Chapter 39: The Child with a Genitourinary Disorder Due
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 Explanation: Recent strep infection, hematuria, and proteinuria are indicative of acute glomerulonephritis. These symptoms do not suggest any of the other options
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." Explanation: 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.
The nurse is caring for a 7-month-old female infant diagnosed with a urinary tract infection (UTI). The parents are upset as this is the infant's second UTI with a fever. Which instruction is most helpful? Select all that apply.
A fever is commonly noted with a UTI. Change diapers promptly, especially after bowel movements.
The nurse is caring for a 7-month-old female infant diagnosed with a urinary tract infection (UTI). The parents are upset as this is the infant's second UTI with a fever. Which instruction is most helpful? Select all that apply.
A fever is commonly noted with a UTI. Change diapers promptly, especially after bowel movements. Female urethras are shorter and straighter than males
The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care?
Abdominal palpation Explanation: Abdominal palpation is contraindicated preoperatively in a client with a Wilms tumor. Cells may break loose and spread the tumor. Intravenous fluids and supine positioning are appropriate in the client's care. A Foley catheter is typically not placed.
Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis enuresis?
The client remains continent throughout the night. Explanation: 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.
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." Explanation: 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 nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause
Escherichia coli Explanation: E. coli most commonly causes UTI. Other less common causative organisms include Klebsiella, S. aureus, and Pseudomonas.
A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause?
Escherichia coli Explanation: E. coli most commonly causes UTI. Other less common causative organisms include Klebsiella, S. aureus, and Pseudomonas.
An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection?
Metronidazole Explanation: Metronidazole is used to treat a trichomonal infection. Miconazole is used to treat candidiasis. Doxycycline is used to treat a chlamydial infection. Acyclovir is used to treat herpes genitalis. Ceftriaxone is used to treat gonorrhea.
The nurse reviews the 2030 National Health Goals for sexual health prior to preparing a presentation for high school students. On what should the nurse focus when preparing this teaching for the students?
Prevention of sexually transmitted infections Explanation: The 2030 National Health Goals for sexual health focus on the prevention and early treatment of sexually transmitted infections. This is the topic in which the nurse should focus during the presentation with adolescent students. The 2030 National Health Goals for sexual health do not address communication with primary care physicians, immunizations, or creating a work-life balance.
An adolescent female is experiencing dysmenorrhea. What should the nurse teach the client to help with this disorder
Take over-the-counter ibuprofen. Explanation: Dysmenorrhea can usually be controlled by a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen. Acetaminophen is not identified as a medication to help with the pain of dysmenorrhea. Fluids do not need to be restricted with dysmenorrhea. Applying heat to the abdomen with a heating pad, hot shower, or tub bath may relax muscle tension and relieve pain.
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 Explanation: With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.
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. Explanation: 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 is working with a child with altered genitourinary status. The child demonstrates excess fluid volume. Which of the following would the nurse most likely do?
Weigh the child 2 times a day on the same scale. Explanation: A child with altered genitourinary status with excess fluid volume needs to be weighed twice daily always with the same scale, wearing the same amount of clothing at the same time each day. A weight gain of greater than 0.5 kg can indicate fluid retention. Withholding all medication and avoiding IV fluids would be inappropriate. IV fluid administration should be monitored closely and given at the prescribed rate. The nurse should also monitor laboratory values such as BUN and creatinine, urine and serum sodium, serum potassium, hemoglobin and hematocrit for changes
An adenosarcoma found in the region of the kidney in a child would most likely be:
Wilms tumor. Explanation: Wilms tumor is an adenosarcoma in the kidney region, one of the most common abdominal neoplasms of early childhood
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
To determine if ascites is increasing in amount in a child with nephrotic syndrome, which measurements would be most appropriate?
abdominal circumference Explanation: Ascites is accumulation of fluid in the abdominal cavity. Increasing abdominal size reveals this
An adolescent girl asks the nurse what she can use to relieve pain during her periods. Upon further questioning, the adolescent reports bloating and light cramping about a day before menses and then sharp and also nagging pain across the lower abdomen during her period. Which would be most appropriate for the nurse to suggest? Select all that apply
aspirin ibuprofen naproxen
A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point
endometriosis Explanation: If dysmenorrhea does not improve within 6 months with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), a laparoscopy is indicated to look for endometriosis, the most common reason for secondary dysmenorrhea. The other conditions listed are not associated with dysmenorrhea.
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. Explanation: Enuresis is the continued incontinence of urine past the age of toilet training. It is a source of shame and embarrassment. It affects the child's life emotionally, behaviorally, and socially. It causes the child to have low self-esteem. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school. The child should not be punished for a behavior he or she cannot control. Demonstrating how to use the toilet and going to the bathroom to void are good subjects but they do not help a child who has no control of the enuresis. Testing may need to be done to see if there are anatomical reasons, and medications may be needed to correct the problem.
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. Explanation: Because the testes sometimes descend spontaneously during the first year of life, treatment is usually delayed until at least 6 months of age. If testes have not descended between 6 and 12 months of age, the client may be given a short course of chorionic gonadotropin hormone to see if testicular descent can be stimulated. If this is not successful, surgical intervention (orchiopexy) will be needed to correct the condition to prevent infertility. Karyotyping is not needed in this situation, because the client's gender is already established.
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. Explanation: 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
The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). In educating the parents, the nurse would recommend that the child avoid:
caffeine. Explanation: Caffeine is an irritant to the bladder and should be avoided. Liberal fluid intake and cranberry juice should be encouraged. The child should wear cotton underwear to avoid perineal irritation.
A 4-year-old boy with nephrotic syndrome has extensive edema. The best intervention to reduce periorbital edema would be to:
elevate the head of the bed. Explanation: Because edema tends to be dependent, elevating an edematous body part usually reduces swelling in that part.
A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point?
endometriosis Explanation: If dysmenorrhea does not improve within 6 months with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), a laparoscopy is indicated to look for endometriosis, the most common reason for secondary dysmenorrhea. The other conditions listed are not associated with dysmenorrhea.
The nurse is reviewing lab work prior to shift handoff on a client with a subnormal urine output. Which is the nurse most correct to report
oliguria Explanation: A subnormal urine output is termed as oliguria. Polyuria is the excessive or abnormally large production of urine. Pyuria is the presence of pus in the urine. Glycosuria is the excretion of glucose in the urine.
The nurse is caring for a client newly diagnosed with acute glomerulonephritis? When receiving the pediatric client's history, which is anticipated?
onset of a streptococcus infection last week Explanation: The nurse is correct to anticipate a streptococcus infection 1 to 3 weeks prior to the diagnosis of acute glomerulonephritis. The presenting symptom is typically gross bloody urine. Acute glomerulonephritis is not related to a kidney infection, does not exhibit symptoms similar to diabetes, or a recent viral infection.
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?
sexual activity Explanation: When cystitis is seen in adolescent girls, it is an alert a girl may be sexually active. Wiping from front to back after voiding helps prevent urinary tract infections, not cause them. Frequent voiding does not cause cystitis, nor does regular participation in a strenuous sport.
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 Explanation: An orchiopexy is the surgical procedure to release the spermatic cord and pull the testes into the scrotum. After the testes are in the scrotum, they are sutured into place to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation. Complete bed rest, a liquid diet, and remaining in a semi-Fowler position are not required as part of the postsurgical care.
The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. What is the most important reason the child needs increased fluids?
to dilute the urine and flush the bladder Explanation: Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder.