PEDS CH 25 Renal

The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what?

2 to 3 years The peak age at onset for minimal change nephrotic syndrome is 2 to 3 years of age.

The nurse is preparing to admit a child to the hospital with a diagnosis of acute poststreptococcal glomerulonephritis. The nurse understands that the peak age at onset for this disease is what?

5 to 7 years The peak age at onset for acute poststreptococcal glomerulonephritis is 5 to 7 years of age.

Which laboratory finding, in conjunction with the presenting symptoms, indicates nephrosis? A. Hypoalbuminemia B. Low specific gravity C. Decreased hemoglobin D. Decreased hematocrit

A. Hypoalbuminemia Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into urine. Specific gravity is increased because of the large amount of protein. These measures would be elevated secondary to the hypovolemia. These measures would be elevated secondary to the hypovolemia.

A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply.) A. Vomiting B. Jaundice C. Swelling of the face D. Persistent diaper rash E. Failure to gain weight

A. Vomiting D. Persistent diaper rash E. Failure to gain weight Vomiting is a clinical manifestation observed in an infant with a urinary tract infection (UTI) and can be related to poor feeding. Persistent diaper rash is a clinical manifestation of UTI in an infant. Failure to gain weight is a clinical manifestation of UTI in an infant related to poor feeding and vomiting. Jaundice is not a clinical manifestation of UTI in an infant. Swelling of the face is not a clinical manifestation of UTI in an infant.

The nurse is caring for a child with Wilms' tumor. The MOST important nursing intervention before surgery is to: A. avoid abdominal palpation. B. closely monitor arterial blood gases. C. prepare child/family for long-term dialysis. D. prepare child/family for renal transplantation.

A. avoid abdominal palpation. Wilms' tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. This is not indicated before this abdominal surgery. This is not indicated unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative radiation and/or chemotherapy are used to minimize the size of the tumor. Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.

The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son. The nurse replies based on what knowledge?

Additional surgery may be necessary to achieve continence After repair of the bladder exstrophy, the child's bladder is allowed to increase capacity. Several surgical procedures may be necessary to create a urethral sphincter mechanism to aid in urination and ejaculation. With the lack of a urinary sphincter, toilet training is unlikely. The child cannot hold the urine in the bladder. Bladder capacity is one component of continence. A functional sphincter is also needed.

The nurse is admitting a 9-year-old child with hemolytic uremic syndrome. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

Anorexia Hypertension Purpura Clinical manifestations of hemolytic uremic syndrome include anorexia; hypertension; and purpura, which persists for several days to 2 weeks. Gross hematuria is seen in acute glomerulonephritis. Substantial proteinuria and periorbital edema are common manifestations in nephrotic syndrome.

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. The nurse's BEST reply is: A. "Blood pressure changes are a common side effect of antibiotic therapy." B. "Blood pressure changes are a sign that the condition has become chronic." C. "Acute hypertension, or high blood pressure, must be anticipated and identified." D. "Hypotension, or low blood pressure, leading to sudden shock can develop at any time."

C. "Acute hypertension, or high blood pressure, must be anticipated and identified." Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations do not indicate chronic disease. Most children with glomerulonephritis fully recover. Vital signs, in particular blood pressure, provide information about the severity of the disease and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Hypertension is more likely with glomerulonephritis.

A 3-year-old child is scheduled for surgery to remove a Wilms' tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's best response is: A. "No additional treatments are usually necessary." B. "Chemotherapy may be necessary." C. "Chemotherapy with or without radiation therapy is indicated." D. "Kidney transplant is indicated eventually."

C. "Chemotherapy with or without radiation therapy is indicated." Additional therapy is indicated after the tumor is removed. Radiation therapy may be necessary. This determination will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiation therapy is usually indicated. Most children with Wilms' tumor do not require renal transplants.

A 6-year-old child with acute renal failure is being transferred out of the intensive care unit. Considering their diagnoses, which child would be the MOST appropriate roommate for this child? A. 6-year-old child with pneumonia B. 4-year-old child with gastroenteritis C. 5-year-old child who has a fractured femur D. 7-year-old child who had surgery for a ruptured appendix

C. 5-year-old child who has a fractured femur These children have potentially infectious disease processes. These children have potentially infectious disease processes. The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin. These children have potentially infectious disease processes.

A child is receiving cyclosporine following a kidney transplant. The nurse should include which information in the teaching plan about this medication? (Select all that apply.) A. Optimal time to take medication to decrease pain B. Recommended foods to take with medication to enhance boosting of immunity C. Purpose of medication is to suppress rejection D. How to palpate pulses to check for improved circulation E. Frequent handwashing

C. Purpose of medication is to suppress rejection E. Frequent handwashing Cyclosporine is given to suppress rejection. Cyclosporine does not decrease pain, boost immunity, or improve circulation. When taking this medication, it is important to avoid others with contagious illnesses and to wash hands often, because it is an immunosuppressant medication.

An advantage of continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents that require dialysis is that: A. hospitalization is only required several nights per week. B. dietary restrictions are no longer necessary. C. adolescents can carry out procedures themselves. D. insertion of catheter does not require surgical placement.

C. adolescents can carry out procedures themselves. Procedure can be done at home. Dietary restrictions are still required but are less strict. This type of dialysis provides the most independence for adolescents with ESRD and their families. Adolescents can carry out the procedure themselves. The catheter is surgically implanted in the abdominal cavity.

A 5-year-old female child has been sent to the school nurse for urinary incontinence 3 times in the past 2 days. The nurse should recommend to her parent that the FIRST action is to have the child evaluated for: A. school phobia. B. emotional causes. C. possible urinary tract infection. D. possible structural defects of the urinary tract.

C. possible urinary tract infection. A physical cause of the problem needs to be eliminated before a psychologic cause is considered. A physical cause of the problem needs to be eliminated before a psychologic cause is considered. Incontinence in a previously toilet trained child can be an indication of a urinary tract infection. Structural defects would be explored after a urinary tract infection is confirmed.

What name is given to inflammation of the bladder?

Cystitis Cystitis is an inflammation of the bladder. Urethritis is an inflammation of the urethra. Urosepsis is a febrile urinary tract infection with systemic signs of bacterial infection. Bacteriuria is the presence of bacteria in the urine.

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed? A. Restraining child as necessary B. Discouraging parents from holding child C. Doing passive range-of-motion exercises once a day D. Adjusting activities to child's tolerance level

D. Adjusting activities to child's tolerance level Restraints should not be used. Parents should be encouraged to hold child. The child should be encouraged to move all extremities while in bed. The child will have a variable level of tolerance for activity. This will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child.

A toddler is hospitalized with acute renal failure secondary to severe dehydration. The nurse should assess the child for what possible complication? A. Hypotension B. Hypokalemia C. Hypernatremia D. Water intoxication

D. Water intoxication The child needs to be monitored for hypertension. Hyperkalemia is a concern in acute renal failure. Hyponatremia may develop in acute renal failure. The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes.

External defects of the genitourinary tract such as hypospadias are usually repaired as early as possible to: A. prevent urinary complications. B. prevent separation anxiety. C. promote acceptance of hospitalization. D. promote development of normal body image.

D. promote development of normal body image. Preventing urinary complications is important for defects that affect function, but all external defects should be repaired as soon as possible. Proper preprocedure preparation can facilitate coping with these issues. Proper preprocedure preparation can facilitate coping with these issues. This is extremely important. Surgery involving sexual organs can be very upsetting to children, especially preschoolers who fear mutilation and castration.

Urosepsis

Febrile urinary tract infection coexisting with systemic signs of bacterial illness

What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.)

Fever Diminished urinary output Swelling and tenderness of graft area The child with a kidney transplant who exhibits any of the following should be evaluated immediately for possible rejection: fever, diminished urinary output, and swelling and tenderness of graft area. Hypertension, not hypotension, and increased, not decreased, serum creatinine are signs of rejection.

