Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder - ML4

Correct response: Reassess the client's testes at 6 months of age. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, REPRODUCTIVE ORGAN DISORDERS, p. 1583. 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.

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? Perform karyotyping to establish the client's gender. Administer low-dose human chorionic gonadotropin hormone. Reassess the client's testes at 6 months of age. Schedule emergency orchiopexy to correct the condition.

Correct response: The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, URINARY TRACT AND RENAL DISORDERS, p. 1567. Enuresis is primary, or functional, if bladder training was never achieved, acquired or secondary or organic if control was established but has now been lost. Enuresis when exceptionally tired, while absorbed in some activity, or when a parent forgets to remind the child is more likely to be primary rather than organic.

A 5-year-old boy occasionally wets his bed at night and his pants during the day. Which finding would indicate an organic cause—as opposed to a functional cause—of this enuresis? The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained. The boy only wets his bed on the nights his father forgets to take him to the bathroom to void before going to bed. The boy only wets his pants when he is absorbed in playing video games. The boy only wets the bed on nights that he is exceptionally tired.

Correct response: The child has been sexually abused, maybe on the fishing trip. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Urinary Disorders, p. 1567. Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse and should be further explored.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting? The child is out of the habit of waking himself up during the night to void. The child has been sexually abused, maybe on the fishing trip. The child did not want to go on the fishing trip and is now retaliating against being made to go. The child has a urinary tract infection due to not bathing while on the fishing trip.

Correct response: Creatinine clearance rate Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 43.1, p. 1554. 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 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? Computed tomography scan Kidneys, ureter, and bladder x-ray Creatinine clearance rate Urinalysis

Correct response: weight, daily Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Acquired Disorders Resulting in Altered Renal Function, p. 1570.

A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? urine output, every shift abdominal circumference weight, daily amount of protein in the urine

Correct response: testicular torsion Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Testicular Torsion, p. 1583. 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. (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. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele. A hardened and tender epididymis points to epididymitis.)

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

Correct response: The foreskin is needed for repair. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Hypospadias/Epispadias, p. 1561. The newborn with hypospadias or epispadias should not undergo circumcision until after surgical repair of the urethral meatus. In more extreme cases, the surgeon may need to use some of the excess foreskin while reconstructing the meatus. Nursing management of the infant who has undergone a hypospadias or epispadias repair focuses on providing routine postoperative care and parent education.

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. Circumcision with hypospadias will cause meatal stenosis. The circumcision may predispose the newborn to renal failure. Circumcision is usually performed after 1 year of age.

Correct response: "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 39: The Child with a Genitourinary Disorder.

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? "Problems with the kidneys raise the risk for infection because there is a problem with producing white blood cells." "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often." "The kidneys help get rid of carbon dioxide from the body, so kidney problems can affect our child's breathing." "We should expect problems with too much fluid in the brain because the kidneys are not able to keep the fluid in balance."

Correct response: Encouraging fluid intake after dinner Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Urinary Disorders, p. 1568. In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.

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 Giving desmopressin intranasally Practicing bladder-stretching exercises Engaging the child in stress-reduction measures

Correct response: Encourage high fluid intake. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Vesicoureteral Reflux, p. 1565. 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 performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? Allow tubes to dangle freely to encourage flow. Increase low-fat foods. Apply antibiotic ointment to tube site. Encourage high fluid intake.

Correct response: Demonstrate love and acceptance at home. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Enuresis, p. 1568. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.

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 how to urinate in the bathroom every time the child has an occurrence. Demonstrate love and acceptance at home. Take away a toy every time the child urinates in his or her pants. Discuss how the child can continue to go to the bathroom instead of in his or her underwear.

Correct response: The child does not have intravenous access. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 43.1, p. 1555. 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 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 is diapered. The child's appetite is poor. The child does not have intravenous access. The child is unable to ambulate.

Correct response: Encourage the child to take all the antibiotics if diagnosed with strep throat. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Acute Poststreptococcal Glomerulonephritis, p. 1571. encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community that the child came in contact with unless they are symptomatic. Ibuprofen does not cure strep throat and that is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this? Encourage the child to take all the antibiotics if diagnosed with strep throat. Tell parents to give ibuprofen if their child has a sore throat. Prophylactic antibiotics after strep throat are important. All children in the child's class should be tested for strep throat if one child has a positive test.

