Chapter 39 (PEDS)

A concerned mother brings her 3-year-old to the primary care office because of nighttime voiding. Which response made by the nurse is best? a) "We will do some further testing to see why this is happening." b) "Why is this such a big concern for you?" c) "I understand your concern, since 3-year-olds should be able to go through the night without voiding." d) "Children are not expected to stay dry through the night until the age of 5."

"Children are not expected to stay dry through the night until the age of 5."

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis? a) Complete white blood count b) History of leukemia in twin c) Lethargy, bruising, and pallor d) Bone marrow aspiration

Bone marrow aspiration

The location of the kidneys in the child in relationship to the location of the kidneys in the adult makes which of the following a greater likelihood in the child? a) The adult has a greater chance of retaining fluids than the child. b) The child has more frequent urges to empty the bladder. c) The child has a greater risk for trauma to the kidney d) The adult has less fat to cushion the kidney

The child has a greater risk for trauma to the kidney

The nurse is caring for a child with possible glomerulonephritis. What diagnostic tests should the nurse prepare the child and family to expect related to this diagnosis? a) blood cultures b) 24 hour urine collection c) stool culture d) anti-streptolysin-O titer

anti-streptolysin-O titer

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with nephrotic syndrome. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of nephrotic syndrome? a) "When you look at the urine of these children it is smoky and bloody." b) "These children have such a big appetite and are always hungry." c) "Their lab work shows a decreased level of cholesterol." d) "The child may look chubby, but they really are malnourished."

"The child may look chubby, but they really are malnourished."

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) "There are several things we can do to help you achieve this goal." b) "You will grow out of this eventually; you just need to be patient." c) "There are almost 5 million people that have enuresis." d) "The pull-ups look just like underwear; no one has to know."

"There are several things we can do to help you achieve this goal."

Urinary tract infections are usually successfully treated by which of the following? a) Increasing fluids, such as cranberry juice b) Administering diuretics c) Administering antibiotics d) Performing bladder irrigations

Administering antibiotics

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

Demonstrate love and acceptance at home.

A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which of the following would the nurse incorporate into the presentation as the most common cause? a) Pseudomonas b) Escherichia coli c) Klebsiella d) Staphylococcus aureus

Escherichia coli

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

Fowler's

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

Proteinuria, hypoalbuminemia, and hypercholesterolemia

A 4-year-old boy with nephrotic syndrome has extensive edema. The best implementation to reduce periorbital edema would be to a) apply warm compresses to his eyes at bedtime. b) apply cool, sterile soaks to his head. c) elevate the head of the bed. d) encourage him to eat low-protein foods.

elevate the head of the bed.

The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which of the following responses would alert the nurse to a confirmed risk factor for this condition? a) "My child has not been sick at all." b) "My child is just 18 months old." c) "He just got over a head cold with laryngitis." d) "She has been very healthy up to now."

"He just got over a head cold with laryngitis."

A child abruptly develops miniature petechiae over his legs, along with epistaxis and bleeding into the joints. Laboratory results reveal a platelet count of 20,000/mm3. The child is eventually diagnosed with idiopathic thrombocytopenic purpura (ITP). The mother of the child is distraught and asks the nurse what the course of this disorder typically is. Which of the following should the nurse mention? a) 4 to 6 weeks b) 1 to 3 months c) Chronic condition d) Terminal condition

1 to 3 months

If the newborn is following a normal development process, the child will most likely void when which of the following amounts of urine is in the bladder? a) 3 mL b) 6 mL c) 25 mL d) 15 mL

15 mL

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with acute glomerulonephritis. In which of the following age ranges is the peak incidence of this disorder noted? a) 2 to 4 years of age b) 6 to 7 years of age c) 15 to 17 years of age d) 12 to 13 years of age

6 to 7 years of age

You care for a 6-year-old boy with acute glomerulonephritis. When planning care for him, you should be aware that glomerulonephritis usually follows an infection of what organism? a) A Beta-hemolytic Streptococcus b) Group B streptococci c) One of the rhinoviruses d) Staphylococcus viridans

A Beta-hemolytic Streptococcus

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTI's). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which of the following statements would be accurate for the nurse to tell this mother? a) "It is unlikely that your daughter is practicing good cleaning habits after she voids." b) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." c) "The position of the urethra in girls makes girls more susceptible than boys to UTI's." d) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."

A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily

To determine if ascites is increasing in amount in a child with nephrotic syndrome, which measurements would be most appropriate? a) Bowel sounds b) Abdominal circumference c) Urine for protein d) Blood pressure

Abdominal circumference

The nurse recognizes that which of the following would be a likely physiologic cause for a child to have enuresis? a) Sexual abuse b) Stress and stressful situations c) Sleeping too soundly d) Regression to get attention

Sleeping too soundly

The nurse is discussing urinary tract infections (UTI's) in children with a group of peers. Which of the following is the most accurate regarding urinary tract infection seen in children? a) Males between the ages of 10 to 12 years of age commonly get UTI's. b) Girls who have gone through puberty most commonly get UTI's. c) The most common age for UTI's in children is 2 to 6 years of age. d) Urinary tract infections are rarely seen after toilet training.

The most common age for UTI's in children is 2 to 6 years of age.

