PEDS Green Book Practice Questions Chapter 8

What is the primary reason a renal ultrasound would be ordered?

Performed to look for structural anomalies or vascular compromise

The diet for a child with CKD should be high in calories and should include: A. Low protein and all minerals and electrolytes B. Low protein and minerals C. High protein and calcium, low potassium and phosphorus D. High protein, phosphorus, and calcium with low potassium and sodium

C

The parent of a child diagnosed with AKI asks the nurse why peritoneal dialysis was selected instead of hemodialysis. Which is the nurse's best response? A. "Hemodialysis is not used in the pediatric population." B. "Peritoneal dialysis has no complications, so it is a treatment used without hesitation." C. "Peritoneal dialysis removed fluid at a slower rate than hemodialysis, so many complications are avoided." D. "Peritoneal dialysis is much more efficient than hemodialysis."

C

The parents of a child hospitalized with MCNS ask why the last blood test revealed elevated lipids. Which is the nurse's best response? A. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated." B. "It is not unusual to see elevated lipids in children because of the dietary habits of today." C. "Because your child is losing so much protein, the liver is stimulated and makes more lipids." D. "Your child's blood is very concentrated because pf the edema, so the lipids are falsely elevated."

C

A child had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis reveals normal results. The child has had no other problems until this visit when the child is complaining of burning with urination. Which is the most appropriate plan? Select all that apply. A. Obtain urinalysis and urine culture B. Evaluate for renal failure C. Admit to the pediatric unit D. Send home with antibiotic if the urinalysis is positive E. Schedule a VCUG

A, D

A 4 week old infant presents to the clinic with a temperature of 101.6 degrees F, fussiness, decreased appetite, and normal physical exam. Which is the next management step? Select all that apply. A. Perform a urinary catheterization B. Start IV fluids C. Draw serum electrolytes D. Draw a blood culture E. Administer acetaminophen

A, E

A child diagnosed with AKI complains of "not feeling well" and "having butterflies in the chest" and their arms and legs feeling "like Jell-O." The cardiac monitor shows that the QRS complex is wider than it was and that an occasional premature ventricular contraction (PVC) is seen. Which should the nurse expect to administer? A. An isotonic saline solution with 20mEq KCl/L B. Sodium bicarbonate via slow IV push C. Calcium gluconate via slow IV push D. Oral potassium supplements

C

Which would the nurse expect to find on assessment in a child with Wilms tumor? A. Decreased blood pressure, increased temperature, and a firm mass located in one flank area. B. Increased blood pressure, normal temperature, and a firm mass located in one flank area. C. Increased blood pressure, normal temperature, and a firm mass located on one side of the midline of the abdomen. D. Decreased blood pressure, normal temperature, and a firm mass located on one side or the other of the midline of the abdomen.

C

A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs. The parent asks the nurse the reason of this test, as a Wilms tumor involves the kidney, not the lung. Which is the nurse's best response? A. "I'm not sure why your child is going for this test. I will check and get back to you." B. "It sounds like we made a mistake. I will check and get back to you." C. "The test is done to check whether the disease has spread to the lungs." D. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery."

C

A child with MCNS has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving furosemide (Lasix) twice daily for several days. What does the nurse expect to be included in the treatment plan to reduce edema? A. An increase in the amount and frequency of furosemide. B. Addition of a second diuretic, such as mannitol. C. Administration of IV albumin. D. Elimination of all fluids and sodium from the child's diet.

C

A renal transplantation is which of the following? A. A curative procedure that will free the child from any more treatment modalities B. An ideal treatment option for families with a history of dialysis noncompliance C. A treatment option that will free the child from dialysis D. A treatment option that is very new to the pediatric population

C

An adolescent woke up complaining of intense pain and swelling of the scrotal area and abdominal pain. He has vomited twice. What should the nurse suggest? A. Encourage him to drink clear fluids until the vomiting subsides and if he gets worse, bring him to the emergency department. B. Bring him to the hcp's office for evaluation C. Take him to the emergency department immediately. D. Encourage him to rest, apply ice to the scrotal area, and go to the emergency department if the pain does not improve.

C

An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse's best response? A. "I understand your concern. Parents do not want their children to undergo extra surgery." B. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." C. "The repair is done to optimize sexual functioning when he is older." D. "This is the best time to repair the chordee because he will be having surgery anyway."

