Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder

While presenting a panel discussion to a group of parents about urinary tract infections in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate?

"A girl's urethra is closer to the rectal opening." Rationale: In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination. Bladder size does not differ between boys and girls. The kidneys are less well protected in the abdomen, increasing the risk for injury but not UTIs.

The nurse is caring for a 4-year-old with a suspected urinary tract infection. Which of the following would be most appropriate when obtaining a urine specimen from the child?

"Let your mom help you tinkle in this cup." Rationale: The nurse needs to use familiar terms to explain to the child what is needed and to gain cooperation. The most positive approach would be to let the mother help rather than demanding.

The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate?

"Let's put you in touch with some other girls who are also having the same body changes."

A nurse is caring for a client with a diagnosis of acute glomerulonephritis. Which intervention would the nurse expect to be included in the treatment plan? Select all that apply.

1. 1 to 2 week course of antibiotics 2. keeping the client in semi-Fowler position 3. antihypertensive therapy 4. high-protein diet Rationale: Children with a diagnosis of acute glomerulonephritis usually will have an underlying streptococcal infection requiring a two-week course of antibiotics. Keeping the child in a semi-Fowler position and initiating a high-protein diet to supplement losing large amounts of protein in the urine is indicated. The child will be started on a course of antihypertensive therapy for high blood pressure. Blood glucose monitoring is not indicated.

The nurse is assessing a child with acute poststreptococcal glomerulonephritis. Which of the following would the nurse expect to assess? Select all answers that apply.

1. Abdominal pain 2. Hypertension 3. Crackles

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. Use all options.

1st. Confirm the client's identity. 2nd. Provide education to the client about the prescribed diagnostic test. 3rd. Document the time of the client's next voiding time. 4th. Begin the testing time period. 5th. Collect urine in a chilled container. 6th. End the test at the 24-hour mark. Rationale: A 24-hour urine collection may be prescribed to assess the level of protein or creatinine. Once the testing prescription has been confirmed, the nurse confirms the identity of the client. Next, the nurse provides client education, followed by instructing the client that the next urine voided will be discarded and the 24-hour time period will begin. The next voided urine will be collected in the chilled container. Each void is collected and stored until the conclusion of the 24-hour time period.

Which child is at risk for acute glomerulonephritis?

7-year-old male with a recent history of an upper respiratory infection. Rationale: Acute glomerulonephritis often follows a group A streptococcal infection. Strep A infections may manifest as an upper respiratory infection. It occurs more frequently in males and children over the age of 3, peaking around 7 years of age. The history of urinary tract infections, renal disorders, or hypertension are not directly associated with the onset of acute glomerulonephritis.

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

Risk for infection Rationale: When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

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 of the following?

Signs of infection Rationale: The parents should be especially alert for signs of infections 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 caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?

hypertension Rationale: Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

A nurse is caring for a client who has been diagnosed with bacterial vaginosis. What medication should the nurse anticipate as part of the treatment plan?

metronidazole Rationale: Metronidazole, either oral or vaginal, is the drug of choice for treatment of clients with bacterial vaginosis. Amoxicillin; amoxicillin + clavulanate potassium; and magnesium sulfate are contraindicated for this diagnosis because they will have no effect on the contributing organism.

The nurse is caring for a child with epididymitis. When planning care, which intervention may be included?

scrotal elevation Rationale: Epididymitis is caused by a bacterial infection. Treatment may include scrotal elevation, bed rest, and ice packs to the scrotum. Pharmacotherapy may include antibiotics, pain medications, and nonsteroidal anti-inflammatory drugs (NSAIDs). Warm compresses would result in vasodilation and do little to relieve the pain and swelling of the condition. Corticosteroid therapy is not included in the plan of care for the condition. Voiding is not impacted by epididymitis. Catheterization is not indicated.

A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition?

testicular torsion Rationale: A hydrocele is a collection of fluid that collects in the fold of the scrotum, requiring no treatment. A varicocele is an abnormal dilation (dilatation) of the veins of the spermatic cord. Testicular torsion is evidenced by severe scrotal pain, nausea, and vomiting and is a surgical emergency. Testicular infection is not indicated.

