Genitourinary Disorders

12. 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 due to vomiting and stomach cramps." 4. "We have a pet turtle but no one washes their hands after playing with the turtle."

✅1. An upper respiratory infection often precedes MCNS by a few days. 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.

61. The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which question would be appropriate for the nurse to ask to obtain more information? Select all that apply. 1. "Has there been a stressful event in the child's life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more irritable, and does your child seem to be in pain when urinating?" 5. "Is your child having difficulties at preschool?"

ANS: 1,2,3,4 ✅1. Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. ✅2. A pattern of enuresis can often be seen in families. ✅3. Increased thirst and incontinence can be associated with diabetes. ✅4. Irritability and incontinence can be associated with UTIs. 5. Preschool-age children do not habitually share, so this information would not help the nurse in gathering more information on enuresis.

37. Which protrusion into the groin of a female most likely causes inguinal hernias? 1. Bowel. 2. Fallopian tube. 3. Large thrombus formation. 4. Muscle tissue.

✅2. Fallopian tube or an ovary is the most common tissue to protrude into the groin in females. 1. Bowel is the most common tissue to protrude into the groin in males. 3. Large thrombus formation does not commonly protrude into the groin. 4.Muscle tissue does not commonly protrude into the groin.

8. 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.

✅3.Mild-to-moderate proteinuria,hematuria, decreased urinary output, and lethargy are common findings in glomerulonephritis. 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

1. The bladder capacity of a 3-year-old is approximately how much? 1. 1.5 fl. oz. 2. 3 fl. oz. 3. 4 fl. oz. 4. 5 fl. oz.

✅4. The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child's age in years.

25. A 5-year-old is discharged from the hospital following the diagnosis of hemolytic uremic syndrome (HUS). The child has been free of diarrhea for 1 week, and renal function has returned. The parent asks the nurse when the child can return to school. Which is the nurse's best response? 1. "Immediately, as your child is no longer contagious." 2. "It would be best to keep your child home for a few more weeks because the immune system is weak, and there could be a relapse of HUS." 3. "Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet." 4. "It would be best to keep your child home to monitor urinary output."

1. Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation. 2. Once the child recovers from HUS, there is usually no relapse. ✅3. Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation. Once free of diarrhea for approximately 17 days, the child is considered not to be contagious and should be encouraged to return to developmentally appropriate activities as tolerated.

32. The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The child's parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

1. Primary enuresis refers to urinary inconti- nence in a child who has never had voluntary bladder control. ✅2. Secondary enuresis refers to urinary incontinence in a child who previously had bladder control. 3. Diurnal enuresis refers to daytime urinary incontinence not caused by something else. 4. Nocturnal enuresis refers to nighttime urinary incontinence.

22. Which laboratory results besides hematuria are most consistent with hemolytic uremic syndrome (HUS)? 1. Massive proteinuria, elevated blood urea nitrogen, and creatinine. 2. Mild proteinuria, decreased blood urea nitrogen, and creatinine. 3. Mild proteinuria, increased blood urea nitrogen, and creatinine. 4. Massive proteinuria, decreased blood urea nitrogen, and creatinine.

1. Protein is not lost in massive amounts in HUS. 2. BUN and creatinine are usually increased in HUS. ✅3. Hematuria, mild proteinuria, increased BUN, and creatinine are all present in HUS. 4. Protein is not lost in massive amounts in HUS.

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

1. The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. Polydipsia and polyuria occur as the kidney's ability to concentrate urine decreases. Metabolic acidosis occurs, not alkalosis. 2. The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. Metabolic acidosis occurs because there is a reduction in hydrogen ion secretion from the distal nephron. There is bacter- ial growth in the urine due to the urinary stasis caused by the obstruction. 3. The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. Polydipsia and polyuria occur as the kidney's ability to concentrate urine decreases. Metabolic acidosis occurs, not alkalosis. ✅4. The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. Metabolic acidosis occurs because there is a reduction in hydrogen ion secretion from the distal nephron. There is bacter- ial growth in the urine due to the urinary stasis caused by the obstruction.

