skin integrity, increased urine output, decreased edema, and decreased general anxiety. What conclusion can be made regarding the assessment findings and the status of the acute kidney injury? Patient has increased urine output which indicates the acute kidney injury has not yet improved. Patient has relapsed without their knowledge. Increased urine output is the key finding during this assessment. Patient is regaining renal function as evidenced by proper skin turgor, increased urine production, and decreased fluid overload. Patient has signs of worsening acute kidney injury. The decrease in general anxiety is likely from acceptance of the diagnosis.

Patient is regaining renal function as evidenced by proper skin turgor, increased urine production, and decreased fluid overload. Proper skin integrity, increased urine output, and decreased edema are all indications that there is an improvement in renal function.

A 2-month-old boy was born prematurely and has bilateral cryptorchidism. What information should the nurse give the parents regarding immediate treatment? An orchiectomy will be performed for both testes. Orchiopexy will be necessary to bring the testis down into the scrotal sac. Patient will be observed for spontaneous descent of the testes which is common in the first 6 months of life. Testicular implant can be placed to preserve the scrotal appearance and reduce psychological consequences.

Patient will be observed for spontaneous descent of the testes which is common in the first 6 months of life. Age adjusting for the premature birth, the patient will be managed by observation until 6 months old. Spontaneous descent of the testes is common in the first 6 months of life.

Which other conditions should the nurse assess for in a patient with hypospadias? Patients with hypospadias might also have epispadias. Patients with hypospadias might also have inguinal hernias. Patients with hypospadias might also have testicular torsion. Patients with hypospadias might also have bladder exstrophy.

Patients with hypospadias might also have inguinal hernias. The risk of inguinal hernia is increased in patients with hypospadias, therefore assessment of the groin area is recommended.

Which nursing actions should be implemented to ensure bowel patency is maintained for an infant with intussusception? SATA Restrict activity Perform an occult blood test Recommend a high-fiber diet Evaluate the consistency of the stool Take a gastrointestinal history

Perform an occult blood test The nurse would evaluate the stool for blood, as the passage of stool without blood is indicative of a successful outcome. Evaluate the consistency of the stool The nurse should observe the characteristics of the stool, including consistency to determine whether the patient has maintained bowel patency. Correct Take a gastrointestinal history The nurse should monitor the patient for return of normal bowel function. This would require having baseline information about bowel/gastrointestinal function.

What force best describes the movement of urine from the renal pelvis to the urinary bladder? Gravity Peristalsis Blood pressure (BP) Skeletal muscle contractions

Peristalsis Peristalsis, wave-like contractions of smooth muscle, propels urine through the ureters that connect the renal pelvis to the urinary bladder.

The nurse is preparing a child for pyloromyotomy. The child has a plasma CO2 of 30 mEq/L. Which nursing actions are appropriate before surgery? Select all that apply. Place infant in isolation Place a nasogastric tube Administer an antipyretic Assess serum electrolytes Withhold oral food and fluids

Place a nasogastric tube An infant who is moderately dehydrated would have a nasogastric tube placed for stomach decompression, and surgery would be delayed for 24 to 48 hours. Assess serum electrolytes Serum electrolytes should be assessed before surgery. Surgery should be delayed until electrolyte deficits are corrected. Withhold oral food and fluids NPO (nothing by mouth) status is part of the essential preoperative care for pyloromyotomy. The nurse should withhold oral food and fluids.

A child is diagnosed with pyelonephritis. Which should be a priority in caring for the patient? Preventing sepsis Preventing hypertension Preventing hyperthermia Correcting ineffective renal tissue perfusion

Preventing sepsis Prevention of sepsis is of the highest priority in patients with pyelonephritis.

Why is it important to understand blood proteins in a patient with nephrotic syndrome? Select all that apply. Hyperalbuminemia develops as edema worsens. Proteins accumulate in the kidney preventing normal GFR. Proteins are filtered in the glomerulus and lost in the urine. Protein metabolism decreases due to negative feedback caused by hyperalbuminemia. Synthesis of liver proteins cannot keep up with need and patient develops hypoalbuminemia.

Proteins are filtered in the glomerulus and lost in the urine. Increased permeability in the glomerulus causes proteinuria in nephrotic syndrome. Synthesis of liver proteins cannot keep up with need and patient develops hypoalbuminemia. As proteins are lost in the urine, the liver works to maintain normal levels of blood proteins. Liver metabolism cannot synthesize proteins fast enough to compensate for loss.

