Chapter 39: The Child with a Genitourinary Disorder

The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea? a) "Emotional stress can be a cause of this disorder." b) "This is what happens if a 16-year-old girl has never had any periods at all." c) "This disorder is usually seen after a girl has had a spontaneous abortion." d) "It is caused from taking birth control pills when a girl is younger than 13 years old."

"Emotional stress can be a cause of this disorder." Correct Explanation: Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.

Which statement made by a parent of a child with nephrotic syndrome indicates an understanding of discharge teaching?

"I should check his urine for protein when he goes to the bathroom."

The parents of a newborn are concerned that their son's scrotum is enlarged and swollen on one side. What is the nurse's best response?

"It is a collection of fluid that will most likely correct itself in a year."

What is the best way for the nurse to detect fluid retention in a child with nephrotic syndrome who has not yet been toilet-trained? A. Weigh the child daily. B. Check the urine for blood. C. Measure the abdominal girth weekly. D. Count the number of wet diapers.

A. Measuring weight at the same time each day is the most accurate way to determine fluid gains and losses.

Which urine test result is abnormal? A. pH: 4.0 B. Specific gravity: 1.020 C. Protein level: absent D. Glucose level: absent

A. The expected pH is 4.8 to 7.8; Normal specific gravity range of 1.010 to 1.030; (Protein should not be present in the urine. It would indicate an abnormality in glomerular filtration; Glucose should not be present. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.)

The extrusion of the bladder to the outside of the body through a developmental defect in the abdominal wall is known as bladder _________.

ANS: exstrophy The exposed bladder is covered with nonadherent plastic wrap until surgery can be done. Surgical management is completed in several stages and includes closing the abdominal defect and reconstructing the bladder and genitalia to allow the child to achieve urinary incontinence.

A nurse is assigned to care for four children who have acute kidney injury (AKI). Which child should the nurse see first after obtaining the handoff report? A. Anuric B. Oliguric C. Has deep, rapid respirations D. Having in-room dialysis

ANS: A Children with AKI generally are not anuric unless a catastrophic event has occurred. The nurse needs to see this child first. Oliguria (low urine output) is an expected finding unless the child is in the diuretic phase (high-output phase) of AKI. Deep rapid respirations (Kussmaul's respirations) are also expected as a compensatory response to the metabolic acidosis of AKI. A child receiving dialysis in the room is being attended to by a dialysis nurse.

A child is prescribed gentamycin (Garamycin) and develops acute kidney injury. Which etiology is the most likely cause of the child's acute kidney injury? A. Intrarenal B. Postrenal C. Prerenal D. Streptococcal

ANS: A Gentamycin is one of the aminoglycoside antibiotics, which are known to be nephrotoxic, leading to intrarenal kidney injury. Prerenal kidney injury is due to decreased perfusion. Postrenal kidney injury is obstructive in nature. Strep infections can cause damage to body systems, but there is no indication this child had a strep infection. Gentamycin is directly related to an intrarenal injury.

A child has acute kidney injury (AKI). Which primary acid-base balance does the nurse assess the child for? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

ANS: A In AKI there is insufficient hydrogen ion excretion and poor bicarbonate reabsorption, leading to metabolic acidosis.

The pediatric clinic nurse calls a parent to report urinalysis findings for her child including microscopic hematuria. Which question by the nurse is most appropriate? A. "Has your child recently had strep throat?" B. "Has your child been in a bike or car crash?" C. "Has your child started menstruating yet?" D. "Has your child taken lots of bubble baths?"

ANS: A The most common causes of microscopic hematuria include UTI, poststreptococcal glomerulonephritis, hypercalciuria, and structural abnormalities. Trauma would more likely cause gross hematuria. The other two questions are appropriate depending on the age and sex of the child, but do not assess for the most common reasons for this finding.

The nurse closely monitors the temperature of a child with nephrotic syndrome. The purpose of this is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A An exacerbation of the disease can occur after an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms. Edema does not manifest with an elevated temperature.

A nurse is teaching a class on acute kidney injury. The nurse relates that acute kidney injury as a result of hemolytic-uremic syndrome (HUS) is classified as a. Intrinsic renal. b. Prerenal. c. Postrenal. d. Chronic.

ANS: A Intrinsic renal acute renal failure is the result of damage to kidney tissue. Possible causes include HUS, glomerulonephritis, and pyelonephritis. Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature. Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics if prescribed b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

ANS: A Prophylactic antibiotics are sometimes used to prevent urinary infection in a child with vesicoureteral reflux, especially if they are waiting for the results of imaging studies or have recurrent UTIs. If prescribed, the parents should be taught that the child must finish the entire course of antibiotics to prevent bacterial resistance. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. Bubble baths should be avoided to prevent urethral irritation and possible UTI. To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

Which dietary modification is appropriate for a child with chronic renal failure? a. Decreased protein b. Decreased fat c. Increased potassium d. Increased phosphorus

ANS: A Protein intake is restricted or strictly regulated because of the kidney's inability to remove waste products. A low-fat diet is not relevant to chronic renal failure. Potassium intake may be restricted because of the kidney's inability to remove it. Phosphorus is restricted to help prevent bone disease.

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine. The nurse explains that casts in the urine indicate a. glomerular injury. b. glomerular healing. c. recent streptococcal infection. d. excessive amounts of protein in the urine.

ANS: A The presence of red blood cell casts in the urine indicates glomerular injury. Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. A urinalysis positive for casts does not confirm a recent streptococcal infection. Casts in the urine are unrelated to proteinuria.

The nurse closely monitors the temperature of a child with nephrotic syndrome. The purpose of this is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A Feedback A An exacerbation of the disease can occur after an infection. B Temperature is not an indication of hypertension or edema. C Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms. D Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.

The primary clinical manifestations of acute renal failure are a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

ANS: A Feedback A The principal feature of acute renal failure is oliguria. B These are not principal features of acute renal failure. C These are not principal features of acute renal failure. D These are not principal features of acute renal failure.

The nurse is planning discharge teaching for a child who just had a kidney transplant. Which information does the nurse provide regarding signs of rejection? (Select all that apply.) A. Decreased urine output B. Edema C. Fever D. Pain over the kidney E. Weight loss

ANS: A, B, C, D Decreased urine output, edema, fever, and pain over the donor kidney site are all signs of possible rejection. The child would have a weight gain related to the edema.

The student studying the renal system learns that the kidneys have several functions. Which options are functions of the kidneys? (Select all that apply.) A. Filtering the blood B. Maintaining electrolyte balance C. Regulating acid-base balance D. Removing waste products E. Suppressing hormone release

ANS: A, B, C, D Functions of the kidneys include filtering the blood, removing waste products from the blood, regulating both fluid and electrolyte and acid-base balance, and releasing hormones.

A faculty member is explaining complications of hemodialysis to a group of students. Which complications does the faculty member include in the discussion with the students? (Select all that apply.) A. Bleeding B. Febrile reactions C. Hypotension D. Infection E. Pulmonary embolism

ANS: A, B, C, D There are many complications associated with hemodialysis, including bleeding, febrile reactions, hypotension, and infection. Although any ill child can develop a pulmonary embolism, this is not a specific complication of this therapy.

A new mother asks the nurse why babies are more prone to dehydration than adults. Which rationales from the nurse best answer this mother's question? (Select all that apply.) A. A greater body surface area than adults B. Higher percentage of total body water C. Improved ability of kidneys to concentrate urine D. Kidneys too efficient in excreting waste E. More fluids losses through GI tract and skin

ANS: A, B, E There are several reasons children are more prone to dehydration than adults, including: a greater body surface area from which to lose fluids, a higher percentage of total body water, more losses from the GI tract and skin, a decreased ability of the kidneys to concentrate urine, and immature kidneys that are not good at excreting waste products.

A nurse is providing teaching on toilet training to a parent education group. Which signs of training readiness does the nurse explain to the parents? (Select all that apply.) A. Can stay dry for at least 2 hours B. Gets up by self at night for toileting C. Showing interest in toileting D. Tells parent of need to use toilet E. Wants to hold urine and not void

ANS: A, C, D There are several "readiness" signs to watch for when planning toilet training. These include being able to stay dry for a specific amount of time, showing interest in toileting, and being able to tell the parent or caretaker of the need to use the toilet. Getting up by oneself and wanting to hold the urine are not signs.

The nurse is explaining the RIFLE classification of kidney injury to a student. Which options are included in this system? (Select all that apply.) A. End-stage kidney disease B. Failure to concentrate urine C. Injury to the kidney D. Loss of protein in the urine E. Risk of renal dysfunction

ANS: A, C, E RIFLE stands for risk of renal dysfunction, injury to the kidney, failure of the kidney, loss of kidney function, and end-stage kidney disease.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? Select all that apply. a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E Feedback Correct The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Incorrect Enuresis and voiding urgency should be assessed in an older child.

A child has just returned to the pediatric intensive care unit after having a kidney transplant. Which assessment takes priority for this child? A. Level of consciousness B. Hourly urine output C. Pain D. Vital signs

ANS: B All assessments are important in a postoperative patient. However, because the child had a kidney transplant, assessment of renal function takes priority.

The parents of a child with chronic kidney disease ask the nurse why the child is prescribed epoetin alfa (Epogen). Which response by the nurse is the most accurate? A. "It binds with and removes phosphorus." B. "It will help his body to make more red blood cells." C. "It will help to boost his white blood cell count." D. "It will help his body to make more platelets so he doesn't bleed."

ANS: B Anemia is common with chronic kidney disease due to reduced erythropoeitin, which is vital for making red blood cells. The other answers are incorrect.

Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs)? a. "I always wear cotton underwear." b. "I really enjoy taking a bubble bath." c. "I go to the bathroom every 3 to 4 hours." d. "I drink four to six glasses of fluid every day."

ANS: B Bubble baths should be avoided because they tend to cause urethral irritation, which leads to UTI. It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture. Children should be encouraged to urinate at least four times a day. An adequate fluid intake prevents the buildup of bacteria in the bladder.

You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS). Which bacterial infection was most likely the cause of HUS? a. Pseudomonas aeruginosa b. Escherichia coli c. Streptococcus pneumoniae d. Staphylococcus aureus

ANS: B Children with HUS become infected by Escherichia coli, which is usually contracted from eating improperly cooked meat or contaminated dairy products. Pseudomonasaeruginosa, Streptococcuspneumoniae,andStaphylococcus aureusare not associated with HUS.

What is an appropriate intervention for a child with nephrotic syndrome who is edematous? a. Teach the child to minimize body movements. b. Change the child's position every 2 hours. c. Avoid the use of skin lotions. d. Bathe every other day.

ANS: B Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. Good skin hygiene consists of daily baths to remove irritating body secretions and applying lotion.

An infant is born with bladder exstrophy. What action by the nurse is the priority? a. Obtain surgical consent for the corrective operation. b. Cover the exposed bladder with non-adherent plastic wrap. c. Insert an indwelling catheter to collect all the urine. d. Obtain consent for genetic testing on parents and infant.

ANS: B In bladder exstrophy, the bladder is outside the body and must be covered with a non-adherent plastic wrap until surgical correction. This is the priority action. Consent will be obtained prior to surgery. A catheter is not needed. Genetic testing is not necessarily done.

A nurse is assessing lab results on four patients in the general pediatric unit. What child should the nurse go see first? a. Urine specific gravity: 1.025 b. Urine ketones: positive in large amounts c. Serum BUN 21 mg/dL d. Serum creatinine 0.7 mg/dL

ANS: B Ketones should not be present in the urine. When found, they are indicative of starvation, diabetic ketoacidosis, fever, prolonged vomiting, anorexia, and severe diarrhea. The nurse should see this child first. The other lab values are normal.

The narrowing of preputial opening of foreskin is called a. chordee. b. phimosis. c. epispadias. d. hypospadias.

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision is difficult, since a normal lifestyle is not possible.

ANS: B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission? a. Urine is negative for casts for 5 days. b. Urine has <1+ protein for 3 to 7 consecutive days. c. Urine is positive for glucose for 1 week. d. Urine is up to a trace for blood for 1 week.

ANS: B The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine has <1+ protein for 3 to 7 consecutive days. The absence of casts, presence of glucose, and presence of hematuria do not constitute remission

Parents ask the nurse, "When should our child's hypospadias be corrected?" The nurse responds that correction of hypospadias should be accomplished by the time the child is a. 1 month of age. b. 6 to 12 months of age. c. school age. d. sexually mature.

ANS: B The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. One month of age is too young for this procedure. It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. Corrective surgery for hypospadias is done long before sexual maturity.

Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake offers protective measures against UTIs. Prostatic secretions have antibacterial properties that inhibit bacteria. Frequent emptying of the bladder also offers protection against UTIs.

A child is admitted with acute glomerulonephritis. The nurse expects the urinalysis during this acute phase to show which of the following? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes is specific gravity would not be expected.

A child is admitted with acute glomerulonephritis. The nurse expects the urinalysis during this acute phase to show a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

ANS: B Feedback A Bacteriuria and changes in specific gravity are not usually present during the acute phase. B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. C Bacteriuria and changes in specific gravity are not usually present during the acute phase. D Bacteriuria and changes in specific gravity are not usually present during the acute phase.

The narrowing of preputial opening of foreskin is called a. Chordee b. Phimosis c. Epispadias d. Hypospadias

ANS: B Feedback A Chordee is the ventral curvature of the penis. B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. C Epispadias is the meatal opening on the dorsal surface of the penis. D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult, since a relatively normal lifestyle is not possible.

