PREPU Urinary Elimination/Genitourinary Disorders PrepU

The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply. A. desmopressin B. albumin C. imipramine D. oxybutynin E. prednisone

A. desmopressin C. imipramine D. oxybutynin Medication therapy for treatment of nocturnal enuresis may include oxybutynin, imipramine, and desmopressin. These agents are prescribed only if behavioral and motivational therapies have been ineffective. Prednisone, a corticosteroid, would be ordered to induce remission and promote dieresis in children with nephritic syndrome. Albumin would be used to treat nephritic syndrome.

Urinary tract infections are usually successfully treated by what means? A. Administering diuretics B. Increasing fluids, such as cranberry juice C. Performing bladder irrigations D. Administering antibiotics

D. Administering antibiotics UTIs may be treated with antibiotics (usually sulfamethoxazole or ampicillin) at home. Fluids are encouraged, but they do not treat the infection. Bladder irrigations and diuretics are not used in the treatment of urinary tract infections.

Most urinary tract infections seen in children are caused by: A. fungal infections. B. dietary insufficiencies. C. hereditary causes. D. intestinal bacteria.

D. intestinal bacteria. 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.

A 3-year-old child is scheduled for a surgery to correct undescended testes. For what postoperative consideration would the nurse want to prepare the parents? A. some discomfort at the surgery site B. the need for maintaining a semi-Fowler position C. a liquid diet for 3 days D. the need for complete bed rest for 10 days

A. some discomfort at the surgery site An orchiopexy is the surgical procedure to release the spermatic cord and pull the testes into the scrotum. After the testes are in the scrotum, they are sutured into place to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation. Complete bed rest, a liquid diet, and remaining in a semi-Fowler position are not required as part of the postsurgical care.

A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition? A. testicular torsion B. testicular infection C. hydrocele D. varicocele

A. testicular torsion A hydrocele is a collection of fluid that collects in the fold of the scrotum, requiring no treatment. A varicocele is an abnormal dilation (dilatation) of the veins of the spermatic cord. Testicular torsion is evidenced by severe scrotal pain, nausea, and vomiting and is a surgical emergency. Testicular infection is not indicated.

A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? A. Allow tubes to dangle freely to encourage flow. B. Increase low-fat foods. C. Encourage high fluid intake. D. Apply antibiotic ointment to tube site.

C. Encourage high fluid intake. Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? A. Excess fluid volume B. Imbalanced nutrition less than body requirements C. Risk for infection D. Activity intolerance

C. Risk for infection 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 doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea? A. "It is caused from taking birth control pills when a girl is younger than 13 years old." B. "Emotional stress can be a cause of this disorder." C. "This is what happens if a 16-year-old girl has never had any periods at all." D. "This disorder is usually seen after a girl has had a spontaneous abortion (miscarriage)."

B. "Emotional stress can be a cause of this disorder." Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion (miscarriage) does not cause secondary amenorrhea.

A 16-year-old adolescent tells the nurse about having severe dysmenorrhea. Which action would be the best health teaching measure? A. Use ice to help in reducing inflammation and pain. B. Drink a minimum of fluid if having pain. C. Take over-the-counter ibuprofen for its prostaglandin action. D. Take acetaminophen beginning with the first day of a menstrual flow.

C. Take over-the-counter ibuprofen for its prostaglandin action. Dysmenorrhea is pain associated with menstruation. A prostaglandin release is responsible for the smooth muscle contraction of the uterus during menstruation. The nonsteroidal anti-inflammatory drug ibuprofen has an antiprostaglandin mechanism that will block the prostaglandin release. It is the best choice for dysmenorrhea. Acetaminophen has no antiprostaglandin properties, so it is not the drug of choice. Ice will only work on localized areas so it has limited, if any, effect on the uterus. Ice also is a vasoconstrictor and reduced blood flow could intensify the pain. Fluid intake has no effect on uterine pain.

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. "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." B. "Girls tend to urinate less frequently than boys, making them more susceptible to UTI's." C. "It is unlikely that your daughter is practicing good cleaning habits after she voids." D. "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."

D. "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." 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 collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis? A. Respirations 24 per minute B. Pulse rate 112 bpm C. Pulse oximetry 93% on room air D. Blood pressure 136/84

D. Blood pressure 136/84 Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for a child this age, but not a concern with this diagnosis. The other vital signs are within normal limits for a child of this age.

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. Edema in the hands B. Facial puffiness C. Sacral edema D. Periorbital edema

D. Periorbital edema 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 caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting? A. The child did not want to go on the fishing trip and is now retaliating against being made to go. B. The child has a urinary tract infection due to not bathing while on the fishing trip. C. The child is out of the habit of waking himself up during the night to void. D. The child has been sexually abused, maybe on the fishing trip.

