PEDS Chapter 44: The Child with a Genitourinary Alteration

A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply. a. Administration of antihypertensive medications b. Daily weights c. Salt-restricted diet d. Frequent position changes e. Teaching parents to expect tea-colored urine

ANS: B, C, D Correct A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Incorrect Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis, but not nephrotic syndrome. The urine in nephrotic syndrome is frothy indicating protein is being lost in the urine.

The care of the child with chronic renal failure is complex and requires a multidisciplinary team approach. Most of these children will ultimately require dialysis. Is this statement true or false?

ANS: T This statement is correct. Children and their families will be most successful with dialysis treatment if the method chosen fits their lifestyle. The goal is to optimize physical, social, and emotional development while addressing the complex physical requirements related to chronic renal failure.

The nurse closely monitors the temperature of a child with nephrotic syndrome. The purpose of this is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A A An exacerbation of the disease can occur after an infection . B Temperature is not an indication of hypertension or edema. C Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms. D Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? Select all that apply. a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E Correct The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Incorrect Enuresis and voiding urgency should be assessed in an older child.

The extrusion of the bladder to the outside of the body through a developmental defect in the abdominal wall is known as bladder _________.

ANS: exstrophy The exposed bladder is covered with nonadherent plastic wrap until surgery can be done. Surgical management is completed in several stages and includes closing the abdominal defect and reconstructing the bladder and genitalia to allow the child to achieve urinary incontinence.

A nurse is teaching a class on acute renal failure. The nurse relates that acute renal failure as a result of hemolytic-uremic syndrome (HUS) is classified as? a. Intrarenal b. Prerenal c. Postrenal d. Chronic

ANS: A A Intrarenal acute renal failure is the result of damage to kidney tissue. Possible causes of intrarenal acute renal failure are HUS, glomerulonephritis, and pyelonephritis. B Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. C Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature. D Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

ANS: A A Prophylactic antibiotics are used to prevent urinary infection in a child with vesicoureteral reflux, although this treatment plan has become controversial. B Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. C Bubble baths should be avoided to prevent urethral irritation and possible UTI. D To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

Which dietary modification is appropriate for a child with chronic renal failure? a. Decreased protein b. Decreased fat c. Increased potassium d. Increased phosphorus

ANS: A A Protein intake is restricted because of the kidney's inability to remove waste products. B A low-fat diet is not relevant to chronic renal failure. C Potassium intake may be restricted because of the kidney's inability to remove it. D Phosphorus is restricted to help prevent bone disease.

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine. The nurse's response is based on the knowledge that the presence of casts in the urine indicates? a. Glomerular injury b. Glomerular healing c. Recent streptococcal infection d. Excessive amounts of protein in the urine

ANS: A A The presence of red blood cell casts in the urine indicates glomerular injury. B Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. C A urinalysis positive for casts does not confirm a recent streptococcal infection. D Casts in the urine are unrelated to proteinuria.

The primary clinical manifestations of acute renal failure are? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

ANS: A A The principal feature of acute renal failure is oliguria. B These are not principal features of acute renal failure. C These are not principal features of acute renal failure. D These are not principal features of acute renal failure.

A child is admitted with acute glomerulonephritis. The nurse expects the urinalysis during this acute phase to show? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

ANS: B A Bacteriuria and changes in specific gravity are not usually present during the acute phase. B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. C Bacteriuria and changes in specific gravity are not usually present during the acute phase. D Bacteriuria and changes in specific gravity are not usually present during the acute phase.

The narrowing of preputial opening of foreskin is called? a. Chordee b. Phimosis c. Epispadias d. Hypospadias

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

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult, since a relatively normal lifestyle is not possible.

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

You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS). Which bacterial infection was most likely the cause of HUS? a. Pseudomonas aeruginosa b. Escherichia coli c. Streptococcus pneumoniae d. Staphylococcus aureus

ANS: B A Pseudomonas aeruginosa is not associated with HUS. B Children with HUS become infected by Escherichia coli, which is usually contracted from eating improperly cooked meat or contaminated dairy products. C Streptococcus pneumoniae is not associated with HUS. D Staphylococcus aureus is not associated with HUS.

Parents ask the nurse "when should our child's hypospadias be corrected?" The nurse responds based upon the knowledge that correction of hypospadias should be accomplished by the time the child is? a. 1 month of age b. 6 to 12 months of age c. School age d. Sexually mature

ANS: B A Surgery to correct hypospadias is not performed when the infant is this young. B The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. C It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. D Corrective surgery for hypospadias is done long before sexual maturity.

Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission? a. Urine is negative for casts for 5 days. b. Urine is up to a trace for protein for 5 to 7 days. c. Urine is positive for glucose for 1 week. d. Urine is up to a trace for blood for 1 week.

ANS: B A The absence of casts in the urine gives no indication about the child's response to treatment. The child with primary nephrotic syndrome is considered to be in remission when the urine is negative for protein for 5 to 7 consecutive days. B The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine is up to trace for protein for 5 to 7 days. C Remission is achieved when the urine is negative for protein for 5 to 7 consecutive days. It is not unusual for glucose to test positive if the child is taking prednisone. D The presence or absence of hematuria is not used to determine remission in primary nephrotic syndrome.

