PEDS: GU EAQ
Which is an advantage of continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents who require dialysis? a. Dietary restrictions are no longer necessary. b. Adolescents can carry out procedures themselves. c. Hospitalization is only required several nights per week. d. Insertion of catheter does not require surgical placement.
d. Adolescents can carry out procedures themselves. Rationale This type of dialysis provides the most independence for adolescents with ESRD and their families. Adolescents can carry out the procedure themselves. Procedures can be done at home. Dietary restrictions are still required but are less strict. The catheter is surgically implanted in the abdominal cavity. p. 1363
The nurse is assessing a child with nephrosis. The medical history indicates that there have been relapses even after steroid therapy. Which medication is likely to be prescribed for the child? a. Imipramine b. Vincristine c. Oxybutynin d. Cyclophosphamide
d. Cyclophosphamide Rationale Cyclophosphamide is an immunosuppressant medication prescribed for children who do not respond to steroid therapy. Imipramine is used for inhibition of urine in children with enuresis. Vincristine is an agent used for treating Wilms tumor. Oxybutynin is used to reduce uninhibited bladder contractions. b. 1354
An 18-month-old patient suffering from cryptorchidism is scheduled for orchiopexy. The parents want to inquire about the outcome of the surgery. Which would be the ideal response of the nurse to the parents' concern? a. Fluid accumulated in the scrotum will be drained. b. The urinary stream will be directed downward. c. Stenosis of preputial opening of foreskin will be corrected. d. The undescended testicle will be saved from further damage.
d. The undescended testicle will be saved from further damage Rationale Cryptorchidismis a defect in which one or both the testes fail to descend into the scrotal sac. In orchiopexy, the testes are surgically pulled down into the scrotal sac. This saves the testes from further damage. Accumulation of fluid in the scrotum happens in the case of hydrocele. The direction of urination is skewed in a child suffering from hypospadias. Circumcision is required to correct stenosis of preputial opening of foreskin.
A toddler is hospitalized with acute kidney injury secondary to severe dehydration. For which possible complication would the nurse assess the child? a. Hypotension b. Hypokalemia c. Hypernatremia d. Water intoxication
d. Water intoxication Rationale The child with acute kidney injury has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes. The child needs to be monitored for hypertension. Hyperkalemia is a concern in acute renal failure. Hyponatremia may develop in acute renal failure. b. 1358
A child is receiving cyclosporine following a kidney transplant. Which information would the nurse include in the teaching plan about this medication? Select all that apply. a. Frequent hand washing b. Purpose of medication (to suppress rejection) c. Optimal time to take medication to decrease pain d. How to palpate pulses to check for improved circulation e. Recommended foods to take with medication to enhance boosting of immunity
a. Frequent hand washing b. Purpose of medication (to suppress rejection) Rationale Cyclosporine is prescribed to suppress rejection. When taking this medication, it is important to avoid others with contagious illnesses and to wash hands often, because it is an immunosuppressant medication. Cyclosporine does not decrease pain, boost immunity, or improve circulation. b. 1364
A family brings their toddler to the clinic because of frothy urine and a swollen face. Serum analysis confirms hypoalbuminemia and elevated hematocrit levels. The child is normotensive. Based on this clinical data, which care measure should the nurse anticipate in managing this patient? a. Hemodialysis to decrease edema b. Immunosuppression with corticosteroids c. Giving normal saline IV to decrease hematocrit d. Decreasing protein in the diet to compensate for hypoalbuminemia
b. Immunosuppression with corticosteroids Rationale For the child with nephrotic syndrome, corticosteroids are continued until the child is in remission, which is defined as < 1+ urine protein for 3 to 7 consecutive days. Steroids are typically continued at the same daily dose for 4 to 6 weeks. Hemodialysis is not required for this patient. Proteinuria indicates damage to nephrons, but kidneys are functioning and no electrolyte imbalances are reported. Increasing hydration in this patient by giving normal saline IV will increase edema as fluid shifts into interstitial space. Decreasing protein in the diet would result in less amino acids for the liver to synthesize albumin and other serum proteins. p. 1363
The mother of a 7-year-old child with acute poststreptococcal glomerulonephritis (APSGN) is expecting her second child. The concerned mother asks the nurse whether the next child may suffer from the same disease. Which would be an appropriate response by the nurse? a. "The disease is highly contagious; do not go near the ill child." b. "Only one child in a family gets APSGN, so the second child is safe." c. "The reason is not genetic; it is not acquired and cannot be inherited from parents." d. "This disease is inherited from the father, so the child to be born has a 50% chance of inheriting it."
