PEDS Chapter 44 Genitourinary- Evolve Flashcards Preview

Nursing 2016 > PEDS Chapter 44 Genitourinary- Evolve > Flashcards

Flashcards in PEDS Chapter 44 Genitourinary- Evolve Deck (33)
Loading flashcards...
1

A child diagnosed with Wilms' tumor is scheduled for surgery within 24 hours of admission. The nurse finds that there is minimal time to prepare the child and the parents for the surgery. What action does the nurse take?
1. Explain the procedure in simple terms.
2. Avoid repeating information or details.
3. Inform about the side effects to the child.
4. Tell the child that the surgery won't be painful

1. Explain the procedure in simple terms.

The nurse explains the procedure in simple terms to the child and the parents so that they are not anxious and understand what will be done. The nurse repeats any information or details that the child or the family does not understand. The nurse does not inform about the side effects to the child to prevent anxiety. The nurse does not speak about the pain involved in the surgery; instead the nurse reassures the child that the procedure will help the child get better.

Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.

2

An important nursing consideration when caring for a child with end-stage renal disease (ESRD) is that:

1. the child with ESRD usually adapts well to the minor inconveniences of treatment.

2. the child with ESRD requires extensive support until they outgrow the condition.

3. multiple stresses are placed on the child and family with ESRD until the illness is cured.

4.multiple stresses are placed on the child and family with ESRD because the child's life is maintained by drugs and artificial means.

4.multiple stresses are placed on the child and family with ESRD because the child's life is maintained by drugs and artificial means.

ESRD is a chronic, progressive disease with dependence on technology. Families need to arrange for continuing examinations and procedures that are painful and may require hospitalization. ESRD is a complex disease process that requires substantial medical intervention. ESRD cannot be outgrown or cured. Dialysis is necessary until renal transplantation is performed.

3

The nurse is discussing bed-wetting with the parents of an 8-year-old patient suffering from enuresis. What are the different aspects of caring that the nurse should make the parents aware of? Select all that apply.

1. Regularly punish the child for this activity.

2. Assure the parents that the condition has nothing to do with upbringing.

3. Reinforce the desired behavior in a positive way.

4. Shame the child publicly in front of friends.

5. Observe for side effects of any medication

2. Assure the parents that the condition has nothing to do with upbringing.

3. Reinforce the desired behavior in a positive way.

5. Observe for side effects of any medication

Enuresis or bedwetting is a common and nagging problem seen in children. Parents play a critical role in this. The parents must be assured that enuresis is not a parental flaw. They must reinforce the desired behavior in a positive and supportive way. They must keep a keen eye on side effects of any medication. The parents should never punish or make the child feel ashamed in front of friends, since that will demoralize the child. Acts like these will harm the self-esteem of the child and consequently enhance the problems.

4

The parents of a school-age child tell the nurse that the child goes to the toilet frequently and the urine smells strong. For which condition is the nurse likely to evaluate the child?

1. Enuresis
2. Urinary tract infection
3. Vesicoureteral reflux (VUR)
4. Nephrotic syndrome

2. Urinary tract infection

Strong-smelling urine and frequency or urgency to urinate are signs of a possible urinary tract infection. Enuresis is passing urine involuntarily into the bed. VUR is abnormal retrograde flow of bladder urine into the ureters. Nephrotic syndrome is characterized by edema and abdominal swelling and the urine volume is decreased.

5

The parent of a child with nephrosis in the edema phase asks the nurse what dietary changes need to be made to promote the child's health. How does the nurse respond?
1. Do not use salt in food.
2. Increase fluid intake.
3.Provide canned food.
4.Avoid bread and cereals.

1. Do not use salt in food.

Salt is restricted in the diet of the child with nephrosis as it reduces proteinuria. Fluid is restricted as it worsens edema. Canned foods contain sodium and salt, which is restricted for patients with nephrosis. Bread and cereals contain potassium, which is restricted in the oliguria phase of nephrosis.

6

A child with glomerulonephritis is instructed to restrict fluid intake. On assessment, the nurse finds that the child has lost weight. Which condition does the nurse suspect?
1. Dehydration
2. Hypertension
3. Hyperkalemia
4. Acidosis

1. Dehydration

When fluids are restricted and the child has lost weight, the nurse needs to assess the child for dehydration and report it promptly. Hypertension is indicated if the blood pressure measurements are high. Hyperkalemia and acidosis occur if the child develops acute renal failure due to fluid and electrolyte imbalance.

Test-Taking Tip: Do not fret over any one question for too long. If you are having trouble, skip the question and go back to it when you have finished answering the other questions.

7

The nurse is assessing a female adolescent for urinary problems. On further assessment the nurse finds that the patient is sexually active. What instructions does the nurse give the patient?
1. Urinate soon after having intercourse.
2. Wipe from back to front after defecating.
3. Use low-dose antibiotics at bedtime.
4. Decrease fluid intake before bedtime.

