PEDIATRIC SUCCESS GENITOURINARY DISORDERS CHAPTER 9

11. The parents of a child with glomerulonephritis ask how will they know that the condition is improving after they take their child home. What 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." 3. "Your child's appetite will decrease." 4. "Your child's laboratory test values will become more normal."

11. 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.

12. A 5-year-old is hospitalized with MCNS. The nurse obtains a history from the parents. Which statement by the parents is most consistent with MCNS? 1. "Our child missed 2 days of school last week because of a really bad cold." 2. "We went camping last week, and our child's legs were covered in bug bites." 3. "Our child came home from school a week ago due to vomiting and stomach cramps." 4. "Our child has a pet turtle but does not wash hands after playing with the turtle."

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

19. A 13-month-old is being discharged following the repair of his epispadias. Which of the following statements made by the parents indicate that 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."

19. 1. Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system.

5. The nurse is working in a pediatric urgent care clinic. Which of the following patients can be discharged without the need for a urinalysis to evaluate for a UTI? 1. A 4-month-old female who presents with a 2-day history of fussiness and poor appetite; her current vital signs include T 100.8°F (38.2°C) (axillary) and heart rate 120 beats per minute. 2. An 8-year-old male who presents with a finger laceration; his mother states he had surgical reimplantation of his ureters 2 years ago. 3. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; she has an oral temperature of 101.5°F (38.6°C). 4. A 4-year-old female who states "it hurts when I pee"; her parent states that she has been asking to urinate every 30 minutes; vital signs are within normal range.

2. 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.

9. The parents of a child with glomerulonephritis ask the nurse why the urine is such a funny color. What 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.

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 of the following statements should be included? 1. "Allowing your child to sleep on the abdomen will provide comfort during the immediate postoperative 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. "In order to encourage your child's development, keep the environment stimulating by having brightly colored things around, such as balloons."

2. Many children with urological malfor mations are prone to latex allergies. The surfaces of playgrounds are often made of rubber, which contains latex.

48. The nurse is caring for a 9-year-old in the pediatric intensive care unit. The patient had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago due to postoperative hemorrhage. The patient's parent noted that her child was "swallow ing 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 patient 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.

37. The nurse is caring for a 3-week-old female diagnosed with an inguinal hernia. The nurse knows that which of the following protruding into the groin most likely caused the inguinal hernia? 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.

20. A 2-year-old is admitted to the pediatric floor with a diagnosis of HUS. Which of the following would the nurse likely find in the child's history? 1. The child has a history of frequent UTIs and possible VUR. 2. The child and parents had vomiting and diarrhea, but the parents believe it was due to "probably something that they ate." 3. The child was stung by a bee and experienced localized edema to the site for 3 days. 4. The child had previously been healthy and did not show any signs of illness until this admission.

2. HUS is often preceded by diarrhea that may be caused by E. coli present in undercooked meat.

13. The nurse is teaching the family about MCNS and explains that the clinical manifestations 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 because of antibody-antigen complex formation. 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.

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 patient'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.

2. Secondary enuresis refers to urinary incontinence in a child who previously had bladder control.

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 postoperative 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 postoperative shift of fluids and organs in the abdominal cavity, leading to increased discomfort.

57. The nurse knows that the child with CRF is at risk for spontaneous fractures because of an electrolyte imbalance. Which of the following best describes the imbalance that occurs? 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.

38. The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. What 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 groin." 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 in guinal hernia occurs when tissue pro trudes into the groin, and a hydrocele is a fluid-filled mass in the groin.

24. The nurse knows that which of the following need to be present to diagnose 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.

2. The triad in HUS includes decreased red blood cells (with a high reticulo cyte count as the body attempts to pro duce more red blood cells), decreased platelet count, and renal failure.

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. The nurse responds, knowing which of the following? 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 still very good. 3. The tumor has been found in three other organs beyond the peritoneal area; the prognosis is poor. 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.

21. The nurse is reviewing the pathophysiology of HUS. The manifestations of the disease are due primarily to which of the following events? 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.

21. 1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen.

