PEDS Ch. 21 GU Prepu

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? a) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." b) "Girls tend to urinate less frequently than boys, making them more susceptable to UTI's." c) "It is unlikely that your daughter is practicing good cleaning habits after she voids." d) "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." 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 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?

"Emotional stress can be a cause of this disorder." Explanation: 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 does not cause secondary amenorrhea.

The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition?

"Our son's condition may resolve on its own." Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended.

A nurse is caring for a 10-year-old boy with nocturnal enuresis with no physiologic cause. He says he is embarrassed and wishes he could stop immediately. How should the nurse respond? a) "There are almost 5 million people that have enuresis." b) "There are several things we can do to help you achieve this goal." c) "You will grow out of this eventually; you just need to be patient." d) "The pull-ups look just like underwear; no one has to know."

"There are several things we can do to help you achieve this goal." 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 conducting a routine wellness examination of a 13-year-old girl. Which question would be best to use when beginning to discuss her sexual behavior? a) "Do you talk to your mom about sex?" b) "Are you curious about sex?" c) "Are you sexually active?" d) "What do you like to do on the weekend?"

"What do you like to do on the weekend?" The best approach is to start with questions about friends and social life, moving the conversation toward sexual behavior. The direct approach is less effective with adolescents.

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? a) Hypertension b) Hypotension c) Hypothermia d) Tachycardia

HTN Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

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

A) 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 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.

______________ ___________ involves the bladder lying open and exposed on the abdomen.

Bladder exstrophy

The condition in which one or both of the testes does not descend in the male infant is referred to as:

Cryptorchidism

A parent is asking how she can help her son deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? a) Discuss how child can continue to go to the bathroom instead of in the underwear. b) Demonstrate love and acceptance at home. c) Take away a toy every time the child urinates in their pants. d) Demonstrate how to urinate in the bathroom every time.

Demonstrate love and acceptance at home. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.

The nurse obtains a history from the mother of a child with glomerulonephritis about how he became ill. What would the nurse expect her to tell you she noticed? a) Diuresis and pallor b) Loss of weight, oliguria c) Dirty green urine d) Headache, loss of appetite

Dirty green urine Acute glomerulonephritis often presents with glomeruli bleeding. Inspect the urine for gross hematuria, which will cause the urine to appear tea colored, cola colored, or even a dirty green color.

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 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.

the urethral opening is on the dorsal surface of the penis

Epispadias

The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. The nurse documents this finding as: a) Epispadias b) Hypospadias c) Bladder exstrophy d) Patent urachus

Hypospadias Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis.

Most urinary tract infections seen in children are caused by: a) Fungal infections b) Hereditary causes c) Dietary insufficiencies d) Intestinal bacteria

Intestinal bacteria 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.

An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection? a) Acyclovir b) Doxycycline c) Miconazole d) Ceftriaxone e) Metronidazole

Metronidazole Metronidazole is used to treat a trichomonal infection. Miconazole is used to treat candidiasis. Doxycycline is used to treat a chlamydial infection. Acyclovir is used to treat herpes genitalis. Ceftriaxone is used to treat gonorrhea.

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? a) Age b) Race c) Age at first menses d) Number of sexual partners

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.

_________ ____________ refers to a fistula between the bladder and umbilicus.

Patent urachus

inflammation of the kidney and renal pelvis=

Pyelonephritis

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant? a) Risk for infection related to immunocompromised state b) Constipation related to effects of administered drugs c) Pain related to tissue rejection d) Deficient fluid volume related to fluid intake restrictions postoperatively

Risk for infection related to immunocompromised state Children are administered anti-immune therapies to lower immune system response and help prevent rejection following a transplant; this leaves them susceptible to infection.

The mother of 6-month-old girl is concerned about her daughter getting a urinary tract infection. What should the nurse mention to the mother to help prevent this condition? a) Bathe the child with bubble bath once a week. b) Wipe from back to front when changing the girl's diaper. c) Report any abnormally colored urine to the child's primary care provider. d) Discontinue prescribed antibiotics once symptoms of UTI have disappeared.

Report any abnormally colored urine to the child's primary care provider. 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.

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

Risk for infection 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.

The nurse is caring for a 10-year-old boy with end-stage renal disease (ESRD) with metabolic acidosis. What would the nurse expect to administer if ordered? a) Erythropoietin b) Sodium bicarbonate tablets c) Vitamin D d) Ferrous sulfate

Sodium bicarbonate tablets 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 renal disease (ESRD) with metabolic acidosis. What would the nurse expect to administer if ordered? a) Ferrous sulfate b) Sodium bicarbonate tablets c) Vitamin D d) Erythropoietin

Sodium bicarbonate tablets 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.

A 16-year-old tells you she has terrible dysmenorrhea. Which action would be the best health teaching measure regarding this?

Take over-the-counter ibuprofen for its prostaglandin action.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to do which action? a) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. b) Weigh the child in the same clothes she had been weighed in the day before and report the two weights to the nurse while the nurse is on the phone. c) Give the child fluids and report back to the nurse in a few hours. d) Give the child a diuretic and report back to the nurse in a few hours.

Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

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

Testis cannot be "milked" down inguinal canal 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 cannot be "milked" down inguinal canal Correct

The nurse knows this is a description of peritoneal dialysis when compared to hemodialysis: a) The child must go into a facility to get peritoneal dialysis. b) The child can live a more normal lifestyle. c) There are strict diet and fluid restrictions. d) Therapy is only 3 to 4 days per week.

The child can live a more normal lifestyle. The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

A nurse is discussing with a family the various causes of their child's vulvovaginitis. What would be included in the education? a) Constipation is a common cause of vulvovaginitis. b) Child protective services will be called since this is a sign of abuse. c) The use of cleansing towelettes may have caused the vulvovaginitis. d) Fevers often occur with vulvovaginitis.

The use of cleansing towelettes may have caused the vulvovaginitis. Cleansing towelettes can contain harsh soaps that can cause vulvovaginitis. This is a common childhood problem and not necessarily a sign of abuse.

A parent asks if their newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? a) If the infant is having swelling or pain, then surgery will be performed. b) This problem needs to be corrected immediately in the newborn period. c) There is a chance the testicles will descend on their own. d) Surgery is not needed for this type of problem.

There is a chance the testicles will descend on their own. The AAP 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 old. This problem does not cause pain or swelling.

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?

Thick, white cheese-like discharge

Urine that stands at room temperature for any length of time changes composition. a) False b) True

True For best results, specimens collected should be fresh because urine that stands at room temperature for any length of time changes composition.

A 12-year-old girl reports pain and a burning sensation on urination. The nurse suspects a urinary tract infection. Which diagnostic test would be most appropriate for confirming this condition? a) Urine culture b) Urinalysis c) Renal biopsy d) Radioisotope scanning

Urine culture A urinary tract infection (UTI), or the presence of bacteria in urine, is diagnosed by urine culture. Urinalysis involves use of a chemical reagent strip to detect glucose, protein, and occult blood and to measure pH, as well as use of a refractometer to measure specific gravity. Radioisotope scanning is used to assess glomeruli filtration ability. Renal biopsy involves passing a thin biopsy needle into the kidney through the skin over the kidney and is used to diagnose the extent of renal disease and thereby predict disease outcome or progress or reveal beginning rejection of a transplanted kidney.

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? a) Weigh the new dialysate b) Empty the old dialysate c) Start the process over with a fresh bag d) Weigh the old dialysate

Weigh the old dialysate 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.

A nurse is caring for a 13-year-old boy with end-stage renal disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate? a) Take his blood pressure measurement in extremity with AV fistula b) Administer his routine medications as scheduled c) Assess the Tenckhoff catheter site d) Withhold his routine medication until after dialysis is completed

Withhold his routine medication until after dialysis is completed The nurse should withhold routine medications on the morning that hemodialysis is scheduled since they would be filtered out through the dialysis process. His medications should be administered after he returns from the dialysis unit. A Tenckhoff catheter is used for peritoneal dialysis, not hemodialysis. The nurse should avoid blood pressure measurement in the extremity with the AV fistula as it may cause occlusion.

The nurse knows this is a description of peritoneal dialysis when compared to hemodialysis: a) Therapy is only 3 to 4 days per week. b) The child can live a more normal lifestyle. c) There are strict diet and fluid restrictions. d) The child must go into a facility to get peritoneal dialysis.

You selected: The child can live a more normal lifestyle. The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

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 degrees Fahrenheit. The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: a) acute glomerulonephritis. b) rheumatic fever. c) lipoid nephrosis (idiopathic nephrotic syndrome). d) a urinary tract infection.

acute glomerulonephritis. 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 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:

amenorrhea.

edema in the peritoneal cavity=

ascites

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration the nurse would want to prepare the parents for is: a) the need for complete bed rest for 10 days. b) a liquid diet for 3 days. c) the need for maintaining a semi-Fowler position. d) some discomfort at the surgery site.

d) some discomfort at the surgery site. After they are returned to the scrotum, testes may be sutured there to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation.

subnormal volume of urine=

oliguria

A 12-year-old girl who has not yet reached menarche comes to the pediatrician's office for her annual well-child check. As the nurse is weighing and measuring her, the child says emphatically that she does not want to get her period. Which response would be most appropriate for the nurse to make to this child? a) "Are you afraid of getting pregnant?" b) "What have you heard about it that makes you worried?" c) "But it's a good thing, having a period is a part of growing up." d) "Do you think it will hurt?"

"What have you heard about it that makes you worried?" The beginning of menstruation, called menarche, normally occurs between the ages of 12 and 13 years. For many girls this is a joyous affirmation of their womanhood, but others may have negative feelings about the event depending on how they have been prepared for menarche and for their roles as women. The nurse would need to explore the child's understanding of the implications of menarche.

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? a) Absence of a thrill b) Dialysate without fibrin or cloudiness c) Presence of a thrill d) Presence of a bruit

Absence of a thrill 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 educating the parents of an infant after a circumcision. The parents demonstrate understanding when they state that they need to report what to the physician? a) Appearance of granulation tissue b) Bleeding that stops without pressure c) Small spots of blood on diaper d) The infant does not urinate within 6 to 8 hours

The infant does not urinate within 6 to 8 hours The parents should immediately notify the physician or nurse practitioner if the infant does not urinate within 6 to 8 hours after the procedure. Small spots of blood on the diaper, bleeding that stops without pressure, and granulation tissue are normal findings.

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, the nurse would want to prepare her to: a) void during the procedure. b) drink three glasses of water during the procedure. c) have a local anesthetic injected prior to the procedure. d) anticipate a headache afterward.

void during the procedure. A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to: a) talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted disease and discuss the importance of safe sex practices. b) take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. c) take the child to a private room and interview her regarding her sexual history and partners. d) contact the necessary authorities to report a suspected case of sexual abuse.

A) take the child to a private room and interview her regarding her sexual history and partners. Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.

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 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.

A milky, gray discharge with a fishy odor suggests

gardnerella

A yellow-green vaginal discharge suggests

gonorrhea.

Fluid in the scrotal sac is a...

hydrocele

. Testis that can be brought into the scrotum refers to a...

retractile testis

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration the nurse would want to prepare the parents for is: a) the need for complete bed rest for 10 days. b) some discomfort at the surgery site. c) a liquid diet for 3 days. d) the need for maintaining a semi-Fowler position.

some discomfort at the surgery site. After they are returned to the scrotum, testes may be sutured there to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation.

