Peds: PrepU Ch. 21
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? -Sodium bicarbonate tablets -Ferrous sulfate -Vitamin 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.
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? -Loose, dark stools -Tea-colored urine -Strawberry-red tongue -Jaundiced skin
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.
The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is: -performing a suprapubic aspiration. -placing a cotton ball in the underwear to catch urine. -placing an indwelling urinary catheter. -obtaining a clean catch voided urine.
obtaining a clean catch voided urine. In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet-trained child, using a cotton ball to collect the urine would not be appropriate.
A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition? -hydrocele -varicocele -testicular infection -testicular torsion
testicular torsion A hydrocele is a collection of fluid that collects in the fold of the scrotum, requiring no treatment. A variocele is an abnormal dilation of the veins of the spermatic cord. Testicular torsion is evidenced by severe scrotal pain, nausea, and vomiting and is a surgical emergency. Testicular infection is not indicated.
The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which is contraindicated in the client's care? -Intravenous fluids -Abdominal palpation -Foley catheter placement -Supine positioning
Abdominal palpation Abdominal palpation is contraindicated preoperatively in a client with a Wilms tumor. Cells may break loose and spread the tumor. Intravenous fluids and supine positioning are appropriate in the client's care. A Foley catheter is typically not placed.
The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis? -Pulse rate 112 bpm -Pulse oximetry 93% on room air -Respirations 24 per minute -Blood pressure 136/84
Blood pressure 136/84 Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for a child this age, but not a concern with this diagnosis. The other vital signs are within normal limits for this age child.
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 girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." -"Girls tend to urinate less frequently than boys, making them more susceptible to UTI's." -"Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." -"It is unlikely that your daughter is practicing good cleaning habits after she voids."
"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.
A parent asks the nurse, "What is precocious puberty?" The nurse's response should be based on which statement? -"Precocious puberty is when children are going through puberty." -"Precocious puberty is early sexual development." -"Precocious puberty only occurs in boys, not girls." -"Precocious puberty is when girls experience a heavy period."
"Precocious puberty is early sexual development." Precocious puberty is the early sexual development or maturation of a girl or boy. It occurs most often in girls, not boys, and does not relate to a heavy menses.
Which instruction should a nurse give to a client who has a history of urinary tract infection to prevent recurrence? -Wipe from front to back. -Use bubble bath to wash. -Encourage fluids throughout the day. -Finish all antibiotic prescribed. -Limit bathing to once a week.
-Wipe from front to back. -Encourage fluids throughout the day. -Finish all antibiotic prescribed. Teaching caregivers to wipe from front to back, encouraging fluids, and finishing all prescribed medications are vital principles in the prevention of recurring UTIs. The use of bubble bath is contraindicated because it can be a source of infection.
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? -Allow tubes to dangle freely to encourage flow. -Encourage high fluid intake. -Increase low-fat foods. -Apply antibiotic ointment to tube site.
Encourage high fluid intake. Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.
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 -Practicing bladder-stretching exercises -Giving desmopressin intranasally -Engaging the child in stress reduction measures
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.
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage tube patency? -Monitor output. -Allow tubes to dangle freely to encourage flow. -Maintain fluid restriction. -Provide a low-sodium diet.
Monitor output. A ureteral stint is placed in the ureter temporarily to aid in the drainage of urine. It is removed via cystoscopy when it is time for discontinuation. The nurse should monitor output cafefully when a ureteral stint is in place. This is an indication that the stent is patent and functioning properly. The tubes are inserted into the ureter so they would not dangle on the outside of the body. There is no need to maintain fluid restriction or a low-sodium diet just because of the stent. This would only be necessary if there were other disease processes affecting the child.
The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? -Sudden onset of severe scrotal pain with significant hemorrhagic swelling -Enlarged inguinal glands and fever -Hardened and tender epididymitis with edema and erythema of scrotum -Fever, scrotal swelling, and urethral discharge
Sudden onset of severe scrotal pain with significant hemorrhagic swelling Testicular torsion is characterized by a testicle that is abnormally attached to the scrotum and twisted. Signs and symptoms include sudden onset of severe scrotal pain with significant hemorrhagic swelling. Enlarged glands and fever point to infection. A hardened and tender epididymitis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.
To prevent further urinary tract infections in a preschooler, what measures would you teach her mother? -Encourage her to be more ambulatory to increase urine output. -Teach her to take frequent tub baths to clean her perineal area. -Suggest she drink less fluid daily to concentrate urine. -Teach her to wipe her perineum front to back after voiding.