The nurse is caring for a child with pyloric stenosis. The nurse notes that the abdomen is distended, skin turgor is poor, and fontanels are sunken. Which action would the nurse take? Administer acetaminophen Give IV potassium supplements Administer narcotic pain medication Provide an intravenous (IV) normal saline bolus

Provide an intravenous (IV) normal saline bolus

child is admitted to the hospital with right lower abdominal pain, anorexia, and fever. Which nursing actions are appropriate to achieve an optimum outcome for this patient? SATA Provide clear liquids only. Provide emotional support. Administer intravenous fluids. Administer IV analgesic medication. Administer oral antipyretic medication.

Provide emotional support. Administer intravenous fluids. Administer IV analgesic medication.

If a child has low blood pressure in their afferent arteriole, which process describes the body's attempt to increase the blood pressure (BP)? Activation of vitamin D Release of erythropoietin Release of renin from the kidney Release of atrial natriuretic peptide

Release of renin from the kidney Release of the hormone renin occurs when low BP is detected in the afferent arteriole. This leads to the activation of angiotensin-II and vasoconstriction to increase BP.

An infant with pyloric stenosis has a nasogastric tube in place. Which assessment finding would be of most concerning to the nurse? Patient is in Fowler's position. Respirations are rapid and shallow. Hyperactive bowel sounds on auscultation. Urine output was 100 mL in the last 3 hours.

Respirations are rapid and shallow. Rapid respirations are an indication of respiratory distress and would be of most concern to the nurse.

A three-year-old patient has recently developed enuresis at preschool. She has not had any urinary accidents for 8 months and does not have any episodes of bedwetting. Identify the classification of enuresis for this patient. Primary, diurnal enuresis Primary, nocturnal enuresis Secondary, diurnal enuresis Secondary, nocturnal enuresis

Secondary, diurnal enuresis Secondary enuresis occurs after the child has had a period of dryness for 6-12 months. Diurnal enuresis occurs during the daytime.

A child presents to the emergency department and is diagnosed with secondary enuresis. Which factors should the nurse consider when suspecting stress-induced secondary enuresis in a young child? Select all that apply. Self-esteem Sexual abuse Detrusor instability Nighttime (prebed) habits Recent changes in family dynamics

Self-esteem Try to determine if the child is worried about starting school or if they have other self-esteem problems. Sexual abuse Sexual abuse should always be a consideration when a child presents with secondary enuresis. Rule out sexual abuse to help confirm stress-induced secondary enuresis. Recent changes in family dynamics Changes in family dynamic may cause the child to crave attention or act out. Enuresis, though providing possible negative attention, allows the child to obtain increased interaction with family.

A child is admitted with right lower quadrant abdominal pain, anorexia, and fever. The pain suddenly subsides, and the child is able to play normally but still has a fever. Which potential complication is an immediate concern for this child? Sepsis Dehydration Malnutrition Hypertension

Sepsis

Which serum test should provide the nurse with the most information regarding hydration status of a patient? Serum creatinine Serum osmolality Leukocyte esterase Blood urea nitrogen (BUN)

Serum osmolality Serum osmolality provides information regarding fluid and electrolyte balance, therefore it is useful in evaluating hydration status.

The nurse is preparing a child for an appendectomy and notes that the child is extremely quiet. Which nursing action is correct? Select all that apply. Encourage the child to try to sleep. Tell the child that everything will be fine. Encourage the child to verbalize feelings. Provide discharge instructions to allow the parents to leave faster.

Sleep Verbalize feelings

The nurse is caring for a child with gastroesophageal reflux disease (GERD). The child is feeding and begins to cough and gag. Which action should the nurse take first? Stop the feeding Elevate the head of the bed Auscultate the child's lung sounds Administer oxygen via nasal cannula

Stop the feeding Coughing and gagging are signs of respiratory distress. The nurse should immediately stop the feeding to ensure a patent airway.

A patient presents with sudden onset of gross hematuria, proteinuria and hypertension. In assessing this patient, what statement best supports the importance for the nurse to assess the presence of throat discomfort over the past two weeks? Streptococcal pharyngitis can induce glomerulonephritis. Hemolytic uremic syndrome (HUS) initially presents with pharyngitis. Hematuria is the primary indicator that the patient has nephrotic syndrome caused by E. coli. Throat discomfort is an indication of edema which is the primary cause of nephrotic syndrome.

Streptococcal pharyngitis can induce glomerulonephritis. Acute poststreptococcal glomerulonephritis occurs as an immune reaction to a group A beta-hemolytic streptococcal infection of the throat or skin. Clinical symptoms usually develop 1-2 weeks after a streptococcal pharyngitis.