23. A 3-year-old is admitted to the pediatric unit with a diagnosis of HUS. The child is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and low hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects which of the following to be added to the plan of care? 1. Administration of blood products and initiation of dialysis. 2. Administration of blood products and close observation of the child's hemodynamic status. 3. Administration of blood products followed by diuretic therapy to force urinary output. 4. Administration of clotting factors to diminish blood loss and continued monitoring of urinary output.

23. 1. Blood products are given to control the anemia. Because the child is symptomatic, dialysis is the treatment of choice.

26. A newborn is diagnosed with bladder exstrophy that includes a malformed pelvis. Which of the following is a priority of care? 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. Immediately administer a dextrose-containing solution intravenously to avoid any possibility of hypoglycemia. 4. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair.

26. 1. Preventing infection from stool con tamination and skin breakdown is the top priority of care.

29. The nurse understands that the clinical manifestations in hydronephrosis are due to which of the following? 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, resulting in an electrolyte imbalance. 4. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate.

29. 1. Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death.

3. A 3-year-old has a recurrent UTI. She had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed results within normal range. The child has had no other problems until this visit. Choose the nurse's best response. 1. The nurse should prepare for the following tests: urinalysis, urine culture, and VCUG. 2. Signs and symptoms of renal failure should be evaluated. 3. The nurse should prepare the child for likely admission to the pediatric unit. 4. Send the child home on an antibiotic and instruct the parent to offer the child lots of fluids.

3. 1. Urinalysis and urine culture are rou tinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when the child has a second UTI within 1 year.

50. The nurse is caring for a 10-kg toddler who is diagnosed with ARF. The toddler has a 24-hour urine output of 110 mL and is afebrile. After calculating daily fluid main tenance, which of the following would the nurse expect the toddler's daily allotment of fluids to be? 1. 1000 mL of oral and intravenous fluids. 2. 2000 mL of oral and intravenous fluids. 3. 350 mL of oral and intravenous fluids. 4. Sips of clear fluids and ice chips only.

3. 350 mL is approximately a third of the daily fluid requirement and is recom mended for the child in the oliguric phase of ARF. If the child were febrile, the fluid intake would be increased.

10. The nurse is caring for a 7-year-old with glomerulonephritis. Which of the following findings requires immediate attention? 1. The child sleeps most of the day and is very "cranky" when awake; blood pressure is 170/90. 2. The child's urine output is 190 mL in an 8-hour period and is the color of Coca Cola. 3. The child complains of a severe headache and photophobia. 4. The child refuses breakfast and lunch and states that 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.

49. The nurse is caring for an 11-year-old diagnosed with ARF. The patient complains of "not feeling well," having "butterflies in the chest," and arms and legs "feeling like Jell-O." The nurse places the child on a cardiac monitor and notes that the QRS complex is wider than before and that an occasional premature ventricular contraction is seen. The nurse would expect to administer which of the following? 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.

25. A 5-year-old is being discharged from the hospital following the diagnosis of 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. What 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."

3. Children with HUS are considered contagious for up to 17 days after the resolution of diarrhea and should be placed on contact isolation.

22. A 16-month-old with HUS has had blood and urine samples sent to the laboratory. Which of the following results are most consistent with his HUS? 1. Hematuria, massive proteinuria, elevated blood urea nitrogen, and creatinine. 2. Hematuria, mild proteinuria, decreased blood urea nitrogen, and creatinine. 3. Hematuria, mild proteinuria, increased blood urea nitrogen, and creatinine. 4. Ketonuria, proteinuria, elevated blood urea nitrogen, and creatinine.

3. Hematuria, mild proteinuria, increased BUN, and creatinine are all present in HUS.

7. On reviewing information about glomerulonephritis, the nurse knows that which of the following children is at risk for developing the disease? 1. A 10-year-old recovering from viral pneumonia. 2. A 6-year-old with new-onset type 1 diabetes. 3. A 3-year-old who had impetigo 1 week ago. 4. A 5-year-old with a history of five UTIs in the previous year.