A nurse should recognize that which symptom would be most consistent with a diagnosis of candidiasis?

thick, white discharge Rationale: A thick, white vaginal discharge is consistent with the findings of a client with suspected candidiasis. Bloody, brown, or absence of vaginal discharge is not typical of this condition.

Which symptoms would the nurse expect to find in a client who has been diagnosed with trichomoniasis? Select all that apply.

1. genital inflammation 2. white-gray vaginal discharge 3. petechiae on the upper vagina rationale: Genital inflammation, white-gray discharge, and pruritis are usual symptoms of an acute episode of trichomoniasis. Fever and vomiting are not associated with this condition.

The nurse is providing instruction to the parents of a newborn boy. The parents have decided not to circumcise the child. What information should be included in the discussion? Select all answers that apply.

1. Clean the penis gently with soap and water. 2. If the foreskin is not retractable do not force it. 3. When the foreskin is retracted, gently replace it prior to completing diapering. Rationale: The newborn's foreskin does not normally retract. This may not be possible until later in infancy. If the foreskin does not retract do not force it. If the foreskin is able to be retracted, do so gently. Return the foreskin to place prior to applying the diaper. Soap and water should be used several times per day to clean the penis and perineal area.

Which nursing diagnosis would the nurse select as the priority when caring for a client with nephrotic syndrome?

1st. Imbalanced nutrition 2nd. Altered skin integrity 3rd. Altered comfort 4th. Anxiety Rationale: The priority nursing intervention for the client is Imbalanced nutrition. Clients diagnosed with nephrotic syndrome should be consulted by a nutritionist and stay on a high-protein, renal diet for optimal results. Skin integrity is important, but it is not the priority. Alteration in comfort and anxiety are important, but they are not priority nursing diagnoses.

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." Rationale: Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

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?

"She can eat whatever she wants on dialysis days." Rationale: The girl cannot eat whatever she wants on dialysis days. She can eat what she wants during the few hours she is actively undergoing treatment in the hemodialysis unit. The other statements regarding a high sodium diet and potassium intake are correct.

The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which of the following responses would alert the nurse to a confirmed risk factor for this condition?

"He just got over a head cold with laryngitis."

The nurse is discharging a client diagnosed with bacterial vaginosis. Which statement would indicate to the nurse that the client has a correct understanding of the discharge instructions?

"I will always use a condom with any further sexual encounters." Rationale: Using condoms with every sexual encounter can help to prevent recurrence and the spread of disease. Bacterial vaginosis is transmittable to sexual partners, and washing in soap and water does not stop the transmission of the disease. If a client suspects an infection, he or she should see a health care provider or clinic.

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?

"Let's meet with the dietitian and plan some meals." Rationale: Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.

The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition?

"Our son's condition may resolve on its own." Rationale: Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended.

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." Rationale: Precocious puberty is the early sexual development or maturation of a girl or boy. It occurs most often in girls, not boys, and does not relate to a heavy menses.

A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant?

"She had surgery to repair a problem with her anus." Rationale: Risk factors associated with obstructive uropathy include prune belly syndrome, chromosome abnormalities, anorectal malformations, and ear defects. The statement about surgery to repair an anal problem suggests an anorectal malformation. Constipation is a risk factor for urinary tract infections. Bedwetting suggests enuresis. A bacterial skin infection is associated with acute glomerulonephritis.

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?

"There are several things we can do to help you achieve this goal." Rationale: The child wants to stop this problem immediately, so the nurse's most therapeutic response is to assure the child that enuresis is indeed solvable. For some children, learning about the high prevalence of the problem may provide consolation. However, this may not alleviate the child's embarrassment and it does not address the desire for solutions. Telling the child that he or she will "grow out of this" downplays the embarrassment and does not address the desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.

After teaching the parents of a child with a hydrocele about this condition, which statement indicates that the teaching was successful?

"This condition should gradually go away on its own." Rationale: Hydrocele requires watchful waiting because it will usually resolve spontaneously on its own. Hydrocele is not associated with the development of infertility; a varicocele, if left untreated, can lead to infertility. Immediate surgery is warranted for testicular torsion. Ice packs to the scrotum are helpful in relieving pain associated with epididymitis.

The nurse is preparing an 8-year-old girl for a cystoscopy. Which instruction would be most appropriate to give to the child?