c. "The reason is not genetic; it is not acquired and cannot be inherited from parents." Rationale APSGN is not a genetic disease, so it cannot be passed from parents to offspring. This disease is caused by an immune complex disorder occurring after the patient suffers from streptococcal throat infection. Because the streptococcal infection subsides by the time of APSGN, the chance of the mother being infected is remote. It is not a Y-linked disease, so it cannot be inherited from the father. Because the disease is not inherited, it cannot be safely predicted whether the child will ever develop the same disease or not.
The nurse is preparing a school-age child for a test of the urinary system for detection of anatomic defects. Which does the nurse include in the instructions? Select all that apply. a Explain the purpose of the procedure. b. Tell the child to recall a pleasant experience. c. Show pictures of parts of the urinary system. d. Let the child handle the procedure equipment. e. Explain the procedure on a doll or a favorite toy.
a Explain the purpose of the procedure. b. Tell the child to recall a pleasant experience. c. Show pictures of parts of the urinary system. d. Let the child handle the procedure equipment. Rationale The nurse explains the purpose of the procedure to the child in simple terms so that the child understands why the test is necessary. The nurse also shows pictures of parts of the urinary system so that the child understands easily. The nurse lets the child handle the procedure equipment, such as empty syringes or other detection devices, to alleviate the child's anxiety. The nurse asks the child to think of a pleasant experience or image so that the child is distracted during the procedure. The nurse explains the procedure on a doll to a child less than 4 years of age, as such a child will not understand verbal explanations of the procedure. b. 1346
The parents of a 6-year-old child tell the nurse that they often find the child's bed wet in the morning. Which question does the nurse include in the assessment to identify other symptoms of enuresis? Select all that apply. One, some, or all responses may be correct. a. "How often do you find the bed wet?" b. "Tell me about the child's daily routine." c. "Which medications does the child take?" d. "Show me the child's latest blood report." e. "How do you find the child's progress at school?"
a. "How often do you find the bed wet?" b. "Tell me about the child's daily routine." c. "Which medications does the child take?" e. "How do you find the child's progress at school?" Rationale The nurse needs to assess if the bed-wetting is an indication of enuresis in the child. Therefore the nurse asks about the frequency of bed-wetting. If it occurs at least twice a week for 3 months, this indicates a serious problem of enuresis. The nurse asks about the medication history to assess if enuresis is caused by any medications or urinary tract infections in the child. The nurse asks about the child's progress or behavior at school and the daily routine to assess if there are any emotional disturbances faced by the child. A blood report is not needed, as there are no indications of an infection. p. 1339
A 5-year-old patient suffering from nephrotic syndrome is admitted to the hospital. With which roommate would the nurse manager assign the patient? a. 5-year-old child with autism b. 3-year-old child with measles c. 3-year-old child with chickenpox d. 4-year-old child with conjunctivitis
a. 5-year-old child with autism Rationale Autism is a genetic disorder prevalent in children. A child suffering from nephritic syndrome is susceptible to infections. Because autism is genetic, it is noncontagious and poses less risk of infection for the patient. Measles and chickenpox are diseases caused by viruses and are highly infectious. The patient who is suffering from nephrotic syndrome will not be safe due to risk of infection. Conjunctivitis is an ocular infection caused by both virus and bacteria. It is also highly contagious and would be avoided in patients with nephrotic syndrome. pp. 1353-1354
The nurse is providing care for a child with acute kidney injury (AKI). The nurse is alert for which rick? Select all that apply. One, some, or all responses may be correct. a. Anemia b. Seizures c. Hypertension d. Sensory or motor loss e. Bloody diarrheal stools
a. Anemia b. Seizures c. Hypertension Rationale The child with AKI is at risk for anemia, as there is a drop in hemoglobin levels. Seizures occur if renal failure progresses to uremia. Hypertension occurs due to overexpansion of extracellular fluid and plasma volume together with activation of the renin-angiotensin system. Bloody diarrheal stools and sensory or motor loss are symptoms of chronic renal failure. p. 1359
The nursing instructor asks the student to differentiate between azotemia and uremia in pediatric patients. Which statement by the student indicates effective learning? a. Azotemia may not be as life threatening or serious as uremia. b. Azotemia is the inability of the kidneys to excrete waste material. c. Azotemia occurs in response to inadequate perfusion or kidney disease. d. In azotemia, retention of nitrogenous waste causes toxic symptoms.
