Pediatric GU

On reviewing information about glomerulonephritis, the nurse knows that which of the following children is at risk for developing the disease? 1. A 10-year-old recovering from viral pneumonia. 2. A 6-year-old with new-onset type 1 diabetes. 3. A 3-year-old who had impetigo 1 week ago. 4. A 5-year-old with a history of five UTIs in the previous year.

3. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis. TEST-TAKING HINT: The test taker may be distracted by answer 1 because streptococcal infections are associated with glomerulonephritis. However, answer 1 states that the illness is viral, so that answer is not a correct choice

Which of the following is true of a Wilms tumor? Select all that apply. 1. It is also referred to as neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a slow-growing tumor. 5. It is associated with a very poor prognosis

2, 3. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. TEST-TAKING HINT: The test taker would have to know about Wilms tumor to answer the question.

The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. What is the nurse's best response? 1. "The terms are used interchangeably and mean the same thing." 2. "The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, whereas a hydrocele is a fluid-filled mass in the groin." 3. "A hydrocele is the term used when an inguinal hernia occurs in females." 4. "A hydrocele presents in a manner similar to that of an inguinal hernia but causes increased concern because it is often malignant."

2. The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, and a hydrocele is a fluid-filled mass in the groin. TEST-TAKING HINT: This question depends on knowledge of the definitions of inguinal hernia and hydrocele.

The parents of a child with glomerulonephritis ask how will they know that the condition is improving after they take their child home. What is the nurse's best response? 1. "Your child's urine output will increase, and the urine will become less tea-colored." 2. "Your child will rest more comfortably." 3. "Your child's appetite will decrease." 4. "Your child's laboratory test values will become more normal."

1. When glomerulonephritis is improving, urine output increases, and the urine becomes less tea-colored. These are signs that can be monitored at home by the child's parents. TEST-TAKING HINT: The test taker should be led to answer 1 because the manifestations represent improvement in the disease process that can be easily recognized by the parents.

The nurse is caring for a newborn male with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect. TEST-TAKING HINT: The test taker can eliminate answer 4 because "never" is infrequently the case in health care.

At a well-child health screening, 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. What 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. TEST-TAKING HINT: The test taker can eliminate answer 2 because negative reinforcement is not recommended and is not helpful

The nurse is caring for a 7-year-old with glomerulonephritis. Which of the following combinations of signs is commonly associated with glomerulonephritis? 1. Massive proteinuria, hematuria, decreased urinary output, and lethargy. 2. Mild proteinuria, increased urinary output, and lethargy. 3. Mild proteinuria, hematuria, decreased urinary output, and lethargy. 4. Massive proteinuria, decreased urinary output, and hypotension.

3. Mild-to-moderate proteinuria, hematuria, decreased urinary output, and lethargy are common findings in glomerulonephritis. TEST-TAKING HINT: The test taker should eliminate answers 1and 4 because glomerulonephritis does not cause massive proteinuria. Answer 2 can be eliminated because increased urine output is not associated with glomerulonephritis.

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. The nurse notifies the physician because this urine output is too low. 2. The nurse encourages the patient to increase oral intake in order to increase urine output. 3. The nurse records the patient's urine output in the chart. 4. The nurse administers isotonic fluid intravenously to help with the rehydration process.

3. Recording the patient'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. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 4 because they address strategies for caring for a dehydrated child

The nurse is caring for a child who has just been diagnosed with a Wilms tumor. The child is scheduled for a magnetic resonance imaging of the lungs. The parents ask the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. What is the nurse's best response? 1. "I'm not sure why your child is going for this test. I will check and get back to you." 2. "It sounds like we made a mistake. I will check and get back to you." 3. "The test is done to check to see if the disease has spread to the lungs." 4. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery."

3. The test is done to see if the disease has spread to the lungs. TEST-TAKING HINT: The test taker should be led to answer 3 because further testing evaluates metastasis to other organs.

The day surgery nurse knows that the parent of a 13-year-old male understands postoperative teaching for a repair of testicular torsion by saying which the following? 1. "We will encourage him to rest for a few days, but he can return to football practice in a week." 2. "We will keep him in bed for 4 days and let him gradually increase his activity after that." 3. "We will seek therapy as he ages because he is now infertile." 4. "We will make sure he knows how to do testicular self-examination on a monthly basis."

