C43 Genitourinary

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 exam is necessary for girls in puberty." "A pelvic examination is not necessary until pregnancy." "A pelvic exam is necessary at 18 to 20 years of age." "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." Explanation: 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.

Which question would be most important for a nurse to ask when taking a history from a client who is suspected of having amenorrhea? "Are you sexually active?" "How many times a week do you exercise?" "What foods do you eat?" "When did you last see your medical provider?"

"Are you sexually active?" Explanation: Amenorrhea strongly suggests pregnancy in an adolescent and is the priority in a client with this diagnosis. Strenuous exercise can be a causative factor, but it is not the priority. Diet and medical visit history do not affect this current diagnosis.

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? a) "This disorder is usually seen after a girl has had a spontaneous abortion." b) "This is what happens if a 16-year-old girl has never had any periods at all." c) "It is caused from taking birth control pills when a girl is younger than 13 years old." d) "Emotional stress can be a cause of this disorder."

"Emotional stress can be a cause of this disorder." Correct Explanation: 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 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? a) "She must severely restrict her sodium intake." b) "Let's meet with the dietitian and plan some meals." c) "Here is some written information from the dietitian." d) "She should try to avoid protein."

"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 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." "Our son may need surgery on his testes before we are discharged to go home." "Our son will likely have a high risk of cancer in his teen years as a result of this condition." "Our son may have to go through life without two testes."

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

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 only occurs in boys, not girls." "Precocious puberty is early sexual development." "Precocious puberty is when girls experience a heavy period."

"Precocious puberty is early sexual development." Explanation: 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.

The caregiver of a 1-year-old son 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 of the following statements regarding the son's treatment? a) "Without the hormone your son will have fluid that will collect in his scrotum." b) "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do." c) "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." d) "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." 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 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." Of the following statements, which would be the most appropriate response by the nurse? a) "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it." b) "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." c) "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive." d) "That must be hard on you, especially because you are raising her by yourself."

"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." Explanation: Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally oral contraceptive pills are prescribed to prevent ovulation.

A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include? a) Instilling saline nose drops and bulb suctioning. b) Keeping the head of the bed flat. c) Avoiding contact with family members. d) Maintaining strict bedrest.

A

You care for a 6-year-old boy with acute glomerulonephritis. When planning care for him, you should be aware that glomerulonephritis usually follows an infection of what organism? a) A Beta-hemolytic Streptococcus b) Staphylococcus viridans c) Group B streptococci d) One of the rhinoviruses

A Acute glomerulonephritis may result as an autoimmune response to the invasion of group A beta-hemolytic Streptococcus.

A teacher sends a child to see the school nurse for irritability and bruising. Which of the following symptoms would be indicative of hemolytic uremic syndrome? a) Oliguria and jaundice b) Polyuria and diarrhea c) Dysuria and lethargy d) Weight gain and high fever

A Signs of hemolytic uremic syndrome include oliguria, irritability, jaundice, bloody diarrhea, purpura, ecchymosis, and pallor 5 to 10 days after a prodromal illness. The child also usually experiences anorexia, slight fevers, and can become lethargic. Symptoms of polyuria, weight gain, high fever, and dysuria are not typically seen with hemolytic uremic syndrome.

The nurse is conducting a presentation for a group of nurses who work with adolescents. The group of nurses discusses dysmenorrhea. Which of the following statements is most accurate related to dysmenorrhea? a) Dysmenorrhea can result from diaphragms or tampons being left in place too long. b) Common symptoms of dysmenorrhea are weight gain and mood swings. c) Genetic abnormalities are the most common cause of dysmenorrhea. d) A contributing factor in dysmenorrhea is the increased secretion of prostaglandins.

A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. The increased secretion of prostaglandins, which occurs in the last few days of the menstrual cycle, is thought to be a contributing factor in primary dysmenorrhea.

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present? Purulent drainage from the penis Swollen testes Enlarged inguinal glands Abdominal mass

Abdominal mass Explanation: An abdominal mass indicates hydronephrosis. Enlarged inguinal glands are not associated with hydronephrosis. Purulent drainage from the penis is not associated with hydronephrosis. Swollen testes are not associated with hydronephrosis.

Urinary tract infections are usually successfully treated by which of the following? a) Administering diuretics b) Increasing fluids, such as cranberry juice c) Administering antibiotics d) Performing bladder irrigations

Administering antibiotics Explanation: UTIs may be treated with antibiotics (usually sulfisoxazole or ampicillin) at home. Fluids are encouraged, but they do not treat the infection. Bladder irrigations and diuretics are not used in the treatment of urinary tract infections.

The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which of the following vital signs would the nurse anticipate with this child's diagnosis? a) Blood Pressure 136/84 b) Respirations 24 per minute c) Pulse rate 112 bpm d) Pulse oximetry 93% on room air

Blood Pressure 136/84 Hypertension appears in 60% to 70% of patients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for this age child, but not a concern with this diagnosis. The other vital signs are within normal limits for this age child

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? a) Tachycardia b) Hypotension c) Hypertension d) Hypothermia

C Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

A 10-year-old child in renal failure is on continuous ambulatory peritoneal dialysis (CAPD). What would be important to teach the parents? The return solution will be cloudy because of urea in it. Cramping should not occur with an infusion. Slight bleeding from the exchange catheter is to be expected. Dialysis solution must be infused over a period of 30 minutes.

Cramping should not occur with an infusion. Explanation: Continuous ambulatory peritoneal dialysis is a method which allows mobility for the child. The child shoud be assessed for toleration of the fluid volume instilled into the peritoneum. The abdomen will remain distended while the fluid is indwelling. The child may be slightly uncomfortable from the pressure but should not experience cramping or pain. The dwell time for this type of dialysis is from 3 to 6 hours.The return flow should be clear. A cloudy return flow suggests infection. The dialysate solution will fill from gravity so there is no specified time frame for instillation and will also be affected by the amount of dialysate solution to be instilled.

A child needs to collect urine for 24 hours and the nurse explains that this test assesses glomerular filtration rate and how the kidneys are functioning. Which of the following would be indicative of this type of test? a) Microscopic studies for RBC casts b) Urine culture and sensitivity c) Urinalysis for casts and bacteria d) Creatinine clearance

Creatinine clearance Creatinine clearance A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate.

A child is being evaluated for renal and urinary tract disease. Which of the following would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? a) Creatinine clearance rate b) Kidneys, ureter, and bladder x-ray c) Computed tomography scan d) Urinalysis

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.

The condition in which one or both of the testes does not descend in the male infant is referred to as which of the following? a) Enuresis b) Hydrocele c) Cryptorchidism d) Orchiopexy

Cryptorchidism Explanation: When one or both of the testes do not descend, the condition is called cryptorchidism.

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? a) Dialysate without fibrin or cloudiness b) Presence of a thrill c) Presence of a bruit d) Absence of a thrill

D 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 born with ambiguous genitalia. Which of the following assessments establishes whether the child is genetically male or female? a) DNA analysis b) Laparoscopy c) Pyelography d) Ultrasound

DNA analysis Explanation: If there is any question about a child's gender, karyotyping or DNA analysis establishes whether the child is genetically male or female. Laparoscopy (introduction of a narrow laparoscope into the abdominal cavity through a half-inch incision under the umbilicus) or possibly exploratory surgery may be necessary to determine if ovaries or undescended testes are present. Intravenous pyelography or ultrasound can be used to establish whether a complete urinary tract is present.