In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information?

Have siblings examined for VUR Siblings are at high risk for VUR. The incidence of reflux in siblings is approximately 36%. The other children should be screened for early detection and to potentially reduce scarring. Fluids are not reduced. The efficacy of cranberry juice in reducing infection in children has not been established. Surgery may be necessary for higher grades of VUR, but the scarring is not reversible.

A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show?

Hematuria and proteinuria Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. Proteinuria generally parallels the hematuria but is not usually the massive proteinuria seen in nephrotic syndrome. Gross discoloration of urine reflects its red blood cell and hemoglobin content. Microscopic examination of the sediment shows many red blood cells, leukocytes, epithelial cells, and granular and red blood cell casts. Bacteria are not seen, and urine culture results are negative.

Cystitis

Inflammation of the bladder

Pyelonephritis

Inflammation of the upper urinary tract and kidneys

Urethritis

Inflammation of the urethra

What statement is an advantage of peritoneal dialysis compared with hemodialysis?

It is easy to learn and safe to perform Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis. Treatments are needed more frequently but can be done at home.

What statement is descriptive of renal transplantation in children?

It is the preferred means of renal replacement therapy in children. Renal transplantation offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

Urinary tract anomalies are frequently associated with what irregularities in fetal development?

Malformed or low-set ears Although unexplained, there is a frequent association between malformed or low-set ears and urinary tract anomalies. During the newborn examination, the nurse should have a high suspicion about urinary tract structure and function if ear anomalies are present. Children who have myelomeningocele may have impaired urinary tract function secondary to the neural defect. When other congenital defects are present, there is an increased likelihood of other issues with other body systems. Cardiac and extremity defects do not have a strong association with renal anomalies.

A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication?

Mannitol (Osmitrol) Furosemide (Lasix) Or both In ARF, if hydration is adequate, mannitol or furosemide (or both) is administered to provoke a flow of urine. If glomerular function is intact, an osmotic diuresis will occur. Propranolol is a beta-blocker; it will not produce a rapid flow of urine in ARF. Calcium gluconate is administered for its protective cardiac effect when hyperkalemia exists. It does not affect diuresis. Electrolyte measurements must be done before administration of sodium, chloride, or potassium. These substances are not given unless there are other large, ongoing losses. In the absence of urine production, potassium levels may be elevated, and additional potassium can cause cardiac dysrhythmias.

What do the clinical manifestations of minimal change nephrotic syndrome include?

Massive proteinuria, hypoalbuminemia, and edema Massive proteinuria, hypoalbuminemia, and edema are clinical manifestations of minimal change nephrotic syndrome. Hematuria and bacteriuria are not seen, and there is usually weight loss, not gain. The blood pressure is normal or hypotensive.

Persistent UTI

Persistence of bacteriuria despite antibiotic treatment

The nurse is caring for a child with a urinary tract infection who is on trimethoprim-sulfamethoxazole (Bactrim). What side effects of this medication should the nurse teach to the parents and the child? (Select all that apply.)

Rash Uticaria Photosensitivity Side effects of Bactrim are rash, urticaria, and photosensitivity. Pneumonitis and renal toxicity are not side effects of Bactrim.

The nurse is caring for an adolescent who has just started dialysis. The child always seems angry, hostile, or depressed. The nurse should recognize that this is most likely related to what underlying cause?

Resentment of the control and enforced dependence imposed by dialysis Older children and adolescents need to feel in control. Dialysis forces the adolescent into a dependent relationship, which results in these behaviors. Being angry, hostile, or depressed are functions of the age of the child, not neurologic or physiologic manifestations of the dialysis.

A child is admitted for minimal change nephrotic syndrome (MCNS). The nurse recognizes that the child's prognosis is related to what factor?

Response to steroid therapy Corticosteroids are the drugs of choice for MCNS. If the child has not responded to therapy within 28 days of daily steroid administration, the likelihood of subsequent response decreases. Blood pressure is normal or low in MCNS. It is not correlated with prognosis. Creatinine clearance is not correlated with prognosis. The presence of significant proteinuria is used for diagnosis. It is not predictive of prognosis.