The nurse is caring for a 3-month-old infant diagnosed with gastroenteritis. The parents report vomiting, diarrhea, poor skin turgor, and lethargy. Which additional finding supports the diagnosis of moderate dehydration? Hypothermia Decreased respiratory rate Sunken or depressed fontanel Urine specific gravity of 1.010

Sunken or depressed fontanel A sunken or depressed fontanel is indicative of moderate dehydration.

Several patients with encopresis are receiving bowel training. Which patient demonstrates successful use of this treatment method? The child who has had four enemas in the past week. The child who goes to the restroom after breakfast and lunch. The child whose parents provide a sticker after every trip to the bathroom. The child who sits on the toilet for 10 minutes during each visit to the bathroom.

The child who sits on the toilet for 10 minutes during each visit to the bathroom. Proper bowel training is accomplished by having the child sit on the toilet for several minutes to allow normal gastrocolic reflex and defecation.

Acid secretion into the kidneys is a necessary process to prevent acidemia. Why would an infant present with a low blood pH despite the ability to regulate acid/base balance at the rate of an adult? The child's kidneys lack the ability to effectively acidify urine via secretion in the distal tubule and collecting duct. The child's kidneys lack the ability to properly filter acids in the glomerulus, therefore the acid remains in the blood. A low blood pH means the infant has a high concentration of base in the body. This is because the infant secretes too much acid into the nephron. A low blood pH means the infant has a low concentration of acid in the body. This is because the infant secretes too much acid into the nephron.

The child's kidneys lack the ability to effectively acidify urine via secretion in the distal tubule and collecting duct. To maintain blood pH the renal system can secrete hydrogen ion (acid) into the filtrate/urine. In the child, ineffective acidification increases the possibility of acidemia.

An 8-year-old patient comes to the clinic with symptoms of acute kidney injury. While discussing recent events with the patient, the nurse learns that the patient attended a family barbeque the day before. Which statement explains the importance of this information? Select all that apply. Patient may have eaten pasteurized juice. The patient may have eaten improperly cooked meat. The patient may have consumed contaminated dairy products. Patient may have consumed too much water during the meal leading to water intoxication. The patient may have eaten mayonnaise products that were left unrefrigerated for too long.

The patient may have eaten improperly cooked meat. Undercooked meats, such as hamburger, may contain E.coli. Shiga toxin from the E.coli can cause gastrointestinal problems and HUS. The patient may have consumed contaminated dairy products. Unpasteurized dairy products may contain E.coli, which can cause HUS.

A school-age child is having urinary frequency and urgency. What should be included in the diagnostic evaluation of this child? Select all that apply. Urinalysis Urine culture Evaluation for pinworms Evaluation of psychological state Evaluation for voiding dysfunction Evaluation of blood urea nitrogen (BUN)

Urinalysis Urinalysis should include specific gravity and glucose concentration to check for diabetes. Presence of bacteria for UTI. Urine culture Urine culture can be used to diagnose or rule out UTI. Evaluation for pinworms Infestation of pinworms can cause symptoms similar to UTI. Evaluation of psychological state Social and emotional situations can contribute to enuresis. Evaluation for voiding dysfunction Voiding dysfunction with urge incontinence should be explored.

What conclusion can be drawn when a febrile patient is positive for nitrites and has >500,000 CFU/ml after a clean catch urine culture? Urinary reflux Pyelonephritis Vesicoureteral reflex (VUR) Urinary tract infection (UTI)

Urinary tract infection (UTI) The presence of nitrites and >100,000 CFU/ml of bacteria with a clean catch urine sample warrant a diagnosis of UTI.

A 1-year-old child presents to the clinic with an abnormal abdominal bulge. The parents state the patient has been asymptomatic and the mass has not grown in size. The mass is also immobile. Upon close observation the child also has unusual appearing eyes. Why are both an ophthalmology and renal referral necessary in this patient? Select all that apply. The unusual appearing eyes, with missing or partial iris, are suggestive of Wilms tumor. Wilms tumor develops within the eye initially. It quickly metastasizes to the kidneys as blood is filtered. Renal referral is required because the large, immobile, abdominal mass in such a young child is indicative of Wilms tumor. The asymptomatic nature of the mass suggests it is a neuroblastoma. Neuroblastoma also affects the development of the eyes. During development, the kidneys and the eyes undergo significant differentiation during the same time. This typically results in anomalies in the kidneys and eyes simultaneously.

The unusual appearing eyes, with missing or partial iris, are suggestive of Wilms tumor. Aniridia, missing or partial iris, can be a sign of Wilms tumor. This is a genetic disorder that is related to Wilms tumor. Renal referral is required because the large, immobile, abdominal mass in such a young child is indicative of Wilms tumor. The large, immobile mass in the abdomen is suggestive of Wilms tumor, which affects the kidney.

