Chapters 46&47

Alternate the use of tampons with sanitary pads. Toxic shock syndrome (TSS) is a cluster of symptoms that involves many systems of the body. Certain bacterial infections release toxins into the bloodstream, which then spreads the toxins to body organs. This can cause severe damage and illness.

A 13-year-old adolescent tells the nurse during a gynecologic visit that a friend developed toxic shock syndrome from tampon use. The adolescent says that tampons work well for her but wonders whether tampons are safe. Which recommendation will the nurse give this adolescent to help prevent toxic shock syndrome? Alternate the use of tampons with sanitary pads. Use the highest absorbency tampon possible. Insert two tampons at a time. Use feminine hygiene sprays in conjunction with tampons.

This may indicate a urinary tract infection. A leukocyte is a white blood cell and is normally not present in the urine. Positive leukocytes may indicate a urinary tract infection. Red blood cells in the urine equate to bleeding. Glucose in the urinalysis would be identified as such and may be a concern for diabetes. Urine that is positive for leukocytes would also need to be cultured to determine the type and amount of bacteria growth so the appropriate antibiotic can be administered.

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. This determines the presence of sugar in the urine. This indicates renal disease. This determines the presence of red blood cells in the urine.

Urine culture A urinary tract infection is diagnosed by a urine culture. A kidney, ureter, and bladder x-ray would provide information about the size and contour of the kidneys. An ultrasound can detect differing sizes of kidneys or ureters and help to differentiate between solid or cystic kidney masses. An intravenous pyelogram provides information about the collecting systems of the kidney and ureters.

A female adolescent comes to the clinic for an evaluation. Assessment reveals a possible urinary tract infection. What would the nurse expect to be done to confirm this suspicion? Kidneys, ureter, and bladder x-ray Urine culture Renal ultrasound Intravenous pyelogram

thick, white discharge Also called vaginal candidiasis, vaginal yeast infection is a fungal infection ( caused by Candida Albicans) that causes irritation, discharge and intense itchiness of the vagina and the vulva — the tissues at the vaginal opening. It affects up to 3 out of 4 women at some point in their lifetimes.The standard recommended dose for most Candida infections is fluconazole at 800 mg as the loading dose, followed by fluconazole at a dose of 400 mg/d either intravenously or orally for at least 2 weeks of therapy after a demonstrated negative blood culture result or clinical signs of improvement.

A nurse should recognize that which symptom would be most consistent with a diagnosis of candidiasis? thick, white discharge brownish discharge bloody discharge no discharge

"Precocious puberty is early sexual development." 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 parent asks the nurse, "What is precocious puberty?" The nurse's response should be based on which statement? "Precocious puberty is when children are going through puberty." "Precocious puberty is early sexual development." "Precocious puberty only occurs in boys, not girls." "Precocious puberty is when girls experience a heavy period."

Acute glomerulonephritis lomerulonephritis, 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.

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 Kidney agenesis Polycystic kidney Nephrosis

wipe from front to back after urinating or defecating. Vulvovaginitis may be caused by spread of Escherichia coli from the rectum to the vagina. It happens when the normal amount of yeast and bacteria in the vagina gets out of balance. This could happen for several reasons, including an infection, a change in hormones, or antibiotic use.Bacterial and antifungal medications may take up to two weeks to clear the infection.

An adolescent asks the nurse how to best prevent vulvovaginitis. The nurse's best answer would be to: apply personal hygiene sprays if vaginal odor develops. use nylon rather than cotton underpants to decrease moisture. wipe from front to back after urinating or defecating. soak in a strong bubble bath solution to maintain hygiene

Urine pH of 3.0 Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine-specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, its color ranging from pale yellow to deep amber.

Nurse Pete is reviewing the report of a client's routine urinalysis. Which value should the nurse consider abnormal? Specific gravity of 1.03 Urine pH of 3.0 Absence of protein Absence of glucose

Fluid intake should be approximately equal to the urine output. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. The core principle of fluid balance is that the amount of water lost from the body must equal the amount of water taken in; for example, in humans, the output (via respiration, perspiration, urination, defecation, and expectoration) must equal the input (via eating and drinking, or by parenteral intake).

Nurse Pippy is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way? Fluid intake should double the urine output. Fluid intake should be approximately equal to the urine output. Fluid intake should be half the urine output. Fluid intake should be inversely proportional to the urine output.

to stimulate red blood cell growth. 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 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 explains that the rationale is: to treat low calcium levels. to stimulate growth in stature. to stimulate red blood cell growth. to correct acidosis.

Number of sexual partners Multiple sexual partners are a risk factor for PID. Race, age, and age at first menses are not considered risk factors for PID.Pelvic inflammatory disease is an infection of a woman's reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea.In most cases, the condition is caused by a bacterial infection spreading from the vagina or cervix (entrance to the womb) into the womb, fallopian tubes and ovaries.

The nurse is taking a history from an adolescent girl with suspected pelvic inflammatory disease (PID). What data will be most helpful in determining this girl's risk factors for PID? Number of sexual partners Age Race Age at first menses

pyelonephritis. Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Ascites is edema in the peritoneal cavity. Kidney infection (pyelonephritis) is a type of urinary tract infection (UTI) that generally begins in your urethra or bladder and travels to one or both of your kidneys

The nurse is teaching a group of nursing students about genitourinary conditions. The nurse tells these students about a condition that occurs when there is an inflammation of the kidney and renal pelvis. The condition the nurse is referring to is: oliguria. amenorrhea. pyelonephritis. ascites.

Teach her to wipe her perineum front to back after voiding. Escherichia coli can be easily spread from the rectum to the urinary meatus and cause infection if girls do not take precautions against this.

To prevent further urinary tract infections in a preschooler, what measures would you teach her mother? Encourage her to be more ambulatory to increase urine output. Teach her to take frequent tub baths to clean her perineal area. Suggest she drink less fluid daily to concentrate urine. Teach her to wipe her perineum front to back after voiding.

missing clitoris 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? menses missing clitoris vaginal discharge redness and swelling

"A girl's urethra is closer to the rectal opening." 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.

While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) 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? "Girls have a smaller bladder size than boys do." "A girl's urethra is closer to the rectal opening." "A girl's urethra is longer than a boy's urethra." "Her kidneys are less well protected."

recent illness such as strep throat. Symptoms of acute glomerulonephritis often appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat. The causative agent is group B hemolytic streptococcus. The treatment for glomerulonephritis includes maintaining fluid volume and managing hypertension. Glomerulonephritis is not contagious, so the child would not have acquired it from a sibling. Glomerulonephritis only affects the kidney, so hemorrhage, bruising, hearing loss, or speech development would not be associated with the disease.

A child diagnosed with acute glomerulonephritis will most likely have a history of: recent illness such as strep throat. a sibling diagnosed with the same disease. hemorrhage or history of bruising easily. hearing loss with impaired speech development.

creatinine clearance A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate. Urine is collected and kept on ice for a 24-hour period. During that time a serum creatinine is obtained. The presence of creatinine in the urine is compared with the serum to determine the amount of creatinine clearance. Casts, bacteria, and a culture and sensitivity are used to evaluate for infection and the antibiotics needed to treat the infection. RBCs are used to look for bleeding in the urine.

A child needs to collect urine for 24 hours. The nurse explains to the parents and child that this test assesses glomerular filtration rate and how the kidneys are functioning. What results would be expected in this type of test? creatinine clearance culture and sensitivity casts and bacteria red blood cell (RBC) casts

The child is not voiding. The presence of voiding is a priority after a renal biopsy to prevent blood clotting and blocked urine flow. The other choices are not of a priority nature.A kidney biopsy is a procedure to remove a small piece of kidney tissue that can be examined under a microscope for signs of damage or disease.

A client has just completed a renal biopsy. Which manifestation should be given priority attention? The sterile dressing needs changing. The child is still. The child is not voiding. The child is sleeping.

Water and sodium retention secondary to a severe decrease in the glomerular filtration rate. A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2, persisting for 3 months or more, irrespective of the cause.