What condition is the most common cause of acute renal failure in children?

Severe dehydration The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause?

Urinary stasis Urinary stasis is the single most important host factor that influences the development of UTIs. Urine is usually sterile but at body temperature provides an excellent growth medium for bacteria. Poor hygiene can be a contributing cause, especially in females because their short urethras predispose them to UTIs. Urinary stasis then provides a growth medium for the bacteria. Intermittent constipation contributes to urinary stasis. A full rectum displaces the bladder and posterior urethra in the fixed and limited space of the bony pelvis, causing obstruction, incomplete micturition, and urinary stasis. Congenital anomalies can contribute to UTIs, but urinary stasis is the primary factor in many cases.

What major complication is associated with a child with chronic renal failure?

Water and sodium retention Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

What signs and symptoms are indicative of a urinary tract disorder in the infancy period (1-24 months)? (Select all that apply.)

Pallor Poor feeding Excessive thirst Frequent urination Signs and symptoms of a urinary tract disorder in the infancy period are pallor, poor feeding, excessive thirst, and frequent urination. Hyperthermia is seen, not hypothermia.

What is the narrowing of preputial opening of foreskin called?

Phimosis Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

An infant has been diagnosed with bladder obstruction. What do symptoms of this disorder include?

Posturination dribbling Symptoms of bladder obstruction include poor force of urinary stream, intermittency of voided stream, feelings of incomplete bladder emptying, and posturination dribbling. They may also include urinary frequency, nocturia, nocturnal enuresis, and urgency. Renal colic is a symptom of upper urinary tract obstruction. Children with bladder obstruction have a weak urinary stream. Urinary tract infections are not associated with bladder obstruction.

Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what?

Promote development of normal body image Promoting development of normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Proper preprocedure preparation can facilitate coping with these issues. Preventing urinary complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible.

What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome?

Reduced serum albumin Total serum protein concentrations are reduced, with the albumin fractions significantly reduced. Specific gravity is high and proportionate to the amount of protein in the urine. Hemoglobin and hematocrit are usually normal or elevated. The platelet count is elevated as a result of hemoconcentration.

The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss?

Reduction of edema This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 lb in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

What diagnostic test allows visualization of renal parenchyma and renal pelvis without exposure to external-beam radiation or radioactive isotopes?

Renal ultrasonography The transmission of ultrasonic waves through the renal parenchyma allows visualization of the renal parenchyma and renal pelvis without exposure to external-beam radiation or radioactive isotopes. Computed tomography uses external radiation, and sometimes contrast media are used. Intravenous pyelography uses contrast medium and external radiation for radiography. Contrast medium is injected into the bladder through the urethral opening. External radiation for radiography is used before, during, and after voiding in voiding cystourethrography.

The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need?

Restricting fluids During the edematous stage of active nephrosis, the child has restricted fluid and sodium intake. As the edema subsides, the child is placed on a diet with increased salt and fluids. A regular diet is not indicated. There is no evidence that a diet high in protein is beneficial or has an effect on the course of the disease. Calories sufficient for growth and tissue healing are essential. With the child having little appetite and the fluid and salt restrictions, achieving adequate nutrition is difficult.

A 12-year-old child is injured in a bicycle accident. When considering the possibility of renal trauma, the nurse should consider what factor?

The amount of hematuria is not a reliable indicator of the seriousness of renal injury. Hematuria is consistently present with renal trauma. It does not provide a reliable indicator of the seriousness of the renal injury. Flank pain results from bleeding around the kidney. Most injuries that cause renal trauma in children are of the nonpenetrating or blunt type and usually involve falls, athletic injuries, and motor vehicle accidents. In children, the kidneys are more mobile, and the outer borders are less protected than in adults.

Parents of a child who will need hemodialysis ask the nurse, "What are the advantages of a fistula over a graft or external access device for hemodialysis?" What response should the nurse give? (Select all that apply.)

