Question 1

What major complication is associated with a child with chronic renal failure?
A) Hypokalemia
B) Metabolic alkalosis
C) Water and sodium retention
D) Excessive excretion of blood urea nitrogen

Accepted Answer

Chronic renal failure leads to water and sodium retention,which contributes to edema and vascular congestion.Hyperkalemia,metabolic acidosis,and retention of blood urea nitrogen are complications of chronic renal failure.

Question 2

What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS)who has scrotal edema?
A) Place an ice pack on the scrotal area.
B) Place the child in an upright sitting position.
C) Elevate the scrotum with a rolled washcloth.
D) Place a warm moist pack to the scrotal area.

Accepted Answer

In children hospitalized with MCNS,elevating edematous parts may be helpful to shift fluid to more comfortable distributions.Areas that are particularly edematous,such as the scrotum,abdomen,and legs,may require support.The scrotum can be elevated with a rolled washcloth.Ice or heat should not be used.Sitting the child in an upright position will not decrease the scrotal edema.

Question 3

A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving.What would be the nurse's best response?
A) Blood pressure will stabilize.
B) Your child will have more energy.
C) Urine will be free of protein.
D) Urine output will increase.

Accepted Answer

The first sign of improvement in acute glomerulonephritis is an increase in urinary output with a corresponding decrease in body weight.With diuresis,the child begins to feel better,the appetite improves,and the blood pressure decreases to normal with the reduction of edema.Gross hematuria diminishes,in part because of dilution of the red blood cells in the more dilute urine.Renal function and hypocomplementemia usually normalize by 8 weeks.

Question 4

The nurse is caring for an adolescent who has just started dialysis.The child always seems angry,hostile,or depressed.The nurse should recognize that this is most likely related to what underlying cause?
A) Physiologic manifestations of renal disease
B) The fact that adolescents have few coping mechanisms
C) Neurologic manifestations that occur with dialysis
D) Resentment of the control and enforced dependence imposed by dialysis

Accepted Answer

Older children and adolescents need to feel in control.Dialysis forces the adolescent into a dependent relationship,which results in these behaviors.Being angry,hostile,or depressed are functions of the age of the child,not neurologic or physiologic manifestations of the dialysis.

Question 5

What is the narrowing of preputial opening of foreskin called?
A) Chordee
B) Phimosis
C) Epispadias
D) Hypospadias

Accepted Answer

Phimosis is the narrowing or stenosis of the preputial opening of the foreskin.Chordee is the ventral curvature of the penis.Epispadias is the meatal opening on the dorsal surface of the penis.Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Question 6

What statement is descriptive of renal transplantation in children?
A) It is an acceptable means of treatment after age 10 years.
B) Children can receive kidneys only from other children.
C) It is the preferred means of renal replacement therapy in children.
D) The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

Accepted Answer

Renal transplantation offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease.It can be done in children as young as age 6 months.Both children and adults can serve as donors for renal transplant purposes.Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

Question 7

Identification and treatment of cryptorchid testes should be done by age 2 years.What is an important consideration?
A) Medical therapy is not effective after this age.
B) Treatment is necessary to maintain the ability to be fertile when older.
C) The younger child can tolerate the extensive surgery needed.
D) Sexual reassignment may be necessary if treatment is not successful.

Accepted Answer

The longer the testis is exposed to higher body heat,the greater the likelihood of damage.To preserve fertility,surgery should be done at an early age.Surgical intervention is the treatment of choice.Simple orchiopexy is usually performed as an outpatient procedure.The surgical procedure restores the testes to the scrotum.This helps the boy to have both testes in the scrotum by school age.Sexual reassignment is not indicated when the testes are not descended.

Question 8

An infant has been diagnosed with bladder obstruction.What do symptoms of this disorder include?
A) Renal colic
B) Strong urinary stream
C) Urinary tract infections
D) Posturination dribbling

Accepted Answer

Symptoms of bladder obstruction include poor force of urinary stream,intermittency of voided stream,feelings of incomplete bladder emptying,and posturination dribbling.They may also include urinary frequency,nocturia,nocturnal enuresis,and urgency.Renal colic is a symptom of upper urinary tract obstruction.Children with bladder obstruction have a weak urinary stream.Urinary tract infections are not associated with bladder obstruction.

Question 9

Surgery is performed on a child to correct cryptorchidism.The parents understand the reason for the surgery if they tell the nurse this was done to do what?
A) "Prevent damage to the undescended testicle."
B) "Prevent urinary tract infections."
C) "Prevent prostate cancer."
D) "Prevent an inguinal hernia."

