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

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.

The nurse knows this is a description of peritoneal dialysis when compared to hemodialysis:

The child can live a more normal lifestyle.

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

The child does not have intravenous access.

A client has just completed a renal biopsy. Which manifestation should be given priority attention?

The child is not voiding.

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.

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician?

Absence of a thrill

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with acute glomerulonephritis. In which age range is the peak incidence of this disorder noted?

6 to 7 years of age

A group of nursing students is discussing terminology related to the genitourinary system during a post-conference setting. One of the students asks what mittelschmerz is or what it means. A classmate of this student correctly answers that mittelschmerz is

a dull, aching abdominal pain at ovulation.

An 8-year-old develops balanoposthitis. A finding of this is:

denuded, reddened surface of the glans of the penis.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is

obtaining a clean catch voided urine.

A client diagnosed with dysmenorrhea has several medications prescribed. Which medication should the nurse question?

oxycodone

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration the nurse would want to prepare the parents for is:

some discomfort at the surgery site.

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

testicular torsion

A baby is born with ambiguous genitalia. When discussing this with her parents, you could accurately assure them that:

their child's true sex can be determined by a genetic karyotype.

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, the nurse would want to prepare her to:

void during the procedure.

To determine if ascites is increasing in amount in a child with nephrotic syndrome, which measurements would be most appropriate?

Abdominal circumference

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

Risk for infection

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant?

Risk for infection related to immunocompromised state

The nurse is most accurate to instruct the client that which occurs during a female's mid-cycle?

Mittelschmerz

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."

Which question would be most important for a nurse to ask when taking a history from a client who is suspected of having amenorrhea?

"Are you sexually active?"

A female child has been diagnosed with precocious puberty at the age of 8. Which of the following would be an important teaching priority to tell the parents?

"Your daughter is physically able to become pregnant."

A nurse is caring for an adolescent diagnosed with toxic shock syndrome. As part of the nursing care for this client, the nurse would anticipate which intervention? Select all that apply.

- use of menstrual pads and avoidance of tampons - iodine douching - cervical and vaginal cultures

A child who has been diagnosed with minimal change nephrotic syndrome (MCNS) is being discharged after a 3-week hospitalization. Her edema has been greatly reduced and her appetite is beginning to return. Her caregivers have promised to have a family party to celebrate her return. The child has requested the following food for the party. Which food would the nurse suggest would be appropriate for the diet this child is on?

Banana splits

The nurse is teaching the parent of a child with chronic renal failure on high-potassium foods that should be restricted. Which foods will the nurse include in this teaching?

Bananas, carrots, nuts, and milk

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

An 8-year-old child is diagnosed with balanoposthitis. What will the nurse most likely assess in this disorder?

Denuded, reddened surface of the glans of the penis

The child with nephrotic syndrome who has ascites and difficulty breathing is probably most comfortable sleeping in which position?

Fowler's

The nurse is caring for a child on a pediatric unit who has hemodialysis 3 times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child?

Grilled chicken, half of a banana, and flavored water

A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching?

Immunosuppression is common after a kidney transplant

The nurse is collecting data on a 6-year-old child admitted with a possible urinary tract infection. Which vital sign might indicate the possibility of an infection?

Pulse rate 135 bpm

The nurse is doing an in-service training with a group of peers on the topic of the genitourinary system. Which function is a major task of the kidneys?

Regulate blood pressure

The nurse is providing a child with oxybutynin as prescribed following surgical repair of a hypospadias. What should the nurse teach the patient about the purpose of this medication?

Relieves bladder spasms

A female preschool patient with a urinary tract infection is scheduled to have a voiding cystourethrogram. What should the nurse include when teaching the patient about this procedure?

The patient will be expected to void during the procedure.

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.

An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, what would lead the nurse to suspect that the adolescent has candidiasis?

Thick, white cheese-like discharge

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother?

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." What would be the most appropriate response by the nurse?

"There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months."

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

A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure?

Encouraging fluid intake after dinner

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

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

The VCUG will rule out VUR.

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

An adolescent is diagnosed as having gonorrhea. The nurse can anticipate that her management will include:

identification of sexual contacts.

The nurse is discussing recommended immunizations with the mother of an adolescent female. Which immunization would be important for the nurse to include during this discussion?

Gardasil

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?

Hypertension

The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea?

"Emotional stress can be a cause of this disorder."

A parent is asking how she can help her son deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse?

Demonstrate love and acceptance at home.

A client is being discharged with a diagnosis of toxic shock syndrome. What would be the priority for the nurse to teach the client?

Finish all antibiotic therapy.