GU/Renal - Ch. 21 Prepu
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) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." b) "Girls tend to urinate less frequently than boys, making them more susceptable to UTI's." c) "It is unlikely that your daughter is practicing good cleaning habits after she voids." d) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C."
"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." 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.
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) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." b) "It is unlikely that your daughter is practicing good cleaning habits after she voids." c) "Girls tend to urinate less frequently than boys, making them more susceptable to UTI's." d) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."
"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." 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.
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?
"Our son's condition may resolve on its own." Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended.
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) "You will grow out of this eventually; you just need to be patient." d) "The pull-ups look just like underwear; no one has to know."
"There are several things we can do to help you achieve this goal." The child wants to stop this problem immediately, so the nurse's most therapeutic response is to assure the child that enuresis is indeed solvable. For some children, learning about the high prevalence of the problem may provide consolation. However, this may not alleviate the child's embarrassment and it does not address his desire for solutions. Telling the child that he will "grow out of this" downplays his embarrassment and does not address his desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.
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) Tell parents to give ibuprofen if their child has a sore throat. d) Prophylactic antibiotics after strep throat are important.
A) Encourage the child to take all the antibiotics if diagnosed with strep throat. 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 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?
BP 136/84
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) Urine culture and sensitivity c) Creatinine clearance d) Microscopic studies for RBC casts
Creatinine clearance 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?
Creatinine clearance rate 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
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) Discuss how child can continue to go to the bathroom instead of in the underwear. b) Demonstrate love and acceptance at home. c) Take away a toy every time the child urinates in their pants. d) Demonstrate how to urinate in the bathroom every time.
Demonstrate love and acceptance at home. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.
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) Dirty green urine d) Headache, loss of appetite
Dirty green urine 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 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?
Encouraging fluid intake after dinner 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.
the urethral opening is on the dorsal surface of the penis
Epispadias
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) Epispadias b) Hypospadias c) Bladder exstrophy d) Patent urachus
Hypospadias Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis.
Most urinary tract infections seen in children are caused by: a) Fungal infections b) Hereditary causes c) Dietary insufficiencies d) Intestinal bacteria
Intestinal bacteria 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.
inflammation of the kidney and renal pelvis=
Pyelonephritis
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) Excess fluid volume d) Imbalanced nutrition less than body requirements
Risk for infection 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) Risk for infection related to immunocompromised state b) Constipation related to effects of administered drugs c) Pain related to tissue rejection d) Deficient fluid volume related to fluid intake restrictions postoperatively
Risk for infection related to immunocompromised state Children are administered anti-immune therapies to lower immune system response and help prevent rejection following a transplant; this leaves them susceptible to infection.
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?
Tea-colored urine The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as tea or cola colored. 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 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) Appearance of granulation tissue b) Bleeding that stops without pressure c) Small spots of blood on diaper d) The infant does not urinate within 6 to 8 hours
The infant does not urinate within 6 to 8 hours 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.
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) There is a chance the testicles will descend on their own. d) Surgery is not needed for this type of problem.
There is a chance the testicles will descend on their own. 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.
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) Urine culture b) Urinalysis c) Renal biopsy d) Radioisotope scanning
Urine culture 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.
In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care?
Weighing on same scale every day
A client has just been admitted to the unit with a history of recent streptococcal infection, hematuria, and proteinuria. Based on these findings, the nurse suspects which condition? a) acute glomerulonephritis b) acute kidney injury c) urinary tract infection d) prune belly syndrome
a) acute glomerulonephritis
A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? a) weigh, daily b) urine output, every shift c) amount of protein in the urine d) abdominal circumference
a) weigh, daily
edema in the peritoneal cavity=
ascites
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) the need for complete bed rest for 10 days. b) a liquid diet for 3 days. c) the need for maintaining a semi-Fowler position. d) some discomfort at the surgery site.
d) some discomfort at the surgery site. 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.
subnormal volume of urine=
oliguria
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) the need for complete bed rest for 10 days. b) some discomfort at the surgery site. c) a liquid diet for 3 days. d) the need for maintaining a semi-Fowler position.
some discomfort at the surgery site. 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.
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) acute glomerulonephritis. b) rheumatic fever. c) lipoid nephrosis (idiopathic nephrotic syndrome). d) a urinary tract infection.
acute glomerulonephritis. 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.
A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse? a) Circumcision is usually performed after 1 year of age. b) The circumcision may predispose the newborn to renal failure. c) The foreskin is needed for repair. d) Circumcision with hypospadias will cause meatal stenosis.
c) The foreskin is needed for repair.
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) Giving desmopressin intranasally b) Practicing bladder-stretching exercises c) Engaging the child in stress reduction measures d) Encouraging fluid intake after dinner
Encouraging fluid intake after dinner 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.
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) Bathe the child with bubble bath once a week. b) Wipe from back to front when changing the girl's diaper. c) Report any abnormally colored urine to the child's primary care provider. d) Discontinue prescribed antibiotics once symptoms of UTI have disappeared.
Report any abnormally colored urine to the child's primary care provider. Several important interventions can help prevent urinary and renal disease in children. The first intervention is to educate parents and caregivers about wiping from front to back (not back to front) when changing diapers of female infants. Remind parents of simple ways to prevent UTI, such as not allowing children to bathe with bubble bath. Teach parents to recognize that abnormally colored urine (red, black, or cloudy) should not be dismissed as this could be the beginning of a UTI or kidney disease. Educating parents about the importance of giving the full course of antibiotics prescribed for UTIs can help prevent return reinfection; giving the full course of antibiotics after a streptococcal infection can help prevent acute glomerulonephritis.
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) 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. c) Give the child fluids and report back to the nurse in a few hours. d) Give the child a diuretic 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. 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.
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) Instruct caregivers to avoid bubble baths, especially in young girls. c) Record and report any indications of urinary burning, frequency, or urgency. d) Observe for possible indications of sexual abuse. e) Collect a "clean catch" voided urine. f) Teach girls to wipe from front to back.
• Collect a "clean catch" voided urine. • Observe the child for signs of any reactions to the The nurse would collect the "clean catch" voided urine specimen before any treatment is started to increase the likelihood of being able to identify the bacterium causing the infection. A priority when giving antibiotics is to always observe for signs of any adverse reaction to the medication. Reporting and recording urinary symptoms and observing for possible sexual abuse would be appropriate but not the priority. Instructing caregivers about avoiding bubble baths and teaching girls to wipe from front to back would be important later in the care of the child.