ANS: B Feedback A It can be done in children as young as age 6 months. B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. C Both children and adults can serve as donors for renal transplant purposes. D Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs)? a. "I always wear cotton underwear." b. "I really enjoy taking a bubble bath." c. "I go to the bathroom every 3 to 4 hours." d. "I drink four to six glasses of fluid every day."

ANS: B Feedback A It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture. B Bubble baths should be avoided because they tend to cause urethral irritation, which leads to UTI. C Children should be encouraged to urinate at least four times a day. D An adequate fluid intake prevents the buildup of bacteria in the bladder.

Parents ask the nurse "when should our child's hypospadias be corrected?" The nurse responds based upon the knowledge that correction of hypospadias should be accomplished by the time the child is a. 1 month of age b. 6 to 12 months of age c. School age d. Sexually mature

ANS: B Feedback A Surgery to correct hypospadias is not performed when the infant is this young. B The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. C It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. D Corrective surgery for hypospadias is done long before sexual maturity.

What is an appropriate intervention for a child with minimal change nephrotic syndrome who is edematous? a. Teach the child to minimize body movements. b. Change the child's position every 2 hours. c. Avoid the use of skin lotions. d. Bathe every other day.

ANS: B Feedback A The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. B Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. C Applying lotion to the skin helps to increase circulation. D Bathing daily removes irritating body secretions from the skin.

A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? (Select all that apply.) a. Administration of antihypertensive medications b. Daily weights c. Salt-restricted diet d. Frequent position changes e. Teaching parents to expect tea-colored urine

ANS: B, C, D A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis but not nephrotic syndrome. The urine in nephrotic syndrome is frothy, indicating that protein is being lost in the urine.

A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply. a. Administration of antihypertensive medications b. Daily weights c. Salt-restricted diet d. Frequent position changes e. Teaching parents to expect tea-colored urine

ANS: B, C, D Feedback Correct A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Incorrect Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis, but not nephrotic syndrome. The urine in nephrotic syndrome is frothy indicating protein is being lost in the urine.

A nurse is explaining to a group of students that there are certain criteria that are met before a child starts renal replacement therapy. Which of the following criteria does the nurse include in the discussion with the students? (Select all that apply.) A. Acidosis with pH < 7.2 or rising rapidly B. BUN > 150 mg/dL, or lower if rising rapidly C. Mental status changes from uremia D. Potassium > 6.5 mEq/L despite treatment E. Presence of dialyzable toxins or poisons

ANS: B, C, D, E There are several criteria for beginning renal replacement therapy, including those listed here. Acidosis with a pH of greater than 7.2 or HCO3 greater than 10 mEq/L are also criteria, but if the pH is rising (normalizing) quickly, that would not be an indication to begin therapy.

A nurse is caring for a child who is scheduled for a kidney biopsy. The prebiopsy laboratory results indicate a platelet count of 88,000, pH of 7.28, and potassium of 5.8 mEq/L. Based on these laboratory results, which action by the nurse is the most appropriate? A. Ensure signed consent is on the chart. B. Document the findings in the chart. C. Notify the provider immediately. D. Prepare to administer Kayexalate (sodium polystyrene).

ANS: C A platelet count this low is too low to perform an invasive procedure, such as a kidney biopsy. The nurse should notify the provider immediately. Documentation should be done and consent should be on the chart prior to a procedure, but in this case, the biopsy may be postponed. The potassium level is slightly high and probably does not warrant Kayexalate, but in any event, notifying the provider takes priority.

A nurse is caring for a child with acute kidney injury (AKI) at home. The child's laboratory work is as follows: serum albumen 2.8 g/dL and serum protein 4 g/dL. Which action by the nurse is the most appropriate? A. Assess the child for edema. B. Document findings in the chart. C. Facilitate a dietitian referral. D. Weigh and measure the child.

ANS: C All interventions are appropriate for a child with AKI. However the child's laboratory results indicate malnutrition, and with the dietary restrictions the child must follow, ensuring adequate nutrition is difficult. A referral to a dietitian is most important.

A 5-year-old child has enuresis. Which medication regime does the nurse educate the parents on related to this diagnosis? A. Imipramine (Tofranil), 10 mg before bed B. Imipramine (Tofranil), 25 mg before bed C. Oxybutynin chloride (Ditropan), 5 mg once daily D. Oxybutynin chloride (Ditropan), 50 mg once daily

ANS: C Both medications are used in this condition. Tofranil cannot be used in children under the age of 6. The dose of Ditropan is 5 mg once daily and can be titrated upward to a maximum dose of 20 mg/day.

A child is receiving hemodialysis. The parents ask why hypotension is a possible complication. Which response by the nurse is the most appropriate? A. "It could be from the anticoagulant we use." B. "Kidney disease can often cause hypotension." C. "The treatment is removing fluid from his body." D. "Your child is critically ill and is unstable."

ANS: C Hemodialysis removes fluid from the child's body, sometimes at a rate that causes hemodynamic instability, including hypotension. The other answers are not accurate.

A school-age boy is in the emergency department with testicular torsion. Which action by the nurse takes priority for this patient? A. Administer prophylactic antibiotics. B. Assess and treat the child's pain. C. Ensure surgical consent is on the chart. D. Ice and elevate the scrotum.

ANS: C Testicular torsion is a surgical emergency, and the nurse's priorities are to facilitate surgery. The nurse must ensure a signed consent is on the chart. Treating pain is important too, but the consent is a legal requirement. Prophylactic antibiotics may or may not be given. Ice and elevation may be helpful as a comfort measure, but do not take priority over the consent.

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

ANS: C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. In acute poststreptococcal glomerulonephritis the urine output may be decreased. In acute poststreptococcal glomerulonephritis blood pressure may be increased. Edema may be noted around the eyelids and ankles in patients with acute post streptococcal glomerulonephritis and can contribute to weight gain; however, weight gain is associated more with nephrotic syndrome.

A major complication in a child with chronic renal failure is a. hypokalemia. b. metabolic alkalosis. c. water and sodium retention. d. excessive excretion of blood urea nitrogen.

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia is a complication of chronic renal failure. Metabolic acidosis is a complication of chronic renal

The diet of a child with chronic renal failure is usually characterized as a. high in protein. b. low in vitamin D. c. low in phosphorus. d. supplemented with vitamins A, E, and K.

ANS: C Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. Protein should be limited. Vitamin D is administered to children with chronic kidney failure. Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease.

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is a. Risk for Injury related to malignant process and treatment. b. Deficient Fluid Volume related to excessive losses. c. Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration. d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces.

ANS: C Glomerulonephritis has a decreased filtration of plasma. The resulting decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. Excess fluid volume is found in this disease process. The fluid accumulation is related to the decreased plasma filtration.

Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts? a. Acute viral gastroenteritis b. Acute glomerulonephritis c. Hemolytic-uremic syndrome d. Acute nephrotic syndrome

ANS: C Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea. Anemia and thrombocytopenia are not associated with acute gastroenteritis. The symptoms described are not suggestive of acute glomerulonephritis. The symptoms described are not suggestive of nephrotic syndrome.

A major complication in a child with chronic renal failure is a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

ANS: C Feedback A Hyperkalemia is a complication of chronic renal failure. B Metabolic acidosis is a complication of chronic renal failure. C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. D Retention of blood urea nitrogen is a complication of chronic renal failure.

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is a. Risk for Injury related to malignant process and treatment b. Deficient Fluid Volume related to excessive losses c. Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces

ANS: C Feedback A No malignant process is involved in acute glomerulonephritis. B Excess fluid volume is found. C Glomerulonephritis has a decreased filtration of plasma. The resulting decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. D The fluid accumulation is secondary to the decreased plasma filtration.

The diet of a child with chronic renal failure is usually characterized as a. High in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K

ANS: C Feedback A Protein should be limited in chronic renal failure to decrease intake of phosphorus. B Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. C Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. D Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease.

The nurse is assisting a 12-year-old kidney transplant recipient to select items from the hospital menu. Which meal indicates an appropriate understanding of dietary restrictions? A. Chicken alfredo, breadstick B. Cheese pizza, fruit cocktail C. Lasagna, salad, breadstick D. Pasta with tomato sauce, salad

ANS: D A kidney transplant recipient is placed on a protein-restricted diet. Pasta with plain tomato sauce is the lowest-protein menu item listed. The other meals are high in protein. Sodium may be limited too.

An adolescent male patient had an orchiopexy for cryptorchidism as an infant. Which health promotion activity does the nurse educate this patient about? A. Annual digital prostate exam B. Fertility testing C. Genetic screening D. Testicular self-exam monthly

ANS: D After orchiopexy, the teen still has a high risk for testicular cancer and should perform testicular self-exams each month. The other actions are not warranted for this condition.

A student nurse wants to know why a bruit is heard and a thrill palpated at the site of an AV fistula used for dialysis. Which response by the nephrology nurse is the most appropriate? A. Abnormal findings signaling complications B. Flapping of the AV valve during circulation C. Small blood clots blocking some blood flow D. Turbulent blood flow through the fistula

ANS: D Blood flowing through an AV fistula goes from a high-pressure system into a low-pressure system during circulation, leading to turbulent flow. It is a normal finding and not caused by the AV valve or small blood clots.

A child is receiving home peritoneal dialysis. When the visiting nurse assesses the patient, he finds the outflow from the dialysis to be cloudy. Which action by the nurse is the most appropriate? A. Call 911 and send the child to the hospital. B. Call the nephrology clinic to make an appointment. C. Review teaching with the child on the process. D. Take a full set of vitals and notify the provider.

ANS: D Cloudy outflow could indicate peritonitis, a serious complication of peritoneal dialysis. The nurse should take a full set of vitals to assess for infection and call the provider. The child does not need 911. Teaching can be done later. The child should not wait for an appointment.

A child is hospitalized with acute kidney injury (AKI) and has a critical hyperkalemia. Which order would the nurse question as inappropriate for this child? A. Calcium gluconate B. Dextrose and insulin C. Emergent dialysis D. Kayexalate (sodium polystyrene) enema

ANS: D Kayexalate enemas can take up to 4 hours to work. With critical hyperkalemia, the drug of choice needs to work faster than this. The other options would all work faster.

A nurse is preparing to administer gentamicin (Garamycin), IV, to a hospitalized child. Before administering the medication, the nurse checks the drug trough level, which is 13 µg/mL. Which action by the nurse is the priority for this child? A. Administer the medication. B. Document the findings. C. Have the laboratory re-run the specimen. D. Notify the health-care provider.

ANS: D This trough level is too high (normal is 2 µg/mL). Because this drug is nephrotoxic, care must be given to avoid causing acute kidney injury. The nurse notifies the health-care provider about the results and does not administer the medication. Documentation should occur, but is not the priority. Asking the laboratory to re-run the specimen is not warranted.

Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet? a. "I can give my child sweet pickles." b. "My child can put ketchup on his hotdog." c. "I can let my child have potato chips." d. "I do not put any salt in foods when I am cooking."

ANS: D A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating. Pickles of any type, hotdogs, and potato chips are all prohibited on this diet.

Which clinical finding warrants further intervention for the child with acute post streptococcal glomerulonephritis? a. Weight loss to within 1 lb of the preillness weight b. Urine output of 1 mL/kg/hr c. A positive antistreptolysin O (ASO) titer d. Inspiratory crackles

ANS: D Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication. Weight loss is an indication that the child is responding to treatment. The urine output of 1 mL/kg/hr is acceptable. A positive ASO titer indicates the presence of antibodies to streptococcal bacteria; it is used to aid in diagnosis of acute post streptococcal glomerulonephritis. This is an expected finding if the child has this acute illness.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI

ANS: D Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.

Hypospadias refers to a. absence of a urethral opening. b. penis shorter than usual for age. c. urethral opening along dorsal surface of penis. d. urethral opening along ventral surface of penis.

ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present in hypospadias but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Epispadias is where the urethral opening is along the dorsal surface of the penis.

Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyperalbuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria

ANS: D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

The most common cause of acute kidney injury in children is a. pyelonephritis. b. tubular destruction. c. urinary tract obstruction. d. severe dehydration.

ANS: D The most common cause of acute kidney injury in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. This is a prerenal cause. Pyelonephritis, tubular destruction, and urinary tract obstruction are not common causes of acute kidney injury in children.

Which of the following is a true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system? a. The young infant's kidneys can more effectively concentrate urine than an adult's kidneys. b. After 6 years of age, kidney function is nearly like that of an adult. c. Unlike adults, most children do not regain normal kidney function after acute renal failure. d. Young children have shorter urethras, which can predispose them to UTIs.

ANS: D Young children have shorter urethras, which can predispose them to UTIs. The young infant's kidneys cannot concentrate urine as efficiently as can those of older children and adults because the loops of Henle are not yet long enough to reach the inner medulla, where concentration and reabsorption occur. By 6 to 12 months of age, kidney function is nearly like that of an adult. Unlike adults, most children with acute renal failure regain normal function.

