Ch 46: Nursing Care of a Family when a Child has a Renal or Urinary Tract Disorder

a) To dilute the urine and flush the bladder Pg. 1303-1304 Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder.

33. The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. What is the most important reason the child needs increased fluids? a) To dilute the urine and flush the bladder b) To decrease the pain of urination c) To prevent the child from developing a fever d) To fill the bladder so a specimen can be obtained

a) Wipe from front to back c) Finish all antibiotics prescribed d) Encourage fluids throughout the day Pg. 1303 Teaching caregivers to wipe from front to back, encouraging fluids, and finishing all prescribed medications are vital principles in the prevention of recurring UTIs. The use of bubble bath is contraindicated because it can be a source of infection.

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

a) The child has a greater risk for trauma to the kidney Pg. 1294 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.

31. 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? a) The child has a greater risk for trauma to the kidney b) The adult has less fat to cushion the kidney c) The adult has a greater chance of retaining fluids than the child d) The child has more frequent urges to empty the bladder

d) Intestinal bacteria Pg. 1303 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.

15. Most urinary tract infections seen in children are caused by: a) Fungal infections b) Hereditary causes c) Dietary insufficiencies d) Intestinal bacteria

b) Oliguria Pg. 1294 A subnormal urine output is termed as oliguria. Polyuria is the excessive or abnormally large production of urine. Pyuria is the presence of pus in the urine. Glycosuria is the excretion of glucose in the urine.

18. The nurse is reviewing lab work prior to shift handoff on a client with a subnormal urine output. Which is the nurse most correct to report? a) Polyuria b) Oliguria c) Glycosuria d) Pyuria

d) Sexual activity Pg. 1304 When cystitis is seen in adolescent girls, it is an alert a girl may be sexually active. Wiping from front to back after voiding helps prevent urinary tract infections, not cause them. Frequent voiding does not cause cystitis, nor does regular participation in a strenuous sport.

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

c) The most common age for UTIs in children is 2 to 6 years of age Pg. 1303 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.

35. 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? a) Girls who have gone through puberty most commonly get UTIs b) Urinary tract infections are rarely seen after toilet training c) The most common age for UTIs in children is 2 to 6 years of age d) Males between the ages of 10 to 12 years of age commonly get UTIs

b) Blood pressure 136/84 Pg. 1308 Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for a child this age, but not a concern with this diagnosis. The other vital signs are within normal limits for a child of this age.

5. 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? a) Respirations 24 per minute b) Blood pressure 136/84 c) Pulse oximetry 93% on room air d) Pulse rate 112 bpm

a) 1200 mL Pg. 1294 The typical 24-hour urine output for a 9 year old would range from 1000 to 1500 mL. Therefore, a urine output of 1200 mL would be within normal limits.

26. The nurse is monitoring the fluid balance of a 9-year-old child. When evaluating urine output for the day, which output would the nurse identify as being within normal limits? a) 1200 mL b) 800 mL c) 2000 mL d) 600 mL

d) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily" Pg. 1303 Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

10. The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother? a) "It is unlikely that your daughter is practicing good cleaning habits after she voids" b) "Girls tend to urinate less frequently than boys, making them more susceptible to UTI's" c) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C" d) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily"

a) Urinalysis Pg. 1295 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 (BUN) are not the primary tests evaluated for the presence of a urinary tract infection.

19. 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? a) Urinalysis b) Chemical reagent strip testing c) Urine specific gravity level d) Serum blood urea nitrogen (BUN) level

c) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone Pg. 1308-1309 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.

2. 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? a) Give the child fluids and report back to the nurse in a few hours b) Give the child a diuretic and report back to the nurse in a few hours c) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone d) 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

c) Encourage the child to take all the antibiotics if diagnosed with strep throat Pg. 1309 Encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community with whom the child came in contact unless they are symptomatic. Ibuprofen does not cure strep throat, and strep infection is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.

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

b) The child has been sexually abused, maybe on the fishing trip Pg. 1306 Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse (child mistreatment) and should be further explored.

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

b) Oliguria and jaundice Pg. 1314 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.