a. Azotemia may not be as life threatening or serious as uremia. Rationale Azotemia indicates an accumulation of nitrogenous waste in the blood, and dependent on the level of presentation it alerts the nurse and health care provider that renal problems exist. Uremia is dangerous as the nitrogenous waste in the blood cause toxic symptoms. Toxic symptoms are not caused by azotemia. The inability of the kidneys to excrete waste material or to concentrate urine and conserve electrolytes is called renal failure. Renal failure occurs in response to inadequate perfusion or kidney disease. p. 1357
The nurse is providing care for a child with vesicoureteral reflux (VUR). Which symptom would the nurse be alert for while providing care? Select all that apply. One, some, or all responses may be correct. a. Fever b. Chills c. Vomiting d. Seizures e. Headaches
a. Fever b. Chills c. Vomiting Rationale Fever, chills, and vomiting in a child with VUR indicate kidney infection, which needs to be promptly reported. Headaches are a symptom of acute glomerulonephritis (AGN) accompanied by abdominal discomfort as well as a clinical presentation associated with hypertension or stress or as a consequence of associated metabolic problems. Seizures are a manifestation of neurologic diseases and/or associated metabolic problems. p. 1345
Which statement helps to explain why immunosuppressive therapy is needed for kidney transplantation? a. To increase endogenous cortisol production b. To prevent rejection of the transplanted organ c. To increase the protection generated by antibodies by decreasing the activity of macrophages d. To increase the number of antibodies produced against infectious agents but decrease the antibodies against 'self"
b. To prevent rejection of the transplanted organ Rationale Even though the donor and recipient have compatible blood and tissue types not all antigens are the same. Immunosuppression is necessary to prevent rejection caused by the antigenic activation of the immune system. The use of immunosuppressive medications would not increase cortisol production by the body. Immunosuppressive treatments suppress all elements of immune function. Immunosuppressive treatments decrease all immune function; it is not selective. p. 1364
The urine analysis of a 7-year-old patient detects acute poststreptococcal glomerulonephritis. Which clinical manifestation does the nurse observe in the patient? Select all that apply. a. Gross discoloration of urine b. Proteinuria or excess protein in urine c Hyperalbuminemia or albumin in urine d. Azotemia or excess nitrogen in blood e. Culture of pharynx positive for streptococci
a. Gross discoloration of urine b. Proteinuria or excess protein in urine d. Azotemia or excess nitrogen in blood Rationale The urine of a patient suffering from acute poststreptococcal glomerulonephritis shows gross discoloration due to increased red blood cells and hemoglobin content in urine. Azotemia is a condition characterized by abnormally high amount of nitrogen contents in blood. It occurs due to defective glomerular filtration. Proteinuria means excess of protein in urine. Urine analysis of the patient suffering from poststreptococcal glomerulonephritis shows presence of excess protein in urine. Culture of pharynx is unlikely to be positive for streptococci since the kidneys are affected many weeks after the initial throat infection. Hyperalbuminemia is caused by excess amount of albumin in urine. This is a symptom of nephrotic syndrome where the glomerular membrane becomes permeable to albumin that leaks through the membrane and is lost in urine.
