Genitourinary

A teenager is prescribed a hormonal oral contraceptive. Which of the following findings indicates to the nurse that the patient is experiencing a serious side effect? Polyuria Heat and swelling of the right lower extremity Distended abdomen Tinnitus

Heat and swelling of the right lower extremity Explanation • Patients taking hormonal oral contraceptives have a risk that is three to five times higher for the development of a venous thromboembolism than those not taking hormonal contraceptives. Smoking increases this risk. • Signs of a venous thrombosis include swelling, warmth, pain, tenderness, and redness in the affected area.

A patient is taking tacrolimus after receiving a kidney transplant. Which of the following symptoms indicates that the patient is experiencing a side effect of this medication? Tremor Hypokalemia Hypotension Polyuria

Tremor Explanation • Tacrolimus (Protopic or Prograf) is an immunosuppressant used after organ transplants to reduce the risk of organ rejection. • Common side effects include infections from impaired immune response, tremor, hypertension, hyperkalemia, decreased urine output and edema, headache, diarrhea, and hypophosphatemia.

A 4-year-old boy is admitted and diagnosed with acute glomerulonephritis. The nurse understands that the patient is experiencing complications of the disease when serum potassium level is at 3.65 mEq/L patient's blood pressure is 95/70 leukocyte count is slightly elevated there are adventitious lung sounds

there are adventitious lung sounds Explanation • The presence of adventitious lung sounds may indicate the presence of fluid in the lungs, a complication resulting from fluid overload secondary to kidney dysfunction. Incorrect options: • An elevated leukocyte count is expected with glomerulonephritis because the disease can be caused by a recent streptococcal infection. • Blood pressure of 95/70 and serum potassium level at 3.65 mEq/L are within normal limits.

To ensure optimum care for a client with acute glomerulonephritis, the nurse's plan of care should include which of the following? Select all that apply. Administer antibiotics Limit protein intake Provide activity and exercise Monitor daily weight Administer corticosteroids Fluid and salt restriction

Administer antibiotics Limit protein intake Monitor daily weight Administer corticosteroids Fluid and salt restriction Explanation • Glomerulonephritis comprises a specific set of renal diseases that causes damage to glomerulus from an immune reaction that results in proliferation and inflammatory changes within the glomerular tissue. • Acute glomerulonephritis is most often caused by a streptococcal infection such as impetigo or strep throat, but it may be caused by chlamydia, klebsiella pneumonia, or others. • Acute glomerulonephritis occurs ten days after the initial infection. • Treatment requires antibiotics to eliminate the infection, corticosteroids and/or immunosuppressive agents to dampen the immune response, as well as diuretics to treat volume overload and hypertension. • Fluid and sodium restriction and a low protein diet as indicated, and bed rest or activity restriction. • Assessments include daily weights, I&O, serum potassium, BUN, and creatinine.

A 16-year-old patient is prescribed erythromycin for the treatment of pelvic inflammatory disease. How should the nurse instruct the patient to take the medication? As prescribed, until the regimen is complete With an antacid As prescribed, until symptoms resolve As prescribed, until adverse effects develop

As prescribed, until the regimen is complete Explanation • All antibiotic prescriptions should be taken until the prescribed regimen is completed to avoid the development of resistant bacteria. Incorrect options: • The resolution of symptoms may occur long before the bacteria are eliminated, so stopping the antibiotic before completion can lead to the infection not being completely resolved and the infection recurring. • Taking antibiotics with an antacid can result in decreased absorption and effectiveness.

When planning ongoing nursing care for a child with recurrence of nephrotic syndrome, which of the following potential disturbances should be the priority consideration? Sexual maturation Psychological development Cognitive development Body image

Body image Explanation • Self-concept and body image disturbances related to changes in appearance and social isolation are a primary consideration. • A child with nephrotic syndrome will manifest generalized edema, periorbital, and pedal and pretibial edema. With marked edema, the child may appear pale and have respiratory distress. Incorrect options: • Cognitive development, sexual maturation, and psychological maturation are not associated with nephrotic syndrome.

