Genitourinary Disorders practice questions

Which statement by a parent is most consistent with minimal change nephrotic syndrome (MCNS)? 1. "My child missed 2 days of school last week because of a really bad cold." 2. "After camping last week, my child's legs were covered in bug bites." 3. "My child came home from school a week ago due to vomiting and stomach cramps." 4. "We have a pet turtle but no one washes their hands after playing with the turtle."

1. An upper respiratory infection often precedes MCNS by a few days.

The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due to which of the following? 1. Chemical changes in the composition of albumin. 2. Increased permeability of the glomeruli. 3. Obstruction of the capillaries of the glomeruli. 4. Loss of the kidney's ability to excrete waste and concentrate urine.

2. Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine.

Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)? 1. A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats per minute. 2. A 4-year-old female who states, "It hurts when I pee"; she has been urinating every 30 minutes; vital signs are within normal range. 3. An 8-year-old male presenting with a finger laceration; mother states he had surgical reimplantation of his ureters 2 years ago. 4. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; oral temperature of 101.5°F (38.6°C).

3. Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time. 1. Fussiness and lack of appetite can indicate a UTI. Signs of infection, such as fever and increased heart rate, should be evaluated to determine whether an infection exists. 2. Frequency and urgency are classic signs of a UTI. 4. Pain to the lower right back can indicate infection of the upper urinary tract. Although the child currently denies any burning or frequency, the child currently has a fever coupled with flank pain, which needs evaluation.

A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? 1. Urinalysis, urine culture, and VCUG. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Discharge home on an antibiotic.

1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a child has a second UTI within 1 year.

The parents of a child hospitalized with minimal change nephrotic syndrome (MCNS) ask why the last blood test revealed elevated lipids. Which is the nurse's best response? 1. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated." 2. "It's not unusual to see elevated lipids in children because of the dietary habits of today." 3. "Since your child is losing so much protein, the liver is stimulated and makes more lipids." 4. "Your child's blood is very concentrated because of the edema, so the lipids are falsely elevated."

3. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver hypoalbuminemia.

The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take? 1. Notifies the physician because this urine output is too low. 2. Encourages the child to increase oral intake to increase urine output. 3. Records the child's urine output in the chart. 4. Administers isotonic fluid intravenously to help with rehydration.

3. Recording the child's urine output in the chart is the appropriate action because the urine output is within the expected range of 0.5-1 mL/kg/hr, or 75-150 mL for the 10-hour period.

1. The bladder capacity of a 3-year-old is approximately how much? 1. 1.5 fl. oz. 2. 3 fl. oz. 3. 4 fl. oz. 4. 5 fl. oz.

4. The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child's age in years.

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 with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony promi-nences. The child has been receiving Lasix twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema? 1. An increase in the amount and frequency of Lasix. 2. Addition of a second diuretic, such as mannitol. 3. Administration of intravenous albumin. 4. Elimination of all fluids and sodium from the child's diet.

3. In cases of severe edema, albumin is used to help return the fluid to the bloodstream from the subcutaneous tissue. Although sodium and fluids are restricted in the severely edematous child, they are not eliminated completely.

The parent of a 7-year-old voices concern over the child's continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. Which is the nurse's best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm, and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening, and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

3. Limiting the child's fluids in the evening will help decrease the nocturnal urge to void. Providing positive reinforcement and allowing the child to choose a reward will increase the child's sense of control. 1. Although DDAVP is used for enuresis, it is not the first treatment chosen. Behavior modification and positive reinforcement are usually tried first. 2. Having the child help with changing the bed is a good idea. The child should be approached in a positive manner, however, not a punitive one, so as not to threaten self-esteem. 4. Enuresis alarms are readily available, but behavior modification and positive reinforcement are usually tried first.

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)? 1. Carefully cleanse the perineum from front to back, and apply a self-adhesive urine collection bag to the perineum. 2. Insert an indwelling Foley catheter, obtain the sample, and wait for results. 3. Place a sterile cotton ball in the diaper, and immediately obtain the sample with a syringe after the first void. 4. Using a straight catheter, obtain the sample, and immediately remove the catheter without waiting for the results of the urine sample.

4. An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained.

A parent asks the nurse how to prevent the child from having minimal change nephrotic syndrome (MCNS) again. Which is the nurse's best response? 1. "It is very rare for a child to have a relapse after having fully recovered." 2. "Unfortunately, many children have cycles of relapses, and there is very little that can be done to prevent it." 3. "Your child is much less likely to get sick again if sodium is decreased in the diet." 4. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

4. Exposure to infectious illness has been linked to the relapse of nephrotic syndrome. 1. It is not unusual for a child to experience relapses. 2. Many children do experience relapses, but exposure to infectious illnesses has been linked to relapses. 3. There is no correlation between the consumption of sodium and nephrotic syndrome.

Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)? 1. Avoiding constipation has no effect on the occurrence of UTIs. 2. After urinating, always wipe from back to front to prevent fecal contamination. 3. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. 4. Increasing fluids will help prevent and treat UTIs.

4. Increasing fluids will help flush the bladder of any organism, encourage urination, and prevent stasis of urine.

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.

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.

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.

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.

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.

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.

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 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 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.