The nurse is assessing an infant with hemolytic uremic syndrome (HUS). The nurse observes hypertension and seizures in the child. Which treatment does the nurse expect the primary health care provider to prescribe? a. Hemodialysis b. Steroid therapy c. Kidney transplant d. Blood transfusions
a. Hemodialysis Rationale Hemodialysis or peritoneal dialysis is an effective treatment for HUS in an infant with uremia or hypertension and seizures. Kidney transplant is performed for end-stage renal disease (ESRD). Steroid therapy is a treatment for renal failure and nephrosis. Blood transfusions are done in case the child with HUS has anemia. p. 1356
The nurse is reviewing laboratory findings and knows the following value would indicate nephrosis? a. Hypoalbuminemia b. Low specific gravity c. Decreased hematocrit d. Decreased hemoglobin
a. Hypoalbuminemia Rationale Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into urine. Specific gravity is increased because of the large amount of protein. Hemoglobin and hematocrit would be elevated secondary to the hypovolemia.
A patient presents with sudden onset of gross hematuria, proteinuria, and hypertension. In assessing this patient, the presence of throat discomfort over the past 2 weeks? a. Streptococcal pharyngitis can induce glomerulonephritis. b. Hemolytic uremic syndrome (HUS) initially presents with pharyngitis. c. Hematuria is the primary indicator that the patient has nephrotic syndrome caused by E.coli. d. Throat discomfort is an indication of edema, which is the primary cause of nephrotic syndrome.
a. Streptococcal pharyngitis can induce glomerulonephritis. Rationale Acute poststreptococcal glomerulonephritis occurs as an immune reaction to a group A beta-hemolytic streptococcal infection of the throat or skin. Clinical symptoms usually develop 1 to 2 weeks after a streptococcal pharyngitis. HUS is typically caused by specific strains of E. coli, and the patient has gastrointestinal disturbances. Severe proteinuria in a normotensive patient may indicate nephrotic syndrome. This patient is hypertensive with hematuria. Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, and edema. Throat discomfort is not a sign of edema. p. 1355
A child with minimal-change nephrotic syndrome (MCNS) is prescribed steroid therapy.Which information does the nurse provide to the family before starting the therapy? Select all that apply. One, some, or all responses may be correct. a. The nurse emphasizes the importance of long-term care. b. The nurse informs the family about the side effects of the therapy. c. The nurse emphasizes that dietary rules need to be followed strictly. d. The nurse instructs the family how to detect signs of relapse or complications. e. The nurse informs the family that the child may have to stop attending school.
a. The nurse emphasizes the importance of long-term care. b. The nurse informs the family about the side effects of the therapy. c. The nurse emphasizes that dietary rules need to be followed strictly. d. The nurse instructs the family how to detect signs of relapse or complications. Rationale The nurse informs the parents about the side effects of the therapy, as there is a change in the child's physical characteristics like weight gain and rounding of the face after the therapy is started. The nurse also instructs the parents how to detect signs of relapse or other complications like infection in the child so that the parents can promptly report it. The nurse emphasizes the importance of long-term care, as the long duration of the treatment process can be stressful for the family. The nurse emphasizes that the diet would be followed as prescribed for effective results. The nurse does not instruct the parents to stop sending the child to school; the nurse instead asks to avoid contact with infected playmates. p. 1354
The nurse is preparing to perform a venipuncture of a graft in a child. Which is a priority action in this case? a. To perform pain-free venipuncture b. To insert the needle at. 90-degree angle c. To insert the needle very slowly into the skin d. To tell the child that the injection will not hurt much
a. To perform pain-free venipuncture Rationale The priority nursing action in this case is to perform a pain-free venipuncture to alleviate stress and panic in the child. The needle is inserted at 15 to 30 degrees, and not a 90-degree angle, into the skin. The child might not believe that the injection will not hurt much; instead, the nurse can distract the child by using imagery or story-telling. The nurse inserts the needle swiftly and quickly to avoid prolonging the stressful procedure.
