Chapter 43 (combined): Nursing Care of the Child With a Genitourinary Disorder

A 15-year-old boy comes to the emergency department accompanied by his parents. The boy reports an abrupt onset of sudden pain on the right side of his scrotum. When asked to rate his pain on a scale of 1 to 10, with 10 being the most severe, the boy states, "It's a 12." Further assessment reveals a blue-black swelling on the affected side. The nurse suspects testicular torsion and immediately notifies the physician based on the understanding of which of the following? A) The condition is a surgical emergency. B) The boy is at risk for sepsis C) Intravenous antibiotics need to be initiated. D) Renal failure is imminent.

A) The condition is a surgical emergency.

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

a. Intermittent hematuria d. Abdominal mass (Rationale: 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 nephritis syndrome.)

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

d. "Let's meet with the dietitian and plan some meals." (Rationale: Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. 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. Restricting sodium may not necessary if the child is not edematous; in addition, the statement does not teach.)

The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them. -Places both diapers under the infant -Closes the larger diaper -Unfolds both diapers, placing smaller diaper inside larger diaper -Closes the smaller diaper -Brings the penis and catheter/stent through the hole in the smaller diaper -Cuts a hole in the front of the smaller diaper

1. Cuts a hole in the front of the smaller diaper 2. Unfolds both diapers, placing smaller diaper inside larger diaper 3. Places both diapers under the infant 4. Brings the penis and catheter/stent through the hole in the smaller diaper 5. Closes the smaller diaper 6. Closes the larger diaper (Rationale: When performing double diapering, the nurse cuts a hole or a cross-shaped slit in the front of the smaller diaper and then unfolds both diapers, placing the smaller diaper with the hold inside the larger one. Next, the nurse places both diapers under the child and carefully brings the penis [if applicable] and catheter/stent through the hole in the smaller diaper, closing the diaper. Finally, the nurse closes the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.)

21. A child returns from surgery in which a stoma was created in the abdominal wall to the bladder. The nurse identifies this as a: A. vesicostomy. B. ureteral stent. C. continent urinary diversion. D. bladder augmentation.

Answer: A Rationale: A vesicostomy refers to a stoma created in the abdominal wall to the bladder. A ureteral stent is a thin catheter temporarily placed in the ureter to drain urine. A continent urinary diversion uses a piece of the intestine to create a bladder that can be catheterized. Bladder augmentation involves the use of a piece of the stomach or intestine to enlarge bladder capacity.

5. The nurse is caring for a 4-year-old girl with vulvovaginitis. After instructing the girl's mother on how to help prevent subsequent episodes, which statement by the mother indicates a need for additional teaching? A. "She tells me she wipes from front to back." B. "I will make sure she changes her underwear every day." C. "She should avoid bubble baths." D. "I will help supervise her wiping after bowel movements."

Answer: A Rationale: At the age of 4, the mother should not assume that the girl will wipe properly. The mother will need to supervise her wiping in order to train her properly. Making sure the child changes her underwear daily, avoiding bubble baths, and supervising her wiping after bowel movements indicate that the mother has understood the instructions.

30. An infant has undergone a hypospadias repair. What intervention will the nurse teach the parents to keep the site clean and to reduce swelling? A. "It is important to use double diapering to keep stool off the site." B. "The compression dressing should be changed if it becomes soiled." C. "Keep the penis taped to the abdomen so stool cannot get to surgical site." D. "You can use a gauze dressing to cover the urethral stent."

Answer: A Rationale: Hypospadias occurs when the urethral opening is on the ventral side of the penis. It needs to be repaired because the male cannot aim a urinary stream while standing and it causes erectile dysfunction when the child is older. The penile dressing following surgery is usually a compression type to decrease edema and bruising. The easiest way to accomplish this type of dressing is through double diapering. Double diapering also prevents the stool from getting to the penis and surgical site causing an infection. The penis is generally taped to the abdomen to prevent the catheter or stent from casuing stress on the urethral sutures, not to keep the site clean or prevent swelling.Gauze is not used over the surgical site. Double diapering provides a compression dressing and the soiled diaper should be changed with every bowel movement.

