Peds - Ch 21: Alteration in Urinary Elimination/Genitourinary Disorder

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? a. Hypertension b. Tachycardia c. Hypotension d. Hypothermia

A Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

A child needs to collect urine for 24 hours. The nurse explains to the parents and child that this test assesses glomerular filtration rate and how the kidneys are functioning. What results would be expected in this type of test? a. creatinine clearance b. red blood cell (RBC) casts c. culture and sensitivity d. casts and bacteria

A A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate. Urine is collected and kept on ice for a 24-hour period. During that time a serum creatinine is obtained. The presence of creatinine in the urine is compared with the serum to determine the amount of creatinine clearance. Casts, bacteria, and a culture and sensitivity are used to evaluate for infection and the antibiotics needed to treat the infection. RBCs are used to look for bleeding in the urine.

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? a. Creatinine clearance rate b. Kidneys, ureter, and bladder x-ray c. Urinalysis d. Computed tomography scan

A 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.

Which instructions should a nurse give to a client who has a history of urinary tract infections to prevent recurrence? Select all that apply. a. Use bubble bath to wash. b. Finish all antibiotics prescribed. c. Encourage fluids throughout the day. d. Limit bathing to once a week. e. Wipe from front to back.

B, C, E Teaching caregivers to wipe from front to back, encouraging fluids, and finishing all prescribed medications are vital principles in the prevention of recurring UTIs. The use of bubble bath is contraindicated because it can be a source of infection.

Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis? a. The client wets only when involved in an activity. b. The parent takes the client to the bathroom at night. c. The client remains continent throughout the night. d. The child wakes up once during the night for a glass of water.

C The goal of therapy is for the client to be continent of urine throughout the night. The nurse should encourage the child to awaken and void and not have any fluids before bedtime. During an activity, the child should be encouraged to void before and after the activity to prevent incontinence.

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? a. Presence of a thrill b. Dialysate without fibrin or cloudiness c. Absence of a thrill d. Presence of a bruit

C The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill. Dialysate without fibrin or cloudiness is normal and is used with peritoneal dialysis, not hemodialysis.

A client's mother asks the nurse, "When should my daughter have a pelvic examination?" Which response by the nurse is most appropriate? a. "As her mother, it is your choice when she should have a pelvic exam." b. "A pelvic examination is not necessary until pregnancy." c. "A pelvic exam is necessary for girls in puberty." d. "A pelvic exam is necessary at 18 to 20 years of age."

D A pelvic exam is unnecessary for girls who have not yet reached adolescence. A pelvic exam should be part of routine health care around the age of 18 to 20 years or at the point when she becomes sexually active.

A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition? a. testicular infection b. testicular torsion c. hydrocele d. varicocele

B A hydrocele is a collection of fluid that collects in the fold of the scrotum, requiring no treatment. A varicocele is an abnormal dilation (dilatation) of the veins of the spermatic cord. Testicular torsion is evidenced by severe scrotal pain, nausea, and vomiting and is a surgical emergency. Testicular infection is not indicated.

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?a. a. Strawberry-red tongue b. Tea-colored urine c. Jaundiced skin d. Loose, dark stools

B 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.

A 16-year-old adolescent tells the nurse about having severe dysmenorrhea. Which action would be the best health teaching measure? a. Take acetaminophen beginning with the first day of a menstrual flow. b. Use ice to help in reducing inflammation and pain. c. Drink a minimum of fluid if having pain. d. Take over-the-counter ibuprofen for its prostaglandin action.

D Dysmenorrhea is pain associated with menstruation. A prostaglandin release is responsible for the smooth muscle contraction of the uterus during menstruation. The nonsteroidal anti-inflammatory drug ibuprofen has an antiprostaglandin mechanism that will block the prostaglandin release. It is the best choice for dysmenorrhea. Acetaminophen has no antiprostaglandin properties, so it is not the drug of choice. Ice will only work on localized areas so it has limited, if any, effect on the uterus. Ice also is a vasoconstrictor and reduced blood flow could intensify the pain. Fluid intake has no effect on uterine pain.