C

A parent asks the nurse how to prevent the child from having MCNS again. Which is the nurse's best response? A. "It is very rare for a child to have a relapse once being fully recovered." B. "Unfortunately, many children have cycles of relapse, and there is very little that can be done to prevent it." C. "Your child is much less likely to get sick again if sodium is decreased in the diet." D. "Try to keep your child away from sick children because relapses have been associated with infectious diseases."

D

In addition to increased blood pressure, which findings would most likely be found in a child with hydronephrosis? A. Metabolic alkalosis and positive renal ultrasound B. Metabolic acidosis and negative renal ultrasound C. Metabolic alkalosis and bacterial growth in the urine D. Metabolic acidosis, polydipsia, and polyuria

D

One week after kidney transplant, a child complains about abdominal pain, and the parents note that the child has been very fussy. The nurse notes a 10% weight gain as well as elevated BUN and creatinine. Which of the following medications would the child most likely be taking? A. Codeine tablets B. Furosemide (lasix) C. Polyethylene glycol 3350 (MiraLAX) D. Corticosteroids

D

The bladder capacity of a 3 yr old is approximately how much? A. 1.5 fl oz B. 3 fl oz C. 4 fl oz D. 5 fl oz

D

The nurse evaluates the parent's understanding of the teaching about an inguinal hernia as successful when they say which of the following? A. "There are no risks associated with waiting to have the hernia reduced, surgery is done for cosmetic reasons." B. "It is normal to see the bulge in the baby's groin decrease with a bowel movement." C. "We will wait for surgery until the baby is older because narcotics for pain control will be required for several days." D. "It is normal for the bulge in the baby's groin to look smaller when the baby is asleep."

D

The nurse evaluates the postoperative teaching for repair of testicular torsion as successful when the parent of an adolescent says which of the following? A. "I will encourage him to rest for a few days, but he can return to football practice in a week." B. "I will keep him in bed for 4 days and let him gradually increase his activity after that." C. "I will seek therapy as he ages because he is now infertile." D. "I will make sure he does testicular self-exams monthly."

D

The nurse is caring for a 1 yr old diagnosed with AKI. Edema is noted throughout the child's body, and the liver is enlarged. The child's urine output is less than 0.5mL/kg/hr and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is note to have nasal flaring and retractions with inspiration. The lung sounds are coarse throughout. Despite receiving oral sodium polystyrene sulfonate (Kayexelate), the child's serum potassium still continues to rise. Which treatment will provide the most benefit to the child? A. Additional rectal sodium polystyrene sulfonate B. IV furosemide (lasix) C. Endotracheal intubation and ventilatory assistance D. Placement of a Tenckhoff catheter for peritoneal dialysis

D

The manifestations of HUS are due primarily to which event? A. The swollen lining of the small blood vessels damage the red blood cells, which are then removed by the spleen, leading to anemia. B. There is a disturbance of the glomerular basement membrane, allowing large proteins to pass through. C. The red blood cell changes shape, causing it to obstruct microcirculation. D. There is a depression in the production of all formed elements of the blood.

A

Which laboratory results besides hematuria are most consistent with HUS? A. Massive proteinuria, elevated blood urea nitrogen and creatinine. B. Mild proteinuria, decreased blood urea nitrogen and creatinine. C. Mild proteinuria, increased blood urea nitrogen and creatinine. D. Massive proteinuria, decreased blood urea nitrogen and creatinine.

C

A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? A. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." B. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." C. "We will make sure the dressing is loosely applied to increase the toddler's comfort." D. "If we notice any yellow drainage, we will know that everything is healing well."

A

A child receiving peritoneal dialysis has not been having adequate volume in the return. The child is currently edematous and hypertensive. Which would the nurse anticipate the hcp to do? A. Increase the glucose concentration of the dialysate B. Decrease the glucose concentration of the dialysate C. Administer antihypertensives and diuretics but not change the dialysate concentration D. Decrease the dwell time of the dialysate

A

A child with HUS is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has not had any urine output in the last 24 hrs. The nurse expects administration of blood products and what else to be added to the plan of care? A. Initiation of dialysis. B. Close observation of the child's hemodynamic status. C. Diuretic therapy to force urinary output. D. Monitoring of urinary output.