Hypospadias refers to a. Absence of a urethral opening b. Penis shorter than usual for age c. Urethral opening along dorsal surface of penis d. Urethral opening along ventral surface of penis

ANS: D Feedback A The urethral opening is present, but not at the glans. B Hypospadias refers to the urethral opening, not to the size of the penis. C This is known as epispadias. D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what conditions? (Select all that apply.) a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI e. Diabetes mellitus

ANS: D, E Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what condition? Select all that apply. a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI e. Diabetes mellitus

ANS: D, E Feedback Correct Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. Incorrect An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

The care of the child with chronic renal failure is complex and requires a multidisciplinary team approach. Most of these children will ultimately require dialysis. Is this statement true or false?

ANS: T This statement is correct. Children and their families will be most successful with dialysis treatment if the method chosen fits their lifestyle. The goal is to optimize physical, social, and emotional development while addressing the complex physical requirements related to chronic renal failure.

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present? a) Swollen testes b) Enlarged inguinal glands c) Purulent drainage from the penis d) Abdominal mass

Abdominal mass

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) Absence of a thrill b) Dialysate without fibrin or cloudiness c) Presence of a thrill d) Presence of a bruit

Absence of a thrill

A 13-year-old girl tells the nurse during a gynecological visit that a friend of hers developed toxic shock syndrome from tampon use. The client says that tampons work well for her, but she wonders whether they are safe. Which of the following recommendations should the nurse give this client to help prevent toxic shock syndrome? a) Insert two tampons at a time b) Use the highest absorbency tampon possible c) Alternate use of tampons with sanitary pads d) Use feminine hygiene sprays in conjunction with tampons

Alternate use of tampons with sanitary pads Correct Explanation: To help prevent toxics shock syndrome, the nurse should recommend that the client alternate use of tampons with use of sanitary pads; change tampons at least every 4 hours; use the lowest absorbency tampon possible that is still adequate for her individual flow; avoid handling the portion of the tampon that will be inserted vaginally; not use tampons near the end of a menstrual flow, when excessive vaginal dryness can result from scant flow; not insert more than one tampon at a time, to avoid abrasions and to keep the vaginal walls from becoming too dry; and avoid deodorant tampons, deodorant sanitary pads, and feminine hygiene sprays as these products can irritate the vulvar-vaginal lining.

An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What is the most appropriate approach by the nurse? A. Help parents understand that no one knows how this occurs. B. Explain the disorder so that parents can explain it to others. C. Encourage parents not to worry while the tests are being done. D. Suggest that parents avoid family and friends until the gender is assigned.

B. Explaining the disorder so that the parents can explain it to others is the most therapeutic approach while the parents await the gender assignment of their child.

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) Pulse rate 112 bpm b) Blood Pressure 136/84 c) Pulse oximetry 93% on room air d) Respirations 24 per minute

Blood Pressure 136/84 Correct Explanation: Hypertension appears in 60% to 70% of patients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for this age child, but not a concern with this diagnosis. The other vital signs are within normal limits for this age child.

A young child is diagnosed with vesicoureteral reflux. What would the nurse expect to read in the medical history that the child had been experiencing? A. Incontinence B. Hypotension C. Recurrent kidney infections D. Increased renal arterial perfusion

C. Reflux allows urine flow to be forced back to the kidneys. When the urine is infected, this contributes to kidney infections.

Why are external defects of the genitourinary tract, such as hypospadias, repaired as early as possible? A. To prevent separation anxiety B. To prevent urinary complications C. To promote acceptance of hospitalization D. To promote development of normal body image

D. This is extremely important. Surgery involving sexual organs can be very upsetting to children, especially preschoolers who fear mutilation and castration.

You obtain a history from the mother of a child with glomerulonephritis about how he became ill. Which of the following would you expect her to tell you she noticed? a) Headache, loss of appetite b) Dark brown urine c) Loss of weight, oliguria d) Diuresis and pallor

Dark brown urine Correct Explanation: Acute glomerulonephritis often presents with glomeruli bleeding, which is revealed as black or brown urine from old blood.

A 7-year-old child has a BUN of 25 mg/dL. What is the nurse aware this lab value might indicate? (Select all that apply.)

Dehydration Renal disease Need for steroid therapy

What special considerations are related to long-term prednisone therapy in preschoolers? (Select all that apply.)

Delayed immunization Increased risk for infection

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) Demonstrate love and acceptance at home. c) Take away a toy every time the child urinates in their pants. d) Discuss how child can continue to go to the bathroom instead of in the underwear.

Demonstrate love and acceptance at home.

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) Engaging the child in stress reduction measures b) Giving desmopressin intranasally c) Encouraging fluid intake after dinner d) Practicing bladder-stretching exercises

Encouraging fluid intake after dinner Correct Explanation: In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.

A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point? a) Mittelschmerz b) Endometriosis c) Toxic shock syndrome d) Amenorrhea

Endometriosis

A symptom often seen in acute glomerulonephritis is edema. The most common site the edema is first noted is in which area of the body? a) Sacrum b) Eyes c) Hands d) Ankles

Eyes Correct Explanation: Periorbital edema may accompany or precede hematuria in children with acute glomerulonephritis. Edema in the ankles, hands and sacrum are not noted in acute glomerulonephritis.

The nurse is caring for an 8-year-old hospitalized child with nephrotic syndrome. Which nursing intervention would be appropriate for this child? a) Administer antipyretics as needed. b) Measure the abdominal girth daily. c) Weigh the child once a week. d) Test the urine for ketones twice a day.

Measure the abdominal girth daily.

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: a) Ascites b) Amenorrhea c) Oliguria d) Pyelonephritis

Oliguria

The nurse caring for a child with nephrotic syndrome is alert to which classic symptoms of this disorder? (Select all that apply.)

Proteinuria Grossly bloody urine Fatigue Generalized edema

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) Ascites b) Oliguria c) Pyelonephritis d) Amenorrhea

Pyelonephritis Correct Explanation: Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Ascites is edema in the peritoneal cavity.

A child diagnosed with acute glomerulonephritis will most likely have a history of: a) Hemorrhage or history of bruising easily b) Sibling diagnosed with the same disease c) Recent illness such as strep throat d) Hearing loss with impaired speech development

Recent illness such as strep throat

A child diagnosed acute glomerulonephritis will most likely have a history of which of the following? a) Recent illness such as strep throat b) Hemorrhage or history of bruising easily c) Sibling diagnosed with the same disease d) Hearing loss with impaired speech development

Recent illness such as strep throat Correct Explanation: Symptoms of acute glomerulonephritis often appear one to three weeks after the onset of a streptococcal infection such as strep throat.

The nurse is doing an in-service training with a group of peers on the topic of the genitourinary system. Which of the following is a major function of the kidneys? a) Regulate blood pressure b) Remove carbon dixoide c) Circulate cerebrospinal fluid d) Produce white blood cells

Regulate blood pressure

The mother of 6-month-old girl is concerned about her daughter getting a urinary tract infection. What should the nurse mention to the mother to help prevent this condition? a) Wipe from back to front when changing the girl's diaper. b) Bathe the child with bubble bath once a week. c) Discontinue prescribed antibiotics once symptoms of UTI have disappeared. d) Report any abnormally colored urine to the child's primary care provider.

Report any abnormally colored urine to the child's primary care provider.

A 16-year-old tells you she has terrible dysmenorrhea. Which action would be the best health teaching measure regarding this? a) Take over-the-counter ibuprofen for its prostaglandin action. b) Use ice to help in reducing inflammation and pain. c) Drink a minimum of fluid if having pain. d) Take acetaminophen beginning with the first day of a menstrual flow.

Take over-the-counter ibuprofen for its prostaglandin action.

The nurse is caring for a 5-month-old boy with an undescended left testis. Which of the following would the nurse identify as indicative of true cryptorchidism? a) Testis can briefly be brought into scrotum b) Venous varicosity detected along the spermatic cord c) Fluid detected in scrotal sac d) Testis cannot be "milked" down inguinal canal

Testis cannot be "milked" down inguinal canal Correct Explanation: With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a one week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out which of the following? a) The child has a urinary tract infection due to not bathing while on the fishing trip b) The child did not want to go on the fishing trip and is now retaliating against being made to go c) The child has been sexually abused, maybe on the fishing trip d) The child is out of the habit of waking himself up during the night to void

The child has been sexually abused, maybe on the fishing trip Correct Explanation: Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse and should be further explored.

A newborn is diagnosed with hypospadias and the parents want him to be circumcised. What would be the best response by the nurse? a) The foreskin is needed for repair. b) The circumcision may predispose the child to renal failure. c) Circumcision is usually performed after 1 year old. d) Circumcision with a hypospadias will cause meatal stenosis.

The foreskin is needed for repair.

A newborn is diagnosed with hypospadias and the parents want him to be circumcised. What would be the best response by the nurse? a) Circumcision is usually performed after 1 year old. b) The circumcision may predispose the child to renal failure. c) Circumcision with a hypospadias will cause meatal stenosis. d) The foreskin is needed for repair.

The foreskin is needed for repair. Correct Explanation: A child's foreskin is not removed since it is needed to help repair a hypospadias. Once the hypospadias is repaired, a circumcision can be performed at the same time. Meatal stenosis has to do with the urethral opening diameter, not the placement.

A nurse is providing education to parents of a child diagnosed with vesicoureteral reflux (VUR). Which of the following would be included in the education? a) This is typically treated with a kidney transplant. b) This occurs when there is backflow of urine into the bladder and sometimes kidneys. c) This occurs only when there is an obstruction of the ureteropelvic junction. d) This is diagnosed by abdominal x-ray.

This occurs when there is backflow of urine into the bladder and sometimes kidneys. Correct Explanation: The cause of VUR is a backflow of urine into the bladder and possibly kidneys. This disorder can occur if there is an obstruction, but not always. The way to determine if a child has VUR is typically by a VCUG diagnostic test. There are five different grades to VUR and it is treated according to the cause and degree of VUR.

A 12-year-old girl reports pain and a burning sensation on urination. The nurse suspects a urinary tract infection. Which diagnostic test would be most appropriate for confirming this condition? a) Renal biopsy b) Urine culture c) Urinalysis d) Radioisotope scanning

Urine culture

A 12-year-old girl reports pain and a burning sensation on urination. The nurse suspects a urinary tract infection. Which of the following diagnostic tests would be most appropriate for confirming this condition? a) Urinalysis b) Radioisotope scanning c) Urine culture d) Renal biopsy

Urine culture Explanation: A urinary tract infection (UTI), or the presence of bacteria in urine, is diagnosed by urine culture. Urinalysis involves use of a chemical reagent strip to detect glucose, protein, and occult blood and to measure pH, as well as use of a refractometer to measure specific gravity. Radioisotope scanning is used to assess glomeruli filtration ability. Renal biopsy involves passing a thin biopsy needle into the kidney through the skin over the kidney and is used to diagnose the extent of renal disease and thereby predict disease outcome or progress or reveal beginning rejection of a transplanted kidney.

A 6-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client? a) Karyotyping to establish the client's gender b) Administer a short course of chorionic gonadotropin hormone for about 5 days c) Orchiopexy to correct the condition d) Wait a year or two to see whether the testes will descend on their own

Wait a year or two to see whether the testes will descend on their own

The nurse is working with a child with altered genitourinary status. Which intervention would be included in the plan of care with excess fluid volume? a) Hold all medication until the fluid retention is improving. b) Measure the amount of nitrates present in the urine. c) Avoid administering IVs. d) Weigh the child twice a day on the same scale.

Weigh the child twice a day on the same scale.

The nurse is working with a child with altered genitourinary status. Which of the following interventions would be included in the plan of care with excess fluid volume? a) Avoid administering IVs. b) Hold all medication until the fluid retention is improving. c) Weigh the child twice a day on the same scale. d) Measure the amount of nitrates present in the urine.

Weigh the child twice a day on the same scale. Correct Explanation: A child with a renal problem needs to be weighed on the same scale for accurate weights. The frequency is important to ensure the child is not retaining fluid.

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) Start the process over with a fresh bag b) Weigh the old dialysate c) Weigh the new dialysate d) Empty the old dialysate

Weigh the old dialysate

A nurse is reviewing the medical record of an infant with hydronephrosis. What would the nurse expect to find in the history and physical examination? Select all that apply. a) Crying on voiding b) History of repeated urinary tract infections c) Hypotension d) Fever e) Abdominal mass on palpation

• History of repeated urinary tract infections • Abdominal mass on palpation • Crying on voiding

What is an initial sign of nephrosis that the nurse might note in a child?

Periorbital edema

What foods does the nurse recommend the child with acute glomerulonephritis avoid to prevent hyperkalemia?

Bananas

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). 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 statement 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) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." d) "Girls tend to urinate less frequently than boys, making them more susceptable to UTI's."

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

The nurse is caring for an infant with grade II vesicoureteral reflux (VUR). The mother is very fearful that her child will have progressive renal damage. Which response by the nurse would be most appropriate? a) "Your son will most likely need surgical intervention." b) "You can expect recurrent urinary tract infections along with progressive renal damage." c) "This problem must be carefully managed to avoid permanent damage." d) "This condition usually resolves spontaneously with no symptoms."

"This condition usually resolves spontaneously with no symptoms."

The nurse is performing education for the parents of an infant with bladder exstrophy. Which statement by the parents would indicate and understanding of the child's future care? 1. "Care will be no different than that of any other infant." 2. "My infant will only need this one surgery." 3. "My child will wear diapers all his life." 4. "We will need to care for the urinary diversion."

"We will need to care for the urinary diversion."

The nurse is conducting a presentation for a group of nurses who work with adolescents. The group of nurses discusses dysmenorrhea. Which statement is most accurate related to dysmenorrhea? a) A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. b) Genetic abnormalities are the most common cause of dysmenorrhea. c) Common symptoms of dysmenorrhea are weight gain and mood swings. d) Dysmenorrhea can result from diaphragms or tampons being left in place too long.

A contributing factor in dysmenorrhea is the increased secretion of prostaglandins.

The nurse is measuring ouput on an infant on the pediatric unit. When weighing the diaper and subtracting the weight of the dry diaper, the nurse records 30 grams and documents this as _________ mL.

30

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) One of the rhinoviruses c) Staphylococcus viridans d) Group B streptococci

A beta-hemolytic streptococcus

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 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) Sacrum b) Abdomen c) Eyes d) Fingers

Eyes Correct Explanation: Edema is usually the presenting symptom in nephrotic syndrome, appearing first around the eyes and ankles.

An infant is diagnosed with a urinary tract infection. What would the nurse expect on assessment? a) Dysuria b) Abdominal pain c) Urgency d) Failure to thrive

Failure to thrive

________________ is a narrowing of the preputial opening of the foreskin, which prevents the foreskin from being retracted over the penis.

Phimosis

Facial edema, anorexia, fatigue and edema in the abdomen, genital area, and lower extremities would be seen if the child has ___ ___________ ________.

Primary nephrotic syndrome.

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) Reduce the child's fluid intake to reduce voiding during the first 24 hours b) Use petroleum jelly on the head of the penis for the first 2 weeks after the procedure c) Report any bleeding to the physician d) Report redness or swelling on the penile shaft

Report redness or swelling on the penile shaft

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) Smoky colored urine b) Jaundiced skin c) Strawberry red tongue d) Loose, dark stools

Smoky colored urine Explanation: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in Hepatitis.

A 6-year-old child with daytime enuresis complains of dysuria and urgency. What does the nurse recognize these signs and symptoms indicate?

Urinary tract infection

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? a) White cottage cheese-like discharge b) Foul yellow-gray discharge c) Irritation of labia and vaginal opening d) Thin gray vaginal discharge with fishy odor

White cottage cheese-like discharge

You are counseling a couple about sexually transmitted diseases. The male partner has genital herpes. To prevent spread of the infection to the female partner, you advise the couple that a) intercourse should be avoided until a Pap test is negative. b) acyclovir should be applied topically prior to intercourse. c) a condom should be used during intercourse. d) coitus should be delayed until 10 days after penicillin is begun.

a condom should be used during intercourse. Correct Explanation: Condoms provide protection against the spread of sexually transmitted diseases as well as conception.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100 degrees Fahrenheit. The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: a) a urinary tract infection. b) acute glomerulonephritis. c) lipoid nephrosis (idiopathic nephrotic syndrome). d) rheumatic fever.

acute glomerulonephritis.

The nurse is assessing a child diagnosed with nephritic syndrome and observes generalized edema. The nurse documents this as: a) hydronephrosis. b) enuresis. c) phimosis. d) anasarca.

anasarca

When a child's ureter becomes completely obstructed from scarring, the nurse explains that urinary diversion may be necessary to prevent the reflux back into the renal pelvis from causing ____________________.

hydronephrosis

The nurse uses a diagram to show how the _______________, the working unit of the kidney, filters and regulates fluids.

nephron

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration the nurse would want to prepare the parents for is: a) a liquid diet for 3 days. b) the need for complete bed rest for 10 days. c) some discomfort at the surgery site. d) the need for maintaining a semi-Fowler position.

some discomfort at the surgery site.

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration you would want to prepare his parents for is a) the need for maintaining a semi-Fowler's position. b) the need for complete bed rest for 10 days. c) some discomfort at the surgery site. d) a liquid diet for 3 days.

some discomfort at the surgery site. Correct Explanation: After they are returned to the scrotum, testes may be sutured there to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to: a) talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted disease and discuss the importance of safe sex practices. b) take the child to a private room and interview her regarding her sexual history and partners. c) take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. d) contact the necessary authorities to report a suspected case of sexual abuse.

take the child to a private room and interview her regarding her sexual history and partners.

The strong urge to void, often despite the inability to do so, is known as _______________.

urgency

The nurse explains that the device that measures the pressure and volume of the urine stream is called the _________________.

uroflowmeter

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, the nurse would want to prepare her to: a) void during the procedure. b) anticipate a headache afterward. c) drink three glasses of water during the procedure. d) have a local anesthetic injected prior to the procedure.

void during the procedure.

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, you would want to prepare her to a) drink three glasses of water during the procedure. b) have a local anesthetic injected prior to the procedure. c) anticipate a headache afterward. d) void during the procedure.

void during the procedure. Correct Explanation: A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.

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) Renal ultrasound b) Urinalysis c) Complete blood cell count (CBC) d) Intravenous pyelogram (IVP) e) Voiding cystourethrogram (VCUG)

• Intravenous pyelogram (IVP) • Voiding cystourethrogram (VCUG) • Renal ultrasound

The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply. a) Albumin b) Imipramine c) Oxybutynin d) Desmopressin e) Prednisone

• Oxybutynin • Imipramine • Desmopressin

The nurse discussed strategies with a parent to prevent a recurrence of urinary tract infection in the child. Which statement made by the parent indicates a need for further teaching?

"It is acceptable to take frequent bubble baths."

A child is born with ambiguous genitalia. Which of the following assessments establishes whether the child is genetically male or female? a) Pyelography b) Ultrasound c) DNA analysis d) Laparoscopy

DNA analysis

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) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." d) "The position of the urethra in girls makes girls more susceptible than boys to UTI's."

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." Correct Explanation: Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

Parents are speaking with the urologist about their son's undescended testicle. Which statement by the child's father causes the nurse to determine he understands the information presented?

"An undescended testicle can reduce fertility."

The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea? a) "It is caused from taking birth control pills when a girl is younger than 13 years old." b) "This is what happens if a 16-year-old girl has never had any periods at all." c) "This disorder is usually seen after a girl has had a spontaneous abortion." d) "Emotional stress can be a cause of this disorder."

"Emotional stress can be a cause of this disorder."

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) "Here is some written information from the dietitian." b) "Let's meet with the dietitian and plan some meals." c) "She should try to avoid protein." d) "She must severely restrict her sodium intake."

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

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) "Let's meet with the dietitian and plan some meals." b) "Here is some written information from the dietitian." c) "She must severely restrict her sodium intake." d) "She should try to avoid protein."

"Let's meet with the dietitian and plan some meals." Correct Explanation: Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.

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 will likely have a high risk of cancer in his teen years as a result of this condition." b) "Our son's condition may resolve on its own." c) "Our son may have to go through life without two testes." d) "Our son may need surgery on his testes before we are discharged to go home."

"Our son's condition may resolve on its own."

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

"She can eat whatever she wants on dialysis days."

The caregiver of a 1-year-old son calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment? a) "Without the hormone your son will have fluid that will collect in his scrotum." b) "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do." c) "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." d) "Without the treatment your child's gonads will not reach normal size."

"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."

The caregiver of a 1-year-old son calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which of the following statements regarding the son's treatment? a) "Without the hormone your son will have fluid that will collect in his scrotum." b) "Without the treatment your child's gonads will not reach normal size." c) "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do." d) "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."

"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." Correct Explanation: Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processus does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." What would be the most appropriate response by the nurse? a) "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive." b) "There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." c) "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it." d) "That must be hard on you, especially because you are raising her by yourself."

"There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months."

A 12-year-old girl who has not yet reached menarche comes to the pediatrician's office for her annual well-child check. As the nurse is weighing and measuring her, the child says emphatically that she does not want to get her period. Which response would be most appropriate for the nurse to make to this child? a) "But it's a good thing, having a period is a part of growing up." b) "Are you afraid of getting pregnant?" c) "What have you heard about it that makes you worried?" d) "Do you think it will hurt?"

"What have you heard about it that makes you worried?"

The nurse is conducting a presentation for a group of nurses who work with adolescents. The group of nurses discusses dysmenorrhea. Which of the following statements is most accurate related to dysmenorrhea? a) Dysmenorrhea can result from diaphragms or tampons being left in place too long. b) Genetic abnormalities are the most common cause of dysmenorrhea. c) A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. d) Common symptoms of dysmenorrhea are weight gain and mood swings.

A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. Correct Explanation: The increased secretion of prostaglandins, which occurs in the last few days of the menstrual cycle, is thought to be a contributing factor in primary dysmenorrhea.

A group of nursing students is discussing terminology related to the genitourinary system during a post-conference setting. One of the students asks what mittelschmerz is or what it means. A classmate of this student correctly answers that mittelschmerz is: a) A medication given to treat dysmenorrhea b) A symptom of premenstrual syndrome c) A dull, aching abdominal pain at ovulation d) The beginning of menstruation

A dull, aching abdominal pain at ovulation

A group of nursing students is discussing terminology related to the genitourinary system during a post-conference setting. One of the students asks what mittelschmerz is or what it means. A classmate of this student correctly answers that mittelschmerz is which of the following? a) A medication given to treat dysmenorrhea b) A dull, aching abdominal pain at ovulation c) A symptom of premenstrual syndrome d) The beginning of menstruation

A dull, aching abdominal pain at ovulation Correct Explanation: Mittelschmerz is a dull, aching abdominal pain at the time of ovulation (hence the name, which means "midcycle"). The beginning of menstruation is called menarche. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Nonsteroidal, anti-inflammatory drugs (NSAIDs), such as ibuprofen (advil, motrin) inhibit prostaglandins and are the treatment of choice for primary dysmenorrhea, which is painful menstruation.

A 5-year-old boy is admitted to the hospital with acute glomerulonephritis. In taking the child's history, what does the nurse recognize as the probable cause?

A sore throat 2 weeks ago.

A 6-year-old girl born with a myelomeningocele has a neurogenic bladder disorder. Her parents have been performing clean intermittent catheterization. Based on the knowledge of child development and chronic disability, what action should the nurse implement? A. Teach the child to do self-catheterization. B. Teach the child appropriate bladder control. C. Continue having the parents do the catheterization. D. Encourage the family to consider urinary diversion.

A. At 6 years of age, this child should be able to perform the intermittent catheterization herself. This will give her more control and mastery over her disability.

In addition to presenting symptoms, which laboratory finding indicates nephrosis? A. Hypoalbuminemia B. Low specific gravity C. Decreased hemoglobin level D. Decreased hematocrit

A. Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into the urine.

The student learns that which hormones are regulated by the kidneys? (Select all that apply.) A. Calcitriol B. Creatinine C. Estradiol D. Erythropoietin E. Renin

ANS: A, B, E Hormones released by the kidneys include calcitriol, erythropoietin, and renin. Creatinine is a laboratory value that measures kidney function. Estradiol is a hormone but is not released by the kidneys.

The most common cause of acute renal failure in children is a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

ANS: D Feedback A These are not common causes of acute renal failure in children. B These are not common causes of acute renal failure in children. C Obstructive uropathy may cause acute renal failure, but it is not the most common cause. D The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume.

Which clinical finding warrants further intervention for the child with acute poststreptococcal glomerulonephritis? a. Weight loss to within 1 lb of the preillness weight b. Urine output of 1 mL/kg/hr c. A positive antistreptolysin O (ASO) titer d. Inspiratory crackles

ANS: D Feedback A This is an indication that the child is responding to treatment. B This is an acceptable urine output and indicates that the child is responding to treatment. C A positive ASO titer indicates the presence of antibodies to streptococcal bacteria; it is used to aid in diagnosis of acute poststreptococcal glomerulonephritis. This is an expected finding if the child has this acute illness. D Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication.

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present? a) Abdominal mass b) Enlarged inguinal glands c) Purulent drainage from the penis d) Swollen testes

Abdominal mass

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 condition should the nurse suspect? a) Nephrosis b) Acute glomerulonephritis c) Kidney agenesis d) Polycystic kidney

Acute glomerulonephritis

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also complains of a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100 degrees Fahrenheit. The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have a) Rheumatic fever b) A urinary tract infection c) Acute glomerulonephritis d) Lipoid nephrosis (idiopathic nephrotic syndrome)

Acute glomerulonephritis Correct Explanation: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear one to three weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103 to 104 degrees Fahrenheit at the onset but decreases in a few days to about 100 degrees Fahrenheit. Slight headache and malaise are usual, and vomiting may occur.

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) Encourage fluids, adequate food intake, and voiding before and after administration c) Provide adequate hydration and encourage voiding d) Administer in the morning, encourage fluids and voiding during and after administration

Administer in the morning, encourage fluids and voiding during and after administration

A 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child? a) Provide a diet high in protein and sodium b) Make sure the IV fluid contains potassium c) Increase oral intake of fluid d) Administer the IV fluid slowly

Administer the IV fluid slowly

A 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child? a) Make sure the IV fluid contains potassium b) Increase oral intake of fluid c) Administer the IV fluid slowly d) Provide a diet high in protein and sodium

Administer the IV fluid slowly Correct Explanation: If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to replace plasma volume. Administer such fluid slowly, however, to avoid heart failure as extra fluid cannot be removed by the nonfunctioning kidneys. Be certain the fluid prescribed does not contain potassium until it is established kidney function is adequate; otherwise, the buildup of potassium could cause heart block. The child's diet should be low in protein, potassium, and sodium and high in carbohydrate to supply enough calories for metabolism yet limit urea production and control serum potassium levels. Oral fluid intake may be limited to prevent heart failure due to accumulating fluid that cannot be excreted.