You obtain a history from the mother of a child with glomerulonephritis about how he became ill. Which of the following would you expect her to tell you she noticed? a) Diuresis and pallor b) Dark brown urine c) Headache, loss of appetite d) Loss of weight, oliguria

Dark brown urine Acute glomerulonephritis often presents with glomeruli bleeding, which is revealed as black or brown urine from old blood.

A parent is asking how she can help her son deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? a) Discuss how child can continue to go to the bathroom instead of in the underwear. b) Demonstrate love and acceptance at home. c) Take away a toy every time the child urinates in their pants. d) Demonstrate how to urinate in the bathroom every time.

Demonstrate love and acceptance at home. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.

A symptom often seen in acute glomerulonephritis is edema. The most common site the edema is first noted is in which area of the body? a) Hands b) Eyes c) Ankles d) Sacrum

Eyes Periorbital edema may accompany or precede hematuria in children with acute glomerulonephritis. Edema in the ankles, hands and sacrum are not noted in acute glomerulonephritis

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? a) Eyes b) Sacrum c) Abdomen d) Fingers

Eyes Correct Explanation: Edema is usually the presenting symptom in nephrotic syndrome, appearing first around the eyes and ankles

Peritoneal dialysis is so effective that 3 hours of peritoneal dialysis accomplishes as much as 12 hours of hemodialysis. a) True b) False

False Correct Explanation: Hemodialysis can be done as a continuous process, but it is so effective 3 hours of hemodialysis accomplishes as much as 12 hours of peritoneal dialysis.

A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching? a) As long as the medications are used properly, the transplant will not be rejected. b) Immunosuppression is common after a kidney transplant. c) The child can stop medication after three months of therapy. d) Induction therapy medication will prevent infection with the transplant.

Immunosuppression is common after a kidney transplant. Explanation: A child is placed on medications for immunosuppression after the transplant to prevent the body from rejecting the allograft.

Which nursing diagnosis would the nurse select as the priority when caring for a client with nephrotic syndrome?

Inbalanced nutrition Altered skin integrity Altered comfort Anxiety Explanation: The priority nursing intervention for the client is Imbalanced nutrition. Clients diagnosed with nephrotic syndrome should be consulted by a nutritionist and stay on a high-protein, renal diet for optimal results. Skin intergrity is important, but it is not the priority. Alteration in comfort and anxiety are important, but they are not priority nursing diagnoses.

Which dietary change is most important to decrease the symptoms of premenstrual syndrome? Encourage a high protein diet Increase fluid intake Maintain a low sodium diet Decrease caffeine

Maintain a low sodium diet Explanation: Symptoms of premenstrual syndrome include edema, weight gain, headache, anxiety and minor depression. A low sodium diet helps with decreasing fluid retention. All of the other options are good dietary habits but are not as helpful in decreasing symptoms.

The nurse is taking a history from an adolescent girl with suspected pelvic inflammatory disease (PID). What data will be most helpful in determining this girl's risk factors for PID? a) Age at first menses b) Race c) Age d) Number of sexual partners

Number of sexual partners Multiple sexual partners are a risk factor for PID. Race, age, and age at first menses are not considered risk factors for PID.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is which of the following? a) Placing an indwelling urinary catherter b) Performing a suprapubic aspiration c) Placing a cotton ball in the underwear to catch urine d) Obtaining a clean catch voided urine

Obtaining a clean catch voided urine Correct Explanation: 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

Urine that stands at room temperature for any length of time changes composition. a) False b) True

True Correct Explanation: For best results, specimens collected should be fresh because urine that stands at room temperature for any length of time changes composition.

The nurse is collecting data on a 6-year-old child admitted with a possible urinary tract infection. Which of the following vital signs might indicate the possibility of an infection? a) Pulse oximetry 93% on room air b) Pulse rate 135 bpm c) Respirations 22 per minute d) Blood Pressure 100/70

Pulse rate 135 bpm Correct Explanation: Data to collect regarding the child includes temperature, pulse (be alert for tachycardia) and respiration rates; normal vital signs for a 6-year-old would be a pulse rate of 70 to 115 beats per minute, so this rate shows tachycardia,. The other vital signs are all within normal limits for this age child.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? a) Activity intolerance b) Risk for infection c) Excess fluid volume d) Imbalanced nutrition, less than body requirements

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 caring for a 10-year-old boy with end-stage renal disease (ESRD) with metabolic acidosis. Which of the following would the nurse expect to administer if ordered? a) Ferrous sulfate b) Erythropoietin c) Sodium bicarbonate tablets d) Vitamin D

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 5-month-old boy with an undescended left testis. Which of the following would the nurse identify as indicative of true cryptorchidism? a) Venous varicosity detected along the spermatic cord b) Testis can briefly be brought into scrotum c) Testis cannot be "milked" down inguinal canal d) Fluid detected in scrotal sac

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 is caring for a 10-year-old girl presenting with fever, dysuria, flank pain, urgency, and hematuria. The nurse would expect to help obtain which test first? Creatinine clearance Total protein, globulin, and albumin Urinalysis Urine culture and sensitivity

Urinalysis Explanation: Urinalysis is ordered to reveal preliminary information about the urinary tract. The test evaluates color, pH, specific gravity, and odor of urine. Urinalysis also assesses for presence of protein, glucose, ketones, blood, leukocyte esterase, red blood cell count, white blood cell count, bacteria, crystals, and casts. Total protein, globulin, albumin, and creatinine clearance would be ordered for suspected renal failure or renal disease. Urine culture and sensitivity is used to determine the presence of bacteria and determine the best choice of antibiotic.

The nurse is working with a child with altered genitourinary status. Which of the following interventions would be included in the plan of care with excess fluid volume? a) Hold all medication until the fluid retention is improving. b) Weigh the child twice a day on the same scale. c) Avoid administering IVs. d) Measure the amount of nitrates present in the urine.

Weigh the child twice a day on the same scale. Explanation: A child with a renal problem needs to be weighed on the same scale for accurate weights. The frequency is important to ensure the child is not retaining fluid.

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 Start the process over with a fresh bag Weigh the old dialysate Weigh the new dialysate

Weigh the old dialysate Explanation: 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.

In caring for a child with nephrotic syndrome, which of the following interventions will be included in the child's plan of care? a) Weighing on the same scale each day b) Testing the urine for glucose levels regularly c) Increasing fluid intake by 50 cc an hour d) Ambulating three to four times a day

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.

A client has just been admitted to the unit with a history of recent strep infection, hematuria, and proteinuria. Based on these findings, the nurse would suspect which condition? renal failure urinary tract infection prune belly syndrome acute glomerulonephritis

acute glomerulonephritis Explanation: Recent strep infection, hematuria, and proteinuria are indicative of acute glomerulonephritis. These symptoms do not suggest any of the other options.

The nurse is discussing genitourinary conditions with a group of 16-year-old girls. One of the girls says she has heard about girls who have stopped taking birth control pills and now don't have periods. The condition the girl is referring to is: ascites. amenorrhea. pyelonephritis. oliguria.

amenorrhea. Explanation: Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Ascites is edema in the peritoneal cavity.