D. The child has been sexually abused, maybe on the fishing trip. Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse (child mistreatment) and should be further explored.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history? A. The child is being treated for asthma. B. The child had a congenital heart defect. C. The child has a sibling with the same diagnosis. D. The child recently had an ear infection.

D. The child recently had an ear infection. In the child with acute glomerulonephritis, presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.

A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? A. urine output, every shift B. weight, daily C. amount of protein in the urine D. abdominal circumference

B. weight, daily 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. The abdomen would only need to be measured if ascites was suspected or known. Measuring urine output will not determine edema, although it should be done to determine if urine is being produced in adequate amounts. Measuring the amount of protein in the urine will also not determine edema. The measurement is important to determine the progress of the disease, however.

The parent of 6-month-old girl is concerned about the child getting a urinary tract infection. What should the nurse mention to the parent regarding this concern? A. Bathe the child with bubble bath once a week. B. Wipe from back to front when changing the girl's diaper. C. Discontinue prescribed antibiotics once symptoms of UTI have disappeared. D. Report any abnormally colored urine to the child's primary care provider.

D. Report any abnormally colored urine to the child's primary care provider. Several important interventions can help prevent urinary and renal disease in children. The first intervention is to educate parents and caregivers about wiping from front to back (not back to front) when changing diapers of female infants. Remind parents of simple ways to prevent UTI, such as not allowing children to bathe with bubble bath. Teach parents to recognize that abnormally colored urine (red, black, or cloudy) should not be dismissed as this could be the beginning of a UTI or kidney disease. Educating parents about the importance of giving the full course of antibiotics prescribed for UTIs can help prevent return reinfection; giving the full course of antibiotics after a streptococcal infection can help prevent acute glomerulonephritis.

A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? A. Surgery is not needed for this type of problem. B. This problem needs to be corrected immediately in the newborn period. C. If the infant is having swelling or pain, then surgery will be performed. D. There is a chance the testicles will descend on their own.

D. There is a chance the testicles will descend on their own. The Association of American Physicians recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year of age. This problem does not cause pain or swelling.

The nurse is reviewing the causative organisms noted on laboratory reports. Which organism is transmitted solely by sexual contact? A. Bacillus B. Cholera bacterium C. Borelli D. Trichomonas

D. Trichomonas The organism transmitted solely by sexual contact is Trichomonas. The other organisms are causes of various infections and acquired in various ways.

A client has just been admitted to the unit with a history of recent strep infection, hematuria, and proteinuria. Based on these findings, the nurse would suspect which condition? A. renal failure B. prune belly syndrome C. urinary tract infection D. acute glomerulonephritis

D. acute glomerulonephritis Recent strep infection, hematuria, and proteinuria are indicative of acute glomerulonephritis. These symptoms do not suggest any of the other options.

The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them. 1. Brings the penis and catheter/stent through the hole in the smaller diaper 2. Closes the smaller diaper 3. Unfolds both diapers, placing smaller diaper inside larger diaper 4. Closes the larger diaper 5. Cuts a hole in the front of the smaller diaper 6. Places both diapers under the infant

5, 3, 6, 1, 2, 4 5. Cuts a hole in the front of the smaller diaper 3. Unfolds both diapers, placing smaller diaper inside larger diaper 6. Places both diapers under the infant 1. Brings the penis and catheter/stent through the hole in the smaller diaper 2. Closes the smaller diaper 4. Closes the larger diaper When performing double diapering, the nurse cuts a hole or a cross-shaped slit in the front of the smaller diaper and then unfolds both diapers, placing the smaller diaper (with the hole) inside the larger one. Next, the nurse places both diapers under the child and carefully brings the penis (if applicable) and catheter/stent through the hole in the smaller diaper, closing the diaper. Finally, the nurse closes the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.

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. "Let's meet with the dietitian and plan some meals." B. "She must severely restrict her sodium intake." C. "She should try to avoid protein." D. "Here is some written information from the dietitian."

A. "Let's meet with the dietitian and plan some meals." 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 caregiver of a 1-year-old boy calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment? A. "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." B. "Without the hormone your son will have fluid that will collect in his scrotum." C. "Without the treatment your child's gonads will not reach normal size." D. "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do."

A. "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processes vaginalis does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.

A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group? A. "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often." B. "We should expect problems with too much fluid in the brain because the kidneys are not able to keep the fluid in balance." C. "The kidneys help get rid of carbon dioxide from the body, so kidney problems can affect our child's breathing." D. "Problems with the kidneys raise the risk for infection because there is a problem with producing white blood cells."

A. "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often." Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. Therefore, monitoring blood pressure is important. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acids-bases. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli in the lungs. Cerebrospinal fluid circulates through the brain and spinal cord.