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

Administering antibiotics

A 13-year-old girl tells the nurse during a gynecological visit that a friend of hers developed toxic shock syndrome from tampon use. The client says that tampons work well for her, but she wonders whether they are safe. Which of the following recommendations should the nurse give this client to help prevent toxic shock syndrome? a) Use feminine hygiene sprays in conjunction with tampons b) Use the highest absorbency tampon possible c) Alternate use of tampons with sanitary pads d) Insert two tampons at a time

Alternate use of tampons with sanitary pads

Which is an advantage of continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents requiring dialysis? A. Dietary restrictions are no longer necessary. B. Adolescents can carry out procedures themselves. C. Hospitalization is only required several nights per week. D. Insertion of the catheter does not require surgical placement.

B. The procedure can be done at home.

The nurse is providing information to parents of a child born with bilateral cryptochidism. What information is accurate to include?

An inguinal hernia may be present.

The nurse is assessing a child diagnosed with nephritic syndrome and observes generalized edema. The nurse documents this as which of the following? a) Phimosis b) Hydronephrosis c) Anasarca d) Enuresis

Anasarca Correct Explanation: Anasarca refers to generalized edema. Enuresis refers to continued incontinence of urine past the age of toilet training. Hydronephrosis refers to a condition in which the pelvis and calyces of the kidney are dilated. Phimosis refers to a condition in which the foreskin of the penis cannot be retracted.

The nurse is explaining to a 17-year-old female the actions to prevent urinary tract infection. Which is the best beverage for the nurse to recommend to keep urine acidic?

Apple juice

A group of nursing students are reviewing the variations in the genitourinary system in children as compared with adults. The students demonstrate understanding of this information when they state: a) A child's kidneys are surrounded by more fat padding than an adult's kidneys. b) Glomerular filtration rate is faster in infants than in adults. c) Bladder capacity reaches adult capacity by age 1 year. d) The renal system usually reaches functional maturity by age 5 years.

Bladder capacity reaches adult capacity by age 1 year.

A group of nursing students are reviewing the variations in the genitourinary system in children as compared with adults. The students demonstrate understanding of this information when they identify which of the following? a) Glomerular filtration rate is faster in infants than in adults. b) Bladder capacity reaches adult capacity by age 1 year. c) The renal system usually reaches functional maturity by age 5 years. d) A child's kidneys are surrounded by more fat padding than an adult's kidneys.

Bladder capacity reaches adult capacity by age 1 year. Correct Explanation: Bladder capacity is about 30 mL in the newborn and increases to the usual adult capacity of about 270 mL by 1 year of age. Glomerular filtration rate is slower in the infant and young toddler compared with the adult. The renal system usually reaches functional maturity by 2 years of age. The kidneys of a child are less well protected from injury by the ribs and fat padding than they are in the adult.

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

Blood pressure 136/84

When a child with nephrotic syndrome is confined to bed, what is an appropriate nursing intervention? A. Restrain the child as necessary. B. Discourage parents from holding the child. C. Adjust activities to child's tolerance level. D. Perform passive range-of-motion exercises daily.

C. The child will have a variable level of tolerance for activity. This will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child.

What is an appropriate intervention for the edematous child with reduced mobility related to nephrotic syndrome?

Change the child's position frequently

What will the nurse caution the parents of a child who has had a nephrectomy that he will have to avoid?

Contact sports

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

Cramping should not occur with an infusion.

A child is being evaluated for renal and urinary tract disease. Which of the following would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? a) Kidneys, ureter, and bladder x-ray b) Urinalysis c) Creatinine clearance rate d) Computed tomography scan

Creatinine clearance rate Correct Explanation: The glomerular filtration rate is measured by creatinine clearance rate or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.

The condition in which one or both of the testes does not descend in the male infant is referred to as which of the following? a) Cryptorchidism b) Orchiopexy c) Enuresis d) Hydrocele

Cryptorchidism Correct Explanation: When one or both of the testes do not descend, the condition is called cryptorchidism.

Diuresis has not occurred on a child with nephrotic syndrome after a month on corticosteroids. What protocol can the nurse encourage to bring about diuresis?

Cyclophosphamide (Cytoxan), an antisuppressant

A child is born with ambiguous genitalia. Which of the following assessments establishes whether the child is genetically male or female? a) DNA analysis b) Laparoscopy c) Ultrasound d) Pyelography

DNA analysis Correct Explanation: If there is any question about a child's gender, karyotyping or DNA analysis establishes whether the child is genetically male or female. Laparoscopy (introduction of a narrow laparoscope into the abdominal cavity through a half-inch incision under the umbilicus) or possibly exploratory surgery may be necessary to determine if ovaries or undescended testes are present. Intravenous pyelography or ultrasound can be used to establish whether a complete urinary tract is present.

The nurse obtains a history from the mother of a child with glomerulonephritis about how he became ill. What would the nurse expect her to tell you she noticed? a) Diuresis and pallor b) Loss of weight, oliguria c) Headache, loss of appetite d) Dirty green urine

Dirty green urine Explanation: Acute glomerulonephritis often presents with glomeruli bleeding. Inspect the urine for gross hematuria, which will cause the urine to appear tea colored, cola colored, or even a dirty green color.

A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? a) Allow tubes to dangle freely to encourage flow. b) Apply antibiotic ointment to tube site. c) Encourage high fluid intake. d) Increase low-fat foods.

Encourage high fluid intake.

A nurse is performing postoperative care on a child with a ureteral stent. Which of the following interventions will help manage bladder spasms? a) Apply antibiotic ointment to tube site. b) Encourage high fluid intake. c) Increase low-fat foods. d) Allow tubes to dangle freely to encourage flow.

Encourage high fluid intake. Correct Explanation: Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this? a) Encourage the child to take all the antibiotics if diagnosed with strep throat. b) All children in the child's class should be tested for strep throat if one child has a positive test. c) Prophylactic antibiotics after strep throat are important. d) Tell parents to give ibuprofen if their child has a sore throat.

Encourage the child to take all the antibiotics if diagnosed with strep throat.

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 what as an appropriate measure? a) Practicing bladder-stretching exercises b) Giving desmopressin intranasally c) Engaging the child in stress reduction measures d) Encouraging fluid intake after dinner

Encouraging fluid intake after dinner

A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point? a) Toxic shock syndrome b) Amenorrhea c) Mittelschmerz d) Endometriosis

Endometriosis Correct Explanation: If dysmenorrhea does not improve within 6 months with the use of NSAIDs and COCs, a laparoscopy is indicated to look for endometriosis, the most common reason for secondary dysmenorrhea. The other conditions listed are not associated with dysmenorrhea.

A 16-year-old girl visits her gynecologist with a complaint of metrorrhagia, or bleeding between menstrual periods, since her last visit, 3 months ago. On consulting the patient's chart, the nurse learns that she was prescribed an oral contraceptive at her last visit. Which of the following interventions should the nurse implement in this situation? a) Recommend that she ask the gynecologist about endometrium ablation to halt the metrorrhagia b) Refer the client to her primary care physician for examination for possible uterine or cervical cancer c) Recommend that she ask the gynecologist to change her prescription to a different oral contraceptive d) Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that

Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that Correct Explanation: Metrorrhagia is bleeding between menstrual periods. This may occur in teenagers taking oral contraceptives (breakthrough bleeding) during the first 3 or 4 months of use. If metrorrhagia occurs for more than one menstrual cycle in a teenager who is not taking oral contraceptives (which is not the case here), she be referred to her primary care provider for examination, because abnormal vaginal bleeding is an early sign of uterine or cervical carcinoma or an ovarian cyst. Endometrium ablation, used with premenopausal women to halt metrorrhagia, is not recommended for adolescents. There is no need at this point for the client to change prescriptions, as the bleeding will likely go away in the next month or so as the client's body adapts to the current contraceptive.

Peritoneal dialysis is so effective that 3 hours of peritoneal dialysis accomplishes as much as 12 hours of hemodialysis. a) True b) False

False

The human papillomavirus (HPV) is commonly passed on from a pregnant woman to her fetus. a) True b) False

False

Peritoneal dialysis is so effective that 3 hours of peritoneal dialysis accomplishes as much as 12 hours of hemodialysis. a) True b) False

False Correct Explanation: Hemodialysis can be done as a continuous process, but it is so effective 3 hours of hemodialysis accomplishes as much as 12 hours of peritoneal dialysis.

The human papillomavirus (HPV) is commonly passed on from a pregnant woman to her fetus. a) False b) True

False Correct Explanation: The presence of vulvar HPV lesions appears to have no effect on the fetus during pregnancy, but if they are so large they obstruct the birth canal for birth, a cesarean birth may be scheduled.

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

Fowler's

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

Fowler's Correct Explanation: A Fowler's position (sitting upright) allows ascites fluid to settle downward and not press against the diaphragm, compromising breathing.

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, thrombocytopenia, and acute renal failure b) Hemolytic anemia, acute renal failure, and hypotension c) Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level d) Thrombocytopenia, hemolytic anemia, and nocturia several times each night

Hemolytic anemia, thrombocytopenia, and acute renal failure

What will the nurse caring for a newborn with exstrophy of the bladder include in the care? (Select all that apply.)

Protect skin around bladder Position infant on back Prepare for surgical closure Cover exposed bladder with shield

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) Not using cleansing towelettes routinely. c) Washing the genital area with water daily. d) Not using soap when cleaning the urethral area.

Holding urine while at school. Correct Explanation: UTIs are often caused by children who do not urinate frequently at school. It is important for a child to avoid using towelettes and soap in the genital area because this can increase the chance of a UTI. Washing the genital area with water daily does not increase the chance of a UTI.

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

Hypertension

The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. The nurse documents this finding as: a) Bladder exstrophy b) Epispadias c) Hypospadias d) Patent urachus

Hypospadias

The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. The nurse documents this finding as which of the following? a) Bladder exstrophy b) Patent urachus c) Epispadias d) Hypospadias

Hypospadias Correct Explanation: Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Epispadias is present when the urethral opening is on the dorsal surface of the penis. Patent urachus refers to a fistula between the bladder and umbilicus. Bladder exstrophy involves the bladder lying open and exposed on the abdomen.

A nurse is assessing a child that may have peritonitis. Which of the following would be signs of this problem? a) Diarrhea b) Increased white blood cell count of dialysate outflow c) Increased red blood cell count of dialysate outflow d) Syncope

Increased white blood cell count of dialysate outflow

A nurse is assessing a child that may have peritonitis. Which of the following would be signs of this problem? a) Increased red blood cell count of dialysate outflow b) Diarrhea c) Syncope d) Increased white blood cell count of dialysate outflow

Increased white blood cell count of dialysate outflow Correct Explanation: Increased white blood cell count of dialysate outflow is one of the signs of peritonitis. Vomiting, fever, and abdominal pain are also signs of peritonitis.

What is it important to assess in a child receiving prednisone to treat nephrotic syndrome?

Infection

A child in kidney failure has had a kidney transplantation. You would prepare the child for which of the following to occur postoperatively? a) Infection-control precautions that may cause him to be lonely b) A transient rash from T-cell suppression c) Full-body irradiation that will leave him nauseated d) Burning on urination from high uric acid content

Infection-control precautions that may cause him to be lonely

The nurse is providing discharge teaching to an adolescent who has been treated for pelvic inflammatory disease (PID). What would the nurse include as a preventive measure? a) Suggesting that sexual partners use antibiotic ointment b) Using a vaginal douche routinely c) Using oral contraceptives as prescribed d) Insisting that sexual partners use condoms

Insisting that sexual partners use condoms

Most urinary tract infections seen in children are caused by: a) Dietary insufficiencies b) Hereditary causes c) Intestinal bacteria d) Fungal infections

Intestinal bacteria

Most urinary tract infections seen in children are caused by which of the following? a) Hereditary causes b) Intestinal bacteria c) Dietary insufficiencies d) Fungal infections

Intestinal bacteria Correct Explanation: Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections.

The nurse is caring for an 8-year-old hospitalized child with nephrotic syndrome. Which of the following nursing interventions would be appropriate for this child? a) Test the urine for ketones twice a day b) Weigh the child once a week. c) Administer antipyretics as needed. d) Measure the abdominal girth daily.

Measure the abdominal girth daily. Correct Explanation: Measure the child's abdomen daily at the level of the um bilicus, and make certain that all staff personnel measure at the same level. Weigh the child at the same time every day on the same scale in the same clothing. Test the urine regularly for albumin and specific gravity. Elevated temperature is not an issue with nephrotic syndrome.

An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection? a) Miconazole b) Acyclovir c) Ceftriaxone d) Metronidazole e) Doxycycline

Metronidazole

A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage tube patency? a) Allow tubes to dangle freely to encourage flow. b) Provide a low-sodium diet. c) Maintain fluid restriction. d) Monitor output.

Monitor output.

When examining the musculoskeletal system of the child, which would be indicative of a potential kidney problem? a) Hypertonia b) Walking with a limp c) Muscle weakness d) A clunk felt in abduction of the hip

Muscle weakness

Which physical assessment technique will the nurse omit when caring for a 2-year-old diagnosed with Wilms' tumor?