28. The nurse is providing discharge instructions to the parents of an infant born with bladder exstrophy who had a continent urinary reservoir placed. Which statement should be included? 1. "Allow your child to sleep on the abdomen to provide comfort during the immediate post-operative period." 2. "As your child grows, be cautious around playgrounds because the surface could be a health hazard." 3. "As your child grows, be sure to encourage many different foods because it is not likely that food allergies will develop." 4. "Encourage your child's development, by having brightly colored objects around, such as balloons."

1. The infant should not be allowed to sleep on the abdomen because the prone position has been associated with sudden infant death syndrome. ✅2. Many children with urological malformations are prone to latex allergies. The surfaces of playgrounds are often made of rubber, which contains latex. 3. Many children with urological malformations are prone to latex allergies. Foods such as bananas can cause a latex allergy. 4. Although children need a stimulating environment, balloons are dangerous because many contain latex and can also be a choking hazard.

24. Which needs to be present to diagnose hemolytic uremic syndrome (HUS)? 1. Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure. 2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure. 3. Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure. 4. Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure.

1. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure. ✅2. The triad in HUS includes decreased red blood cells (with a high reticulo- cyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure. 3. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure. 4. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure.

62. Which is true of a Wilms tumor? Select all that apply. 1. It is also referred to as neuroblastoma. 2. It can occur at any age but is seen most often between the ages of 2 and 5 years. 3. It can occur on its own or can be associated with many congenital anomalies. 4. It is a slow-growing tumor. 5. It is associated with a very poor prognosis.

ANS: 2, 3. ✅2. It can occur at any age but is seen most often between the ages of 2 and 5 years. ✅3. It can occur on its own or can be associated with many congenital anomalies. 1. It is referred to as a nephroblastoma, not a neuroblastoma. 4. It is a tumor that grows very quickly. 5. It is associated with a very good prognosis.

27. Which medication would most likely be included in the post-operative care of a child with repair of bladder exstrophy? 1. Lasix. 2. Mannitol. 3. Meperidine. 4. Oxybutynin.

1. Lasix is a loop diuretic that is not routinely used in the care of the child with a repair of bladder exstrophy. 2. Mannitol is an osmotic diuretic that is not routinely used in the care of the child with a repair of bladder exstrophy. Meperidine is a narcotic that is not a first-line drug for pain management after a bladder reconstruction. ✅4. Oxybutynin is used to control bladder spasm

34. An adolescent woke up complaining of intense pain and swelling of the scrotal area and abdominal pain. He has vomited twice. Which should the nurse suggest? 1. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the emergency room. 2. Bring him to the pediatrician's office for evaluation. 3. Take him to the emergency room immediately. 4. Encourage him to rest; apply ice to the scrotal area, and go to the emergency room if the pain does not improve.

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35. Which causes the symptoms in testicular torsion? 1. Twisting of the spermatic cord interrupts the blood supply. 2. Swelling of the scrotal sac leads to testicular displacement. 3. Unmanaged undescended testes cause testicular displacement. 4. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

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36. The nurse evaluates post-operative teaching for repair of testicular torsion as successful when the parent of an adolescent says which the following? 1. "I will encourage him to rest for a few days, but he can return to football practice in a week." 2. "I will keep him in bed for 4 days and let him gradually increase his activity after that." 3. "I will seek therapy as he ages because he is now infertile." 4. "I will make sure he does testicular self-examination monthly."

✅ 4. The child and family should be taught the importance of testicular self-examination. 1. Lifting and strenuous activity should be avoided for 2 to 4 weeks. 2. The child should not be placed on bedrest and should be encouraged to gradually increase activity while resting as necessary. 3. Most cases of testicular torsion involve only one testis, so most children do not become infertile.

