Flashcards in Davis Pediatric Genitourinary Disorders NCLEX Questions Deck (62)
A 10-kg toddler is diagnosed with acute renal failure (ARF), is afebrile, and has a 24-hour urine output of 110 mL. After calculating daily fluid maintenance, which would the nurse expect the toddler’s daily allotment of fluids to be? 1. Sips of clear fluids and ice chips only. 2. 350 mL of oral and intravenous fluids. 3. 1000 mL of oral and intravenous fluids. 4. 2000 mL of oral and intravenous fluids.
2. 350 mL is approximately a third of the daily fluid requirement and is recommended for the child in the oliguric phase of ARF. If the child were febrile, the fluid intake would be increased.
A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates 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.”
1. Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system.
A 5-year-old is discharged from the hospital following the diagnosis of hemolytic uremic syndrome (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. Which 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.
A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs. The parent asks the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. Which 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.
A child diagnosed with acute renal failure (ARF) complains of “not feeling well,” having “butterflies in the chest,” and arms and legs “feeling like Jell-O.” The cardiac monitor shows that the QRS complex is wider than before and that an occasional premature ventricular contraction (PVC) is seen. Which would the nurse expect to administer? 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.
A child had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago due to post-operative hemorrhage. The parent noted that her child was “swal- lowing 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 child 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.
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? 1. Urinalysis, urine culture, and VCUG. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Discharge home on an antibiotic.
1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a child has a second UTI within 1 year
A child receiving peritoneal dialysis has not been having adequate volume in the return. The child is currently edematous and hypertensive. Which would the nurse anticipate the physician to do? 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.
1. Increasing the concentration of glucose will pull more fluid into the return.
A child with hemolytic uremic syndrome (HUS) is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglo- bin and hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects administration of blood products and what else to be added to the plan of care? 1. Initiation of dialysis. 2. Close observation of the child’s hemodynamic status. 3. Diuretic therapy to force urinary output. 4. Monitoring of urinary output.
1. Because the child is symptomatic, dialysis is the treatment of choice.
A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony promi- nences. The child has been receiving Lasix twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema? 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.
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? 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 decreased in the 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.
A renal transplantation is which of the following? 1. A curative procedure that will free the child 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 child from dialysis. 4. A treatment option that is very new to the pediatric population.
3. Renal transplantation frees the patient from dialysis.
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? 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. Take 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 testicular torsion, which is a surgical emergency and needs immediate attention.
An infant 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?” Which 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 sexual functioning 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.
Chronic hypertension in the child who has chronic renal failure (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.
1. The retention of sodium and water leads to hypertension.
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. This can 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.
1. The child is experiencing signs of disequilibrium syndrome, which is caused by free water shifting from intravascular spaces and can be prevented by slowing the rate of dialysis.
In addition to increased blood pressure, which findings would most likely be found in a child with hydronephrosis? 1. Metabolic alkalosis, polydipsia, and polyuria. 2. Metabolic acidosis, and bacterial growth in the urine. 3. Metabolic alkalosis, and bacterial growth in the urine. 4. Metabolic acidosis, polydipsia, and polyuria.
4. The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. 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.
One week after kidney transplant, a child complains about abdominal pain, and the parents note that the child has been very irritable. The nurse notes a 10% weight gain as well as elevated BUN and creatinine levels. Which of the following medications would the child most likely be taking? 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.
The bladder capacity of a 3-year-old is approximately how much? 1. 1.5 fl. oz. 2. 3 fl. oz. 3. 4 fl. oz. 4. 5 fl. oz.
4. The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child’s age in years.
The clinical manifestations of minimal change nephrotic syndrome (MCNS) 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. 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.
The diet for a child with chronic renal failure (CRF) should be high in calories and include: 1. Low protein, and all minerals and electrolytes. 2. Low protein and minerals. 3. High protein and calcium and low potassium and phosphorus. 4. High protein, phosphorus, and calcium and low potassium and sodium.
3. The child with CRF needs a diet high in calories, protein, and calcium and low in potassium and phosphorus.
The manifestations of hemolytic uremic syndrome (HUS) are due primarily to which event? 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.
1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen.
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 post-operative 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 post-operative shift of fluids and organs in the abdominal cavity, leading to increased discomfort.
The nurse evaluates post-operative teaching for repair of testicular torsion as successful when the parent of an adolescent says which the following? 1. “I will encourage him to rest for a few days, but he can return to football practice in a week.” 2. “I will keep him in bed for 4 days and let him gradually increase his activity after that.” 3. “I will seek therapy as he ages because he is now infertile.” 4. “I will make sure he does testicular self-examination monthly.”
4. The child and family should be taught the importance of testicular self-examination.
The nurse evaluates the parents’ understanding of the teaching about an inguinal hernia as successful 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.
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? 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.
The nurse is caring for a 1-year-old diagnosed with acute renal failure (ARF). Edema is noted throughout the child’s body, and the liver is enlarged. The child’s urine out- put 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 treatment will provide the most benefit to the child? 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
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. Which 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.”
1. Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fluid.
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. Notifies the physician because this urine output is too low. 2. Encourages the child to increase oral intake to increase urine output. 3. Records the child’s urine output in the chart. 4. Administers isotonic fluid intravenously to help with rehydration.
3. Recording the child’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, or 75–150 mL for the 10-hour period.