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Flashcards in Chapter 27 Deck (17):

Which urine test would be considered abnormal?
a. pH: 4
b. Specific gravity: 1.020
c. Protein level: absent
d. Glucose level: absent

Ans: A
The expected pH of urine is 4.8 to 7.8.
A specific gravity of 1.020 is within the normal specific gravity range of 1.015 to 1.030.
Protein should not be present in the urine. It would indicate an abnormality in glomerular filtration.
Glucose should not be present in the urine. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.


A young child is diagnosed with vesicoureteral reflux. The nurse should know that this is usually associated with
a. incontinence.
b. urinary obstruction.
c. recurrent kidney infections.
d. infarction of renal vessels.

Ans: C
Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to kidney infections.
Incontinence may be associated with urinary tract infections but not directly with vesicoureteral reflux.
Vesicoureteral reflux can cause renal scarring but not obstruction.
Infarction of the renal vessels does not occur with vesicoureteral reflux.


A 5-year-old child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to the child’s parent that the first action is to have the child evaluated for
a. school phobia.
b. emotional causes.
c. possible urinary tract infection.
d. possible structural defects of urinary tract.

Ans: C
Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection.
A physical cause of the problem needs to be eliminated before a psychological cause is considered.
Emotional causes should be investigated only once a physical cause has been ruled out.
Possible structural defects would be explored as a cause after a urinary tract infection is confirmed.


External defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to ensure
a. prevention of urinary tract complications.
b. prevention of separation anxiety.
c. acceptance of hospitalization.
d. development of normal body image.

Ans: D
Promotion of a normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Surgical intervention for external defects of the genitourinary system should be done as soon as possible.
Prevention of urinary tract complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible.
Proper preprocedure preparation can help prevent or at least reduce separation anxiety.
Acceptance of hospitalization is important but not the reason for early surgical intervention of external defects of the genitourinary system.


In addition to presenting symptoms, what laboratory finding indicates nephrosis?
a. Hypoalbuminemia
b. Low specific gravity
c. Decreased hematocrit
d. Decreased hemoglobin

Ans: A
Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into the urine in a child with nephrosis.
The specific gravity is increased due to the large amount of protein in a child with nephrosis.
The hematocrit would be elevated secondary to nephrosis.
The hemoglobin would be elevated secondary to the hypovolemia in a child with nephrosis.


In a non–potty-trained child with nephrotic syndrome, what is the best way to detect fluid retention?
a. Weigh the child daily.
b. Test the urine for hematuria.
c. Measure the abdominal girth weekly.
d. Count the number of wet diapers.

Ans: A
A daily weight taken at the same time every day, with the child wearing the same clothing, is the most accurate way to determine fluid gains and losses.
The presence or absence of blood in the urine will not help with the determination of fluid retention.
The abdominal girth will reflect edema, but weekly measurements are too infrequent.
The number of wet diapers reflects how often the diapers have been changed. The diapers should be weighed to reflect the fluid balance.


What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed?
a. Restrain the child as necessary.
b. Discourage the parents from holding the child.
c. Do passive range-of-motion exercises once a day.
d. Adjust activities to the child's tolerance level.

Ans: D
The child will have a variable level of tolerance for activity. The activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child that are age appropriate.
Restraints should not be used to confine children to bed, unless they are a potential threat to themselves or others.
Parents should be encouraged to hold the child.
The child should be encouraged to move all extremities while in bed to prevent the potential complications of immobility.


The parent of a child hospitalized with acute glomerulonephritis (AGN) asks the nurse why blood pressure readings are being taken so often. Based on the nurse’s knowledge of AGN, the most appropriate response by the nurse is
a. blood pressure fluctuations are a common side effect of antibiotic therapy.
b. blood pressure fluctuations are a sign that the condition has become chronic.
c. acute hypertension must be anticipated and identified.
d. hypotension leading to sudden shock can develop at any time.

Ans: C
Vital signs, in particular the blood pressure, provide information about the severity of AGN and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention.
Blood pressure does not commonly fluctuate with antibiotic therapy.
Blood pressure fluctuations are not indicative of chronic disease. Most children with AGN fully recover.
Hypertension, not hypotension, is more likely with AGN.


A 3-year-old child is scheduled for surgery to remove a Wilms’ tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation should be based on knowledge that
a. no additional treatments are usually necessary.
b. chemotherapy is usually not necessary.
c. chemotherapy with or without radiotherapy is indicated.
d. kidney transplant will be indicated within the year.

