Ch 26 GU

The nurse is caring for an 8-year-old girl with dehydration who has demonstrated diminished urine output and lethargy since shortly after undergoing surgery. For what condition should the child be evaluated? 1 Chronic renal failure 2 Acute kidney injury 3 Acute glomerular nephritis 4 Hemolytic uremic syndrome

2 A child with dehydration who experiences diminished urine output and lethargy within a short time (especially if in shock or after surgery) is at risk for acute renal failure. The child's symptoms began after surgery and are not chronic. Some common signs of acute glomerular nephritis include edema, anorexia, cloudy urine, oliguria, pallor, lethargy, and headaches. Signs of hemolytic uremic syndrome include vomiting, irritability, lethargy, pallor, bruising, and signs of neurologic involvement. Wilms tumor, hemolytic uremic syndrome, and acute glomerular nephritis are not the most common complications seen after surgery. Dehydration with decreased perfusion to the kidneys is the most likely cause of this patient's symptoms, considering that the patient has just undergone surgery.

What is the name of the defect in which the meatal opening is located on the dorsal surface of the penis? 1 Chordee 2 Epispadias 3 Hypospadias 4 Cryptorchidism

2 In epispadias, the meatal opening is located on the dorsal surface of the penis. Chordee is a ventral curvature of penis, often associated with hypospadias. In hypospadias, the urethral opening is located behind glans penis or anywhere the ventral surface of the penile shaft. Cryptorchidism is the failure of one or both testes to descend.

The nurse is reviewing the urinalysis results of a 12-hour sample of urine of a patient. The nurse finds that the creatinine level in the urine is significantly reduced. What does the nurse interpret from this? 1 The glomerular filtration rate (GFR) is reduced. 2 The patient has excess protein metabolism. 3 The patient is in a state of hypovolemic shock. 4 The patient has a urinary tract infection.

1 (I guessed 3) The clearance rate of creatinine levels is a good indicator of glomerular filtration. Low urinary creatinine levels indicate that the GFR is reduced and creatinine levels are rising in the bloodstream. Creatinine is an end product of protein metabolism. Thus, excess protein metabolism would increase the creatinine levels in the blood and the urine. Thus the nurse cannot conclude that the patient's urine output is reduced for this reason. Impairment of renal function does not cause excessive fluid loss from the body; thus, the patient cannot be in a state of hypovolemic shock. Increase in urinary creatinine levels does not cause urinary tract infection.

The nurse is collecting a urine sample for culture from a child who has undergone surgery and has an indwelling urinary catheter in place. What should the nurse keep in mind while collecting the sample? 1 The nurse should avoid taking the urine sample from a catheter. 2 The nurse should use aseptic techniques while collecting the sample. 3 The nurse should store the sample for 2 hours before sending it to the lab. 4 The nurse should obtain the parents' consent before collecting the sample.

2 The nurse should take aseptic measures while collecting the urine sample of the child. This should be done to prevent contamination of the sample. The nurse can take the urine sample from a catheter if required. The nurse should send the urine sample for testing immediately after it is collected. The nurse need not obtain the consent of the parents before collecting the sample of urine.

What findings are commonly observed in the child who is in the acute phase of acute glomerulonephritis? 1 Hematuria and ketosis 2 Hematuria and proteinuria 3 Increased serum complement 4 Positive cultures of the pharynx for streptococci

2 Urinalysis during the acute phase of acute glomerulonephritis reveals hematuria and proteinuria. Urinalysis during the acute phase of acute glomerulonephritis shows hematuria and proteinuria not hematuria and ketosis. Serum complement (C3) is decreased, not increased. Streptococci are not typically found on culture.

The nurse is reviewing the cystourethrography results of a child with urinary tract infection. Cystourethrography results reveal that the child has vesicoureteral reflex. What complication could be associated with this finding? 1 The child is unlikely to respond to any kind of antibiotics. 2 The child is at risk for the development of pyelonephritis. 3 The child is susceptible to have infection spread in the blood. 4 The child is prone to anatomic variations in the renal system

2 Vesicoureteral reflux refers to the abnormal retrograde flow of urine from the bladder into the ureters. Reflux of urine into the ureters may cause the spread of the infection to the proximal parts of the renal system, mainly the kidneys. Therefore, the most important complication associated with vesicoureteral reflex is pyelonephritis. Based on this finding, the nurse cannot conclude that the child will not be responsive to antibiotics. The child needs to be given continuous low-dose antibiotics to prevent infection from spreading to the kidneys.This finding does not confirm whether the infection in the child has spread to the blood. This can be determined with a blood culture. Anatomic variation in the renal system causes vesicoureteral reflex. It is not a complication associated with vesicoureteral reflex.

The intravenous pyelogram results of the patient indicate a urinary obstruction. Which treatment will be beneficial for the patient? 1 Orchiopexy 2 Circumcision 3 Nephrostomy 4 Renal transplantation

3 A nephrostomy is an artificial opening created between the kidney and the skin. The tube passes through the flank into the pelvis of the kidney, which allows for urinary diversion directly from the pelvis into an ostomy bag. Orchiopexy is a surgical treatment which helps in descending the testis through inguinal canal. Circumcision is treatment which helps to retract the foreskin and helps in voiding. The patient with chronic renal failure is a more likely candidate for kidney transplant.

What are common clinical manifestations of acute poststreptococcal glomerulonephritis? 1 Edema, increased urine volume, hypotension 2 Edema, decreased urine volume, hypotension 3 Edema, decreased urine volume, hypertension 4 Edema, increased urine volume, hypertension

3 Edema, decreased urine volume, and hypertension are common clinical manifestations of acute poststreptococcal glomerulonephritis. Pallor, cloudy, brown urine, irritability, lethargy, and vomiting are other signs. Increased urine volume and hypotension are not clinical manifestations of acute poststreptococcal glomerulonephritis.

A 5-year-old child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to the child's parents, as a priority action, that the child be evaluated for which condition? 1 School phobia 2 Emotional causes 3 Urinary tract infection 4 Structural defects of the urinary tract

3 Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection. A physical cause of the problem needs to be eliminated before a psychologic cause is considered. Emotional causes should be investigated only once a physical cause has been ruled out. Structural defects would be explored as a cause after a urinary tract infection has been confirmed.

The nurse is caring for a 10-year-old boy with nephrotic syndrome. What are the objectives of therapeutic management for this child? 1 Decreasing intravascular fluid volume, preventing infection, and minimizing complications related to therapies 2 Reducing excretion of urinary protein, enhancing fluid retention in the tissues, treating infection, and minimizing complications related to therapies 3 Reducing excretion of urinary protein, reducing fluid retention in the tissues, preventing infection, and minimizing complications related to therapies 4 Increasing excretion of urinary protein, reducing fluid retention in the tissues, preventing infection, and minimizing complications related to therapies

3 Objectives for therapeutic management of the child with nephrotic syndrome include reducing (not increasing) excretion of urinary protein, reducing fluid retention in the tissues, preventing (rather than treating) infection, and minimizing complications related to therapies.

The parent of a child undergoing continuous ambulatory peritoneal dialysis tells the nurse the solution draining from the child is cloudy. What is the most appropriate response by the nurse to the parent's statement? 1 The bag should be changed. 2 Clean the area around the catheter. 3 Notify the practitioner immediately. 4 The solution is expected to be cloudy.

3 The solution draining from peritoneal dialysis should be clear; the parent should be told to notify the practitioner immediately if the fluid appears cloudy. Changing the bag will not affect the cloudiness of the solution. Cleaning the area around the catheter is appropriate, but when the solution is cloudy the practitioner should be notified.

Which is an advantage of continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents who require dialysis? 1 Hospitalization is only required several nights per week. 2 Dietary restrictions are no longer necessary. 3 Adolescents can carry out procedures themselves. 4 Insertion of catheter does not require surgical placement.

3 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.

The nurse is caring for a child with urinary retention and bladder infection. The child has not passed urine for the last 4 to 5 hours. What interventions does the nurse perform to relieve the child of urinary retention? 1 Administer diuretics as prescribed. 2 Catheterize the child immediately. 3 Stimulate the bladder using warm water. 4 Keep fluid intake to a minimum.

3 Urinary retention can be relieved by pouring warm water on the genital organs. This helps to stimulate the bladder for contraction and voiding. Diuretics are helpful in increasing urinary output, but they do not relieve urinary retention. They can worsen the retention by increasing the formation of urine. Catheterization is done only in severe urinary retention. The patient is encouraged to take adequate fluids, and fluid intake is not restricted.

Vesicoureteral reflux will most likely lead to which condition? 1 Hypotension 2 Incontinence 3 Recurrent kidney infections 4 Increased renal arterial perfusion

3 Vesicoureteral reflux is associated with recurrent kidney infections, not hypotension, incontinence, or increased renal arterial perfusion.

Which is an important nursing consideration when caring for a child with end-stage renal disease (ESRD)? 1 The child with ESRD usually adapts well to the minor inconveniences of treatment. 2 The child with ESRD requires extensive support until he or she outgrows the condition. 3 Multiple stresses are placed on the child and family with ESRD until the illness is cured. 4 Multiple stresses are placed on the child and family with ESRD because the child's life is maintained by drugs and artificial means.

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What causes primary reflux? 1 Trauma 2 Acquired infection 3 Acquired condition 4 Congenitally abnormal insertion of ureters into the bladder

4 Primary reflux occurs when a congenitally abnormal insertion of ureters into the bladder occurs. It is not caused by an acquired infection, acquired condition, or trauma.