Correct response: Acute glomerulonephritis Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Acute Poststreptococcal Glomerulonephritis, pp. 1571-1572. Acute glomerulonephritis often follows a group A streptococcal infection. Strep A infections may manifest as an upper respiratory infection. The history of urinary tract infections, renal disorders, or hypotension is not directly associated with the onset of acute glomerulonephritis.

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? Polycystic kidney Acute glomerulonephritis Nephrosis Kidney agenesis

Correct response: Thick, white cheese-like discharge Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, TABLE 43.3 Vulvovaginitis: Types and Treatments, p. 1580. With candidiasis, the vaginal discharge is thick, white, and cheese-like. A frothy, gray-green discharge is noted with trichomoniasis. A milky, gray discharge with a fishy odor suggests gardnerella. A yellow-green vaginal discharge suggests gonorrhea.

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? Yellow-green discharge Milky, gray, fishy-odor discharge Frothy, gray-green discharge Thick, white cheese-like discharge

Correct response: intestinal bacteria. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Urinary Disorders, p. 1566. 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.

Most urinary tract infections seen in children are caused by: dietary insufficiencies. intestinal bacteria. fungal infections. hereditary causes.

Correct response: acute glomerulonephritis. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Acute Poststreptococcal Glomerulonephritis, p. 1572. 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 one to three 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 degrees Fahrenheit at the onset but decreases in a few days to about 100 degrees Fahrenheit. Slight headache and malaise are usual, and vomiting may occur.

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: a urinary tract infection. lipoid nephrosis (idiopathic nephrotic syndrome). rheumatic fever. acute glomerulonephritis.

Correct response: Sodium bicarbonate tablets Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, TABLE 43.2 Medications and Supplements Commonly Used to Treat ESRD Complications, p. 1576. 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 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? Vitamin D Erythropoietin Sodium bicarbonate tablets Ferrous sulfate

Correct response: "There are several things we can do to help you achieve this goal." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, URINARY TRACT AND RENAL DISORDERS, p. 1568. 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 his desire for solutions. Telling the child that he will "grow out of this" downplays his embarrassment and does not address his desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.

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? "You can wear pull-ups to bed and, since they look like underwear, no one will know." "You are not alone. There are almost 5 million people that have enuresis." "There are several things we can do to help you achieve this goal." "You will grow out of this eventually; you just need to be patient."

(Rationale: White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Irritation of the labia and vaginal opening is commonly found with poor hygiene. Foul yellow-gray discharge indicates Trichomonas vaginalis.)

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? Foul yellow-gray discharge White cottage cheese-like discharge Irritation of labia and vaginal opening Thin gray vaginal discharge with fishy odor

Correct response: Testis cannot be "milked" down inguinal canal Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Cryptorchidism, p. 1582. 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.

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 can briefly be brought into scrotum Testis cannot be "milked" down inguinal canal Venous varicosity detected along the spermatic cord Fluid detected in scrotal sac

Correct response: Tea-colored urine Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Acute Poststreptococcal Glomerulonephritis, p. 1572. 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.

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 Strawberry-red tongue Jaundiced skin Loose, dark stools

Correct response: hypertension Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, URINARY TRACT AND RENAL DISORDERS, p. 1564. Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

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

Correct response: grilled chicken, apple slices, and flavored water Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, End-Stage Renal Disease, p. 1575. Since hemodialysis is usually performed only every other day, larger amounts of waste products build up in the child's blood; therefore, the child must follow a stricter diet between hemodialysis treatments, though dietary restrictions are usually lifted while the child is actually undergoing the treatment. Since the kidneys are not functioning, foods high in sodium, protein, and potassium must be avoided.

The nurse is caring for a child on a pediatric unit who has hemodialysis three times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child? cheeseburger, french fries, and lemonade tomato soup, crackers, and diet soda three-egg omelet, bacon, and orange juice grilled chicken, apple slices, and flavored water

Correct response: intravenous pyelogram (IVP) voiding cystourethrogram (VCUG) renal ultrasound Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, URINARY TRACT AND RENAL DISORDERS, p. 1564. 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 hydronephritis.