Which laboratory value would the nurse recognize as being abnormal? a. Urine pH: 4 b. Protein level: absent c. Glucose level: absent d. Specific gravity: 1.020
a. Urine pH: 4 Rationale The expected pHis 4.8 to 7.8. A specific gravity of 1.02 is within the normal range of 1.016 to 1.022. Protein would not be present in the urine. It would indicate an abnormality in glomerular filtration. Glucose would not be present. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations. p. 1344
A 5-year-old female child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse would recommend to the parent that the child be evaluated for which condition first? a. School phobia b. Emotional causes c. Possible urinary tract infection d. Possible structural defects of the urinary tract
c. Possible urinary tract infection Rationale Incontinence in a previously toilet trained child can be an indication of aurinary tract infection. A physical cause of the problem needs to be eliminated before a psychological cause is considered. Structural defects would be explored after a urinary tract infection is confirmed. pp. 1339-1340
The nurse is taking care of a 14-month-old child with nephrotic syndrome. Which is the ideal method by which the nurse can monitor fluid retention or excretion? a. Use diapers and weigh wet pads. b. Maintain intake and output records. c. Make the patient drink excess water. d. Use collection bags for urine collection.
a. Use diapers and weigh wet pads. Rationale Continuous monitoring of fluid retention and excretion is an important duty of the nurse. The best method of monitoring fluid intake and output for a 14-month-old child is using diapers and weighing wet pads. This pad keeps an accurate tab on the fluid dynamics. Keeping intake and output records is difficult for a toddler who is not properly toilet trained. Use of collection bags may lead to rashes and irritations on an already edematous skin. Intake and output data are monitored and measured for a patient suffering from nephrotic syndrome. If the patient is provided too much fluid, it will be extremely difficult for the nurse to monitor output data due to frequent urination. p. 1354
A 4-year-old child with a history of chronic kidney infections presents with osteodystrophy.Why is this significant for understanding the role kidneys play in vitamin metabolism? a. Vitamin D, which is required for calcium absorption, is converted to its active form in the kidney. b. Vitamin C, which is required for collagen production, is converted to its active form in the kidney. c. Erythropoietin is released by the kidney to stimulate the production of red blood cells from the bonemarrow. d. Renin will help to regulate blood pressure, which will decrease blood flow in the kidney and therefore decrease injury.
a. Vitamin D, which is required for calcium absorption, is converted to its active form in the kidney. Rationale The kidneys convert vitamin D into its active form. Vitamin D is needed for calcium metabolism and without this process, the bones are susceptible to disease, such as osteodystrophy. Vitamin C is required for the production of collagen, which makes up about one-third of the bone mass. However, it is not metabolized by the kidney to function properly. Erythropoietin is not a vitamin; it is a hormone. It is released during times of low oxygen to increase erythrocyte production. Though it stimulates bone marrow, it does not play a role in bone health. Renin is a hormone secreted to increase blood pressure. It is not a vitamin nor does it play a role in bone health. p. 1361
A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestations would be observed? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected a. Vomiting b. Jaundice c. Swelling of the face d. Failure to gain weight e. Persistent diaper rash
a. Vomiting d. L Failure to gain weight e. L Persistent diaper rash Rationale Vomiting is a clinical manifestation observed in an infant with a urinary tract infection (UTI) and can be related to poor feeding. Persistent diaper rash is a clinical manifestation of UTI in an infant. Failure to gain weight is a clinical manifestation of UTI in an infant related to poor feeding and vomiting. Jaundice and swelling of the face are not clinical manifestations of UTI in an infant. p. 1344
In a non-toilet-trained child with nephrotic syndrome, which is the best way to detect fluid retention? a. Weigh the child daily. b. Test the urine for hematuria. c. Count the number of wet diapers. d. Measure the abdominal girth weekly.
a. Weigh the child daily. Rational Measuring weight at the same time each day is the most accurate way to determine fluid gains and losses. The presence or absence of blood in the urine will not help with the determination of fluid retention. Abdominal girth is reflective of edema, but weekly is too infrequent a measure. The number of wet diapers reflects how often they have been changed. The diapers would be weighed to reflect fluid balance.
