The Child with a Genitourinary Alteration

MULTIPLE CHOICE

1. Which statement made by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections?

a.
“I always wear cotton underwear.”
b.
“I really enjoy taking a bubble bath.”
c.
“I go to the bathroom every 3 to 4 hours.”
d.
“I drink four to six glasses of fluid every day.”

ANS: B

Bubble baths should be avoided because they tend to cause urethral irritation, which leads to urinary tract infection. It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture. Children should be encouraged to urinate at least four times a day. An adequate fluid intake prevents the buildup of bacteria in the bladder.

DIF: Cognitive Level: Application REF: p. 463

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

2. The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding?

a.
Increased urine output
b.
Hypotension
c.
Tea-colored urine
d.
Weight gain

ANS: C

Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. In acute poststreptococcal glomerulonephritis, the urine output may be decreased and the blood pressure increased. Edema may be noted around the eyelids and ankles in patients with acute poststreptococcal glomerulonephritis; however, weight gain is associated with nephrotic syndrome.

DIF: Cognitive Level: Application REF: p. 466

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

3. The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about “casts” in the urine. The nurse’s response is based on the knowledge that the presence of casts in the urine indicates:

a.
glomerular injury.
b.
glomerular healing.
c.
recent streptococcal infection.
d.
excessive amounts of protein in the urine.

ANS: A

The presence of red blood cell casts in the urine indicates glomerular injury. Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing. A urinalysis positive for casts does not confirm a recent streptococcal infection. Casts in the urine are unrelated to proteinuria.

DIF: Cognitive Level: Application REF: p. 466

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

4. What is a clinical finding that warrants further intervention for the child with acute poststreptococcal glomerulonephritis?

a.
Weight loss to within 1 pound of the preillness weight
b.
Urine output of 1 milliliter per kilogram per hour
c.
A normal blood pressure
d.
Inspiratory crackles

ANS: D

Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication. Weight loss to within 1 pound of the preillness weight is an indication that the child is responding to treatment. A urine output of 1 milliliter per kilogram per hour is an acceptable urine output and indicates that the child is responding to treatment. A normal blood pressure is also an indication that the child is responding to treatment.

DIF: Cognitive Level: Application REF: pp. 467-468

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

5. Which diagnostic finding is assessed by the nurse when a child has primary nephrotic syndrome?

a.
Hyperalbuminemia
b.
Positive ASO titer
c.
Leukocytosis
d.
Proteinuria

ANS: D

Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver’s inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

DIF: Cognitive Level: Comprehension REF: p. 470

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

6. Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission?

a.
Urine is negative for casts for 5 days.
b.
Urine is 0 to trace for protein for 5 to 7 days.
c.
Urine is negative for protein for 2 weeks.
d.
Urine is 0 to trace for blood for 1 week.

ANS: B

The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine is 0 to trace for protein for 5 to 7 days. The absence of casts in the urine gives no indication about the child’s response to treatment. The child with primary nephrotic syndrome is considered to be in remission when the urine is negative for protein for 5 to 7 consecutive days. The absence of proteinuria for 2 consecutive weeks indicates a continued remission. The presence or absence of hematuria is not used to determine remission in primary nephrotic syndrome.

DIF: Cognitive Level: Analysis REF: p. 471

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

7. Which of the following statements made by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet?

a.
“I only give my child sweet pickles.”
b.
“My child just puts a little salt on his food.”
c.
“I let my child have ‘slightly’ salted potato chips.”
d.
“I do not put any salt in foods when I am cooking.”

ANS: D

A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating. All types of pickles and potato chips are high in sodium and should not be served to the child on a no-added-salt diet. The child should not be allowed to use a salt shaker at meals when on a no-added-salt diet.

DIF: Cognitive Level: Analysis REF: p. 472

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

8. Which is an appropriate intervention for a child with nephrotic syndrome who is edematous?

a.
Teach the child to minimize body movements.
b.
Change the child’s position every 2 hours.
c.
Avoid the use of skin lotions.
d.
Bathe every other day.

ANS: B

Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas. The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown. Applying lotion to the skin helps to increase circulation. Bathing daily removes irritating body secretions from the skin.

DIF: Cognitive Level: Application REF: p. 473

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

9. A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition?

a.
Hypocalciuria
b.
Nephrotic syndrome
c.
Glomerulonephritis
d.
Urinary tract infection

ANS: D

Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a urinary tract infection. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.