6. A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test? A. Checking with the parents for any allergies B. Ensuring adequate hydration C. Giving the girl an enema D. Screening her for pregnancy

Answer: A Rationale: It is important to double-check whether the girl has any allergies. The test is contraindicated in children allergic to shellfish or iodine. Adequate hydration is also important, but the check for allergies is a priority. Only females of reproductive age must be screened for pregnancy. An enema is not necessary at all institutions.

8. The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A. "Let's put you in touch with some other girls who are also having the same body changes." B. "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C. "Your real friends do not care about your appearance and just want you to get well." D. "You are beautiful in your own way; what matters is what is on the inside."

Answer: A Rationale: It is important to introduce the girl to other youngsters with chronic renal conditions so she does not feel so isolated. Adolescents need interaction with peers. Telling the girl that this is a temporary condition, her real friends don't care about her appearance, and she is beautiful in her own way dismisses the girl's concerns and does not offer solutions. Nephrotic syndrome is a chronic condition, so telling her the condition is temporary also is inaccurate.

28. The nurse is administering an IV infusion of albumin to a child with nephrotic syndrome. What is the primary concern for the nurse when administering this medication to the child? A. Fluid overload B. Electrolyte imbalance C. Increased blood pressure D. Urine output

Answer: A Rationale: Many children with nephrotic syndrome develop hypoalbuminemia and require the administration of albumin. Albumin increases the intravascular pressure, causing the movement of fluid from the interstitial space to the intravascular space. As a result, fluid overload can occur. The treatment is to administer furosemide after the albumin infusion is complete. Furosemide is a diuretic that will help excrete the extra fluid from the vascular space, thus preventing fluid overload. Electrolyte imbalances would occur if the low albumin was not treated. The blood pressure and urine output should be assessed during the medication administration to determine renal function.

1. The nurse is caring for a child who is experiencing an acute renal transplant rejection and is to receive muromonab-CD3. What would the nurse most likely expect to assess after the first dose is administered? A. Fever with chills, chest tightness B. Cough, hyperkalemia C. Photosensitivity, gastrointestinal (GI) upset D. Urinary retention, decreased appetite

Answer: A Rationale: The first dose of muromonab-CD3 can cause fever, chills, chest tightness, wheezing, nausea, and vomiting. Cough and hyperkalemia are associated with angiotensin-converting enzyme inhibitors. Photosensitivity and GI upset are often associated with diuretics. Urinary retention and decreased appetite are associated with imipramine.

10. The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). In educating the parents, the nurse would recommend that the child avoid: A. a liberal fluid intake. B. caffeine. C. cranberry juice. D. cotton underwear.

Answer: B Rationale: Caffeine is an irritant to the bladder and should be avoided. Liberal fluid intake and cranberry juice should be encouraged. The child should wear cotton underwear to avoid perineal irritation.

22. The nurse is preparing an 8-year-old girl for a cystoscopy. Which instruction would be most appropriate to give to the child? A. "You need to make sure that you don't go to the bathroom before the test." B. "You might feel some burning when you go to the bathroom afterward." C. "I'm going to have to put a tube into your bladder to empty it." D. "I have to put a thick tight rubber band around your arm to get a blood specimen."

Answer: B Rationale: Cystoscopy is an endoscopic visualization of the urethra and bladder. The nurse would instruct the child that she might experience some burning when she voids after the procedure. A full bladder is needed for urodynamic studies. Putting a tube into the bladder describes a catheterization. Putting a thick tight rubber band suggests a tourniquet, which is used to obtain blood specimens.

17. A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause? A. Klebsiella B. Escherichia coli C. Staphylococcus aureus D. Pseudomonas

Answer: B Rationale: E. coli most commonly causes UTI. Other less common causative organisms include Klebsiella, S. aureus, and Pseudomonas.

2. The nurse is visually inspecting a urine specimen from a 12-year-old boy. The nurse documents gross hematuria with a specimen of which color? A. Cloudy yellow B. Cola colored C. Pale to almost clear urine D. Light orange to moderately yellow colored

Answer: B Rationale: Gross hematuria causes the urine to appear tea, cola, or even dirty green colored. Cloudy urine is typically a sign of infection. Normal urine ranges from moderately yellow to pale or almost clear. Orange-colored urine can occur because of medication.