A nurse caring for a client diagnosed with chlamydia trachomatis can expect what subsequent tests? syphilis gonorrhea trichomoniasis candidiasis

gonorrhea Explanation: Since there is a strong association between gonorrhea and a chlamydial infection, the client would be tested for gonorrhea as well.

Which symptom would be consistent with a diagnosis of menorrhagia? Select all that apply. vomiting constipation heavy menstrual flow diarrhea abdominal cramping

heavy menstrual flow abdominal cramping Explanation: Heavy menstrual flow and abdominal cramping are indicators of menorrhagia. Vomiting and diarrhea are not usually assessed in clients with this condition.

What is a clinical manifestation of pelvic inflammatory disease (PID)? Select all that apply. fever blurred vision decreased appetieite lower severe abdominal pain purulent vaginal discharge

lower severe abdominal pain purulent vaginal discharge fever Explanation: Abdominal pain, purulent discharge, and fever are clinical manifestions associated with pelvic inflammatroy disease. Decreased appetiete is not a clinical symptom of PID.

A nurse is caring for a client who has been diagnosed with bacterial vaginosis. What medication should the nurse anticipate as part of the treatment plan? metronidazole amoxicillin augmentin magnesium sulfate

metronidazole Explanation: Metronidazole, either oral or vaginal, is the drug of choice for treatment of clients with bacterial vaginosis. Augmentin, amoxicillin, and magnesium sulfate are contraindicative for this diagnsos because they will have no effect on the contributing organism.

While obtaining a history from a 15-year-old girl, the girl tells the nurse that she often experiences cramping abdominal pain about midway through her menstrual cycle. The nurse documents this as: metrorrhagia. dysmenorrhea. mittelschmerz. menorrhagia.

mittelschmerz. Explanation: Mittelschmerz refers to abdominal pain that usually occurs midway through the menstrual cycle that varies from a few sharp cramps to several hours of crampy pain. It is believed to be the result of egg release from the ovary. Dysmenorrhea refers to the pain associated with menstruation. Menorrhagia refers to excessive menstrual bleeding. Metrorrhagia refers to bleeding between menstrual periods.

Which condition is a risk factor for the development of pelvic inflammatory disease? recurrent urinary infections multiple sexual partners oral contraceptive use history of dysmmenorrhea

multiple sexual partners Explanation: 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.

An adolescent client has several medications prescribed for a diagnosis of menstrual migraine. What medication should the nurse question? oral contraceptives acetaminophen sumatriptan NSAID

oral contraceptives Explanation: NSAIDS, sumatriptan, and acetaminophen are all used in the treatment of menstrual migraines. Oral contraceptives are not indicated, because they worsen migraines.

A client diagnosed with dysmenorrhea has several medications prescribed. Which medication should the nurse question? oxycodone ibuprofen acetaminophen oral contraceptives

oxycodone Explanation: NSAIDS and mild pain relievers such as acetaminophen and ibuprofen are prescribed for this condition. Oral contraceptives prevent ovulation. Oxycodone is not indicated for long-term therapeutic management of pain.

Which is a priority for the nurse caring for a client with bladder exstrophy? increasing fluid intake encouraging voiding placing the child in prone position preventing skin breakdown

preventing skin breakdown Explanation: 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.

A child diagnosed with acute glomerulonephritis will most likely have a history of: recent illness such as strep throat. a sibling diagnosed with the same disease. hemorrhage or history of bruising easily. hearing loss with impaired speech development.

recent illness such as strep throat. Explanation: Symptoms of acute glomerulonephritis often appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat. The causative agent is group B hemolytic streptococcus. The treatment for glomerulonephritis includes maintaining fluid volume and managing hypertension. Glomerulonephritis is not contagious, so the child would not have acquired it from a sibling. Glomerulonephritis only affects the kidney, so hemorrhage, bruising, hearing loss, or speech development would not be associated with the disease.

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration you would want to prepare his parents for is a) a liquid diet for 3 days. b) the need for maintaining a semi-Fowler's position. c) some discomfort at the surgery site. d) the need for complete bed rest for 10 days.

some discomfort at the surgery site. After they are returned to the scrotum, testes may be sutured there to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation.

A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition? testicular infection varicocele testicular torsion hydrocele

testicular torsion Explanation: 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.

You care for a 3-year-old with hypospadias. After a surgical repair, he has a urethral urinary catheter inserted. You would want to teach his parents that a) He will always have tenderness on penile erection. b) the catheter insertion site will leave only a minimal scar. c) He must be reevaluated at puberty for testicular function. d) back pressure from such drainage may result in nephrotic syndrome.

the catheter insertion site will leave only a minimal scar. Explanation: The tube insertion site will leave only a minimal scar. A hypospadias repair should have no long-term consequences.

A teenager comes to the clinic with fever, muscle pain, and a macular rash on the palms and soles of the feet. Based on these findings, what diagnosis would the nurse anticipate for this client? polycystic ovary syndrome ammenorrhea premenstrual dysmorphic disorder toxic shock syndrome

toxic shock syndrome Explanation: Fever, severe muscle pain, and a sunburn-like rash on the palms and soles of the hands and feet are consistent with the diagnosis of toxic shock syndrome.

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, you would want to prepare her to a) void during the procedure. b) anticipate a headache afterward. c) drink three glasses of water during the procedure. d) have a local anesthetic injected prior to the procedure.

void during the procedure. A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.

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? pelvic inflammatory disease vaginal inflammation vulvovaginitis urinary tract infection

vulvovaginitis Explanation: 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 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child? a) Increase oral intake of fluid b) Provide a diet high in protein and sodium c) Administer the IV fluid slowly d) Make sure the IV fluid contains potassium

Administer the IV fluid slowly Correct Explanation: If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to replace plasma volume. Administer such fluid slowly, however, to avoid heart failure as extra fluid cannot be removed by the nonfunctioning kidneys. Be certain the fluid prescribed does not contain potassium until it is established kidney function is adequate; otherwise, the buildup of potassium could cause heart block. The child's diet should be low in protein, potassium, and sodium and high in carbohydrate to supply enough calories for metabolism yet limit urea production and control serum potassium levels. Oral fluid intake may be limited to prevent heart failure due to accumulating fluid that cannot be excreted.

A 13-year-old girl tells the nurse during a gynecological visit that a friend of hers developed toxic shock syndrome from tampon use. The client says that tampons work well for her, but she wonders whether they are safe. Which of the following recommendations should the nurse give this client to help prevent toxic shock syndrome? a) Alternate use of tampons with sanitary pads b) Use feminine hygiene sprays in conjunction with tampons c) Insert two tampons at a time d) Use the highest absorbency tampon possible

Alternate use of tampons with sanitary pads Explanation: To help prevent toxics shock syndrome, the nurse should recommend that the client alternate use of tampons with use of sanitary pads; change tampons at least every 4 hours; use the lowest absorbency tampon possible that is still adequate for her individual flow; avoid handling the portion of the tampon that will be inserted vaginally; not use tampons near the end of a menstrual flow, when excessive vaginal dryness can result from scant flow; not insert more than one tampon at a time, to avoid abrasions and to keep the vaginal walls from becoming too dry; and avoid deodorant tampons, deodorant sanitary pads, and feminine hygiene sprays as these products can irritate the vulvar-vaginal lining.

A nurse is performing postoperative care on a child with a ureteral stent. Which of the following interventions will help manage bladder spasms? a) Increase low-fat foods. b) Apply antibiotic ointment to tube site. c) Allow tubes to dangle freely to encourage flow. d) Encourage high fluid intake.