DIF: Cognitive Level: Comprehension REF: p. 458

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

10. What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux?

a.
Screening for urinary tract infection (UTI) if febrile
b.
Suggestions for how to maintain fluid restrictions
c.
The use of bubble baths as an incentive to increase bath time
d.
The need for the child to hold urine for 6 to 8 hours

ANS: A

A child with vesicoureteral reflux is screened for a UTI if febrile. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent urinary tract infections. Bubble baths should be avoided to prevent urethral irritation and possible urinary tract infection. To prevent urinary tract infections, the child should be taught to void frequently and never resist the urge to urinate.

DIF: Cognitive Level: Application REF: p. 462

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

11. Which intervention is appropriate when examining a male infant for cryptorchidism?

a.
Cooling the examiner’s hands
b.
Taking a rectal temperature
c.
Placing the infant on the examination table
d.
Warming the room

ANS: D

For the infant’s comfort, the infant should be examined in a warm room with the examiner’s hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. Examining the infant with cold hands is uncomfortable for the infant and is likely to cause the infant’s testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. A rectal temperature yields no information about cryptorchidism. When possible, the infant should be examined in the caregiver’s lap to elicit cooperation and avoid upsetting the infant.

DIF: Cognitive Level: Application REF: p. 465

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

12. Parents ask the nurse, “When should our child’s hypospadias be corrected?” The nurse responds based upon the knowledge that correction of hypospadias should be accomplished by the time the child is:

a.
1 month of age.
b.
6 to 8 months of age.
c.
school age.
d.
sexually mature.

ANS: B

The correction of hypospadias should ideally be accomplished by the time the child is 6 to 8 months of age and before toilet training. Surgery to correct hypospadias is not performed when the infant is less than 6 months of age. It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. Corrective surgery for hypospadias is done long before sexual maturity.

DIF: Cognitive Level: Application REF: p. 465

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

13. A nurse is teaching a class on acute renal failure. The nurse relates that acute renal failure as a result of hemolytic-uremic syndrome is classified as:

a.
prerenal.
b.
intrarenal.
c.
postrenal.
d.
chronic.

ANS: B

Intrarenal acute renal failure is the result of damage to kidney tissue. Possible causes of intrarenal acute renal failure are hemolytic uremic syndrome, glomerulonephritis, and pyelonephritis. Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by hemolytic-uremic syndrome is of the acute nature. Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

DIF: Cognitive Level: Comprehension REF: p. 474

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

14. Which dietary modification is appropriate for a child with chronic renal failure?

a.
Decreased salt
b.
Decreased fat
c.
Increased potassium
d.
Increased phosphorus

ANS: A

Salt is restricted to prevent fluid overload and hypertension. A low-fat diet is not relevant to chronic renal failure. Potassium intake may be restricted because of the kidney’s inability to remove it. Phosphorus is restricted to help prevent bone disease.

DIF: Cognitive Level: Comprehension REF: p. 477

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

15. Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts?

a.
Acute viral gastroenteritis
b.
Acute glomerulonephritis
c.
Hemolytic-uremic syndrome
d.
Acute nephrotic syndrome

ANS: C

Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea. Anemia and thrombocytopenia are not associated with acute gastroenteritis. The symptoms described are not suggestive of acute glomerulonephritis or nephrotic syndrome.

DIF: Cognitive Level: Comprehension REF: p. 474

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

16. Which is a true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system?

a.
The young infant’s kidneys can more effectively concentrate urine than can an adult’s kidneys.
b.
After 6 years of age, kidney function is nearly like that of an adult.
c.
Unlike adults, most children do not regain normal kidney function after acute renal failure.
d.
Young children have shorter urethras, which can predispose them to urinary tract infections.

ANS: D

Young children have shorter urethras, which can predispose them to urinary tract infections. The young infant’s kidneys cannot concentrate urine as efficiently as those of older children and adults because the loop of Henle is not yet long enough to reach the inner medulla, where concentration and reabsorption occur. By 6 to 12 months of age, kidney function is nearly like that of an adult. Unlike adults, most children with acute renal failure regain normal function.

DIF: Cognitive Level: Comprehension REF: p. 455

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply.

a.
Administration of antihypertensive medications
b.
Daily weights
c.
Salt-restricted diet
d.
Frequent position changes
e.
Teach parents to expect tea-colored urine

ANS: B, C, D

A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis, but not nephrotic syndrome. The urine in nephrotic syndrome is frothy indicating protein is being lost in the urine.

DIF: Cognitive Level: Application REF: p. 472

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

2. A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? Select all that apply.

a.
Change in urine odor or color
b.
Enuresis
c.
Fever or hypothermia
d.
Voiding urgency
e.
Poor weight gain

ANS: A, C, E

The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain and feeding difficulties. Enuresis and voiding urgency would be assessed in an older child.

DIF: Cognitive Level: Analysis REF: p. 462

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity