Chapter 24: Alterations in Genitourinary Function

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. When interviewing the caregivers, which question would be most important for the nurse to ask? "Is your child potty trained?" "How often do you bathe your child?" "Has your child complained of pain?" "Do any of your other children have a temperature?"

"Has your child complained of pain?" Rationale: Gather information about the current illness: when the fever started and its course thus far, signs of pain or discomfort on voiding, recent change in feeding pattern, presence of vomiting or diarrhea, irritability, lethargy, abdominal pain, unusual odor to urine, chronic diaper rash, and signs of febrile convulsions. Toilet training and bathing habits would be of importance, but they are not the most important to ask. Temperatures in other children in the family would not be related to this child's current situation.

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? "She needs to restrict her potassium intake." "My daughter can eat what she wants when she is hooked to the machine." "She can eat whatever she wants on dialysis days." "My daughter must avoid high sodium foods."

"She can eat whatever she wants on dialysis days." Rationale: 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 teaching manifestations of nephrotic syndrome to the parents of a child with the disorder. What should the nurse instruct the parents to monitor to determine if edema is increasing? Breathing rate Abdominal circumference Tightness of shoes Appetite

Abdominal circumference Rationale: Edema tends to be dependent or occur in the lower parts of the body. Parents may notice clothing no longer fits a child around the waist because edematous fluid is beginning to collect in the abdominal cavity or ascites. This is what the parents should monitor in the child. Appetite and breathing rate will be affected later after a significant amount of ascites fluid accumulates. Edema in the feet is not a typical manifestation of this disorder.

While receiving hemodialysis, a child begins to show signs of dialysis disequilibrium syndrome. Which of the following would the nurse most likely assess? Select all that apply. Confusion Fever Hallucinations Intense abdominal pain Blurred vision

Confusion Hallucinations Blurred vision Rationale: Dialysis disequilibrium syndrome is manifested by signs of confusion, vomiting, visual blurring, or hallucinations. This occurs because the hemodialysis is removing urea from the blood at too rapid a rate—faster than urea can be shifted from the brain to the blood. This causes fluid to shift into the brain, resulting in cerebral edema. Intense abdominal pain and fever would be more commonly associated with peritonitis from peritoneal dialysis.

A 10-year-old child in renal failure is on continuous ambulatory peritoneal dialysis (CAPD). What would be important to teach the parents? Dialysis solution must be infused over a period of 30 minutes. The return solution will be cloudy because of urea in it. Slight bleeding from the exchange catheter is to be expected. Cramping should not occur with an infusion.

Cramping should not occur with an infusion. Rationale: Continuous ambulatory peritoneal dialysis is a method which allows mobility for the child. The child shoud be assessed for toleration of the fluid volume instilled into the peritoneum. The abdomen will remain distended while the fluid is indwelling. The child may be slightly uncomfortable from the pressure but should not experience cramping or pain. The dwell time for this type of dialysis is from 3 to 6 hours.The return flow should be clear. A cloudy return flow suggests infection. The dialysate solution will fill from gravity so there is no specified time frame for instillation and will also be affected by the amount of dialysate solution to be instilled.

The parents of a child with acute glomerulonephritis ask the nurse to explain the cause of the disease. What organism should the nurse instruct the parents as being the cause for the disorder? Staphylococcus viridans Group B streptococci One of the rhinoviruses Group A beta-hemolytic streptococci

Group A beta-hemolytic streptococci Rationale: Glomerulonephritis usually occurs in children as an immune complex disease after infection with group A beta-hemolytic streptococci. Acute glomerulonephritis is not caused by group B streptococci, rhinoviruses, or Staphylococcus viridans.

An 8-year-old girl is scheduled for a renal ultrasound. What would the nurse include in the plan of care when preparing the child for this test? Informing the child she should feel no discomfort Withholding food and fluids after midnight Checking the child for allergies to shellfish Ensuring the child has a full bladder

Informing the child she should feel no discomfort Rationale: The nurse should inform the child that she should feel no discomfort during the test. No fasting is required and no dye is used, so allergies are not a concern. A full bladder is needed for urodynamic studies.

A child is getting a diagnostic work-up for nephrotic syndrome. Which lab results would the nurse expect to see? Proteinuria, hyperalbuminemia, and hypocholesterolemia Proteinuria, hypoalbuminemia, and hypercholesterolemia Hematuria, proteinuria, and hyperalbuminemia Neutropenia, hematuria, and hypocholesterolemia

Proteinuria, hypoalbuminemia, and hypercholesterolemia Rationale: Proteinuria, hypoalbuminemia, and hypercholesterolemia are diagnostic of a child with nephritic syndrome. The child will also present symptomatically with a sudden onset of edema. Hematuria is typically seen with glomerulonephritis.

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

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

The nurse 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? Urinalysis Total protein, globulin, and albumin Urine culture and sensitivity Creatinine clearance

Urinalysis Rationale: 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.