19. A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? 1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." 2. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." 3. "We will make sure the dressing is loosely applied to increase the toddler's comfort." 4. "If we notice any yellow drainage, we will know that everything is healing well."

✅1. Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system. 2. The mucous plug should be removed by irrigation because it could cause a blockage of the urinary drainage system. 3. The dressing is usually a compression type of dressing that helps decrease edema. 4. Foul-smelling yellow drainage is often a sign of infection that needs to be evaluated.

23. A child with hemolytic uremic syndrome (HUS) is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin (normal 10-13 mL/d )and hematocrit (42-52%) levels. The child has not had any urine output in 24 hours. The nurse expects administration of blood products and what else to be added to the plan of care? 1. Initiation of dialysis. 2. Close observation of the child's hemodynamic status. 3. Diuretic therapy to force urinary output. 4. Monitoring of urinary output.

✅1. Because the child is symptomatic, dialysis is the treatment of choice. 2. Because the child is symptomatic, dialysis is the treatment of choice. 3. Diuretics are given to prevent fluid overload, but they cannot cause the child in renal failure to produce urine. 4. Clotting factors are not used in HUS. The nurse would expect the plan to include dialysis, because the child is no longer producing urine.

7. 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

✅1. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis. 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

54. A child receiving peritoneal dialysis has not been having adequate volume in the return. The child is currently edematous and hypertensive. Which would the nurse anticipate the physician to do? 1. Increase the glucose concentration of the dialysate. 2. Decrease the glucose concentration of the dialysate. 3. Administer antihypertensives and diuretics but not change the dialysate concentration. 4. Decrease the dwell time of the dialysate.

✅1. Increasing the concentration of glucose will pull more fluid into the return. 2. Decreasing the concentration of glucose will pull less fluid into the return. 3. Antihypertensives and diuretics may be administered, but changing the concentration of glucose in the dialysate will help regulate the fluid balance. 4. Increasing the dwell time would help pull more fluid into the return. Decreasing the dwell time would pull less fluid into the return.

26. Which is a care priority for a newborn diagnosed with bladder exstrophy and a malformed pelvis? 1. Change the diaper frequently and assess for skin breakdown. 2. Keep the exposed bladder open in a warm and dry environment to avoid any heat loss. 3. Offer formula for infant growth and fluid management. 4. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair.

✅1. Preventing infection from stool contamination and skin breakdown is the top priority of care. 2. The bladder should be covered with a moist dressing and not kept open where it can be exposed to pathogens or subject to irritation from drying. 3. Infant formula would not provide enough fluid for this infant. An umbilical artery catheter would be inserted to provide fluids because of large insensible fluid losses from the exposed viscera. 4. Although the child should be encouraged to rest, it is important to change the diaper immediately to prevent fecal contamination and subsequent infection.

21. The manifestations of hemolytic uremic syndrome (HUS) are due primarily to which event? 1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia. 2. There is a disturbance of the glomerular basement membrane, allowing large proteins to pass through. 3. The red blood cell changes shape, causing it to obstruct microcirculation. 4. There is a depression in the production of all formed elements of the blood

✅1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen. 2The increased permeability of the basement membrane occurs in MCNS. 3 The red blood cell changing shape is typical of sickle cell anemia. 4 The depression of all formed elements of the blood occurs in aplastic anemia.

45. The nurse is caring for a child due for surgery on a Wilms tumor. The child's procedure will consist of which of the following? 1. Only the affected kidney will be removed. 2. Both the affected kidney and the other kidney will be removed in case of recurrence. 3. The mass will be removed from the affected kidney. 4. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done.

✅1. The treatment of a Wilms tumor involves removal of the affected kidney. 2. Removal of the unaffected kidney is not necessary and is not done. 3. The entire kidney is removed. 4. A biopsy of the tissue of the unaffected kidney is not necessary and is not obtained.

3. 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. Urinalysis, urine culture, and VCUG. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Discharge home on an antibiotic.

✅1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a child has a second UTI within 1 year. 2. There are no data to suggest that renal failure should be evaluated. 3. A UTI is usually treated with oral antibiotics at home, not routinely requiring admission to the hospital. 4. A second UTI requires more extensive evaluation and diagnostic testing.

53. The nurse is caring for a 12-year-old receiving peritoneal dialysis. The nurse notes the return to be cloudy, and the child is complaining of abdominal pain. The child's parents ask what the next step will likely be. Which is the nurse's best response? 1. "We will probably place antibiotics in the dialysis fluid before the next dwell time." 2. "Many children experience cloudy returns. We do not usually worry about it." 3. "We will probably give your child some oral antibiotics just to make sure nothing else develops." 4. "The abdominal pain is likely due to the fluid going in too slowly. We will increase the rate of administration with the next fill."

✅1.Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fluid. 2. Cloudy returns and abdominal pain are signs of peritonitis and need to be treated. 3. Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fluid. 4. Cloudy returns and abdominal pain are signs of peritonitis. In addition to peritonitis, abdominal pain can be caused by the rapid infusion of dialysis fluid.

29. 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 filtration rate.

✅1.Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death. 2. Hydronephrosis is due to pressure created by an obstruction, causing urine to back up. There is no free flow of urine. 3. A decreased production of urine does not lead to hydronephrosis. 4. Hydronephrosis is not caused by abnormalities in the urine.

40. Which would the nurse expect to hear the parents of an infant with an incarcerated hernia report? 1. Acute onset of pain, abdominal distention, and a mass that cannot be reduced. 2. Gradual onset of pain, abdominal distention, and a mass that cannot be reduced. 3. Acute onset of pain, abdominal distention, and a mass that is easily reduced. 4. Gradual onset of pain, abdominal distention, and a mass that is easily reduced.

✅1.Signs of an incarcerated hernia include an acute onset of pain, abdominal distention, and a mass that cannot be reduced. Other signs are bloody stools, edema of the scrotum, and a history of poor feeding. 2. The pain is not gradual but is acute in onset. 3. The mass is not easily reduced. 4. The mass is not easily reduced, and the child experiences acute, not gradual, onset of pain.

55. During hemodialysis, the nurse notes that a 10-year-old becomes confused and restless. The child complains of a headache and nausea and has generalized muscle twitching. This can be prevented by which of the following? 1. Slowing the rate of solute removal during dialysis. 2. Ensuring the patient is warm during dialysis. 3. Administering antibiotics before dialysis. 4. Obtaining an accurate weight the night before dialysis.

✅1.The child is experiencing signs of disequilibrium syndrome, which is caused by free water shifting from intravascular spaces and can be prevented by slowing the rate of dialysis. 2. The patient's temperature is not a causative factor in disequilibrium syndrome. 3. Antibiotics are used to prevent peritonitis, not disequilibrium syndrome. 4. The child's weight should be obtained immediately prior to dialysis.

56. Chronic hypertension in the child who has chronic renal failure (CRF) is due to which of the following? 1. Retention of sodium and water. 2. Obstruction of the urinary system. 3. Accumulation of waste products in the body. 4. Generalized metabolic alkalosis.

✅1.The retention of sodium and water leads to hypertension. 2. The obstruction of the urinary system can lead to renal failure but is not a direct cause of hypertension. 3. The accumulation of waste products leads to metabolic acidosis. 4. In CRF, the body experiences a state of metabolic acidosis, not alkalosis.

11. The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which is the nurse's best response? 1. "Your child's urine output will increase, and the urine will become less tea-colored." 2. "Your child will rest more comfortably 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."

✅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. 2.As glomerulonephritis improves, the child should have more energy and rest less. 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.

50. A 10-kg toddler is diagnosed with acute renal failure (ARF), is afebrile, and has a 24-hour urine output of 110 mL. After calculating daily fluid maintenance, which would the nurse expect the toddler's daily allotment of fluids to be? 1. Sips of clear fluids and ice chips only. 2. 350 mL of oral and intravenous fluids. 3. 1000 mL of oral and intravenous fluids. 4. 2000 mL of oral and intravenous fluids.

