Carman Essentials of Pediatric Nursing 3rd Ed - Ch. 21 Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? a.Hypertension b.Hypotension c.Hypothermia d.Tachycardia

Answer: a Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

A nurse is caring for a 13-year-old boy with end-stage renal disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate? a.Administer his routine medications as scheduled b.Take his blood pressure measurement in extremity with AV fistula c.Withhold his routine medication until after dialysis is completed d.Assess the Tenckhoff catheter site

Answer: c The nurse should withhold routine medications in the morning that hemodialysis is scheduled since they would be filtered out through the dialysis process. His medications should be administered after he returns from the dialysis unit. A Tenckhoff catheter is used for peritoneal dialysis, not hemodialysis. The nurse should avoid blood pressure measurement in the extremity with the AV fistula as it may cause occlusion.

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? a.Presence of a bruit b.Presence of a thrill c.Dialysate without fibrin or cloudiness d.Absence of a thrill

Answer: d The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill. Dialysate without fibrin or cloudiness is normal and is used with peritoneal dialysis, not hemodialysis.

The nurse is caring for a child with epididymitis. When planning care which intervention may be included? a.Scrotal elevation b.Warm compresses c.Corticosteroid therapy d.Catheterization

Answer: a Epididymitis is caused by a bacterial infection. Treatment may include scrotal elevation, bed rest, and ice packs to the scrotum. Pharmacotherapy may include antibiotics, pain medications, and nonsteroidal anti-inflammatory drugs (NSAIDs). Warm compresses would result in vasodilation and do little to relieve the pain and swelling of the condition. Corticosteroid therapy is not included in the plan of care for the condition. Voiding is not impacted by epididymitis. Catheterization is not indicated.

A nurse is caring for a 12-year-old girl recently diagnosed with end-stage renal disease. The nurse is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? a."My daughter can eat what she wants when she is hooked to the machine." b."My daughter must avoid high sodium foods." c."She needs to restrict her potassium intake." d."She can eat whatever she wants on dialysis days."

Answer: d The girl cannot eat whatever she wants on dialysis days. She can eat what she wants during the few hours she is actively undergoing treatment in the hemodialysis unit. The other statements regarding a high sodium diet and potassium intake are correct.

The nurse is planning the discharge instructions for the parents of a 1-month-old infant who has had a circumcision completed. Which information should be included in the education provided? a.Use petroleum jelly on the head of the penis for the first 2 weeks after the procedure b.Report any bleeding to the physician c.Reduce the child's fluid intake to reduce voiding during the first 24 hours d.Report redness or swelling on the penile shaft

Answer: d The discharge instructions for the child who has had a circumcision will include a listing of warning signs to report. Redness or swelling of the penile shaft is not a normal finding and must be reported. Petroleum jelly is often used for the first 24 hours after the procedure but not for a period of 2 weeks. Small amounts of bleeding may be noted. This bleeding if scant in amount does not warrant reporting to the physician. Reduction of water to impact voiding is inappropriate.

The nurse is caring for a child who has been admitted to the acute care facility with manifestations consistent with hydronephrosis. Which tests will confirm the diagnosis? Select all that apply. a.Intravenous pyelogram (IVP) b.Urinalysis c.Voiding cystourethrogram (VCUG) d.Complete blood cell count (CBC) e.Renal ultrasound

Answer: a, c, e A VCUG will be performed to determine the presence of a structural defect that may be causing the hydronephrosis. Other diagnostic tests, such as a renal ultrasound or an intravenous pyelogram, may also be performed to clarify the diagnosis. A urinalysis may be performed to assess the quality and characteristics of the urine but the test will not confirm a diagnosis of hydronephrosis. A CBC may be used to assess the level of a genitourinary infection but it will not confirm the diagnosis of hydronephritis.