Encourage high fluid intake. Explanation: 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.

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 which of the following? a) Bladder exstrophy b) Hypospadias c) Epispadias d) Patent urachus

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.

A nurse is caring for a child who has had a urethral stent. What would be included in the care of this child? Decrease fluid intake until drain is working properly. Prevent constipation in the child. Avoid using ointments at the tube site. Ensure tube is clamped postoperatively.

Prevent constipation in the child. Explanation: 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 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 one 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 which of the following? a) The child is out of the habit of waking himself up during the night to void b) The child has been sexually abused, maybe on the fishing trip c) The child did not want to go on the fishing trip and is now retaliating against being made to go d) The child has a urinary tract infection due to not bathing while on the fishing trip

The child has been sexually abused, maybe on the fishing trip 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 and should be further explored.

You are counseling a couple about sexually transmitted diseases. The male partner has genital herpes. To prevent spread of the infection to the female partner, you advise the couple that a) a condom should be used during intercourse. b) coitus should be delayed until 10 days after penicillin is begun. c) intercourse should be avoided until a Pap test is negative. d) acyclovir should be applied topically prior to intercourse.

a condom should be used during intercourse. Explanation: Condoms provide protection against the spread of sexually transmitted diseases as well as conception.

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTI's). 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 of the following statements would be accurate for the nurse to tell this mother? a) "It is unlikely that your daughter is practicing good cleaning habits after she voids." b) "The position of the urethra in girls makes girls more susceptible than boys to UTI's." c) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." d) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." Explanation: 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 nurse is caring for a 12-year-old girl recently diagnosed with end-stage renal disease. The nurse is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? "My daughter must avoid high sodium foods." "She needs to restrict her potassium intake." "She can eat whatever she wants on dialysis days." "My daughter can eat what she wants when she is hooked to the machine."

"She can eat whatever she wants on dialysis days." Explanation: The girl cannot eat whatever she wants on dialysis days. She can eat what she wants during the few hours she is actively undergoing treatment in the hemodialysis unit. The other statements regarding a high sodium diet and potassium intake are correct.

A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point? a) Endometriosis b) Mittelschmerz c) Toxic shock syndrome d) Amenorrhea

Endometriosis If dysmenorrhea does not improve within 6 months with the use of NSAIDs and COCs, a laparoscopy is indicated to look for endometriosis, the most common reason for secondary dysmenorrhea. The other conditions listed are not associated with dysmenorrhea.

The child with nephrotic syndrome who has ascites and difficulty breathing is probably most comfortable sleeping in which position? a) Fowler's b) Sims' position c) Supine d) Prone

Fowler's Explanation: A Fowler's position (sitting upright) allows ascites fluid to settle downward and not press against the diaphragm, compromising breathing.

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review? Hemolytic anemia, thrombocytopenia, and acute renal failure Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level Hemolytic anemia, acute renal failure, and hypotension Thrombocytopenia, hemolytic anemia, and nocturia several times each night

Hemolytic anemia, thrombocytopenia, and acute renal failure Explanation: Hemolytic uremic syndrome is defined by all three particular features - hemolytic anemia, thrombocytopenia, and acute renal failure. Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level are indicative of acute glomerulonephritis. Hypertension, not hypotension, would be seen and the child would have decreased urinary output which would not cause nocturia.

The mother of 6-month-old girl is concerned about her daughter getting a urinary tract infection. Which of the following should the nurse mention to the mother to help prevent this condition? a) Bathe the child with bubble bath once a week b) Discontinue prescribed antibiotics once symptoms of UTI have disappeared c) Wipe from back to front when changing the girl's diaper d) Report any abnormally colored urine to the child's primary care provider

Report any abnormally colored urine to the child's primary care provider Correct Explanation: 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 measure would help an adolescent relax best during a pelvic examination? a) Assure her that no part of the exam will hurt. b) Help her hold her breath during the exam. c) Advise her to keep one hand on her abdomen. d) Show her a speculum prior to the exam.

Show her a speculum prior to the exam. Correct Explanation: Distraction and information about the procedure are effective measures to promote relaxation. Holding her breath tenses the abdomen; a pelvic exam is not necessarily pain-free.

A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents? The VCUG will rule out vesicoureteral reflux. The VCUG will detect if the infection is gone. The VCUG will rule out kidney stones. The VCUG will prevent further complications of the urinary tract infection (UTI).

The VCUG will rule out vesicoureteral reflux. Explanation: A VCUG is performed by having the bladder filled with a contrast medium via catheterization. Under fluoroscopy, the bladder is visualized filling and emptying. A VCUG is used to rule out reflux in the urinary tract, causes of hematuria, UTI, and structural anomalies. Reflux may cause frequent infections and scarring in the urinary tract if not diagnosed and treated. A VCUG will not diagnose renal stones. Renal stones would be detected by a CT scan. A VCUG would not be performed to detect if infections of the UTI have cleared. This would be done by assessing a urinalysis.

A child is administered oxybutynin (Ditropan) following surgical repair of a hypospadias. The purpose of this drug is to a) prevent nausea and vomiting. b) stimulate kidney function. c) acidify urine. d) relieve bladder spasms.

relieve bladder spasms. Correct Explanation: The presence of a urethral catheter can cause painful bladder spasms. A drug such as ocybutynin reduces the possibility of this.

A nurse is assessing an adolescent who comes to the clinic for a follow-up. During the history, the adolescent tells the nurse that she often experiences pain with her menstrual periods. When gathering additional information, which question would be most appropriate for the nurse to ask? a) "Have you ever been pregnant?" b) "Do you have any nausea or vomiting when you have the pain?" c) "How heavy is your menstrual flow?" d) "Do you have any discharge with a strange odor?"

"Do you have any nausea or vomiting when you have the pain?" Nausea, vomiting, dizziness, or loose stools are lanation: symptoms that commonly are associated with pain with menstruation (dysmenorrheal). A malodorous discharge suggests an infection. The adolescent is describing menstrual cramps; these are unrelated to pregnancy. Although obtaining information about the amount of the adolescent's menstrual flow is important, it is unrelated to the adolescent's complaint

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. When interviewing the caregivers, which question would be most important for the nurse to ask? "Is your child potty trained?" "Has your child complained of pain?" "How often do you bathe your child?" "Do any of your other children have a temperature?"

"Has your child complained of pain?" Explanation: Gather information about the current illness: when the fever started and its course thus far; signs of pain or discomfort on voiding; recent change in feeding pattern; presence of vomiting or diarrhea; irritability; lethargy; abdominal pain; unusual odor to urine; chronic diaper rash; and signs of febrile convulsions. Toilet training and bathing habits would be of importance, but they are not the most important to ask. Temperatures in other children in the family would not be related to this child's current situation.

The nurse is conducting a follow-up visit for a 13-year-old girl who has been treated for pelvic inflammatory disease. Which remark indicates a need for further teaching? "I cannot have unprotected sex again until my partner is treated." "Douching is not necessary and can cause bacteria to flourish." "My partner needs to be treated with antibiotics." "I should be tested for other sexually transmitted diseases."

"I cannot have unprotected sex again until my partner is treated." Explanation: The girl's partner should be treated, but she must strongly encourage the girl to require her partner to wear a condom every time they have sex, even after he undergoes antibiotic therapy. The other statements are accurate.