13. After teaching the parents of a child with a hydrocele about this condition, which statement indicates that the teaching was successful? A. "If this gets worse and we don't treat it, our son could become infertile." B. "This condition should gradually go away on its own." C. "The surgeon is going to operate on him immediately." D. "It's going to be difficult putting ice packs on his scrotum."

Answer: B Rationale: Hydrocele requires watchful waiting because it will usually resolve spontaneously on its own. Hydrocele is not associated with the development of infertility; a varicocele, if left untreated, can lead to infertility. Immediate surgery is warranted for testicular torsion. Ice packs to the scrotum are helpful in relieving pain associated with epididymitis.

20. While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate? A. "Girls have a smaller bladder size than boys do." B. "A girl's urethra is closer to the rectal opening." C. "A girl's urethra is longer than a boy's urethra." D. "Her kidneys are less well protected."

Answer: B Rationale: In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination. Bladder size does not differ between boys and girls. The kidneys are less well protected in the abdomen, increasing the risk for injury but not UTIs.

27. The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response by the client's parent will the nurse highlight for the primary health care provider as an indicator for this condition? A. "My child's has recently reported urinary frequency." B. "My child just got over a head cold with laryngitis." C. "My child's urine is pale yellow in color." D. "My child's eyes appear sunken to me."

Answer: B Rationale: Known risk factors include a recent episode of pharyngitis or other streptococcal infection, decreased urine output, rust or cola colored urine, and swelling around the eyes. Edema may occur in the abdomen, face, eyes, feet, ankles, hands, or generally.

12. A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding? A. Decreased blood urea nitrogen (BUN) and creatinine B. Decreased platelets and leukocytosis C. Hypernatremia and hypokalemia D. Respiratory acidosis and proteinuria

Answer: B Rationale: The child with HUS typically exhibits severe thrombocytopenia (decreased platelets) and leukocytosis. BUN and creatinine are elevated. Hyponatremia, hyperkalemia, metabolic acidosis, and proteinuria also may be noted.

3. The nurse is caring for a 4-year-old with a suspected urinary tract infection. What would be most appropriate to say to the child when obtaining a urine specimen from him? A. "I will need a urine sample." B. "Let your mom help you tinkle in this cup." C. "Please tinkle in this cup right now." D. "Please void in this cup instead of the toilet."

Answer: B Rationale: The nurse needs to use familiar terms to explain to the child what is needed and to gain cooperation. The most positive approach would be to let the child's mother help rather than demanding that he tinkle right now. Using the terms "urine sample" or "void" is not appropriate for a 4-year-old.

23. The nurse is assessing a 5-year-old child's genitourinary system. Which findings would the nurse document as normal? Select all that apply. A. Labial fusion B. Round abdomen C. Positive bowel sounds D. Dullness over the spleen E. Undescended testicles

Answer: B, C, D Rationale: Normal findings include a round abdomen, positive bowel sounds, dullness over the spleen, and descended testicles. Labial fusion, a distended abdomen, and undescended testicles are abnormal findings.

29. A child is hospitalized with acute poststreptococcal glomerulonephritis. What assessments should the nurse include in the plan of care for this child?? Select all that apply. A. Assess level of consciousness B. Assess pain C. Monitor blood pressure D. Auscultate lung sounds E. Inspect the urine

Answer: B, C, D, E Rationale: Acute poststreptococcal glomerulonephritis (APSGN) is an immune process that injures the renal glomeruli. Children come to the healthcare provider with fever, anorexia, headaches and abdominal pain. The focus of care is primarily on fluid volume and managing hypertension.The child would have edema so the nurse should assess thoroughly the lung sounds for crackles, and the work of breathing. Hypertension occurs from the damaged kidneys so the blood pressure should be assessed often and hypertension treated. Assessment of pain is necessary. The pain is abdominal in nature and should be treated appropriately. The urine will have proteinuria and hematuria. It is tea colored from the gross blood in the urine. The level of consciousness is not affected by APSGN.

11. The mother of a child with end-stage renal disease asks the nurse why her son is getting an injection of erythropoietin. When responding to the mother, the nurse explains that the rationale is: A. to treat low calcium levels. B. to stimulate growth in stature. C. to stimulate red blood cell growth. D. to correct acidosis.