"You might feel some burning when you go to the bathroom afterward." Rationale: Cystoscopy is an endoscopic visualization of the urethra and bladder. The nurse would instruct the child that she might experience some burning when she voids after the procedure. A full bladder is needed for urodynamic studies.

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?

1. Collect a "clean catch" voided urine. 2. Observe the child for signs of any reactions to the antibiotics. Rationale: The nurse would collect the "clean catch" voided urine specimen before any treatment is started to increase the likelihood of being able to identify the bacterium causing the infection. A priority when giving antibiotics is to always observe for signs of any adverse reaction to the medication. Reporting and recording urinary symptoms and observing for possible sexual abuse would be appropriate but not the priority. Instructing caregivers about avoiding bubble baths and teaching girls to wipe from front to back would be important later in the care of the child.

When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply.

1. intermittent hematuria 2. abdominal mass Rationale: Intermittent hematuria is a common symptom of hydronephrosis. An abdominal mass may be palpated with hydronephrosis. Foul-smelling urine is associated with obstructive uropathy. Flank pain is associated with obstructive uropathy and vesicoureteral reflux. Proteinuria is associated with nephritic syndrome.

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.

1. intravenous pyelogram (IVP) 2. voiding cystourethrogram (VCUG) 3. renal ultrasound Rationale: A VCUG will be performed to determine the presence of a structural defect that may be causing the hydronephrosis. Other diagnostic tests, such as a renal ultrasound or an intravenous pyelogram, may also be performed to clarify the diagnosis. A urinalysis may be performed to assess the quality and characteristics of the urine but the test will not confirm a diagnosis of hydronephrosis. A CBC may be used to assess the level of a genitourinary infection but it will not confirm the diagnosis of hydronephrosis.

The nurse is caring for a client who had a kidney transplant 4 months ago. What symptom would be indicative of an acute transplant rejection? Select all that apply

1. temperature >100.8°F (38.7°C) 2. weight gain 3. increased blood urea nitrogen level Rationale: Fever, increased blood urea nitrogen level, and weight gain are all indicative signs of a transplant rejection. A decreasing serum creatinine is not an indicator; creatine levels will rise in this scenario.

Which cause of pediatric enuresis must be ruled out before psychological causes are investigated? Select all that apply.

1. urinary tract infection 2. small bladder capacity 3. lack of awareness Rationale: Pediatric enuresis may be caused by physiologic problems, including urinary tract infections, small bladder capacity, and lack of awareness of the need to void at night. Stress incontinence and cognitive function are not common causes of pediatric enuresis. It is not until all physiologic factors are ruled out that psychological factors are investigated.

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect?

Acute glomerulonephritis Rationale: Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described above. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old. Nephrosis is altered glomerular permeability apparently due to an autoimmune process or a T-lymphocyte dysfunction that results in fusion of the glomeruli membrane surfaces, which, in turn, lead to abnormal loss of protein in urine. The highest incidence is at 3 years of age, and it occurs more often in boys than in girls. In addition to proteinuria, a major symptom of nephrosis is edema, which is absent in this case.

The nurse is caring for an infant with bladder exstrophy. As part of the infant's preoperative plan of care, the nurse monitors for abdominal skin excoriation. Which action would be most appropriate for promoting healing and preventing further skin breakdown?

Applying a barrier/healing cream or paste on skin

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 Rationale: 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.

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?

Cystoscopy Rationale: Cystoscopy, or examination of the bladder and ureter openings by direct examination with a cystoscope introduced into the bladder through the urethra, is done to evaluate for possible vesicoureteral reflux or urethral stenosis. A urine culture is used to diagnose a urinary tract infection (UTI), or the presence of bacteria in urine. Urinalysis involves use of a chemical reagent strip to detect glucose, protein, and occult blood and to measure pH, as well as use of a refractometer to measure specific gravity. A blood urea nitrogen (BUN) test measures the level of urea in blood or how well the kidneys can clear this from the bloodstream.

The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. Which of the following would the nurse least likely expect to find?

Decreased blood urea nitrogen (BUN) Rationale: With nephrotic syndrome, proteinuria, hyperlipidemia, decreased serum protein levels (hypoproteinemia), and decreased serum albumin levels (hypoalbuminemia) are present. BUN typically becomes elevated.