The nurse is discharging a client diagnosed with bacterial vaginosis. Which statement would indicate to the nurse that the client has a correct understanding of the discharge instructions? "I will always use a condom with any further sexual encounters." "If I suspect anything, I will be sure to use soap and water after sex." "I do not have to worry about speading this infection to my partner." "I do not need to see my health care provider for this infection."

"I will always use a condom with any further sexual encounters." Explanation: Using condoms with every sexual encounter can help to prevent recurrence and the spread of disease. Bacterial vaginosis is transmittable to sexual partners, and washing in soap and water does not stop the transmission of the disease. If a client suspects an infection, he or she should see a health care provider or clinic.

The nurse is teaching a group of nursing students about genitourinary conditions. The nurse tells these students about a condition that occurs when there is an inflammation of the kidney and renal pelvis. The condition the nurse is referring to is which of the following? a) Pyelonephritis b) Ascites c) Oliguria d) Amenorrhea

Pyelonephritis Explanation: Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Ascites is edema in the peritoneal cavity.

The nurse is conducting a routine wellness examination of a 13-year-old girl. Which question would be best to use when beginning to discuss her sexual behavior? a) "Are you curious about sex?" b) "Are you sexually active?" c) "Do you talk to your mom about sex?" d) "What do you like to do on the weekend?"

"What do you like to do on the weekend?" The best approach is to start with questions about friends and social life, moving the conversation toward sexual behavior. The direct approach is less effective with adolescents.

A group of nursing students is discussing terminology related to the genitourinary system during a post-conference setting. One of the students asks what mittelschmerz is or what it means. A classmate of this student correctly answers that mittelschmerz is which of the following? a) The beginning of menstruation b) A medication given to treat dysmenorrhea c) A symptom of premenstrual syndrome d) A dull, aching abdominal pain at ovulation

A dull, aching abdominal pain at ovulation Mittelschmerz is a dull, aching abdominal pain at the time of ovulation (hence the name, which means "midcycle"). The beginning of menstruation is called menarche. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Nonsteroidal, anti-inflammatory drugs (NSAIDs), such as ibuprofen (advil, motrin) inhibit prostaglandins and are the treatment of choice for primary dysmenorrhea, which is painful menstruation.

A 2-year-old has a history of fever and fussiness. Which additional symptoms would make the nurse suspect a urinary tract infection? Skin rash Increased thirst Abdominal pain Swollen lymph nodes

Abdominal pain Explanation: The symptoms of urinary tract infection can vary depending on the age of the child. Abdominal pain is a common symptom in a child with a UTI. Swollen lymph nodes, skin rash, and thirst are not the common symptoms associated with a UTI.

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? Foley catheter placement Abdominal palpation Supine positioning Intravenous fluids

Abdominal palpation Explanation: 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 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 complains of 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 a) A urinary tract infection b) Lipoid nephrosis (idiopathic nephrotic syndrome) c) Rheumatic fever d) Acute glomerulonephritis

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 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 occur.

The nurse is administering cyclophosphamide as ordered for a 12-year-old boy with nephrotic syndrome. Which instruction is most accurate regarding administration? Administer in the evening on an empty stomach Encourage fluids, adequate food intake, and voiding before and after administration Provide adequate hydration and encourage voiding Administer in the morning, encourage fluids and voiding during and after administration

Administer in the morning, encourage fluids and voiding during and after administration Explanation: It is very important to administer in the morning, encourage large amounts of water/fluids and encourage frequent voiding during and after infusion to decrease the risk of hemorrhagic cystitis

The nurse is assessing a child diagnosed with nephritic syndrome and observes generalized edema. The nurse documents this as which of the following? a) Anasarca b) Hydronephrosis c) Phimosis d) Enuresis

Anasarca Explanation: Anasarca refers to generalized edema. Enuresis refers to continued incontinence of urine past the age of toilet training. Hydronephrosis refers to a condition in which the pelvis and calyces of the kidney are dilated. Phimosis refers to a condition in which the foreskin of the penis cannot be retracted

A child in kidney failure has had a kidney transplantation. You would prepare the child for which of the following to occur postoperatively? a) Infection-control precautions that may cause him to be lonely b) Full-body irradiation that will leave him nauseated c) Burning on urination from high uric acid content d) A transient rash from T-cell suppression

Infection-control precautions that may cause him to be lonely Correct Explanation: Children may be isolated following a transplant to help them resist infection during the time their immune system response is lowered to help them avoid transplant rejection.

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

Encourage the child to take all the antibiotics if diagnosed with strep throat. Explanation: Encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community that the child came in contact with unless they are symptomatic. Ibuprofen does not cure strep throat and that is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.

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 which of the following as an appropriate measure? a) Giving desmopressin intranasally b) Encouraging fluid intake after dinner c) Practicing bladder-stretching exercises d) 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 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 patient's chart, the nurse learns that she was prescribed an oral contraceptive at her last visit. Which of the following interventions should the nurse implement in this situation? a) Refer the client to her primary care physician for examination for possible uterine or cervical cancer b) Recommend that she ask the gynecologist about endometrium ablation to halt the metrorrhagia c) Recommend that she ask the gynecologist to change her prescription to a different oral contraceptive d) 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

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 Correct Explanation: Metrorrhagia is bleeding between menstrual periods. This may occur in teenagers taking oral contraceptives (breakthrough bleeding) during the first 3 or 4 months of use. If metrorrhagia occurs for more than one menstrual cycle in a teenager who is not taking oral contraceptives (which is not the case here), she be referred to her primary care provider for examination, because abnormal vaginal bleeding is an early sign of uterine or cervical carcinoma or an ovarian cyst. Endometrium ablation, used with premenopausal women to halt metrorrhagia, is not recommended for adolescents. There is no need at this point for the client to change prescriptions, as the bleeding will likely go away in the next month or so as the client's body adapts to the current contraceptive.

Most urinary tract infections seen in children are caused by which of the following? a) Intestinal bacteria b) Dietary insufficiencies c) Fungal infections d) Hereditary causes

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.

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. Explanation: Metrorrhagia is bleeding between menstrual periods. This may occur in teenagers taking oral contraceptives (breakthrough bleeding) during the first 3 or 4 months of use. If metrorrhagia occurs for more than one menstrual cycle in a teenager who is not taking oral contraceptives (which is not the case here), she be referred to her primary care provider for examination, because abnormal vaginal bleeding is an early sign of uterine or cervical carcinoma or an ovarian cyst. Endometrium ablation, used with premenopausal women to halt metrorrhagia, is not recommended for adolescents. There is no need at this point for the client to change prescriptions, as the bleeding will likely go away in the next month or so as the client's body adapts to the current contraceptive.

The human papillomavirus (HPV) is commonly passed on from a pregnant woman to her fetus. a) False b) True

False Explanation: The presence of vulvar HPV lesions appears to have no effect on the fetus during pregnancy, but if they are so large they obstruct the birth canal for birth, a cesarean birth may be scheduled.

A nurse is assessing a child that may have peritonitis. Which of the following would be signs of this problem? a) Diarrhea b) Syncope c) Increased white blood cell count of dialysate outflow d) Increased red blood cell count of dialysate outflow

Increased white blood cell count of dialysate outflow Explanation: Increased white blood cell count of dialysate outflow is one of the signs of peritonitis. Vomiting, fever, and abdominal pain are also signs of peritonitis.

