DAVIS GU

A child has been diagnosed with acute glomerular nephritis. Which of the following changes would the nurse expect to see in the child's laboratory reports? 1. Urine white blood cell count: elevated 2. Urine specific gravity: decreased 3. Urine creatinine clearance: decreased 4. Urine red blood cell count: elevated

ANSWER: 4 Rationale: 1. The nurse would expect to see white blood cells in the urine if the child had a UTI.2. Because of the hematuria and proteinuria, the nurse would expect to see an increase in the child's urinary specific gravity. 3. Because the child's kidney function is compromised, the nurse would expect to see reduced creatinine clearance in the urine, but a concurrent rise in the serum creatinine. 4. The number of red blood cells in the urine increases dramatically.TEST-TAKING TIP: Laboratory data often can provide the nurse with important information regarding a patient's clinical course. It is essential that the nurse become familiar with normal laboratory results and expected changes in relation to disease states.

A child with nephrotic syndrome has been prescribed prednisone. The nurse should monitor the child for which of the following medication side effects? 1. Gastric distress 2. Bradycardia 3. Hypoglycemia 4. Weight loss

ANSWER: 1 Rationale: 1. Gastric distress is a common side effect of prednisone. 2. Bradycardia is not a documented side effect of prednisone.3. Hyperglycemia is seen in patients taking high doses of prednisone. 4. Weight loss is not a documented side effect of prednisone. TEST-TAKING TIP: It is important for the test taker to read questions carefully. Hyperglycemia is a side effect of prednisone, while hypoglycemia is not.

Four babies were delivered in the maternity unit during a 24-hour period. Which of the babies would the nurse most predict would exhibit cryptorchidism? 1. 34 weeks' gestation, 2,200 grams, Apgar 9/9 2. 37 weeks' gestation, 4,000 grams, Apgar 8/9 3. 39 weeks' gestation, 3,500 grams, Apgar 7/8 4. 42 weeks' gestation, 2,400 grams, Apgar 8/8

ANSWER: 1 Rationale: 1. Most babies who are born with cryptorchidism are preterm.2. By 36 weeks' gestation, the testes should be descended. 3. By 36 weeks' gestation, the testes should be descended. 4. By 36 weeks' gestation, the testes should be descended. TEST-TAKING TIP: The testes develop in the abdomen and slowly descend through the inguinal canal into the scrotal sac. Babies who are born preterm are, therefore, most likely to exhibit cryptorchidism. Apgar and weight do not affect whether or not the testes descend.

The oncologist caring for a child immediately postsurgery for Wilms' tumor reports: the child is in Stage III. The child will go through a series of chemotherapy. Based on the proposed therapy, which of the following patient-care goals should be included in the child's nursing care plan? Select all that apply. 1. The child will be free of infection. 2. The child will experience no tissue damage. 3. The child will have regular bowel movements. 4. The child will not complain of nausea and will not vomit. 5. The child will regress to the previous level of growth and development.

ANSWER: 1, 2, 3, and 4 Rationale: 1. This is an appropriate patient-care goal.2. This is an appropriate patient-care goal.3. This is an appropriate patient-care goal.4. This is an appropriate patient-care goal.5. Although the child may regress, the goal should be that the child will regain or maintain his or her level of growth and development. TEST-TAKING TIP: Chemotherapy places children at high risk for a number of complications. The goals of patient care should state that the child will not develop any of the complications, including infection, stomatitis, nausea, vomiting, and constipation.

The nurse is educating the parents and their 10-year-old child regarding home care for the child's diagnosis of acute glomerular nephritis. Which of the following statements by the child indicate that the child understood the teaching? Select all that apply. 1. "I can't eat any potato chips or other salty foods." 2. "I can't go to school for a week because I am contagious." 3. "I won't be able to go back to soccer practice for a long time." 4. "I'm going to have to go to the doctor's office a lot during the next few months." 5. "When I get home, I will have to stay in bed, except when I need to go to the bathroom."

