CH 43 PREP U MATERNAL
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 may need surgery on his testes before we are discharged to go home." "Our son may have to go through life without two testes." "Our son's condition may resolve on its own." "Our son will likely have a high risk of cancer in his teen years as a result of this condition."
"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.
The caregiver of a 1-year-old boy 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 statement regarding the son's treatment? "Without the hormone your son will have fluid that will collect in his scrotum." "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." "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do."
"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." Explanation: 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 processes vaginalis 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.
When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? Risk for infection Excess fluid volume Imbalanced nutrition less than body requirements Activity intolerance
Risk for infection Explanation: 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 taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? Sudden onset of severe scrotal pain with significant hemorrhagic swelling Enlarged inguinal glands and fever Hardened and tender epididymitis with edema and erythema of scrotum Fever, scrotal swelling, and urethral discharge
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 epididymis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.
A 5-year-old boy occasionally wets his bed at night and his pants during the day. Which finding would indicate an organic cause—as opposed to a functional cause—of this enuresis? The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained. The boy only wets the bed on nights that he is exceptionally tired. The boy only wets his pants when he is absorbed in playing video games. The boy only wets his bed on the nights his father forgets to take him to the bathroom to void before going to bed.
The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained. Explanation: Enuresis is primary, or functional, if bladder training was never achieved; it is considered 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 to void prior to bedtime are more likely to be primary rather than organic.
The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? presence of a bruit presence of a thrill dialysate without fibrin or cloudiness absence of a thrill
absence of a thrill Explanation: 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 client has just been admitted to the unit with a history of recent streptococcal infection, hematuria, and proteinuria. Based on these findings, the nurse suspects which condition? acute kidney injury urinary tract infection prune belly syndrome acute glomerulonephritis
acute glomerulonephritis Explanation: Recent streptococcal infection, hematuria, and proteinuria are indicative of acute glomerulonephritis. These symptoms do not suggest acute kidney injury, prune belly syndrome, or urinary tract infection.
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 state which as an appropriate measure? encouraging fluid intake after dinner practicing bladder-stretching exercises giving desmopressin intranasally engaging the child in stress-reduction measures
encouraging fluid intake after dinner Explanation: 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 condition. Therefore, measures to address stress and promote coping are appropriate.
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 magnesium sulfate amoxicillin and clavulanate potassium
metronidazole Explanation: Metronidazole, either oral or vaginal, is the drug of choice for treatment of clients with bacterial vaginosis. Amoxicillin; amoxicillin + clavulanate potassium; and magnesium sulfate are contraindicated for this diagnosis because they will have no effect on the contributing organism.
The nurse is providing care to a child with acute kidney injury. What assessment is priority for the nurse to determine if this child is developing hyperkalemia? pulse rate and rhythm muscle tone blood pressure abdominal pain
pulse rate and rhythm Explanation: Hyperkalemia occurs when the potassium levels rise above normal laboratory values. Although it varies among laboratories, a normal potassium range is generally between 3.5 and 5 mEq/l (3.5 and 5 mmol/l). When the potassium levels rise, the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm, because potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmia occurs or the heart starts to fail.
The nurse is caring for a client who had a kidney transplant 4 months ago. What symptom would be indicative of an acute transplant rejection? Select all that apply temperature >100.8°F (38.7°C) weight gain increased blood urea nitrogen level decreased serum creatinine weight loss
temperature >100.8°F (38.7°C) weight gain increased blood urea nitrogen level Explanation: Fever, increased blood urea nitrogen level, and weight gain are all indicative signs of a transplant rejection. A decreasing serum creatinine is not an indicator; creatine levels will rise in this scenario.
A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition? hydrocele varicocele testicular infection testicular torsion
testicular torsion Explanation: A hydrocele is a collection of fluid that collects in the fold of the scrotum, requiring no treatment. A varicocele is an abnormal dilation (dilatation) 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.
A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition? vulvovaginitis urinary tract infection (UTI) pelvic inflammatory disease (PID) vaginal inflammation
vulvovaginitis Explanation: Vulvovaginitis is diagnosed with clients experiencing vaginal or vulval inflammation, pain odor, and pruritus. Pelvic inflammatory disease and urinary tract infection are not consistent with these symptoms.