A nurse is caring for a 10-year-old boy with nocturnal enuresis with no physiologic cause. He says he is embarrassed and wishes he could stop immediately. How should the nurse respond? a."You will grow out of this eventually; you just need to be patient." b."There are several things we can do to help you achieve this goal." c."There are almost 5 million people that have enuresis." d."The pull-ups look just like underwear; no one has to know."

Answer: b The best response would be to include the child in plans for nighttime urinary control. This gives the child a sense of hope and reminds him that there are actions he can take to help achieve dryness. Telling him that he will grow out of this does not offer solutions. Providing statistics can be helpful, but does not offer a solution. Reminding him that pull-ups look just like underwear does not address his concerns.

The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately? a.Empty the old dialysate b.Weigh the old dialysate c.Weigh the new dialysate d.Start the process over with a fresh bag

Answer: b The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.

The nurse is caring for a 12-year-old boy diagnosed with acute glomerulonephritis. When reviewing the boy's health history which finding will likely be noted? a.History of recurrent urinary tract infections b.Family history of renal disorders c.Recent history of an upper respiratory infection d.History of hypotension

Answer: c Acute glomerulonephritis often follows a group A streptococcal infection. Strep A infections may manifest as an upper respiratory infection. The history of urinary tract infections, renal disorders, or hypotension is not directly associated with the onset of acute glomerulonephritis.

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review? a.Hemolytic anemia, acute renal failure, and hypotension b.Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level c.Hemolytic anemia, thrombocytopenia, and acute renal failure d.Thrombocytopenia, hemolytic anemia, and nocturia several times each night

Answer: c Hemolytic uremic syndrome is defined by all three particular features—hemolytic anemia, thrombocytopenia, and acute renal failure. Dirty green-colored urine, elevated erythrocyte sedimentation, and depressed serum complement level are indicative of acute glomerulonephritis. Hypertension, not hypotension, would be seen and the child would have decreased urinary output which would not cause nocturia.

The nurse is administering cyclophosphamide as ordered for a 12-year-old boy with nephrotic syndrome. Which instruction is most accurate regarding administration? a.Administer in the evening on an empty stomach. b.Provide adequate hydration and encourage voiding. c.Administer in the morning, encourage fluids and voiding during and after administration. d.Encourage fluids, adequate food intake, and voiding before and after administration.

Answer: c It is very important to administer in the morning, encourage large amounts of water/fluids and encourage frequent voiding during and after infusion to decrease the risk of hemorrhagic cystitis.

The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition? a."Our son may need surgery on his testes before we are discharged to go home." b."Our son may have to go through life without two testes." c."Our son's condition may resolve on its own." d."Our son will likely have a high risk of cancer in his teen years as a result of this condition."

Answer: c Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended.

The nurse is conducting a follow-up visit for a 13-year-old girl who has been treated for pelvic inflammatory disease. Which remark indicates a need for further teaching? a."I should be tested for other sexually transmitted diseases." b."Douching is not necessary and can cause bacteria to flourish." c."I cannot have sex again until my partner is treated." d."My partner needs to be treated with antibiotics."

Answer: c The girl's partner should be treated, but she must strongly encourage the girl to require her partner to wear a condom every time they have sex, even after he undergoes antibiotic therapy. The other statements are accurate.

The nurse is caring for a 10-year-old girl presenting with fever, dysuria, flank pain, urgency, and hematuria. The nurse would expect to help obtain which test first? a.Total protein, globulin, and albumin b.Creatinine clearance c.Urinalysis d.Urine culture and sensitivity

Answer: c Urinalysis is ordered to reveal preliminary information about the urinary tract. The test evaluates color, pH, specific gravity, and odor of urine. Urinalysis also assesses for presence of protein, glucose, ketones, blood, leukocyte esterase, red blood cell count, white blood cell count, bacteria, crystals, and casts. Total protein, globulin, albumin, and creatinine clearance would be ordered for suspected renal failure or renal disease. Urine culture and sensitivity is used to determine the presence of bacteria and determine the best choice of antibiotic.