ANSWER: 1, 3, and 4 Rationale: 1. This statement is true. Children with AGN are usually on salt restricted diets.2. This is not correct. It is rare for children with AGN still to be contagious. If they are still S. pyogenes positive, they will be prescribed penicillin. Once they have been on the medication for one full day, they are no longer contagious. 3. This statement is correct. Until the urinalyses are normal, children are restricted from participating in contact sports. 4. This statement is correct. The child will require frequent urinalyses and blood pressure assessments to monitor the progression of the disease.5. Children with AGN rarely are placed on strict bedrest. In the early days of the disease, they usually modify their own activity level. Once they feel well enough, they are allowed to ambulate. TEST-TAKING TIP: The nurse should educate both the parents and the child and should evaluate the child's as well as the parents' understanding. The large part of a child's day is spent at school away from parents. It is critically important that sick children be included in age-appropriate discussions about their illnesses as well as their plans of care.

A child is admitted to the pediatric unit with nephrotic syndrome. Which of the following laboratory results would the nurse expect to see? 1. Thrombocytopenia 2. Hypoalbuminemia 3. Neutropenia 4. Hypermagnesemia

ANSWER: 2 Rationale: 1. The nurse would expect the platelet count to be within normal limits. 2. The child's serum albumin levels would be markedly decreased. 3. The nurse would expect the serum white blood cell count to be within normal limits.4. The nurse would expect the serum magnesium levels to be within normal limits. TEST-TAKING TIP: Children with nephrotic syndrome lose large quantities of albumin into the urine. As a result, the child's serum albumin levels are markedly decreased. Because antibodies are protein, children with hypoalbuminemia are at high risk for infections.

A 3-year-old child is admitted to the pediatric unit for surgery. The child has a tumor in his left kidney. The child is to undergo surgery the next day. Which of the following primary health-care practitioner prescriptions is most important for the nurse to follow? 1. Maintain the child NPO after midnight. 2. Place a sign at the head of the bed stating, "Do not touch abdomen." 3. Send a urine specimen for a urinalysis. 4. Send a blood specimen for electrolyte analysis.

ANSWER: 2 Rationale: 1. Even if it were within the 12-hr window before surgery, this is not the first order that the nurse should complete. 2. The nurse should first place a sign at the head of the child's bed stating, "Do not touch abdomen." 3. The nurse can wait to send the urine specimen for urinalysis.4. The nurse can wait to send the blood specimen for protein and electrolytes. TEST-TAKING TIP: The prognosis of Wilms' tumor is dependent on the tumor remaining encapsulated in the kidney. If it were to rupture, the likelihood of metastasis markedly increases. The nurse must place the sign at the head of the child's bed to make sure that no one entering the room palpates the child's abdomen.

A 2-year-old child with nephrotic syndrome is admitted to the pediatric unit. The following orders have been written in the child's medical record. Which of the actions is highest priority for the nurse to perform? 1. Place child on alternating pressure mattress. 2. Administer intravenous albumin. 3. Weigh all wet diapers. 4. Administer oral antibiotics.

ANSWER: 2 Rationale: 1. It is important to place the child on an alternating pressure mattress, but it is not the priority action.2. Administering IV albumin is the priority action.3. Weighing all wet diapers is important, but it is not the priority action. 4. Administering oral antibiotics is important, but it is not the priority action.TEST-TAKING TIP: To determine the priority action, the nurse should determine which action will reverse the problem. The only response that is a treatment that will help to reverse the pathology of nephrotic syndrome is the administration of albumin.

The parents of a Hispanic American child who has been diagnosed with Wilms' tumor ask the nurse about the origin of the tumor. Which of the following information should the nurse provide the parents? 1. "Nephroblastoma is a cancer that originated in another part of your child's body." 2. "The tumor often starts growing in the kidney while the baby is still in the uterus." 3. "Wilms' tumor is especially prevalent in the Hispanic population." 4. "The cancer is often seen in children who live in areas near nuclear reactors."

