Pediatrics Quiz 8 Alterations in Genitourinary Function

A child with acute glomerulonephritis is in the playroom and experiences blurred vision and headache. Which of the following actions should be taken by the nurse?

Obtain a blood pressure on the child; notify the physician.

Scenario: A nurse is caring for a 9-year-old child who is being seen for the second time with a UTI. Which of the following findings should the nurse expect during an initial assessment? (Select all that apply.)

dysuria foul smelling urine

Urethral meatus located on the dorsal (upper) side of the glans penis

epispadias

A nurse is reviewing a patient's chart and notices that the child suffers from a urinary tract infection. Which of the following microorganisms is related to this condition?

escherichia coli

A nurse is preparing to admit a child with possible hydronephrosis. What labs should the nurse expect to draw on this child?

Blood urea nitrogen (BUN) and creatinine.

A child with a renal condition has developed oliguria. Which action(s) should the nurse anticipate performing?

continue monitoring intake and output draw blood to check potassium and creatinine weigh the child monitor the child's bp

Failure of one or both testicles to descend into the scrotum

cryptorchidism

The client in end-stage of renal failure had undergone kidney transplant. Which of the following assessment findings indicate kidney transplant rejection?

decreased urinary output, sudden weight gain

A nurse enters the room of a teenager after the physician has obtained informed consent for a voiding cystourethrogram. The teenager asks the nurse to explain the procedure again. The nurse tells the client that the client is asked to void after:

injection of contrast dye into the bladder via a catheter

A child with nephrotic syndrome has been placed on prednisone for several weeks. An important point of teaching with the parents should include:

never stop the med suddenly

A child with nephrotic syndrome is severely edematous. The primary health-care provider has placed the child on bed rest. An important nursing intervention for this child should be to

reposition the child every two hours

The pediatric nurse understands that which of the following is normal and expected for a child with end-stage renal disease (ESRD)?

serum of hemoglobin if 7.2 g/dL history of glomerulonephritis or nephrotic syndrome oliguria and hypertension history of pyelonephritis lack or loss of appetite

A child has undergone a kidney transplant and is receiving tacrolimus and cyclosporine. The parents ask the nurse about the reason for these two medications. The nurse should explain that these medications are given to

suppress rejection

Accurate fluid intake and output records and daily weights are particularly important in patients with kidney disease because:

they aid in assessing kidney damage

A 4-year-old has acute glomerulonephritis and is admitted to the hospital. An appropriate nursing diagnosis for this child should be

Excess Fluid Volume Related to Decreased Plasma Filtration.

Scenario: A child with acute poststreptococcal glomerulonephritis (APSGN) is admitted to the pediatric ICU for overnight observation. When obtaining a nursing history from the child's mother, the nurse should expect a recent ________________ infection.

Streptococcal

Protrusion of bladder through lower abdominal wall

bladder exstrophy

The RN is reviewing the discharge plans for a newborn with hypospadias. What statement by the parents indicates their understanding of the plan of care for hypospadias?

"Our child won't be circumcised until after surgery so the skin can be used during the repair."

A nurse is assisting with the admission of a toddler who has nephrotic syndrome. Which of the following objective data should the nurse anticipate collecting from the child?

3+ or 4+ protein in the urine

Which of the following problems is expected in a child who is in end-stage renal failure?

Anemia

A child is being treated for strep throat. The nurse tells the parent to report any abrupt onset of mid-abdominal pain along with malaise, irritability and fever. The nurse is teaching the parent signs of:

Acute post-streptococcal glomerulonephritis

A 12-year-old child has just been diagnosed with end-stage renal disease. The nurse gives the child instructions in which foods to avoid, including

Apricots

The nurse is providing teaching to the mother to help prevent another UTI. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

Avoid giving the child bubble baths Change the child's bathing suit immediately after swimming have the child wear cotton, rather than nylon, underpants instruct the child to wipe from front to back after voiding

The client has been diagnosed to have glomerulonephritis. What should the nurse observe in the urine?

Blood

A 10-year-old patient is admitted to 2 West by the family nurse practitioner who suspects a diagnosis of acute glomerulonephritis. The pediatric nurse would expect to see which of the following findings?

Serum creatinine of 2.2 mg/dL. Gross hematuria. Urine output of 350 ml in 24 hours. Mild periorbital edema. Brown ("tea-colored") urine. Hypertension. Blood urea nitrogen (BUN) of 40 mg/dL.

A child is undergoing hemodialysis. The child should be monitored closely for (Select all that apply):

Shock, hypotension, infections, bleeding at the access site

An infant is born with bladder exstrophy. The nurse should:

Cover exposed bladder tissue with sterile plastic wrap. Assess skin surace around the exposed area for excoriation. Irrigate bladder mucosa with warm saline. Tie umbilical cord with 2.0 silk suture

Discharge instructions for care of a child who has just had an orchiopexy should include

Explanation to the parents about the need for loose, nonrestrictive clothing.