The nurse is caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis. What would the nurse expect to administer if ordered? a. Sodium bicarbonate tablets b. Vitamin D c. Erythropoietin d. Ferrous sulfate

A Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth.

A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition? a. vulvovaginitis b. urinary tract infection (UTI) c. pelvic inflammatory disease (PID) d. vaginal inflammation

A Vulvovaginitis is diagnosed with clients experiencing vaginal or vulval inflammation, pain odor, and pruritus. Pelvic inflammatory disease and urinary tract infection are not consistent with these symptoms.

Most urinary tract infections seen in children are caused by: a. dietary insufficiencies. b. fungal infections. c. intestinal bacteria. d. hereditary causes.

C 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.

The nurse is caring for a 9-month-old with cryptorchidism noted on the medical record. In which manner will the nurse assess this condition? a. Auscultate for bowel sounds b. Assess the upper extremity strength c. Note any bruising on the skin d. Palpate the scrotum for the testes

D Cryptorchidism occurs when the male gonads (testes) have not descended into the scrotum. Either one or both of the testes may not be in the scrotum. In most infants, the testes descend by the time the male is 1 year old. The nurse assesses the client's status by palpation of the scrotum.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting? a. The child has been sexually abused, maybe on the fishing trip. b. The child is out of the habit of waking himself up during the night to void. c. The child has a urinary tract infection due to not bathing while on the fishing trip. d. The child did not want to go on the fishing trip and is now retaliating against being made to go.

A Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse and should be further explored.

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? a. Blood pressure 136/84 b. Pulse oximetry 93% on room air c. Respirations 24 per minute d. Pulse rate 112 bpm

A Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for a child this age, but not a concern with this diagnosis. The other vital signs are within normal limits for a child of this age.

A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? a. Encourage high fluid intake. b. Apply antibiotic ointment to tube site. c. Increase low-fat foods. d. Allow tubes to dangle freely to encourage flow.

A Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.

A 3-year-old child is scheduled for a surgery to correct undescended testes. For what postoperative consideration would the nurse want to prepare the parents? a. a liquid diet for 3 days b. some discomfort at the surgery site c. the need for maintaining a semi-Fowler position d. the need for complete bed rest for 10 days

B An orchiopexy is the surgical procedure to release the spermatic cord and pull the testes into the scrotum. After the testes are in the scrotum, they are sutured into place to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation. Complete bed rest, a liquid diet, and remaining in a semi-Fowler position are not required as part of the postsurgical care.

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." What would be the most appropriate response by the nurse? a. "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it." b. "There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." c. "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive." d. "That must be hard on you, especially because you are raising her by yourself."

B Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally, oral contraceptive pills are prescribed to prevent ovulation.

Which condition is a risk factor for the development of pelvic inflammatory disease (PID)? a. history of dysmenorrhea b. oral contraceptive use c. multiple sexual partners d. recurrent urinary infections

C Clients who have had multiple sexual partners have a higher incidence of developing pelvic inflammatory disease. Oral contraceptive use, history of UTI, and dysmenorrhea are not risk factors for developing pelvic inflammatory disease.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to: a. take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. b. talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted infection and discuss the importance of safe sex practices. c. take the child to a private room and interview her regarding her sexual history and partners. d. contact the necessary authorities to report a suspected case of sexual abuse.

C Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.

A parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? a. Take away a toy every time the child urinates in his or her pants. b. Demonstrate how to urinate in the bathroom every time the child has an occurrence. c. Discuss how the child can continue to go to the bathroom instead of in his or her underwear. d. Demonstrate love and acceptance at home.

D Enuresis is the continued incontinence of urine past the age of toilet training. It is a source of shame and embarrassment. It affects the child's life emotionally, behaviorally, and socially. It causes the child to have low self-esteem. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school. The child should not be punished for a behavior he or she cannot control. Demonstrating how to use the toilet and going to the bathroom to void are good subjects but they do not help a child who has no control of the enuresis. Testing may need to be done to see if there are anatomical reasons, and medications may be needed to correct the problem.