Accepted Answer

If the testes do not descend spontaneously,orchiopexy is performed before the child's second birthday,preferably between 1 and 2 years of age.Surgical repair is done to (1)prevent damage to the undescended testicle by exposure to the higher degree of body heat in the undescended location,thus maintaining future fertility; (2)decrease the incidence of malignancy formation,which is higher in undescended testicles; (3)avoid trauma and torsion; (4)close the processus vaginalis; and (5)prevent the cosmetic and psychologic disability of an empty scrotum.Parents understand the teaching if they respond the surgery is done to prevent damage.

Question 10

The parents of a child born with ambiguous genitalia tell the nurse that family and friends are asking what caused the baby to be this way.Tests are being done to assist in gender assignment.What should the nurse's intervention include?
A) Explain the disorder so they can explain it to others.
B) Help parents understand that this is a minor problem.
C) Suggest that parents avoid family and friends until the gender is assigned.
D) Encourage parents not to worry while the tests are being done.

Accepted Answer

Explaining the disorder to parents so they can explain it to others is the most therapeutic approach while the parents await the gender assignment of their child.Ambiguous genitalia is a serious issue for the family.Careful testing and evaluation are necessary to aid in gender assignment to avoid lifelong problems for the child.Suggesting that parents avoid family and friends until the gender is assigned is impractical and would isolate the family from their support system while awaiting test results.The parents will be concerned.Telling them not to worry without giving them specific alternative actions would not be effective.

Question 11

The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS).What statement by the parent indicates a correct understanding of the teaching?
A) "My child needs to stay home from school for at least 1 more month."
B) "I should not add additional salt to any of my child's meals."
C) "My child will not be able to participate in contact sports while receiving corticosteroid therapy."
D) "I should measure my child's urine after each void and report the 24-hour amount to the health care provider."

Accepted Answer

Children with MCNS can be treated at home after the initial phase with appropriate discharge instructions,including a salt restriction of no additional salt to the child's meals.The child may return to school but should avoid exposure to infected playmates.Participation in contact sports is not affected by corticosteroid therapy.The parent does not need to measure the child's urine on a daily basis but may be instructed to test for albumin.

Question 12

A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS)that is in remission after administration of prednisone.The nurse realizes further teaching is required if the parents state what?
A) "We will keep our child away from anyone who is ill."
B) "We will be sure to administer the prednisone as ordered."
C) "We will encourage our child to eat a balanced diet, but we will watch his salt intake."
D) "We understand our child will not be able to attend school, so we will arrange for home schooling."

Accepted Answer

The child with MCNS in remission can attend school.The child needs socialization and will be socially isolated if home schooled.The other statements are accurate for home care for a child with MCNS.

Question 13

What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD)?
A) Children with ESRD usually adapt well to 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 children's lives are maintained by drugs and artificial means.

Accepted Answer

Stressors on the family are often overwhelming because of the progressive deterioration.The child progresses from renal insufficiency to uremia to dialysis and transplantation,each of which requires intensive therapy and supportive care.The treatment of ESRD is intense and requires multiple examinations,dietary restrictions,and medications.Adherence to the regimen is often difficult for children and families because of the progressive nature of the renal failure.ESRD has an unrelenting course that has no known cure.Children do not outgrow the renal failure.

Question 14

Parents of a newborn with ambiguous genitalia want to know how long they will have to wait to know whether they have a boy or a girl.The nurse answers the parents based on what knowledge?
A) Chromosome analysis will be complete in 7 days.
B) A physical examination will be able to provide a definitive answer.
C) Additional laboratory testing is necessary to assign the correct gender.
D) Gender assignment involves collaboration between the parents and a multidisciplinary team.

Accepted Answer

Gender assignment is a complex decision-making process.Endocrine,genetic,social,psychologic,and ethical elements of sex assignment have been integrated into the process.Parent participation is included.The goal is to enable the affected child to grow into a well-adjusted,psychosocially stable person.Chromosome analysis usually takes 2 or 3 days.A physical examination reveals ambiguous genitalia,but additional testing is necessary.A "correct" gender may not be identifiable.

Question 15

What statement is an advantage of peritoneal dialysis compared with hemodialysis?
A) Protein loss is less extensive.
B) Dietary limitations are not necessary.
C) It is easy to learn and safe to perform.
D) It is needed less frequently than hemodialysis.

Accepted Answer

Peritoneal dialysis is the preferred form of dialysis for parents,infants,and children who wish to remain independent.Parents and older children can perform the treatments themselves.Protein loss is not significantly different.The dietary limitations are necessary,but they are not as stringent as those for hemodialysis.Treatments are needed more frequently but can be done at home.

