PEDIATRIC SUCCESS GENITOURINARY DISORDERS CHAPTER 9

17. 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."

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18. 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."

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7. 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.

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8. 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.

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11. 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."

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19. A 13-month-old is being discharged following the repair of his epispadias. Which of the following statements made by the parents indicate that they understand the discharge teaching? 1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." 2. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." 3. "We will make sure the dressing is loosely applied to increase the toddler's comfort." 4. "If we notice any yellow drainage, we will know that everything is healing well."

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9. 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."

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3. 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.

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35. 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.

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40. 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.

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61. 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?"

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32. The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The patient's parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

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37. 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.

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38. 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."

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46. 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.

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5. 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.

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10. 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."

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2. 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.

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33. 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."

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34. The nurse receives a call from the parent of a 15-year-old male. The son woke up complaining of intense pain and swelling to the scrotal area. He has vomited twice and is also complaining of abdominal pain. Which of the following should the nurse suggest? 1. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the emergency room. 2. Bring him to the pediatrician's office for evaluation. 3. Bring him to the emergency room immediately. 4. Encourage him to rest; apply ice to the scrotal area, and go to the emergency room if the pain does not improve.

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1. The nurse is reviewing the basic anatomy and physiology of the genitourinary system. e 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.

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36. 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."

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39. 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."

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4. 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.

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6. 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.

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