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. Rationale: 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 nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms?

Encourage high fluid intake. Rationale: Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.

A nurse is conducting a physical examination of an infant and observes the urethral opening on the dorsal side of the penis. The nurse documents this finding as which of the following?

Epispadias

A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which of the following would the nurse incorporate into the presentation as the most common cause?

Escherichia coli Rationale: E. coli most commonly causes UTI. Other less common causative organisms include: Klebsiella, S. Aureus, and Pseudomonas.

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 Rationale: The symptoms of nephrotic syndrome include periorbital edema upon awakening with progressive edema throughout the day in all extremities and abdomen. Ascites can develop in the abdomen and the nurse should assess the child regularly for this development. The child with nephrotic syndrome generally does not have sacral edema, unless the edema is extreme and has not been treated.

The nurse is caring for a child who is experiencing an acute renal transplant rejection and is to receive muromonab-CD3. Which of the following would the nurse most likely expect to assess after the first dose is administered?

Fever with chills, chest tightness Rationale: The first dose of muromonab-CD3 can cause fever, chills, chest tightness, wheezing, nausea, and vomiting. Cough and hyperkalemia are associated with angiotensin-converting enzyme inhibitors. Photosensitivity and GI upset are often associated with diuretics. Urinary retention and decreased appetite are associated with imipramine.

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.

Generalized Edema, Weight Gain, Headache Rationale: Acute post-streptococcal glomerulonephritis often follows a respiratory infection caused by one of the strains of group A beta-hemolytic streptococcus. With kidney function being decreased the nurse expects to assess signs and symptoms such as weight gain from edema and headache. Urine will likely be concentrated causing it to be dark in color.

An 8-year-old girl is scheduled for a renal ultrasound. Which of the following would the nurse include in the plan of care when preparing the child for this test?

Informing the child she should feel no discomfort Rationale: The nurse should inform the child that she should feel no discomfort during the test. No fasting is required and no dye is used, so allergies are not of concern. A full bladder is needed for urodynamic studies.

An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection?

Metronidazole Rationale: 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 is educating the parents of a child requiring renal replacement therapy The parents express 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?

Peritoneal dialysis Rationale: Peritoneal dialysis is performed in the home setting after proper training. Hemodialysis is completed several times a week at a dialysis center. Renal transplant would be a discussion if the child needed a kidney transplant.

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.

A child is getting a diagnostic work-up for nephrotic syndrome. Which lab results would the nurse expect to see?

Proteinuria, hypoalbuminemia, and hypercholesterolemia Rationale: Proteinuria, hypoalbuminemia, and hypercholesterolemia are diagnostic of a child with nephrotic syndrome. The child will also present symptomatically with a sudden onset of edema. Hematuria is typically seen with glomerulonephritis.

A 10-year-old child in renal failure is on continuous cycling peritoneal dialysis (CCPD). What would be important to teach the parents?

Severe cramping and pain should not occur with an infusion. Rationale: Continuous cycling peritoneal dialysis (CCPD) allows a child to go to school or participate in other activities while receiving dialysis . With CCPD, a permanent dialysis catheter is inserted and sutured into place at the abdomen. Although commercial devices may be used, for the simplest method, the child or parent attaches a bag of dialysis fluid and tubing to this and infuses a prescribed dialysis solution by gravity drainage; the bag and tubing are then rolled into a compact square under the child's clothes. The infused solution remains in the child for 4 to 6 hours during the day (8 hours at night); the dialysate bag is then lowered, and the solution drains from the peritoneal cavity into it. The bag and fluid are then discarded and a new bag of dialysate solution is attached and raised, and new solution is infused. The child should be assessed for toleration of the fluid volume instilled into the peritoneum. The abdomen will remain distended while the fluid is indwelling. The child may be slightly uncomfortable from the pressure but should not experience severe cramping or pain. The return flow should be clear. A cloudy return flow or severe pain or cramping suggests infection. The dialysate solution will fill from gravity so there is no specified time frame for instillation and will also be affected by the amount of dialysate solution to be instilled.

The nurse recognizes that what would be a likely physiologic cause for a child to have enuresis?

