Pediatric Success - Chapter 8 - Genitourinary

Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)? 1. Avoiding constipation has no effect on the occurrence of UTIs. 2. After urinating, always wipe from back to front to prevent fecal contamination. 3. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. 4. Increasing fluids will help prevent and treat UTIs.

*4. Increasing fluids will help flush the bladder of any organisms, encourage urination, and prevent stasis of urine.

The nurse evaluates postoperative teaching for repair of testicular torsion as successful when the parent of an adolescent says which the following? 1. "I will encourage him to rest for a few days, but he can return to football practice in a week." 2. "I will keep him in bed for 4 days and let him gradually increase his activity after that." 3. "I will seek therapy as he ages because he is now infertile." 4. "I will make sure he does testicular self-examination monthly."

*4. The child and family should be taught the importance of testicular self-examination.

Which combination of signs is commonly associated with glomerulonephritis? 1. Massive proteinuria, hematuria, decreased urinary output, and lethargy. 2. Mild proteinuria, increased urinary output, and lethargy. 3. Mild proteinuria, hematuria, decreased urinary output, and lethargy. 4. Massive proteinuria, decreased urinary output, and hypotension.

3. Mild-to-moderate proteinuria, hematuria, decreased urinary output, and lethargy are common findings in glomerulonephritis.

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse ' s best responses? Select all that apply. 1. "Your child ' s urine output will increase, and the urine will become less tea-colored." 2. "Your child will have more energy as lab tests become more normal." 3. "Your child ' s appetite will decrease as urine output increases." 4. "Your child ' s laboratory values will become more normal." 5. "Your child ' s weight will increase as the urine becomes less tea-colored."

1, 5. 1. When glomerulonephritis is improving, urine output increases, and the urine becomes less tea-colored. These are signs that can be monitored at home by the child ' s parents. 5. The child ' s weight will increase as the urine resumes a more normal color, indicating lab values are returning to normal and the child is better.

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse ' s best response? 1. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." 2. "There is blood in your child ' s urine that causes it to be tea-colored." 3. "Your child ' s urine is very concentrated, so it appears to be discolored." 4. "A ketogenic diet often causes the urine to be tea-colored."

2. Blood in the child ' s urine causes it to be tea-colored.

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse ' s best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)? 1. Carefully cleanse the perineum from front to back and apply a self-adhesive urine collection bag to the perineum. 2. Insert an indwelling Foley catheter, obtain the sample, and wait for results. 3. Place a sterile cotton ball in the diaper and immediately obtain the sample with a syringe after the first void. 4. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample.

4. An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained.

A child with hemolytic uremic syndrome (HUS) is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects administration of blood products and what else to be added to the plan of care? 1. Initiation of dialysis. 2. Close observation of the child ' s hemodynamic status. 3. Diuretic therapy to force urinary output. 4. Monitoring of urinary output.

*1. Because the child is symptomatic, dialysis is the treatment of choice.

Which child is at risk for developing glomerulonephritis? 1. A 3-year-old who had impetigo 1 week ago. 2. A 5-year-old with a history of fi ve UTIs in the previous year. 3. A 6-year-old with new-onset type 1 diabetes. 4. A 10-year-old recovering from viral pneumonia.

*1. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis.

Which causes the symptoms in testicular torsion? 1. Twisting of the spermatic cord interrupts the blood supply. 2. Swelling of the scrotal sac leads to testicular displacement. 3. Unmanaged undescended testes cause testicular displacement. 4. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

*1. Testicular torsion is caused by an interruption of the blood supply due to twisting of the spermatic cord.

The manifestations of hemolytic uremic syndrome (HUS) are due primarily to which event? 1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia. 2. There is a disturbance of the glomerular basement membrane, allowing large proteins to pass through. 3. The red blood cell changes shape, causing it to obstruct microcirculation. 4. There is a depression in the production of all formed elements of the blood.

*1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen.

A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? 1. Obtain urinalysis and urine culture. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Send home on an antibiotic. 5. Schedule a VCUG.

*1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a renal ultrasound shows scaring or possible reflux. If the child has a UTI related to bubble baths, constipation, or wiping back to front, a VCUG would not be ordered.

The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The child ' s parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

*2. Secondary enuresis refers to urinary incontinence in a child who previously had bladder control.

Which needs to be present to diagnose hemolytic uremic syndrome (HUS)? 1. Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure. 2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure. 3. Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure. 4. Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure.

*2. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure.

Which finding requires immediate attention in a child with glomerulonephritis? 1. Sleeping most of the day and being very "cranky" when awake; blood pressure is 170/90. 2. Urine output is 190 mL in an 8-hour period and is the color of Coca-Cola. 3. Complaining of a severe headache and photophobia. 4. Refusing breakfast and lunch and stating he "just is not hungry."

*3. A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention.

Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)? 1. A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats per minute. 2. A 4-year-old female who states, "It hurts when I pee"; she has been urinating every 30 minutes; vital signs are within normal range. 3. An 8-year-old male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. 4. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; oral temperature of 101.5°F (38.6°C).

*3. Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time.

A 5-year-old is discharged from the hospital following the diagnosis of hemolytic uremic syndrome (HUS). The child has been free of diarrhea for 1 week, and renal function has returned. The parent asks the nurse when the child can return to school. Which is the nurse ' s best response? 1. "Immediately, as your child is no longer contagious." 2. "It would be best to keep your child home for a few more weeks because the immune system is weak, and there could be a relapse of HUS." 3. "Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet." 4. "It would be best to keep your child home to monitor urinary output."

*3. Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation.

Which laboratory results besides hematuria are most consistent with hemolytic uremic syndrome (HUS)? 1. Massive proteinuria, elevated blood urea nitrogen and creatinine. 2. Mild proteinuria, decreased blood urea nitrogen and creatinine. 3. Mild proteinuria, increased blood urea nitrogen and creatinine. 4. Massive proteinuria, decreased blood urea nitrogen and creatinine.

*3. Hematuria, mild proteinuria, and increased BUN and creatinine are all present in HUS.

The parent of a 7-year-old voices concern over the child ' s continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. Which is the nurse ' s best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

*3. Limiting the child ' s fluids in the evening will help decrease the nocturnal urge to void. Providing positive reinforcement and allowing the child to choose a reward will increase the child ' s sense of control.

An adolescent woke up complaining of intense pain and swelling of the scrotal area and abdominal pain. He has vomited twice. Which should the nurse suggest? 1. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the emergency room. 2. Bring him to the health-care provider ' s office for evaluation. 3. Take him to the emergency department immediately. 4. Encourage him to rest; apply ice to the scrotal area and go to the emergency department if the pain does not improve.

*3. The child is having symptoms of testicular torsion, which is a surgical emergency and needs immediate attention.

Which would the nurse most likely find in the history of a child with hemolytic uremic syndrome (HUS)? Select all that apply. 1. Frequent UTIs and possible vesicoureteral reflux (VUR). 2. Vomiting and diarrhea before admission. 3. Bee sting and localized edema of the site for 3 days. 4. Previously healthy with no signs of illness. 5. Anorexia and bruising.

2, 5. 2. HUS is often preceded by diarrhea that may be caused by E. coli present in undercooked meat. 5. Anorexia and bruising (purura and/ or petechiae) are common clinical manifestations.

An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse ' s best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize sexual functioning when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

3. Releasing the chordee surgically is necessary for future sexual function.