There are fewer complications with a fistula There is less restriction of activity with a fistula It produces dilation and thickening got the superficial vessels The creation of a subcutaneous (internal) arteriovenous fistula by anastomosing a segment of the radial artery and brachiocephalic vein produces dilation and thickening of the superficial vessels of the forearm to provide easy access for repeated venipuncture. Fewer complications and less restriction of activity are observed with the use of a fistula. Both the graft and the fistula require needle insertion at each dialysis. The fistula cannot be used immediately.

Identification and treatment of cryptorchid testes should be done by age 2 years. What is an important consideration?

Treatment is necessary to maintain the ability to be fertile when older. The longer the testis is exposed to higher body heat, the greater the likelihood of damage. To preserve fertility, surgery should be done at an early age. Surgical intervention is the treatment of choice. Simple orchiopexy is usually performed as an outpatient procedure. The surgical procedure restores the testes to the scrotum. This helps the boy to have both testes in the scrotum by school age. Sexual reassignment is not indicated when the testes are not descended.

A girl, age 5 1/2 years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for what condition?

Urinary tract infection (UTI) Girls between the ages of 2 and 6 years are considered high risk for UTIs. This child is showing signs of a UTI, including incontinence in a toilet-trained child and possible urinary frequency or urgency. A physiologic cause should be ruled out before psychosocial factors are investigated. Glomerulonephritis usually manifests with decreased urinary output and fluid retention. ADHD can contribute to urinary incontinence because the child is distracted, but the first manifestation was incontinence, not distractibility.

A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurse's best response?

Urine output will increase The first sign of improvement in acute glomerulonephritis is an increase in urinary output with a corresponding decrease in body weight. With diuresis, the child begins to feel better, the appetite improves, and the blood pressure decreases to normal with the reduction of edema. Gross hematuria diminishes, in part because of dilution of the red blood cells in the more dilute urine. Renal function and hypocomplementemia usually normalize by 8 weeks.

What urine test result is considered abnormal?

pH 4.0 The expected pH ranges from 4.8 to 7.8. A pH of 4.0 can be indicative of urinary tract infection or metabolic alkalosis or acidosis. Less than 1 or 2 white blood cells per milliliter is the expected range. The absence of protein is expected. The presence of protein can be indicative of glomerular disease. A specific gravity of 1.020 is within the anticipated range of 1.001 to 1.030. Specific gravity reflects level of hydration in addition to renal disorders and hormonal control such as antidiuretic hormone.

The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching?

"I should not add additional salt to any of my child's meals." Children with MCNS can be treated at home after the initial phase with appropriate discharge instructions, including a salt restriction of no additional salt to the child's meals. The child may return to school but should avoid exposure to infected playmates. Participation in contact sports is not affected by corticosteroid therapy. The parent does not need to measure the child's urine on a daily basis but may be instructed to test for albumin.

Surgery is performed on a child to correct cryptorchidism. The parents understand the reason for the surgery if they tell the nurse this was done to do what?

"Prevent damage to the undescended testicle." If the testes do not descend spontaneously, orchiopexy is performed before the child's second birthday, preferably between 1 and 2 years of age. Surgical repair is done to (1) prevent damage to the undescended testicle by exposure to the higher degree of body heat in the undescended location, thus maintaining future fertility; (2) decrease the incidence of malignancy formation, which is higher in undescended testicles; (3) avoid trauma and torsion; (4) close the processus vaginalis; and (5) prevent the cosmetic and psychologic disability of an empty scrotum. Parents understand the teaching if they respond the surgery is done to prevent damage.

A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone. The nurse realizes further teaching is required if the parents state what?

"We understand our child will not be able to attend school, so we will arrange for home schooling." The child with MCNS in remission can attend school. The child needs socialization and will be socially isolated if home schooled. The other statements are accurate for home care for a child with MCNS.

