GU Practice Q
A 6 year old male is diagnosed with nephrotic syndrome. In your nursing care plan you will include which of the following as a nursing diagnosis for this patient? A. Risk for infection B. Deficient fluid volume C. Constipation D. Overflow urinary incontinence
A A patient with nephrotic syndrome is at risk for infection due to the potential loss of proteins (immunoglobulins) in the urine that help fight infection. In addition, medication treatment for nephrotic syndrome may include corticosteroids or immune suppressors, which will further suppress the immune system.
Endoscopic evaluation of the urethra and bladder is achieved with _____________.
Cystoscopy
The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is: A. placing an indwelling urinary catheter. B. performing a suprapubic aspiration. C. placing a cotton ball in the underwear to catch urine. D. obtaining a clean catch voided urine.
D In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible.
The nurse is caring for a 6-year-old male child who was brought to the pediatrician's office by the parent for a fever for the past few days. Identify the statements that indicate a need for a further follow up. Assessment reveals the client has also been experiencing increased urinary frequency, dysuria, and costovertebral pain. Vital signs: temperature, 101.2F (38.4 C); heart rate, 110 beats/min; blood pressure, 88/48 mm Hg; respiratory rate, 22 breaths/min; oxygen saturation, 98% room air. Laboratory results: urinalysis, positive for leukocytes; white blood cell (WBC) count elevated
-A change in urinary frequency requires further assessment. -Painful urination (dysuria) is an abnormal finding requiring further assessment. -Costovertebral pain requires further follow-up, because it may indicate a complicated urinary tract infection (UTI) (ex. Affecting the kidneys) -Temperature of 101.2°F (38.4°C) is an abnormal finding requiring further assessment -The presence of leukocytes in urinalysis indicates urinary tract infection (UTI) -An elevated white blood cell (WBC) count indicates infection and requires follow-up.
A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client? A. Reassess the client's testes at 6 months of age. B. Administer low-dose human chorionic gonadotropin hormone. C. Perform karyotyping to establish the client's gender. D. Schedule emergency orchiopexy to correct the condition.
A Because the testes sometimes descend spontaneously during the first year of life, treatment is usually delayed until at least 6 months of age. If testes have not descended between 6 and 12 months of age, the client may be given a short course of chorionic gonadotropin hormone to see if testicular descent can be stimulated. If this is not successful, surgical intervention (orchiopexy) will be needed to correct the condition to prevent infertility.
A nurse is planning care for a child with hemolytic-uremic syndrome (HUS). The child has been anuric and will be receiving peritoneal dialysis treatment. The nurse plans to: A. Restrict fluids, as prescribed. B. Administer analgesics, as prescribed. C. Care for the arteriovenous (AV) fistula. D. Encourage the intake of foods that are high in potassium.
A HUS is thought to be associated with bacterial toxins, chemicals, and viruses that cause acute renal failure in children. Clinical features of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with HUS who is undergoing peritoneal dialysis for the treatment of anuria will be on fluid restrictions.
A 2-year-old male was brought to the clinic by his parents because of difficulty retracting the foreskin of his penis. Other than that, there were no other complaints like irritation, infection, dysuria, or bleeding. The parents also say that the patient does not have trouble urinating and has had no episodes of urinary obstruction. What is the treatment for an individual with this condition? A. Penicillin B. Vacuum-assisted cleaning C. Topical corticosteroids D. Neosporin ointment
C Phimosis is a term used to describe the difficulty in retracting the prepuce. Topical corticosteroids can help reverse phimosis.
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 must severely restrict her sodium intake." B. "Here is some written information from the dietitian." C. "She should try to avoid protein." D. "Let's meet with the dietitian and plan some meals."
D 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.
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 need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." C. "Girls tend to urinate less frequently than boys, making them more susceptible to UTI's." D. "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."
D 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.
The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition? A. "Our son may have to go through life without two testes." B. "Our son may need surgery on his testes before we are discharged to go home." C. "Our son will likely have a high risk of cancer in his teen years as a result of this condition." D. "Our son's condition may resolve on its own."
D Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended.
True or false: Foreskin should be retracted in patients with paraphimosis.