The nurse is caring for an 8-year-old hospitalized child with nephrotic syndrome. Which of the following nursing interventions would be appropriate for this child? a) Weigh the child once a week. b) Administer antipyretics as needed. c) Test the urine for ketones twice a day d) Measure the abdominal girth daily.

Measure the abdominal girth daily. Measure the child's abdomen daily at the level of the um bilicus, and make certain that all staff personnel measure at the same level. Weigh the child at the same time every day on the same scale in the same clothing. Test the urine regularly for albumin and specific gravity. Elevated temperature is not an issue with nephrotic syndrome.

The nurse is caring for an 8-year-old child hospitalized with nephrotic syndrome. Which nursing intervention would be appropriate for this child? Measure the abdominal girth daily. Weigh the child once a week. Test the urine for ketones twice a day. Administer antipyretics as needed.

Measure the abdominal girth daily. Explanation: Measure the child's abdomen daily at the level of the umbilicus, and make certain that all staff personnel measure at the same level. Weigh the child at the same time every day on the same scale in the same clothing. Test the urine regularly for albumin and specific gravity. Elevated temperature is not an issue with nephrotic syndrome.

An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection? Ceftriaxone Metronidazole Acyclovir Doxycycline Miconazole

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.

The nurse is most accurate to instruct the client that which occurs during a female's mid-cycle? Bloating Mittelschmerz Dysmenorrhea Menarche

Mittelschmerz Explanation: Mittelschmerz refers to a dull, aching abdominal pain at the time of ovulation. The discomfort usually lasts a few hours and is relieved by analgesics. Bloating occurs for some during premenstrual syndrome. Menarche is the beginning of menstruation. Dysmenorrhea means painful menstruation.

A nurse is performing postoperative care on a child with a ureteral stent. Which of the following interventions will help manage tube patency? a) Maintain fluid restriction. b) Provide a low-sodium diet. c) Monitor output. d) Allow tubes to dangle freely to encourage flow.

Monitor output. Urinary output is a good indicator of patency

When examining the musculoskeletal system of the child, which would be indicative of a potential kidney problem? Walking with a limp A clunk felt in abduction of the hip Hypertonia Muscle weakness

Muscle weakness Explanation: Muscle weakness occurs in many renal conditions. Walking with a limp, a hip clunk, and hypertonia are indicative of musculoskeletal problems, but not necessarily renal problems as well.

The nurse is teaching a group of nursing students about acute glomerulonephritis genitourinary conditions. A student asks the about a condition that occurs when there is a decreased volume of urine output. The condition the student is referring to is which of the following? a) Ascites b) Amenorrhea c) Pyelonephritis d) Oliguria

Oliguria Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis. Ascites is edema in the peritoneal cavity

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 Explanation: Cryptorchidism occurs when the male gonads (testes) have not descended into the scrotum. Either one or both of the testes may not be in the scrotum. In most infants, the testes descend by the time the male is 1 year old. The nurse assesses the client's status by palpation of the scrotum.

The nurse is triaging clients as they come in to an express care facility. Which assessment finding is clinically significant for early nephrotic syndrome? Edema in the hands Periorbital edema Facial puffiness Sacral edema

Periorbital edema Explanation: Periorbital edema and edema in the ankles are the initial presenting symptoms. As the swelling advances, the edema becomes generalized with a pendulous abdomen full of fluid. Edema in the scrotum also appears. Edema in the hands, sacrum and facial puffiness can be a progression of the disease.

The nurse is educating the parents of a child requiring renal replacement. The parents express concern because they live in a remote, rural area with no access to pediatric speciality dialysis units. Which would the nurse recommend to the parents? Renal transplant Peritoneal dialysis Hemodialysis In home hemodialysis

Peritoneal dialysis Explanation: Perioneal dialysis is performed in the home setting after proper training. Hemodialysis is completed several times a week at a diaylisis center. Renal transplant would be a discussion if the child needed a kidney transplant.

When developing the preoperative plan of care for an infant with bladder exstrophy, which intervention would the nurse least likely include? Changing soiled diapers immediately Covering the bladder with a sterile plastic bag Sponge-bathing instead of tub bathing Placing the infant in a side-lying position

Placing the infant in a side-lying position Explanation: When providing care to an infant with bladder exstrophy, the nurse would keep the infant in the supine position, cover the bladder with a sterile plastic bag, change soiled diapers immediately to prevent contamination, and sponge-bathe the infant rather than immersing him or her in bath water.

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? Urine culture positive for contaminants Negative for respiratory syncytial virus White blood cells: 8,000/µL (8.0 ×109/L) Positive culture for beta-hemolytic streptococcus

Positive culture for beta-hemolytic streptococcus Explanation: Acute glomerulonephritis may result as an autoimmune response to the invasion of group A beta-hemolytic streptococcus. This group of streptococci affect the glomeruli of the kidneys. This would be addressed by the health care provider and is the most important of the laboratory results presented. If there is an active strep infection, it would need to be treated with an antibiotic.The white blood cell count is within normal limits. It is good to be negative for respiratory syncytial virus. The urine culture would have to be redone due to contamination. It does not provide an accurate status of the child's urine.

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

Proteinuria, hypoalbuminemia, and hypercholesterolemia Explanation: Proteinuria, hypoalbuminemia, and hypercholesterolemia are diagnostic of a child with nephrotic syndrome. The child will also present symptomatically with a sudden onset of edema. Hematuria is typically seen with glomerulonephritis.

The nurse is caring for a 12-year-old boy diagnosed with acute glomerulonephritis. When reviewing the boy's health history,y which finding will likely be noted? History of recurrent urinary tract infections Recent history of an upper respiratory infection Family history of renal disorders History of hypotension

Recent history of an upper respiratory infection Explanation: Acute glomerulonephritis often follows a group A streptococcal infection. Strep A infections may manifest as an upper respiratory infection. The history of urinary tract infections, renal disorders, or hypotension are not directly associated with the onset of acute glomerulonephritis.

A child diagnosed acute glomerulonephritis will most likely have a history of which of the following? a) Hearing loss with impaired speech development b) Sibling diagnosed with the same disease c) Hemorrhage or history of bruising easily d) Recent illness such as strep throat

Recent illness such as strep throat Symptoms of acute glomerulonephritis often appear one to three weeks after the onset of a streptococcal infection such as strep throat.

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? a) Regulate blood pressure b) Produce white blood cells c) Circulate cerebrospinal fluid d) Remove carbon dixoide

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 nurse is planning the discharge instructions for the parents of a 1-month-old infant who has had a circumcision completed. Which information should be included in the education provided? Report redness or swelling on the penile shaft Use petroleum jelly on the head of the penis for the first 2 weeks after the procedure Reduce the child's fluid intake to reduce voiding during the first 24 hours Report any bleeding to the physician

Report redness or swelling on the penile shaft Explanation: The discharge instructions for the child who has had a circumcision will include a listing of warning signs to report. Redness or swelling of the penile shaft is not a normal finding and must be reported. Petroleum jelly is often used for the first 24 hours after the procedure but not for a period of 2 weeks. Small amounts of bleeding may be noted. This bleeding if scant in amount does not warrant reporting to the physician. Reduction of water to impact voiding is inappropriate.