A nurse is reviewing the medical record of an infant with hydronephrosis. Which finding(s) will the nurse anticipate in the history and physical examination? Select all that apply. History of repeated urinary tract infections Itching Hypotension Abdominal mass on palpation Crying on voiding
History of repeated urinary tract infections Abdominal mass on palpation Crying on voiding
A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client? Reassess the client's testes at 6 months of age. Administer low-dose human chorionic gonadotropin hormone. Perform karyotyping to establish the client's gender. Schedule emergency orchiopexy to correct the condition.
Reassess the client's testes at 6 months of age. Explanation: Because the testes sometimes descend spontaneously during the first year of life, treatment is usually delayed until at least 6 months of age. If testes have not descended between 6 and 12 months of age, the client may be given a short course of chorionic gonadotropin hormone to see if testicular descent can be stimulated. If this is not successful, surgical intervention (orchiopexy) will be needed to correct the condition to prevent infertility. Karyotyping is not needed in this situation, because the client's gender is already established.
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. Weigh the old dialysate. Weigh the new dialysate. Start the process over with a fresh bag.
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 intervention will be included in the child's plan of care? Weighing on the same scale each day Ambulating 3 to 4 times a day Increasing fluid intake by 50 ml per hour Testing the urine for glucose levels regularly
Weighing on the same scale each day Explanation: The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss. The child with nephrotic syndrome is very edematous so increasing fluid intake would be counterproductive to care needed. In nephrotic syndrome the urine is tested for protein, not glucose. Ambulation is important for all but it is not specific to the child with nephrotic syndrome.
A nurse is caring for a 13-year-old boy with end-stage kidney 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 the extremity with the AV fistula. Withhold his routine medication until after dialysis is completed. Assess the Tenckhoff catheter site.
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.
The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? hypertension hypotension hypothermia tachycardia
hypertension Explanation: Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.
Most urinary tract infections seen in children are caused by: hereditary causes. fungal infections. intestinal bacteria. dietary insufficiencies.
intestinal bacteria. Explanation: 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.
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? "Let's meet with the dietitian and plan some meals." "She must severely restrict her sodium intake." "She should try to avoid protein." "Here is some written information from the dietitian."
"Let's meet with the dietitian and plan some meals." Explanation: 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.
A nurse has admitted a 3-year-old female diagnosed with a urinary tract infection. When developing the plan of care, what should the nurse do first? Develop a schedule for bladder emptying. Encourage fluid intake. Assess usual voiding patterns. Monitor intake and output.
Assess usual voiding patterns. Explanation: The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action.
The nurse obtains a history from the parent of a child with glomerulonephritis about how the child became ill. What would the nurse expect the parent to report? Reddish-brown, smoky-colored urine Diuresis and pallor Headache, loss of appetite Loss of weight, oliguria
Reddish-brown, smoky-colored urine Explanation: Acute glomerulonephritis can occur following a streptococcal infection. The immune process of the illness affects the structure of the kidney as well as the function of the kidney. Acute glomerulonephritis often presents with glomeruli bleeding. The nurse should inspect the urine with a dipstick. There will be increased protein evident. Inspect the urine for gross hematuria, which will cause the urine to appear tea colored, reddish-brown or smoky. The child may have a slight weight gain from slight edema. The blood pressure will be elevated and the child will experience a decreased urine output.
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? total protein, globulin, and albumin creatinine clearance 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.
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 is early sexual development." "Precocious puberty only occurs in boys, not girls." "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 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? "You will grow out of this eventually; you just need to be patient." "There are several things we can do to help you achieve this goal." "You are not alone. There are almost 5 million people that have enuresis." "You can wear pull-ups to bed and, since they look like underwear, no one will know."
"There are several things we can do to help you achieve this goal." Explanation: 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.
A nurse is caring for a client with a diagnosis of acute glomerulonephritis. Which intervention would the nurse expect to be included in the treatment plan? Select all that apply. 1 to 2 week course of antibiotics keeping the client in semi-Fowler position antihypertensive therapy high-protein diet blood glucose checks
1 to 2 week course of antibiotics keeping the client in semi-Fowler position antihypertensive therapy high-protein diet Explanation: Children with a diagnosis of acute glomerulonephritis usually will have an underlying streptococcal infection requiring a two-week course of antibiotics. Keeping the child in a semi-Fowler position and initiating a high-protein diet to supplement losing large amounts of protein in the urine is indicated. The child will be started on a course of antihypertensive therapy for high blood pressure. Blood glucose monitoring is not indicated.
The nurse is caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis. What would the nurse expect to administer if ordered? Sodium bicarbonate tablets Ferrous sulfate Vitamin D Erythropoietin
Sodium bicarbonate tablets Explanation: Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth.
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? Allow tubes to dangle freely to encourage flow. Encourage high fluid intake. Increase low-fat foods. Apply antibiotic ointment to tube site.
Encourage high fluid intake. 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 parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? There is a chance the testicles will descend on their own. This problem needs to be corrected immediately in the newborn period. If the infant is having swelling or pain, then surgery will be performed. Surgery is not needed for this type of problem.
There is a chance the testicles will descend on their own. Explanation: The Association of American Physicians 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 of age. This problem does not cause pain or swelling.
A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? weight, daily urine output, every shift amount of protein in the urine abdominal circumference
weight, daily Explanation: The classic sign of nephrotic syndrome is edema. It is usually generalized, but may be manifested as ascites or be periorbital depending on the seriousness of the disease. The easiest way to determine edema is by weighing the child. The child should be weighed on the same scale, at the same time daily, and with the same amount of clothing. The abdomen would only need to be measured if ascites was suspected or known. Measuring urine output will not determine edema, although it should be done to determine if urine is being produced in adequate amounts. Measuring the amount of protein in the urine will also not determine edema. The measurement is important to determine the progress of the disease, however.
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: a urinary tract infection. lipoid nephrosis (idiopathic nephrotic syndrome). acute glomerulonephritis. rheumatic fever.
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.
The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? Testis cannot be "milked" down inguinal canal Fluid detected in scrotal sac Venous varicosity detected along the spermatic cord Testis can briefly be brought into scrotum
Testis cannot be "milked" down inguinal canal Explanation: 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 collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history? The child has a sibling with the same diagnosis. The child had a congenital heart defect. The child recently had an ear infection. The child is being treated for asthma.
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.
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 child wakes up once during the night for a glass of water. The client wets only when involved in an activity. The client remains continent throughout the night. The parent takes the client to the bathroom at night.
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 the newborn to be circumcised. What would be the best response by the nurse? The foreskin is needed for repair. Circumcision is usually performed after 1 year of age. Circumcision with hypospadias will cause meatal stenosis. The circumcision may predispose the newborn to renal failure.
The foreskin is needed for repair. Explanation: Hypospadias occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circumcised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair. Once the hypospadias is repaired, a circumcision can be performed as part of the procedure. Hypospadias repair is usually done after the newborn is 1 year or older. Meatal stenosis has to do with the urethral opening diameter, not the placement. Circumcision or hypospadias repair does not affect the functioning of the renal system so neither would predispose the newborn to renal failure.
The health care provider has prescribed a 24-hour urine specimen on a 15-year-old client. Review the steps below and place them in the correct order. Use all options. 1Confirm the client's identity. 2Provide education to the client about the prescribed diagnostic test. 3Document the time of the client's next voiding time. 4Begin the testing time period. 5Collect urine in a chilled container. 6End the test at the 24-hour mark.
Confirm the client's identity. Provide education to the client about the prescribed diagnostic test. Document the time of the client's next voiding time. Begin the testing time period. Collect urine in a chilled container. End the test at the 24-hour mark. Explanation: A 24-hour urine collection may be prescribed to assess the level of protein or creatinine. Once the testing prescription has been confirmed, the nurse confirms the identity of the client. Next, the nurse provides client education, followed by instructing the client that the next urine voided will be discarded and the 24-hour time period will begin. The next voided urine will be collected in the chilled container. Each void is collected and stored until the conclusion of the 24-hour time period.