False! Paraphimosis- painful constriction of the glans penis by the foreskin, caused by the retracted foreskin. Never leave the foreskin retracted, as it can obstruct the lymphatics, leading to lymphedema
Urinary tract infections occur more frequently in male infants and young infants as compared with adult males. A. TRUE B. FALSE
True Shorter urethra-> Higher risk for UTIs
A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse? A. The foreskin is needed for repair. B. Circumcision with hypospadias will cause meatal stenosis. C. Circumcision is usually performed after 1 year of age. D. The circumcision may predispose the newborn to renal failure.
A Hypospadias occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circumcised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair. Once the hypospadias is repaired, a circumcision can be performed as part of the procedure. Hypospadias repair is usually done after the newborn is 1 year or older.
The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child? A. Eyes B. Sacrum C. Fingers D. Abdomen
A The symptoms of nephrotic syndrome include periorbital edema upon awakening with progressive edema throughout the day in all extremities and abdomen. Ascites can develop in the abdomen and the nurse should assess the child regularly for this development. The child with nephrotic syndrome generally does not have sacral edema, unless the edema is extreme and has not been treated.
In caring for a child with a urinary tract infection, the nurse would perform all of the following nursing interventions. Which two interventions would the nurse identify as the priority? A. Collect a "clean catch" voided urine. B. Instruct caregivers to avoid bubble baths, especially in young girls. C. Observe the child for signs of any reactions to the antibiotics. D. Observe for possible indications of sexual abuse. E. Teach girls to wipe from front to back. F. Record and report any indications of urinary burning, frequency, or urgency.
A, C The nurse would collect the "clean catch" voided urine specimen before any treatment is started to increase the likelihood of being able to identify the bacterium causing the infection. A priority when giving antibiotics is to always observe for signs of any adverse reaction to the medication. Reporting and recording urinary symptoms and observing for possible sexual abuse would be appropriate but not the priority. Instructing caregivers about avoiding bubble baths and teaching girls to wipe from front to back would be important later in the care of the child.
A child is admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which findings would the nurse expect to observe? Select all that apply. A. Pallor B. Edema C. Anorexia D. Proteinuria E. Weight loss F. Decreased serum lipids
A,B,C,D Nephrotic syndrome is a kidney disorder that is characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The urine volume is decreased, and the urine is dark and frothy in appearance. The child with this condition gains weight.
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. Finish all antibiotics prescribed. B. Use bubble bath to wash. C. Limit bathing to once a week. D. Wipe from front to back. E. Encourage fluids throughout the day.
A,D,E 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.
Most urinary tract infections seen in children are caused by: A. dietary insufficiencies. B. intestinal bacteria. C. fungal infections. D. hereditary causes.
B 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.
The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? A. hypothermia B. hypertension C. tachycardia D. hypotension
B Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.
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. The nurse tells the caregiver that the most important reason the child needs increased fluids is to: A. decrease the pain of urination. B. dilute the urine and flush the bladder. C. prevent the child from developing a fever. D. fill the bladder so a specimen can be obtained.
B Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder. An increase in fluid intake also helps decrease the pain experienced in urination, but this is not the most important reason the child needs increased fluids. Fluids may help decrease the chance of the child developing a fever, but this is not the most important reason fluids are given.
A nurse has admitted a 3-year-old female diagnosed with a urinary tract infection. When developing the plan of care, what should the nurse do first? A. Develop a schedule for bladder emptying. B. Encourage fluid intake. C. Assess usual voiding patterns. D. Monitor intake and output.
C The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action.
The nurse is triaging clients as they come in to an urgent care facility. Which assessment finding is clinically significant for early nephrotic syndrome? A. Sacral edema B. Edema in the hands C. Facial puffiness D. Periorbital edema
D Periorbital edema and edema in the ankles are the initial presenting symptoms. As the swelling advances, the edema becomes generalized with a pendulous abdomen full of fluid. Edema in the scrotum also appears. Edema in the hands, sacrum and facial puffiness can be a progression of the disease.
A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? A. abdominal circumference B. weight, daily C. urine output, every shift D. amount of protein in the urine
B 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.