The nurse should recognize which laboratory value as being abnormal? A. pH: 4 B. Specific gravity: 1.020 C. Protein level: absent D. Glucose level: absent

A. pH: 4 The expected pH is 4.8 to 7.8. This is within the normal specific gravity range of 1.016 to 1.022. Protein should not be present in the urine. It would indicate an abnormality in glomerular filtration. Glucose should not be present. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations

In a non-potty-trained child with nephrotic syndrome, the best way to detect fluid retention is to: A. weigh the child daily. B. test the urine for hematuria. C. measure the abdominal girth weekly. D. count the number of wet diapers.

A. weigh the child daily. Measuring weight at the same time each day is the most accurate way to determine fluid gains and losses. The presence or absence of blood in the urine will not help with the determination of fluid retention. Abdominal girth is reflective of edema, but weekly is too infrequent a measure. The number of wet diapers reflects how often they have been changed. The diapers should be weighed to reflect fluid balance.

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. What knowledge should influence the nurse's reply?

Acute hypertension is a concern that requires monitoring. Blood pressure monitoring is essential to identify acute hypertension, which is treated aggressively. Antibiotic therapy is usually not indicated for glomerulonephritis. Hypertension, not hypotension, is a concern in glomerulonephritis. Blood pressure control is essential to prevent further renal damage. Blood pressure fluctuations do not provide information about the chronicity of the disease.

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually is associated with: A. incontinence. B. urinary obstruction. C. recurrent kidney infections. D. infarction of renal vessels.

C. recurrent kidney infections. Incontinence may be associated with urinary tract infections. When reflux is associated with vesicoureteral reflux, it can cause renal scarring but not obstruction. Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to kidney infections. Infarction of renal vessels does not occur.

A child is hospitalized in acute renal failure and has a serum potassium greater than 7 mEq/L. What temporary measures that will produce a rapid but transient effect to reduce the potassium should the nurse expect to be prescribed? (Select all that apply.)

Calcium gluconate Sodium bicarbonate Glucose 50% and insulin Several measures are available to reduce the serum potassium concentration, and the priority of implementation is usually based on the rapidity with which the measures are effective. Temporary measures that produce a rapid but transient effect are calcium gluconate, sodium bicarbonate, and glucose 50%, and insulin. Definitive but slower-acting measures are then implemented which include administration of a cation exchange resin such as sodium polystyrene sulfonate (Kayexalate), 1 g/kg, administered orally or rectally, and/or dialysis.

An important nursing consideration when caring for a child with end-stage renal disease (ESRD) is that: A. children with ESRD usually adapt well to the minor inconveniences of treatment. B. children with ESRD require extensive support until they outgrow the condition. C. multiple stresses are placed on children with ESRD and their families until the illness is cured. D. multiple stresses are placed on children with ESRD and their families because the children's lives are maintained by drugs and artificial means.

D. multiple stresses are placed on children with ESRD and their families because the children's lives are maintained by drugs and artificial means. ESRD is a complex disease process that requires substantial medical intervention. ESRD cannot be outgrown. Dialysis is necessary until renal transplantation is performed. ESRD cannot be cured. Dialysis is necessary until renal transplantation is performed. This is a chronic, progressive disease with dependence on technology. Families need to arrange for continuing examinations and procedures that are painful and may require hospitalization.

What measure of fluid balance status is most useful in a child with acute glomerulonephritis?

Daily weight A record of daily weight is the most useful means to assess fluid balance and should be kept for children treated at home or in the hospital. Proteinuria does not provide information about fluid balance. Specific gravity does not accurately reflect fluid balance in acute glomerulonephritis. If fluid is being retained, the excess fluid will not be included. Also proteinuria and hematuria affect specific gravity. Intake and output can be useful but are not considered as accurate as daily weights. In children who are not toilet trained, measuring output is more difficult.

For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs?

Diuresis occurs as urinary protein excretion diminishes Studies suggest that the duration of steroid treatment for the initial episode should be at least 3 months. In most patients, diuresis occurs as the urinary protein excretion diminishes within 7 to 21 days after the initiation of steroid therapy. The blood pressure is normal with MCNS, so remaining so is not an improvement. There is no urinary tract infection with MCNS.