Sleeping too soundly Rationale: Physiologic causes may include a small bladder capacity, urinary tract infection, and lack of awareness of the signal to empty the bladder because of sleeping too soundly. Psychological causes might include rigorous toilet training, resentment toward family caregivers, a desire to regress to an earlier level of development to receive more care and attention, or emotional stress and stressful situations. Enuresis can be a symptom of sexual abuse.

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 Rationale: Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth.

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion?

Sudden onset of severe scrotal pain with significant hemorrhagic swelling Rationale: Testicular torsion is characterized by a testicle that is abnormally attached to the scrotum and twisted. Signs and symptoms include sudden onset of severe scrotal pain with significant hemorrhagic swelling. Enlarged glands and fever point to infection. A hardened and tender epididymis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.

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?

Tea-colored urine Rationale: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as tea- or cola-colored. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry-colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in hepatitis.

A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which situation would require immediate attention by the nurse?

The child does not have intravenous access. Rationale: An intravenous pyelogram is an X-ray study of the upper urinary tract in which a radio opaque dye is injected into a peripheral vein, requiring intravenous access. The other choices are not a priority for this client.

A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents?

The VCUG will rule out vesicoureteral reflux. Rationale: A VCUG is performed by having the bladder filled with a contrast medium via catheterization. Under fluoroscopy, the bladder is visualized filling and emptying. A VCUG is used to rule out reflux in the urinary tract, causes of hematuria, UTI, and structural anomalies. Reflux may cause frequent infections and scarring in the urinary tract if not diagnosed and treated. A VCUG will not diagnose renal stones. Renal stones would be detected by a CT scan. A VCUG would not be performed to detect if infections of the UTI have cleared. This would be done by assessing a urinalysis.

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

The child can live a more normal lifestyle. Rationale: 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.

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. Rationale: In the child with acute glomerulonephritis, presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.

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. Rationale: 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 15-year-old boy comes to the emergency department accompanied by his parents. The boy reports an abrupt onset of sudden pain on the right side of his scrotum. When asked to rate his pain on a scale of 1 to 10, with 10 being the most severe, the boy states, "It's a 12." Further assessment reveals a blue-black swelling on the affected side. The nurse suspects testicular torsion and immediately notifies the physician based on the understanding of which of the following?

The condition is a surgical emergency.

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. Rationale: Hypospadias occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circumcised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair. Once the hypospadias is repaired, a circumcision can be performed as part of the procedure. Hypospadias repair is usually done after the newborn is 1 year or older. Meatal stenosis has to do with the urethral opening diameter, not the placement. Circumcision or hypospadias repair does not affect the functioning of the renal system so neither would predispose the newborn to renal failure.

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. Rationale: Hypospadias occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circumcised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair. Once the hypospadias is repaired, a circumcision can be performed as part of the procedure. Hypospadias repair is usually done after the newborn is 1 year or older. Meatal stenosis has to do with the urethral opening diameter, not the placement. Circumcision or hypospadias repair does not affect the functioning of the renal system so neither would predispose the newborn to renal failure.

NextGen: A 15-year-old female adolescent visits the school nurse. The client appears anxious and states they have been dating a couple of different friends. The client states that they went to a party the other night and does not remember the entire night. The client states "I woke up and some of my clothes were missing. Now I have been experiencing some pain when I pee and there is yellow, green drainage that smells awful." Complete the following sentence(s) by choosing from the lists of options. The nurse suspects the client has ______________ as evidence by ___________________.

The nurse suspects the client has *a sexually transmitted infection as evidenced by *yellow, green odorous drainage. Rationale: The symptoms the client is experiencing—yellow, green odorous discharge and painful urination—are consistent with trichomoniasis, a sexually transmitted infection (STI). Yellow, green odorous vaginal drainage indicates an STI. Yellow, green odorous vaginal drainage is indicative of a STI; it is not a sign or symptom of a urinary tract infection (UTI) or cervical cancer. The client did not state having sexual relations with the friends they were dating. Dysuria is a common sign of UTI and may occur in some STIs; however, green, yellow drainage is not consistent with a UTI. Yellow, green odorous vaginal drainage is a sign and symptom of an STI.

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. Rationale: The Association of American Physicians recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year of age. This problem does not cause pain or swelling.

The mother of a child with end-stage renal disease asks the nurse why her son is getting an injection of erythropoietin. When responding to the mother, the nurse incorporates understanding of which of the following as the rationale?

To stimulate red blood cell growth Rationale: Erythropoietin is given to stimulate red blood cell growth. Vitamin D and calcium are used to correct hypocalcemia. Growth hormone is used to stimulate growth in stature. Citric acid and sodium citrate (or sodium bicarbonate tablets) are used to correct acidosis.

The nurse is providing postsurgical care for an infant who has undergone a hypospadias repair. Which action by the nurse would be most important to help keep the area clean while maintaining proper position of the drainage tubing?

Using a double-diapering technique Rationale: Double diapering is a method used to protect a child's urethra and stent or catheter after surgery and additionally helps to keep the area clean and free from infection. Keeping the drainage tube taped in an upright position, administering antibiotics, and administering analgesics are also important, but double diapering keeps the area clean and helps prevent infection.

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?

Weigh the old dialysate. Rationale: The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.

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. Rationale: The nurse should withhold routine medications on the morning that hemodialysis is scheduled since they would be filtered out through the dialysis process. His medications should be administered after he returns from the dialysis unit. A Tenckhoff catheter is used for peritoneal dialysis, not hemodialysis. The nurse should avoid blood pressure measurement in the extremity with the AV fistula as it may cause occlusion.

A nurse caring for a client diagnosed with Chlamydia trachomatis can expect which subsequent tests?

gonorrhea Rationale: Since there is a strong association between gonorrhea and a chlamydial infection, the client would be tested for gonorrhea as well.

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 Rationale: Hemolytic uremic syndrome is defined by all three particular features—hemolytic anemia, thrombocytopenia, and acute renal failure. Dirty green-colored urine, elevated erythrocyte sedimentation, and depressed serum complement level are indicative of acute glomerulonephritis. Hypertension, not hypotension, would be seen and the child would have decreased urinary output, which would not cause nocturia.

Most urinary tract infections seen in children are caused by:

intestinal bacteria. Rationale: Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections.

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 Rationale: 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.

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. Rationale: 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. In the toilet-trained child, using a cotton ball to collect the urine would not be appropriate.

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

weight, daily Rationale: 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.

An adolescent asks the nurse how to best prevent vulvovaginitis. The nurse's best answer would be to:

wipe from front to back after urinating or defecating. Rationale: Vulvovaginitis may be caused by spread of Escherichia coli from the rectum to the vagina.

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.

1. The child may be dehydrated. 2. The child's diet contains high levels of protein. 3. There may be an infectious process in the child. Rationale: Blood urea nitrogen may be elevated with a high-protein diet or dehydration, and may be decreased with overhydration or water intoxication. There is no direct link between this test and the presence of diabetes. BUN levels may be increased with an infectious process such as glomerulonephritis.

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. Rationale: A child with a urinary tract infection can have symptoms of dysuria, frequency, hesitancy, and urgency. Many children will not want to void because it burns or causes spasms and pain when attempting to do so. One way to help the child is to have them sit in a tub of warm water. The warmth helps the muscles relax so voiding can occur more easily and with less pain. Cranberry juice can be useful when a urinary tract infection is occurring. Bacteria causes the urine to be more alkaline and cranberry juice has the ability to produce more acidity. Pain medications may be prescribed, but they are of little benefit if the problem with voiding is spasms. Diversionary activities may be helpful but they do not have the relaxing benefit of the warmth of the water.

The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). Which of the following would the nurse encourage the parents to avoid?

Caffeine Rationale: 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 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.

1. History of repeated urinary tract infections. 2. Abdominal mass on palpation. 3. Crying on voiding. Rationale: Children with hydronephrosis are usually asymptomatic. They may have repeated urinary tract infections from urinary stasis, which may be difficult to detect in an infant except as general irritability or crying on voiding. Blood pressure is elevated (although blood pressure is not routinely taken in an infant). The infant experiences flank or abdominal pain. Abdominal palpation may reveal an abdominal mass.

The nurse is assessing a 5-year-old child's genitourinary system. Which of the following would the nurse document as a normal finding? Select all answers that apply.

1. Round abdomen 2. Positive bowel sounds 3. Dullness over the spleen Rationale: Normal findings include a round abdomen, positive bowel sounds, dullness over the spleen, and descended testicles. Labial fusion, a distended abdomen, an undescended testicles are abnormal findings.

