chapter 21 peds
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 girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."
A client's mother asks the nurse, "When should my daughter have a pelvic examination?" Which response by the nurse is most appropriate?
"A pelvic exam is necessary at 18 to 20 years of age. Rationale: 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 parent asks the nurse, "What is precocious puberty?" The nurse's response should be based on which statement?
"Precocious puberty is early sexual development."
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?
"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."
The nurse is conducting a routine wellness examination of a 13-year-old client. Which question would be best to ask first, when opening a discussion on sexual behavior?
"What do you like to do on the weekend?"
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.
The nurse is administering cyclophosphamide as ordered for a 12-year-old boy with nephrotic syndrome. Which instruction is most accurate regarding administration?
Administer in the morning; encourage fluids and voiding during and after administration.
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?
Assess for bladder distention. Rationale: 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 collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis?
Blood pressure 136/84 Rationale: 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 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
A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure?
Encouraging fluid intake after dinner
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?
Demonstrate love and acceptance at home
A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this?
Encourage the child to take all the antibiotics if diagnosed with strep throat.
The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child?
Eyes
A child, diagnosed with a urinary tract infection, is afraid to void because it hurts. What action should the nurse recommend to the parent to help relieve this fear?
Have the child sit in a sitz bath of warm water to void
The nurse is most accurate to instruct the client that which occurs during a female's mid-cycle?
Mittelschmerz Rationale: Mittelschmerz refers to a dull, aching abdominal pain at the time of ovulation. The discomfort usually lasts a few hours and is relieved by analgesics. Bloating occurs for some during premenstrual syndrome. Menarche is the beginning of menstruation. Dysmenorrhea means painful menstruation
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage tube patency?
Monitor output Rationale: A ureteral stent is placed in the ureter temporarily to aid in the drainage of urine. It is removed via cystoscopy when it is time for discontinuation. The nurse should monitor output carefully when a ureteral stent is in place. This is an indication that the stent is patent and functioning properly. The tubes are inserted into the ureter so they would not dangle on the outside of the body. There is no need to maintain fluid restriction or a low-sodium diet just because of the stent. This would only be necessary if there were other disease processes affecting the child.
The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider?
Positive culture for group A streptococcus Rationale: Acute glomerulonephritis may result as an autoimmune response to the invasion of group A streptococcus. This group of streptococci affect the glomeruli of the kidneys. This would be addressed by the health care provider and is the most important of the laboratory results presented. If there is an active strep infection, it would need to be treated with an antibiotic. The white blood cell count is within normal limits. It is good to be negative for respiratory syncytial virus. The urine culture would have to be redone due to contamination. It does not provide an accurate status of the child's urine.
A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client?
Reassess the client's testes at 6 months of age
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.
The nurse is planning the discharge instructions for the parents of a 1-month-old infant who has had a circumcision completed. Which information should be included in the education provided?
Report redness or swelling on the penile shaft.
When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?
Risk for infection
Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant?
Risk for infection related to immunocompromised state Rationale: Children are administered immunosuppressants following a transplant. These drugs lower the immune system response and help prevent rejection following the transplant. As a result, this leaves them susceptible to infection. The child may have pain from the surgical procedure but it does not occur from the rejection of the organ. Constipation may occur from the opioids used for pain management but it is not the priority nursing diagnosis. The fluid volume should return to normal once the transplanted kidney is functioning properly
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?
Sodium bicarbonate tablets
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?
Testis cannot be "milked" down inguinal canal
A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents?
The VCUG will rule out vesicoureteral reflux
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 nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history?
The child recently had an ear 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?
The client remains continent throughout the night.
A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse?
The foreskin is needed for repair.
A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse?
There is a chance the testicles will descend on their own
In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care?
Weighing on the same scale each day
A nurse is caring for a 13-year-old boy with end-stage kidney disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate?
Withhold his routine medication until after dialysis is completed
The nurse is caring for a child on a pediatric unit who has hemodialysis three times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child?
grilled chicken, half of a banana, and flavored water
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?
acute glomerulonephritis
The nurse is administering an IV infusion of albumin to a child with nephrotic syndrome. What is the primary concern for the nurse when administering this medication to the child?
fluid overload
The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review?
hemolytic anemia, thrombocytopenia, and acute renal failure
The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?
hypertension
The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess?
leukocyte count
Which condition is a risk factor for the development of pelvic inflammatory disease (PID)?
multiple sexual partners
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.
A child diagnosed with acute glomerulonephritis will most likely have a history of:
recent illness such as strep throat.
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?
some discomfort at the surgery site
The nurse is caring for a 10-year-old girl presenting with fever, dysuria, flank pain, urgency, and hematuria. The nurse would expect to help obtain which test first?
urinalysis Rationale: Urinalysis is ordered to reveal preliminary information about the urinary tract. The test evaluates color, pH, specific gravity, and odor of urine. Urinalysis also assesses for presence of protein, glucose, ketones, blood, leukocyte esterase, red blood cell count, white blood cell count, bacteria, crystals, and casts. Total protein, globulin, albumin, and creatinine clearance would be ordered for suspected renal failure or renal disease. Urine culture and sensitivity is used to determine the presence of bacteria and determine the best choice of antibiotic.
A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema?
weight, daily