Palpating the abdomen

A nurse notices clear fluid draining from the base of the umbilical cord stump of a newborn boy while changing his diaper. Which of the following conditions does this finding most likely indicate? a) Vesicoureteral reflux b) Exstrophy of the bladder c) Patent urachus d) Hypospadias

Patent urachus Explanation: When the bladder first forms in utero, it is joined to the umbilicus by a narrow tube, the urachus. If this fails to close during embryologic development, a fistula is left between the bladder and umbilicus (patent urachus).

A 5-year-old child with acute renal failure develops hyperkalemia. What would the nurse expect to administer? a) Polystyrene sulfonate b) Furosemide c) Labetalol d) Nifedipine

Polystyrene sulfonate Polystyrene sulfonate (Kayexalate) is used to decrease potassium levels. Nifedipine and Labetalol would be used to treat hypertension. Furosemide would be used to promote dieresis with fluid overload.

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

Proteinuria, hypoalbuminemia, and hypercholesterolemia

A 7-year-old child with acute glomerulonephritis has gross hematuria and has been confined to bed. What is the most appropriate nursing intervention for this child?

Providing activities for the child on restricted activity

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) Respirations 22 per minute c) Pulse rate 135 bpm d) Pulse oximetry 93% on room air

Pulse rate 135 bpm

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) Respirations 22 per minute b) Blood Pressure 100/70 c) Pulse rate 135 bpm d) Pulse oximetry 93% on room air

Pulse rate 135 bpm Correct Explanation: Data to collect regarding the child includes temperature, pulse (be alert for tachycardia) and respiration rates; normal vital signs for a 6-year-old would be a pulse rate of 70 to 115 beats per minute, so this rate shows tachycardia,. The other vital signs are all within normal limits for this age child.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? a) Imbalanced nutrition less than body requirements b) Excess fluid volume c) Risk for infection d) Activity intolerance

Risk for infection

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? a) Risk for infection b) Activity intolerance c) Imbalanced nutrition, less than body requirements d) Excess fluid volume

Risk for infection Correct Explanation: When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant? a) Constipation related to effects of administered drugs b) Deficient fluid volume related to fluid intake restrictions postoperatively c) Risk for infection related to immunocompromised state d) Pain related to tissue rejection

Risk for infection related to immunocompromised state

Which of the following nursing diagnoses would be the priority when caring for a child in renal failure following a kidney transplant? a) Constipation related to effects of administered drugs b) Deficient fluid volume related to fluid intake restrictions postoperatively c) Pain related to tissue rejection d) Risk for infection related to immunocompromised state

Risk for infection related to immunocompromised state Correct Explanation: Children are administered anti-immune therapies to lower immune system response and help prevent transplant rejection following a transplant; this leaves them susceptible to infection.

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

Scrotal elevation

A 16-year-old girl has had several cases of cystitis in the past year. Which of the following should the nurse suspect as the cause, based on this finding? a) Sexual activity b) Frequent voiding c) Wiping from front to back after voiding d) Regular participation in a strenuous sport

Sexual activity Correct Explanation: When cystitis is seen in adolescent girls, it is an alert a girl may be sexually active. Wiping from front to back after voiding helps prevent urinary tract infections, not cause them. Frequent voiding does not cause cystitis, nor does regular participation in a strenuous sport.

Which measure would help an adolescent relax best during a pelvic examination? a) Help her hold her breath during the exam. b) Advise her to keep one hand on her abdomen. c) Show her a speculum prior to the exam. d) Assure her that no part of the exam will hurt.

Show her a speculum prior to the exam.

Which measure would help an adolescent relax best during a pelvic examination? a) Advise her to keep one hand on her abdomen. b) Show her a speculum prior to the exam. c) Help her hold her breath during the exam. d) Assure her that no part of the exam will hurt.

Show her a speculum prior to the exam. Correct Explanation: Distraction and information about the procedure are effective measures to promote relaxation. Holding her breath tenses the abdomen; a pelvic exam is not necessarily pain-free.

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

Sleeping too soundly

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) Strawberry red tongue b) Smoky colored urine c) Jaundiced skin d) Loose, dark stools

Smoky colored urine Correct Explanation: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in Hepatitis.

The nurse is caring for a 10-year-old boy with end-stage renal disease (ESRD) with metabolic acidosis. What would the nurse expect to administer if ordered? a) Sodium bicarbonate tablets b) Ferrous sulfate c) Vitamin D d) Erythropoietin

Sodium bicarbonate tablets

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? a) Sudden onset of severe scrotal pain with significant hemorrhagic swelling b) Hardened and tender epididymitis with edema and erythema of scrotum c) Enlarged inguinal glands and fever d) Fever, scrotal swelling, and urethral discharge

Sudden onset of severe scrotal pain with significant hemorrhagic swelling

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? a) Hardened and tender epididymitis with edema and erythema of scrotum b) Enlarged inguinal glands and fever c) Sudden onset of severe scrotal pain with significant hemorrhagic swelling d) Fever, scrotal swelling, and urethral discharge

Sudden onset of severe scrotal pain with significant hemorrhagic swelling Correct Explanation: Testicular torsion is characterized by a testicle that is abnormally attached to the scrotum and twisted. Signs and symptoms include sudden onset of severe scrotal pain with significant hemorrhagic swelling. Enlarged glands and fever point to infection. A hardened and tender epididymitis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.

When asked about correcting the hypospadias of a newborn, what does the nurse explain about this condition?

Surgical repair of the hypospadias is done before 18 months of age

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to do which action? a) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. b) Give the child a diuretic and report back to the nurse in a few hours. c) Weigh the child in the same clothes she had been weighed in the day before and report the two weights to the nurse while the nurse is on the phone. d) Give the child fluids and report back to the nurse in a few hours.

Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to do which of the following actions? a) Give the child fluids and report back to the nurse in a few hours. b) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. c) Give the child a diuretic and report back to the nurse in a few hours. d) Weigh the child in the same clothes she had been weighed in the day before and report the two weighs to the nurse while the nurse is on the phone.

Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Correct Explanation: Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

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

Tea-colored urine

The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they state that they need to report what to the physician? a) Bleeding that stops without pressure b) The infant does not urinate within 6 to 8 hours c) Small spots of blood on diaper d) Appearance of granulation tissue

The infant does not urinate within 6 to 8 hours

A 14-year-old girl visits her gynecologist and is found to have vaginal candidiasis. She is obese, claims to not be sexually active, and is not on an oral contraceptive. Which intervention should be considered for this client? a) Prescription of an antibiotic b) Insertion of antifungal tablets or creams in the morning c) Test her urine for glucose to rule out diabetes mellitus d) Prescription of an oral contraceptive

Test her urine for glucose to rule out diabetes mellitus

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? a) Fluid detected in scrotal sac b) Venous varicosity detected along the spermatic cord c) Testis cannot be "milked" down inguinal canal d) Testis can briefly be brought into scrotum

Testis cannot be "milked" down inguinal canal

A voiding cystourethrogram (VCUG) is ordered on a child. What education should be provided to the parents? a) The VCUG will prevent further complications of UTI. b) The VCUG will rule out kidney stones. c) The VCUG will rule out VUR. d) The VCUG will detect if the infection is gone.

The VCUG will rule out VUR.

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

The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained Correct Explanation: 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 knows this is a description of peritoneal dialysis when compared to hemodialysis: a) The child must go into a facility to get peritoneal dialysis. b) The child can live a more normal lifestyle. c) Therapy is only 3 to 4 days per week. d) There are strict diet and fluid restrictions.

The child can live a more normal lifestyle.

The nurse knows which of the following is a description of peritoneal dialysis when compared to hemodialysis? a) The child must go into a facility to get peritoneal dialysis. b) There are strict diet and fluid restrictions. c) The child can live a more normal lifestyle. d) Therapy is only 3 to 4 days per week.

The child can live a more normal lifestyle. Correct Explanation: The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history? a) The child has a sibling with the same diagnosis. b) The child is being treated for asthma. c) The child had a congenital heart defect. d) The child recently had an ear infection.

The child recently had an ear infection.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. Which of the following would the nurse likely find in this child's history? a) The child has a sibling with the same diagnosis. b) The child recently had an ear infection. c) The child had a congenital heart defect. d) The child is being treated for asthma.

The child recently had an ear infection. Correct Explanation: In the child with acute glomerulonephritis presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.

The primary clinical manifestations of acute kidney injury are which of the following? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

The principal feature of acute kidney injury is oliguria, and many children are hypertensive. Hematuria, pallor, proteinuria, cramps, bacteriuria, and edema are not principal features.

A nurse is discussing with a family the various causes of their child's vulvovaginitis. What would be included in the education? a) Fevers often occur with vulvovaginitis. b) The use of cleansing towelettes may have caused the vulvovaginitis. c) Child protective services will be called since this is a sign of abuse. d) Constipation is a common cause of vulvovaginitis.

The use of cleansing towelettes may have caused the vulvovaginitis.

A parent asks if their newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? a) If the infant is having swelling or pain, then surgery will be performed. b) This problem needs to be corrected immediately in the newborn period. c) Surgery is not needed for this type of problem. d) There is a chance the testicles will descend on their own.

There is a chance the testicles will descend on their own.

The nurse is aware that genitourinary surgery is especially stressful for preschool children. What factor(s) lend to this stress? (Select all that apply.)

They may perceive the treatment as punishment They are especially prone to separation anxiety They are sexually curious and developmentally fixated on their genitals They have a fear of castration

A child is having their urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate? a) This determines the presence of sugar in the urine. b) This may indicate a urinary tract infection. c) This determines the presence of RBCs in the urine. d) This indicates renal disease.

This may indicate a urinary tract infection. Correct Explanation: Positive leukocytes may indicate a urinary tract infection. The urine would also need to be cultured to determine the type and amount of bacteria growth.

A 9-year-old boy who is uncircumcised has developed balanoposthitis. There is no sign of phimosis. Which of the following recommendations should the nurse give the boy and his parents to help prevent future occurrences? a) To become circumcised b) To avoid warm baths c) To apply a local antibiotic ointment daily d) To pull back the foreskin and clean the penis thoroughly when showering

To pull back the foreskin and clean the penis thoroughly when showering

An adolescent male is admitted to the ED with severe acute scrotal pain. When documenting medical history the nurse notes cryptorchidism at birth. What diagnosis does the nurse expect?

Torsion

Syphilis in a pregnant woman can cause spontaneous miscarriage, preterm labor, stillbirth, or congenital anomalies in the newborn. a) False b) True

True

While assessing a child with end-stage renal disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication? a) Hypocalcemia b) Immunosuppression c) Metabolic acidosis d) Uremia

Uremia

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) Urinalysis c) Creatinine clearance d) Urine culture and sensitivity

Urinalysis

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

Weighing on the same scale each day Correct Explanation: The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss.

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? a) Foul yellow-gray discharge b) Irritation of labia and vaginal opening c) Thin gray vaginal discharge with fishy odor d) White cottage cheese-like discharge

White cottage cheese-like discharge Correct Explanation: White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene.

You are counseling a couple about sexually transmitted diseases. The male partner has genital herpes. To prevent spread of the infection to the female partner, you advise the couple that a) intercourse should be avoided until a Pap test is negative. b) a condom should be used during intercourse. c) coitus should be delayed until 10 days after penicillin is begun. d) acyclovir should be applied topically prior to intercourse.

a condom should be used during intercourse.

A mother is distraught that her 7-year-old daughter has begun puberty early. She worries about both the physical and social implications of this change for her daughter. Which of the following should the nurse say to the mother to address these concerns? (Select all that apply.) a) "Your daughter can start on oral contraceptives to alleviate any concerns about possible pregnancies." b) "Medication is available that can halt sexual maturation at this point." c) "After reaching the age of normal puberty, your daughter will maintain normal growth, development and appearance." d) "Your daughter is not only sexually precocious but also emotionally and psychologically precocious, so she should be able to handle this change."

• "After reaching the age of normal puberty, your daughter will maintain normal growth, development and appearance." • "Medication is available that can halt sexual maturation at this point." Explanation: Both parents and children need reassurance that, after reaching the age of normal puberty, the child with precocious puberty will maintain normal growth and development and appearance. Administration of a synthetic analog desensitizes GnRH receptors, making stimulation by GnRH ineffective and halting sexual maturation at the point to which it has advanced. Oral contraceptives are not advisable for girls this young, because the estrogen in them also causes early closure of epiphyseal lines, possibly stunting the child's growth further. Parents may need to be reminded also, that, although their child appears to be much older, the changes are only in sexual characteristics. Household tasks, responsibility, and expectations must be geared to the child's chronologic age, not to outward appearance.

In caring for a child with a urinary tract infection, the nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse? a) Observe the child for signs of any reactions to the antibiotics. b) Teach girls to wipe from front to back. c) Observe for possible indications of sexual abuse. d) Collect a "clean catch" voided urine. e) Record and report any indications of urinary burning, frequency, or urgency. f) Instruct caregivers to avoid bubble baths, especially in young girls.

• Collect a "clean catch" voided urine. • Observe the child for signs of any reactions to the antibiotics.

A female adolescent comes to the clinic for an evaluation. Assessment reveals a possible urinary tract infection. What would the nurse expect to be done to confirm this suspicion? a) Urine culture b) Kidneys, ureter, and bladder x-ray c) Renal ultrasound d) Intravenous pyelogram

Urine culture

An adolescent patient with acute kidney injury (AKI) asks why she is taking Tums (calcium carbonate). Which response by the nurse is the most appropriate? A. Gets rid of phosphorus B. Prevents Curling ulcers C. Prevents gastric reflux D. Provides calcium

ANS: A In AKI, phosphorus is high, and patients are given phosphorus binders, such as Tums. They are not used to prevent reflux or Curling ulcers (seen in burns), or to provide calcium.

