GU

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

ANS: 1 1. An upper respiratory infection often precedes MCNS by a few days. WRONG: 2. Bug bites are not typically associated with MCNS. 3. Vomiting and abdominal cramping are not typically associated with MCNS. 4. Pet turtles often carry salmonella, which can cause vomiting and diarrhea but not MCNS. TEST-TAKING HINT: The test taker should be led to answer 1 because MCNS is most often associated with upper respiratory infections.

Which should be included in the plan of care for a child diagnosed with hydronephrosis? 1. Intake and output as well as vital signs should be strictly monitored. 2. Fluids and sodium in the diet should be limited. 3. Steroids should be administered as ordered. 4. Limited contact with other people to avoid infection

ANS: 1 1. Fluid status is monitored to ensure adequate urinary output. Assessing blood pressure monitors kidney function. WRONG: 2. Fluid and sodium restriction are not required in hydronephrosis. 3. Steroids are not routinely used in the treatment of hydronephrosis. 4. Limiting the child ' s exposure to other people does not help prevent UTIs. TEST-TAKING HINT: The test taker can eliminate answer 2 because fl uids and sodium are not limited in the child ' s diet.

Which causes the clinical manifestations of hydronephrosis? 1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. 2. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances. 3. Decreased production of urine in one or both kidneys results in an electrolyte imbalance. 4. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular fi ltration rate.

ANS: 1 1. Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death. WRONG: 2. Hydronephrosis is due to pressure created by an obstruction, causing urine to back up. There is no free fl ow of urine. 3. A decreased production of urine does not lead to hydronephrosis. 4. Hydronephrosis is not caused by abnormalities in the urine. TEST-TAKING HINT: This question requires familiarity with the pathophysiology of hydronephrosis.

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

ANS: 1 1. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis. WRONG: 2. Frequent UTIs have not been associated with glomerulonephritis. 3. Type 1 diabetes is not a cause of glomerulonephritis. 4. Glomerulonephritis can be caused by a streptococcal organism, not a viral pneumonia. TEST-TAKING HINT: The test taker may be distracted by answer 4, but that choice is a viral infection so that makes it an incorrect choice.

A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? 1. Obtain urinalysis and urine culture. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Send home on an antibiotic. 5. Schedule a VCUG.

ANS: 1 1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a renal ultrasound shows scaring or possible refl ux. If the child has a UTI related to bubble baths, constipation, or wiping back to front, a VCUG would not be ordered. WRONG: 2. There are no data to suggest that renal failure should be evaluated. 3. A UTI is usually treated with oral antibiotics at home and does not routinely require admission to the hospital. 4. A second UTI requires more extensive evaluation and diagnostic testing. 5. If the child has a UTI related to bubble baths, constipation, or wiping back to front, a VCUG would not be ordered. TEST-TAKING HINT: The test taker can eliminate answer 2 because it is the only answer that does not address the UTI. Answer 1 is the best choice because it will provide more data about the cause of the child ' s recurrent UTIs

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

ANS: 1, 5. 1. When glomerulonephritis is improving, urine output increases, and the urine becomes less tea-colored. These are signs that can be monitored at home by the child ' s parents. 5. The child ' s weight will increase as the urine resumes a more normal color, indicating lab values are returning to normal and the child is better. WRONG: 2. As glomerulonephritis improves, the child should have more energy and require less rest, but lab test values are not something that will be readily apparent to the family at home. 3. The child ' s appetite should increase as the condition improves. 4. Although the laboratory test values will normalize, this is not something that will be readily apparent to the family at home. TEST-TAKING HINT: The test taker should be led to answers 1 and 5 because the manifestations represent improvement in the disease process that can be easily recognized by the parents

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

ANS: 2 2. Blood in the child ' s urine causes it to be tea-colored. WRONG: 1. Steroids and antihypertensives do not cause urine to change color. 3. The tea color of the urine is due to hematuria, not concentration. 4. The child with glomerulonephritis is not on a ketogenic diet. The ketogenic diet does not cause the urine to change color. TEST-TAKING HINT: The test taker can immediately eliminate answer 4 because the child is not placed on a ketogenic diet.

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

ANS: 2 2. Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine. WRONG: 1. Albumin does not undergo any chemical changes in MCNS. 3. Obstruction of the capillaries of the glomeruli due to the formation of antibody-antigen complexes occurs in glomerulonephritis. 4. Loss of the kidneys 'ability to excrete waste and concentrate urine occurs in renal failure. TEST-TAKING HINT: The test taker should recognize the pathophysiology of MCNS.

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

ANS: 3 3. A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention. WRONG: 1. Children with glomerulonephritis usually have an elevated blood pressure and tend to rest most of the day. 2. The urine output is often decreased, and the urine is often tea-colored due to hematuria. 4. Anorexia is often seen with glomerulonephritis. TEST-TAKING HINT: The test taker should eliminate answers 1, 2, and 4 because they are manifestations of glomerulonephritis

Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)? 1. A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats per minute. 2. A 4-year-old female who states, "It hurts when I pee"; she has been urinating every 30 minutes; vital signs are within normal range. 3. An 8-year-old male presenting with a fi nger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. 4. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; oral temperature of 101.5°F (38.6°C).

ANS: 3 3. Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time. WRONG: 1. Fussiness and lack of appetite can indicate a UTI. Signs of infection, such as fever and increased heart rate, should be evaluated to determine whether an infection exists. 2. Frequency and urgency are classic signs of a UTI. 4. Pain to the lower right back can indicate infection of the upper urinary tract. Although the child currently denies any burning or frequency, the child currently has a fever coupled with flank pain, which needs evaluation. TEST-TAKING HINT: The test taker should be led to answer 3 because it states that the child is not currently having any manifestations of a UTI.