Ans: C
The determination of chemotherapy and/or radiotherapy as treatment modalities will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiotherapy is usually indicated.
Additional therapy of some type is indicated after the tumor is removed.
Chemotherapy or radiotherapy, or both, may be indicated as a postsurgical intervention.
Most children with Wilms’ tumor do not require renal transplants.


The nurse is caring for a child with a Wilms’ tumor. What is the most important nursing intervention preoperatively?
a. Avoid abdominal palpation.
b. Closely monitor the arterial blood gases.
c. Prepare the child and family for long-term dialysis.
d. Prepare the child and family for renal transplantation.

Ans: A
Wilms’ tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. A sign should be placed over the bed indicating that no abdominal palpation should be conducted.
Monitoring of arterial blood gases is not indicated preoperatively for this abdominal surgery.
Long-term dialysis is not indicated, unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative irradiation and/or chemotherapy is used to minimize the tumor size.
Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.


A toddler is hospitalized with acute renal failure (ARF) secondary to severe dehydration. The nurse should assess the child for what possible complications?
a. Hypotension
b. Hypokalemia
c. Hypernatremia
d. Water intoxication

Ans: D
The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes.
The child needs to be monitored for hypertension, not hypotension, when hospitalized with acute renal failure.
Hyperkalemia, not hypokalemia, is a concern in acute renal failure.
Hyponatremia, not hypernatremia, may develop in acute renal failure as the sodium is diluted in large amounts of water.


A 6-year-old child with acute renal failure (ARF) is being transferred out of the intensive care unit. Which children, considering their diagnoses, would be the most appropriate roommate for this child?
a. 6-year-old child with pneumonia
b. 4-year-old child with gastroenteritis
c. 5-year-old child who has a fractured femur
d. 7-year-old child who had surgery for a ruptured appendix

Ans: C
The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin.
A child with pneumonia has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.
A child with gastroenteritis has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.
A child who has had surgery for a ruptured appendix may have an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.


What is an important nursing consideration when caring for a child with end-stage renal disease (ESRD)?
a. Children with ESRD usually adapt well to the minor inconveniences of treatment.
b. Children with ESRD require extensive support until they outgrow the condition.
c. Multiple stresses are placed on children with ESRD and their families until the illness is cured.
d. Multiple stresses are placed on children with ESRD and their families because their lives are maintained by drugs and artificial means.

Ans: D
ESRD is a chronic, progressive illness with dependence on technology. Families need to arrange for continuing examinations and procedures that are often painful and may require hospitalization.
ESRD is a complex disease process that requires substantial medical intervention and is not minor in its treatment modalities.
ESRD cannot be outgrown. Dialysis is necessary until renal transplantation is performed.
ESRD cannot be cured. Dialysis is necessary until renal transplantation is performed.


What is an advantage to teach to the family about continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents who require dialysis?
a. Hospitalization is only required several nights per week.
b. Dietary restrictions are no longer necessary.
c. Adolescents can carry out procedures themselves.
d. Insertion of a catheter does not require surgical placement.

Ans: C
This type of dialysis provides the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves, and the procedure is usually performed at night, enabling the adolescent to live life more normally during the day.
CCPD and CAPD can be done at home.
Dietary restrictions are still required but are less strict when an adolescent is on CCPD or CAPD.
The catheter is surgically implanted in the abdominal cavity for both CCPD and CAPD.


A child is receiving cyclosporine following a kidney transplant. The child’s parents ask the nurse the reason for the cyclosporine. The nurse’s response is based on the knowledge that the medication’s purpose is to
a. Decrease pain
b. Boost immunity
c. Suppress rejection
d. Improve circulation to the kidney

Ans: C
Cyclosporine is given to suppress rejection.
Cyclosporine does not decrease pain, boost immunity, or improve circulation.


A child in renal failure has hyperkalemia. Which foods should be avoided?
a. Cold cuts, chips, and canned foods
b. Hamburger on a bun and lime Jell-O
c. Spaghetti with meat sauce and breadsticks
d. Bananas, carrots, and green leafy vegetables

Ans: D
Bananas, carrots, and green leafy vegetables are high in potassium.
Cold cuts, chips, and canned foods are high in sodium but not necessarily in potassium.
A hamburger on a bun and lime Jell-O is an acceptable choice for a low-potassium diet.
Spaghetti with meat sauce and breadsticks is an acceptable choice for a low-potassium diet.


A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse’s knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply)
a. Vomiting
b. Jaundice
c. Swelling of the face
d. Persistent diaper rash
e. Failure to gain weight

Ans: A, D, E