The nurse is providing care for a child after kidney transplantation. The nurse is alert for which sign? Select all that apply. One, some, or all responses may be correct. a. Decreased appetite b. Elevated blood pressure c. Diminished urinary output d. Swelling over the graft area e. Sallow, muddy appearance of skin
b. Elevated blood pressure c. Diminished urinary output d. Swelling over the graft area Rationale The nurse is alert for elevated blood pressure, diminished urinary output, and swelling over the graft area, as this indicates a rejection of the transplanted kidney. Decreased appetite and sallow, muddy appearance of skin are symptoms of chronic renal failure. p. 1364
A child with acute glomerulonephritis (AGN) with edema and oliguria is hospitalized. Which sign does the nurse remain alert for in the child? a. Jaundice b. Hypertension c. Stupor or coma d. Bloody diarrhea
b. Hypertension Rationale A child with AGN in the edema or oliguria phase is at risk for acute hypertension. Therefore the nurse needs to take blood pressure measurements every 4 to 6 hours. Jaundice, bloody diarrhea, and stupor or coma are clinical manifestations of hemolytic uremic syndrome (HUS). b. 1340
A child with a renal transplant is reported to have diminished urinary output. Which would the nurse infer from the report? a. The patient is suffering from poststreptococcal infection. b. The kidney is being rejected by the body due to graft rejection. c. The kidney that has been recently introduced has suffered an injury. d. The urinary output remains low after renal transplants during the first month.
b. The kidney is being rejected by the body due to graft rejection. Rationale Urinary output is a symptom of graft rejection.Graft rejection is characterized by rejection of the organ that has been introduced into the system of the transplanted patient. Injury might cause swelling over the area, but it is unlikely to cause a difference in urinary output. The symptoms for nephrotic syndrome caused by poststreptococcal infection are edema, proteinuria, and hypoalbuminemia. If the patient is having diminished output of urine, then the kidney is not functioning properly. p. 1364
A young child is diagnosed with vesicoureteral reflux. The nurse would know that this condition is usually is associated with which complication? a Incontinence b Urinary obstruction c. Recurrent kidney infections d. Infarction of renal vessels
c. Recurrent kidney infections Rationale Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to kidney infections. Incontinence may be associated with urinary tract infections. When reflux is associated with vesicoureteral reflux, it can cause renal scarring but not obstruction. Infarction of renal vessels does not occur. p. 1345
Which statement helps to explain why immunosuppressive therapy is needed for kidney transplantation? a. To increase endogenous cortisol production b. To prevent rejection of the transplanted organ c. To increase the protection generated by antibodies by decreasing the activity of macrophages d. To increase the number of antibodies produced against infectious agents but decrease the antibodies against "self"
b. To prevent rejection of the transplanted organ Rationale Even though the donor and recipient have compatible blood and tissue types not all antigens are the same. Immunosuppression is necessary to prevent rejection caused by the antigenic activation of the immune system. The use of immunosuppressive medications would not increase cortisol production by the body. Immunosuppressive treatments suppress all elements of immune function. Immunosuppressive treatments decrease all immune function; it is not selective. p. 1364
The nurse is providing care for a preschool child with edema. Which would the nurse use to record the urine output in the child? a. Collection bag b. Weighing wet pads c. Collection container d. Suprapubic aspiration
b. Weighing wet pads Rationale The nurse weighs wet pads to record the urine output in the child, as it is more comfortable for the child. Collection bags are irritating to edematous skin and cause skin breakdown. Suprapubic aspiration is done in infants. A collection container is more convenient for older children or adults because it needs to be positioned correctly for urine collection. b. 1354
A parent of a child with enuresis tells the nurse, "I am sure my child started bed-wetting because I have been scolding my child too much. I'm not a good parent." How does the nurse respond? a. "You must stop disciplining your child henceforth." b. "Of course you are a good parent. Scolding is not bad. c. "Enuresis is not caused due to emotional disturbance." d. "Have patience. It doesn't do good to think about these things now."
c. "Enuresis is not caused due to emotional disturbance." Rationale The nurse encourages the parent to have patience and understanding. By telling the parent to not think about the past the nurse can divert the parent's feelings and thoughts on the treatment that the child now requires. Telling the parent that scolding is not bad is inappropriate, as scolding does have a negative emotional impact on the child. The nurse does not say that the parent must stop disciplining the child; instead the nurse encourages the use of positive reinforcement with the child. Sometimes enuresis is influenced by emotional factors, so it is wrong to say that enuresis is not caused by emotional disturbances.