Which of the following should be avoided if a neonate has hypospadias? Catheterization Intravenous pyelography Circumcision Administration of diuretics

Circumcision Explanation • Hypospadias refers to the condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface of the penile shaft (Hypo- means "below"). • Circumcision should be delayed until after surgical repair because the foreskin is used for grafting in the surgery. Incorrect options: • Catheterization may be used to ensure urinary elimination. Hypospadias does not prevent catheterization. • Diuretics are not contraindicated in a patient with hypospadias. • Intravenous pyelography is contraindicated only if the child has an allergy to contrast material. In the past, a history of an allergic reaction or sensitivity to seafood/shellfish allergy was thought to indicate an increased risk of allergy to contrast/dye containing iodine. This has proven to be untrue, and shellfish allergy is no longer considered an absolute contraindication to the administration of IV contrast material.

The nurse is caring for a 5-year-old who has frequent involuntary urination at night. The child is diagnosed with nocturnal enuresis. What is the most likely cause? Psychological stress Delayed bladder maturation Vesicoureteral reflux Urinary tract infection

Delayed bladder maturation Explanation • In young children, nocturnal enuresis is primarily a problem of delayed or incomplete neuromuscular maturation of the bladder. The condition is benign and self-limiting. Up to 20% of 5-year-olds have nocturnal enuresis. No treatment is required. Incorrect options: • Urinary tract infections (UTIs) are suspected as the cause of enuresis after a child is old enough to control the bladder. UTIs can also cause enuresis in adults. • Psychological stress may cause enuresis, but it is not the leading cause. • Vesicoureteral reflux is the reversal of urine flow back into the kidneys. This generally does not cause enuresis.

A 5-year-old boy is admitted to the hospital for acute glomerulonephritis. What are typically the first symptoms? Proteinuria and azotemia Hypertension and hematuria Edema and fever Hematuria and proteinuria

Hematuria and proteinuria Explanation • Glomerulonephritis comprises a specific set of renal diseases that causes inflammation and proliferation of glomerular tissue. • Acute glomerulonephritis is often caused by a recent streptococcal infection such as impetigo or strep throat. • Hematuria (pink or cola-colored urine) and proteinuria (foamy urine) are the first clinical symptoms of a patient with acute glomerulonephritis. • High blood pressure, edema, and heart failure may result after the loss of protein and blood in the urine. Incorrect options: • Azotemia is the elevation of urea and creatinine in the blood. In glomerulonephritis, this is uncommon in the beginning but may indicate advanced disease after severe damage to the kidney. • Fever will accompany a streptococcal infection, which precedes acute glomerulonephritis.

The nurse is assessing a neonatal boy. Upon assessment, the nurse notes that the urethral opening is at the lower aspect of the penis. Based on these findings, the nurse is correct to suspect which of the following disorders? Epispadias Hypospadias Cryptorchidism Hypospadias with chordee

Hypospadias Explanation • Hypospadias refers to the condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface of the penile shaft (Hypo- means "below"). • Hypospadias is generally corrected with surgery. Incorrect options: • Cryptorchidism is undescended testes in newborns. They generally descend by the first year of life. • Epispadias refers to the condition in which the urethral opening is located on the dorsal or superior surface of the penis (Epi- means "above"). • Hypospadias with chordee is having a fibrous band that causes the penis to curve downward, often called a cobra-head appearance.

A child with acute glomerulonephritis (AGN) is being discharged from the hospital. In giving follow up information to his parents, the nurse talks about which of the following infections known to lead to AGN? Impetigo Herpes simplex Meningitis Pneumonia

Impetigo Explanation • Impetigo, a bacterial infection of the skin caused by streptococcal pyogenes, may precede AGN. Strep throat can also precede AGN. • AGN is commonly caused by infection, but can also be caused by vasculitis, SLE, membranoproliferative glomerulonephritis, and hypersensitivity disorders. • Although most streptococcal infections do not cause AGN, when they do, a latent period of 10 to 14 days occurs between the infection and the onset of clinical manifestations. Incorrect options: • Herpes simplex virus is not associated with AGN. • Meningitis and pneumonia are commonly caused by a type of streptococcus but are not associated with AGN.

