Ch 24: GU
The nurse is instructing the parents of an infant boy with cryptorchidism. Which nursing statement is correct?
"No treatment is needed unless no change is noted by 6 to 12 months." Explanation: The testes may descend into the scrotum during the first year; therefore, no treatment should be provided unless the testes do not descend. Estrogen would not be appropriate for this situation, and no definitive statement can be made about development of testicular cancer.
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." Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended.
The mother of a child diagnosed with pyelonephritis asks if the kidneys were damaged because of this. Which of the following responses would be most appropriate?
"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. Pyelonephritis can result in renal scarring, 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 and if damage has occurred.
When assessing the infant for cryptorchidism, the nurse would be prepared for which of the following?
A bulge in the inguinal area During the third trimester of pregnancy, the inguinal canal opens and a space is created in the scrotal sac. The testicle is supposed to migrate into the sac, and closure of the inguinal canal concludes. In cryptorchidism, this process does not complete, and the testicle occupies an anomalous position. The nurse will be able to feel a bulge in the inguinal area. The other answers are not related to cryptorchidism.
To determine if ascites is increasing in amount in a child with nephrotic syndrome, which measurements would be most appropriate?
Abdominal circumference Explanation: Ascites is accumulation of fluid in the abdominal cavity. Increasing abdominal size reveals this.
A teacher sends a child to see the school nurse for irritability and bruising. Which symptom would be indicative of hemolytic uremic syndrome?
Oliguria and jaundice 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 determines that interventions for a voiding disorder have been effective when the family of a child with enuresis demonstrates evidence of which of the following?
Parents/family use positive coping mechanisms in response to the child and the voiding disorder. The family caregiver may become extremely frustrated dealing with wet bedding every morning. Health care personnel must facilitate coping and take a supportive and understanding attitude towards the caregiver and child. Surgery is not needed—fluid restrictions, bladder training and alarms are the most common approaches. Medications are sometimes used with alarms and positive reinforcement, parents usually accept the voiding disorder and often have a family member with a history of enuresis.
The nurse is collecting data on a 6-year-old child admitted with a possible urinary tract infection. Which vital sign might indicate the possibility of an infection?
Pulse rate 135 bpm 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 a child this age.
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 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.
The nurse is discussing urinary tract infections (UTI's) in children with a group of peers. Which fact is the most accurate regarding urinary tract infection seen in children?
The most common age for UTIs in children is 2 to 6 years of age. Urinary tract infections (UTIs) are fairly common in the "diaper age," in infancy, and again between the ages of 2 and 6 years. Older school-aged and adolescent girls are not as prone to UTIs.
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. 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 child is scheduled to undergo a voiding cystourethrogram (VCUG). When teaching the parents about this procedure, which of the following would the nurse include?
The test will help to rule out vesicoureteralreflus (VUR). Explanation: A VCUG will rule out reflux in the urinary tract, which may lead to frequent infections and scarring if not diagnosed and treated. The test is not performed if a urinary tract infection is present. It will not identify kidney stones.
An 8-year-old develops balanoposthitis. A finding of this is
denuded, reddened surface of the glans of the penis. Balanoposthitis is inflammation of the glans and prepuce of the penis. These appear reddened and are painful.
Most urinary tract infections seen in children are caused by:
intestinal bacteria. Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections.
Which of these laboratory results would be most important for the nurse to assess in a child who has a diagnosis of urinary tract infection?
urinalysis A urinalysis is one of the simplest tests to reveal kidney function and presence of a urinary tract infection. A chemical reagent strip, specific gravity, and blood urea nitrogen are not the primary tests evaluated for the presence of a urinary tract disease.
A 4-year-old child with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing the child for this procedure, the nurse would want to prepare the child to:
void during the procedure. At the start of the voiding cystourethrogram, a catheter is inserted into the bladder. The contrast medium is inserted through the catheter into the bladder. Fluroscopy is performed to demonstarate the filling of the bladder and the collapsing of the bladder upon emptying. The assessment of emptying requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed. No anesthetic is required for this procedure. The fluid filling the bladder is inserted via the catheter so no drinking of water is required. A headache following the procedure would not be expected.
The nurse is caring for a 7-month-old female infant diagnosed with a urinary tract infection (UTI). The parents are upset as this is the infant's second UTI with a fever. Which instruction is most helpful? Select all that apply.
-A fever is commonly noted with a UTI. -Change diapers promptly, especially after bowel movements. -Female urethras are shorter and straighter than males. Urinary tract infections are common in females in the "diaper age" because the female urethras are shorter and straighter than in the males. This poses a potential for infection. Males have a higher rate of UTI's in the first 4 months. A fever is common with this diagnosis. Changing the diapers promptly eliminates the time that the infant is exposed to E-coli. The infant may feel better after 3 days of antibiotic use but it takes a full course of antibiotics to clear an infection.
A group of nursing students are reviewing information about urinary tract infections in children. The students demonstrate understanding of the information when they identify which of the following organisms as most commonly involved? Select all that apply.
-Escherichia coli -Klebsiella Escherichia coli, prevalent in the gastrointestinal tract, and Klebsiella are the organisms predominantly responsible for pediatric UTIs. Staphylococcus, Streptococcus and Chlamydia are not associated with pediatric UTIs.
Which child has the highest risk of urinary tract infection?