A group of students are reviewing information about renal failure in children. The students demonstrate a need for additional teaching when they identify which agent as a potential contributor to renal failure?

Amoxicillin Rationale: Amoxicillin is a penicillin and is not associated with nephrotoxicity leading to renal failure. Vancomycin, gentamicin (an aminoglycoside), and co-trimoxazole (a sulfonamide) are nephrotoxic.

A nurse identifies a nursing diagnosis of impaired urinary elimination related to urinary tract infection. When developing the plan of care, which of the following would be most important for the nurse to do first?

Assess usual voiding patterns Rationale: The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action.

A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which of the following would be the priority before the test?

Checking with the parents for any allergies Rationale: It is important to double-check whether the girl has any allergies. The test is contraindicated in children allergic to shellfish or iodine. Adequate hydration is also important, but the check for allergies is a priority. Only females of reproductive age must be screened for pregnancy. An enema is not necessary at all institutions.

The nurse is visually inspecting a urine specimen from a 12-year-old boy. The nurse documents gross hematuria with a specimen of which color?

Cola colored Rationale: Gross hematuria causes the urine to appear tea, cola, or even dirty green colored. Cloudy urine is typically a sign of infection. Normal urine ranges from moderately yellow to pale or almost clear. Orange-colored urine can occur because of medication.

A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which of the following?

Decreased platelets and leukocytosis Rationale: The child with HUS typically exhibits severe thrombocytopenia (decreased platelets) and leukocytosis. BUN and creatinine are elevated. Hyponatremia, hyperkalemia, metabolic acidosis, and proteinuria also may be noted.

The nurse is caring for a 4-year-old girl with vulvovaginitis. After explaining to the girl's mother how to help prevent subsequent episodes, which statement by the mother indicates a need for additional teaching?

"She needs to wipe from front to back." Rationale: At the age of 4, the mother should not assume that the girl will wipe properly. The mother will need to supervise her wiping in order to train her properly. Making sure the child changes her underwear daily, avoiding bubble baths, and supervising her wiping after bowel movements indicate that the mother has understood the instructions.

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.

1. furosemide 2. dialysis 3. serum electrolyte levels 4. urinalysis 5. labetalol Rationale: The child is experiencing complications of the acute renal failure including oliguria, interstitial fluid shifting, and hypertension. Oliguria is defined as a urine output that is less than 0.5 mL/kg/h in children. The nurse would prepare to administer furosemide to assist with the edema and labetalol to lower the blood pressure. Dialysis may be needed due to the severe oliguria. The client is at risk for electrolyte disturbances and should be monitored closely. A urinalysis may reveal proteinuria or hematuria, which could indicate additional complications.

The nurse is reviewing the health history of a client suspected of having vesicoureteral reflux. What findings in the health history are consistent with this disorder? Select all that apply.

1. hematuria 2. flank pain 3. urinary frequency 4. history of repeated urinary tract infections Rationale: Vesicoureteral reflux (VUR) is a condition in which urine from the bladder flows back up the ureters. Primary VUR results from a congenital abnormality at the vesicoureteral junction that results in incompetence of the valve. Secondary VUR is related to other structural or functional problems such as neurogenic bladder, bladder dysfunction, or bladder outlet obstruction. Symptoms consistent with this condition include dysuria, urinary frequency, hematuria, back or flank pain, and previous urinary tract infections. Pus in the urine is not associated with this condition.

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.

The caregiver of a child being treated at home for acute glomerulonephritis 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?

Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Rationale: Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

A 14-year-old girl visits her gynecologist and is found to have vaginal candidiasis. She is obese, claims to not be sexually active, and is not on oral contraceptive pills. Which intervention should be considered for this client?

Test her urine for glucose to rule out diabetes mellitus Rationale: Candidiasis is a vaginal infection spread by the fungus Candida, an organism which thrives on glycogen. Because oral contraceptive pills produce a pseudopregnancy state, adolescents using OCPs tend to have frequent vaginal candidal infections. If being treated with an antibiotic for another infection (which destroys normal vaginal flora and lets fungal organisms grow more readily), they are also particularly susceptible to this infection. Thus, neither prescription of OCPs or prescription of an antibiotic would be appropriate in this case. Incidence is also strongly associated with immune suppression and diabetes mellitus because hyperglycemia provides the perfect glucose-rich environment for candidal growth. If a girl has frequent candidal infections, her urine should be tested for glucose to rule out diabetes mellitus. Teach women to insert antifungal tablets or creams at bedtime, not in the morning, so the drug does not drain from the vagina immediately afterward.