The parents of a child diagnosed with vesicoureteral reflux (VUR) want to know why their child's kidneys appear large on an abdominal x-ray. Which response by the nurse is the most appropriate? A. Enlarged due to urine backup B. Genetic defect causing VUR C. Multiple tumors D. Unrelated finding

ANS: A In VUR, urine backflows into the kidneys, causing hydronephrosis, or distention of the kidneys. The other answers are incorrect.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? (Select all that apply.) a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Enuresis and voiding urgency should be assessed in an older child.

The nurse is caring for a child admitted with nephrotic syndrome. Which clinical manifestations would likely have been noted in the child with this diagnosis? a) Oliguria b) Pyelonephritis c) Ascites d) Amenorrhea

Ascites

A 4-year-old male is continuing to have periodic daytime and nocturnal enuresis, His mother is very worried and calls the pediatrician's office nurse for advice. What information would be appropriate for the nurse to give? (Select all that apply.) A. He needs evaluation by a psychiatrist before having a medical workup to determine if there are anxiety issues present. B. Diet modifications can be made including avoidance of extraneous sugar and caffeine intake after late afternoon. C. Reassure the mother that the cause will be found through testing. D. It's important to limit the child's interactions with others until the situation is corrected. E. The child needs to realize that he can control the enuresis if he wants to. F. Urinary tract infections can cause enuresis.

B. Diet modifications can be made including avoidance of extraneous sugar and caffeine intake after late afternoon. C. Reassure the mother that the cause will be found through testing. F. Urinary tract infections can cause enuresis.

A 5-year-old female has been sent to the school nurse for urinary incontinence three times in the past 2 days. What nursing action should be taken first? A. Talking with the parents about a possible school phobia. B. Determining if there are emotional causes. C. Talking with the parents about a possible urinary tract infection. D. Asking the parents if there is a possible structural defect of the urinary tract.

C. Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection.

The parent of a child hospitalized with acute glomerulonephritis asks the nurse, "Why are blood pressure readings being taken so often?" What is the best explanation by the nurse? A. "Blood pressure fluctuations are a common side effect of antibiotic therapy." B. "Blood pressure fluctuations are a sign that the condition has become chronic." C. "Acute hypertension must be anticipated and identified." D. "Hypotension can lead to sudden shock can develop at any time."

C. Vital signs, in particular blood pressure, provide information about the severity of the disease and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention.

A child needs to collect urine for 24 hours and the nurse explains that this test assesses glomerular filtration rate and how the kidneys are functioning. What would be indicative of this type of test? a) Urinalysis for casts and bacteria b) Microscopic studies for RBC casts c) Creatinine clearance d) Urine culture and sensitivity

Creatinine clearance

A child needs to collect urine for 24 hours and the nurse explains that this test assesses glomerular filtration rate and how the kidneys are functioning. Which of the following would be indicative of this type of test? a) Urinalysis for casts and bacteria b) Creatinine clearance c) Microscopic studies for RBC casts d) Urine culture and sensitivity

Creatinine clearance Correct Explanation: A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate.

A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? a) Computed tomography scan b) Urinalysis c) Creatinine clearance rate d) Kidneys, ureter, and bladder x-ray

Creatinine clearance rate

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) Take away a toy every time the child urinates in their pants. b) Demonstrate how to urinate in the bathroom every time. c) Demonstrate love and acceptance at home. d) Discuss how child can continue to go to the bathroom instead of in the underwear.

Demonstrate love and acceptance at home. Correct Explanation: Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.

An infant is diagnosed with a urinary tract infection. What would the nurse expect on assessment? a) Urgency b) Failure to thrive c) Dysuria d) Abdominal pain

Failure to thrive

A parent tells the nurse that her child is scheduled for an x-ray of the bladder and urethra that is done while the child is urinating. What is this test known as?

Voiding cystourethrogram

The nurse is caring for a child admitted with a urinary tract infection. In addition to foul-smelling urine, which clinical manifestation would likely have been noted in the child with this diagnosis? a) Vomiting b) Increased appetite c) Decreased urination d) Weight gain

Vomiting

When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply. a) Proteinuria b) Intermittent hematuria c) Foul-smelling urine d) Abdominal mass e) Flank pain

• Intermittent hematuria • Abdominal mass

When assessing a child with hydronephrosis, which of the following would the nurse expect to find? Select all that apply. a) Abdominal mass b) Foul-smelling urine c) Flank pain d) Intermittent hematuria e) Proteinuria

• Intermittent hematuria • Abdominal mass Explanation: Intermittent hematuria is a common symptom of hydronephrosis. An abdominal mass may be palpated with hydronephrosis. Foul-smelling urine is associated with obstructive uropathy. Flank pain is associated with obstructive uropathy and vesicoureteral reflux. Proteinuria is associated with nephritic syndrome.

A 4-year-old girl presents with recurrent urinary tract infection. A prior workup did not reveal any urinary tract abnormalities. What is the priority nursing action? 1. Obtain a sterile urine sample after completion of antibiotics. 2. Teach appropriate toileting hygiene. 3. Prepare the child for surgery to reimplant the ureters. 4. Adminitser antibiotics intramuscularly

Teach appropriate toileting hygiene.

A child is having their urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate? a) This determines the presence of RBCs in the urine. b) This may indicate a urinary tract infection. c) This indicates renal disease. d) This determines the presence of sugar in the urine.

This may indicate a urinary tract infection.

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." Of the following statements, which would be the most appropriate response by the nurse? a) "There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." b) "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive." c) "That must be hard on you, especially because you are raising her by yourself." d) "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it."

"There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." Correct Explanation: Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally oral contraceptive pills are prescribed to prevent ovulation.

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

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

The 6-year-old scheduled for an orchiopexy shyly asks the nurse, "What are they going to do to me 'down there'?" What is the nurse's best response?

"What do you think your doctor is going to do?"

An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, what would lead the nurse to suspect that the adolescent has candidiasis? a) Frothy, gray-green discharge b) Milky, gray, fishy-odor discharge c) Thick, white cheese-like discharge d) Yellow-green discharge

Thick, white cheese-like discharge

A true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system is that a. The young infant's kidneys can more effectively concentrate urine than an adult's kidneys. b. After 6 years of age, kidney function is nearly like that of an adult. c. Unlike adults, most children do not regain normal kidney function after acute renal failure. d. Young children have shorter urethras, which can predispose them to UTIs.

ANS: D Feedback A The young infant's kidneys cannot concentrate urine as efficiently as those of older children and adults because the loops of Henle are not yet long enough to reach the inner medulla, where concentration and reabsorption occur. B By 6 to 12 months of age, kidney function is nearly like that of an adult. C Unlike adults, most children with acute renal failure regain normal function. D Young children have shorter urethras, which can predispose them to UTIs.

A 5-year-old who had a renal transplant 9 months ago and has no history of chickenpox presents to the pediatric clinic for his vaccinations. Which is the most appropriate set to give? 1. DTap, IPV 2. DTap, IPV, MMR, varicella 3. DTap, IPV, varicella 4. IPV only

DTap, IPV

Which urinary diversion procedure is the least damaging to the body image of the adolescent?

Ileal conduit

A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching? a) As long as the medications are used properly, the transplant will not be rejected. b) Immunosuppression is common after a kidney transplant. c) The child can stop medication after three months of therapy. d) Induction therapy medication will prevent infection with the transplant.

Immunosuppression is common after a kidney transplant.

A child in kidney failure has had a kidney transplantation. You would prepare the child for which of the following to occur postoperatively? a) A transient rash from T-cell suppression b) Full-body irradiation that will leave him nauseated c) Burning on urination from high uric acid content d) Infection-control precautions that may cause him to be lonely

Infection-control precautions that may cause him to be lonely Correct Explanation: Children may be isolated following a transplant to help them resist infection during the time their immune system response is lowered to help them avoid transplant rejection.

During a physical assessment of a hospitalized 5-year-old, the nurse notes that the foreskin has been retracted and is very tight on the shaft of the penis; the nurse is unable to return it over the head of the penis. What action should the nurse implement?

Notify the charge nurse

The nurse is taking a history from an adolescent girl with suspected pelvic inflammatory disease (PID). What data will be most helpful in determining this girl's risk factors for PID? a) Age b) Number of sexual partners c) Race d) Age at first menses

Number of sexual partners

The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone?

Should be delayed

A 16-year-old tells you she has terrible dysmenorrhea. Which of the following actions would be the best health teaching measure regarding this? a) Take over-the-counter ibuprofen for its prostaglandin action. b) Take acetaminophen beginning with the first day of a menstrual flow. c) Drink a minimum of fluid if having pain. d) Use ice to help in reducing inflammation and pain.

Take over-the-counter ibuprofen for its prostaglandin action. Correct Explanation: An anti-inflammatory medication is most helpful in reducing the discomfort of dysmenorrhea.

To prevent further urinary tract infections in a preschooler, what measures would you teach her mother? a) Teach her to take frequent tub baths to clean her perineal area. b) Teach her to wipe her perineum front to back after voiding. c) Suggest she drink less fluid daily to concentrate urine. d) Encourage her to be more ambulatory to increase urine output.

Teach her to wipe her perineum front to back after voiding. Correct Explanation: Escherichia coli can be easily spread from the rectum to the urinary meatus and cause infection if girls do not take precautions against this.

When the nurse is caring for a child with hyemolytic-uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention? 1. Test urine for specific gravity 2. Weigh child daily 3. Weigh the wet diapers 4. Measure abdominal girth daily

Weigh child daily

A child has acute kidney injury following a serious motor vehicle crash. Which intervention takes priority? A. Administer IV fluids and blood products. B. Insert an indwelling urinary catheter. C. Monitor hourly urine output measurements. D. Place the child on a low-sodium diet.

ANS: A Hypovolemia, blood loss, and shock all can lead to prerenal kidney injury. The priority interventions include administering fluids and blood products if needed. An indwelling urinary catheter will be important for hourly urine output measurements, but this will not actively help the problem. A low-sodium diet may or may not be appropriate.

A child is being treated for nephrotic syndrome. Which assessment finding indicates that an important goal for this child is being met? A. Decreased abdominal girth B. Diminished urine output C. Improved rash D. Increased weight over a week

ANS: A The combination of fluid retention and protein loss through the urine produces ascites, or a swollen belly. Decreasing abdominal girth signifies that the disease is being successfully treated. Urine output is already diminished in nephrotic syndrome. There is no rash. Increasing weight means increased fluid retention, which would not be an improvement.

A 6-year-old child is scheduled for a voiding cystourethrogram. Which action by the nurse is the most appropriate? A. Ask the parents about shellfish or iodine allergies. B. Give the child a preprocedure cleansing enema. C. Instruct the parents to give the child clear liquids afterward. D. Provide developmentally appropriate teaching.

ANS: A Because this test uses iodinized contrast material, it is important to assess for allergies to this substance or to iodine, which is often found in shellfish. Teaching would be provided but does not take priority over this important safety measure. There is no need for an enema. After the procedure, the child resumes a normal diet.

An adolescent on the cross-country track team had a urinalysis during a school physical that showed proteinuria. Which action by the nurse is the most appropriate? A. Advise the teen not to run for 48 hours and repeat the test. B. Collaborate with the provider to order kidney imaging tests. C. Explain the finding is insignificant and does not need follow-up. D. Take the teen's blood pressure on three separate occasions.

ANS: A Proteinuria can be a benign finding, especially if it is noted after heavy exercise or fever. The teen should avoid exercise for 48 hours and repeat the test. At this point, further testing is not warranted.

A child is brought to the pediatric clinic, where the parent reports that the child has tea-colored urine and puffy eyes. Which diagnostic test does the nurse prepare the parent and child for based on the assessment findings? A. BUN and creatinine B. Intravenous pyelogram C. Suprapubic aspiration D. Voiding cystourethrogram

ANS: A This child has manifestations of possible glomerulonephritis. To assess kidney function, the patient needs a BUN and creatinine. A pyelogram is used when kidney stones are suspected. Suprapubic aspiration is one way of collecting a sterile urine sample, but is very invasive. A voiding cystourethrogram is used to assess for reflux.

A nurse is teaching a class on acute renal failure. The nurse relates that acute renal failure as a result of hemolytic-uremic syndrome (HUS) is classified as a. Intrarenal b. Prerenal c. Postrenal d. Chronic

ANS: A Feedback A Intrarenal acute renal failure is the result of damage to kidney tissue. Possible causes of intrarenal acute renal failure are HUS, glomerulonephritis, and pyelonephritis. B Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. C Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature. D Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

ANS: A Feedback A Prophylactic antibiotics are used to prevent urinary infection in a child with vesicoureteral reflux, although this treatment plan has become controversial. B Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. C Bubble baths should be avoided to prevent urethral irritation and possible UTI. D To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

Which dietary modification is appropriate for a child with chronic renal failure? a. Decreased protein b. Decreased fat c. Increased potassium d. Increased phosphorus

ANS: A Feedback A Protein intake is restricted because of the kidney's inability to remove waste products. B A low-fat diet is not relevant to chronic renal failure. C Potassium intake may be restricted because of the kidney's inability to remove it. D Phosphorus is restricted to help prevent bone disease.