An 18-year-old female who is sexually active Explanation: After the neonatal period, females are at a higher risk for developing a urinary tract infection than males. The incidence of urinary tract infections in sexually active females is high. Circumcised males have a lower risk of urinary tract infections than uncircumcised males.
The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:
acute glomerulonephritis. Explanation: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.
A newborn is diagnosed with hypospadias and the parents want him to be circumcised. Which response by the nurse would be most appropriate?
"It's important to have your son see by a urologist because the foreskin is needed for repair." If any degree of hypospadias is present, a circumcision should not be performed without a urologic evaluation because the prepuce is used for the reconstructive surgery. The surgery is typically performed between the ages of 6 and 12 months. The child's condition does not involve a narrowing of the opening. The meatus opens on the ventral surface of the penis. There is no association with circumcision, hypospadias and renal failure.
The nurse is caring for a 10-year-old child experiencing nocturnal enuresis with no physiologic cause. The child states, "I am embarrassed and I wish I could stop this right now!" How will the nurse respond?
"There are several things we can do to help you achieve this goal." The child wants to stop this problem immediately, so the nurse's most therapeutic response is to assure the child that enuresis is indeed solvable. For some children, learning about the high prevalence of the problem may provide consolation. However, this may not alleviate the child's embarrassment and it does not address the desire for solutions. Telling the child that he or she will "grow out of this" downplays the embarrassment and does not address the desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.
Which cause of pediatric enuresis must be ruled out before psychological causes are investigated? Select all that apply.
-urinary tract infection -small bladder capacity -lack of awareness Pediatric enuresis may be caused by physiologic problems, including urinary tract infections, small bladder capacity, and lack of awareness of the need to void at night. Stress incontinence and cognitive function is not a common symptom in pediatrics. It is not until all physiologic factors are ruled out that psychological factors are investigated.
A child needs to collect urine for 24 hours. The nurse explains to the parents and child that this test assesses glomerular filtration rate and how the kidneys are functioning. What results would be expected in this type of test?
Creatinine clearance A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate. Urine is collected and kept on ice for a 24-hour period. During that time a serum creatinine is obtained. The presence of creatinine in the urine is compared with the serum to determine the amount of creatinine clearance. Casts, bacteria, and a culture and sensitivity are used to evaluate for infection and the antibiotics needed to treat the infection. RBCs are used to look for bleeding in the urine.
The child with nephrotic syndrome who has ascites and difficulty breathing is probably most comfortable sleeping in which position?
Fowler's A Fowler's position (sitting upright) allows ascites fluid to settle downward and not press against the diaphragm, compromising breathing.
The nurse is providing a child with oxybutynin as prescribed following surgical repair of a hypospadias. What should the nurse teach the patient about the purpose of this medication?
Relieves bladder spasms The child may notice painful bladder spasms as long as the catheter is in place after surgical repair of a hypospadias. An anticholinergic medication, which relieves bladders spasms such as oxybutynin (Ditropan), may be prescribed for pain relief. Oxybutynin (Ditropan) does not acidify the urine, stimulate kidney function, or prevent nausea and vomiting.
The location of the kidneys in the child in relationship to the location of the kidneys in the adult makes which fact a greater likelihood in the child?
The child has a greater risk for trauma to the kidney. The kidneys in children are located lower in relationship to the ribs than in adults. This placement and the fact that the child has less of a fat cushion around the kidneys cause the child to be at greater risk for trauma to the kidneys. The location of the kidneys does not affect the urges to empty the bladder nor the retaining of fluids.
The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history?
The child recently had an ear infection. Explanation: In the child with acute glomerulonephritis, presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.
The mother of a child brings the child in for an evaluation because "she is urinating all of the time." A child is having her urine checked. When reviewing the results, the nurse notes that the urine is positive for glucose. The nurse interprets as which of the following?
This may suggest diabetes mellitus. Explanation: Positive glucose determines the presence of sugar in the urine. This could signify diabetes and needs to be evaluated immediately. 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 female adolescent comes to the clinic for an evaluation. Assessment reveals a possible urinary tract infection. What would the nurse expect to be done to confirm this suspicion?
Urine culture 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.
A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test?
Checking with the parents for any allergies It is important to double-check whether the girl has any allergies. The test is contraindicated in children allergic to shellfish or iodine. Adequate hydration is also important, but the check for allergies is a priority. Only females of reproductive age must be screened for pregnancy. An enema is not necessary at all institutions.
A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate?
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 mother of a 10-year-old being treated for kidney failure speaks very broken English and is clearly overstressed. What is the priority nursing intervention?
Gaining more information about her stress Explanation: The priority intervention is to determine the sources of the mother's stressors. What are her fears and concerns? What pressures are present in her life? An interpreter may be necessary to ensure effective communication. Until then, the nurse cannot be sure that the other measures are appropriate, although they are caring.
The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?
Hypertension Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.
The mother of 6-month-old girl is concerned about her daughter getting a urinary tract infection. What should the nurse mention to the mother to help prevent this condition?
Report any abnormally colored urine to the child's primary care provider. 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.
The nurse is caring for a 1-year-old patient with nephritis. The nurse is giving an IV antibiotic to the patient. Which of the following is the most important documentation for the nurse to include for this patient?
The amount of solution infused on the I and O record. Explanation: The amount of the infusion is especially important to document on the I and O record of a young patient with compromised kidneys. The infusion time, length, and method are not important to document.