A

Chronic hypertension in the child who has CKD is due to which of the following? A. Retention of sodium and water B. Obstruction of the urinary system C. Accumulation of waste products in the body D. Generalized metabolic alkalosis

A

During hemodialysis, the nurse notes that a 10 yr old becomes confused and restless. The child complains of a headache and has generalized muscle twitching. This can be prevented by which of the following? A. Slowing the rate of solute removal during dialysis B. Ensuring the patient is warm during dialysis C. Administering antibiotics before dialysis D. Obtaining an accurate weight the night before dialysis

A

The nurse is caring for a 12 yr old receiving peritoneal dialysis. The nurse notes the return to be cloudy, and the child is complaining of abdominal pain. The child's parents ask what the next step will likely be. Which is the nurse's best response? A. "We will probably place antibiotics in the dialysis fluids before the next dwell time." B. "Many children experience cloudy returns. We do not usually worry abut it." C. "We will probably give your child some oral antibiotics just to make sure nothing else develops." D. "The abdominal pain is likely due to the fluid going in too slowly. We will increase the rate of the administration with the next fill."

A

The nurse is caring for a child due for surgery on a Wilms tumor. The child's procedure will consist of which of the following? A. Only the affected kidney will be removed B. Both the affected kidney and the other kidney will be removed in case of recurrence C. The mass will be removed from the affected kidney D. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done

A

Which causes the clinical manifestations of hydronephrosis? A. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. B. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances. C. Decreased production of urine in one or both kidneys results in an electrolyte imbalance. D. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate.

A

Which causes the symptoms in testicular torsion? A. Twisting of the spermatic cord interrupts the blood supply. B. Swelling of the scrotal sac leads to testicular displacement. C. Unmanaged undescended testes cause testicular displacement. D. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

A

Which child is at risk for developing glomerulonephritis? A. A 3 yr old who had impetigo one week ago. B. A 5 yr old with a history of 5 UTIs in the previous year. C. a 6 yr old with a new onset of Type 1 diabetes. D. A 10 yr old recovering from viral pneumonia.

A

Which is a care priority for a newborn diagnosed with bladder exstrophy and a malformed pelvis? A. Change the diaper frequently and assess for skin breakdown. B. Keep the exposed bladder open in a warm and dry environment to avoid any heat loss. C. Offer formula for infant growth and fluid management. D. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair.

A

Which should be included in the plan of care for a child diagnosed with hydronephrosis? A. Intake and output, as well as vital signs, should be strictly monitored B. Fluids and sodium in the diet should be limited C. Steroids should be administered as ordered D. Limited contact with other people to avoid infection

A

Which statement by a parent is most consistent with MCNS? A. "My child missed 2 days of school last week because of a really bad cold." B. "After camping last week, my child's legs were covered in bug bites." C. "My child came home from school a week ago because of vomiting and stomach cramps." D. "We have a pet turtle, but no one washes their hands after playing with the turtle."

A

Which would the nurse expect to hear the parents of an infant with an incarcerated hernia report? A. Acute onset of pain, abdominal distention, and a mass that cannot be reduced. B. Gradual onset of pain, abdominal distention, and a mass that cannot be reduced. C. Acute onset of pain, abdominal distention, and a mass that is easily reduced. D. Gradual onset of pain, abdominal distention, and a mass that is easily reduced.

A

The parents of a 3 yr old are concerned that the child is having "more accidents" during the day. Which question would be appropriate for the nurse to ask to obtain more information? Select all that apply. A. "Has there been a stressful event in the child's life, such as the birth of a sibling?" B. " Has anyone else in the family had problems with accidents?" C. "Does your child seem to be drinking more than usual?" D. "Is your child fussier than usual, and do they seem to be in pain when urinating?" E. "Is your child having difficulties at preschool?"

A, B, C, D

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse's best responses? Select all that apply. A. "Your child's urine output will increase, and the urine will become less tea-colored." B. "Your child will have more energy as laboratory tests become more normal." C. "Your child's appetite will decrease as urine output increases." D. "Your child's laboratory values will become more normal." E. "Your child's weight will increase as the urine becomes less tea-colored."

A, E

A 10-kg toddler is diagnosed with AKI, is afebrile, and has a 24-hour urine output of 110 mL. After calculating daily fluid maintenance, which would the nurse expect the toddler's daily allotment of fluids to be? A. Sips of clear fluids and ice chips only. B. 350 mL of oral and intravenous fluids. C. 1000 mL of oral and intravenous fluids. D. 2000 mL of oral and intravenous fluids.