✅2. 350 mL is approximately a third of the daily fluid requirement and is recommended for the child in the oliguric phase of ARF. If the child were febrile, the fluid intake would be increased. 1. Sips of clear fluids and ice chips would not replace the insensible losses. All oral intake needs to be measured and accurately recorded because "sips" can be very subjective. 3. 1000 mL represents the daily fluid requirement in a healthy child. 4. 2000 mL is double the fluid requirement of a healthy child and is contraindicated in a child in the oliguric phase of ARF.

9. 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."

✅2. Blood in the child's urine causes it to be tea-colored. 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

48. A child had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago due to post-operative hemorrhage. The parent noted that her child was "swal- lowing a lot and finally began vomiting large amounts of blood." The child's vital signs are as follows: T 99.5°F (37.5°C), HR 124, BP 84/48, and RR 26. The nurse knows that this child is at risk for which type of renal failure? 1. CRF due to advanced disease process. 2. Prerenal failure due to dehydration. 3. Primary kidney damage due to a lack of urine flowing through the system. 4. Postrenal failure due to a hypotensive state.

✅2. Examples of causes of prerenal failure include dehydration and hemorrhage. 1.CRF occurs gradually. 3. Primary kidney failure occurs when the kidney experiences a direct injury. Examples include HUS and glomerulonephritis. 4. Postrenal failure occurs when there is an obstruction to urinary flow. Hypotension does not cause postrenal failure.

20. Which would the nurse most likely find in the history of a child with hemolytic uremic syndrome (HUS)? 1. Frequent UTIs and possible vesicoureteral reflux (VUR). 2. Vomiting and diarrhea before admission. 3. Bee sting and localized edema of the site for 3 days. 4. Previously healthy and no signs of illness.

✅2. HUS is often preceded by diarrhea that may be caused by E. coli present in undercooked meat. 1. Frequent UTIs and VUR do not lead to HUS. 3. Insect stings are not associated with HUS. 4. HUS is usually preceded by diarrhea.

13. 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 kidney's ability to excrete waste and concentrate urine.

✅2. Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine. 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.

57. Which best describes the electrolyte imbalance that occurs in chronic renal failure (CRF)? 1. Decreased serum phosphorus and calcium levels. 2. Depletion of phosphorus and calcium stores from the bones. 3. Change in the structure of the bones, causing calcium to remain in the bones. 4. Nutritional needs are poorly met, leading to a decrease in many electrolytes such as calcium and phosphorus.

✅2. The calcium and phosphorus levels are drawn from the bones in response to low calcium levels. 1. The kidneys are unable to excrete phosphorus, so phosphorus levels increase, and calcium levels fall. 3. The calcium is drawn from the bones in response to low serum calcium levels. 4. Although the child may not be consuming enough calcium, dietary deficiency is not the primary cause of hypocalcemia.

38. The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. Which is the nurse's best response? 1. "The terms are used interchangeably and mean the same thing." 2. "The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, whereas a hydrocele is a fluid-filled mass in the scrotum." 3. "A hydrocele is the term used when an inguinal hernia occurs in females." 4. "A hydrocele presents in a manner similar to that of an inguinal hernia but causes increased concern because it is often malignant."

✅2. The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, and a hydrocele is a fluid-filled mass in the scrotum. 1. The terms are not used interchangeably. Inguinal hernia refers to protrusion of abdominal tissue into the groin, and a hydrocele refers to a fluid-filled mass in the scrotum. 3. A hydrocele does not occur in females. 4. A hydrocele is not associated with an increased risk of malignancy.

44. The parents overhear the health-care team refer to their child's disease as in stage III. The parents ask the nurse what this means. Which is the nurse's best response? 1. The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is poor. 2. The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is very good. 3. The tumor has been found in three other organs beyond the peritoneal area; the prognosis is good. 4. The tumor has spread to other organs beyond the peritoneal area; the prognosis is poor.