A nurse is discussing with a family the various causes of their child's vulvovaginitis. What would be included in the education?

The use of cleansing towelettes may have caused the vulvovaginitis. Rationale: Vulvovaginitis can result from an overgrowth of bacteria or yeast or from chemical factors. Chemical factors include bubble baths, and soaps or perfumes in personal care items like cleansing towelettes. This is a common childhood problem in girls. It is not necessarily a sign of abuse so child protective services would not need to be involved. Constipation and fevers are usually associated with this disorder but are not the cause.

When examining the musculoskeletal system of the child, which would be indicative of a potential kidney problem?

Muscle weakness Rationale: Muscle weakness occurs in many renal conditions. Walking with a limp, a hip clunk, and hypertonia are indicative of musculoskeletal problems, but not necessarily renal problems as well.

The nurse is applying a urine bag to a 15-month-old boy to collect a urine specimen. Which of the following would the nurse do first?

Pat the perineal area dry after cleaning Rationale: When applying a urine bag, the nurse would first clean the perineal area well and pat it dry. If a culture was to be obtained, the nurse would cleanse the genital area with povidone-iodine or according to institutional protocol. Next the nurse would apply benzoin around the scrotum and allow it to dry. Then the nurse would apply the urine bag, making sure that the penis is fully inside the bag, tucking it downward inside the diaper to discourage leaking.

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." Rationale: Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processes vaginalis does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.

NextGen: Click to highlight the findings that will require follow-up. The nurse is caring for a 6-year-old male child who was brought to the pediatrician's office by the parent for a fever for the past few days.

1. Increased Urinary Frequency 2. Dysuria (painful urination) 3. Costovertebral Pain 4. Temperature, 101.2 F. 38.4 C. 5. Urinalysis, positive for leukocytes; white blood cell (WBC) count Rationale: A change in urinary frequency requires further assessment. Painful urination (dysuria) is an abnormal finding requiring further assessment. Costovertebral pain requires further follow-up, because it may indicate a complicated urinary tract infection (UTI). A temperature of 101.2°F (38.4°C) is an abnormal finding requiring further assessment. The presence of leukocytes in urinalysis indicates urinary tract infection (UTI). An elevated white blood cell (WBC) count of 12 × 103/mm3 (12 × 109/l) indicates infection and requires follow-up. A heart rate 110 beats/min is within normal range (70 to 110 beats/min). A respiratory rate 22 breaths/min is within normal range (20 to 30 breaths/min). A blood pressure 88/48 mm Hg is within normal range (the systolic blood pressure normal range is 80 to 120 mm Hg).

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 returns from surgery in which a stoma was created in the abdominal wall to the bladder. The nurse identifies this as which of the following?

Vesicostomy Rationale: A vesicostomy refers to a stoma created in the abdominal wall to the bladder. A ureteral stent is a thin catheter temporarily placed in the ureter to drain urine. A continent urinary diversion uses a piece of the intestine to create a bladder that can be catheterized. Bladder augmentation involves the use of a piece of the stomach or intestine to enlarge bladder capacity.

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℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:

acute glomerulonephritis. Rationale: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.

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?

heart rate and blood pressure Rationale: In nephrotic syndrome, hypoalbuminemia occurs with a loss of protein and albumin in the bloodstream. This causes many fluid shifts from the bloodstream (intravascular) to the interstitial tissues. The result is edema, as the fluid in the interstitial spaces increases. This leaves the intravascular fluid decreased or depleted, causing hypovolemia. The best set of assessments for this condition is to assess the heart rate and blood pressure. These will indicate hypovolemia from the fluid shifts occurring. The respiratory rate and the work of breathing are assessed for fluid overload in the lungs. The heart sounds and the lung sounds are assessed for fluid overload, not decreased fluid. Assessing the oxygen saturation is only necessary if there are adventitious lung sounds or increased work of breathing.