Chapter 21 PREP U
The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained. -if bladder training was never achieved; it is considered acquired or secondary or organic if control was established but has now been lost
A 5-year-old boy occasionally wets his bed at night and his pants during the day. Which finding would indicate an organic cause—as opposed to a functional cause—of this enuresis?
The child is not voiding.
A client has just completed a renal biopsy. Which manifestation should be given priority attention?
the child is not voiding
A client has just completed a renal biopsy. Which manifestation should be given priority attention?
Urine culture
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?
The foreskin is needed for repair.
A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse?
Assess usual voiding patterns.
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?
"She can eat whatever she wants on dialysis days." NOT: "My daughter can eat what she wants when she is hooked to the machine." "My daughter must avoid high sodium foods." "She needs to restrict her potassium intake."
A nurse is caring for a 12-year-old girl recently diagnosed with end-stage kidney disease. The nurse is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching?
Withhold his routine medication until after dialysis is completed.
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?
Prevent constipation in the child.
A nurse is caring for a child who has had a urethral stent. What would be included in the care of this child?
History of repeated urinary tract infections Abdominal mass on palpation Crying on voiding
A nurse is reviewing the medical record of an infant with hydronephrosis. Which finding(s) will the nurse anticipate in the history and physical examination? Select all that apply.
Immunosuppression is common after a kidney transplant.
A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching?
Demonstrate love and acceptance at home.
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?
The VCUG will rule out vesicoureteral reflux.
A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents?
Weighing on the same scale each day
In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care?
Positive culture for group A streptococcus
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?
Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone.
The caregiver of a child being treated at home for acute glomerúlonephritis calls the nurse reporting that her daughter has just had a convulsion, The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action?
acute glomerulonephritis.
The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100°F (37.8°C). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:
the child can live a more normal lifestyle.
The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis:
obtaining a clean catch voided urine.
The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is:
1. Confirm the client's identity. 2. Provide education to the client about the prescribed diagnostic test. 3. Document the time of the client's next voiding time. 4. Begin the testing time period. 5. Collect urine in a chilled container. 6. End the test at the 24-hour mark.
The health care provider has prescribed a 24-hour urine specimen on a 15-year-old client. Review the steps below and place them in the correct order.
fluid overload
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?
Administer in the morning; encourage fluids and voiding during and after administration.
The nurse is administering cyclophosphamide as ordered for a 12-year-old boy with nephrotic syndrome. Which instruction is most accurate regarding administration?
abdominal mass
The nurse is assessing a hospitalized child diagnosed with nephrotic syndrome. What set of assessments is most important for the nurse to complete to help identify hypoalbuminemia in this child?
furosemide dialysis: due to severe oliguria serum electrolyte levels urinalysis: may reveal proteinuria or hematuria labetalol
The nurse is caring for a 6-year-old client diagnosed with acute renal failure. During assessment, the nurse notes: temperature 99.0°F (37.2°C), urine output less than 0.4 mL/kg/hr, blood pressure 130/88 mm Hg, periorbital edema, and respirations 28 breaths/minute. Which prescriptions will the nurse anticipate from the primary health care provider? Select all that apply.
Tea-colored urine
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?
generalized edema weight gain headache NOT: a recent gastrointestinal infection resulting in severe diarrhea, clear, straw colored urine
The nurse is caring for a child diagnosed with acute post-streptococcal glomerulonephritis. When assessing the child, what findings does the nurse anticipate? Select all that apply.
Hypertension
The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?
grilled chicken, apple slices, and flavored water
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?
intravenous pyelogram (IVP) voiding cystourethrogram (VCUG) renal ultrasound
The nurse is caring for a child who has been admitted to the acute care facility with manifestations consistent with hydronephrosis. Which tests will confirm the diagnosis? Select all that apply.
Weigh the old dialysate.
The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately?
absence of a thrill
The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician?
Eyes
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?
Measure the abdominal girth daily.
The nurse is caring for an 8-year-old child hospitalized with nephrotic syndrome. Which nursing intervention would be appropriate for this child?
The child recently had an ear infection.
The nurse is collecting data for a child diagnosed with acute glomerulonephritis, What would the nurse likely find in this child's history?
"Has your child complained of pain?"
The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. When interviewing the caregivers, which question would be most important for the nurse to ask?
Peritoneal dialysis
The nurse is educating the parents of a child requiring renal replacement therapy The parents expréss concern because they live in a remote, rural area with no access to pediatric specialty dialysis units. Which would the nurse recommend to the parents?
The infant does not urinate within 6 to 8 hours
The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they reiterate the need to report which concerning development to the health care provider?
holding urine while at school
The nurse is performing an assessment on a child. Which finding indicates to the nurse the child is at risk for a urinary tract infection (UTI)?
1. Cuts a hole in the front of the smaller diaper 2. Unfolds both diapers, placing smaller diaper inside larger diaper 3. Places both diapers under the infant 4. Brings the penis and catheter/stent through the hole in the smaller diaper 5. Closes the smaller diaper 6. Closes the larger diaper
The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them.
Report redness or swelling on the penile shaft.
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?
"Let's meet with the dietitian and plan some meals." -may have to restrict sodium and protein-rich snacks should be encouraged
The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents?
pulse rate and rhythm
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 girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."
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?
Reddish-brown, smoky-colored urine
The nurse obtains a history from the parent of a child with glomerulonephritis about how the child became ill. What would the nurse expect the parent to report?
sleeping too soundly
The nurse recognizes that what would be a likely physiologic cause for a child to have enuresis?
Report any abnormally colored urine to the child's primary care provider.
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?
