Question 1

Which clinical finding warrants further intervention for the child with acute post streptococcal glomerulonephritis?
A) Weight loss to within 1 lb of the preillness weight
B) Urine output of 1 mL/kg/hr
C) A positive antistreptolysin O (ASO) titer
D) Inspiratory crackles

Accepted Answer

Children with excess fluid volume may have pulmonary edema.Inspiratory crackles indicate fluid in the lungs.Pulmonary edema can be a life-threatening complication.Weight loss is an indication that the child is responding to treatment.The urine output of 1 mL/kg/hr is acceptable.A positive ASO titer indicates the presence of antibodies to streptococcal bacteria; it is used to aid in diagnosis of acute post streptococcal glomerulonephritis.This is an expected finding if the child has this acute illness.

Question 2

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding?
A) Increased urine output
B) Hypotension
C) Tea-colored urine
D) Weight gain

Accepted Answer

Acute poststreptococcal glomerulonephritis is characterized by hematuria,proteinuria,edema,and renal insufficiency.Tea-colored urine is an indication of hematuria.In acute poststreptococcal glomerulonephritis the urine output may be decreased.In acute poststreptococcal glomerulonephritis blood pressure may be increased.Edema may be noted around the eyelids and ankles in patients with acute post streptococcal glomerulonephritis and can contribute to weight gain; however,weight gain is associated more with nephrotic syndrome.

Question 3

Which dietary modification is appropriate for a child with chronic renal failure?
A) Decreased protein
B) Decreased fat
C) Increased potassium
D) Increased phosphorus

Accepted Answer

Protein intake is restricted or strictly regulated because of the kidney's inability to remove waste products.A low-fat diet is not relevant to chronic renal failure.Potassium intake may be restricted because of the kidney's inability to remove it.Phosphorus is restricted to help prevent bone disease.

Question 4

Parents ask the nurse,"When should our child's hypospadias be corrected?" The nurse responds that correction of hypospadias should be accomplished by the time the child is
A) 1 month of age.
B) 6 to 12 months of age.
C) school age.
D) sexually mature.

Accepted Answer

The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training.One month of age is too young for this procedure.It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers.Corrective surgery for hypospadias is done long before sexual maturity.

Question 5

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux?
A) The importance of taking prophylactic antibiotics if prescribed
B) Suggestions for how to maintain fluid restrictions
C) The use of bubble baths as an incentive to increase bath time
D) The need for the child to hold urine for 6 to 8 hours

Accepted Answer

Prophylactic antibiotics are sometimes used to prevent urinary infection in a child with vesicoureteral reflux,especially if they are waiting for the results of imaging studies or have recurrent UTIs.If prescribed,the parents should be taught that the child must finish the entire course of antibiotics to prevent bacterial resistance.Fluids are not restricted when a child has vesicoureteral reflux.In fact,fluid intake should be increased as a measure to prevent UTIs.Bubble baths should be avoided to prevent urethral irritation and possible UTI.To prevent UTIs,the child should be taught to void frequently and never resist the urge to urinate.

Question 6

Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission?
A) Urine is negative for casts for 5 days.
B) Urine has <1+ protein for 3 to 7 consecutive days.
C) Urine is positive for glucose for 1 week.
D) Urine is up to a trace for blood for 1 week.

Accepted Answer

The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine has <1+ protein for 3 to 7 consecutive days.The absence of casts,presence of glucose,and presence of hematuria do not constitute remission.

Question 7

Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs)?
A) "I always wear cotton underwear."
B) "I really enjoy taking a bubble bath."
C) "I go to the bathroom every 3 to 4 hours."
D) "I drink four to six glasses of fluid every day."

Accepted Answer

Bubble baths should be avoided because they tend to cause urethral irritation,which leads to UTI.It is desirable to wear cotton rather than nylon underwear.Nylon tends to hold in moisture and promote bacterial growth,whereas cotton absorbs moisture.Children should be encouraged to urinate at least four times a day.An adequate fluid intake prevents the buildup of bacteria in the bladder.

Question 8

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine.The nurse explains that casts in the urine indicate
A) glomerular injury.
B) glomerular healing.
C) recent streptococcal infection.
D) excessive amounts of protein in the urine.

Accepted Answer

The presence of red blood cell casts in the urine indicates glomerular injury.Casts in the urine are abnormal findings and are indicative of glomerular injury,not glomerular healing.A urinalysis positive for casts does not confirm a recent streptococcal infection.Casts in the urine are unrelated to proteinuria.

Question 9

What is an appropriate intervention for a child with nephrotic syndrome who is edematous?
A) Teach the child to minimize body movements.
B) Change the child's position every 2 hours.
C) Avoid the use of skin lotions.
D) Bathe every other day.

Accepted Answer

Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas.The child with edema is at risk for impaired skin integrity.It is important for the child to change position frequently to prevent skin breakdown.Good skin hygiene consists of daily baths to remove irritating body secretions and applying lotion.

Question 10

Which intervention is appropriate when examining a male infant for cryptorchidism?
A) Cooling the examiner's hands
B) Taking a rectal temperature
C) Eliciting the cremasteric reflex
D) Warming the room

Accepted Answer

For the infant's comfort,the infant should be examined in a warm room with the examiner's hands warmed.Testes can retract into the inguinal canal if the infant is upset or cold.A rectal temperature yields no information about cryptorchidism.Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited.This can lead to an incorrect diagnosis.

