Prep U

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?

pulse rate and rhythm. 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.

A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema?

weight, daily. The classic sign of nephrotic syndrome is edema. It is usually generalized, but may be manifested as ascites or be periorbital depending on the seriousness of the disease. The easiest way to determine edema is by weighing the child. The child should be weighed on the same scale, at the same time daily, and with the same amount of clothing. The abdomen would only need to be measured if ascites was suspected or known. Measuring urine output will not determine edema, although it should be done to determine if urine is being produced in adequate amounts. Measuring the amount of protein in the urine will also not determine edema. The measurement is important to determine the progress of the disease, however.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?

Risk for infection. When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys.

The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis:

The child can live a more normal lifestyle.The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

A nurse is preparing a plan of care for an infant with bladder exstrophy. Which intervention(s) will the nurse include? Select all that apply.

applying ointment to the abdomen to prevent excoriation, keeping the infant's legs flexed and together, performing sponge bathing instead of tub baths. Exstrophy of the bladder is a midline closure defect that occurs during the 10th week of pregnancy. At birth, the bladder lies exposed on the anterior abdominal wall. Care for the infant born with bladder exstrophy includes keeping the exposed bladder covered with a sterile plastic bowel bag, applying ointment to the abdomen to prevent excoriation, keeping the infant's legs flexed and together, positioning the infant supine to promote urine drainage, and using sponge baths instead of tub baths. Water is not to enter the ureters, because it can become a source of infection.

Which is a priority for the nurse caring for a client with bladder exstrophy?

preventing skin breakdown. Prevention of skin breakdown is the priority to prevent infection and the surface from drying out. Encouraging fluids and voiding are not the priority for this client. Prone position is not recommended; the correct position is supine so urine drains freely.

The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response by the client's parent will the nurse highlight for the primary health care provider as an indicator for this condition?

"My child just got over a head cold with laryngitis."Known risk factors include a recent episode of pharyngitis or other streptococcal infection, decreased urine output, rust or cola colored urine, and swelling around the eyes. Edema may occur in the abdomen, face, eyes, feet, ankles, or hands.

The nurse is educating the parent of a child who will receive a kidney transplant. Which statement made by the parent indicates further teaching is needed?

"This surgery will cure my child's condition."Most children waiting for a kidney transplant will need to undergo dialysis until they receive their new kidney. Once a kidney transplant has been completed, the child will remain on immunosuppression medication for life. Most children can lead a normal life after successful kidney transplantation. Kidney transplantation is not a cure, however. The child will need medical attention and medication for the remainder of their life.

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?

Creatinine clearance rate. 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.

The parent of 6-month-old girl is concerned about the child getting a urinary tract infection. What should the nurse mention to the parent regarding this concern?

Report any abnormally colored urine to the child's primary care provider. Several important interventions can help prevent urinary and renal disease in children. The first intervention is to educate parents and caregivers about wiping from front to back (not back to front) when changing diapers of female infants. Remind parents of simple ways to prevent UTI, such as not allowing children to bathe with bubble bath. Teach parents to recognize that abnormally colored urine (red, black, or cloudy) should not be dismissed as this could be the beginning of a UTI or kidney disease. Educating parents about the importance of giving the full course of antibiotics prescribed for UTIs can help prevent return reinfection; giving the full course of antibiotics after a streptococcal infection can help prevent acute glomerulonephritis.

A child who has been diagnosed with minimal change nephrotic syndrome (MCNS) is being discharged after a 3-week hospitalization. Her edema has been greatly reduced and her appetite is beginning to return. Her caregivers have promised to have a family party to celebrate her return. The child has requested the following foods for the party. Which of these foods would the nurse suggest is appropriate for this child's diet?

banana splits. For the child with nephrotic syndrome, the addition of salt is discouraged, and sometimes the child is put on a low sodium diet. In addition, the child may be placed on a high protein diet. Popcorn, potato chips, and orange soda all have higher sodium content than a banana split. The banana split would also have higher protein content.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is:

obtaining a clean catch voided urine. 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.