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

ANS: 3 3. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver caused by hypoalbuminemia. WRONG: 1. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver caused by hypoalbuminemia. 2. The elevated lipids are unrelated to the child ' s dietary habits. 4. The lipids are not falsely elevated. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because they do not represent changes associated with a disease process.

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

ANS: 3 3. In cases of severe edema, albumin is used to help return the fluid to the bloodstream from the subcutaneous tissue. WRONG: 1. The dosage of the diuretic may be adjusted, but other medications such as albumin are likely to be used. 2. Mannitol is not usually used in the treatment of MCNS. 4. Although sodium and fluids are restricted in the severely edematous child, they are not eliminated completely. TEST-TAKING HINT: The test taker can eliminate answer 2 because mannitol is used to treat cerebral edema

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse ' s best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

ANS: 3 3. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect. WRONG: 1. Routine circumcision is recommended by the American Academy of Pediatrics; it is not contraindicated in most children. 2. It is not recommended that circumcision of children with hypospadias be done immediately because the foreskin may be needed later for repair of the defect. 4. Circumcision can usually be performed in the child with hypospadias when the defect is corrected. TEST-TAKING HINT: The test taker can eliminate answer 4 because "never" is infrequently the case in health care.

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

ANS: 3 3. Mild-to-moderate proteinuria, hematuria, decreased urinary output, and lethargy are common findings in glomerulonephritis. WRONG: 1. Unlike nephrotic syndrome, protein is lost in mild-to-moderate amounts. 2. Urinary output is decreased in the child with glomerulonephritis. 4. Hypertension, not hypotension, is a common finding in glomerulonephritis. TEST-TAKING HINT: The test taker should eliminate answers 1 and 4 because glomerulonephritis does not cause massive proteinuria. Answer 2 can be eliminated because increased urine output is not associated with glomerulonephritis.

An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fi x the chordee as well?" Which is the nurse ' s best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize sexual functioning when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

ANS: 3 3. Releasing the chordee surgically is necessary for future sexual function. WRONG: 1. This response is empathetic. It does not, however, answer the parent ' s concern, whereas a simple explanation would immediately do so. 2. Although a cosmetic component exists, straightening the penis is important for future sexual function. 4. Although the two surgeries are usually done simultaneously, each has its own importance and necessity. TEST-TAKING HINT: The test taker should be led to answer 3 because it provides the parents with a simple, accurate explanation.

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)? 1. Carefully cleanse the perineum from front to back and apply a self-adhesive urine collection bag to the perineum. 2. Insert an indwelling Foley catheter, obtain the sample, and wait for results. 3. Place a sterile cotton ball in the diaper and immediately obtain the sample with a syringe after the first void. 4. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample

ANS: 4 4. An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained. WRONG: 1. A sample obtained from a urine bag would contain microorganisms from the skin, causing contamination of the sample. 2. There is no need to leave the catheter in because it serves as a portal for infection. 3. The cotton ball would not remain sterile and would therefore contaminate the urine sample. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because they both lead to a contaminated sample.

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

ANS: 4 4. Exposure to infectious illness has been linked to the relapse of minimal change nephrotic syndrome. WRONG: 1. It is not unusual for a child to experience relapses. 2. Many children do experience relapses, but exposure to infectious illnesses has been linked to relapses. 3. There is no correlation between the consumption of sodium and minimal change nephrotic syndrome. TEST-TAKING HINT: The test taker can eliminate answers 1 and 2 because relapses are common and can be prevented.

Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)? 1. Avoiding constipation has no effect on the occurrence of UTIs. 2. After urinating, always wipe from back to front to prevent fecal contamination. 3. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. 4. Increasing fluids will help prevent and treat UTIs.

ANS: 4 4. Increasing fluids will help flush the bladder of any organisms, encourage urination, and prevent stasis of urine. WRONG: 1. The increased pressure associated with evacuating hardened stool can result in the backflow of urine into the bladder, leading to infection. 2. To prevent infection, a female child should wipe from front to back. 3. Tub baths are not recommended because they may cause irritation of the urethra, leading to infection. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 3 because they do not provide accurate information.

In addition to increased blood pressure, which findings would most likely be found in a child with hydronephrosis? 1. Metabolic alkalosis and positive renal ultrasound. 2. Metabolic acidosis and negative renal ultrasound. 3. Metabolic alkalosis and bacterial growth in the urine. 4. Metabolic acidosis, polydipsia, and polyuria.

ANS: 4 4. Metabolic acidosis is caused by a reduction in hydrogen ion secretion from the distal nephron. Polydipsia and polyuria occur as the kidney ' s ability to concentrate urine decreases. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction. WRONG: 1. A positive renal ultrasound would indicate a blockage, causing hydronephrosis. Metabolic acidosis occurs, not alkalosis. 2. Metabolic acidosis occurs because there is a reduction in hydrogen ion secretion from the distal nephron. A positive renal ultrasound would indicate a blockage, causing hydronephrosis. 3. Metabolic acidosis, not alkalosis, occurs because there is a reduction in hydrogen ion secretion from the distal nephron. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction. TEST-TAKING HINT: The test taker can eliminate answers 1 and 3 because hydronephrosis does not lead to metabolic alkalosis