B

A child had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago due to post-operative hemorrhage. The parent noted that her child was "swallowing a lot and finally began vomiting large amounts of blood." The child's vital signs are as follows: T 99.5°F (37.5°C), HR 124, BP 84/48, and RR 26. The nurse knows that this child is at risk for which type of renal problem? A. CKD due to advanced disease process. B. Prerenal failure due to dehydration. C. Primary kidney damage due to a lack of urine flowing through the system. D. Postrenal failure due to a hypotensive state.

B

The clinical manifestations of MCNS are caused by which of the following? A. Chemical changes in the composition of albumin. B. Increased permeability of the glomeruli. C. Obstruction of the capillaries of the glomeruli. D. Loss of the kidney's ability to excrete waste and concentrate urine.

B

The nurse anticipates that the child who has had a kidney removed will have a high level of pain and will require invasive and noninvasive measures for pain relief. The nurse anticipates that the child will have pain because of which of the following? A. The kidney is removed laparoscopically, and there will be residual pain from accumulated air in the abdomen B. There is a postoperative shift of fluids and organs in the abdominal cavity, leading to increased discomfort C. The chemotherapy makes the child more sensitive to pain D. The radiation therapy makes the child less sensitive to pain

B

The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The child's parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? A. Primary enuresis. B. Secondary enuresis. C. Diurnal enuresis. D. Nocturnal enuresis.

B

The nurse is providing discharge instructions to the parents of an infant born with bladder exstrophy who had a continent urinary reservoir placed. Which statement should be included? A. "Allow your child to sleep on the abdomen to provide comfort during the immediate postoperative period." B. "As your child grows, be cautious around playgrounds because the surface could be a health hazard." C. "As your child grows, be sure to encourage many different foods because it is not likely that food allergies will develop." D. "Encourage your child's development by having brightly colored objects around, such as balloons."

B

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse's best response? A. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." B. "There is blood in your child's urine that causes it to be tea-colored." C. "Your child's urine is very concentrated, so it appears to be discolored." D. "A ketogenic diet often causes the urine to be tea-colored."

B

The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. Which is the nurse's best response? A. "The terms are used interchangeably and mean the same thing." B. "The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, whereas a hydrocele is a fluid-filled mass in the scrotum." C. "A hydrocele is the term used when an inguinal hernia occurs in females." D. "A hydrocele presents in a manner similar to that of an inguinal hernia but causes increased concern because it is often malignant."

B

The parents overhear the health-care team refer to their child's disease as in stage III. The parents ask the nurse what this means. Which is the nurse's best response? A. The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is poor. B. The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is very good. C. The tumor has been found in three other organs beyond the peritoneal area; the prognosis is good. D. The tumor has spread to other organs beyond the peritoneal area; the prognosis is poor.

B

Which best describes the electrolyte imbalance that occurs in CKD? A. Decreased serum phosphorus and calcium levels B. Depletion of phosphorus and calcium stores from the bones C. Change in the structure of the bones, causing calcium to remain in the bones D. Nutritional needs are poorly met, leading to a decrease in many electrolytes such as calcium and phosphorus

B

Which needs to be present to diagnose hemolytic uremic syndrome (HUS)? A. Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure. B. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure. C. Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure. D. Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure.

B

Which protrusion into the groin of a female most likely causes inguinal hernias? A. Bowel. B. Fallopian tube. C. Large thrombus formation. D. Muscle tissue.

B

Which is true of a Wilms tumor? Select all that apply. A. It is also referred to as a neuroblastoma B. It can occur at any age but is seen most often between the ages of 2 and 5. C. It can occur on its own or can be associated with many congenital anomalies D. It is a slow growing tumor E. It is associated with a poor prognosis

B, C

Which of the following lab results would be of concern? Select all that apply. A. Urinalysis with 1+ protein B. Urinalysis with positive nitrates C. BUN of 15mg/dL D. Serum creatinine of 0.7 umol/L E. Colony amount of 50,000 of a bacterium

B, E

Which would the nurse most likely find in the history of a child with HUS? Select all that apply. A. Frequent UTIs and possible VUR B. Vomiting and diarrhea before admission C. Bee sting and localized edema of the site for 3 days D. Previously healthy with no signs of illness E. Anorexia and bruising

B, E

A 5-year-old is discharged from the hospital following the diagnosis of HUS. The child has been free from diarrhea for 1 week, and renal function has returned. The parent asks the nurse when the child can return to school. Which is the nurse's best response? A. "Immediately, your child is no longer contagious." B. "It would be best to keep your child home for a few more weeks because the immune system is weak, and therefore there could be a relapse of HUS." C. "Your child will still be contagious for approximately another 10 days, so it is best to not allow them to return just yet." D. "It would be best to keep your child home to monitor urinary output."

C

The nurse is caring for a 4 yr old who weighs 15kg. At the end of a 10 hr period, the nurse notes the urine output as 150 mL. What action doe the nurse take? A. Notifies the hcp because this output is too low. B. Encourages the child to increase oral intake to increase output C. Records the child's urine output in the chart. D. Administers isotonic fluid intravenously to help with rehydration.

C

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. What is the nurse's best response? A. "Circumcision is a fading practice and now contraindicated in most children." B. "Circumcision in children with hypospadias is recommended because it helps prevent infection." C. "Circumcision is an option, but it cannot be done at this time." D. "Circumcision can never be performed in a child with hypospadias."

C

The parent of a 7-year-old voices concern over the child's continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 pm, but the child still wakes up wet. Which is the nurse's best response about what the parent should do next? A. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." B. "When your child wakes up wet, be very firm and indicate how displeased you are. Have your child change the sheets to see how much work is involved." C. "Limit fluids in the evening and start a new reward system in which your child can choose a reward after a certain number of dry nights." D. "Bed-wetting alarms are readily available, and most children do very well with them."

C

Which child does not need a urinalysis to evaluate for a UTI? A. A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C) and HR of 120 bpm. B. A 4-year-old female who states, "It hurts when I pee"; she has been urinating every 30 minutes; vital signs are within normal range. C. An 8-year-old male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. D. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; oral temperature of 101.5°F (38.6°C).

C

Which combination of signs is commonly associated with glomerulonephritis? A. Massive proteinuria, hematuria, decreased urinary output, and lethargy. B. Mild proteinuria, increased urinary output, and lethargy. C. Mild proteinuria, hematuria, decreased urinary output, and lethargy. D. Massive proteinuria, decreased urinary output, and hypotension.

C

Which finding requires immediate attention in a child with glomerulonephritis? A. Sleeping most of the day and being very cranky when awake, blood pressure is 170/90. B. Urine output is 190 mL in an 8 hr period and is the color of cola. C. Complaining of a severe headache and photophobia. D. Refusing breakfast and lunch and stating he is "just not hungry."

C

The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says "How could I have missed a lump this big?" Which is the nurse's best response? A. "Do not be hard on yourself. It is easy to overlook something that has probably been growing for months when we see our child on a regular basis." B. "I understand you must be very upset. Your child would have had a better prognosis had you caught it earlier." C. "It really takes a trained professional to recognize something like this." D. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

D

The parents of a 7-year-old tell the nurse they do not understand the difference between CKD and AKI. Which is the nurse's best response? A. "There is really not much difference because the terms are used interchangeably." B. "Most children experience AKI. It is highly unusual for a child to experience CKD." C. "CKD tends to occur suddenly and is irreversible." D. "AKI is often reversible, whereas CKD results in permanent deterioration of kidney function."

D

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a UTI A. Carefully cleanse the perineum from front to back and apply a self-adhesive urine collection bag to the perineum. B. Insert an indwelling foley catheter, obtain the sample, and wait for results. C. Place a sterile cotton ball in the diaper and immediately obtain the sample with a syringe after the first void. D. Using a straight catheter, obtain the sample, and immediately remove the catheter without waiting for results of the sample.

D

Which medication would most likely be included in the postoperative care of a child with repair of bladder exstrophy? A. Furosemide (Lasix) B. Mannitol C. Meperidine (Demerol) D. Oxybutynin (Ditropan)

D

Which should the nurse teach a group of girls and parents about the importance of preventing UTIs? A. Avoiding constipation has no effect on the occurrence of UTIs B. After urinating, always wipe from back to front to prevent fecal contamination C. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. D. Increasing fluids will help prevent and treat UTIs

D