Placing the infant in a side-lying position -the nurse would keep the infant in the supine position, cover the bladder with a sterile plastic bag, change soiled diapers immediately to prevent contamination, and sponge-bathe the infant rather than immersing him or her in bath water
When developing the preoperative plan of care for an infant with bladder exstrophy, which intervention would the nurse least likely include?
muscle weakness
When examining the musculoskeletal system of the child, which would be indicative of a potential kidney problem?
7-year-old male with a recent history of an upper respiratory infection
Which child is at risk for acute glomerulonephritis?
Cystoscopy
A 7-year-old boy has experienced repeated urinary tract infections (UTIs). His older sister also experienced repeated UTIs and was diagnosed with vesicoureteral reflux, a condition that tends to appear in families. Therefore, the nurse suspects this same condition in this client. Which diagnostic tests would confirm this suspicion?
recent illness such as strep throat.
A child diagnosed with acute glomerulonephritis will most likely have a history of:
Creatinine clearance rate
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?
Proteinuria, hypoalbuminemia, and hypercholesterolemia
A child is getting a diagnostic work-up for nephrotic syndrome. Which lab results would the nurse expect to see?
This may indicate a urinary tract infection.
A child is having the urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate?
weight, daily
A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema?
The peritoneal dialysis should help the child with his or her growth and blood pressure.
A child needs to undergo peritoneal dialysis. What type of education would the nurse provide to the family about this process?
Have the child sit in a sitz bath of warm water to void.
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?
Encourage high fluid intake.
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention wilI help manage bladder spasms?
Monitor output
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage tube patency?
monitor output
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage tube patency?
The child does not have intravenous access.
A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which situation would require immediate attention by the nurse?
Assess for bladder distention
A school-aged child has come to the clinic with symptoms of a urinary tract infection. The child reports dysuria, frequency and hesitancy. What nursing assessment is most important for the nurse to complete?
Assess for bladder distention.
A school-aged child has come to the clinic with symptoms of a urinary tract infection. The child reports dysuria, frequency and hesitancy. What nursing assessment is most important for the nurse to complete?
Failure to thrive
An infant is diagnosed with a urinary tract infection (UTI). What corroborating finding would the nurse expect on assessment?
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?
Assess usual voiding patterns.
Collect a "clean catch" voided urine. Observe the child for signs of any reactions to the antibiotics. -A priority when giving antibiotics is to always observe for signs of any adverse reaction to the medication
In caring for a child with a urinary tract infection, the nurse would perform all of the following nursing interventions. Which two interventions would the nurse identify as the priority?
intestinal bacteria
Most urinary tract infections seen in children are caused by:
heart rate and blood pressure
The nurse is assessing a hospitalized child diagnosed with nephrotic syndrome. What set of assessments is most important for the nurse to complete to help identify hypoalbuminemia in this child?
hemolytic anemia, thrombocytopenia, and acute renal failure
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?
Sodium bicarbonate tablets
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?
"There are several things we can do to help you achieve this goal."
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?
urinalysis
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?
Blood pressure 136/84
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?
Leukocyte count
The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess?
The child may be dehydrated. The child's diet contains high levels of protein. There may be an infectious process in the child.
The nurse is reviewing the blood urea nitrogen (BUN) results of an assigned client. The test is elevated. What factors may be associated with this result? Select all that apply.
Sudden onset of severe scrotal pain with significant hemorrhagic swelling
The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion?
Periorbital edema
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
The nurse is triaging clients as they come in to an urgent care facility. Which assessment finding is clinically significant for early nephrotic syndrome?
Weigh the child daily on the same scale.
The nurse is working with a child with altered genitourinary status. Which intervention would be included in the plan of care for the client with excess fluid volume?
The child can live a more normal lifestyle.
The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis:
oxybutynin imipramine desmopressin NOT: albumin, prednisone
The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply.
Administering antibiotics
Urinary tract infections are usually successfully treated by what means?
Report any burning, itching, or discharge to a health care provider. Follow up with a primary care provider.
When preparing discharge instructions for the parents of an infant who has been diagnosed with hypospadias, the nurse should include which instruction in the teaching plan? Select all that apply.
urinary tract infection small bladder capacity lack of awareness
Which cause of pediatric enuresis must be ruled out before psychological causes are investigated? Select all that apply.
The client remains continent throughout the night.
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?
Wipe from front to back. Encourage fluids throughout the day. Finish all antibiotics prescribed.
Which instructions should a nurse give to a client who has a history of urinary tract infections to prevent recurrence? Select all that apply.
preventing skin breakdown
Which is a priority for the nurse caring for a client with bladder exstrophy?
Urinalysis
Which laboratory test result would be most important for the nurse to assess in a child who is suspected of having a urinary tract infection?
Encouraging fluid intake after dinner
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?
Testicular torsion
A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition?
acute glomerulonephritis
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?
"The kidneys help control blood pressure, so our child's blood pressure needs to be checked often."
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 nursę determines that the teaching was successful based on which statement by the group?
The catheter insertion site will leave only a minimal scar.
The nurse is caring for a 3-year-old child with the surgical repair of hypospadias. The preschooler returned from the postanesthesia care unit with an indwelling urinary catheter. What parental teaching is most helpful?
1 to 2 week course of antibiotics keeping the client in semi-Fowler position antihypertensive therapy high-protein diet NOT: blood glucose checks
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
Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant?
Imbalanced nutrition Altered skin integrity Altered comfort Anxiety
Which nursing diagnosis would the nurse put in order by priority when caring for a client with nephrotic syndrome?
Uremia
While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication?
Uremia (results from depression of CNS leading to headache or coma)
While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication?
uremia
While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication?