4. The child and family should be taught the importance of testicular selfexamination. TEST-TAKING HINT: The test taker can eliminate answer 1 because this activity could place the postoperative child at risk for injury

The nurse is speaking to the parents of an infant with an inguinal hernia. The nurse knows the parents understand the teaching when they say which of the following? 1. "There are no risks associated with waiting to have the hernia reduced; surgery is done for cosmetic reasons." 2. "It is normal to see the bulge in the baby's groin decrease with a bowel movement." 3. "We will wait for surgery until the baby is older because narcotics for pain control will be required for several days." 4. "It is normal for the bulge in the baby's groin to look smaller when the baby is asleep."

4. The hernia often appears smaller when the child is asleep. TEST-TAKING HINT: The test taker can eliminate answer 1 because there are risks associated with waiting for the repair, and surgery is not done solely for cosmetic reasons.

The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" What is the nurse's best response? 1. "Do not be hard on yourself. It's easy to overlook something that has probably been growing for months when we see our children on a regular basis." 2. "I understand you must be very upset. Your child would have had a better prognosis had you caught it earlier." 3. "It really takes a trained professional to recognize something like this." 4. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

4. The tumor is fast-growing and could very easily not have been evident a few days earlier. TEST-TAKING HINT: The test taker can eliminate answer 2 because the nurse should never cause the parent to feel guilt and responsibility over any diagnosis.

The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which of the following questions would be appropriate for the nurse to ask in order to obtain more information? Select all that apply. 1. "Has there been a stressful event in the child's life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more irritable, and does your child seem to be in pain when urinating?" 5. "Is your child having difficulties sharing at preschool?"

1, 2, 3, 4. 1. Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. 2. A pattern of enuresis can often be seen in families. 3. Increased thirst and incontinence can be associated with diabetes. 4. Irritability and incontinence can be associated with UTIs. TEST-TAKING HINT: The test taker should be able to eliminate answer 5 by knowing lack of sharing is not unusual in preschoolers

A 16-month-old is admitted to the pediatric unit with a diagnosis of hydronephrosis. Which of the following should be included in the plan of care? 1. Intake and output as well as vital signs should be strictly monitored. 2. Fluids and sodium in the diet should be limited. 3. Steroids should be administered as ordered. 4. The child's contact with other people should be limited to avoid infectio

1. Fluid status is monitored to ensure adequate urinary output. Assessing blood pressure monitors kidney function. TEST-TAKING HINT: The test taker can eliminate answer 2 because fluids and sodium are not eliminated from the child's diet.

The nurse understands that the clinical manifestations in hydronephrosis are due to which of the following? 1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. 2. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances. 3. Decreased production of urine in one or both kidneys, resulting in an electrolyte imbalance. 4. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate.

1. Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death TEST-TAKING HINT: This question requires familiarity with the pathophysiology of hydronephrosis

The nurse is working in the emergency department when an infant with a diagnosis of incarcerated hernia is brought in. The nurse would expect to hear the parents report a history of which of the following? 1. Acute onset of pain, abdominal distention, and a mass that cannot be reduced. 2. Gradual onset of pain, abdominal distention, and a mass that cannot be reduced. 3. Acute onset of pain, abdominal distention, and a mass that is easily reduced. 4. Gradual onset of pain, abdominal distention, and a mass that is easily reduced.

1. Signs of an incarcerated hernia include an acute onset of pain, abdominal distention, and a mass that cannot be reduced. Other signs are bloody stools, edema of the scrotum, and a history of poor feeding. TEST-TAKING HINT: The test taker can eliminate answers 2 and 4 because the onset of pain is not gradual

The nurse knows that which of the following causes the symptoms seen in testicular torsion? 1. Twisting of the spermatic cord interrupts the blood supply. 2. Swelling of the scrotal sac leads to testicular displacement. 3. Unmanaged undescended testes cause testicular displacement. 4. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

1. Testicular torsion is caused by an interruption of the blood supply due to twisting of the spermatic cord. TEST-TAKING HINT: This question depends on familiarity with the pathophysiology of testicular torsion.

The nurse is caring for a child due for surgery on a Wilms tumor. The nurse knows that the child's procedure will consist of which of the following? 1. Only the affected kidney will be removed. 2. Both the affected kidney and the other kidney will be removed in case of recurrence. 3. The mass will be removed from the affected kidney. 4. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done.