Question 11

Which factor predisposes the urinary tract to infection?
A) Increased fluid intake
B) Short urethra in young girls
C) Prostatic secretions in males
D) Frequent emptying of the bladder

Accepted Answer

The short urethra in females provides a ready pathway for invasions of organisms.Increased fluid intake offers protective measures against UTIs.Prostatic secretions have antibacterial properties that inhibit bacteria.Frequent emptying of the bladder also offers protection against UTIs.

Question 12

The narrowing of preputial opening of foreskin is 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 13

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition?
A) Hypocalciuria
B) Nephrotic syndrome
C) Glomerulonephritis
D) UTI

Accepted Answer

Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI.An excessive loss of calcium in the urine (hypercalciuria)can be associated with complaints of painful urination,urgency,frequency,and wetting.Nephrotic syndrome is not usually associated with complaints of dysuria or urgency.Glomerulonephritis is not a likely cause of dysuria or urgency.

Question 14

Which of the following is a true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system?
A) The young infant's kidneys can more effectively concentrate urine than an adult's kidneys.
B) After 6 years of age, kidney function is nearly like that of an adult.
C) Unlike adults, most children do not regain normal kidney function after acute renal failure.
D) Young children have shorter urethras, which can predispose them to UTIs.

Accepted Answer

Young children have shorter urethras,which can predispose them to UTIs.The young infant's kidneys cannot concentrate urine as efficiently as can those of older children and adults because the loops of Henle are not yet long enough to reach the inner medulla,where concentration and reabsorption occur.By 6 to 12 months of age,kidney function is nearly like that of an adult.Unlike adults,most children with acute renal failure regain normal function.

Question 15

You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS).Which bacterial infection was most likely the cause of HUS?
A) Pseudomonas aeruginosa
B) Escherichia coli
C) Streptococcus pneumoniae
D) Staphylococcus aureus

Accepted Answer

Children with HUS become infected by Escherichia coli,which is usually contracted from eating improperly cooked meat or contaminated dairy products.Pseudomonas aeruginosa,Streptococcus pneumoniae,and Staphylococcus aureus are not associated with HUS.

Question 16

Which diagnostic finding is present when a child has primary nephrotic syndrome?
A) Hyperalbuminemia
B) Positive ASO titer
C) Leukocytosis
D) Proteinuria

Accepted Answer

Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane.Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss.ASO titer is negative in a child with primary nephrotic syndrome.Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

Question 17

Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet?
A) "I can give my child sweet pickles."
B) "My child can put ketchup on his hotdog."
C) "I can let my child have potato chips."
D) "I do not put any salt in foods when I am cooking."

Accepted Answer

A no-added-salt diet meAnswer that no salt should be added to foods,either when cooking or before eating.Pickles of any type,hotdogs,and potato chips are all prohibited on this diet.

Question 18

A nurse is teaching a class on acute kidney injury.The nurse relates that acute kidney injury as a result of hemolytic-uremic syndrome (HUS)is classified as
A) Intrinsic renal.
B) Prerenal.
C) Postrenal.
D) Chronic.

Accepted Answer

Intrinsic renal acute renal failure is the result of damage to kidney tissue.Possible causes include HUS,glomerulonephritis,and pyelonephritis.Prerenal acute renal failure is the result of decreased perfusion to the kidney.Possible causes include dehydration,septic and hemorrhagic shock,and hypotension.Postrenal acute renal failure results from obstruction of urine outflow.Conditions causing postrenal failure include ureteropelvic obstruction,ureterovesical obstruction,or neurogenic bladder.Renal failure caused by HUS is of the acute nature.Chronic renal failure is an irreversible loss of kidney function,which occurs over months or years.

Question 19

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.

Accepted Answer

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 in hypospadias but not at the glAnswer.Hypospadias refers to the urethral opening,not to the size of the penis.Epispadias is where the urethral opening is along the dorsal surface of the penis.

Question 20

Which condition is characterized by a history of bloody diarrhea,fever,abdominal pain,and low hemoglobin and platelet counts?
A) Acute viral gastroenteritis
B) Acute glomerulonephritis
C) Hemolytic-uremic syndrome
D) Acute nephrotic syndrome

Accepted Answer

Hemolytic-uremic syndrome is an acute disorder characterized by anemia,thrombocytopenia,and acute renal failure.Most affected children have a history of gastrointestinal symptoms,including bloody diarrhea.Anemia and thrombocytopenia are not associated with acute gastroenteritis.The symptoms described are not suggestive of acute glomerulonephritis.The symptoms described are not suggestive of nephrotic syndrome.

Quiz 44: The Child with a Genitourinary Alteration

Which clinical finding warrants further intervention for the child with acute post streptococcal glomerulonephritis?

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding?

Which dietary modification is appropriate for a child with chronic renal failure?

Parents ask the nurse,"When should our child's hypospadias be corrected?" The nurse responds that correction of hypospadias should be accomplished by the time the child is

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux?

Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission?

Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs) ?

The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about "casts" in the urine.The nurse explains that casts in the urine indicate

What is an appropriate intervention for a child with nephrotic syndrome who is edematous?

Which intervention is appropriate when examining a male infant for cryptorchidism?

Which factor predisposes the urinary tract to infection?

The narrowing of preputial opening of foreskin is called

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition?

Which of the following is a true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system?

You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS) .Which bacterial infection was most likely the cause of HUS?

Which diagnostic finding is present when a child has primary nephrotic syndrome?

Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet?

A nurse is teaching a class on acute kidney injury.The nurse relates that acute kidney injury as a result of hemolytic-uremic syndrome (HUS) is classified as

Hypospadias refers to

Which condition is characterized by a history of bloody diarrhea,fever,abdominal pain,and low hemoglobin and platelet counts?