FINAL EXAM PEDI 2023/ PrepU CH21

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. 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 a 6-year-old client diagnosed with acute kidney injury. During assessment, the nurse notes: temperature 99.0°F (37.2°C), urine output less than 0.4 mL/kg/hr, blood pressure 130/88 mm Hg, periorbital edema, and respirations 28 breaths/minute. Which prescription(s) will the nurse anticipate from the primary health care provider? Select all that apply. furosemide dialysis serum electrolyte levels urinalysis labetalol

ALL Explanation: The child is experiencing complications of the acute kidney injury including oliguria, interstitial fluid shifting, and hypertension. Oliguria is defined as a urine output that is less than 0.5 mL/kg/h in children. The nurse will prepare to administer furosemide to assist with the edema and labetalol to lower the blood pressure. Dialysis may be needed due to the severe oliguria. The client is at risk for electrolyte disturbances and should be monitored closely. A urinalysis may reveal proteinuria or hematuria, which could indicate additional complications.

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

Blood pressure 136/84 Explanation: Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis.

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

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this? Encourage the child to take all the antibiotics if diagnosed with strep throat. Tell parents to give ibuprofen if their child has a sore throat. All children in the child's class should be tested for strep throat if one child has a positive test. Prophylactic antibiotics after strep throat are importan

Encourage the child to take all the antibiotics if diagnosed with strep throat.

The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child? Eyes Fingers Abdomen Sacrum

Eyes Explanation: The symptoms of nephrotic syndrome include periorbital edema upon awakening with progressive edema throughout the day in all extremities and abdomen. Ascites can develop in the abdomen and the nurse should assess the child regularly for this development. The child with nephrotic syndrome generally does not have sacral edema, unless the edema is extreme and has not been treated.

The nurse is caring for a 6-year-old male child who was brought to the pediatrician's office by the parent for a fever for the past few days

Increased urinary frequency dysuria costovertebral pain temperature, 101.2°F (38.4°C) urinalysis, positive for leukocytes; white blood cell (WBC) count, 12 × 103/mm3 (12 × 109/l)

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

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 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.

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

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

Risk for infection related to immunocompromised state Explanation: Children are administered immunosuppressants following a transplant. These drugs lower the immune system response and help prevent rejection following the transplant.

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis? Loose, dark stools Tea-colored urine Strawberry-red tongue Jaundiced skin

Tea-colored urine

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

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

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.

Which instructions should a nurse give to a client who has a history of urinary tract infections to prevent recurrence? Select all that apply. Wipe from front to back. Use bubble bath to wash. Encourage fluids throughout the day. Finish all antibiotics prescribed. Limit bathing to once a week.

Wipe from front to back. Encourage fluids throughout the day. Finish all antibiotics prescribed.

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

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 that ___________ is appropriate? encouraging fluid intake after dinner practicing bladder-stretching exercises giving desmopressin intranasally engaging the child in stress-reduction measure

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.

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 concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess? red blood count leukocyte count eosinophils basophils

leukocyte count Explanation: Since the nurse is concerned about the client's immune system, it is most correct to assess the client's white blood cells or cells of the immune system called leukocytes.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is: performing a suprapubic aspiration. placing a cotton ball in the underwear to catch urine. placing an indwelling urinary catheter. obtaining a clean catch voided urine.

obtaining a clean catch voided urine.

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: 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.

A 3-year-old child is scheduled for a surgery to correct undescended testes. For what postoperative consideration would the nurse want to prepare the parents? the need for complete bed rest for 10 days some discomfort at the surgery site a liquid diet for 3 days the need for maintaining a semi-Fowler position

some discomfort at the surgery site Explanation: An orchiopexy is the surgical procedure to release the spermatic cord and pull the testes into the scrotum. After the testes are in the scrotum, they are sutured into place to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation. Complete bed rest, a liquid diet, and remaining in a semi-Fowler position are not required as part of the postsurgical care.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) 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: 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. take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted infection and discuss the importance of safe sex practices.

take the child to a private room and interview her regarding her sexual history and partners. Explanation: 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

Which laboratory test result would be most important for the nurse to assess in a child who is suspected of having a urinary tract infection? urinalysis chemical reagent strip testing urine specific gravity level serum blood urea nitrogen (BUN) level

urinalysis Explanation: A urinalysis is one of the simplest tests to reveal kidney function and presence of a urinary tract infection.

A 15-year-old female adolescent visits the school nurse. The client appears anxious and states they have been dating a couple of different friends. The client states that they went to a party the other night and does not remember the entire night. The client states "I woke up and some of my clothes were missing. Now I have been experiencing some pain when I pee and there is yellow, green drainage that smells awful." The nurse suspects the client has_________as evidenced by_______

STI cervical cancer yellow, green odorous discharge Explanation: The symptoms the client is experiencing—yellow, green odorous discharge and painful urination—are consistent with trichomoniasis, a sexually transmitted infection (STI). Yellow, green odorous vaginal drainage indicates an STI.

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

White cottage cheese-like discharge

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 1-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 what possible explanation for the bedwetting? The child has a urinary tract infection due to not bathing while on the fishing trip. The child is out of the habit of waking himself up during the night to void. The child did not want to go on the fishing trip and is now retaliating against being made to go. The child has been sexually abused, maybe on the fishing trip.

The child has been sexually abused, maybe on the fishing trip.