Question 16

The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son.The nurse replies based on what knowledge?
A) Most boys in the United States can be toilet trained at age 3 years.
B) Training can begin when he has sufficient bladder capacity.
C) Additional surgery may be necessary to achieve continence.
D) They should begin now because he will require additional time.

Accepted Answer

After repair of the bladder exstrophy,the child's bladder is allowed to increase capacity.Several surgical procedures may be necessary to create a urethral sphincter mechanism to aid in urination and ejaculation.With the lack of a urinary sphincter,toilet training is unlikely.The child cannot hold the urine in the bladder.Bladder capacity is one component of continence.A functional sphincter is also needed.

Question 17

Congenital defects of the genitourinary tract,such as hypospadias,are usually repaired as early as possible to accomplish what?
A) Minimize separation anxiety.
B) Prevent urinary complications.
C) Increase acceptance of hospitalization.
D) Promote development of normal body image.

Accepted Answer

Promoting development of normal body image is extremely important.Surgery involving sexual organs can be upsetting to children,especially preschoolers,who fear mutilation and castration.Proper preprocedure preparation can facilitate coping with these issues.Preventing urinary complications is important for defects that affect function,but for all external defects,repair should be done as soon as possible.

Question 18

For minimal change nephrotic syndrome (MCNS),prednisone is effective when what occurs?
A) Appetite increases and blood pressure is normal
B) Urinary tract infection is gone and edema subsides
C) Generalized edema subsides and blood pressure is normal
D) Diuresis occurs as urinary protein excretion diminishes

Accepted Answer

Studies suggest that the duration of steroid treatment for the initial episode should be at least 3 months.In most patients,diuresis occurs as the urinary protein excretion diminishes within 7 to 21 days after the initiation of steroid therapy.The blood pressure is normal with MCNS,so remaining so is not an improvement.There is no urinary tract infection with MCNS.

Question 19

What diet is most appropriate for the child with chronic renal failure (CRF)?
A) Low in protein
B) Low in vitamin D
C) Low in phosphorus
D) Supplemented with vitamins A, E, and K

Accepted Answer

Dietary phosphorus may need to be restricted by limiting protein and milk intake.Substances that bind phosphorus are given with meals to prevent its absorption,which enables a more liberal intake of phosphorus-containing protein.Protein is limited to the recommended daily allowance for the child's age.Further restriction is thought to negatively affect growth and neurodevelopment.Vitamin D therapy is administered in children with CRF to increase calcium absorption.Supplementation of vitamins A,E,and K,beyond normal dietary intake,is not advised in children with CRF.These fat-soluble vitamins can accumulate.

Question 20

What do the clinical manifestations of minimal change nephrotic syndrome include?
A) Hematuria, bacteriuria, and weight gain
B) Gross hematuria, albuminuria, and fever
C) Hypertension, weight loss, and proteinuria
D) Massive proteinuria, hypoalbuminemia, and edema

Accepted Answer

Massive proteinuria,hypoalbuminemia,and edema are clinical manifestations of minimal change nephrotic syndrome.Hematuria and bacteriuria are not seen,and there is usually weight loss,not gain.The blood pressure is normal or hypotensive.

Quiz 25: The Child With Renal Dysfunction

What major complication is associated with a child with chronic renal failure?

What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema?

A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving.What would be the nurse's best response?

The nurse is caring for an adolescent who has just started dialysis.The child always seems angry,hostile,or depressed.The nurse should recognize that this is most likely related to what underlying cause?

What is the narrowing of preputial opening of foreskin called?

What statement is descriptive of renal transplantation in children?

Identification and treatment of cryptorchid testes should be done by age 2 years.What is an important consideration?

An infant has been diagnosed with bladder obstruction.What do symptoms of this disorder include?

Surgery is performed on a child to correct cryptorchidism.The parents understand the reason for the surgery if they tell the nurse this was done to do what?

The parents of a child born with ambiguous genitalia tell the nurse that family and friends are asking what caused the baby to be this way.Tests are being done to assist in gender assignment.What should the nurse's intervention include?

The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS) .What statement by the parent indicates a correct understanding of the teaching?

A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone.The nurse realizes further teaching is required if the parents state what?

What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD) ?

Parents of a newborn with ambiguous genitalia want to know how long they will have to wait to know whether they have a boy or a girl.The nurse answers the parents based on what knowledge?

What statement is an advantage of peritoneal dialysis compared with hemodialysis?

The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son.The nurse replies based on what knowledge?

Congenital defects of the genitourinary tract,such as hypospadias,are usually repaired as early as possible to accomplish what?

For minimal change nephrotic syndrome (MCNS) ,prednisone is effective when what occurs?

What diet is most appropriate for the child with chronic renal failure (CRF) ?

What do the clinical manifestations of minimal change nephrotic syndrome include?