1. The treatment of a Wilms tumor involves removal of the affected kidney. TEST-TAKING HINT: The test taker should eliminate answers 3 and 4 because the entire kidney is removed, not only the mass.

A 3-year-old has a recurrent UTI. She had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed results within normal range. The child has had no other problems until this visit. Choose the nurse's best response. 1. The nurse should prepare for the following tests: urinalysis, urine culture, and VCUG. 2. Signs and symptoms of renal failure should be evaluated. 3. The nurse should prepare the child for likely admission to the pediatric unit. 4. Send the child home on an antibiotic and instruct the parent to offer the child lots of fluids.

1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when the child has a second UTI within 1 year. TEST-TAKING HINT: The test taker can eliminate answer 2 because it is the only answer that does not address the UTI. Answer 1 is the best choice because it will provide more data about the cause of the child's recurrent UTIs.

The nurse is working in a pediatric urgent care clinic. Which of the following patients can be discharged without the need for a urinalysis to evaluate for a UTI? 1. A 4-month-old female who presents with a 2-day history of fussiness and poor appetite; her current vital signs include T 100.8°F (38.2°C) (axillary) and heart rate 120 beats per minute. 2. An 8-year-old male who presents with a finger laceration; his mother states he had surgical reimplantation of his ureters 2 years ago. 3. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; she has an oral temperature of 101.5°F (38.6°C). 4. A 4-year-old female who states "it hurts when I pee"; her parent states that she has been asking to urinate every 30 minutes; vital signs are within normal range.

2. 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. TEST-TAKING HINT: The test taker should be led to answer 2 because it states that the child is not currently having any manifestations of a UTI.

The parents of a child with glomerulonephritis ask the nurse why the urine is such a funny color. What is the nurse's best response? 1. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." 2. "There is blood in your child's urine that causes it to be tea-colored." 3. "Your child's urine is very concentrated, so it appears to be discolored." 4. "A ketogenic diet often causes the urine to be tea-colored."

2. Blood in the child's urine causes it to be tea-colored. TEST-TAKING HINT: The test taker can immediately eliminate answer 4 because the child is not placed on a ketogenic diet.

The nurse is caring for a 3-week-old female diagnosed with an inguinal hernia. The nurse knows that which of the following protruding into the groin most likely caused the inguinal hernia? 1. Bowel. 2. Fallopian tube. 3. Large thrombus formation. 4. Muscle tissue

2. Fallopian tube or an ovary is the most common tissue to protrude into the groin in females. TEST-TAKING HINT: The test taker should be led to answer 2 because the question specifically states that the child is a female

The nurse anticipates that the child who has had a kidney removed will have a high level of pain and will require invasive and noninvasive measures for pain relief. The nurse anticipates that the child will have pain because of which of the following? 1. The kidney is removed laparoscopically, and there will be residual pain from accumulated air in the abdomen. 2. There is a postoperative shift of fluids and organs in the abdominal cavity, leading to increased discomfort. 3. The chemotherapy makes the child more sensitive to pain. 4. The radiation therapy makes the child more sensitive to pain.

2. There is a postoperative shift of fluids and organs in the abdominal cavity, leading to increased discomfort. TEST-TAKING HINT: The test taker should eliminate answer 1 because the kidney is not removed laparoscopically.

The nurse is caring for a 7-year-old with glomerulonephritis. Which of the following findings requires immediate attention? 1. The child sleeps most of the day and is very "cranky" when awake; blood pressure is 170/90. 2. The child's urine output is 190 mL in an 8-hour period and is the color of Coca Cola. 3. The child complains of a severe headache and photophobia. 4. The child refuses breakfast and lunch and states that he "just is not hungry."

3. A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention TEST-TAKING HINT: The test taker should eliminate answers 1, 2, and 4 because they are manifestations of glomerulonephritis

The parents of a child hospitalized with MCNS ask why the last blood test revealed elevated lipids. What 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 ends up making 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. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because they do not represent changes associated with a disease process.

The nurse is caring for a 2-year-old hospitalized with MCNS. The edema has progressed from periorbital to generalized. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving Lasix twice daily for several days. In order to reduce edema, which of the following does the nurse expect to be included in the treatment plan? 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. TEST-TAKING HINT: The test taker can eliminate answer 2 because mannitol is used to treat edema of the central nervous system.