Which is a priority for the nurse caring for a client with bladder exstrophy? increasing fluid intake placing the child in prone position preventing skin breakdown encouraging voiding

preventing skin breakdown Rationale: Prevention of skin breakdown is the priority to prevent infection and the surface from drying out. Encouraging fluids and voiding are not the priority for this client. Prone position is not recommended; the correct position is supine so urine drains freely.

The nurse is collecting data on a school-aged child with the following symptoms: gross hematuria, hypertension and mild edema. Which condition does the child have? Nephrotic syndrome Wilms tumor Acute glomerulonephritis Urinary tract infection

Acute glomerulonephritis This is consistent with acute glomerulonephritis. Urinary tract infection includes a fever, burning upon urination and irritability. Nephrotic Syndrome begins insidiously. Hematuria is rare but edema is extreme. Wilms Tumor is a neoplasm of childhood.

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

Administer in the morning, encourage fluids and voiding during and after administration Rationale: 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 obtains a history from the parent of a child with glomerulonephritis about how the child became ill. What would the nurse expect the parent to report? Loss of weight, oliguria Dirty green urine Headache, loss of appetite Diuresis and pallor

Dirty green urine Rationale: Acute glomerulonephritis can occur following a streptococcal infection. The immune process of the illness affect the structure of the kidney as well as the function of the kidney. Acute glomerulonephritis often presents with glomeruli bleeding. The nurse should inspect the urine with a dipstick. There will be increased protein evident. Inspect the urine for gross hematuria, which will cause the urine to appear tea colored, cola colored, or even a dirty green color. The child may have a slight weight gain from slight edema. The blood pressure will be elevated and the child will experience a decreased urine output.

A teacher sends a child to see the school nurse for irritability and bruising. Which symptom would be indicative of hemolytic uremic syndrome? Oliguria and jaundice Dysuria and lethargy Polyuria and diarrhea Weight gain and high fever

Oliguria and jaundice Rationale: Signs of hemolytic uremic syndrome include oliguria, irritability, jaundice, bloody diarrhea, purpura, ecchymosis, and pallor 5 to 10 days after a prodromal illness. The child also usually experiences anorexia, slight fevers, and can become lethargic. Symptoms of polyuria, weight gain, high fever, and dysuria are not typically seen with hemolytic uremic syndrome.

The nurse is applying a urine bag to a 15-month-old boy to collect a urine specimen. Which action would the nurse take first? Pat the perineal area dry after cleaning. Apply the narrow portion of the bag on the perineal space. Apply benzoin to the scrotal area. Tuck the bag downward inside the diaper.

Pat the perineal area dry after cleaning. Rationale: When applying a urine bag, the nurse would first cleanse the perineal area well and pat it dry. If a culture was to be obtained, the nurse would cleanse the genital area with povidone-iodine or according to institutional protocol. Next the nurse would apply benzoin around the scrotum and allow it to dry. Then the nurse would apply the urine bag, making sure that the penis is fully inside the bag, tucking it downward inside the diaper to discourage leaking.

The nurse is caring for a child who has just been diagnosed with nephrotic syndrome. What health education should the nurse provide to the child and family? The need to avoid high-sodium foods The need for hemodialysis The advantage of peritoneal dialysis The importance of increasing fluid intake

The need to avoid high-sodium foods Rationale: High sodium intake exacerbates the symptoms of nephrotic syndrome. Dialysis is not normally needed. Fluid balance must be carefully monitored and there is not normally a need to increase intake.

A home health care nurse is providing follow-up care to a child with nephrotic syndrome. Which of the following would the nurse include as part of the child's plan of care? A normal finding of more than 1 g of protein in urine every 24 hours No medications necessary if the child develops a common childhood viral infection Foamy urine is a reliable indication of proteinuria. The need to withhold immunizations if the child is on steroids

The need to withhold immunizations if the child is on steroids

The nurse discovers a hypospadias during the physical assessment of a newborn. What information is most important? (Select all that apply.) Hypospadias does not need any medical intervention. Surgical repair is often completed between ages 6 and 12 months. Delay the circumcision until the hypospadias is surgically repaired. This congenital anomaly will cause further problems for the child as he grows to an adult. Save the diapers so that output can be measured.

Surgical repair is often completed between ages 6 and 12 months. Delay the circumcision until the hypospadias is surgically repaired. Save the diapers so that output can be measured. Rationale: Surgery is needed to repair a hypospadias and typically occurs between 6 and 12 months of age. The prepuce is often used in the surgical repair, so circumcision should be delayed until the repair. Have the parents save the diapers to assess urination by measuring output. Most children do not experience any further problems once the repair is completed.

A child needs to undergo peritoneal dialysis. What type of education would the nurse provide to the family about this process? The child will need to have increased fluid restrictions with this. This is performed for 24 hours a day. Infection risk is low. The peritoneal dialysis should help the child with their growth and blood pressure.

The peritoneal dialysis should help the child with their growth and blood pressure. Rationale: The advantages of peritoneal dialysis over hemodialysis include improved growth as a result of more dietary freedom, increased independence in daily activities, and a steadier state of electrolyte balance. However, the risk for infection (peritonitis and sepsis) is a continual concern with peritoneal dialysis.