A child who has difficulty passing urine, along with edema in the genital area, is scheduled for placement of a temporary percutaneous nephrostomy tube. Which diagnostic examination helps the nurse to determine dilation of the ureters and the bladder wall? 1 Scout film 2 Whitaker perfusion test 3 Testicular ultrasonography 4 Renal and bladder ultrasonography

4 Renal and bladder ultrasonography is helpful in visualization of renal parenchyma and dilation of the ureters and the bladder wall. A scout film is a radiograph examination of abdomen and pelvis that helps to detect renal outline and calculi. A Whitaker perfusion test helps to determine obstructions in the upper urinary tract. However, it does not determine dilation of ureter and bladder wall. Testicular ultrasonography helps in visualization of the bladder outline and urethra.

The nurse is educating an adolescent female about proper hygiene and necessary care to prevent urinary tract infections. What should the nurse include in the teaching plan? 1 The importance of urinating two times a day 2 The importance of limiting water intake to 5 ounces a day 3 The importance of wearing nylon underwear instead of cotton 4 The importance of wiping the perineum from the front to the back

4 The adolescent should clean the perineum in a front-to-back direction, because back-to-front will increase the risk of infection. Holding urine in the bladder and voiding only twice a day will increase the risk of urinary tract infections; the patient should void whenever the bladder gets full. Proper hygiene and hydration help to prevent the risk of urinary tract infections. The nurse should instruct the patient to drink as much water as possible. The patient should avoid tight clothing, and wear cotton panties rather than nylon.

The nurse is providing discharge teaching to the parents of the child who had a urinary tract infection (UTI). The nurse tells the parents, "Always ask the child if he needs to use the bathroom. You should not let your child hold it for a long time." What is the reason for the nurse to give this advice to the parents? 1 It would reduce the blood supply of the kidneys. 2 It would cause severe abdominal pain in the child. 3 It would inhibit the process of urine formation. 4 It would increase the chances of another infection.

4 Urinary stasis is the most important factor influencing the occurrence of UTI. Children at times may tend to hold urine for long periods of time, even when their parents repeatedly ask whether they feel the need to urinate. This is very important to prevent infections. Holding urine does not reduce the blood supply to the kidneys significantly. Abdominal pain is associated with UTIs and is not caused by holding urine. The child holding his or her urine does not impact urine formation.

The nurse is assessing a child with recurrent urinary tract infections. The health care provider has prescribed voiding cystourethrography to evaluate the vesicoureteral reflux. After assessing the child, the nurse suggests the health care provider to prescribe aradionuclide (nuclear) cystogram instead. What would be the rationale for this suggestion? 1 The child displays symptoms of renal calculi. 2 The child presents with severe abdominal pain. 3 The child is unwilling to undergo catheterization. 4 The child is allergic to intravenous contrast medium.

4 Voiding cystourethrography is used to visualize the bladder outline and urethra and check for reflux of urine into the ureters. It uses a contrast medium to visualize the bladder. If the child has an allergy to contrast material, then a radionuclide cystogram is used to evaluate vesicoureteral reflux. A radionuclide cystogram does not give clear anatomic details of the urinary system and thus cannot be used to detect renal calculi. These investigations do not aggravate abdominal pain. These investigations could be done once the pain is under control. Both these procedures involve catheterizing the patient.

The nurse is teaching the parents of preschoolers about preventing urinary tract infections (UTIs). What strategies should the nurse instruct the parents to use to prevent UTIs? Select all that apply. 1 "Give cranberry juice to your children on a regular basis." 2 "Put a diaper on your child overnight." 3 "Do not allow your children to urinate in public toilets." 4 "Encourage your children to drink 6 to 8 glasses of water each day." 5 "Ensure that your children evacuate their bowels regularly."

4, 5 Drinking adequate amounts of water promotes flushing of the normal bladder and lowers the concentration of pathogens in the bladder. It also helps enhance the antibacterial properties of the renal medulla. Constipation can cause bladder obstruction and increase the risk of UTI. Thus, the parents must ensure that the children clear their bowels regularly. Much has been reported about the use of cranberry products for prevention of UTI. Initially it was thought to alter the urine acidity, but studies have not shown that ingestion results in a lower pH; but instead it appeared to decrease the adherence of certain bacteria to the bladder wall. Recent review of the literature showed that cranberry products did not significantly reduce the occurrence of symptomatic UTI overall or in any of the subgroups, including children. Because the benefit is small, cranberry juice cannot currently be recommended for prevention of UTIs. Other cranberry preparations need to be quantified using standardized methods to ensure the potency before being evaluated in clinical studies or recommended for use. Diapers would not be recommended in preschool age children because these children have adequate bladder control and extended use of diapers is known to increase the risk of developing UTI. If the child is outside the home and has a desire to void, the child should be allowed to use the public toilets, because holding urine in the bladder for a long time can increase the risk of UTI.