A 6-week-old male is scheduled for a hypospadias and chordee repair. The parent tells the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" What is the nurse's best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize his sexual function when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

3. Releasing the chordee surgically is necessary for future sexual function. TEST-TAKING HINT: The test taker should be led to answer 3 because it provides the parents with a simple, accurate explanation.

A 10-year-old with renal failure is scheduled to undergo renal transplantation. The nurse knows that this treatment option is which of the following? 1. A curative procedure that will free the patient from any more treatment modalities. 2. An ideal treatment option for families with a history of dialysis noncompliance. 3. A treatment option that will free the patient from dialysis. 4. A treatment option that is very new to the pediatric population.

3. Renal transplantation frees the patient from dialysis TEST-TAKING HINT: The test taker should eliminate answer 1 because transplantation is a treatment, not a cure.

The nurse is caring for a 4-year-old child with a Wilms tumor. Which of the following would the nurse expect to find on assessment? 1. Decreased blood pressure, increased temperature, and a firm mass located in one flank area. 2. Increased blood pressure, temperature within normal limits, and a firm mass located in one flank area. 3. Increased blood pressure, temperature within normal limits, and a firm mass located on one side or the other of the midline of the abdomen. 4. Decreased blood pressure, temperature within normal limits, and a firm mass located on one side or the other of the midline of the abdomen.

3. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because the mass is felt in the abdomen, not the back.

An 8-month-old is being evaluated for a UTI. A urinalysis and urine culture are ordered. Which of the following is the best way to obtain the urine sample? 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 and begin antibiotic administration. 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. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because they both lead to a contaminated sample.

The nurse is caring for a 7-year-old who received a kidney transplant 1 week ago. The child complains to the nurse about abdominal pain, and the parents note that the child has been very irritable. The nurse notes a 10% weight gain and elevated blood urea nitrogen and creatinine levels. The nurse asks the parents if the child has been taking which of the following medications? 1. Codeine tablets. 2. Furosemide. 3. MiraLAX powder. 4. Corticosteroids

4. Corticosteroids are considered to be part of the antirejection regimen that is essential after a kidney transplant. TEST-TAKING HINT: The test taker should be led to answer 4 because it is the only listed answer that is part of an antirejection regimen.

A 3-year-old returns to the pediatric clinic after having had MCNS. His parents ask the nurse how to prevent the child from having it again. What 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 avoided in his 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. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because relapses are common and can be prevented.

The nurse is instructing a group of girls and parents about the importance of preventing UTIs. Which of the following should the nurse teach? 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, encouraging urination and preventing stasis of urine. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 3 because they do not provide accurate information.

Which of the following medications would most likely be included in the postoperative care of a child with repair of bladder exstrophy? 1. Lasix. 2. Mannitol. 3. Meperidine. 4. Oxybutynin.

4. Oxybutynin is used to control bladder spasms. TEST-TAKING HINT: The test taker can eliminate answer 2 because mannitol is a diuretic that is used for central nervous system edema.

A 20-month-old is admitted with hydronephrosis. The nurse notes which of the following findings? 1. Increased blood pressure, metabolic alkalosis, polydipsia, and polyuria. 2. Increased blood pressure, metabolic acidosis, and bacterial growth in the urine. 3. Increased blood pressure, metabolic alkalosis, and bacterial growth in the urine. 4. Increased blood pressure, metabolic acidosis, polydipsia, polyuria, and bacterial growth in the urine

4. The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. Metabolic acidosis is caused by a reduction in hydrogen ion secretion from the distal nephron. Polydipsia and polyuria occur as the kidney's ability to concentrate urine decreases. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because hydronephrosis does not lead to metabolic alkalosis.

The nurse is reviewing the basic anatomy and physiology of the genitourinary system. The nurse knows that the bladder capacity of a 3-year-old could be estimated to be approximately how much? 1. 1.5 oz. 2. 3 oz. 3. 4 oz. 4. 5 oz.

4. The capacity of the bladder can be estimated by adding 2 to the child's age in years. TEST-TAKING HINT: The test taker can eliminate answer 1 because 1.5 oz represents a very small bladder capacity.