renal/ut disorder ch 46
The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with acute glomerulonephritis. In which of the following age ranges is the peak incidence of this disorder noted?
6 to 7 years of age Explanation: Acute glomerulonephritis has a peak incidence in children 6 to 7 years of age and occurs twice as often in boys.
A nurse identifies a nursing diagnosis of impaired urinary elimination related to urinary tract infection. When developing the plan of care, what would be most important for the nurse to do first?
Assess usual voiding patterns. Explanation: The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action.
The nurse is collecting data on a child recently diagnosed with acute glomerulonephritis. Which of the following clinical manifestations was likely noted in this child?
Bloody urine Explanation: The presenting symptom in the child with acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody.
The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child?
Eyes Explanation: Edema is usually the presenting symptom in nephrotic syndrome, appearing first around the eyes and ankles.
The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. The nurse documents this finding as:
Hypospadias Explanation: Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Epispadias is present when the urethral opening is on the dorsal surface of the penis. Patent urachus refers to a fistula between the bladder and umbilicus. Bladder exstrophy involves the bladder lying open and exposed on the abdomen.
The nurse is doing an in-service training with a group of peers on the topic of the genitourinary system. Which of the following is a major function of the kidneys?
Regulate blood pressure Explanation: Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acid-base. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli. Cerebrospinal fluid circulates through the brain and spinal cord.
The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to do which action?
Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Explanation: 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 location of the kidneys in the child in relationship to the location of the kidneys in the adult makes which of the following a greater likelihood in the child?
The child has a greater risk for trauma to the kidney Explanation: The kidneys in children are located lower in relationship to the ribs than in adults. This placement and the fact that the child has less of a fat cushion around the kidneys cause the child to be at greater risk for trauma to the kidneys. The location of the kidneys does not affect the urges to empty the bladder nor the retaining of fluids.
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 recently had an ear infection. Explanation: 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 home health care nurse is visiting a child undergoing continuous ambulatory peritoneal dialysis (CAPD). Which of the following would lead the nurse to identify a nursing diagnosis of fluid overload related to CAPD? Select all that apply.
Weight gain Shortness of breath Explanation: Evidence of fluid overload would be indicated by weight gain, moist cough, and shortness of breath. Fever and redness at the tube insertion site suggest infection. Poor skin turgor suggests fluid deficit.
A voiding cystourethrogram (VCUG) is ordered on a child. What education should be provided to the parents?
The VCUG will rule out VUR. Explanation: A VCUG will rule out reflux in the urinary tract. This may cause frequent infections and scarring if not diagnosed and treated.
The nurse is caring for a post-surgical child with a new suprapubic catheter. The child begins to moan in pain suddenly. Which nursing intervention is the priority?
Check the catheter for patency. Explanation: During the postoperative period after placement of a suprapubic catheter, the catheter has a risk of getting clogged with mucous. This results in pain experienced in the lower abdomen. If pain is reported, the first priority is to check for patency of the catheter. Assessing the child's pain and vital signs, along with repositioning are all good interventions, just not the priority action.
A child is brought to the clinic for evaluation. Assessment reveals a sudden onset of hematuria. The mother states, "His urine looks like tea." The child had impetigo about 2 weeks ago. He also has a low-grade fever and vomiting. Acute post-streptococcal glomerulonephritis is diagnosed and laboratory tests are performed. Which result would the nurse identify as supporting this diagnosis? (Select all that apply.)
Decreased blood protein level Increased blood urea nitrogen level Increased blood creatinine level Explanation: Blood analysis will indicate a lowered blood protein level (hypoalbuminemia) caused by the massive proteinuria. Low serum complement will be present, and, as the blood volume expands, a mild anemia also will occur. As in all inflammatory diseases, the erythrocyte sedimentation rate will increase. Because the glomeruli cannot filter properly, concentrations of urea, nonprotein nitrogen (BUN), and creatinine in blood will increase. The antistreptolysin O (anti-DNase B) titer or antibody formation against streptococci is generally elevated.
The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100 degrees Fahrenheit. The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:
acute glomerulonephritis. Explanation: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear one to three weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103 to 104 degrees Fahrenheit at the onset but decreases in a few days to about 100 degrees Fahrenheit. Slight headache and malaise are usual, and vomiting may occ
A child who has been diagnosed with minimal change nephrotic syndrome (MCNS) is being discharged after a 3-week hospitalization. Her edema has been greatly reduced and her appetite is beginning to return. Her caregivers have promised to have a family party to celebrate her return. The child has requested the following food for the party. Which of the following foods would the nurse suggest would be appropriate for the diet this child is on?
Banana splits Explanation: For the child with nephrotic syndrome, the addition of salt is discouraged, and sometimes the child is put on a low sodium diet. In ad dition the child may be placed on a high protein diet. Popcorn, potato chips and orange soda all have higher sodium content than do banana splits. In addition the banana split would have higher protein content.
A 7-year-old boy has experienced repeated urinary tract infections (UTIs). His older sister also experienced repeated UTIs and was diagnosed with vesicoureteral reflux, a condition that tends to appear in families. Therefore, the nurse suspects this same condition in this client. Which diagnostic tests would confirm this suspicion?
Cystoscopy Explanation: Cystoscopy, or examination of the bladder and ureter openings by direct examination with a cystoscope introduced into the bladder through the urethra, is done to evaluate for possible vesicoureteral reflux or urethral stenosis. A urine culture is used to diagnose a urinary tract infection (UTI), or the presence of bacteria in urine. Urinalysis involves use of a chemical reagent strip to detect glucose, protein, and occult blood and to measure pH, as well as use of a refractometer to measure specific gravity. A blood urea nitrogen (BUN) test measures the level of urea in blood or how well the kidneys can clear this from the bloodstream.