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

14. The parents of a child hospitalized with MCNS ask why the last blood test revealed elevated lipids. What 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 ends up making 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.

15. The nurse is caring for a 2-year-old hospitalized with MCNS. The edema has pro gressed from periorbital to generalized. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving Lasix twice daily for several days. In order to reduce edema, which of the following does the nurse expect to be included in the treatment plan? 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.

17. The nurse is caring for a newborn male 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 circum cision be delayed in the child with hy pospadias because the foreskin may be needed for repair of the defect.

33. At a well-child health screening, the parent of a 7-year-old voices concern over the child's continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. What is the nurse's best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm, and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening, and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

3. Limiting the child's fluids in the evening will help decrease the noctur nal urge to void. Providing positive re inforcement and allowing the child to choose a reward will increase the child's sense of control.

8. The nurse is caring for a 7-year-old with glomerulonephritis. Which of the following combinations 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, hema turia, decreased urinary output, and lethargy are common findings in glomerulonephritis.

52. The parent of a child diagnosed with ARF asks the nurse why peritoneal dialysis was selected instead of hemodialysis. What 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 con trolled than that of hemodialysis.

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. The nurse notifies the physician because this urine output is too low. 2. The nurse encourages the patient to increase oral intake in order to increase urine output. 3. The nurse records the patient's urine output in the chart. 4. The nurse administers isotonic fluid intravenously to help with the rehydration process.

3. Recording the patient'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.

18. A 6-week-old male 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?" What 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 his sexual function 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.

60. A 10-year-old with renal failure is scheduled to undergo renal transplantation. The nurse knows that this treatment option is which of the following? 1. A curative procedure that will free the patient 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 patient from dialysis. 4. A treatment option that is very new to the pediatric population.

3. Renal transplantation frees the patient from dialysis.

47. The parents of a 7-year-old tell the nurse they do not understand the difference between CRF and ARF. What is the nurse's best response? 1. "There really is not much a 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.

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

34. The nurse receives a call from the parent of a 15-year-old male. The son woke up complaining of intense pain and swelling to the scrotal area. He has vomited twice and is also complaining of abdominal pain. Which of the following 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. Bring 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.

3. The child is having symptoms of testic ular torsion, which is a surgical emer gency and needs immediate attention.

58. The nurse on the pediatric unit is verifying that the patients have received the correct lunches. She knows that the child with CRF needs to receive which of the following diets? 1. A diet high in calories, protein, and all minerals and electrolytes. 2. A diet with high calories but low protein and minerals. 3. A diet high in calories, protein, and calcium and low in potassium and phosphorus. 4. A diet high in calories, protein, phosphorus, and calcium and low in potassium and sodium.

3. The child with CRF needs a diet high in calories, protein, and calcium and low in potassium and phosphorus.

43. The nurse is caring for a child who has just been diagnosed with a Wilms tumor. The child is scheduled for a magnetic resonance imaging of the lungs. The parents ask the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. What 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.

31. A 16-month-old is admitted to the pediatric unit with a diagnosis of hydronephrosis. Which of the following should be included in the plan of care? 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. The child's contact with other people should be limited to avoid infection.

31. 1. Fluid status is monitored to ensure ad equate urinary output. Assessing blood pressure monitors kidney function.

35. The nurse knows that which of the following causes the symptoms seen 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.

35. 1. Testicular torsion is caused by an interruption of the blood supply due to twisting of the spermatic cord.

6. An 8-month-old is being evaluated for a UTI. A urinalysis and urine culture are ordered. Which of the following is the best way to obtain the urine sample? 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 and begin antibiotic administration. 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.

59. The nurse is caring for a 7-year-old who received a kidney transplant 1 week ago. The child complains to the nurse about abdominal pain, and the parents note that the child has been very irritable. The nurse notes a 10% weight gain and elevated blood urea nitrogen and creatinine levels. The nurse asks the parents if the child has been taking which of the following medications? 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.

16. A 3-year-old returns to the pediatric clinic after having had MCNS. His parents ask the nurse how to prevent the child from having it again. What 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 avoided in his 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.