A school-aged child has come to the clinic with symptoms of a urinary tract infection. The child reports of dysuria, frequency and hesitancy. What nursing assessment is most important for the nurse to complete? a. Assess for bladder distention. b. Monitor the temperature. c. Assess for flank pain. d. Measure the urine output.

A In school-aged and older children, a urinary tract infection can be manifested by fever, vomiting, dysuria, frequency, hesitancy, urgency, flank pain and poor appetite. Because there is dysuria and hesitancy, the bladder may not empty fully. It is most important for the nurse to palpate the bladder for distention. Keeping a distended bladder can cause reflux and continues to harbor bacteria. The urine output can be measured to determine the amount, but the urine also provides a look at color for hematuria. The temperature should be measured, and antipyretics administered if necessary. Pain medication may be prescribed by the health care provider. The nurse can also recommend warm sitz baths and the use of a heating pad over the flank area for pain relief.

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. "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 susceptible to UTI's." d. "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C."

A 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 doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea? a. "Emotional stress can be a cause of this disorder." b. "This disorder is usually seen after a girl has had a spontaneous abortion." c. "This is what happens if a 16-year-old girl has never had any periods at all." d. "It is caused from taking birth control pills when a girl is younger than 13 years old."

A Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.

The nurse is caring for a 10-year-old child experiencing nocturnal enuresis with no physiologic cause. The child states, "I am embarrassed and I wish I could stop this right now!" How will the nurse respond? a. "There are several things we can do to help you achieve this goal." b. "You can wear pull-ups to bed and, since they look like underwear, no one will know." c. "You are not alone. There are almost 5 million people that have enuresis." d. "You will grow out of this eventually; you just need to be patient."

A 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 the desire for solutions. Telling the child that he or she will "grow out of this" downplays the embarrassment and does not address the desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.

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. Small spots of blood on diaper b. Bleeding that stops without pressure c. Appearance of granulation tissue d. The infant does not urinate within 6 to 8 hours

D 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 nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching? a. Induction therapy medication will prevent infection with the transplant. b. Immunosuppression is common after a kidney transplant. c. The child can stop medication after 3 months of therapy. d. As long as the medications are used properly, the transplant will not be rejected.

B A kidney may be transplanted into the child with end-stage renal failure as a way of sustaining life and promoting adequate cognitive skills and growth. Because the kidney is a foreign object to the body it can be rejected. To prevent this, immunosuppressants are given. It is extremely important for these medications to be given on schedule. The levels of the drugs should be monitored to make sure the drugs stay within safe ranges. The drugs are extremely helpful in preventing rejection but they are not a 100% guarantee. There are other factors that play into the role of rejection. The transplant recipient will be taking these medications will be for the rest of his or her life. Induction therapy is related to the beginning of chemotherapy administration.

A 4-year-old child with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing the child for this procedure, the nurse would want to prepare the child to: a. anticipate a headache afterward. b. void during the procedure. c. drink three glasses of water during the procedure. d. have a local anesthetic injected prior to the procedure.

B At the start of the voiding cystourethrogram, a catheter is inserted into the bladder. The contrast medium is inserted through the catheter into the bladder. Fluoroscopy is performed to demonstrate the filling of the bladder and the collapsing of the bladder upon emptying. The assessment of emptying requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed. No anesthetic is required for this procedure. The fluid filling the bladder is inserted via the catheter so no drinking of water is required. A headache following the procedure would not be expected.

