Peds Exam 2

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. C. Offer formula for infant growth and fluid management. D. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair.

1. Change the diaper frequently and assess for skin breakdown. Preventing infection from stool contamination and skin breakdown is the top priority of care. The bladder should be protected with a film wrap to keep the mucosa moist.

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

A, B, C, D Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. A pattern of enuresis can often be seen in families. Increased thirst and incontinence can be associated with diabetes. Fussiness and incontinence can be associated with UTIs.

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse's best responses? Select all that apply. A. "Your child's urine output will increase, and the urine will become less tea-colored." B. "Your child will have more energy as lab tests become more normal." C. "Your child's appetite will decrease as urine output increases." D. "Your child's laboratory values will become more normal." E. "Your child's weight will increase as the urine becomes less tea-colored."

A, E When glomerulonephritis is improving, UO increases and the urine becomes less tea colored. These are signs that can be monitored at home by the child's parents. The child's weight will increase as the urine resumes a more normal color, indicating lab values are returning to normal and the child is better.

A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? A. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." B. "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." C. "We will make sure the dressing is loosely applied to increase the toddler's comfort." D. "If we notice any yellow drainage, we will know that everything is healing well."

A. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system.

Which statement by a parent is most consistent with minimal change nephrotic syndrome (MCNS)? A. "My child missed 2 days of school last week because of a really bad cold." B. "After camping last week, my child's legs were covered in bug bites." C. "My child came home from school a week ago because of vomiting and stomach cramps." D. "We have a pet turtle, but no one washes their hands after playing with the turtle."

A. "My child missed 2 days of school last week because of a really bad cold." An upper respiratory infection often precedes MCNS by a few days.

Which child is at risk for developing glomerulonephritis? A. A 3-year-old who had impetigo 1 week ago. B. A 5-year-old with a history of five UTIs in the previous year. C. A 6-year-old with new-onset type 1 diabetes. D. A 10-year-old recovering from viral pneumonia.

A. A 3-year-old who had impetigo 1 week ago. Impetigo is a skin infection caused by the streptococcal organisms that is commonly associated w/ glomerulonephritis.

Which causes the clinical manifestations of hydronephrosis? A. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. B. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances. C. Decreased production of urine in one or both kidneys results in an electrolyte imbalance. D. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate.

A. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death.

Which should be included in the plan of care for a child diagnosed with hydronephrosis? A. Intake and output as well as vital signs should be strictly monitored. B. Fluids and sodium in the diet should be limited. C. Steroids should be administered as ordered. D. Limited contact with other people to avoid infection.

A. Intake and output as well as vital signs should be strictly monitored. Fluid status is monitored to ensure adequate urinary output. Assessing blood pressure monitors kidney function.

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? A. Obtain urinalysis and urine culture. B. Evaluate for renal failure. C. Admit to the pediatric unit. D. Send home on an antibiotic. E. Schedule a VCUG.

A. Obtain urinalysis and urine culture Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a renal ultrasound shows scaring or possible reflux. If the child has a UTI related to bubble baths, constipation, or wiping back to front, a VCUG would not be ordered.

Which causes the symptoms in testicular torsion? A. Twisting of the spermatic cord interrupts the blood supply. B. Swelling of the scrotal sac leads to testicular displacement. C. Unmanaged undescended testes cause testicular displacement. D. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

A. Twisting of the spermatic cord interrupts the blood supply. Testicular torsion is caused by an interruption of the blood supply due to twisting of the spermatic cord.

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? A. "Allow your child to sleep on the abdomen to provide comfort during the immediate post-operative period." B. "As your child grows, be cautious around playgrounds because the surface could be a health hazard." C. "As your child grows, be sure to encourage many different foods because it is not likely that food allergies will develop." D. "Encourage your child's development, by having brightly colored objects around, such as balloons."

B. "As your child grows, be cautious around playgrounds because the surface could be a health hazard." Many children w/ urological malformations are prone to latex allergies. The surfaces of playgrounds are often made of rubber, which contains latex.

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? A. "The terms are used interchangeably and mean the same thing." B. "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." C. " 'Hydrocele' is the term used when an inguinal hernia occurs in females." D. "A hydrocele presents in a manner similar to that of an inguinal hernia but causes increased concern because it is often malignant."

B. "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."

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? A. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." B. "There is blood in your child's urine that causes it to be tea-colored." C. "Your child's urine is very concentrated, so it appears to be discolored." D. "A ketogenic diet often causes the urine to be tea-colored."

B. "There is blood in your child's urine that causes it to be tea-colored." Blood causes tea coloring

The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due to which of the following? A. Chemical changes in the composition of albumin. B. Increased permeability of the glomeruli. C. Obstruction of the capillaries of the glomeruli. D. Loss of the kidneys' ability to excrete waste and concentrate urine.

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

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? A. Primary enuresis. B. Secondary enuresis. C. Diurnal enuresis. D. Nocturnal enuresis.

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

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? A. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated." B. "It's not unusual to see elevated lipids in children because of the dietary habits of today." C. "Because your child is losing so much protein, the liver is stimulated and makes more lipids." D. "Your child's blood is very concentrated because of the edema, so the lipids are falsely elevated."

C. "Because your child is losing so much protein, the liver is stimulated and makes more lipids." In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver caused by hypoalbuminemia.