✅2. The tumor is confined to the abdomen but has spread to the lymph nodes or peritoneal area. The prognosis is still very good. 1. The tumor is confined to the abdomen but has spread to the lymph nodes or peritoneal area. The prognosis is still very good. 3. Stage III does not indicate that the tumor has spread to three other organs. 4. The tumor has not spread to other organs beyond the peritoneal area. This would represent stage IV, but with aggressive treatment the child would still have a good prognosis.

46. The nurse anticipates that the child who has had a kidney removed will have a high level of pain and will require invasive and noninvasive measures for pain relief. The nurse anticipates that the child will have pain because of which of the following? 1. The kidney is removed laparoscopically, and there will be residual pain from accumulated air in the abdomen. 2. There is a post-operative shift of fluids and organs in the abdominal cavity, leading to increased discomfort. 3. The chemotherapy makes the child more sensitive to pain. 4. The radiation therapy makes the child more sensitive to pain.

✅2. There is a post-operative shift of fluids and organs in the abdominal cavity, leading to increased discomfort. 1. A large incision is used because the kidney is not removed laparoscopically at this time. 3. The increased pain is due to shifting of fluid and organs. 4. The increased pain is due to shifting of fluid and organs.

2. The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take? 1. Notifies the physician because this urine output is too low. 2. Encourages the child to increase oral intake to increase urine output. 3. Records the child's urine output in the chart. 4. Administers isotonic fluid intravenously to help with rehydration.

✅3 .Recording the child's urine output in the chart is the appropriate action because the urine output is within the expected range of 0.5-1 mL/kg/hr, or 75-150 mL for the 10-hour period. 1,3,4 The child weighs 15 kg, and the expected urine output is 0.5-1 mL/kg/hr. 0.5 15 kg = 7.5 mL; 1 mL 15 kg = 15 mL. 7.5-15 mL/hour 10 hours = 75-150 mL of urine for the 10-hour period. Therefore, the output is not too low.

10. Which finding 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."

✅3. A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention. 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.

49. A child diagnosed with acute renal failure (ARF) complains of "not feeling well," having "butterflies in the chest," and arms and legs "feeling like Jell-O." The cardiac monitor shows that the QRS complex is wider than before and that an occasional premature ventricular contraction (PVC) is seen. Which would the nurse expect to administer? 1. An isotonic saline solution with 20 mEq KCl/L. 2. Sodium bicarbonate via slow intravenous push. 3. Calcium gluconate via slow intravenous push. 4. Oral potassium supplements.

✅3. Calcium gluconate is the drug of choice for cardiac irritability secondary to hyperkalemia. 1. The patient is demonstrating signs of hyperkalemia; therefore, intravenous potassium would be contraindicated. 2. Sodium bicarbonate would be administered when metabolic acidosis is present. 4. The patient is demonstrating signs of hyperkalemia; therefore, oral potassium supplements would be contraindicated.

14. 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. "Since your child is losing so much protein, the liver is stimulated and makes more lipids." 4. "Your child's blood is very concentrated because of the edema, so the lipids are falsely elevated."

✅3. In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver hypoalbuminemia. 1.In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver hypoalbuminemia. 2. The elevated lipids are unrelated to the child's dietary habits. 4. The lipids are not falsely elevated.

15. A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony promi- nences. The child has been receiving 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 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.

✅3. In cases of severe edema, albumin is used to help return the fluid to the bloodstream from the subcutaneous tissue. 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.

17. 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."

✅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. 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.

52. The parent of a child diagnosed with acute renal failure (ARF) asks the nurse why peritoneal dialysis was selected instead of hemodialysis. Which is the nurse's best response? 1. "Hemodialysis is not used in the pediatric population." 2. "Peritoneal dialysis has no complications, so it is a treatment used without hesitation." 3. "Peritoneal dialysis removes fluid at a slower rate than hemodialysis, so many complications are avoided." 4. "Peritoneal dialysis is much more efficient than hemodialysis."