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

a) Placing the infant in a side-lying position Pg. 1301 When providing care to an infant with bladder exstrophy, the nurse would keep the infant in the supine position, cover the bladder with a sterile plastic bag, change soiled diapers immediately to prevent contamination, and sponge-bathe the infant rather than immersing him or her in bath water.

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

a) "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often" Pg. Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. Therefore, monitoring blood pressure is important. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acids-bases. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli in the lungs. Cerebrospinal fluid circulates through the brain and spinal cord.

30. A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group? a) "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often" b) "The kidneys help get rid of carbon dioxide from the body, so kidney problems can affect our child's breathing" c) "Problems with the kidneys raise the risk for infection because there is a problem with producing white blood cells" d) "We should expect problems with too much fluid in the brain because the kidneys are not able to keep the fluid in balance"

c) Weight, daily Pg. 1310 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.

1. A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? a) Amount of protein in the urine b) Abdominal circumference c) Weight, daily d) Urine output, every shift

a) Sodium bicarbonate tablets Pg. 1315 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.

12. 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? a) Sodium bicarbonate tablets b) Vitamin D c) Erythropoietin d) Ferrous sulfate

d) Risk for infection Pg. 1304 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.

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

b) Acute glomerulonephritis Pg. 1308 Recent strep infection, hematuria, and proteinuria are indicative of acute glomerulonephritis. These symptoms do not suggest any of the other options.

14. A client has just been admitted to the unit with a history of recent strep infection, hematuria, and proteinuria. Based on these findings, the nurse would suspect which condition? a) Renal failure b) Acute glomerulonephritis c) Prune belly syndrome d) Urinary tract infection

d) Measure the abdominal girth daily Pg. 1310-1312 Measure the child's abdomen daily at the level of the umbilicus, and make certain that all staff personnel measure at the same level. Weigh the child at the same time every day on the same scale in the same clothing. Test the urine regularly for albumin and specific gravity. Elevated temperature is not an issue with nephrotic syndrome.

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

d) Sudden onset of severe scrotal pain with significant hemorrhagic swelling Pg. 1328 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.

23. The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? a) Enlarged inguinal glands and fever b) Fever, scrotal swelling, and urethral discharge c) Hardened and tender epididymitis with edema and erythema of scrotum d) Sudden onset of severe scrotal pain with significant hemorrhagic swelling

c) Acute glomerulonephritis Pg. 1308 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.

24. 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) Rheumatic fever b) A urinary tract infection c) Acute glomerulonephritis d) Lipoid nephrosis (idiopathic nephrotic syndrome)

c) Onset of a streptococcus infection last week Pg. 1308 The nurse is correct to anticipate a streptococcus infection 1 to 3 weeks prior to the diagnosis of acute glomerulonephritis. The presenting symptom is typically gross bloody urine. Acute glomerulonephritis is not related to a kidney infection, does not exhibit symptoms similar to diabetes, or a recent viral infection.

25. The nurse is caring for a client newly diagnosed with acute glomerulonephritis. When receiving the pediatric client's history, which is anticipated? a) Increased thirst, sweating, and shakiness since yesterday b) A sports injury to the kidney two weeks ago c) Onset of a streptococcus infection last week d) Fatigue from viral infection onset 3 days ago

b) A fever is commonly noted with a UTI d) Change diapers promptly, especially after bowel movements e) Female urethras are shorter and straighter than males Pg. 1303 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.

27. 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) UTI's are common in male infants at this age b) A fever is commonly noted with a UTI c) After 3 days on antibiotics, the infection is clear d) Change diapers promptly, especially after bowel movements e) Female urethras are shorter and straighter than males

a) Demonstrate love and acceptance at home Pg. 1306 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.

28. 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? a) Demonstrate love and acceptance at home b) Demonstrate how to urinate in the bathroom every time the child has an occurrence c) Take away a toy every time the child urinates in his or her pants d) Discuss how the child can continue to go to the bathroom instead of in his or her underwear

a) Creatinine clearance rate Pg. 1295-1296 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.

29. 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? a) Creatinine clearance rate b) Computed tomography scan c) Urinalysis d) Kidneys, ureter, and bladder x-ray

a) Pulse rate and rhythm Pg. 1315 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.

