Chapter 43: Nursing Care of the Child With a Genitourinary Disorder

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present? a. Abdominal mass b. Swollen testes c. Enlarged inguinal glands d. Purulent drainage from the penis

a. Abdominal mass (Rationale: An abdominal mass indicates hydronephrosis. Swollen testes, enlarged inguinal glands, and purulent drainage from the penis are not associated with hydronephrosis.)

When assessing a child with hydronephrosis, which of the following would the nurse expect to find? Select all that apply. a. Intermittent hematuria b. Foul-smelling urine c. Proteinuria d. Abdominal mass e. Flank pain

a. Intermittent hematuria d. Abdominal mass (Rationale: Intermittent hematuria is a common symptom of hydronephrosis. An abdominal mass may be palpated with hydronephrosis. Foul-smelling urine is associated with obstructive uropathy. Flank pain is associated with obstructive uropathy and vesicoureteral reflux. Proteinuria is associated with nephritis syndrome.)

The nurse is caring for a 10-year-old boy with end-stage renal disease (ESRD) with metabolic acidosis. Which of the following would the nurse expect to administer if ordered? a. Erythropoietin b. Sodium bicarbonate tablets c. Vitamin D d. Ferrous sulfate

b. Sodium bicarbonate tablets (Rationale: Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Erythropoietin stimulates red blood cell growth. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Ferrous sulfate is used for the treatment of anemia.

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on what finding? a. Thin gray vaginal discharge with fishy odor b. Irritation of labia and vaginal opening c. Foul yellow-gray discharge d. White cottage cheese-like discharge

d. White cottage cheese-like discharge (Rationale: White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Irritation of the labia and vaginal opening is commonly found with poor hygiene. Foul yellow-gray discharge indicates Trichomonas vaginalis.)

While obtaining a history from a 15-year-old girl, the girl tells the nurse that she often experiences cramping abdominal pain about the middle of her menstrual cycle. The nurse documents this as which of the following? a. Mittelschmerz b. Dysmenorrhea c. Menorrhagia d Metrorrhagia

a. Mittelschmerz (Rationale: Mittelschmerz refers to abdominal pain that usually occurs midway through the menstrual cycle that varies from a few sharp cramps to several hours of crampy pain. It is believed to be the result of egg release from the ovary. Dysmenorrhea refers to the pain associated with menstruation. Menorrhagia refers to excessive menstrual bleeding. Metrorrhagia refers to bleeding between menstrual periods.)

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. Sudden onset of severe scrotal pain with significant hemorrhagic swelling b. Enlarged inguinal glands and fever c. Fever, scrotal swelling, and urethral discharge d. Hardened and tender epididymis with edema and erythema of scrotum

a. Sudden onset of severe scrotal pain with significant hemorrhagic swelling (Rationale: 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. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele. A hardened and tender epididymis points to epididymitis.)

The nurse is caring for a 5-month-old boy with an undescended left testis. Which of the following would the nurse identify as indicative of true cryptorchidism? a. Venous varicosity detected along the spermatic cord b. Testis cannot be "milked" down inguinal canal c. Fluid detected in scrotal sac d. Testis can briefly be brought into scrotum

b. Testis cannot be "milked" down inguinal canal (Rationale: With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. A venous varicosity along the spermatic cord is a varicocele. Fluid in the scrotal sac is a hydrocele. Testis that can be brought into the scrotum refers to a retractile testis.)

The nurse is conducting a routine wellness examination of a 13-year-old girl. Which question would be best to use when beginning to discuss her sexual behavior? a. "Are you curious about sex?" b. "Are you sexually active?" c. "What do you like to do on the weekend?" d. "Do you talk to your mom about sex?"

c. "What do you like to do on the weekend?" (Rationale: The best approach is to start with questions about friends and social life, moving the conversation toward sexual behavior. The direct approach is less effective with adolescents.)

The nurse is providing discharge teaching to an adolescent who has been treated for pelvic inflammatory disease (PID). Which of the following would the nurse include as a preventative measure? a. Using oral contraceptives as prescribed b. Using a vaginal douche routinely c. Insisting that sexual partners use condoms d. Suggesting that sexual partners use antibiotic ointment

c. Insisting that sexual partners use condoms (Rationale: PID is a sexually transmitted infection; use of condoms prevents PID. Oral contraceptives prevent pregnancy, not PID. Using a vaginal douche routinely leads to bacterial overgrowth and increases the risk for PID. Sexual partners should also receive treatment with antibiotics.)

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. "She should try to avoid protein." b. "Here is some written information from the dietitian." c. "She must severely restrict her sodium intake." d. "Let's meet with the dietitian and plan some meals."

d. "Let's meet with the dietitian and plan some meals." (Rationale: 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. Restricting sodium may not necessary if the child is not edematous; in addition, the statement does not teach.)

The nurse is assessing a child diagnosed with nephritic syndrome and observes generalized edema. The nurse documents this as which of the following? a. Enuresis b. Phimosis c. Hydronephrosis d. Anasarca

d. Anasarca (Rationale: Anasarca refers to generalized edema. Enuresis refers to continued incontinence of urine past the age of toilet training. Phimosis refers to a condition in which the foreskin of the penis cannot be retracted. Hydronephrosis refers to a condition in which the pelvis and calyces of the kidney are dilated.)