A child with nephrotic syndrome is being treated with corticosteroids. The child's parents tell the nurse that the child has suddenly gained weight and the child's face has become round. How does the nurse respond? a. "The child needs to be assessed for other viral infections. b. "You need to increase the child's fluid intake immediately." c. "These side effects will diminish after completing the therapy. d. "Have you made any dietary changes in the child's care plan?"
c. "These side effects will diminish after completing the therapy. Rationale The nurse informs the parents that weight gain and rounding of the face are side effects of the steroid therapy that diminish as the therapy is withdrawn. It does not indicate that the child has acquired viral infections, as there is no elevation in temperature. The change in the child's physical characteristics is a side effect of medications and not due to any dietary changes. The child's appetite increases and may contribute to weight gain, but it does not make the face round. Increasing fluids will not help to lose weight as it is caused by the therapy. p. 1354
A 6-year-old child with acute kidney injury is being transferred out of the intensive care unit. Considering their diagnoses, which child would be the most appropriate roommate for this child? a. 6-year-old child with pneumonia b. 4-year-old child with gastroenteritis c. 5-year-old child who has a fractured femur d. 6-year-old child who had surgery for a ruptured appendix
c. 5-year-old child who has a fractured femur Rationale The 5-year-old orthopedic patient is the best choice for a roommate. This child does not have an illness of viral or bacterial origin. Children with pneumonia, gastroenteritis, or a ruptured appendix have potentially infectious disease processes.
The nurse observes that a child has diminished urinary output and shows signs of lethargy and dehydration following surgery. Which condition does the nurse suspect in the child? a. Seizures b. Chronic renal failure c. Acute kidney injury (AKI) d. Acute glomerulonephritis (AGN)
c. Acute kidney injury (AKI) Rationale Lethargy, dehydration, and diminished urinary output in the child after surgery indicate acute kidney injury. Chronic renal failure is characterized by pallor and elevated blood pressure. Diminished urinary output, lethargy, and dehydration are not signs of seizures; instead seizures may occur in case acute renal failure (ARF) progresses to uremia. AGN is indicated by oliguria, hypertension, and circulatory congestion. p. 1357
Which is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed? a. Restraining the child as necessary b. Discouraging parents from holding the child c. Adjusting activities to the child's tolerance level d. Doing passive range-of-motion exercises once a day
c. Adjusting activities to the child's tolerance level Rationale The child will have a variable level of tolerance for activity. This will also be affected by the labile moods associated with steroid administration. The nurse would assist the family in adjusting activities for the child. Restraints would not be used. Parents would be encouraged to hold child. The child would be encouraged to move all extremities while in bed. pp. 1354-1355
A patient is admitted with a relapse of minimal-change nephrotic syndrome (MCNS).Which probable cause does the nurse suspect for the relapse? a. Down syndrome b. Abdominal injury c. Bacterial pneumonia d. Overdose of the medicine
c. Bacterial pneumonia Rationale Relapse of MCNS is often caused by a combination of viral or bacterial infection. In this case the patient is suffering from bacterial pneumonia, which has synergized a relapse of MCNS in the patient. Down syndrome is a genetic disease; relapse of MCNS is not related to any genetic disease. Abdominal injury may deteriorate the process of recovery, but it is unlikely to cause a relapse. Overdose of the prescribed medicine will be manifested by different sets of symptoms other than the relapse. p. 1361
The nurse is asked to obtain a urine sample from an infant with a fever to confirm the diagnosis of a urinary tract infection. Which method does the nurse use for this purpose? a. Cotton-ball method b. Urine collection bag c. Suprapubic aspiration d. Aspirate from a diaper
c. Suprapubic aspiration Rationale Suprapubic aspiration of urine is done in infants with fever, as there are fewer chances of contamination of the specimen. Aspiration from a diaper increases the chances of contamination. A urine collection bag is not used, as the presence of perineal and perianal flora in the collection bag contaminates the specimen. The cotton-ball method is not used, as it is traumatic to the infant's skin. p. 1345
The nurse is providing care for a child with chronic renal failure (CRF). The blood pressure measurements of the child indicate that the child is at risk for hypertension. Which dietary intervention does the nurse implement? a. The nurse eliminates salty foods. b. The nurse increases milk intake. c. The nurse limits sodium and water. d. The nurse increases protein supplements.
c. The nurse limits sodium and water. Rationale The nurse limits sodium and water intake in the child to reduce hypertension and edema. Salt is eliminated in patients with nephrosis. Milk is restricted to prevent calcium-phosphorus imbalance. Protein intake is minimized to decrease excretory demands on the kidneys.