✅3. Peritoneal dialysis removes fluid at a slower rate that is more easily controlled than that of hemodialysis. 1. Hemodialysis is used in the pediatric population. 2. Peritoneal dialysis has many complications, such as peritonitis. 4. Hemodialysis is much more efficient than peritoneal dialysis.

18. An infant is scheduled for a hypospadias and chordee repair. The parent tells the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix 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."

✅3. Releasing the chordee surgically is necessary for future sexual function. 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.

60. A renal transplantation is which of the following? 1. A curative procedure that will free the child from any more treatment modalities. 2. An ideal treatment option for families with a history of dialysis noncompliance. 3. A treatment option that will free the child from dialysis. 4. A treatment option that is very new to the pediatric population.

✅3. Renal transplantation frees the patient from dialysis. 1. There are extensive post-transplant care requirements. 2. This treatment option is not ideal for families with a history of noncompliance because there is extensive post-transplant care associated with the receipt of a kidney. 4. Renal transplantation is not new to the pediatric population.

42. Which would the nurse expect to find on assessment in a child with Wilms tumor? 1. Decreased blood pressure, increased temperature, and a firm mass located in one flank area. 2. Increased blood pressure, normal temperature, and a firm mass located in one flank area. 3. Increased blood pressure, normal temperature, and a firm mass located on one side of the midline of the abdomen. 4. Decreased blood pressure, normal temperature, and a firm mass located on one side or the other of the midline of the abdomen.

✅3. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected. 1. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected. 2. The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected. 4. The blood pressure may be increased if there is renal damage. The mass is located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected.

58. The diet for a child with chronic renal failure (CRF) should be high in calories and include: 1. Low protein, and all minerals and electrolytes. 2. Low protein and minerals. 3. High protein and calcium and low potassium and phosphorus. 4. High protein, phosphorus, and calcium and low potassium and sodium.

✅3. The child with CRF needs a diet high in calories, protein, and calcium and low in potassium and phosphorus. 1. The child's diet should be high in calories and protein, but not all minerals and electrolytes should be high. Sodium, potassium, and phosphorus should be restricted. 2. The child with CRF needs a diet high in protein. 4. Phosphorus should be restricted because the kidneys are unable to excrete phosphorus.

43. A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs. The parent asks the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. Which is the nurse's best response? 1. "I'm not sure why your child is going for this test. I will check and get back to you." 2. "It sounds like we made a mistake. I will check and get back to you." 3. "The test is done to check to see if the disease has spread to the lungs." 4. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery."

✅3. The test is done to see if the disease has spread to the lungs. 1. When the nurse is unsure of the answer, it is best to check and get back to the parents. The nurse should be aware that tests of other organs are often performed to evaluate for the presence of metastases. 2. The test is ordered to check for metastasis to the lungs. 4. A chest x-ray, not a magnetic resonance image, is ordered routinely to evaluate the health of the lungs prior to surgery.

5. 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 finger laceration; mother states he had surgical reimplantation 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).

✅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. 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 cou- pled with flank pain, which needs evaluation.

47. The parents of a 7-year-old tell the nurse they do not understand the difference be- tween chronic renal failure (CRF) and acute renal failure (ARF). Which is the nurse's best response? 1. "There really is not much difference because the terms are used interchangeably." 2. "Most children experience ARF. It is highly unusual for a child to experience CRF." 3. "CRF tends to occur suddenly and is irreversible." 4. "ARF is often reversible, whereas CRF results in permanent deterioration of kidney function."

✅4. ARF is often reversible, whereas CRF results in permanent deterioration of kidney function. 1. Both disease processes are characterized by the kidney's inability to excrete waste. CRF occurs gradually and is irreversible, whereas ARF occurs suddenly and may be reversible. 2. Children can experience CRF and ARF. 3.CRF is irreversible, and it tends to occur gradually.

