The Child with Renal/Genitourinary Dysfunction

Which child is at risk for developing glomerulonephritis? 1. A 3-year-old who had impetigo 1 week ago. 2. A 5-year-old with a history of five UTIs in the previous year. 3. A 6-year-old with new-onset type 1 diabetes. 4. A 10-year-old recovering from viral pneumonia.

1. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis.

Which combination of signs is commonly associated with glomerulonephritis? 1. Massive proteinuria, hematuria, decreased urinary output, and lethargy. 2. Mild proteinuria, increased urinary output, and lethargy. 3. Mild proteinuria, hematuria, decreased urinary output, and lethargy. 4. Massive proteinuria, decreased urinary output, and hypotension.

3. Mild-to-moderate proteinuria, hematuria, decreased urinary output, and lethargy are common findings in glomerulonephritis.

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? Select all that apply. 1. Pallor 2. Edema 3. Anorexia 4. Proteinuria 5. Weight loss 6. Decreased serum lipid

1, 2, 3, 4 Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids (impaired clearance and, to a lesser extent, increased biosynthesis), anorexia, and pallor. NOT 5!The child gains weight (too many fluids and salt build up in the body).

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse's best responses? Select all that apply. 1. "Your child ' s urine output will increase, and the urine will become less tea-colored." 2. "Your child will have more energy as lab tests become more normal." 3. "Your child ' s appetite will decrease as urine output increases." 4. "Your child ' s laboratory values will become more normal." 5. "Your child ' s weight will increase as the urine becomes less tea-colored."

1,5; When glomerulonephritis is improving, urine output increases, and the urine becomes less tea-colored. These are signs that can be monitored at home by the child's parents. The child's weight will increase as the urine resumes a more normal color, indicating lab values are returning to normal and the child is better.

The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due to which of the following? 1. Chemical changes in the composition of albumin. 2. Increased permeability of the glomeruli. 3. Obstruction of the capillaries of the glomeruli. 4. Loss of the kidneys 'ability to excrete waste and concentrate urine

2. Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine.

Which statement by a parent is most consistent with minimal change nephrotic syndrome (MCNS)? 1. "My child missed 2 days of school last week because of a really bad cold." 2. "After camping last week, my child ' s legs were covered in bug bites." 3. "My child came home from school a week ago because of vomiting and stomach cramps." 4. "We have a pet turtle, but no one washes their hands after playing with the turtle."

1. An upper respiratory infection often precedes MCNS by a few days.

Which is true of a Wilms tumor? Select all that apply. 1. It is also referred to as neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a slow-growing tumor. 5. It is associated with a poor prognosis.

2,3; It can occur at any age but is seen most often between the ages of 2 and 5 years. It can occur on its own or can be associated with many congenital anomalies

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse's best response? 1. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." 2. "There is blood in your child's urine that causes it to be tea-colored." 3. "Your child's urine is very concentrated, so it appears to be discolored." 4. "A ketogenic diet often causes the urine to be tea-colored."

2. Blood in the child ' s urine causes it to be tea-colored.

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis? 1. "His pediatrician said his kidneys are working well." 2. "I noticed his urine was the color of cola lately." 3. "I'm so glad they didn't find any protein in his urine." 4. "The nurse who admitted my child said his blood pressure was low."

2. Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common because of fluid volume overload secondary to the kidneys not working properly

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension 2. Generalized edema 3. Increased urinary output 4. Frank, bright red blood in the urine

2.Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

Which finding requires immediate attention in a child with glomerulonephritis? 1. Sleeping most of the day and being very "cranky" when awake; blood pressure is 170/90. 2. Urine output is 190 mL in an 8-hour period and is the color of Coca-Cola. 3. Complaining of a severe headache and photophobia. 4. Refusing breakfast and lunch and stating he "just is not hungry."

3. A severe headache and photophobia can be signs of encephalopaly due to hypertension, and the child needs immediate attention.

The parents of a child hospitalized with minimal change nephrotic syndrome (MCNS) ask why the last blood test revealed elevated lipids. Which is the nurse ' s best response? 1. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated." 2. "It ' s not unusual to see elevated lipids in children because of the dietary habits of today." 3. "Because your child is losing so much protein, the liver is stimulated and makes more lipids." 4. "Your child ' s blood is very concentrated because of the edema, so the lipids are falsely elevated."

3. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver caused by hypoalbuminemia

A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving furosemide (Lasix) twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema? 1. An increase in the amount and frequency of furosemide (Lasix). 2. Addition of a second diuretic, such as mannitol. 3. Administration of intravenous albumin. 4. Elimination of all fluids and sodium from the child's diet.

3. In cases of severe edema, albumin is used to help return the fluid to the bloodstream from the subcutaneous tissue.

A parent asks the nurse how to prevent the child from having minimal change nephrotic syndrome (MCNS) again. Which is the nurse ' s best response? 1. "It is very rare for a child to have a relapse after having fully recovered." 2. "Unfortunately, many children have cycles of relapse, and there is very little that can be done to prevent it." 3. "Your child is much less likely to get sick again if sodium is decreased in the diet." 4. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

4. Exposure to infectious illness has been linked to the relapse of minimal change nephrotic syndrome.

A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerulonephritis. Which of the following nursing measures should be considered? Select all that apply. A. On examination there is usually a mild to moderate elevation in blood pressure compared with normal values for age, although severe hypertension may be present. B. Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. C. The primary objective is to reduce the excretion of urinary protein and maintain protein-free urine. D. Assessment of the child's appearance for signs of cerebral complications is an important nursing function because the severity of the acute phase is variable and unpredictable. E. Because these children are particularly vulnerable to upper respiratory tract infection, protect them from contact with infected roommates, family, or visitors.

A,B,D

What is the 24-hour fluid requirement for a child weighing 32 kg? A. 1920 ml/day B. 1740 ml/day C. 1840 ml/day D. 1620 ml/day

B