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? A. "Circumcision is a fading practice and is now contraindicated in most children." B. "Circumcision in children with hypospadias is recommended because it helps prevent infection." C. "Circumcision is an option, but it cannot be done at this time." D. "Circumcision can never be performed in a child with hypospadias."

C. "Circumcision is an option, but it cannot be done at this time." It is usually recommended that circumcision by delayed in the child w/ hypospadias because the foreskin may be needed for repair of the defect.

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. Which is the nurse's best response about what the parent should do next? A. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." B. "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." C. "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." D. "Bed-wetting alarms are readily available, and most children do very well with them."

C. "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." Limiting the child's fluids in the evening will help decrease the nocturnal urge to void. Providing positive reinforcement and allowing the child to choose a reward will increase the child's sense of control.

An infant is scheduled for a hypospadias and chordee repair. The parent asks 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? A. "I understand your concern. Parents do not want their children to undergo extra surgery." B. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." C. "The repair is done to optimize sexual functioning when he is older." D. "This is the best time to repair the chordee because he will be having surgery anyway."

C. "The repair is done to optimize sexual functioning when he is older." Releasing the chordee surgically is necessary for future sexual function

A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving furosemide (Lasix) twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema? A. An increase in the amount and frequency of furosemide (Lasix). B. Addition of a second diuretic, such as mannitol. C. Administration of intravenous albumin. D. Elimination of all fluids and sodium from the child's diet.

C. Administration of intravenous albumin. In cases of severe edema, albumin is used to help return the fluid to the bloodstream from the subcutaneous tissue.

Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)? A. 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. B. 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. C. An 8-year-old male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. D. 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).

C. An 8-year-old male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. Although this child has had a history of urinary infections, the child is not currently displaying any signs and therefore does not need a urinalysis at this time.

Which finding requires immediate attention in a child with glomerulonephritis? A. Sleeping most of the day and being very "cranky" when awake; blood pressure is 170/90. B. Urine output is 190 mL in an 8-hour period and is the color of Coca-Cola. C. Complaining of a severe headache and photophobia. D. Refusing breakfast and lunch and stating he "just is not hungry."

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

Which combination of signs is commonly associated with glomerulonephritis? A. Massive proteinuria, hematuria, decreased urinary output, and lethargy. B. Mild proteinuria, increased urinary output, and lethargy. C. Mild proteinuria, hematuria, decreased urinary output, and lethargy. D. Massive proteinuria, decreased urinary output, and hypotension.

C. Mild proteinuria, hematuria, decreased urinary output, and lethargy. These are the common findings in glomerulonephritis.

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? A. Notifies the health-care provider because this urine output is too low. B. Encourages the child to increase oral intake to increase urine output. C. Records the child's urine output in the chart. D. Administers isotonic fluid intravenously to help with rehydration.

C. Record the child's UO in the chart Recording the child's output in the chart is the appropriate action because the UO is w/ in the expected range of 0.5-1 mL/kg/hr, which is 75-150 mL for the 10 hour period

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? A. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the emergency room. B. Bring him to the health-care provider's office for evaluation. C. Take him to the emergency department immediately. D. Encourage him to rest; apply ice to the scrotal area and go to the emergency department if the pain does not improve.

C. Take him to the emergency department immediately. The child is having symptoms of testicular torsion, which is a surgical emergency and needs immediate attention.

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

D. "I will make sure he does testicular self-examination monthly." The child and family should be taught the importance of testicular self-examination.

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? A. "It is very rare for a child to have a relapse after having fully recovered." B. "Unfortunately, many children have cycles of relapse, and there is very little that can be done to prevent it." C. "Your child is much less likely to get sick again if sodium is decreased in the diet." D. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

D. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses." Exposure to infectious illness has been linked to the relapse of minimal change nephrotic syndrome.

Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)? A. Avoiding constipation has no effect on the occurrence of UTIs. B. After urinating, always wipe from back to front to prevent fecal contamination. C. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. D. Increasing fluids will help prevent and treat UTIs.

D. Increasing fluids will help prevent and treat UTIs Increasing fluids will help flush the bladder of any organisms, encourage urination, and prevent stasis of urine.

In addition to increased blood pressure, which findings would most likely be found in a child with hydronephrosis? A. Metabolic alkalosis and positive renal ultrasound. B. Metabolic acidosis and negative renal ultrasound. C. Metabolic alkalosis and bacterial growth in the urine. D. Metabolic acidosis, polydipsia, and polyuria.

D. Metabolic acidosis, polydipsia, and polyuria. Metabolic acidosis is caused by a reduction in hydrogen ion secretion from the distal nephron. Polydipsia and polyuria occur as the kidney's ability to concentrate urine decreases. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction.

Which medication would most likely be included in the postoperative care of a child with repair of bladder exstrophy? A. Furosemide (Lasix). B. Mannitol. C. Meperidine (Demerol). D. Oxybutynin (Ditropan).

D. Oxybutynin (Ditropan). It is used to help control bladder spasms.

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)? A. Carefully cleanse the perineum from front to back and apply a self-adhesive urine collection bag to the perineum. B. Insert an indwelling Foley catheter, obtain the sample, and wait for results. C. Place a sterile cotton ball in the diaper and immediately obtain the sample with a syringe after the first void. D. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample.

D. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample An in and out catheterization is the best way to obtain a urine culture in a child who is not yet toilet trained.