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine. The nurse's response is based on the knowledge that the presence of casts in the urine indicates a. Glomerular injury b. Glomerular healing c. Recent streptococcal infection d. Excessive amounts of protein in the urine

ANS: A Feedback A The presence of red blood cell casts in the urine indicates glomerular injury. B Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. C A urinalysis positive for casts does not confirm a recent streptococcal infection. D Casts in the urine are unrelated to proteinuria.

Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B Feedback A This offers protective measures against UTIs. B The short urethra in females provides a ready pathway for invasions of organisms. C Prostatic secretions have antibacterial properties that inhibit bacteria. D This offers protective measures against UTIs.

A child is admitted to the hospital with suspected hemolytic uremic syndrome (HUS). Laboratory results indicate elevated BUN, creatinine, and potassium. Which action by the nurse takes priority? A. Administer antibiotics. B. Apply cardiac monitoring. C. Insert a urinary catheter. D. Obtain a stool sample.

ANS: B An elevated potassium can cause serious, even fatal, dysrhythmias. The nurse applies cardiac monitoring first for patient safety. Inserting a urinary catheter and sending a stool sample are appropriate but do not take priority. Antibiotics are not given in HUS because they exacerbate the condition.

An acutely ill child is admitted for a suspected severe urinary tract infection (UTI). Which is the priority action by the nurse? A. Administer broad-spectrum antibiotics as ordered. B. Obtain a urine sample for culture and sensitivity. C. Start an IV line for aggressive fluid resuscitation. D. Teach the parents how to prevent future UTIs.

ANS: B Antibiotics need to be started as soon as possible, but it is imperative to obtain a urine sample for a culture and sensitivity to guide medication choices first. While awaiting the results, the nurse will administer a broad-spectrum antibiotic. The child does need an IV, but there is no indication that the child needs aggressive fluid resuscitation. Teaching is always an important task, but does not take priority over obtaining the sample for urinalysis.

A child is in the emergency department following a car crash. Which finding noted by the nurse warrants immediate intervention? A. Complains "I hurt all over." B. Grey-Turner's sign C. Increased WBCs D. Tachycardia

ANS: B Grey-Turner's sign is bruising in the flank area and can indicate a renal injury. The other signs would be expected after a traumatic event.

An infant has poor feeding, fever, and malodorous urine. The parents do not want the nurse to catheterize the child. Which response by the nurse is the most appropriate? A. Apply a urine collection bag on the baby. B. Explain how this procedure obtains the best results. C. Give the baby acetaminophen (Tylenol) for fever. D. Inform the health-care provider of the refusal.

ANS: B Parents can be understandably distraught at the thought of their baby having an invasive procedure. The nurse should ensure that the parents understand why the catheterized urine sample or a suprapubic aspirated urine sample is the best choice for obtaining the most accurate urinalysis results. If the parents still refuse, the nurse should document their refusal, inform the provider, and apply a collection bag. The nurse should also treat the baby's fever with acetaminophen, but this option is not directly related to the question.

A child presents to the pediatric clinic, where the parent reports that the child has had bloody diarrhea and joint pain. Which diagnostic test does the nurse prepare the child and parent for first? A. Echocardiogram B. Skin assessment C. Serum renal studies D. Urinalysis

ANS: B The classic signs of Henoch-Schönlein purpura are rash, gastrointestinal complaints (often bloody diarrhea), hematuria, and arthritis. The nurse needs to assess the child's skin for a rash. The diagnosis is usually made by clinical findings, as there is no specific diagnostic test.

A school-age child has renal disease and the parent wants to know how this could cause the child's hypertension. Which response by the nurse is the most appropriate? A. "The high blood pressure caused the kidney disease." B. "The kidneys regulate renin, which controls blood pressure." C. "The medication your child takes often raises blood pressure." D. "The renal diet includes a lot of sodium, which raises blood pressure."

ANS: B The kidneys regulate renin, a hormone that controls blood pressure. Kidney abnormalities often affect renin, leading to hypertension. In a child this young, the kidney disease most likely came first; in adults, long-standing hypertension is a frequent cause of renal disease. Medications are not the reason. The typical renal diet is low in sodium.

An infant appears dehydrated. Laboratory results indicate a serum sodium of 143 mEq/L. Which fluid would the nurse use for IV replacement? A. 0.45% normal saline B. 0.9% normal saline C. 3% normal saline D. D5W with 20 mEq KCL

ANS: B This child has an isotonic dehydration, in which fluids and solutes are lost in balanced proportions, as evidenced by the normal serum sodium level. The child needs an isotonic IV solution, which would be 0.9% normal saline. The 0.45% normal saline ("half normal saline") is hypotonic, as is D5W, with or without potassium. The 3% normal saline is hypertonic.

You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS). Which bacterial infection was most likely the cause of HUS? a. Pseudomonas aeruginosa b. Escherichia coli c. Streptococcus pneumoniae d. Staphylococcus aureus

ANS: B Feedback A Pseudomonas aeruginosa is not associated with HUS. B Children with HUS become infected by Escherichia coli, which is usually contracted from eating improperly cooked meat or contaminated dairy products. C Streptococcus pneumoniae is not associated with HUS. D Staphylococcus aureus is not associated with HUS.

Which finding indicates that a child receiving prednisone for minimal change nephrotic syndrome is in remission? a. Urine is negative for casts for 5 days. b. Urine is up to a trace for protein for 5 to 7 days. c. Urine is positive for glucose for 1 week. d. Urine is up to a trace for blood for 1 week.

ANS: B Feedback A The absence of casts in the urine gives no indication about the child's response to treatment. The child with primary nephrotic syndrome is considered to be in remission when the urine is negative for protein for 5 to 7 consecutive days. B The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine is up to trace for protein for 5 to 7 days. C Remission is achieved when the urine is negative for protein for 5 to 7 consecutive days. It is not unusual for glucose to test positive if the child is taking prednisone. D The presence or absence of hematuria is not used to determine remission in primary nephrotic syndrome.

A practicing nurse explains to a nursing student that which is the most common cause of acute renal failure in children? A. Congenital renal problems B. Glomerulonephritis C. Hemolytic uremic syndrome D. Tylenol (acetaminophen) overdose

ANS: C Hemolytic uremic syndrome is most often associated with children eating undercooked meat and is the most common cause of acute renal failure in the pediatric population. Tylenol overdose is associated with liver failure.

Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts? a. Acute viral gastroenteritis b. Acute glomerulonephritis c. Hemolytic-uremic syndrome d. Acute nephrotic syndrome

ANS: C Feedback A Anemia and thrombocytopenia are not associated with acute gastroenteritis. B The symptoms described are not suggestive of acute glomerulonephritis. C Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea. D The symptoms described are not suggestive of nephrotic syndrome.

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

ANS: C Feedback A In acute poststreptococcal glomerulonephritis the urine output may be decreased. B In acute poststreptococcal glomerulonephritis blood pressure may be increased. C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. D Edema may be noted around the eyelids and ankles in patients with acute poststreptococcal glomerulonephritis; however, weight gain is associated with nephrotic syndrome.

A school-age female child has a urinary tract infection (UTI). The culture has come back positive for Escherichia coli. Which teaching measure is most important for the nurse to include in the teaching plan? A. Avoid bubble baths and nylon panties. B. Offer the child fluids frequently. C. Place the child on a voiding schedule. D. Teach the child to wipe from front to back.

ANS: D All items are appropriate to teach when a child has a UTI. However, E. coli infection stems from contamination with fecal material. The female child should be taught to wipe from front to back to prevent this cross-contamination.

A nurse is obtaining a bagged urine collection on an infant. Which action by the nurse is most important? A. Clean and powder the skin prior to bagging. B. Remove the bag as soon as it contains urine. C. Send the sample to the laboratory as soon as possible. D. Use universal precautions, including gloves.

ANS: D For infection control, the nurse uses universal precautions, including wearing gloves when collecting urine samples. The baby's skin should be clean and dry; powder will cause the bag to not adhere. The other answers are appropriate, but infection control and safety come first.

A child has glomerulonephritis and hypertension. Which dietary modification is most appropriate for the nurse to suggest? A. High fiber B. High potassium C. Low saturated fat D. Low sodium

ANS: D Hypertension in glomerulonephritis is usually due to fluid overload, and a sodium-restricted diet can help this problem. If the patient is on loop diuretics (often prescribed for hypertension in these patients), potassium is important. High fiber and low saturated fat are healthy diets for nearly everyone.

An infant is born with exstrophy of the bladder but otherwise appears healthy. Which nursing diagnosis is the priority for this infant? A. Altered family processes B. Fluid volume deficit C. Hypothermia D. Risk for infection

ANS: D In this condition, the bladder is open on the abdominal wall, and priority interventions revolve around preventing infection. There is no indication that the child has fluid volume deficit or hypothermia. Altered family processes might be a diagnosis, but physical diagnoses take priority over psychosocial ones.

Which statement by a parent of a child with minimal change nephrotic syndrome indicates an understanding of a no-added-salt diet? a. "I can give my child sweet pickles." b. "My child can put ketchup on his hotdog." c. "I can let my child have potato chips." d. "I do not put any salt in foods when I am cooking."

ANS: D Feedback A All types of pickles are high in sodium and should not be served to the child on a no-added-salt diet. B The child should not be allowed to eat hotdogs; they are considered a cured or processed meat and are high in sodium. C Potato chips are a high-sodium food and should not be included in the child's diet when sodium intake is restricted. D A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI

ANS: D Feedback A An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. B Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. C Glomerulonephritis is not a likely cause of dysuria or urgency. D Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI.

Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D Feedback A Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infant's testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. B A rectal temperature yields no information about cryptorchidism. C Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis. D For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold.

Which diagnostic finding is present when a child has minimal change nephrotic syndrome? a. Hyperalbuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria

ANS: D Feedback A Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss. B ASO titer is negative in a child with primary nephrotic syndrome. C Leukocytosis is not a diagnostic finding in primary nephrotic syndrome. D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane.

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. Which of the following would be the best way to prevent this? a) Prophylactic antibiotics after strep throat are important. b) Tell parents to give ibuprofen if their child has a sore throat. c) All children in the child's class should be tested for strep throat if there is a positive. d) Encourage the child to take all the antibiotics if diagnosed with strep throat.

Encourage the child to take all the antibiotics if diagnosed with strep throat. Correct Explanation: Encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community that the child came in contact with unless they are symptomatic. Ibuprofen does not cure strep throat and that is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.

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) Performing a suprapubic aspiration b) Placing an indwelling urinary catherter c) Placing a cotton ball in the underwear to catch urine d) Obtaining a clean catch voided urine

Obtaining a clean catch voided urine Correct Explanation: In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet trained child, using a cotton ball to collect the urine would not be appropriate.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent complains of severe abdominal pain. A diagnosis of pelvic inflammatory disease is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to a) Take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity b) Contact the necessary authorities to report a suspected case of sexual abuse c) Take the child to a private room and interview her regarding her sexual history and partners d) Talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted disease and discuss the importance of safe sex practices

Take the child to a private room and interview her regarding her sexual history and partners Correct Explanation: Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a one-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting? a) The child did not want to go on the fishing trip and is now retaliating against being made to go b) The child has been sexually abused, maybe on the fishing trip c) The child has a urinary tract infection due to not bathing while on the fishing trip d) The child is out of the habit of waking himself up during the night to void

The child has been sexually abused, maybe on the fishing trip

The mother of a child diagnosed with pyelonephritis asks if the kidneys were damaged because of this. What is the best response by the nurse? a) The child's risk for renal scarring is increased with pyelonephritis. b) No, if the child is urinating normally, the kidneys were not damaged. c) Yes, all children who get pyelonephritis have renal scarring. d) As long as IV antibiotics are started, there is no risk of renal damage.

The child's risk for renal scarring is increased with pyelonephritis.

The mother of a child diagnosed with pyelonephritis asks if the kidneys were damaged because of this. What is the best response by the nurse? a) Yes, all children who get pyelonephritis have renal scarring. b) The child's risk for renal scarring is increased with pyelonephritis. c) As long as IV antibiotics are started, there is no risk of renal damage. d) No, if the child is urinating normally, the kidneys were not damaged.

The child's risk for renal scarring is increased with pyelonephritis. Correct Explanation: It would not be possible to determine if the child has renal scarring with pyelonephritis until more testing is performed. It can result in renal scarring with this type of problem, but that does not mean there will definitely be complications. Antibiotics are usually the treatment of choice in this situation, but it cannot be determined when the damage had occurred.

A parent asks if their newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? a) There is a chance the testicles will descend on their own. b) If the infant is having swelling or pain, then surgery will be performed. c) This problem needs to be corrected immediately in the newborn period. d) Surgery is not needed for this type of problem.

There is a chance the testicles will descend on their own. Correct Explanation: The AAP recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year old. This problem does not cause pain or swelling.

An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, which of the following would lead the nurse to suspect that the adolescent has candidiasis? a) Thick, white cheese-like discharge b) Yellow-green discharge c) Milky, gray, fishy-odor discharge d) Frothy, gray-green discharge

Thick, white cheese-like discharge Correct Explanation: With candidiasis, the vaginal discharge is thick, white, and cheese-like. A frothy, gray-green discharge is noted with trichomoniasis. A milky, gray discharge with a fishy odor suggests gardnerella. A yellow-green vaginal discharge suggests gonorrhea.