A 14-year-old girl visits her gynecologist and is found to have vaginal candidiasis. She is obese, claims to not be sexually active, and is not on oral contraceptive pills. Which intervention should be considered for this client? a. Insertion of antifungal tablets or creams in the morning b. Test her urine for glucose to rule out diabetes mellitus c. Prescription of an antibiotic d. Prescription for oral contraceptive pills

B Candidiasis is a vaginal infection spread by the fungus Candida, an organism which thrives on glycogen. Because oral contraceptive pills produce a pseudopregnancy state, adolescents using OCPs tend to have frequent vaginal candidal infections. If being treated with an antibiotic for another infection (which destroys normal vaginal flora and lets fungal organisms grow more readily), they are also particularly susceptible to this infection. Thus, neither prescription of OCPs or prescription of an antibiotic would be appropriate in this case. Incidence is also strongly associated with immune suppression and diabetes mellitus because hyperglycemia provides the perfect glucose-rich environment for candidal growth. If a girl has frequent candidal infections, her urine should be tested for glucose to rule out diabetes mellitus. Teach women to insert antifungal tablets or creams at bedtime, not in the morning, so the drug does not drain from the vagina immediately afterward.

An adolescent female client reports experiencing abdominal pain about halfway through her menstrual cycle. The adolescent describes the pain and asks the nurse why it is occurring. How should the nurse respond? a. "This pain occurs because the ovary enlarges mid cycle." b. "The pain most likely occurs when the egg is released from the ovary." c. "The pain is due to hormone changes preparing for ovulation." d. "Because there is an unsure reason for the pain, testing will be prescribed."

B Mittelschmerz refers to unilateral abdominal pain that usually occurs midway through the menstrual cycle. This pain can vary from a few sharp cramps to several hours of crampy pain. The pain occurs during ovulation and is thought to occur when the egg is released from the ovary. The pain does not occur as a result of hormone changes or ovary enlargement. The pain is "normal" and benign and does not require further testing.

A client has just been admitted to the unit with a history of recent strep infection, hematuria, and proteinuria. Based on these findings, the nurse would suspect which condition? a. urinary tract infection b. acute glomerulonephritis c. prune belly syndrome d. renal failure

B Recent strep infection, hematuria, and proteinuria are indicative of acute glomerulonephritis. These symptoms do not suggest any of the other options.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? a. Activity intolerance b. Risk for infection c. Imbalanced nutrition less than body requirements d. Excess fluid volume

B 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.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is: a. placing a cotton ball in the underwear to catch urine. b. placing an indwelling urinary catheter. c. obtaining a clean catch voided urine. d. performing a suprapubic aspiration.

C In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet-trained child, using a cotton ball to collect the urine would not be appropriate.

The caregiver of a 1-year-old boy calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment? a. "Without the hormone your son will have fluid that will collect in his scrotum." b. "Without the treatment your child's gonads will not reach normal size." c. "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." d. "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do."

C Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processes vaginalis does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.

A nurse has admitted a 3-year-old female diagnosed with a urinary tract infection. When developing the plan of care, what should the nurse do first? a. Develop a schedule for bladder emptying. b. Encourage fluid intake. c. Assess usual voiding patterns. d. Monitor intake and output.

C The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action.

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? a. Venous varicosity detected along the spermatic cord b. Testis can briefly be brought into scrotum c. Testis cannot be "milked" down inguinal canal d. Fluid detected in scrotal sac

C With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.

The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia? a. muscle tone b. blood pressure c. abdominal pain d. pulse rate and rhythm

D Hyperkalemia occurs when the potassium levels rise above normal laboratory values. Although it varies among laboratories, a normal potassium range is generally between 3.5 and 5 mEq/l (3.5 and 5 mmol/l). When the potassium levels rise, the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm, because potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmia occurs or the heart starts to fail.

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? a. "Our son will likely have a high risk of cancer in his teen years as a result of this condition." b. "Our son may need surgery on his testes before we are discharged to go home." c. "Our son may have to go through life without two testes." d. "Our son's condition may resolve on its own."

D 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.

In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care? a. Testing the urine for glucose levels regularly b. Increasing fluid intake by 50 ml per hour c. Ambulating 3 to 4 times a day d. Weighing on the same scale each day

D The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss. The child with nephrotic syndrome is very edematous so increasing fluid intake would be counterproductive to care needed. In nephrotic syndrome the urine is tested for protein, not glucose. Ambulation is important for all but it is not specific to the child with nephrotic syndrome.