Question 1

An adolescent male patient had an orchiopexy for cryptorchidism as an infant.Which health promotion activity does the nurse educate this patient about?

Accepted Answer

After orchiopexy,the teen still has a high risk for testicular cancer and should perform testicular self-exams each month.The other actions are not warranted for this condition.

Question 2

A student nurse wants to know why a bruit is heard and a thrill palpated at the site of an AV fistula used for dialysis.Which response by the nephrology nurse is the most appropriate?

Accepted Answer

Blood flowing through an AV fistula goes from a high-pressure system into a low-pressure system during circulation,leading to turbulent flow.It is a normal finding and not caused by the AV valve or small blood clots.

Question 3

The student learns that which hormones are regulated by the kidneys?

Accepted Answer

Hormones released by the kidneys include calcitriol,erythropoietin,and renin.Creatinine is a laboratory value that measures kidney function.Estradiol is a hormone but is not released by the kidneys.

Question 4

A child is receiving hemodialysis.The parents ask why hypotension is a possible complication.Which response by the nurse is the most appropriate?

Accepted Answer

Hemodialysis removes fluid from the child's body,sometimes at a rate that causes hemodynamic instability,including hypotension.The other answers are not accurate.

Question 5

The nurse is assisting a 12-year-old kidney transplant recipient to select items from the hospital menu.Which meal indicates an appropriate understanding of dietary restrictions?

Accepted Answer

A kidney transplant recipient is placed on a protein-restricted diet.Pasta with plain tomato sauce is the lowest-protein menu item listed.The other meals are high in protein.Sodium may be limited too.

Question 6

An adolescent patient with acute kidney injury (AKI)asks why she is taking Tums (calcium carbonate).Which response by the nurse is the most appropriate?

Accepted Answer

In AKI,phosphorus is high,and patients are given phosphorus binders,such as Tums.They are not used to prevent reflux or Curling ulcers (seen in burns),or to provide calcium.

Question 7

A nurse is caring for a child with acute kidney injury (AKI)at home.The child's laboratory work is as follows: serum albumen 2.8 g/dL and serum protein 4 g/dL.Which action by the nurse is the most appropriate?

Accepted Answer

All interventions are appropriate for a child with AKI.However the child's laboratory results indicate malnutrition,and with the dietary restrictions the child must follow,ensuring adequate nutrition is difficult.A referral to a dietitian is most important.

Question 8

A child is hospitalized with acute kidney injury (AKI)and has a critical hyperkalemia.Which order would the nurse question as inappropriate for this child?

Accepted Answer

Kayexalate enemas can take up to 4 hours to work.With critical hyperkalemia,the drug of choice needs to work faster than this.The other options would all work faster.

Question 9

A school-age boy is in the emergency department with testicular torsion.Which action by the nurse takes priority for this patient?

Accepted Answer

Testicular torsion is a surgical emergency,and the nurse's priorities are to facilitate surgery.The nurse must ensure a signed consent is on the chart.Treating pain is important too,but the consent is a legal requirement.Prophylactic antibiotics may or may not be given.Ice and elevation may be helpful as a comfort measure,but do not take priority over the consent.

Question 10

A child is receiving home peritoneal dialysis.When the visiting nurse assesses the patient,he finds the outflow from the dialysis to be cloudy.Which action by the nurse is the most appropriate?

Accepted Answer

Cloudy outflow could indicate peritonitis,a serious complication of peritoneal dialysis.The nurse should take a full set of vitals to assess for infection and call the provider.The child does not need 911.Teaching can be done later.The child should not wait for an appointment.

Question 11

A nurse is assigned to care for four children who have acute kidney injury (AKI).Which child should the nurse see first after obtaining the handoff report?

Accepted Answer

Children with AKI generally are not anuric unless a catastrophic event has occurred.The nurse needs to see this child first.Oliguria (low urine output)is an expected finding unless the child is in the diuretic phase (high-output phase)of AKI.Deep rapid respirations (Kussmaul's respirations)are also expected as a compensatory response to the metabolic acidosis of AKI.A child receiving dialysis in the room is being attended to by a dialysis nurse.

Question 12

A new mother asks the nurse why babies are more prone to dehydration than adults.Which rationales from the nurse best answer this mother's question?

Accepted Answer

There are several reasons children are more prone to dehydration than adults,including: a greater body surface area from which to lose fluids,a higher percentage of total body water,more losses from the GI tract and skin,a decreased ability of the kidneys to concentrate urine,and immature kidneys that are not good at excreting waste products.

Question 13

A nurse is preparing to administer gentamicin (Garamycin),IV,to a hospitalized child.Before administering the medication,the nurse checks the drug trough level,which is 13 µg/mL.Which action by the nurse is the priority for this child?

Accepted Answer

This trough level is too high (normal is 2 µg/mL).Because this drug is nephrotoxic,care must be given to avoid causing acute kidney injury.The nurse notifies the health-care provider about the results and does not administer the medication.Documentation should occur,but is not the priority.Asking the laboratory to re-run the specimen is not warranted.

Question 14

The parents of a child with chronic kidney disease ask the nurse why the child is prescribed epoetin alfa (Epogen).Which response by the nurse is the most accurate?

Accepted Answer

Anemia is common with chronic kidney disease due to reduced erythropoeitin,which is vital for making red blood cells.The other answers are incorrect.

Question 15

The student studying the renal system learns that the kidneys have several functions.Which options are functions of the kidneys?

Accepted Answer

Functions of the kidneys include filtering the blood,removing waste products from the blood,regulating both fluid and electrolyte and acid-base balance,and releasing hormones.

Question 16

A child has acute kidney injury (AKI).Which primary acid-base balance does the nurse assess the child for?

Accepted Answer

In AKI there is insufficient hydrogen ion excretion and poor bicarbonate reabsorption,leading to metabolic acidosis.

Question 17

A child has just returned to the pediatric intensive care unit after having a kidney transplant.Which assessment takes priority for this child?

Accepted Answer

All assessments are important in a postoperative patient.However,because the child had a kidney transplant,assessment of renal function takes priority.

Question 18

A 5-year-old child has enuresis.Which medication regime does the nurse educate the parents on related to this diagnosis?

Accepted Answer

Both medications are used in this condition.Tofranil cannot be used in children under the age of 6.The dose of Ditropan is 5 mg once daily and can be titrated upward to a maximum dose of 20 mg/day.

Question 19

The nurse is explaining the RIFLE classification of kidney injury to a student.Which options are included in this system?

Accepted Answer

RIFLE stands for risk of renal dysfunction,injury to the kidney,failure of the kidney,loss of kidney function,and end-stage kidney disease.

Question 20

A nurse is caring for a child who is scheduled for a kidney biopsy.The prebiopsy laboratory results indicate a platelet count of 88,000,pH of 7.28,and potassium of 5.8 mEq/L.Based on these laboratory results,which action by the nurse is the most appropriate?

Accepted Answer

A platelet count this low is too low to perform an invasive procedure,such as a kidney biopsy.The nurse should notify the provider immediately.Documentation should be done and consent should be on the chart prior to a procedure,but in this case,the biopsy may be postponed.The potassium level is slightly high and probably does not warrant Kayexalate,but in any event,notifying the provider takes priority.

Quiz 31: Caring for the Child With a Genitourinary Condition

An adolescent male patient had an orchiopexy for cryptorchidism as an infant.Which health promotion activity does the nurse educate this patient about?

A student nurse wants to know why a bruit is heard and a thrill palpated at the site of an AV fistula used for dialysis.Which response by the nephrology nurse is the most appropriate?

The student learns that which hormones are regulated by the kidneys?

A child is receiving hemodialysis.The parents ask why hypotension is a possible complication.Which response by the nurse is the most appropriate?

The nurse is assisting a 12-year-old kidney transplant recipient to select items from the hospital menu.Which meal indicates an appropriate understanding of dietary restrictions?

An adolescent patient with acute kidney injury (AKI) asks why she is taking Tums (calcium carbonate) .Which response by the nurse is the most appropriate?

A nurse is caring for a child with acute kidney injury (AKI) at home.The child's laboratory work is as follows: serum albumen 2.8 g/dL and serum protein 4 g/dL.Which action by the nurse is the most appropriate?

A child is hospitalized with acute kidney injury (AKI) and has a critical hyperkalemia.Which order would the nurse question as inappropriate for this child?

A school-age boy is in the emergency department with testicular torsion.Which action by the nurse takes priority for this patient?

A child is receiving home peritoneal dialysis.When the visiting nurse assesses the patient,he finds the outflow from the dialysis to be cloudy.Which action by the nurse is the most appropriate?

A nurse is assigned to care for four children who have acute kidney injury (AKI) .Which child should the nurse see first after obtaining the handoff report?

A new mother asks the nurse why babies are more prone to dehydration than adults.Which rationales from the nurse best answer this mother's question?

A nurse is preparing to administer gentamicin (Garamycin) ,IV,to a hospitalized child.Before administering the medication,the nurse checks the drug trough level,which is 13 µg/mL.Which action by the nurse is the priority for this child?

The parents of a child with chronic kidney disease ask the nurse why the child is prescribed epoetin alfa (Epogen) .Which response by the nurse is the most accurate?

The student studying the renal system learns that the kidneys have several functions.Which options are functions of the kidneys?

A child has acute kidney injury (AKI) .Which primary acid-base balance does the nurse assess the child for?

A child has just returned to the pediatric intensive care unit after having a kidney transplant.Which assessment takes priority for this child?

A 5-year-old child has enuresis.Which medication regime does the nurse educate the parents on related to this diagnosis?

The nurse is explaining the RIFLE classification of kidney injury to a student.Which options are included in this system?

A nurse is caring for a child who is scheduled for a kidney biopsy.The prebiopsy laboratory results indicate a platelet count of 88,000,pH of 7.28,and potassium of 5.8 mEq/L.Based on these laboratory results,which action by the nurse is the most appropriate?