The nurse is caring for a child admitted with acute glomerulonephritis. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Loose, dark stools b) Strawberry red tongue c) Jaundiced skin d) Tea colored urine

Tea colored urine

A child admitted with immune (idiopathic) thrombocytopenic purpura. What will the nurse anticipate the history to include? a) Petechial rash following a viral infection b) Frequent urinary tract infections c) Recent asapirin use d) Recent transfusion of platelets

Petechial rash following a viral infection

The nurse is collecting data on a 6-year-old child admitted with a possible urinary tract infection. Which of the following vital signs might indicate the possibility of an infection? a) Blood Pressure 100/70 b) Pulse oximetry 93% on room air c) Respirations 22 per minute d) Pulse rate 135 bpm

Pulse rate 135 bpm

The nurse is teaching a group of nursing students about genitourinary conditions. The nurse tells these students about a condition that occurs when there is an inflammation of the kidney and renal pelvis. The condition the nurse is referring to is which of the following? a) Oliguria b) Pyelonephritis c) Amenorrhea d) Ascites

Pyelonephritis

The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. The nurse tells the caregiver that the most important reason the child needs increased fluids is for which of the following reasons? a) To dilute the urine and flush the bladder. b) To decrease the pain of urination. c) To fill the bladder so a specimen can be obtained. d) To prevent the child from developing a fever.

To dilute the urine and flush the bladder.

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state which of the following? a) "We should administer the drug on an empty stomach." b) "He might develop a rounded face from this drug." c) "We should check our son's urine for glucose." d) "We will need to gradually decrease the dosage."

We should administer the drug on an empty stomach."

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

Weighing on the same scale each day

When diuresis has not occurred after a month on corticosteroids, the nurse explains to the parents of a child with nephrotic syndrome that diuresis can be brought about by a protocol of: a) ciprofloxacin (Cipro), an antibiotic b) furosemide (Lasix), a diuretic. c) ibuprofen, an antiinflammatory agent. d) cyclophosphamide (Cytoxan), an antisuppressant.

cyclophosphamide (Cytoxan), an antisuppressant.

The administration of prednisone to children with nephrosis creates the problem of: a) weight loss b) increased risk of infection c) increased periorbital edema d) intolerance of foods

increased risk of infection

When planning care for a child with idiopathic thrombocytopenic purpura, you plan to teach her a) what foods are high in folic acid. b) not to pick or irritate her nose. c) to use mainly cold water to wash. d) to apply a soothing cream to lesions.

not to pick or irritate her nose.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is which of the following? a) Placing an indwelling urinary catherter b) Placing a cotton ball in the underwear to catch urine c) Performing a suprapubic aspiration d) Obtaining a clean catch voided urine

Obtaining a clean catch voided urine

The nurse is teaching a group of nursing students about acute glomerulonephritis genitourinary conditions. A student asks the about a condition that occurs when there is a decreased volume of urine output. The condition the student is referring to is which of the following? a) Pyelonephritis b) Ascites c) Amenorrhea d) Oliguria

Oliguria

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as which of the following? a) Ecchymosis b) Purpura c) Petechiae d) Poikilocytosis

Petechiae

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. Which of the following would be most important for the nurse to include in the child's preoperative plan of care? a) Administering analgesics for pain b) Avoiding further abdominal palpation c) Preparing the child for amputation d) Performing dressing changes to the affected area

Avoiding further abdominal palpation

The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). Which of the following would the nurse encourage the parents to avoid? a) Caffeine b) Liberal fluid intake c) Cotton underwear d) Cranberry juice

Caffeine

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

Encouraging fluid intake after dinner

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

Eyes

The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen? a) Nighttime itching b) Loss of appetite c) Facial changes d) Urinary incontinence

Facial changes

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

Holding urine while at school.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which of the following sites should she prepare? a) Sternum b) Femur c) Iliac crest d) Anterior tibia

Iliac crest

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered? a) Intravenous immune globulin b) Folic acid c) Deferoxamine d) Dimercaprol

Intravenous immune globulin

The nurse is teaching a group of nursing students about acute glomerulonephritis genitourinary conditions. A student asks the about a condition that occurs when there is a decreased volume of urine output. The condition the student is referring to is which of the following? a) Pyelonephritis b) Oliguria c) Ascites d) Amenorrhea

Keep him away from people with known infections

The parents of a 6-year-old male with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response? a) "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood." b) "ITP is characterized by the loss of surface area on the red blood cell membrane." c) "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." d) "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which of the following conditions should the nurse suspect? a) Kidney agenesis b) Acute glomerulonephritis c) Nephrosis d) Polycystic kidney

Acute glomerulonephritis

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which of the following as having the highest incidence? a) Neuroblastoma b) Acute lymphocytic (lymphoblastic) leukemia c) Non-Hodgkin's lymphoma d) Osteogenic sarcoma

Acute lymphocytic (lymphoblastic) leukemia

A child who has been diagnosed with minimal change nephrotic syndrome (MCNS) is being discharged after a 3-week hospitalization. Her edema has been greatly reduced and her appetite is beginning to return. Her caregivers have promised to have a family party to celebrate her return. The child has requested the following food for the party. Which of the following foods would the nurse suggest would be appropriate for the diet this child is on? a) Banana splits b) Potato chips c) Popcorn d) Orange soda

Banana splits

The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which of the following vital signs would the nurse anticipate with this child's diagnosis? a) Respirations 24 per minute b) Blood Pressure 136/84 c) Pulse oximetry 93% on room air d) Pulse rate 112 bpm

Blood Pressure 136/84

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another? a) "Don't feel bad. Children get lots of colds." b) "Young children develop minor illness easily and often. Stop being hard on yourselves." c) "You need to focus on the present treatment now and not worry about the past." d) "Keep in mind that the signs of leukemia are often subtle and difficult to recognize."

"Keep in mind that the signs of leukemia are often subtle and difficult to recognize."

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

"Let's meet with the dietitian and plan some meals."