A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage tube patency? A. Monitor output. B. Allow tubes to dangle freely to encourage flow. C. Maintain fluid restriction. D. Provide a low-sodium diet.

A. Monitor output. A ureteral stent is placed in the ureter temporarily to aid in the drainage of urine. It is removed via cystoscopy when it is time for discontinuation. The nurse should monitor output carefully when a ureteral stent is in place. This is an indication that the stent is patent and functioning properly. The tubes are inserted into the ureter so they would not dangle on the outside of the body. There is no need to maintain fluid restriction or a low-sodium diet just because of the stent. This would only be necessary if there were other disease processes affecting the child.

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. Testis cannot be "milked" down inguinal canal B. Fluid detected in scrotal sac C. Testis can briefly be brought into scrotum D. Venous varicosity detected along the spermatic cord

A. Testis cannot be "milked" down inguinal canal 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.

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 remains continent throughout the night. B. The client wets only when involved in an activity. C. The child wakes up once during the night for a glass of water. D. The parent takes the client to the bathroom at night.

A. The client remains continent throughout the night. 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.

The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately? A. Weigh the old dialysate. B. Weigh the new dialysate. C. Start the process over with a fresh bag. D. Empty the old dialysate.

A. Weigh the old dialysate. The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to: A. take the child to a private room and interview her regarding her sexual history and partners. B. talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted infection and discuss the importance of safe sex practices. C. contact the necessary authorities to report a suspected case of sexual abuse. D. take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity.

A. take the child to a private room and interview her regarding her sexual history and partners. Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect? A. Nephrosis B. Acute glomerulonephritis C. Polycystic kidney D. Kidney agenesis

B. Acute glomerulonephritis Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described above. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old. Nephrosis is altered glomerular permeability apparently due to an autoimmune process or a T-lymphocyte dysfunction that results in fusion of the glomeruli membrane surfaces, which, in turn, lead to abnormal loss of protein in urine. The highest incidence is at 3 years of age, and it occurs more often in boys than in girls. In addition to proteinuria, a major symptom of nephrosis is edema, which is absent in this case.

A parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? A. Discuss how the child can continue to go to the bathroom instead of in his or her underwear. B. Demonstrate how to urinate in the bathroom every time the child has an occurrence. C. Take away a toy every time the child urinates in his or her pants. D. Demonstrate love and acceptance at home.

B. Demonstrate how to urinate in the bathroom every time the child has an occurrence. Enuresis is the continued incontinence of urine past the age of toilet training. It is a source of shame and embarrassment. It affects the child's life emotionally, behaviorally, and socially. It causes the child to have low self-esteem. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school. The child should not be punished for a behavior he or she cannot control. Demonstrating how to use the toilet and going to the bathroom to void are good subjects but they do not help a child who has no control of the enuresis. Testing may need to be done to see if there are anatomical reasons, and medications may be needed to correct the problem.

A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure? A. Giving desmopressin intranasally B. Encouraging fluid intake after dinner C. Practicing bladder-stretching exercises D. Engaging the child in stress-reduction measures

B. Encouraging fluid intake after dinner In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.

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. Administer low-dose human chorionic gonadotropin hormone. B. Reassess the client's testes at 6 months of age. C. Schedule emergency orchiopexy to correct the condition. D. Perform karyotyping to establish the client's gender.

B. Reassess the client's testes at 6 months of age. 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. Karyotyping is not needed in this situation, because the client's gender is already established.

The nurse is caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis. What would the nurse expect to administer if ordered? A. Ferrous sulfate B. Sodium bicarbonate tablets C. Vitamin D D. Erythropoietin

B. Sodium bicarbonate tablets Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action? A. Give the child fluids and report back to the nurse in a few hours. B. Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. C. Give the child a diuretic and report back to the nurse in a few hours. D. Weigh the child in the same clothes she had been weighed in the day before and report the two weights to the nurse while the nurse is on the phone.

B. Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis? A. Strawberry-red tongue B. Tea-colored urine C. Loose, dark stools D. Jaundiced skin

B. Tea-colored urine The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as tea- or cola-colored. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry-colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in hepatitis.

The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis: A. There are strict diet and fluid restrictions. B. The child can live a more normal lifestyle. C. Therapy is only 3 to 4 days per week. D. The child must go into a facility to get peritoneal dialysis.

B. The child can live a more normal lifestyle. The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

A nurse is caring for a 13-year-old boy with end-stage kidney disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate? A. Take his blood pressure measurement in the extremity with the AV fistula. B. Withhold his routine medication until after dialysis is completed. C. Assess the Tenckhoff catheter site. D. Administer his routine medications as scheduled.