1. Urinate soon after having intercourse.

The nurse advises the patient to urinate soon after having intercourse so that the bacteria are eliminated that may have entered during the intercourse. The nurse instructs the female patients to wipe from front to back to eliminate bacteria. The nurse does not prescribe any antibiotics as it is not in the scope of the nurse's practice. Fluid intake is decreased in patients who are at risk for nocturnal enuresis.

8

A parent of a child with enuresis tells the nurse that they often scold the child for bedwetting, but it has not made any difference in the child's behavior. How does the nurse respond?
1. "You are damaging the child's confidence."
2. "I wouldn't scold the child if I were you."
3. "I would suggest you use positive reinforcement"
4. "You must speak to the child about this misbehavior."

3. "I would suggest you use positive reinforcement"

The nurse suggests the use of positive reinforcement to modify the child's behavior and help the child gain confidence. Saying that the parent is damaging the child's confidence or that scolding is not a good idea and will make the parent feel guilty. The nurse does not say that the parent should talk to the child about the misbehavior as the child is not misbehaving, but has a genuine problem.

Test-Taking Tip: Avoid choosing answers that use words such as always, never, must, all, and none. If you are confused about the question, read the choices, label them true or false, and choose the answer that is the odd one out (i.e., the one false one or the one true one). When a question is framed in the negative, such as "When assessing for pain, you should not," the false option is the correct choice.

9

A 6-year-old child with acute renal failure is being transferred out of the intensive care unit. Considering their diagnoses, which child would be the most appropriate roommate for this child?
1. 6-year-old child with pneumonia
2. 4-year-old child with gastroenteritis
3. 5-year-old child who has a fractured femur
4. 7-year-old child who had surgery for a ruptured appendix

3. 5-year-old child who has a fractured femur

The 5-year-old orthopedic patient is the best choice for a roommate. This child does not have an illness of viral or bacterial origin. Children with pneumonia, gastroenteritis, or a ruptured appendix have potentially infectious disease processes.

Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period , can provide a clue to the most appropriate response or (in some cases) responses.

10

The mother of a 7-year-old child with acute poststreptococcal glumerulonephritis (APSGN) is expecting her second child. The concerned mother asks the nurse whether the next child may suffer from the same disease. What should be an appropriate response by the nurse?
1. ''The reason is not genetic; it is not acquired or cannot be inherited from parents.''
2. ''The disease is highly contagious; do not go near the ill child."
3. ''This disease is inherited from the father so the child to be born has a 50% chance of inheriting it."
4. ''Only one child in a family gets (APSGN), the second child is safe.''

1. ''The reason is not genetic; it is not acquired or cannot be inherited from parents.''

APSGN is not a genetic disease so it cannot be passed from parents to offspring. This disease is caused by an immune complex disorder occurring after the patient suffers from streptococcal throat infection. Since the streptococcal infection subsides by the time of APSGN, the chance of the mother being infected is remote. It is not a Y-linked disease so it cannot be inherited from the father. Since the disease is not inherited, it cannot be safely predicted whether the child will ever develop the same disease or not.

Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. NCLEX item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints."

11

The nurse and the dietician are making a diet chart for a patient with acute glomerulonephritis (AGN). What are the foods that they should include in the patient's diet?
1. Chicken soup, rice, apple, and milk
2. Pretzel, baked potato, pickle, and meat loaf
3. Ham burger, cheese, French fries, and milk
4. Bread and butter, pickled herrings, potato chips, and lime soda

1. Chicken soup, rice, apple, and milk

Chicken soup, rice, apple, and milk are the preferred foods when the patient is kept on a low-sodium diet. Pretzels and pickles contain high amount of salt, so they should be avoided. Hamburger, French fries, and other junk foods should be avoided as well due to high salt content. Pickled herrings and potato chips also contain high amount of salt, so they should be avoided in diet.

Test-Taking Tip: Do not read too much into the question or worry that it is a "trick." If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures.

12

The nurse is implementing therapeutic techniques in a child's plan of care to manage nocturnal enuresis. Which technique does the nurse include in the care plan?
1. Provide fluids or juices before meals.
2. Avoid caffeinated beverages after 4 PM.
3. Avoid interrupting the child's sleep at night.
4. Ask the parents to stay with the child ofte

2. Avoid caffeinated beverages after 4 PM.

The nurse avoids providing caffeinated beverages after 4 PM to the child, which reduces the chances of nocturnal enuresis. Fluids and juices are provided after meals, but restricted after the evening meals to prevent enuresis at night. The nurse interrupts the child's sleep at night purposefully to enable the child to void. Asking the parents to stay with the child often may reduce separation anxiety, but it does not ensure that enuresis will be prevented.