The neonatal nurse is expecting a patient born with bladder exstrophy. What feature may have been viewed in the antenatal sonogram? The urinary bladder is located outside of the body. The urinary bladder is located high within the abdominal cavity. The urinary bladder is significantly reduced in size and is barely visible in pelvic cavity. The urinary bladder is significantly enlarged and occupies the majority of the pelvic cavity space.

The urinary bladder is located outside of the body. Due to a developmental defect in the lower abdominal wall, the extrusion of the urinary bladder outside of the body would be evident.

An infant with gastroesophageal reflux disease (GERD) vomits after every feeding. Which provider orders would the nurse anticipate? Select all that apply. Daily weight Hourly breastfeeding Thicken formula feedings Daily abdominal assessment Refer infant for respiratory therapy

Thicken formula feedings Thickened liquids decrease the infant's risk for aspiration; the infant has better control when swallowing a thicker formula. Daily abdominal assessment A daily abdominal assessment is important for evaluating the child with GERD; excessive gas can worsen symptoms. Refer infant for respiratory therapy Infants with GERD are at increased risk for aspiration. Referral for respiratory therapy may be indicated.

What is the significance of thrombocytopenia in a patient with HUS? Select all that apply. Thrombocytopenia causes increased fluid loss and increased GFR. Thrombocytopenia causes anemia due to increased loss of RBCs in the urine. Thrombocytopenia potentiates small vessel occlusion and development of thrombi. Thrombocytopenia facilities a decrease in the hemoglobinuria that develops in HUS. Thrombocytopenia develops as platelets occlude vessels and then decreases blood flow and GFR.

Thrombocytopenia potentiates small vessel occlusion and development of thrombi. Thrombocytopenia results from nonimmunologic platelet destruction. Small thrombi are found throughout the body. Anemia can also result from the capture of RBCs in the clots. Thrombocytopenia develops as platelets occlude vessels and then decreases blood flow and GFR. As platelets occlude vessels, including in the kidney, blood flow decreases and there is a reduction in GFR.

Which statement helps to explain why immunosuppressive therapy is needed for kidney transplantation? To increase endogenous cortisol production To prevent rejection of the transplanted organ To increase the protection generated by antibodies by decreasing the activity of macrophages To increase the number of antibodies produced against infectious agents but decrease the antibodies against "self"

To prevent rejection of the transplanted organ Even though the donor and recipient have compatible blood and tissue types, not all antigens are the same. Immunosuppression is necessary to prevent rejection caused by the antigenic activation of the immune system.

An infant with gastroenteritis presents with severe diarrhea and vomiting. Which assessment finding is most concerning? Capillary refill of 3 seconds Serum potassium level of 4.9 mEq/L Two wet diapers in the last 12 hours Fontanels bulging when the infant cries

Two wet diapers in the last 12 hours Two wet diapers in 12 hours indicates dehydration and is concerning for an infant.

What assumption regarding urinary system anatomy can be made if a child is born with hydronephrosis? Urethral atresia Ureter obstruction Low number of nephrons Coalescence of glomeruli

Ureter obstruction Hydronephrosis is caused by a build-up of urine, typically caused by obstruction of the ureter.

What is the next step in diagnosis of urinary tract infection (UTI) when urine dipstick shows nitrites and urinalysis shows hematuria and white blood cells? Urine culture Analysis of ketones Analysis of glucose in urine Estimation of glomerular filtration rate (GFR)

Urine culture Any bacterial growth of a single-strain bacterium >100,000 CFU/mL in a clean-catch urine specimen establishes a diagnosis of UTI.

What is a likely consequence of urine reflux? Urine reflux leads to pyrexia. Urine reflux can lead to hypertension. Urine reflux increases urine stagnation. Urine reflux leads to increased urine acidity.

Urine reflux increases urine stagnation. As urine backflows into the ureter or to the kidney, this will increase the amount of time the urine spends in the renal system. Bacteria will have increased incubation time and may cause UTI.

The nurse is caring for a child with esophageal atresia who has been diagnosed with failure to thrive. Which assessment findings indicate the expected outcomes have been met for this patient? Select all that apply. Weight gain Normal sleep patterns Increased head circumference Normal urine specific gravity Normal cognitive milestones met

Weight gain The child with esophageal atresia may experience malnutrition and dehydration. Daily weights should be obtained to assess for weight gain, which indicates successful management of the condition. Increased head circumference The child with esophageal atresia may experience malnutrition and dehydration. Daily head circumference measurements should be obtained to assess for head growth, which indicates successful management of the condition. Normal urine specific gravity The child with esophageal atresia may experience dehydration. A normal urine specific gravity indicates successful management of dehydration.