The parents of a child with glomerulonephritis tell the nurse that the child has asked them to bring pretzels for snacks. How does the nurse respond? a. "Try to get pretzels with low salt." b. "You may bring pretzels once a week." c. "Provide adequate water with pretzels." d. "Pretzels should be avoided completely."
d. "Pretzels should be avoided completely." Rationale Pretzels are high in salt, so they are avoided if the child has glomerulonephritis. Asking the parents to get low-salt pretzels is not appropriate, as the child may have increased proteinuria even with small amounts of salt intake. Telling the parents to bring pretzels once a week is not advisable, as salt is restricted. Water and salt are restricted in the child to decrease proteinuria.
A child reports to the nurse about abdominal discomfort and headache. On further assessment the nurse finds that the child's urine is smoky brown. Which condition does the nurse suspect in the child? a. Hyperlipidemia b. Hypoalbuminemia c. Chronic renal failure d. Acute glomerulonephritis (AGN)
d. Acute glomerulonephritis (AGN) Rationale Reports from the patient of headache, abdominal discomfort, and smoky brown urine indicateacute glomerulonephritis (AGN). Hypoalbuminemia and hyperlipidemia are characteristics of nephrotic syndrome. Chronic renal failure is characterized by increased or decreased urinary output, fatigue, loss of energy, and pallor. b. 1344
The parents of a 5-year-old child report their child's persistent weight gain over days and weeks. While assessing the child, the nurse observes generalized edema along with irritability and lethargy. Which condition would the nurse interpret from the patient's symptoms? a. Hydrocele b. Hypospadias c. Cryptorchidism d. Minimal-change nephrotic syndrome (MCNS)
d. Minimal-change nephrotic syndrome (MCNS) Rationale MCN Snephrotic syndromeis characterized by a child's persistent weight gain over days and weeks. The patient looks edematous and may develop an irritable and lethargic nature. MCNS is a clinical state that is characterized by hypoalbuminemia, hyperlipidemia, and generalized edema. Cryptorchidism is failure of one or both the testes to descend naturally into the scrotal sac. Hydrocele is accumulation of fluid in scrotum. If the urethral opening is located behind glans penis or anywhere in the ventral surface of the shaft, it is called hypospadias.
External defects of the genitourinary tract such as hypospadias are usually repaired as early as possible to accomplish which goal? a. Prevent separation anxiety. b. Prevent urinary complications. c. Promote acceptance of hospitalization. d. Promote development of normal body image.
d. Promote development of normal body image. Rationale Promoting the development of normal body image is extremely important. Surgery involving sexual organs can be very upsetting to children, especially preschoolers who fear mutilation and castration. Preventing urinary complications is important for defects that affect function, but all external defects would be repaired as soon as possible. Proper preprocedure preparation can facilitate coping with separation anxiety and the acceptance of hospitalization. b. 1352
The nurse is caring for a child who is on steroid therapy for minimal-change nephrotic syndrome (MCNS). For which condition in the child does the nurse remain alert? a. Diarrhea b. Labial swelling c. Abdominal swelling d. Upper respiratory tract infection
d. Upper respiratory tract infection Rationale Edematous children who are on steroid therapy are vulnerable to upper respiratory tract infections. Therefore they must be kept warm, dry, and active. Labial swelling, abdominal swelling, and diarrhea are symptoms of nephrotic syndrome and not the risks after steroid therapy. b. 1354
An 11-year-old boy acquired a testicular malignancy at the age of 10 years. An abdominal x-ray at the age of 6 months may have revealed which disorder? a. Phimosis b. Hydrocele c. Hypospadias d. cryptorchidism
d. cryptorchidism Rationale Cryptorchidismincreases the risk for testicular malignancy. Phimosis would be obvious upon physical examination. This defect is not directly related to testicular malignancy. Hydrocele is painless swelling of the scrotum that is visible during the physical examination. This defect is not directly related to testicular malignancy. Hypospadias would be obvious upon physical examination. This defect is not directly related to testicular malignancy.