What is an appropriate intervention for a child with nephrotic syndrome who is edematous? a. Teach the child to minimize body movements. b. Change the child's position every 2 hours. c. Avoid the use of skin lotions. d. Bathe every other day.

ANS: B A The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. B Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. C Applying lotion to the skin helps to increase circulation. D Bathing daily removes irritating body secretions from the skin.

Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B A This offers protective measures against UTIs. B The short urethra in females provides a ready pathway for invasions of organisms. C Prostatic secretions have antibacterial properties that inhibit bacteria. D This offers protective measures against UTIs.

Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs)? a. "I always wear cotton underwear." b. "I really enjoy taking a bubble bath." c. "I go to the bathroom every 3 to 4 hours." d. "I drink four to six glasses of fluid every day."

ANS: B A It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture. B Bubble baths should be avoided because they tend to cause urethral irritation, which leads to UTI. C Children should be encouraged to urinate at least four times a day. D An adequate fluid intake prevents the buildup of bacteria in the bladder.

Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts? a. Acute viral gastroenteritis b. Acute glomerulonephritis c. Hemolytic-uremic syndrome d. Acute nephrotic syndrome

ANS: C A Anemia and thrombocytopenia are not associated with acute gastroenteritis. B The symptoms described are not suggestive of acute glomerulonephritis. C Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea. D The symptoms described are not suggestive of nephrotic syndrome.

A major complication in a child with chronic renal failure is a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

ANS: C A Hyperkalemia is a complication of chronic renal failure. B Metabolic acidosis is a complication of chronic renal failure. C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. D Retention of blood urea nitrogen is a complication of chronic renal failure.

Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyperalbuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria

ANS: D A Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss. B ASO titer is negative in a child with primary nephrotic syndrome. C Leukocytosis is not a diagnostic finding in primary nephrotic syndrome. D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane.

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

ANS: C A In acute poststreptococcal glomerulonephritis the urine output may be decreased. B In acute poststreptococcal glomerulonephritis blood pressure may be increased. C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. D Edema may be noted around the eyelids and ankles in patients with acute poststreptococcal glomerulonephritis; however, weight gain is associated with nephrotic syndrome.

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is? a. Risk for Injury related to malignant process and treatment b. Deficient Fluid Volume related to excessive losses c. Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces

ANS: C A No malignant process is involved in acute glomerulonephritis. B Excess fluid volume is found. C Glomerulonephritis has a decreased filtration of plasma. The resulting decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. D The fluid accumulation is secondary to the decreased plasma filtration.

The diet of a child with chronic renal failure is usually characterized as? a. High in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K

ANS: C A Protein should be limited in chronic renal failure to decrease intake of phosphorus. B Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. C Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. D Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease.

Hypospadias refers to? a. Absence of a urethral opening b. Penis shorter than usual for age c. Urethral opening along dorsal surface of penis d. Urethral opening along ventral surface of penis

ANS: D A The urethral opening is present, but not at the glans . B Hypospadias refers to the urethral opening, not to the size of the penis. C This is known as epispadias. D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet? a. "I can give my child sweet pickles." b. "My child can put ketchup on his hotdog." c. "I can let my child have potato chips." d. "I do not put any salt in foods when I am cooking."

ANS: D A All types of pickles are high in sodium and should not be served to the child on a no-added-salt diet. B The child should not be allowed to eat hotdogs; they are considered a cured or processed meat and are high in sodium. C Potato chips are a high-sodium food and should not be included in the child's diet when sodium intake is restricted. D A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI

ANS: D A An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. B Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. C Glomerulonephritis is not a likely cause of dysuria or urgency. D Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI.

Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D A Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infant's testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. B A rectal temperature yields no information about cryptorchidism. C Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis. D For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold.

A true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system is that? a. The young infant's kidneys can more effectively concentrate urine than an adult's kidneys. b. After 6 years of age, kidney function is nearly like that of an adult. c. Unlike adults, most children do not regain normal kidney function after acute renal failure. d. Young children have shorter urethras, which can predispose them to UTIs.

ANS: D A The young infant's kidneys cannot concentrate urine as efficiently as those of older children and adults because the loops of Henle are not yet long enough to reach the inner medulla, where concentration and reabsorption occur. B By 6 to 12 months of age, kidney function is nearly like that of an adult. C Unlike adults, most children with acute renal failure regain normal function. D Young children have shorter urethras, which can predispose them to UTIs.

The most common cause of acute renal failure in children is? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

ANS: D A These are not common causes of acute renal failure in children. B These are not common causes of acute renal failure in children. C Obstructive uropathy may cause acute renal failure, but it is not the most common cause. D 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.

Which clinical finding warrants further intervention for the child with acute poststreptococcal glomerulonephritis? a. Weight loss to within 1 lb of the preillness weight b. Urine output of 1 mL/kg/hr c. A positive antistreptolysin O (ASO) titer d. Inspiratory crackles

ANS: D A This is an indication that the child is responding to treatment. B This is an acceptable urine output and indicates that the child is responding to treatment. C A positive ASO titer indicates the presence of antibodies to streptococcal bacteria; it is used to aid in diagnosis of acute poststreptococcal glomerulonephritis. This is an expected finding if the child has this acute illness. D Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what condition? Select all that apply. a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. UTI e. Diabetes mellitus

ANS: D, E Correct Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. Incorrect An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.