Which of the following nursing diagnoses would be the priority when caring for a child in renal failure following a kidney transplant? a) Risk for infection related to immunocompromised state b) Pain related to tissue rejection c) Constipation related to effects of administered drugs d) Deficient fluid volume related to fluid intake restrictions postoperatively

Risk for infection related to immunocompromised state Explanation: Children are administered anti-immune therapies to lower immune system response and help prevent transplant rejection following a transplant; this leaves them susceptible to infection.

he nurse is caring for a child with epididymitis. When planning care, which intervention may be included? Corticosteroid therapy Warm compresses Catheterization Scrotal elevation

Scrotal elevation Explanation: Epididymitis is caused by a bacterial infection. Treatment may include scrotal elevation, bed rest, and ice packs to the scrotum. Pharmacotherapy may include antibiotics, pain medications, and nonsteroidal anti-inflammatory drugs (NSAIDs). Warm compresses would result in vasodilation and do little to relieve the pain and swelling of the condition. Corticosteroid therapy is not included in the plan of care for the condition. Voiding is not impacted by epididymitis. Catheterization is not indicated.

A 16-year-old girl has had several cases of cystitis in the past year. Which of the following should the nurse suspect as the cause, based on this finding? a) Wiping from front to back after voiding b) Regular participation in a strenuous sport c) Frequent voiding d) Sexual activity

Sexual activity Correct Explanation: When cystitis is seen in adolescent girls, it is an alert a girl may be sexually active. Wiping from front to back after voiding helps prevent urinary tract infections, not cause them. Frequent voiding does not cause cystitis, nor does regular participation in a strenuous sport

The nurse is caring for a child admitted with acute glomerulonephritis. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Strawberry red tongue b) Smoky colored urine c) Jaundiced skin d) Loose, dark stools

Smoky colored urine The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody. 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 taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? a) Sudden onset of severe scrotal pain with significant hemorrhagic swelling b) Enlarged inguinal glands and fever c) Fever, scrotal swelling, and urethral discharge d) Hardened and tender epididymitis with edema and erythema of scrotum

Sudden onset of severe scrotal pain with significant hemorrhagic swelling Explanation: 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

A 16-year-old tells you she has terrible dysmenorrhea. Which of the following actions would be the best health teaching measure regarding this? a) Take acetaminophen beginning with the first day of a menstrual flow. b) Drink a minimum of fluid if having pain. c) Use ice to help in reducing inflammation and pain. d) Take over-the-counter ibuprofen for its prostaglandin action.

Take over-the-counter ibuprofen for its prostaglandin action. Explanation: An anti-inflammatory medication is most helpful in reducing the discomfort of dysmenorrhea.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent complains of severe abdominal pain. A diagnosis of pelvic inflammatory disease 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 a) Talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted disease and discuss the importance of safe sex practices b) Take the child to a private room and interview her regarding her sexual history and partners c) Take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity d) 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 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.

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 of the following actions? a) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. b) Weigh the child in the same clothes she had been weighed in the day before and report the two weighs to the nurse while the nurse is on the phone. c) Give the child fluids and report back to the nurse in a few hours. d) Give the child a diuretic 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.

A 14-year-old girl visits her gynecologist and is found to have vaginal candidiasis. She is obese, claims to not be sexually active, and is not on an oral contraceptive. Which intervention should be considered for this client? Test her urine for glucose to rule out diabetes mellitus Insertion of antifungal tablets or creams in the morning Prescription of an antibiotic Prescription of an oral contraceptive

Test her urine for glucose to rule out diabetes mellitus Explanation: Candidiasis is a vaginal infection spread by the fungus Candida, an organism which thrives on glycogen. Because oral contraceptives produce a pseudopregnancy state, adolescents using oral contraceptives tend to have frequent vaginal candidal infections. If being treated with an antibiotic for another infection (which destroys normal vaginal flora and lets fungal organisms grow more readily), they are also particularly susceptible to this infection. Thus, neither prescription of an oral contraceptive or prescription of an antibiotic would be appropriate in this case. Incidence is also strongly associated with immune suppression and diabetes mellitus, because hyperglycemia provides the perfect glucose-rich environment for candidal growth. If a girl has frequent candidal infections, her urine should be tested for glucose to rule out diabetes mellitus. Teach women to insert antifungal tablets or creams at bedtime, not in the morning, so the drug does not drain from the vagina immediately afterward.

A voiding cystourethrogram (VCUG) is ordered on a child. What education should be provided to the parents? a) The VCUG will prevent further complications of UTI. b) The VCUG will rule out kidney stones. c) The VCUG will rule out VUR. d) The VCUG will detect if the infection is gone.

The VCUG will rule out VUR. Explanation: A VCUG will rule out reflux in the urinary track. This may cause frequent infections and scarring if not diagnosed and treated.

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

The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained Enuresis is primary, or functional, if bladder training was never achieved, acquired or secondary or organic if control was established but has now been lost. Enuresis when exceptionally tired, while absorbed in some activity, or when a parent forgets to remind the child is more likely to be primary rather than organic.

The nurse knows which of the following is a description of peritoneal dialysis when compared to hemodialysis? a) The child must go into a facility to get peritoneal dialysis. b) There are strict diet and fluid restrictions. c) Therapy is only 3 to 4 days per week. d) The child can live a more normal lifestyle.

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.

A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which of these actions by the nurse would require immediate attention? The child is diapered. The child's appetite is poor. The child does not have intravenous access. The child is unable to ambulate.

The child does not have intravenous access. Explanation: An intravenous pyelogram is an X-ray study of the upper urinary tract in which a radio opaque dye is injected into a peripheral vein, requiring intravenous access. The other choices are not a priority for this client.

A client has just completed a renal biopsy. Which manifestation should be given priority attention? The sterile dressing needs changing. The child is still. The child is not voiding. The child is sleeping.

The child is not voiding. Explanation: The presence of voiding is a priority after a renal biopsy to prevent blood clotting and blocked urine flow. The other choices are not of a priority nature.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. Which of the following would the nurse likely find in this child's history? a) The child had a congenital heart defect. b) The child recently had an ear infection. c) The child is being treated for asthma. d) The child has a sibling with the same diagnosis.

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 mother of a child diagnosed with pyelonephritis asks if the kidneys were damaged because of this. What is the best response by the nurse? a) As long as IV antibiotics are started, there is no risk of renal damage. b) The child's risk for renal scarring is increased with pyelonephritis. c) No, if the child is urinating normally, the kidneys were not damaged. d) Yes, all children who get pyelonephritis have renal scarring.

The child's risk for renal scarring is increased with pyelonephritis. Explanation: It would not be possible to determine if the child has renal scarring with pyelonephritis until more testing is performed. It can result in renal scarring with this type of problem, but that does not mean there will definitely be complications. Antibiotics are usually the treatment of choice in this situation, but it cannot be determined when the damage had occurred.

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 client remains continent throughout the night. The parent takes the client to the bathroom at night. The client wets only when involved in an activity. The child wakes up once during the night for a glass of water.

The client remains continent throughout the night. Explanation: 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 him to be circumcised. What would be the best response by the nurse? a) The foreskin is needed for repair. b) Circumcision is usually performed after 1 year old. c) Circumcision with a hypospadias will cause meatal stenosis. d) The circumcision may predispose the child to renal failure.