ANSWER: 2 Rationale: 1. Nephroblastomas arise from embryonic tissue and develop over time.2. This statement is correct.3. Wilms' tumor is slightly more prevalent in the African American population. 4. This statement is untrue. TEST-TAKING TIP: Usually, the etiology of Wilms' is unknown. About 10% of patients who develop Wilms' were also born with a birth defect, about 2% of children with Wilms' have a family member who also was diagnosed with the tumor, and Wilms' is seen slightly more often in the African American population than in other ethnic groups.

A 6-year-old child with antistreptolysin antibodies and negative cultures is admitted to the pediatric unit with a diagnosis of acute poststreptococcal glomerular nephritis. It would be most appropriate for the nurse to admit the child into which of the following rooms? 1. Isolation room on droplet isolation with no roommate 2. Isolation room on droplet and contact isolation with a child with bronchiolitis 3. Regular patient room with 8-year-old child in traction for a broken femur 4. Regular patient room with 6-year-old child with diabetes for insulin control

ANSWER: 3 Rationale: 1. Isolation is not needed. The child has negative cultures. 2. Isolation is not needed. The child has negative cultures. 3. This would be the most appropriate room to place the child. Children in the early stages of AGN often remain in their beds because of marked fatigue. A child in traction would also be confined to his or her bed. 4. A child in the hospital for insulin control is likely up and about with no medically imposed or self-imposed activity restrictions. Although the children are the same age, their activity levels will be much different. TEST-TAKING TIP: One of the important actions of the pediatric nurse is the assignment of children to patient rooms. The nurse should take into consideration all aspects of each child's characteristics, including growth and development, activity levels, and potential for transmission of infection.

A 6-year-old child is admitted to the pediatric unit with a diagnosis of acute poststreptococcal glomerular nephritis. Which of the following toys/ activities would be most appropriate for the nurse to provide to the child? 1. Push and pull toy 2. Bean bags and target 3. Crayons and paper 4. Set of blocks

ANSWER: 3 Rationale: 1. Push and pull toys are appropriate for active toddlers.2. Bean bags would be appropriate for an active child who is angry at being confined to a bed.3. It would be most appropriate to provide the child with crayons and paper. The activity would not be too strenuous, and the child could express his or her feelings about being hospitalized in a drawing.4. A set of blocks would be appropriate for an active child who could get down onto the floor and build a tower. TEST-TAKING TIP: Toys and activities provided to sick children should be appropriate to the age without being overly challenging. Materials for drawing and painting are especially appropriate for school-age children because the art supplies enable the child to express him or herself through the art. In addition, puppets and dolls enable children to act out their frustrations through play.

A 7-year-old child has been prescribed desmopressin (DDAVP) 20 mcg intranasal (10 mcg in each nostril) for nocturnal enuresis. Which of the following information regarding the medication should the nurse include in the parent/child teaching session? 1. Child must consume at least five cups of fluid each day. 2. Medication should be stored in the freezer between administrations. 3. Severe headaches with blurred vision should be reported to the prescribing practitioner. 4. Spray should be administered into the nostrils while the child is lying supine with head extended.

ANSWER: 3 Rationale: 1. This statement is incorrect. The child's fluid intake should be restricted, especially before bedtime.2. This statement is incorrect. The medication should be kept in the refrigerator but should not be frozen.3. This statement is correct. If the dosage is too high, the child may develop adverse signs, including severe high blood pressure with headaches and blurred vision.4. This statement is incorrect. The child should be sitting upright, and the nasal spray bottle should be vertical during medication administration.TEST-TAKING TIP: Desmopressin is one of the few medications administered to children with nocturnal enuresis. It is important to monitor the child for possible side effects, including severe hypertension with headaches and blurred vision and injuries to the nasal mucosa.