Answer: C Rationale: Erythropoietin is given to stimulate red blood cell growth. Vitamin D and calcium are used to correct hypocalcemia. Growth hormone is used to stimulate growth in stature. Citric acid and sodium citrate (or sodium bicarbonate tablets) are used to correct acidosis.

25. The nurse is caring for a client with hemolytic-uremic syndrome (HUS). The cilent is demonstrating oliguria. What does the nurse expect to find when reviewing the client's records? A. A pattern of below-normal blood pressure B. Higher fluid output than fluid intake C. Elevated BUN and creatinine levels D. Increased glomerular filtration rate (GFR)

Answer: C Rationale: Oliguria is the result of acute renal failure associated with HUS. The BUN and creatinine level are indications of kidney function and are elevated with acute renal failure. Hypertension is associated with HUS. Output is decreased with renal failure, as is GFR.

18. A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant? A. "She's been constipated quite a few times." B. "We've noticed that her bed is wet in the morning." C. "She had surgery to repair a problem with her anus." D. "She had a bacterial skin infection about a week ago."

Answer: C Rationale: Risk factors associated with obstructive uropathy include prune belly syndrome, chromosome abnormalities, anorectal malformations, and ear defects. The statement about surgery to repair an anal problem suggests an anorectal malformation. Constipation is a risk factor for urinary tract infections. Bedwetting suggests enuresis. A bacterial skin infection is associated with acute glomerulonephritis.

19. A nurse identifies a nursing diagnosis of Impaired urinary elimination related to infection in the urinary tract as manifested by dysuria for a preschooler. When developing the plan of care, what would be most important for the nurse to do first? A. Develop a schedule for bladder emptying. B. Encourage fluid intake. C. Assess usual voiding patterns. D. Monitor intake and output.

Answer: C Rationale: The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action.

26. A 15-year-old client presents to the emergency room reporting an abrupt onset of severe, sudden pain on the right side of the scrotum while playing football. The nurse notes a blue-black swelling of the affected scrotum. Which action will the nurse complete next? A. Complete a head-to-toe assessment B. Have the client rate the pain C. Notify the primary health care provider D. Monitor the client's urine output

Answer: C Rationale: The nurse would suspect testicular torsion, which is a surgical emergency that necessitates immediate surgical correction to prevent testicular necrosis and possible gangrene. Therefore, the nurse would notify the health care provider immediately. The nurse would then have the client rate the pain, complete a head-to-toe assessment, and monitor urine output.

7. A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication? A. Weight loss B. Hypotension C. Signs of infection D. Hair loss

Answer: C Rationale: The parents should be especially alert for signs of infection as cyclosporine is an immunosuppressant drug. Weight gain instead of weight loss, hypertension instead of hypotension, and increased facial hair instead of hair loss are some other potential side effects.

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

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

14. The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find? A. Hyperlipidemia B. Hypoalbuminemia C. Decreased blood urea nitrogen (BUN) D. Hypoproteinemia

Answer: C Rationale: With nephrotic syndrome, proteinuria, hyperlipidemia, decreased serum protein levels (hypoproteinemia), and decreased serum albumin levels (hypoalbuminemia) are present. BUN typically becomes elevated.

24. The nurse is providing instruction to the parents of a newborn boy. The parents have decided not to circumcise the child. What information should be included in the discussion? Select all answers that apply. A. The foreskin should be pulled back for cleaning at least once per day. B. The foreskin should be pulled back gently with each diaper change. C. Clean the penis gently with soap and water. D. If the foreskin is not retractable do not force it. E. When the foreskin is retracted, gently replace it prior to completing diapering.

Answer: C, D, E Rationale: The newborn's foreskin does not normally retract. This may not be possible until later in infancy. If the foreskin does not retract do not force it. If the foreskin is able to be retracted, do so gently. Return the foreskin to place prior to applying the diaper. Soap and water should be used several times per day to clean the penis and perineal area.

16. A group of students are reviewing information about renal failure in children. The students demonstrate a need for additional teaching when they identify which agent as a potential contributor to renal failure? A. Vancomycin B. Gentamicin C. Co-trimoxazole D. Amoxicillin

Answer: D Rationale: Amoxicillin is a penicillin and is not associated with nephrotoxicity leading to renal failure. Vancomycin, gentamicin (an aminoglycoside), and co-trimoxazole (a sulfonamide) are nephrotoxic.