The nurse is monitoring the fluid balance of a 9-year-old child. When evaluating urine output for the day, which output would the nurse identify as being within normal limits?

1200 mL. The typical 24-hour urine output for a 9 year old would range from 1000 to 1500 mL. Therefore, a urine output of 1200 mL would be within normal limits.

A female adolescent comes to the clinic for an evaluation. Assessment reveals a possible urinary tract infection. What would the nurse expect to be done to confirm this suspicion?

A urinary tract infection is diagnosed by a urine culture.

A 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child?

Administer the IV fluid slowly. If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to replace plasma volume. Administer such fluid slowly, however, to avoid heart failure, as extra fluid cannot be removed by the non-functioning kidneys. Be certain the fluid prescribed does not contain potassium until it is established kidney function is adequate; otherwise, the buildup of potassium could cause heart block. The child's diet should be low in protein, potassium, and sodium and high in carbohydrates to supply enough calories for metabolism, yet limit urea production and control serum potassium levels. Oral fluid intake may be limited to prevent heart failure due to accumulating fluid that cannot be excreted.

Urinary tract infections are usually successfully treated by what means?

Administering antibiotics. UTIs may be treated with antibiotics (usually sulfamethoxazole or ampicillin) at home. Fluids are encouraged, but they do not treat the infection. Bladder irrigations and diuretics are not used in the treatment of urinary tract infections.

A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching?

Immunosuppression is common after a kidney transplant.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.

The nurse is triaging clients as they come in to an urgent care facility. Which assessment finding is clinically significant for early nephrotic syndrome?

Periorbital edema. Periorbital edema and edema in the ankles are the initial presenting symptoms. As the swelling advances, the edema becomes generalized with a pendulous abdomen full of fluid. Edema in the scrotum also appears. Edema in the hands, sacrum and facial puffiness can be a progression of the disease.

A 3-year-old child is exhibiting irritability, fever, and decreased appetite. A recent history of which of the following would make the nurse suspicious of a urinary tract infection (UTI)?

Signs and symptoms of UTI in the young child often are not clear-cut. The most frequent complaints are of abdominal pain.

A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication?

Signs of infection. The parents should be especially alert for signs of infection as cyclosporine is an immunosuppressant drug. Weight gain instead of weight loss, hypertension instead of hypotension, and increased facial hair instead of hair loss are some other potential side effects.

The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess?

Since the nurse is concerned about the client's immune system, it is most correct to assess the client's white blood cells or cells of the immune system called leukocytes. Red blood cells are in a complete blood count, and low red blood cells result in anemia. Eosinophils and basophils are components of the white blood cells. They can indicate allergies.

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?

The client remains continent throughout the night. 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 determines that interventions for a voiding disorder have been effective when the family of a child with enuresis demonstrates evidence of which of the following?

The family caregiver may become extremely frustrated dealing with wet bedding every morning. Health care personnel must facilitate coping and take a supportive and understanding attitude toward the caregiver and child. Surgery is not needed—fluid restrictions, bladder training, and alarms are the most common approaches. Medications are sometimes used with alarms and positive reinforcement. Parents usually accept the voiding disorder and often have a family member with a history of enuresis.

A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group?

The kidneys help control blood pressure, so our child's blood pressure needs to be checked often."Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. Therefore, monitoring blood pressure is important. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acids-bases. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli in the lungs. Cerebrospinal fluid circulates through the brain and spinal cord.

A 16-year-old girl has had several cases of cystitis in the past year. Which of the following should the nurse suspect as the cause, based on this finding?

When cystitis is seen in adolescent girls, it is an alert a girl may be sexually active.

Which instructions should a nurse give to a client who has a history of urinary tract infections to prevent recurrence? Select all that apply.

Wipe from front to back.Encourage fluids throughout the day.Finish all antibiotics prescribed. 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.

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?

The child has been sexually abused, maybe on the fishing trip.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 (child mistreatment) and should be further explored.