A female client is admitted for treatment of chronic renal failure (CRF). Nurse Julian knows that this disorder increases the client's risk of: Water and sodium retention secondary to a severe decrease in the glomerular filtration rate. A decreased serum phosphate level secondary to kidney failure. An increased serum calcium level secondary to kidney failure. Metabolic alkalosis secondary to retention of hydrogen ions.

There is a chance the testicles will descend on their own. 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.

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. This problem needs to be corrected immediately in the newborn period. If the infant is having swelling or pain, then surgery will be performed. Surgery is not needed for this type of problem.

Encourage the child to take all the antibiotics if diagnosed with strep throat. 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 with whom the child came in contact unless they are symptomatic. Ibuprofen does not cure strep throat, and strep infection 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. All children in the child's class should be tested for strep throat if one child has a positive test. Prophylactic antibiotics after strep throat are important.

"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." Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally, oral contraceptive pills are prescribed to prevent ovulation.

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? "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it." "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." "That must be hard on you, especially because you are raising her by yourself." "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive."

Palpate the scrotum for the testes Cryptorchidism occurs when the male gonads (testes) have not descended into the scrotum. Either one or both of the testes may not be in the scrotum. In most infants, the testes descend by the time the male is 1 year old. The nurse assesses the client's status by palpation of the scrotum.

The nurse is caring for a 9-month-old with cryptorchidism noted on the medical record. In which manner will the nurse assess this condition? Auscultate for bowel sounds Note any bruising on the skin Assess the upper extremity strength Palpate the scrotum for the testes

Tea-colored urine 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? Loose, dark stools Tea-colored urine Strawberry-red tongue Jaundiced skin

dilute the urine and flush the bladder. Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder. An increase in fluid intake also helps decrease the pain experienced in urination, but this is not the most important reason the child needs increased fluids. Fluids may help decrease the chance of the child developing a fever, but this is not the most important reason fluids are given.

The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. The nurse tells the caregiver that the most important reason the child needs increased fluids is to: fill the bladder so a specimen can be obtained. dilute the urine and flush the bladder. prevent the child from developing a fever. decrease the pain of urination.

amenorrhea. Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Ascites is edema in the peritoneal cavity.

The nurse is discussing genitourinary conditions with a group of 16-year-old girls. One of the girls says she has heard about girls who have stopped taking birth control pills and now don't have periods. The condition the girl is referring to is: oliguria. amenorrhea. pyelonephritis. ascites.

"Emotional stress can be a cause of this disorder." Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion (miscarriage) does not cause secondary amenorrhea.

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? "It is caused from taking birth control pills when a girl is younger than 13 years old." "This disorder is usually seen after a girl has had a spontaneous abortion (miscarriage)." "Emotional stress can be a cause of this disorder." "This is what happens if a 16-year-old girl has never had any periods at all."

regulate blood pressure Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acid-base. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli. Cerebrospinal fluid circulates through the brain and spinal cord.

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? produce white blood cells remove carbon dioxide circulate cerebrospinal fluid regulate blood pressure

Insisting that sexual partners use condoms PID is a sexually transmitted infection; use of condoms prevents PID. Using a vaginal douche routinely leads to bacterial overgrowth and increases the risk for PID. Sexual partners should also receive treatment with antibiotics. Oral contraceptives prevent pregnancy, not PID.

The nurse is providing discharge teaching to an adolescent who has been treated for pelvic inflammatory disease (PID). What would the nurse include as a preventive measure? Insisting that sexual partners use condoms Using a vaginal douche routinely Suggesting that sexual partners use antibiotic ointment Using oral contraceptives as prescribed

Administering antibiotics UTIs may be treated with antibiotics (usually sulfamethoxazole or ampicillin) at home. Fluids are encouraged, but they do not treat the infection. Bladder irrigations and diuretics are not used in the treatment of urinary tract infections.

Urinary tract infections are usually successfully treated by what means? Increasing fluids, such as cranberry juice Administering antibiotics Performing bladder irrigations Administering diuretics