4. The nurse is providing postsurgical care for an infant who has undergone a hypospadias repair. Which action by the nurse would be most important to help keep the area clean while maintaining proper position of the drainage tubing? A. Keeping the drainage tube taped in an upright position B. Administering antibiotics as ordered C. Administering analgesics as prescribed D. Using a double-diapering technique

Answer: D Rationale: Double diapering is a method used to protect a child's urethra and stent or catheter after surgery and additionally helps to keep the area clean and free from infection. Keeping the drainage tube taped in an upright position, administering antibiotics, and administering analgesics are also important, but double diapering keeps the area clean and helps prevent infection.

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

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

The nurse is assessing a child with acute poststreptococcal glomerulonephritis. Which of the following would the nurse expect to assess? Select all answers that apply. A) Irritability B) Abdominal pain C) Hypertension D) Crackles E) Polyphagia

B) Abdominal pain C) Hypertension D) Crackles

The nurse is caring for an infant with bladder exstrophy. As part of the infant's preoperative plan of care, the nurse monitors for abdominal skin excoriation. Which action would be most appropriate for promoting healing and preventing further skin breakdown? A) Cleaning the area well with a scented diaper wipe B) Applying a barrier/healing cream or paste on skin C) Keeping the bladder moist and covered with a sterile bag D) Covering the area with sterile gauze pads after tub baths

B) Applying a barrier/healing cream or paste on skin

A nurse is conducting a physical examination of an infant and observes the urethral opening on the dorsal side of the penis. The nurse documents this finding as which of the following? A) Hypospadias B) Epispadias C) Varicocele D) Hydrocele

B) Epispadias

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. Swollen testes c. Enlarged inguinal glands d. Purulent drainage from the penis

a. Abdominal mass (Rationale: An abdominal mass indicates hydronephrosis. Swollen testes, enlarged inguinal glands, and purulent drainage from the penis are not associated with hydronephrosis.)

While obtaining a history from a 15-year-old girl, the girl tells the nurse that she often experiences cramping abdominal pain about the middle of her menstrual cycle. The nurse documents this as which of the following? a. Mittelschmerz b. Dysmenorrhea c. Menorrhagia d Metrorrhagia

a. Mittelschmerz (Rationale: Mittelschmerz refers to abdominal pain that usually occurs midway through the menstrual cycle that varies from a few sharp cramps to several hours of crampy pain. It is believed to be the result of egg release from the ovary. Dysmenorrhea refers to the pain associated with menstruation. Menorrhagia refers to excessive menstrual bleeding. Metrorrhagia refers to bleeding between menstrual periods.)

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. Oxybutynin b. Desmopressin c. Albumin d. Imipramine e. Prednisone

a. Oxybutynin b. Desmopressin d. Imipramine (Rationale: Medication therapy for treatment of nocturnal enuresis may include oxybutynin, imipramine, and desmopressin. These agents are prescribed only if behavioral and motivational therapies have been ineffective. Prednisone, a corticosteroid, would be ordered to induce remission and promote diuresis in children with nephritis syndrome. Albumin would be sued to treat nephritis syndrome.)

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. Enlarged inguinal glands and fever c. Fever, scrotal swelling, and urethral discharge d. Hardened and tender epididymis with edema and erythema of scrotum

a. Sudden onset of severe scrotal pain with significant hemorrhagic swelling (Rationale: 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. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele. A hardened and tender epididymis points to epididymitis.)

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

a. The infant does not urinate within 6 to 8 hours (Rationale: The parents should immediately notify the physician or nurse practitioner if the infant does not urinate within 6 to 8 hours after the procedure. Small spots of blood on the diaper, bleeding that stops without pressure, and granulation tissue are normal findings.)

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 responsive by the nurse would be most appropriate? a. "This problem must be carefully managed to avoid permanent damage." b. "This condition usually resolves spontaneously with no symptoms." c. "You can expect recurrent urinary tract infections along with progressive renal damage." d. "Your son will most likely need surgical intervention."

b. "This condition usually resolves spontaneously with no symptoms." (Rationale: Grade I/II VUR usually resolves spontaneously. Grades III to V are generally associated with recurrent urinary tract infections, hydronephrosis, and renal damage. Typically, only grades III to V need surgical intervention.)