A frothy, gray-green vaginal discharge

trichomoniasis

A venous varicosity along the spermatic cord is a...

varicocele

A child needs to collect urine for 24 hours and the nurse explains that this test assesses glomerular filtration rate and how the kidneys are functioning. What would be indicative of this type of test? a) Urinalysis for casts and bacteria b) Urine culture and sensitivity c) Creatinine clearance d) Microscopic studies for RBC casts

Creatinine clearance A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate.

A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate?

Creatinine clearance rate The 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 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? a) Giving desmopressin intranasally b) Practicing bladder-stretching exercises c) Engaging the child in stress reduction measures d) Encouraging fluid intake after dinner

Encouraging fluid intake after dinner 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.

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

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." 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 caregiver of a 1-year-old son calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment? a) "Without the hormone your son will have fluid that will collect in his scrotum." b) "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do." c) "Without the treatment your child's gonads will not reach normal size." d) "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."

"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." Correct Explanation: Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processus does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.

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

"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 group of nursing students is discussing terminology related to the genitourinary system during a post-conference setting. One of the students asks what mittelschmerz is or what it means. A classmate of this student correctly answers that mittelschmerz is:

A dull, aching abdominal pain at ovulation Mittelschmerz is a dull, aching abdominal pain at the time of ovulation (hence the name, which means "midcycle"). The beginning of menstruation is called menarche. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Nonsteroidal, anti-inflammatory drugs (NSAIDs), such as ibuprofen (advil, motrin) inhibit prostaglandins and are the treatment of choice for primary dysmenorrhea, which is painful menstruation.

A 16-year-old girl visits her gynecologist with a complaint of metrorrhagia, or bleeding between menstrual periods, since her last visit 3 months ago. On consulting the client's chart, the nurse learns that she was prescribed an oral contraceptive at her last visit. Which intervention should the nurse implement in this situation? a) Recommend that she ask the gynecologist to change her prescription to a different oral contraceptive. b) Recommend that she ask the gynecologist about endometrium ablation to halt the metrorrhagia. c) Refer the client to her primary care physician for examination for possible uterine or cervical cancer. d) Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that.

Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that. Metrorrhagia is bleeding between menstrual periods. This may occur in teenagers taking oral contraceptives (breakthrough bleeding) during the first 3 or 4 months of use. If metrorrhagia occurs for more than one menstrual cycle in a teenager who is not taking oral contraceptives (which is not the case here), she be referred to her primary care provider for examination, because abnormal vaginal bleeding is an early sign of uterine or cervical carcinoma or an ovarian cyst. Endometrium ablation, used with premenopausal women to halt metrorrhagia, is not recommended for adolescents. There is no need at this point for the client to change prescriptions, as the bleeding will likely go away in the next month or so as the client's body adapts to the current contraceptive.

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 one-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? a) The child has a urinary tract infection due to not bathing while on the fishing trip b) The child has been sexually abused, maybe on the fishing trip c) The child did not want to go on the fishing trip and is now retaliating against being made to go d) 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 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.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to: a) talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted disease and discuss the importance of safe sex practices. b) take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. c) contact the necessary authorities to report a suspected case of sexual abuse. d) take the child to a private room and interview her regarding her sexual history and partners.

take the child to a private room and interview her regarding her sexual history and partners. Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.

In caring for a child with a urinary tract infection, the nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse? a) Observe the child for signs of any reactions to the antibiotics. b) Instruct caregivers to avoid bubble baths, especially in young girls. c) Record and report any indications of urinary burning, frequency, or urgency. d) Observe for possible indications of sexual abuse. e) Collect a "clean catch" voided urine. f) Teach girls to wipe from front to back.

• Collect a "clean catch" voided urine. • Observe the child for signs of any reactions to the The nurse would collect the "clean catch" voided urine specimen before any treatment is started to increase the likelihood of being able to identify the bacterium causing the infection. A priority when giving antibiotics is to always observe for signs of any adverse reaction to the medication. Reporting and recording urinary symptoms and observing for possible sexual abuse would be appropriate but not the priority. Instructing caregivers about avoiding bubble baths and teaching girls to wipe from front to back would be important later in the care of the child.