A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? Urinalysis Creatinine clearance rate Kidneys, ureter, and bladder x-ray Computed tomography scan
Creatinine clearance rate Explanation: The glomerular filtration rate is measured by creatinine clearance rate, or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.
A parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? Demonstrate love and acceptance at home. Discuss how the child can continue to go to the bathroom instead of in his or her underwear. Take away a toy every time the child urinates in his or her pants. Demonstrate how to urinate in the bathroom every time the child has an occurrence.
Demonstrate love and acceptance at home. Explanation: Enuresis is the continued incontinence of urine past the age of toilet training. It is a source of shame and embarrassment. It affects the child's life emotionally, behaviorally, and socially. It causes the child to have low self-esteem. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school. The child should not be punished for a behavior he or she cannot control. Demonstrating how to use the toilet and going to the bathroom to void are good subjects but they do not help a child who has no control of the enuresis. Testing may need to be done to see if there are anatomical reasons, and medications may be needed to correct the problem.
The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider? White blood cells: 8,000/µL (8.0 ×109/L) Urine culture positive for contaminants Positive culture for group A streptococcus Negative for respiratory syncytial virus (RSV)
Positive culture for group A streptococcus Explanation: Acute glomerulonephritis may result as an autoimmune response to the invasion of group A 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.
The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action? Weigh the child in the same clothes she had been weighed in the day before and report the two weights to the nurse while the nurse is on the phone. Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Give the child a diuretic and report back to the nurse in a few hours. Give the child fluids and report back to the nurse in a few hours.
Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Explanation: Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.
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 oral contraceptive pills. Which intervention should be considered for this client? Test her urine for glucose to rule out diabetes mellitus Prescription for oral contraceptive pills Prescription of an antibiotic Insertion of antifungal tablets or creams in the morning
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 contraceptive pills produce a pseudopregnancy state, adolescents using OCPs 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 OCPs 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 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 voiding cystourethrogram (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, urinary tract infection, and structural anomalies. Reflux may cause frequent infections and scarring in the urinary tract if not diagnosed and treated. A VCUG will not diagnose kidney stones. Kidney stones would be detected by computed tomography. A VCUG would not be performed to detect if infections of the urinary tract have cleared. This would be done by urinalysis.
The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis: The child can live a more normal lifestyle. There are strict diet and fluid restrictions. Therapy is only 3 to 4 days per week. The child must go into a facility to get peritoneal dialysis.
The child can live a more normal lifestyle. Explanation: 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 nurse is discussing with a family the various causes of their child's vulvovaginitis. What would be included in the education? The use of cleansing towelettes may have caused the vulvovaginitis. Child protective services will be called since this is a sign of child abuse (child maltreatment). Constipation is a common cause of vulvovaginitis. Fevers often occur with vulvovaginitis.
The use of cleansing towelettes may have caused the vulvovaginitis. Explanation: Vulvovaginitis can result from an overgrowth of bacteria or yeast or from chemical factors. Chemical factors include bubble baths, and soaps or perfumes in personal care items like cleansing towelettes. This is a common childhood problem in girls. It is not necessarily a sign of abuse so child protective services would not need to be involved. Constipation and fevers are usually associated with this disorder but are not the cause.
The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which set of assessment findings most likely led the nurse to this conclusion? hemolytic anemia, acute kidney injury, and hypotension dirty green-colored urine, elevated erythrocyte sedimentation, and depressed serum complement level hemolytic anemia, thrombocytopenia, and acute kidney injury thrombocytopenia, hemolytic anemia, and nocturia several times each night
hemolytic anemia, thrombocytopenia, and acute kidney injury Explanation: Hemolytic uremic syndrome is defined by all three particular features—hemolytic anemia, thrombocytopenia, and acute kidney injury. Dirty green-colored urine, elevated erythrocyte sedimentation, and depressed serum complement level are indicative of acute glomerulonephritis. Hypertension, not hypotension, would be seen in a child with hemolytic uremic syndrome, and the child would have decreased urinary output, which would not cause nocturia.
