pter 21:

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."

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 (miscarriage)." "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."

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

"Our son's condition may resolve on its own."

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." What would be the most appropriate response by the nurse? "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it." "There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." "That must be hard on you, especially because you are raising her by yourself." "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive."

"There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months."

he 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?

"There are several things we can do to help you achieve this goal."

The nurse is conducting a routine wellness examination of a 13-year-old client. Which question would be best to ask first when opening a discussion on sexual behavior? "What do you like to do on the weekend?" "Are you curious about sex?" "Do any of your siblings have sexual relationships?" "Do you talk to your parents about sex?"

"What do you like to do on the weekend?"

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 his or her 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 occurrence.

Demonstrate love and acceptance at home.

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

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 Explanation: The glomerular filtration rate is measured by creatinine clearance rate, or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.

A nurse is 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.

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

Encourage the child to take all the antibiotics if diagnosed with strep throat.

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

Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that.

The nurse is caring for a 9-month-old with cryptorchidism noted on the medical record. In which manner will the nurse assess this condition? Auscultate for bowel sounds Note any bruising on the skin Assess the upper extremity strength Palpate the scrotum for the testes

Palpate the scrotum for the testes

The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider? White blood cells: 8,000/µL (8.0 ×109/L) Urine culture positive for contaminants Positive culture for group A streptococcus Negative for respiratory syncytial virus (RSV)

Positive culture for group A streptococcus

A child is getting a diagnostic work-up for nephrotic syndrome. Which lab results would the nurse expect to see? Proteinuria, hypoalbuminemia, and hypercholesterolemia Hematuria, proteinuria, and hyperalbuminemia Neutropenia, hematuria, and hypocholesterolemia Proteinuria, hyperalbuminemia, and hypocholesterolemia

Proteinuria, hypoalbuminemia, and hypercholesterolemia

A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client? Reassess the client's testes at 6 months of age. Administer low-dose human chorionic gonadotropin hormone. Perform karyotyping to establish the client's gender. Schedule emergency orchiopexy to correct the condition.

Reassess the client's testes at 6 months of age.

The parent of 6-month-old girl is concerned about the child getting a urinary tract infection. What should the nurse mention to the parent regarding this concern? 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.

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

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

Sodium bicarbonate tablets Explanation: 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 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.

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 Explanation: 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 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

A 5-year-old boy occasionally wets his bed at night and his pants during the day. Which finding would indicate an organic cause—as opposed to a functional cause—of this enuresis? The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained. The boy only wets the bed on nights that he is exceptionally tired. The boy only wets his pants when he is absorbed in playing video games. The boy only wets his bed on the nights his father forgets to take him to the bathroom to void before going to bed.

The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting?

The child has been sexually abused, maybe on the fishing trip. Explanation: Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse (child mistreatment) and should be further explored.

The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they reiterate the need to report which concerning development to the health care provider? The infant does not urinate within 6 to 8 hours. There are small spots of blood on diaper. There is bleeding that stops without pressure. There is an appearance of granulation tissue.

The infant does not urinate within 6 to 8 hours.

An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, what would lead the nurse to suspect that the adolescent has candidiasis? Thick, white cheese-like discharge Frothy, gray-green discharge Milky, gray, fishy-odor discharge Yellow-green discharge

Thick, white cheese-like discharge

A nurse is providing education to parents of a child diagnosed with vesicoureteral reflux (VUR). Which would be included in the parental education? This occurs when there is backflow of urine into the bladder and sometimes the kidneys. This occurs only when there is an obstruction of the ureteropelvic junction. This is diagnosed by abdominal x-ray. This is typically treated with a kidney transplant.

This occurs when there is backflow of urine into the bladder and sometimes the kidneys.

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 (UTI) pelvic inflammatory disease (PID) vaginal inflammation

vulvovaginitis

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 Explanation: 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

Which instructions should a nurse give to a client who has a history of urinary tract infections to prevent recurrence? Select all that apply. Wipe from front to back. Use bubble bath to wash. Encourage fluids throughout the day. Finish all antibiotics prescribed. Limit bathing to once a week.

Wipe from front to back. Encourage fluids throughout the day. Finish all antibiotics prescribed.

A client has just been admitted to the unit with a history of recent streptococcal infection, hematuria, and proteinuria. Based on these findings, the nurse suspects which condition?

acute glomerulonephritis

An 8-year-old client presents with sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the child's health history, the nurse learns that the child had strep throat 9 days ago. Which condition does the nurse suspect? acute glomerulonephritis kidney agenesis polycystic kidney nephrosis

acute glomerulonephritis

he nurse is caring for a child on a pediatric unit who has hemodialysis three times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child? cheeseburger, french fries, and lemonade grilled chicken, apple slices, and flavored water three-egg omelet, bacon, and orange juice tomato soup, crackers, and diet soda

grilled chicken, apple slices, and flavored water

The nurse is performing an assessment on a child. Which finding indicates to the nurse the child is at an increased risk for a urinary tract infection (UTI)? washing the genital area with water daily wiping front to back after using the restroom drinking water and juice during the day holding urine while at school

holding urine while at school

Most urinary tract infections seen in children are caused by: hereditary causes. fungal infections. intestinal bacteria. dietary insufficiencies.

intestinal bacteria.

he 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.

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 child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? weight, daily urine output, every shift amount of protein in the urine abdominal circumference

weight, daily