13

The parents of a 5-year-old child complain of their child's persistent weight gain over days and weeks. While assessing the child, the nurse observes generalized edema along with irritability and lethargy. What does the nurse interpret from the patient's symptoms?
1. Minimal-change nephritic syndrome
2. Cryptorchidism
3. Hydrocele
4. Hypospadias

1. Minimal-change nephritic syndrome


Minimal-change nephritic syndrome (MCNS) is characterized by a child's persistent weight gain over days and weeks. The patient looks edematous and may develop an irritable and lethargic nature. MCNS is a clinical state that is characterized by hypoalbuminemia, hyperlipidemia,and generalized edema. Cryptorchidism is failure of one or both the testes to descend naturally into the scrotal sac. Hydrocele is accumulation of fluid in scrotum. If the urethral opening is located behind glans penis or anywhere in the ventral surface of the shaft it is called hypospadias.

Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice.

14

Which laboratory value should the nurse recognize as being abnormal?
1. pH: 4
2. Specific gravity: 1.020
3. Protein level: absent
4. Glucose level: absent

1. pH: 4

The expected pH is 4.8 to 7.8. This is within the normal specific gravity range of 1.016 to 1.022. Protein should not be present in the urine. It would indicate an abnormality in glomerular filtration. Glucose should not be present. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

15

A 5-year-old patient suffering from nephrotic syndrome is admitted to the hospital. With which roommate should the nurse manager assign the patient?
1. A 3-year-old child with measles.
2. A 3-year-old child with chickenpox.
3. A 4-year-old child with conjunctivitis.
4. A 5-year-old child with autism.

4. A 5-year-old child with autism.

Autism is a genetic disorder prevalent in children. A child suffering from nephritic syndrome is susceptible to infections. Since autism is genetic, it is noncontagious posing less risk of infection for the patient. Measles and chickenpox are diseases caused by viruses and are highly infectious. The patient who is suffering from nephrotic syndrome will not be safe due to risk of infection. Conjunctivitis is an ocular infection caused by both virus and bacteria. It is also highly contagious and should be avoided in patients with nephrotic syndrome.

16

cystourethrogram

X-ray test that takes pictures of your bladder and urethra while your bladder is full and while you are urinating. A thin flexible tube (urinary catheter ) is inserted through your urethra into your bladder- CONTRAST MEDIUM IS INJECTED INTO THE BLADDER THROUGH URETHRAL OPENING FOR VOIDING-EXTERNAL RADIATION FOR X-RAY FILMS IS USED BEFORE, DURING, AND AFTER VOIDING

17

Nephrotic syndrome

clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Characterized by increased glomerular permeability to plasma protein- edema and abdominal swelling- higher risk of infection

18

Renal and bladder ultrasound

ULTRASONIC WAVES-allows visulization of renal parenchyma and renal pelvis without exposure to external beam RADIATION or RADIOACTIVE ISOTOPES- visualization of dilated ureters and bladder walls also possible- noninvasive

19

Computed tomography

external radiation and sometimes contrast media are used

20

Intravenous pyelography

uses contrast medium and external radiation for X-RAY films

21

Primary nephrotic syndrome

clinical presentation-Severe swelling (edema), particularly around your eyes and in your ankles and feet, Foamy urine, which may be caused by excess protein in your urine, Weight gain due to excess fluid retention
Diagnostic- large amounts of protein in urine (Normal- protein should be absent)

22

Hypospadias

congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not the glans. - does not refer to the SIZE of the penis

23

Epispadias

urethral opening along the dorsal surface of the penis

24

phimosis

narrowing or stenosis of the preputial opening of the foreskin

25

chordee

the ventral curvature of the penis

26

Which factor predisposes the urinary tract to infection?
a. Increased fluid intake
b. Prostatic secretions in males
c. Short urethra in young girls
d. Frequent emptying of the bladder

c. short urethra in young girls

The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake and frequent bladder emptying offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.

27

4. What should the nurse recommend to prevent urinary tract infections in young girls?
a. Wearing cotton underpants
b. Limiting bathing as much as possible
c. Increasing fluids; decreasing salt intake
d. Cleansing the perineum with water after voiding

ANS: A
Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids, decreasing salt intake, or cleansing the perineum with water decreases urinary tract infections in young girls.

28

Hypospadias refers to:
a. Absence of a urethral opening.
b. Penis shorter than usual for age.
c. Urethral opening along dorsal surface of penis.
d. Urethral opening along ventral surface of penis.

ANS: D
Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias does not refer to the size of the penis. When the urethral opening is along the dorsal surface of the penis, it is known as epispadias.

29

An objective of care for the child with nephrosis is to:
a. Reduce blood pressure.
b. Reduce excretion of urinary protein.
c. Increase excretion of urinary protein.
d. Increase ability of tissues to retain fluid.

ANS: B
The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimizing of complications associated with therapy. Blood pressure is usually not elevated in nephrosis. Increased excretion of urinary protein and increased ability to tissues to retain fluid are part of the disease process and must be reversed.

30

Therapeutic management of nephrosis includes:
a. Corticosteroids.
b. Long-term diuretics.
c. Antihypertensive agents.
d. Increased fluids to promote diuresis.

A.
Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.