3. The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia? a) Pulse rate and rhythm b) Muscle tone c) Abdominal pain d) Blood pressure

a) Small bladder capacity b) Lack of awareness c) Urinary tract infection Pg. 1306 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 are not common causes of pediatric enuresis. It is not until all physiologic factors are ruled out that psychological factors are investigated.

32. Which cause of pediatric enuresis must be ruled out before psychological causes are investigated? Select all that apply. a) Small bladder capacity b) Lack of awareness c) Urinary tract infection d) Cognitive dysfunction e) Stress incontinence

d) "Let's meet with the dietitian and plan some meals" Pg. 1312 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.

34. The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? a) "Here is some written information from the dietitian" b) "She must severely restrict her sodium intake" c) "She should try to avoid protein" d) "Let's meet with the dietitian and plan some meals"

b) Abdominal pain Pg. 1303 Signs and symptoms of UTI in the young child often are not clear-cut. The most frequent complaints are of abdominal pain.

36. A 3-year-old child is exhibiting irritability, fever, and decreased appetite. A recent history of which of the following would make the nurse suspicious of a urinary tract infection (UTI)? a) Lymphadenopathy b) Abdominal pain c) Rash d) Leg pain

a) "Children are not expected to stay dry through the night until the age of 5" Pg. 1306 Nighttime urinary control is not expected until a child reaches the age of 5. No testing is needed before that age. Asking why it is a concern is not effective therapeutic communication.

37. A concerned mother brings her 3-year-old to the primary care office because of nighttime voiding. Which response made by the nurse is best? a) "Children are not expected to stay dry through the night until the age of 5" b) "I understand your concern, since 3-year-olds should be able to go through the night without voiding" c) "Why is this such a big concern for you?" d) "We will do some further testing to see why this is happening"

b) Bloody urine Pg. 1308 The presenting symptom in the child with acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody.

38. The nurse is collecting data on a child recently diagnosed with acute glomerulonephritis. Which clinical manifestation was likely noted in this child? a) Increased nocturia b) Bloody urine c) Hypotension d) Decreased specific gravity

b) "Has your child complained of pain?" Pg. 1303 Gather information about the current illness: when the fever started and its course thus far; signs of pain or discomfort on voiding; recent change in feeding pattern; presence of vomiting or diarrhea; irritability; lethargy; abdominal pain; unusual odor to urine; chronic diaper rash; and signs of febrile convulsions. Toilet training and bathing habits would be of importance, but they are not the most important to ask. Temperatures in other children in the family would not be related to this child's current situation.

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

d) Checking with the parents for any allergies Pg. 1296 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.

6. 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? a) Ensuring adequate hydration b) Screening her for pregnancy c) Giving the girl an enema d) Checking with the parents for any allergies

c) Tea-colored urine Pg. 1308 The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as tea- or cola-colored. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry-colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in hepatitis.

7. 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? a) Jaundiced skin b) Strawberry-red tongue c) Tea-colored urine d) Loose, dark stools

a) Parents/family use positive coping mechanisms in response to the child and the voiding disorder Pg. 1306-1307 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 toward 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.

8. 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? a) Parents/family use positive coping mechanisms in response to the child and the voiding disorder b) Parents administer medications for enuresis c) Parents/family accept the child and the voiding disorder d) Parents take the child for surgery

d) Banana splits Pg. 1312 For the child with nephrotic syndrome, the addition of salt is discouraged, and sometimes the child is put on a low sodium diet. In addition, the child may be placed on a high protein diet. Popcorn, potato chips, and orange soda all have higher sodium content than a banana split. The banana split would also have higher protein content.

9. A child who has been diagnosed with minimal change nephrotic syndrome (MCNS) is being discharged after a 3-week hospitalization. Her edema has been greatly reduced and her appetite is beginning to return. Her caregivers have promised to have a family party to celebrate her return. The child has requested the following foods for the party. Which of these foods would the nurse suggest is appropriate for this child's diet? a) Orange soda b) Popcorn c) Potato chips d) Banana splits