Deck 12: Elimination Patterns

Question 1

The primary care pediatric nurse practitioner is managing a 6­year­old child
who has chronic constipation and encopresis. The nurse practitioner has ruled out neurogenic etiology. The parents report that the child was difficult to toilet train as a toddler. What is key to managing this child's condition?
A. Encouraging use of maintenance medications for at least 2 months after resolution of constipation
B. Referral to a mental health consultant to manage problems in the parent­child dyad
C. Spending time with the parents to uncover their feelings about their child's condition
D. Teaching the parents that the symptom of stool retention is often voluntary for the child

Answer 1

Encouraging use of maintenance medications for at least 2 months after resolution of constipation

Question 2

The primary care pediatric nurse practitioner is evaluating a 4­year­old
female child for enuresis. The parents reports that the child has never been dry at night and has recently begun having daytime incontinence, usually when at preschool. The nurse practitioner learns that the child does not appear to have an abnormal urine stream. What will the nurse practitioner do next?
A. Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis.
B. Reassure the parent that the child probably gets distracted and puts off voiding until it is urgent.
C. Refer the child to a pediatric urologist for evaluation of possible vesicoureteral reflux.
D. Suggest a bladder retraining program and use of a nighttime bedwetting alarm.

Answer 2

Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis.

Question 3

The primary care pediatric nurse practitioner is counseling the parent of an 8­
year­old child who has primary nocturnal enuresis. The nurse practitioner recommends an enuresis alarm, but the parent wishes to use medication. What will the nurse practitioner tell the parent?
A. Anticholinergic medications are most commonly used for enuresis.
B. Drug therapy is an effective way to achieve long­term control.
C. Drug therapy is safest when the nasal spray form is used.
D. The combination of alarm therapy and intermittent drug therapy is best.

Answer 3

The combination of alarm therapy and intermittent drug therapy is best.

Question 4

The primary care pediatric nurse practitioner is performing a well child exam
on a 24­month­old child. The parent tells the nurse practitioner that the child is being toilet trained and expresses frustration that on some days the child uses the toilet every time and on other days not at all. What will the nurse practitioner do?
A. Advise the parent to make the child get clean clothes after an accident.
B. Ask the parent about the child's toilet habits and understanding of toilet training.
C. Recommend using an awards system to encourage toilet use.
D. Suggest that the parent place the child on the toilet at predictable intervals.

Question 5

The primary care pediatric nurse practitioner is evaluating a 5­year­old child
who has frequent soiling of stool associated with stomach aches and decreased appetite for the past 2 months. The parent states that the child has two or fewer formed bowel movements each week and has been toilet trained for about 2 years. Which initial assessment will the nurse practitioner make?
A. History of neurogenic conditions
B. Recent adjustments in the family
C. Recent illnesses, fluid intake, changes in diet
D. Toilet training history

Question 6

The primary care pediatric nurse practitioner is discussing toileting issues
with the parent of a 3­year­old toddler who reports that the child has been toilet trained for several months but has recently been refusing to have bowel movements and is becoming constipated. What will the nurse practitioner do?
A. Ask the parent about bathroom facilities in the child's day care.
B. Refer the child to a gastroenterologist for evaluation of pathology.
C. Suggest putting the child in diapers and resuming toilet training in a few weeks.
D. Tell the parent that this represents a developmental delay.

Question 7

The primary care pediatric nurse practitioner evaluates a 4­year­old girl
whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially?
A. Examination for labial adhesions
B. Palpation for abdominal masses
C. Screening for potential child abuse
D. Urine culture and sensitivity

Question 8

The primary care pediatric nurse practitioner is performing a well child exam
on a 4­month­old infant who is nursing exclusively. The mother reports that the infant has had a marked decrease in the number of stools each day, from 3 to 5 stools each day to only one stool every other day. How will the nurse practitioner respond?
A. Ask the mother to describe the color and consistency of the stools.
B. Explain to the mother that breastfed infants should have daily stools.
C. Recommend using a glycerin suppository as needed.
D. Suggest to the mother that she increase her intake of fluids.

Question 9

The parent of a 5­year­old child tells the primary care pediatric nurse
practitioner that the child has been using the toilet to urinate for since age 3 but continues to defecate in "pull­ups." The nurse practitioner learns that the child has predictable bowel movements and a physical examination is normal. What will the nurse practitioner recommend?
A. Providing a reward system to offer incentives when the child uses the toilet
B. Put the child back in diapers and resume toilet training in a few months.
C. Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation
D. Use of polyethylene glycol until the child is able to use the toilet regularly

Question 10

The primary care pediatric nurse practitioner is performing a well child exam
on a 12­month­old infant. The parent tells the nurse practitioner that the infant has predictable bowel and bladder habits and asks about toilet training. What will the nurse practitioner tell this parent?
A. It is too early to begin introducing the child to the toilet, and the parent should wait until the child is at least 2 years old.
B. Placing the child on a "potty" chair helps the child associate elimination cues with the toilet.
C. Predictability of elimination patterns indicates readiness for toilet training, and the parent can begin this process.
D. The parent should wait until other signs of toilet training readiness occur before introducing the child to the toilet.

Question 11

The primary care pediatric nurse practitioner is concerned that a toddler may
have vesicoureteral reflux based on a history of dysfunctional voiding patterns and a series of urinary tract infections. Which intervention is appropriate?
A. Initiating a bladder retraining program
B. Ordering a voiding cystourethrogram
C. Referral to a urologist for evaluation
D. Treatment with prophylactic antibiotics