A group of nursing students are reviewing the variations in the genitourinary system in children as compared with adults. The students demonstrate understanding of this information when they identify which of the following? a. Glomerular filtration rate is faster in infants than in adults. b. A child's kidneys are surrounded by more fat padding than an adult's kidneys. c. The renal system usually reaches functional maturity by age 5 years. d. Bladder capacity reaches adult capacity by age 1 year.

d. Bladder capacity reaches adult capacity by age 1 year. (Rationale: Bladder capacity is about 30 mL in the newborn and increases to the usual adult capacity of about 270 mL by 1 year of age. Glomerular filtration rate is slower in the infant and young toddler compared with the adult. The kidneys of a child are less well protected from injury by the ribs and fat padding than they are in the adult. The renal system usually reaches functional maturity by 2 years of age.)

The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them. -Places both diapers under the infant -Closes the larger diaper -Unfolds both diapers, placing smaller diaper inside larger diaper -Closes the smaller diaper -Brings the penis and catheter/stent through the hole in the smaller diaper -Cuts a hole in the front of the smaller diaper

1. Cuts a hole in the front of the smaller diaper 2. Unfolds both diapers, placing smaller diaper inside larger diaper 3. Places both diapers under the infant 4. Brings the penis and catheter/stent through the hole in the smaller diaper 5. Closes the smaller diaper 6. Closes the larger diaper (Rationale: When performing double diapering, the nurse cuts a hole or a cross-shaped slit in the front of the smaller diaper and then unfolds both diapers, placing the smaller diaper with the hold inside the larger one. Next, the nurse places both diapers under the child and carefully brings the penis [if applicable] and catheter/stent through the hole in the smaller diaper, closing the diaper. Finally, the nurse closes the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.)

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

d. Risk for infection (Rationale: When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Activity intolerance is not associated with VUR. Nutritional problems are not associated with VUR. Fluid volume typically is not a problem associated with VUR.)

The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply. a. Oxybutynin b. Desmopressin c. Albumin d. Imipramine e. Prednisone

a. Oxybutynin b. Desmopressin d. Imipramine (Rationale: Medication therapy for treatment of nocturnal enuresis may include oxybutynin, imipramine, and desmopressin. These agents are prescribed only if behavioral and motivational therapies have been ineffective. Prednisone, a corticosteroid, would be ordered to induce remission and promote diuresis in children with nephritis syndrome. Albumin would be sued to treat nephritis syndrome.)

The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they state that they need to report which of the following to the physician? a. The infant does not urinate within 6 to 8 hours b. Appearance of granulation tissue c. Small spots of blood on diaper d. Bleeding that stops without pressure

a. The infant does not urinate within 6 to 8 hours (Rationale: The parents should immediately notify the physician or nurse practitioner if the infant does not urinate within 6 to 8 hours after the procedure. Small spots of blood on the diaper, bleeding that stops without pressure, and granulation tissue are normal findings.)

The nurse is caring for an infant with grade II vesicoureteral reflux (VUR). The mother is very fearful that her child will have progressive renal damage. Which responsive by the nurse would be most appropriate? a. "This problem must be carefully managed to avoid permanent damage." b. "This condition usually resolves spontaneously with no symptoms." c. "You can expect recurrent urinary tract infections along with progressive renal damage." d. "Your son will most likely need surgical intervention."

b. "This condition usually resolves spontaneously with no symptoms." (Rationale: Grade I/II VUR usually resolves spontaneously. Grades III to V are generally associated with recurrent urinary tract infections, hydronephrosis, and renal damage. Typically, only grades III to V need surgical intervention.)

While assessing a child with end-stage renal disease, the nurse notes a decreasing level of consciousness. The nurse interprets this finding as resulting from which of the following? a. Metabolic acidosis b. Uremia c. Immunosuppression d. Hypocalcemia

b. Uremia (Rationale: Uremia may result in depression of the central nervous system leading to symptoms such as headache or coma or gastrointestinal or neuromuscular disturbances. Metabolic acidosis causes lethargy, dull headache, and confusion. Immunosuppression is not involved with end-stage renal disease. Hypocalcemia is manifested by muscle twitching, or tetany.)

A nurse is assessing an adolescent who comes to the clinic for a follow-up. During the history, the adolescent tells the nurse that she often experiences pain with her menstrual periods. When gathering additional information, which question would be the most appropriate for the nurse to ask? a. "How heavy is your menstrual flow?" b. "Have you ever been pregnant?" c. "Do you have any nausea or vomiting when you have the pain?" d. "Do you have any discharge with a strange odor?"

c. "Do you have any nausea or vomiting when you have the pain?" (Rationale: Nausea, vomiting, dizziness, or loose stools are symptoms that commonly are associated with pain with menstruation [dysmenorrhea]. Although obtaining information about the amount of the adolescent's menstrual flow is important, it is unrelated to the adolescent's complaint. The adolescent is describing menstrual cramps; these are unrelated to pregnancy. A malodorous discharge suggests an infection.)

The nurse is taking a history from an adolescent girl with suspected pelvic inflammatory disease (PID). What data will be most helpful in determining this girl's risk factors for PID? a. Age b. Age at first menses c. Number of sexual partners d. Race

c. Number of sexual partners (Rationale: Multiple sexual partners are a risk factor for PID. Race, age, and age at first menses are not considered risk factors for PID.)

A 5-year-old child with acute renal failure develops hyperkalemia. Which of the following would the nurse expect to administer? a. Labetalol b. Nifedipine c. Polystyrene sulfonate d. Furosemide

c. Polystyrene sulfonate (Rationale: Polystyrene sulfonate [Kayexalate] is used to decrease potassium levels. Labetalol would be used to treat hypertension. Nifedipine would be used to treat hypertension. Furosemide would be used to promote diuresis with fluid overload.)

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

d. Placing the infant in a side-lying position (Rationale: 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.)