Teach her to wipe her perineum front to back after voiding. Escherichia coli can be easily spread from the rectum to the urinary meatus and cause infection if girls do not take precautions against this.
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 -Fluid detected in scrotal sac -Venous varicosity detected along the spermatic cord -Testis can briefly be brought into scrotum
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 knows this is a description of peritoneal dialysis when compared to hemodialysis: -The child can live a more normal lifestyle. -There are strict diet and fluid restrictions. -Therapy is only 3 to 4 days per week. -The child must go into a facility to get peritoneal dialysis.
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 nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history? -The child has a sibling with the same diagnosis. -The child had a congenital heart defect. -The child recently had an ear infection. -The child is being treated for asthma.
The child recently had an ear infection. In the child with acute glomerulonephritis, presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.
The nurse is reviewing the causative organisms noted on laboratory reports. Which organism is transmitted solely by sexual contact? -Bacillus -Trichomonas -Cholera Bacterium -Borelli
Trichomonas The organism transmitted solely by sexual contact is Trichomonas. The other organisms are causes of various infections and acquired in various ways.
In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care? -Weighing on the same scale each day -Ambulating 3 to 4 times a day -Increasing fluid intake by 50 ml per hour -Testing the urine for glucose levels regularly
Weighing on the same scale each day The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss. The child with nephrotic syndrome is very edematous so increasing fluid intake would be counterproductive to care needed. In nephrotic syndrome the urine is tested for protein, not glucose. Ambulation is important for all but it is not specific to the child with nephrotic syndrome.
The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? -White cottage cheese-like discharge -Thin gray vaginal discharge with fishy odor -Foul yellow-gray discharge -Irritation of labia and vaginal opening
White cottage cheese-like discharge White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene.
Most urinary tract infections seen in children are caused by: -hereditary causes. -fungal infections. -intestinal bacteria. -dietary insufficiencies.
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.
Which of these laboratory results would be most important for the nurse to assess in a child who has a diagnosis of urinary tract infection? -urinalysis -chemical reagent strip -specific gravity -blood urea nitrogen
urinalysis A urinalysis is one of the simplest tests to reveal kidney function and presence of a urinary tract infection. A chemical reagent strip, specific gravity, and blood urea nitrogen are not the primary tests evaluated for the presence of a urinary tract disease.
A 4-year-old child with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing the child for this procedure, the nurse would want to prepare the child to: -have a local anesthetic injected prior to the procedure. -drink three glasses of water during the procedure. -void during the procedure. -anticipate a headache afterward.
void during the procedure. At the start of the voiding cystourethrogram, a catheter is inserted into the bladder. The contrast medium is inserted through the catheter into the bladder. Fluroscopy is performed to demonstrate the filling of the bladder and the collapsing of the bladder upon emptying. The assessment of emptying requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed. No anesthetic is required for this procedure. The fluid filling the bladder is inserted via the catheter so no drinking of water is required. A headache following the procedure would not be expected.
A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition? -vulvovaginitis -urinary tract infection -pelvic inflammatory disease -vaginal inflammation
vulvovaginitis Vulvovaginitis is diagnosed with clients experiencing vaginal or vulval inflammation, pain odor, and purititis. Pelvic inflammatory disease and urinary tract infection are not consistent with these symptoms.
A client's mother asks the nurse, "When should my daughter have a pelvic examination?" Which response by the nurse is most appropriate? -"A pelvic examination is not necessary until pregnancy." -"A pelvic exam is necessary at 18 to 20 years of age." -"A pelvic exam is necessary for girls in puberty." -"As her mother, it is your choice when she should have a pelvic exam."
"A pelvic exam is necessary at 18 to 20 years of age." A pelvic exam is unnescessary for girls who have not yet reached adolescence. A pelvic exam should be part of routine health care around the age of 18 to 20 years or at the point when she becomes sexually active.
The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? -Hypertension -Hypotension -Hypothermia -Tachycardia
Hypertension Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.
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? -Report any abnormally colored urine to the child's primary care provider. -Wipe from back to front when changing the girl's diaper. -Discontinue prescribed antibiotics once symptoms of UTI have disappeared. -Bathe the child with bubble bath once a week.
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.
Which is a priority for the nurse caring for a client with bladder exstrophy? -increasing fluid intake -encouraging voiding -preventing skin breakdown -placing the child in prone position
preventing skin breakdown Prevention of skin breakdown is the priority to prevent infection and the surface from drying out. Encouraging fluids and voiding are not the priority for this client. Prone position is not recommended; the correct position is supine so urine drains freely.
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 may need surgery on his testes before we are discharged to go home." -"Our son may have to go through life without two testes." -"Our son's condition may resolve on its own." -"Our son will likely have a high risk of cancer in his teen years as a result of this 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.
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 take which action? -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. -Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. -Give the child a diuretic and report back to the nurse in a few hours. -Give the child fluids 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 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℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: -a urinary tract infection. -lipoid nephrosis (idiopathic nephrotic syndrome). -acute glomerulonephritis. -rheumatic fever.
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 1 to 3 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℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.
The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? -"Let's meet with the dietitian and plan some meals." -"She must severely restrict her sodium intake." -"She should try to avoid protein." -"Here is some written information from the dietitian."
"Let's meet with the dietitian and plan some meals." Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.
The nurse is caring for a 10-year-old child experiencing nocturnal enuresis with no physiologic cause. The child states, "I am embarrassed and I wish I could stop this right now!" How will the nurse respond? -"You will grow out of this eventually; you just need to be patient." -"There are several things we can do to help you achieve this goal." -"You are not alone. There are almost 5 million people that have enuresis." -"You can wear pull-ups to bed and, since they look like underwear, no one will 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 the desire for solutions. Telling the child that he or she will "grow out of this" downplays the embarrassment and does not address the desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.
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? -Empty the old dialysate -Weigh the old dialysate -Weigh the new dialysate -Start the process over with a fresh bag
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.
Which condition is a risk factor for the development of pelvic inflammatory disease? -multiple sexual partners -oral contraceptive use -recurrent urinary infections -history of dysmmenorrhea
multiple sexual partners Clients who have had multiple sexual partners have a higher incidence of developing pelvic inflammatory disease. Oral contraceptive use, history of UTI, and dysmmeorrhea are not risk factors for developing pelvic inflammatory disease.
A 3-year-old child is scheduled for a surgery to correct undescended testes. For what postoperative consideration would the nurse want to prepare the parents? -the need for complete bed rest for 10 days -some discomfort at the surgery site -a liquid diet for 3 days -the need for maintaining a semi-Fowler position
some discomfort at the surgery site A orchiopexy is the surgical procedure to release the spermatic cord and pull the testes into the scrotum. After the testes are in the scrotum, they are sutured into place to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation. Complete bed rest, a liquid diet, and remaining in a semi-Fowler position are not required as part of the post surgical care.
When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? -Risk for infection -Excess fluid volume -Imbalanced nutrition less than body requirements -Activity intolerance
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 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? -"It is caused from taking birth control pills when a girl is younger than 13 years old." -"This disorder is usually seen after a girl has had a spontaneous abortion." -"Emotional stress can be a cause of this disorder." -"This is what happens if a 16-year-old girl has never had any periods at all."
"Emotional stress can be a cause of this disorder." 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 caregiver of a 1-year-old boy 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? -"Without the hormone your son will have fluid that will collect in his scrotum." -"Without the treatment your child's gonads will not reach normal size." -"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." -"Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do."
"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." 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 2-year-old has a history of fever and fussiness. Which additional symptoms would make the nurse suspect a urinary tract infection? -Swollen lymph nodes -Skin rash -Increased thirst -Abdominal pain
Abdominal pain The symptoms of urinary tract infection can vary depending on the age of the child. Abdominal pain is a common symptom in children of a UTI. Swollen lymph nodes, skin rash, and thirst are not the common symptoms associated with a UTI.
The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? -Presence of a bruit -Presence of a thrill -Dialysate without fibrin or cloudiness -Absence of a thrill
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.
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? -Urinalysis -Creatinine clearance rate -Kidneys, ureter, and bladder x-ray -Computed tomography scan
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 parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? -Demonstrate love and acceptance at home. -Discuss how the child can continue to go to the bathroom instead of in the underwear. -Take away a toy every time the child urinates in his or her pants.- -Demonstrate how to urinate in the bathroom every time the child has an occurence.
Demonstrate love and acceptance at home. Enuresis is the contined incontinence of urine past the age of toliet training. It is a source of shame and embarrassment. It affects the child's life emotionally, behaviorally and socially. It causes the child to have a low self-esteem. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.The child should not be punished for a behavior he or she cannot control. Demonstrating how to use the toliet and going to the bathroom to void are good subjects but they do not help a child who has no control of the enuresis. Testing may need to be done to see if there are anatomical reasons and medications may be needed to correct the problem.
An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection? -Metronidazole -Miconazole -Doxycycline -Acyclovir -Ceftriaxone
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.
A 16-year-old adolescent tells the nurse about having severe dysmenorrhea. Which action would be the best health teaching measure? -Take over-the-counter ibuprofen for its prostaglandin action. -Take acetaminophen beginning with the first day of a menstrual flow. -Drink a minimum of fluid if having pain. -Use ice to help in reducing inflammation and pain.
Take over-the-counter ibuprofen for its prostaglandin action. Dysmenorrhea is pain associated with menstruation. A prostaglandin release is responsible for the smooth muscle contraction of the uterus during menstruation. The nonsteroidal anti-inflammatory drug Ibuprofen has an antiprostaglandin mechanisim that will block the prostaglandin release. It is the best choice for dysmenorrhea. Acetominophen has no antiprostaglandin properties, so it is not the drug of choice. Ice will only work on localized areas so it has limitied, if any, effect on the uterus. Ice also is a vasoconstrictor and reduced blood flow could intensify the pain. Fluid intake has no effect on uterine pain.
The nurse is caring for a 3-year-old child with the surgical repair of hypospadias. The preschooler returned from the postanesthesia care unit with an indwelling urinary catheter. What parental teaching is most helpful? -The catheter insertion site will leave only a minimal scar. -Back pressure from such drainage may result in nephrotic syndrome. -The child must be reevaluated at puberty for testicular function. -The childwill always have tenderness on penile erection.
The catheter insertion site will leave only a minimal scar. Hypospadius is a urethral defect in which the opening is on the ventral surface rather than at the end of the penis. If left untreated it may mean the boy will not be able to void standing as the aim will be different; in addition, it will cause intereference with the deposition of sperm during intercourse. The completed surgery requires the use of a catheter. The catheter, along with the penis, is taped to the abdomen to reduce pressure on the urethral sutures.The tube insertion site will leave only a minimal scar, if any. A hypospadias repair should have no long-term consequences.
Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis? -The child wakes up once during the night for a glass of water. -The client wets only when involved in an activity. -The client remains continent throughout the night. -The parent takes the client to the bathroom at night.
The client remains continent throughout the night. The goal of therapy is for the client to be continent of urine throughout the night. The nurse should encourage the child to awaken and void and not have any fluids before bedtime. During an activity, the child should be encouraged to void before and after the activity to prevent incontinence.
A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse? -The foreskin is needed for repair. -Circumcision is usually performed after 1 year of age. -Circumcision with a hypospadias will cause meatal stenosis. -The circumcision may predispose the newborn to renal failure.
The foreskin is needed for repair. Hypospadias occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circucised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair. Once the hypospadias is repaired, a circumcision can be performed as part of the procedure. Hypospadias repair is usually done after the newborn is 1 year or older. Meatal stenosis has to do with the urethral opening diameter, not the placement. Circumcision or hypospadias repair does not affect the functioning of the renal system so neither would predispose the newborn to renal failure.
The home care nurse is conducting an in-home visit for a child who had corrective surgery for hypospadias 3 days prior. What would alert the home care nurse to provide additional teaching? -The mother indicates the child is fussy, but calms down when she holds him on her hip. -The mother states, "I can't wait until I can bath him the tub again...he enjoys it so much." -The mother expresses relief that the child was not also diagnosed with cryptorchidism at birth. -The mother states, "I have had to buy more diapers since having to double diaper him."
The mother indicates the child is fussy, but calms down when she holds him on her hip. Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Surgical repair involves a catheter or stent left in place for 3-7 days postoperatively. Activities or play that involves straddling (such a being carried on mom's hip) are discouraged to prevent trauma to the surgical site and catheter/stent. The child should be double diapered to prevent stool from contaminating the catheter/stent and operative site and causing an infection. The child should not be bathed in a tub until the catheter/stent is removed. Crypotoorchidism is a common diagnosis along with hypospadias.
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: -contact the necessary authorities to report a suspected case of sexual abuse. -take the child to a private room and interview her regarding her sexual history and partners. -take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. -talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted infection and discuss the importance of safe sex practices.
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.