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. renal ultrasound intravenous pyelogram (IVP) voiding cystourethrogram (VCUG) complete blood cell count (CBC) urinalysis

Correct response: Weigh the old dialysate. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Dialysis and Transplantation, p. 1578 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.

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. Empty the old dialysate. Weigh the new dialysate. Start the process over with a fresh bag.

The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill. Dialysate without fibrin or cloudiness is normal and is used with peritoneal dialysis, not hemodialysis.

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? dialysate without fibrin or cloudiness absence of a thrill presence of a bruit presence of a thrill

Correct response: The child recently had an ear infection. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Acute Poststreptococcal Glomerulonephritis, p. 1572. 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.

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 is being treated for asthma. The child had a congenital heart defect. The child recently had an ear infection. The child has a sibling with the same diagnosis.

Correct response: Blood pressure 136/84 Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Acute Poststreptococcal Glomerulonephritis, p. 1572. 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.

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 Pulse rate 112 bpm Pulse oximetry 93% on room air Respirations 24 per minute

Correct response: leukocyte count Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, DRUG GUIDE 43.1 Common Drugs for GU Disorders, p. 1559.

The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess? eosinophils basophils red blood count leukocyte count

Correct response: "I will always use a condom with any further sexual encounters." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, TABLE 43.3 Vulvovaginitis: Types and Treatments, p. 1580. 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 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 do not have to worry about speeding this infection to my partner." "If I suspect anything, I will be sure to use soap and water after sex." "I will always use a condom with any further sexual encounters." "I do not need to see my health care provider for this infection."

Correct response: pulse rate and rhythm Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Acute Renal Failure, p. 1574. Hyperkalemia occurs when the potassium levels rise above normal laboratory values. Although it varies among laboratories, a normal potassium range is generally between 3.5 and 5 mEq/l (3.5 and 5 mmol/l). When the potassium levels rise, the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm, because potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmia occurs or the heart starts to fail.

The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia? muscle tone abdominal pain blood pressure pulse rate and rhythm

Correct response: "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Urinary Disorders, p. 1566. 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.

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? "It is unlikely that your daughter is practicing good cleaning habits after she voids." "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." "Girls tend to urinate less frequently than boys, making them more susceptible to UTI's."

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 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. Bathe the child with bubble bath once a week. Wipe from back to front when changing the girl's diaper. Discontinue prescribed antibiotics once symptoms of UTI have disappeared.

Correct response: Report any burning, itching, or discharge to a health care provider. Follow up with a primary care provider. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Hypospadias/Epispadias, p. 1561. Follow up with a health care provider and renal specialist to determine the best course for this client. Circumcision is not indicated as the foreskin can be used for future repair. Increase of fluids in the diet is not an indication.

When preparing discharge instructions for the parents of an infant who has been diagnosed with hypospadias, the nurse should include which instruction in the teaching plan? Select all that apply. Monitor voiding patterns. Encourage circumcision. Increase fluid intake. Follow up with a primary care provider. Report any burning, itching, or discharge to a health care provider.

Correct response: Risk for infection Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, vesicoureteral reflux, p. 1565. 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.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? Activity intolerance Imbalanced nutrition less than body requirements Risk for infection Excess fluid volume

Correct response: missing clitoris Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, REPRODUCTIVE ORGAN DISORDERS, p. 1582. Clients who are assessed with a missing clitoris should receive further workup for female circumcision. Redness, swelling, and vaginal discharge can be indicated for infection. Menses is not affected in clients with female circumcision.

Which clinical manifestation should a nurse recognize as most significant when assessing a client who is suspected of having female circumcision? missing clitoris menses vaginal discharge redness and swelling

Correct response: The client remains continent throughout the night. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder, Enuresis, p. 1568. 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.

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 wets only when involved in an activity. The child wakes up once during the night for a glass of water. The client remains continent throughout the night. The parent takes the client to the bathroom at night.