An Orthodox Jewish couple deliver a baby boy with hypospadias. The parents state, "We are so excited. We are planning the baby's bris (ritual circumcision) for next week. Which of the following responses by the nurse is appropriate? 1. "I know how happy you must be. I know that you will have a wonderful party." 2. "If you are comfortable sharing the information, what Hebrew name do you plan to give your baby next week?" 3. "I understand how important it is to have a bris, but the baby will not be able to be circumcised next week." 4. "Do you have a mohel to perform the bris?I know how hard it is to locate one who you feel you can trust."

ANSWER: 3 Rationale: 1. It would be appropriate for the nurse to congratulate the couple, but this is not the most appropriate statement for the nurse to make.2. It is true that the baby's Hebrew name would be bestowed at the bris, but this is not the most appropriate statement for the nurse to make.3. This is the most appropriate statement for the nurse to make. The baby will not be able to be circumcised at the bris.4. It is true that a mohel is the individual who does the circumcision at a bris, but this is not the most appropriate statement for the nurse to make. TEST-TAKING TIP: When a baby is born with hypospadias, circumcisions are postponed until surgical correction of the urethra is performed. The surgeon will use the foreskin from the circumcision as grafting material for the reconstruction.

A young girl is being discharged from the pediatric unit after a left nephrectomy for Stage 1 Wilms' tumor of the left kidney and the first round of chemotherapy. The nurse is providing the parents with discharge planning. Which of the following statements should the nurse include? 1. Child will need to restrict fluids for the rest of his or her life. 2. Child will require dialysis until a kidney for transplant is found. 3. Child will be able to live a normal life after the surgical site heals. 4. Child will have to take antirejection medications after surgery.

ANSWER: 3 Rationale: 1. The child will not need to restrict fluids for the rest of his or her life. 2. The child still has one kidney. There will be no need for dialysis. 3. Child will be able to live a normal life after the surgical site heals. This statement is correct.4. The child did not receive a transplant. The child will not need to take antirejection medications after surgery. TEST-TAKING TIP: Stage 1 tumors are tumors that are completely encapsulated, are contained within one kidney, and completely removed during surgery. The prognosis is excellent following successful surgery.

An 8-year-old child is seen in the pediatrician's office for primary nocturnal enuresis. Which of the following nursing diagnoses should the nurse include in the child's nursing care plan? 1. Overflow Urinary Incontinence 2. Risk for Impaired Skin Integrity 3. Risk for Imbalanced Fluid Volume 4. Situational Low Self-Esteem

ANSWER: 4 Rationale: 1. The child is not experiencing overflow incontinence, which results from an overly distended bladder.2. The child's skin integrity is intact.3. The child is not experiencing imbalanced fluid volume. 4. Situational Low Self-Esteem is an appropriate nursing diagnosis for the nurse to include in the care plan. TEST-TAKING TIP: When older children are still wetting the bed, they often feel guilty and ashamed. Situational Low Self-Esteem is an appropriate nursing diagnosis for the nurse to include in the child's care plan.

A baby is admitted to the newborn nursery with a chordee penis. The nurse carefully assesses the baby for which of the following signs/symptoms? 1. Blood-tinged urine 2. Constant dripping of urine from the urethra 3. Absence of urinary output 4. Urine flowing from the under surface of the penis

ANSWER: 4 Rationale: 1. Babies with a chordee penis are not at high risk for blood-tinged urine.2. Babies with a chordee penis are not at high risk for constant urine dripping from the urethra. 3. Babies with a chordee penis are not at high risk for absence of urinary output.4. Babies with a chordee penis are at high risk for hypospadias. TEST-TAKING TIP: Nurses should be prepared to assess for birth defects that commonly accompany assessment findings. Babies who are born with a chordee penis (a penis that curves downward) should carefully be assessed for hypospadias, that is, for urine that exits from the underside of the penis.