A 6-month-old boy is diagnosed with cryptorchidism. He is scheduled for surgery. What surgical intervention will the nurse prepare the child for to correct the condition? Orchiopexy Orchiectomy Sclerotherapy Meatotomy

Orchiopexy Explanation • Orchiopexy is a surgical procedure for undescended testes. The testicle is manipulated into the scrotum and sutured in place (-pexy refers to surgical fixation). • Children with cryptorchidism may be given chorionic gonadotropin hormone to stimulate testicular descent, but this therapy is not always successful and surgery may be required. Incorrect options: • Orchiectomy is surgery to remove part of a testis due to a malignancy (-ectomy means "surgical removal" or "excision"). • Sclerotherapy is an injection of a drug to decrease the size of blood vessels. • Meatotomy is a surgical repair of a split penile glans (-otomy means "to cut into").

The nurse is preparing a care plan for a 5-year-old with enuresis. Which of the following is an appropriate nursing action to help train a child to increase overnight dryness? Retention control training Provision of emotional support Use of a diaper at night Insertion of a foley catheter

Retention control training Explanation • To promote dryness, it is recommended to teach children retention control training. This involves the child drinking fluids and delaying urination as long as tolerated to stretch the bladder for the purpose of accommodating larger amounts of urine at nighttime. • Enuresis is primarily a problem of delayed or incomplete neuromuscular maturation of the bladder. The condition is benign and self-limiting. Incorrect options: • Providing emotional support will promote healthy self-esteem but not dryness. • Diapers and catheterization will not help in training the child in bladder control.

A 7-year-old girl has been diagnosed with nephrotic syndrome. She appears bloated, weak, and eats less than expected. The physician recommends dietary protein in each meal to supplement the losses from her condition. To achieve a healthy diet and avoid worsening the condition, which of the following should be done? Avoid giving snacks, as this will alter the child's feeding pattern Give her some candy as a reward when meals are finished Play with her while eating Serve her favorite food

Serve her favorite food Explanation • Serving the child's favorite food increases appetite and is more appealing. Nutritious foods like fish, poultry, fruits, and vegetables should be prepared in a familiar way and included in each meal. Incorrect options: • It's important to separate meals from activities so the child can focus on food. • Offering sweet rewards diminishes the child's food preference. • Various nutritious snacks contribute to a healthy diet, but constant snacking throughout the day alters meal patterns.

The nurse is caring for a newborn with hypospadias. To correct this disorder, the nurse will anticipate preoperative care measures for which surgical repair? Sclerotherapy Orchiopexy Orchiectomy Tubularized urethroplasty

Tubularized urethroplasty Explanation • Hypospadias is a urethral defect in which the urethral opening is not at the end of the penis but instead on the ventral aspect of the penis. • Tubularized urethroplasty is a common surgical technique used to repair hypospadias. Penile foreskin is used as a tubular graft to create a new location for the urethral opening. Incorrect: • Orchiopexy is a surgical procedure for undescended testes in which they are lowered and sutured into place (-pexy refers to surgical fixation). • Orchiectomy is surgery to remove part of the testis due to a malignancy (-ectomy refers to surgical removal, excision). • Sclerotherapy is an injection of a drug to decrease the size of blood vessels.

The nurse is caring for a preschooler with nephrotic syndrome. Which of the following signs and symptoms is a characteristic of minimal change nephrotic syndrome? Hypertension, edema, and hematuria Weight gain, edema, and proteinuria Hypertension, hematuria, and proteinuria Proteinuria, fever, and hematuria

Weight gain, edema, and proteinuria Explanation • Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged and allow the leakage of proteins into the urine. Minimal change disease refers to damage to the glomeruli of the kidneys that cannot be seen under a regular microscope. It is idiopathic in origin. • Minimal change disease is the most common cause of nephrotic syndrome in children. • Clinical manifestations of nephrotic syndrome include edema, proteinuria, and weight gain due to fluid overload. Incorrect options: • Gross hematuria is associated with nephritic syndrome. • Fever would occur only if there is an infection. • Hypertension may occur, but these patients are generally normotensive.