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

b. Sodium bicarbonate tablets (Rationale: Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Erythropoietin stimulates red blood cell growth. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Ferrous sulfate is used for the treatment of anemia.

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. Venous varicosity detected along the spermatic cord b. Testis cannot be "milked" down inguinal canal c. Fluid detected in scrotal sac d. Testis can briefly be brought into scrotum

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

While assessing a child with end-stage renal disease, the nurse notes a decreasing level of consciousness. The nurse interprets this finding as resulting from which of the following? a. Metabolic acidosis b. Uremia c. Immunosuppression d. Hypocalcemia

b. Uremia (Rationale: Uremia may result in depression of the central nervous system leading to symptoms such as headache or coma or gastrointestinal or neuromuscular disturbances. Metabolic acidosis causes lethargy, dull headache, and confusion. Immunosuppression is not involved with end-stage renal disease. Hypocalcemia is manifested by muscle twitching, or tetany.)

A nurse is assessing an adolescent who comes to the clinic for a follow-up. During the history, the adolescent tells the nurse that she often experiences pain with her menstrual periods. When gathering additional information, which question would be the most appropriate for the nurse to ask? a. "How heavy is your menstrual flow?" b. "Have you ever been pregnant?" c. "Do you have any nausea or vomiting when you have the pain?" d. "Do you have any discharge with a strange odor?"

c. "Do you have any nausea or vomiting when you have the pain?" (Rationale: Nausea, vomiting, dizziness, or loose stools are symptoms that commonly are associated with pain with menstruation [dysmenorrhea]. Although obtaining information about the amount of the adolescent's menstrual flow is important, it is unrelated to the adolescent's complaint. The adolescent is describing menstrual cramps; these are unrelated to pregnancy. A malodorous discharge suggests an infection.)

The nurse is conducting a routine wellness examination of a 13-year-old girl. Which question would be best to use when beginning to discuss her sexual behavior? a. "Are you curious about sex?" b. "Are you sexually active?" c. "What do you like to do on the weekend?" d. "Do you talk to your mom about sex?"

c. "What do you like to do on the weekend?" (Rationale: The best approach is to start with questions about friends and social life, moving the conversation toward sexual behavior. The direct approach is less effective with adolescents.)

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

c. Insisting that sexual partners use condoms (Rationale: PID is a sexually transmitted infection; use of condoms prevents PID. Oral contraceptives prevent pregnancy, not PID. Using a vaginal douche routinely leads to bacterial overgrowth and increases the risk for PID. Sexual partners should also receive treatment with antibiotics.)

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. Age at first menses c. Number of sexual partners d. Race

c. Number of sexual partners (Rationale: Multiple sexual partners are a risk factor for PID. Race, age, and age at first menses are not considered risk factors for PID.)

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

c. Polystyrene sulfonate (Rationale: Polystyrene sulfonate [Kayexalate] is used to decrease potassium levels. Labetalol would be used to treat hypertension. Nifedipine would be used to treat hypertension. Furosemide would be used to promote diuresis with fluid overload.)

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

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

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. A child's kidneys are surrounded by more fat padding than an adult's kidneys. c. The renal system usually reaches functional maturity by age 5 years. d. Bladder capacity reaches adult capacity by age 1 year.

d. Bladder capacity reaches adult capacity by age 1 year. (Rationale: 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 kidneys of a child are less well protected from injury by the ribs and fat padding than they are in the adult. The renal system usually reaches functional maturity by 2 years of age.)

When developing the preoperative plan of care for an infant with bladder exstrophy, which of the following would the nurse least likely include? a. Covering the bladder with a sterile plastic bag b. Changing soiled diapers immediately c. Sponge-bathing instead of tub bathing d. Placing the infant in a side-lying position

d. Placing the infant in a side-lying position (Rationale: When providing care to an infant with bladder exstrophy, the nurse would keep the infant in the supine position, cover the bladder with a sterile plastic bag, change soiled diapers immediately to prevent contamination, and sponge-bathe the infant rather than immersing him or her in bath water.)

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

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

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

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