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

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

Risk for infection

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

The VCUG will rule out vesicoureteral reflux.

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

Encourage high fluid intake.

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

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

Proteinuria, hypoalbuminemia, and hypercholesterolemia

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."

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."

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

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

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 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.

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

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.

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.

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.

A child is having the urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate?

This may indicate a urinary tract infection.

A nurse is providing education to parents of a child diagnosed with vesicoureteral reflux (VUR). Which would be included in the parental education?

This occurs when there is backflow of urine into the bladder and sometimes the kidneys.

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 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."

A symptom often seen in acute glomerulonephritis is edema. The most common site the edema is first noted is in which area of the body?

Eyes

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

Imbalanced nutrition Altered skin integrity Altered comfort Anxiety

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 caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis. What would the nurse expect to administer if ordered?

Sodium bicarbonate tablets

The nurse is 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.

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.

In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care?

Weighing on the same scale each day

An 8-year-old client presents with sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the child's health history, the nurse learns that the child had strep throat 9 days ago. Which condition does the nurse suspect?

acute glomerulonephritis

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.

A nurse is caring for a 13-year-old boy with end-stage kidney disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate?

Withhold his routine medication until after dialysis is completed.

The 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.

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 state which as an appropriate measure?

encouraging fluid intake after dinner

The nurse is working with a child with altered genitourinary status. Which intervention should be included in the plan of care for the client with excess fluid volume?

headache irritability depression

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which set of assessment findings most likely led the nurse to this conclusion?

hemolytic anemia, thrombocytopenia, and acute kidney injury

The nurse is performing an assessment on a child. Which finding indicates to the nurse the child is at an increased risk for a urinary tract infection (UTI)?

holding urine while at school

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

hypertension

Which clinical manifestation should a nurse recognize as most significant when assessing a client who is suspected of having female circumcision?

missing clitoris

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

The nurse is providing care to a child with acute kidney injury. What assessment is priority for the nurse to determine if this child is developing hyperkalemia?

pulse rate and rhythm

A child diagnosed with acute glomerulonephritis will most likely have a history of:

recent illness such as strep throat.

A teenager comes to the clinic with fever, muscle pain, and a macular rash on the palms and soles of the feet. Based on these findings, what diagnosis would the nurse anticipate for this client?

toxic shock syndrome

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?

urinalysis

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

void during the procedure.

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

weight, daily

When developing the preoperative plan of care for an infant with bladder exstrophy, which intervention would the nurse least likely include?

Placing the infant in a side-lying position