What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema?

Elevate the scrotum with a rolled washcloth In children hospitalized with MCNS, elevating edematous parts may be helpful to shift fluid to more comfortable distributions. Areas that are particularly edematous, such as the scrotum, abdomen, and legs, may require support. The scrotum can be elevated with a rolled washcloth. Ice or heat should not be used. Sitting the child in an upright position will not decrease the scrotal edema.

The nurse is caring for a child with a urinary tract infection who is on intravenous gentamicin (Garamycin). What interventions should the nurse plan for this child with regard to this medication? (Select all that apply.)

Encourage fluids Monitor urinary output Monitor serum peak and trough levels Garamycin can cause renal toxicity and ototoxicity. Fluids should be encouraged and urinary output and serum peak and trough levels monitored. It is not necessary to monitor potassium sodium levels for patients taking this medication.

What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls?

Ensure clear liquid intake of 2 L/day Adequate fluid intake minimizes urinary stasis. The recommended fluid intake is 50 ml/kg or 100 ml/lb per day. The average 5- to 6-year-old weighs approximately 18 kg (40 lb), so she should drink 2 L/day of fluid. There is no evidence that using public toilet facilities increases UTIs. Long baths are not associated with increased UTIs. Proper hand washing and perineal cleansing are important, but no evidence exists that these decrease UTIs in young girls.

The parents of a child born with ambiguous genitalia tell the nurse that family and friends are asking what caused the baby to be this way. Tests are being done to assist in gender assignment. What should the nurse's intervention include?

Explain the disorder so they can explain it to others Explaining the disorder to parents so they can explain it to others is the most therapeutic approach while the parents await the gender assignment of their child. Ambiguous genitalia is a serious issue for the family. Careful testing and evaluation are necessary to aid in gender assignment to avoid lifelong problems for the child. Suggesting that parents avoid family and friends until the gender is assigned is impractical and would isolate the family from their support system while awaiting test results. The parents will be concerned. Telling them not to worry without giving them specific alternative actions would not be effective.

What signs and symptoms are indicative of a urinary tract disorder in the childhood period (2 to 14 years)? (Select all that apply.)

Fatigue Growth failure Blood in the urine Signs and symptoms of a urinary tract disorder in the childhood period are fatigue, growth failure, and blood in the urine. Edema is noted, not dehydration, and hypertension is present, not hypotension.

What dietary instructions should the nurse give to parents of a child undergoing chronic hemodialysis? (Select all that apply.)

Fluid restriction Sodium restriction Potassium restriction Dietary limitations are necessary in patients undergoing chronic dialysis to avoid biochemical complications. Fluid and sodium are restricted to prevent fluid overload and its associated symptoms of hypertension, cerebral manifestations, and congestive heart failure. Potassium is restricted to prevent complications related to hyperkalemia; phosphorus restriction helps prevent parathyroid hyperactivity and its attendant risk of abnormal calcification in soft tissues. Adequate protein, not high intake, is necessary to maximize growth potential. Fluid limitations are determined by residual urinary output and the need to limit intradialytic weight gain.

What signs and symptoms are indicative of a urinary tract disorder in the neonatal period (birth to 1 month)? (Select all that apply.)

Frequent urination Poor urinary stream Failure to gain weight Signs and symptoms of a urinary tract disorder in the neonatal period are frequent urination, poor urinary stream, and failure to gain weight. The respirations would be rapid, not slow, and dehydration, not edema, occurs.

Parents of a newborn with ambiguous genitalia want to know how long they will have to wait to know whether they have a boy or a girl. The nurse answers the parents based on what knowledge?

Gender assignment involves collaboration between the parents and a multidisciplinary team. Gender assignment is a complex decision-making process. Endocrine, genetic, social, psychologic, and ethical elements of sex assignment have been integrated into the process. Parent participation is included. The goal is to enable the affected child to grow into a well-adjusted, psychosocially stable person. Chromosome analysis usually takes 2 or 3 days. A physical examination reveals ambiguous genitalia, but additional testing is necessary. A "correct" gender may not be identifiable.