In infants, infections account for the highest proportion of genitourinary disorders. A. True B. Falsee
B- False Congenital disorders account for a large proportion of genitourinary disorders in infants.
An 8-year-old girl is brought for evaluation of bedwetting. Upon questioning, the patient's mother states that she was potty trained at age three but has never been dry at night for more than three weeks. The mother denies any daytime incontinence. The patient usually has hard stools that are painful to pass and sometimes go up to 3 days without a bowel movement. The mother has tried restricting fluids a couple of hours before bedtime and taking the girl to the bathroom before going to sleep without any significant improvement. What is the best next step in the management of this patient? A. Timed voiding every 2 - 3 hours during the day B. Start polyethylene glycol (Miralax), continue evening fluid restriction, and reevaluate in 1 month C. Start the patient on desmopressin therapy D. Refer to psychology to start psychotherapy
B If a patient with enuresis suffers from significant constipation, the bowel problem should be treated first. Constipation and developmental delays are the two most common causes of enuresis. Timed voiding every 2-3 hours during the day can help. Desmopressin can be used when behavioral measures have failed.
Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis? A. The client wets only when involved in an activity. B. The client remains continent throughout the night. C. The parent takes the client to the bathroom at night. D. The child wakes up once during the night for a glass of water.
B The goal of therapy is for the client to be continent of urine throughout the night. The nurse should encourage the child to awaken and void and not have any fluids before bedtime. During an activity, the child should be encouraged to void before and after the activity to prevent incontinence.
When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? A. Activity intolerance B. Risk for infection C. Excess fluid volume D. Imbalanced nutrition less than body requirements
B 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.
The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? A. Fluid detected in scrotal sac B. Testis cannot be "milked" down inguinal canal C. Venous varicosity detected along the spermatic cord D. Testis can briefly be brought into scrotum
B With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.
A 6 year old male is brought to the hospital because he is lethargic and oliguric. He recently developed diarrhea earlier in the week and was having frankly bloody stools. Lab studies are conducted and reveal increased levels of BUN and creatinine in the serum. A blood smear shows the presence of fragmented erythrocytes. What is the most likely diagnosis in this patient? A. Urinary tract infection B. Hemolytic Uremic Syndrome (HUS) C. Nephrotic Syndrome D. Pyelonephritis
B Hemolytic Uremic Syndrome Presence of bloody diarrhea+ elevated BUN/Cr (actue renal failure) + fragmented erythrocytes (breakdown of RBCs that could lead to hemolytic anemia) = HUS The patient may also present symptoms related to thrombocytopenia
The mother of a child, who was recently diagnosed with nephrotic syndrome, asks how she can identify early signs that her child is experiencing a relapse with the condition. You would tell her to monitor the child for the following: Select-all-that-apply: A. Weight loss B. Protein in the urine using an over-the-counter kit C. Tea-colored urine D. Swelling in the legs, hands, face, or abdomen
B,D The patient will NOT experience weight loss but weight GAIN as a sign of relapse with this condition. In addition, the urine will appear dark and foamy. Tea-colored urine indicates there is blood in the urine, which is NOT common with nephrotic syndrome.
The infant kidneys' increased capacity for urine concentration places the infant at higher risk for dehydration as compared with older children and adults. A. True B. False
B- False The infant's kidneys demonstrate a decreased ability to concentrate urine and reabsorb amino acids, thus the infant is at higher risk for dehydration as compared with older children and adults.
The nurse is caring for a 10-year-old girl presenting with fever, dysuria, flank pain, urgency, and hematuria. The nurse would expect to help obtain which test first? A. total protein, globulin, and albumin B. creatinine clearance C. urinalysis D. urine culture and sensitivity
C Urinalysis is ordered to reveal preliminary information about the urinary tract. The test evaluates color, pH, specific gravity, and odor of urine. Urinalysis also assesses for presence of protein, glucose, ketones, blood, leukocyte esterase, red blood cell count, white blood cell count, bacteria, crystals, and casts. Total protein, globulin, albumin, and creatinine clearance would be ordered for suspected renal failure or renal disease. Urine culture and sensitivity is used to determine the presence of bacteria and determine the best choice of antibiotic.