B. Withhold his routine medication until after dialysis is completed. The nurse should withhold routine medications on the morning that hemodialysis is scheduled since they would be filtered out through the dialysis process. His medications should be administered after he returns from the dialysis unit. A Tenckhoff catheter is used for peritoneal dialysis, not hemodialysis. The nurse should avoid blood pressure measurement in the extremity with the AV fistula as it may cause occlusion.

The nurse is administering an IV infusion of albumin to a child with nephrotic syndrome. What is the primary concern for the nurse when administering this medication to the child? A. urine output B. fluid overload C. electrolyte imbalance D. increased blood pressure

B. fluid overload Many children with nephrotic syndrome develop hypoalbuminemia and require the administration of albumin. Albumin increases the intravascular pressure, causing the movement of fluid from the interstitial space to the intravascular space. As a result, fluid overload can occur. The treatment is to administer furosemide after the albumin infusion is complete. Furosemide is a diuretic that will help excrete the extra fluid from the vascular space, thus preventing fluid overload. Electrolyte imbalances would occur if the low albumin was not treated. The blood pressure and urine output should be assessed during the medication administration to determine renal function.

A parent asks the nurse, "What is precocious puberty?" The nurse's response should be based on which statement? A. "Precocious puberty only occurs in boys, not girls." B. "Precocious puberty is when girls experience a heavy period." C. "Precocious puberty is early sexual development." D. "Precocious puberty is when children are going through puberty."

C. "Precocious puberty is early sexual development." Precocious puberty is the early sexual development or maturation of a girl or boy. It occurs most often in girls, not boys, and does not relate to a heavy menses.

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." What would be the most appropriate response by the nurse? A. "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive." B. "That must be hard on you, especially because you are raising her by yourself." C. "There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." D. "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it."

C. "There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally, oral contraceptive pills are prescribed to prevent ovulation.

The nurse is caring for an infant with grade II vesicoureteral reflux (VUR). The parent is very fearful that the infant will have progressive renal damage. Which response by the nurse would be appropriate? A. "You can expect recurrent urinary tract infections along with progressive renal damage." B. "This problem must be carefully managed to avoid permanent damage." C. "This condition usually resolves spontaneously with no symptoms." D. "Your infant will most likely need surgical intervention."

C. "This condition usually resolves spontaneously with no symptoms." Grades I and II VUR usually resolves spontaneously. Grades III to V are generally associated with recurrent urinary tract infections, hydronephrosis, and renal damage. Typically, only grades III to V need surgical intervention.

The nurse is conducting a presentation for a group of nurses who work with adolescents. The group discusses dysmenorrhea. Which statement is most accurately related to dysmenorrhea? A. Genetic abnormalities are the most common cause of dysmenorrhea. B. Dysmenorrhea can result from diaphragms or tampons being left in place too long. C. A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. D. Common symptoms of dysmenorrhea are weight gain and mood swings.

C. A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. The increased secretion of prostaglandins, which occurs in the last few days of the menstrual cycle, is thought to be a contributing factor in primary dysmenorrhea. Tampons or diaphragms being left in too long are related to pelvic and vaginal infections, not dysmenorrhea. Dysmenorrhea is the pain associated with smooth muscles. The weight gain and mood swings are related to hormonal changes during this time. Genetic abnormalities do not contribute to dysmenorrhea.

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? A. Foul yellow-gray discharge B. Irritation of labia and vaginal opening C. White cottage cheese-like discharge D. Thin gray vaginal discharge with fishy odor

C. White cottage cheese-like discharge White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene.

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? A. hypotension B. hypothermia C. hypertension D. tachycardia

C. hypertension Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is: A. performing a suprapubic aspiration. B. placing a cotton ball in the underwear to catch urine. C. obtaining a clean catch voided urine. D. placing an indwelling urinary catheter.

C. obtaining a clean catch voided urine. 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. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet-trained child, using a cotton ball to collect the urine would not be appropriate.

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? A. Hardened and tender epididymitis with edema and erythema of scrotum B. Enlarged inguinal glands and fever C. Fever, scrotal swelling, and urethral discharge D. Sudden onset of severe scrotal pain with significant hemorrhagic swelling

D. Sudden onset of severe scrotal pain with significant hemorrhagic swelling Testicular torsion is characterized by a testicle that is abnormally attached to the scrotum and twisted. Signs and symptoms include sudden onset of severe scrotal pain with significant hemorrhagic swelling. Enlarged glands and fever point to infection. A hardened and tender epididymis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: A. lipoid nephrosis (idiopathic nephrotic syndrome). B. rheumatic fever. C. a urinary tract infection. D. acute glomerulonephritis.

D. acute glomerulonephritis. Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.