The nurse is caring for a child with acute renal failure. What laboratory findings should the nurse expect to find? (Select all that apply.)

Hyponatremia Hyperkalemia Elevated blood urea nitrogen level A child with acute renal failure would have hyponatremia, hyperkalemia, and elevated blood urea nitrogen levels. The child would have metabolic acidosis, not alkalosis, and the plasma creatinine levels would be increased, not decreased.

What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis?

Immune complex formation and glomerular deposition After a streptococcal infection, antibodies are formed, and immune-complex reaction occurs. The immune complexes are trapped in the glomerular capillary loop. Infarction of renal vessels occurs in renal involvement in sickle cell disease. Bacterial endotoxin deposition on and destruction of glomeruli is not a mechanism for postinfectious glomerulonephritis. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation is the pathology of renal involvement with bacterial endocarditis.

What diet is most appropriate for the child with chronic renal failure (CRF)?

Low in phosphorus Dietary phosphorus may need to be restricted by limiting protein and milk intake. Substances that bind phosphorus are given with meals to prevent its absorption, which enables a more liberal intake of phosphorus-containing protein. Protein is limited to the recommended daily allowance for the child's age. Further restriction is thought to negatively affect growth and neurodevelopment. Vitamin D therapy is administered in children with CRF to increase calcium absorption. Supplementation of vitamins A, E, and K, beyond normal dietary intake, is not advised in children with CRF. These fat-soluble vitamins can accumulate.

What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)?

Minimize excretion of urinary protein The objectives of therapy for the child with MCNS include reducing the excretion of urinary protein, reducing fluid retention, preventing infection, and minimizing complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Serum protein levels are already reduced as part of the disease process. This needs to be reversed. The tissue is already retaining fluid as part of the edema. The goal of therapy is to reduce edema.

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child?

Minimize risk of infection High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

What dietary instructions should the nurse give to parents of a child in the oliguria phase of acute glomerulonephritis with edema and hypertension? (Select all that apply.)

Moderate sodium restriction Limit foods high in potassium Dietary restrictions depend on the stage and severity of acute glomerulonephritis, especially the extent of edema. A regular diet is permitted in uncomplicated cases, but sodium intake is usually limited (no salt is added to foods). Moderate sodium restriction is usually instituted for children with hypertension or edema. Foods with substantial amounts of potassium are generally restricted during the period of oliguria. Protein restriction is reserved only for children with severe azotemia resulting from prolonged oliguria. A low-protein, high-fat diet with encouragement of fluids would not be recommended.

What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD)?

Multiple stresses are placed on children with ESRD and their families because children's lives are maintained by drugs and artificial means. Stressors on the family are often overwhelming because of the progressive deterioration. The child progresses from renal insufficiency to uremia to dialysis and transplantation, each of which requires intensive therapy and supportive care. The treatment of ESRD is intense and requires multiple examinations, dietary restrictions, and medications. Adherence to the regimen is often difficult for children and families because of the progressive nature of the renal failure. ESRD has an unrelenting course that has no known cure. Children do not outgrow the renal failure.

What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply.)

No salt added at the table Restriction of foods high in sodium The child with minimal change nephrotic syndrome maintains a regular diet, not soft. However, salt is restricted during periods of massive edema and while the patient is on corticosteroid therapy; no salt is added at the table, and foods with very high salt content are excluded. Although a low-sodium diet will not remove edema, its rate of increase may be reduced. Water is seldom restricted. A diet generous in protein is logical, but there is no evidence that it is beneficial or alters the outcome of the disease.

A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take?

Obtain the child's blood pressure and notify the health care provider. The premonitory signs of encephalopathy are headache, dizziness, abdominal discomfort, and vomiting. If the condition progresses, there may be transient loss of vision or hemiparesis, disorientation, and generalized tonic-clonic seizures. The health care provider should be notified of these symptoms.