59. One week after kidney transplant, a child complains about abdominal pain, and the parents note that the child has been very irritable. The nurse notes a 10% weight gain as well as elevated BUN and creatinine levels. Which of the following medications would the child most likely be taking? 1. Codeine tablets. 2. Furosemide. 3. MiraLAX powder. 4. Corticosteroids.

✅4. Corticosteroids are considered to be part of the antirejection regimen that is essential after a kidney transplant. 1. The child is demonstrating signs of rejection. Although pain control is always important, antirejection medications are of utmost importance. 2. Furosemide may be given to reduce edema, but antirejection medications are the most important for this child. 3. MiraLAX powder will help with constipation, but it will not help prevent rejection.

16. 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 relapses, 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."

✅4. Exposure to infectious illness has been linked to the relapse of nephrotic syndrome. 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 nephrotic syndrome.

4. 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

✅4. Increasing fluids will help flush the bladder of any organism, encourage urination, and prevent stasis of urine. 1. The increased pressure associated with evacuating the 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.

51. The nurse is caring for a 1-year-old diagnosed with acute renal failure (ARF). Edema is noted throughout the child's body, and the liver is enlarged. The child's urine out- put is less than 0.5 mL/kg/hr, and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is noted to have nasal flaring and retractions with inspiration. The lung sounds are coarse throughout. Despite receiving oral Kayexalate, the child's serum potassium continues to rise. Which treatment will provide the most benefit to the child? 1. Additional rectal Kayexalate. 2. Intravenous furosemide. 3. Endotracheal intubation and ventilatory assistance. 4. Placement of a Tenckhoff catheter for peritoneal dialysis.

✅4. Placement of a Tenckhoff catheter for peritoneal dialysis is needed when the child's condition deteriorates despite medical treatment. 1. Although the child will likely receive additional Kayexalate, the child's condition will likely not improve without dialysis. 2. Although the child will likely receive intravenous furosemide, the child's condition will likely not improve without dialysis. 3. Endotracheal intubation and ventilatory assistance may be required, but ultimately the child will need dialysis.

39. The nurse evaluates the parents' understanding of the teaching about an inguinal hernia as successful when they say which of the following? 1. "There are no risks associated with waiting to have the hernia reduced; surgery is done for cosmetic reasons." 2. "It is normal to see the bulge in the baby's groin decrease with a bowel movement." 3. "We will wait for surgery until the baby is older because narcotics for pain control will be required for several days." 4. "It is normal for the bulge in the baby's groin to look smaller when the baby is asleep."

✅4. The hernia often appears smaller when the child is asleep. 1. Surgery is usually done at an early age to avoid incarceration, in which the hernia causes impaired circulation to the surrounding tissue. 2. The hernia tends to look larger when the child strains or has a bowel movement. 3. The surgery is usually done on an outpatient basis, and narcotics are not usually needed.

41. The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says, "How could I have missed a lump this big?" Which is the nurse's best response? 1. "Do not be hard on yourself. It's easy to overlook something that has probably been growing for months when we see our children on a regular basis." 2. "I understand you must be very upset. Your child would have had a better prognosis had you caught it earlier." 3. "It really takes a trained professional to recognize something like this." 4. "Do not blame yourself. This mass grows so fast that it was probably not noticeable a few days ago."

✅4. The tumor is fast-growing and could very easily not have been evident a few days earlier. 1. Wilms tumor grows very rapidly and doubles in size in fewer than 2 weeks. 2. This response places blame on the parent. Wilms tumor has a very good prognosis, even when first diagnosed at a more advanced stage. 3. This response is condescending and does not acknowledge the parent as the person who knows the child best.

6. 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.

✅4.An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained. 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.

31. 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.

✅Fluid status is monitored to ensure adequate urinary output. Assessing blood pressure monitors kidney function 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.