A nurse is teaching a client to perform peritoneal dialysis in preparation for discharge to home. The nurse tells the client to use which of the following to prevent infection when connecting and disconnecting the peritoneal dialysis system?

Gloves and mask

Hemodialysis and peritoneal dialysis are both used to treat kidney failure. Which of the following are correct statements? (Select all that apply)

Hemodialysis uses a man-made membrane (dialyzer) to filter wastes and remove extra fluid from the blood. Peritoneal dialysis uses the lining of the abdominal cavity (peritoneal membrane) and a solution (dialysate) to remove wastes and extra fluid from the body. With hemodialysis, disequilibrium syndrome can occur. Disequilibrium syndrome of dialysis has essentially the same symptoms as cerebral edema: dizzy, faint, lightheaded, ringing in the ears, racing pulse, feeling warm, sweating, nausea, vomiting, yawning, itching and severe muscle cramps (anywhere on the body). It is due to a shift of water to the intracellular spaces as a result of the loss of urea With peritoneal dialysis, the child can ambulate and interact with the environment. Hemodialysis usually is done 3 days a week and takes 3 to 5 hours a day. With peritoneal dialysis, the fluid remains in the peritoneal cavity for 4 to 8 hours.

A nurse is caring for a 4-year-old child who is being seen for the second time with a UTI. The child is to return to the office in 1 week for follow-up and is scheduled for a voiding cystourethrogram (VCUG) in 2 weeks. The purpose of the VCUG is as follows: The VCUG checks for problems of the urethra and bladder, specifically problems with bladder emptying. Having two UTIs in such a short time is unusual for an infant; therefore, it is important to find out the cause of the infection. The VCUG will be scheduled after eradication of the UTI. True or False?

True

Which of the following are characteristic or descriptive of an intravenous pyelogram (IVP)? (Select-all-that-apply)

Visualize kidneys, ureters and bladder Laxatives or enemas may be ordered prior to remove gas or fecal material Nephrotoxic dye Use of intravenous contrast medium Ask about allergies to contrast or shellfish Increase fluids afterwards to flush contrast

The nurse is reviewing discharge instructions with the child and his parent for a school-age child with acute glomerulonephritis. Which of the following should the nurse include? (Select all that apply.)

Weigh the child daily Check the child's blood pressure daily Continue the prescribed antibiotics Elevate edematous body parts

Nocturnal enuresis (bedwetting) is a common problem that can be troubling for children and their families. The evaluation of nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis. Treatment options include nonpharmacologic and pharmacologic measures. Which of the following are recommended treatment strategies for this condition? (Select-all-that-apply)

a bed wetting alarm system positive reinforcement system, such as rewarding the child with a prize for staying dry at night desmopresssin (DDVAP) by nasal spray or by tablet scheduled awakenings during the night to void limit fluid intake int he evening and before the child goes to bed have the child urinate before going to bed

A child, in renal failure, has hyperkalemia. The nurse plans to instruct that the child should avoid the following foods:

carrots and green, leafy vegetables

A fibrous band on the ventral side of the penis resulting in a ventral curvature of the penis

chordee

The nurse admitting and assessing a teenage boy with suspected testicular torsion (twisted testicle) will most likely find which of the following manifestations in addition to possible nausea and vomiting and acute testicular pain? (Select the one best answer.)

cremasteric reflex depressed or absent

Which of the following conditions or factors places the child at risk for development of renal failure? (Select-all-that-apply)

dehydration hydronephrosis vesicoureteral reflux glomerulonephritis pyelonephritis nephrotic syndrome gentamicin use history of intravenous pyelogram

Which of the following clinical manifestations of a lower urinary tract infection (UTI) are commonly seen in infants? (Select-all-that-apply)

fever of the unknown origin failure to thrive poor feeding foul smelling urine vomiting and/or diarrhea irritability and lethargy failure to gain weight

Collection of fluid in the scrotal sac

hydrocele

Urethral meatus located on the ventral (lower) side of the glans penis

hypospadias

The administration of prednisone to children with nephrotic syndrome creates the problem of:

increased risk of infection

A child has been diagnosed with stage 3 chronic kidney disease (CKD). The nurse would question the medical order for:

intravenous pyelogram with contrast to visualize kidneys

A school-aged client admitted to the hospital because of decreased urine output and periorbital edema is diagnosed with glomerulonephritis. Which of the following interventions should receive the highest priority?

obtaining daily weight measurements

Narrowing of the preputial opening of the foreskin that prevents retraction of the foreskin over the glans penis

phimosis

A child who has nephrotic syndrome is admitted to the pediatric unit. Which of the following should the nurse expect to find?

proteinuria hypoalbuminemia hyperlipidemia

A nurse is taking care of a school-age child with acute glomerulonephritis who is taking potassium-sparing diuretics. The nurse anticipates discussing the diet with the child and his parents. The diet should include:

sodium restriction

An adolescent with a history of surgical repair for undescended testes (cryptorchidism) comes to the clinic for a sports physical. Anticipatory guidance for the parents and adolescent would focus on which of the following as most important?

technique for monthly testicular self- examinations