4. The nurse is instructing a group of girls and parents about the importance of preventing UTIs. Which of the following should the nurse teach? 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, encouraging urination and preventing stasis of urine.

39. The nurse is speaking to the parents of an infant with an inguinal hernia. The nurse knows the parents understand the teaching 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.

27. Which of the following medications would most likely be included in the postoperative care of a child with repair of bladder exstrophy? 1. Lasix. 2. Mannitol. 3. Meperidine. 4. Oxybutynin.

4. Oxybutynin is used to control bladder spasms.

51. The nurse is caring for a 1-year-old diagnosed with ARF. The patient's parent calls the nurse to the bedside and says "My child's eyes cannot open." Edema is noted throughout the child's body, and the liver is enlarged. The child's urine output 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 of the following treatments will provide the most benefit to the patient? 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.

30. A 20-month-old is admitted with hydronephrosis. The nurse notes which of the following findings? 1. Increased blood pressure, metabolic alkalosis, polydipsia, and polyuria. 2. Increased blood pressure, metabolic acidosis, and bacterial growth in the urine. 3. Increased blood pressure, metabolic alkalosis, and bacterial growth in the urine. 4. Increased blood pressure, metabolic acidosis, polydipsia, polyuria, and bacterial growth in the urine.

4. The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. Metabolic acidosis is caused by a re duction in hydrogen ion secretion from the distal nephron. Polydipsia and polyuria occur as the kidney's abil ity to concentrate urine decreases. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction.

1. The nurse is reviewing the basic anatomy and physiology of the genitourinary system. e The nurse knows that the bladder capacity of a 3-year-old could be estimated to be approximately how much? 1. 1.5 oz. 2. 3 oz. 3. 4 oz. 4. 5 oz.

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

36. The day surgery nurse knows that the parent of a 13-year-old male understands postoperative teaching for a repair of testicular torsion by saying which the following? 1. "We will encourage him to rest for a few days, but he can return to football practice in a week." 2. "We will keep him in bed for 4 days and let him gradually increase his activity after that." 3. "We will seek therapy as he ages because he is now infertile." 4. "We will make sure he knows how to do testicular self-examination on a monthly basis."

4. The child and family should be taught the importance of testicular self examination.

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?" What 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.

40. The nurse is working in the emergency department when an infant with a diagnosis of incarcerated hernia is brought in. The nurse would expect to hear the parents report a history of which of the following? 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.

40. 1. Signs of an incarcerated hernia include an acute onset of pain, abdominal dis tention, and a mass that cannot be re duced. Other signs are bloody stools, edema of the scrotum, and a history of poor feeding.

45. The nurse is caring for a child due for surgery on a Wilms tumor. The nurse knows that 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.

45. 1. The treatment of a Wilms tumor in volves removal of the affected kidney.

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. What 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."

53. 1. Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fluid.

54. The nurse is working in the pediatric intensive care unit, caring for a child receiving peritoneal dialysis. The nurse notes that the child has not been having adequate volume in the return. The child is currently edematous and hypertensive. The nurse would anticipate the physician to do which of the following? 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.

54. 1. Increasing the concentration of glucose will pull more fluid into the return.

55. The nurse is working in a hemodialysis center for children. 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. The nurse knows that this situation is called disequilibrium syndrome and may 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.

55. 1. The child is experiencing signs of dis equilibrium syndrome, which is caused by free water shifting from intravascu lar spaces and can be prevented by slowing the rate of dialysis.

56. The nurse is caring for a 9-year-old diagnosed with CRF. The child's blood pressure has been consistently elevated. The nurse knows that chronic hypertension in the child who has 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.

56. 1. The retention of sodium and water leads to hypertension.

61. The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which of the following questions would be appropriate for the nurse to ask in order 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 sharing at preschool?"

61. 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.

62. Which of the following 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.

62. 2, 3. 1. It is referred to as a nephroblastoma, not a 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 asso ciated with many congenital anomalies. 4. It is a tumor that grows very quickly. 5. It is associated with a very good prognosis.