The foreskin is needed for repair. A child's foreskin is not removed since it is needed to help repair a hypospadias. Once the hypospadias is repaired, a circumcision can be performed at the same time. Meatal stenosis has to do with the urethral opening diameter, not the placement.

The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they state that they need to report which of the following to the physician? a) Bleeding that stops without pressure b) Small spots of blood on diaper c) The infant does not urinate within 6 to 8 hours d) Appearance of granulation tissue

The infant does not urinate within 6 to 8 hours Explanation: The parents should immediately notify the physician or nurse practitioner if the infant does not urinate within 6 to 8 hours after the procedure. Small spots of blood on the diaper, bleeding that stops without pressure, and granulation tissue are normal findings

A child needs to undergo peritoneal dialysis. What type of education would the nurse provide to the family about this process? The peritoneal dialysis should help the child with their growth and blood pressure. The child will need to have increased fluid restrictions with this. Infection risk is low. This is performed for 24 hours a day.

The peritoneal dialysis should help the child with their growth and blood pressure. Explanation: The advantages of peritoneal dialysis over hemodialysis include improved growth as a result of more dietary freedom, increased independence in daily activities, and a steadier state of electrolyte balance. However, the risk for infection (peritonitis and sepsis) is a continual concern with peritoneal dialysis.

A nurse is discussing with a family the various causes of their child's vulvovaginitis. What would be included in the education? a) Constipation is a common cause of vulvovaginitis. b) Fevers often occur with vulvovaginitis. c) Child protective services will be called since this is a sign of abuse. d) The use of cleansing towelettes may have caused the vulvovaginitis.

The use of cleansing towelettes may have caused the vulvovaginitis. Cleansing towelettes can contain harsh soaps that can cause vulvovaginitis. This is a common childhood problem and not necessarily a sign of abuse.

A parent asks if their newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? a) Surgery is not needed for this type of problem. b) There is a chance the testicles will descend on their own. c) This problem needs to be corrected immediately in the newborn period. d) If the infant is having swelling or pain, then surgery will be performed.

There is a chance the testicles will descend on their own. The AAP recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year old. This problem does not cause pain or swelling.

An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, which of the following would lead the nurse to suspect that the adolescent has candidiasis? a) Frothy, gray-green discharge b) Thick, white cheese-like discharge c) Milky, gray, fishy-odor discharge d) Yellow-green discharge

Thick, white cheese-like discharge Explanation: With candidiasis, the vaginal discharge is thick, white, and cheese-like. A frothy, gray-green discharge is noted with trichomoniasis. A milky, gray discharge with a fishy odor suggests gardnerella. A yellow-green vaginal discharge suggests gonorrhea.

A child is having their urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate? a) This determines the presence of sugar in the urine. b) This determines the presence of RBCs in the urine. c) This indicates renal disease. d) This may indicate a urinary tract infection.

This may indicate a urinary tract infection. Correct Explanation: Positive leukocytes may indicate a urinary tract infection. The urine would also need to be cultured to determine the type and amount of bacteria growth.

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

This occurs when there is backflow of urine into the bladder and sometimes kidneys. The cause of VUR is a backflow of urine into the bladder and possibly kidneys. This disorder can occur if there is an obstruction, but not always. The way to determine if a child has VUR is typically by a VCUG diagnostic test. There are five different grades to VUR and it is treated according to the cause and degree of VUR.

A 9-year-old boy who is uncircumcised has developed balanoposthitis. There is no sign of phimosis. Which of the following recommendations should the nurse give the boy and his parents to help prevent future occurrences? a) To pull back the foreskin and clean the penis thoroughly when showering b) To apply a local antibiotic ointment daily c) To avoid warm baths d) To become circumcised

To pull back the foreskin and clean the penis thoroughly when showering Explanation: Balanoposthitis is inflammation of the glans and prepuce of the penis. It tends to occur in uncircumcised boys, is usually caused by poor hygiene, or may accompany a urethritis or a regional dermatitis. Medical treatment involves local application of heat by warm wet soaks or warm baths. A local antibiotic ointment may be prescribed, but this would be to eliminate an existing infection, not to prevent future recurrences. If phimosis (a tight foreskin) appears to be contributing to the condition, circumcision may be advocated after the inflammation subsides to prevent the condition from recurring.

The nurse is reviewing the causative organisms noted on laboratory reports. Which organism is transmitted solely by sexual contact? Trichomonas Bacillus Borelli Cholera Bacterium

Trichomonas Explanation: The organism transmitted solely by sexual contact is Trichomonas. The other organisms are causes of various infections and acquired in various ways.

Syphilis in a pregnant woman can cause spontaneous miscarriage, preterm labor, stillbirth, or congenital anomalies in the newborn. a) True b) False

True Correct No rationale was given

A female adolescent comes to the clinic for an evaluation. Assessment reveals a possible urinary tract infection. Which of the following would the nurse expect to be done to confirm this suspicion? a) Kidneys, ureter, and bladder x-ray b) Intravenous pyelogram c) Renal ultrasound d) Urine culture

Urine culture Correct Explanation: A urinary tract infection is diagnosed by a urine culture. A kidney, ureter, and bladder x-ray would provide information about the size and contour of the kidneys. An ultrasound can detect differing sizes of kidneys or ureters and help to differentiate between solid or cystic kidney masses. An intravenous pyelogram provides information about the collecting systems of the kidney and ureters.

The nurse is caring for a child admitted with a urinary tract infection. In addition to foul smelling urine, which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Increased appetite b) Weight gain. c) Decreased urination d) Vomiting

Vomiting Correct Explanation: In children, the symptoms or a urinary tract infection may be fever, nausea, vomiting, foul-smelling urine, weight loss, and increased urination. Occasionally there is little or no fever. Vomiting is common, and diarrhea may occur.

A 6-month-old boy is found to have undescended testes. The parents are concerned. Which of the following should the nurse anticipate as the next step for this client? a) Administer a short course of chorionic gonadotropin hormone for about 5 days b) Wait a year or two to see whether the testes will descend on their own c) Orchiopexy to correct the condition d) Karyotyping to establish the client's gender

Wait a year or two to see whether the testes will descend on their own Correct Explanation: Because the testes sometimes descend spontaneously during the first year of life, treatment is usually delayed for 1 year, possibly 2. Boys may be given a short course of chorionic gonadotropin hormone for about 5 days to see if testicular descent can be stimulated. If this is not successful, Surgery (orchiopexy) by laparoscopy will then correct the condition. Karyotyping is not needed in this situation as the client's gender is already established.

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? a) Irritation of labia and vaginal opening b) White cottage cheese-like discharge c) Foul yellow-gray discharge d) Thin gray vaginal discharge with fishy odor

White cottage cheese-like discharge Correct Explanation: 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.

A nurse is caring for a 13-year-old boy with end-stage renal disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate? Administer his routine medications as scheduled Take his blood pressure measurement in extremity with AV fistula Assess the Tenckhoff catheter site Withhold his routine medication until after dialysis is completed

Withhold his routine medication until after dialysis is completed Explanation: The nurse should withhold routine medications on the morning that hemodialysis is scheduled since they would be filtered out through the dialysis process. His medications should be administered after he returns from the dialysis unit. A Tenckhoff catheter is used for peritoneal dialysis, not hemodialysis. The nurse should avoid blood pressure measurement in the extremity with the AV fistula as it may cause occlusion.