Deck 22: Genitourinary Alterations

Question 1

Which of the following makes it easy to palpate a full bladder on infants and children?

A) Their skin is thinner than adults' skin.
B) Their bladders can be filled fuller than adults' bladders.
C) Their bladders are closer to the anterior abdominal wall.
D) The bladder is oversized at birth.

Answer 1

Their bladders are closer to the anterior abdominal wall.

Question 2

Which of the following makes the kidneys of a child more susceptible to trauma compared to those of an adult?

A) The kidneys are less protected in the child due to unossified ribs and less fat padding.
B) Backward falls are associated with direct compression of the kidneys.
C) The kidneys are much smaller and closer to the surface.
D) There are not as many renal tubules, and the kidneys themselves are not as thick as the adult kidneys.

Answer 2

The kidneys are less protected in the child due to unossified ribs and less fat padding.

Question 3

The ability to concentrate urine varies between adults and newborns. Which of the following describes the ability of the newborn to concentrate urine when compared to the adult?

A) better
B) about the same
C) much more poorly
D) slightly less

Answer 3

much more poorly

Question 4

The bladder capacity of a 4-year-old child is how many ounces?

A) 4
B) 6
C) 8
D) 10

Question 5

Which of the following statements is true regarding a urinary tract infection (UTI) in the newborn?

A) The incidence is higher in female newborns.
B) After the first year, the incidence is more common in boys.
C) Boys who are uncircumcised are more likely to have a UTI.
D) UTI is more common in African-American girls than in Caucasian girls.

Question 6

Which of the following are the most common bacteria to infect the urinary tract?

A) Escherichia coli
B) Enterobacter
C) Proteus species
D) Pseudomonas

Question 7

The nurse assessing a child who has a urinary tract infection will suspect pyelonephritis rather than cystitis then the child exhibits which of the following symptoms?

A) scant amounts of strong-smelling urine of a very dark orange or brown color
B) fever greater than 38.3 degrees C (101 degrees F), chills, back pain, and appearing quite ill
C) low-grade fever, urgency, hesitancy, burning on urination, and cloudy urine
D) low specific gravity of urine, extreme thirst, and nausea and vomiting

Question 8

Untreated urinary tract infections could most likely lead to which of the following problems?

A) renal scarring
B) loss of bladder capacity
C) septicemia
D) loss of bladder tone

Question 9

The nurse is assigned to work with a child who has a urinary tract infection. The child is having bladder spasms. Which of the following interventions would be best initially to try to relieve the bladder spasms?

A) pain medication
B) bladder massages
C) ice packs, provided they do not induce chills
D) warm, moist heat if it does not increase fever

Question 10

The nurse completed discharge teaching for the family of a child with a urinary tract infection. Which of the following statements by one of the caregivers would indicate an understanding of the nurse's teaching about the antibiotics?

A) "We will stop the antibiotics then the child is fever free or the urine culture comes back negative."
B) "We will give the antibiotics until they are all gone, even if the child is feeling well and looks well."
C) "We will fill half the prescription for antibiotics and if there are still symptoms then those are gone, we will fill the other half."
D) "We will save a few of the antibiotic tablets and then the next time our child has this problem, we can start them early."

Question 11

The school nurse is talking with caregivers and school-aged girls about the prevention of urinary tract infections. Which of the following teachings will be most helpful in preventing urinary tract infections?

A) "Children will benefit from warm bubble baths to keep the external urinary openings clean."
B) "Have the children wear nylon underwear rather than cotton underwear."
C) "Girls should always wipe with the toilet tissue from front to back and never from back to front."
D) "Children can learn to hold their urine for 3-4 hours to strengthen the bladder muscle tone."

Question 12

A parent asks the nurse to explain what is meant by a secondary enuretic, because the pediatrician referred to this parent's child as a secondary enuretic. Which of the following statements by the nurse would best explain a secondary enuretic?

A) "A child who primarily has encopresis and secondarily has enuresis as a problem."
B) "In secondary enuresis the cause is not the structure of the urinary system but some pathogen or problem that has come into the system."
C) "Secondary enuretics have suffered enuresis in the past, and this is a repeat of the problem."
D) "A secondary enuretic is a child who has been dry for at least 3 to 6 months and then resumes wetting."

Question 13

When the nurse uses the terms enuresis and incontinence correctly, the nurse uses these terms keeping in mind which of the following facts?

A) These terms mean the same thing.
B) Incontinence is caused by a malformation of the urinary tract, and enuresis is not.
C) Incontinence can occur anytime, while enuresis only occurs with bed-wetting at night.
D) Incontinence is a term used only for adults, and enuresis is a term used only for children.

Question 14

In addition to oxybutynin chloride (Ditropan), which of the following medications is the one most commonly used to treat enuresis in children?

A) imipramine hydrochloride (Tofranil)
B) carbamazepine (Tegretol)
C) propranolol hydrochloride (Inderal)
D) tacrine (Cognex)

Question 15

Which of the following is the most widely used form of treatment for enuresis?

A) medication
B) surgery
C) bed-wetting alarms
D) behavior modification

Question 16

The nurse is working on dietary interventions in a care plan for a child who has enuresis. Which of the following interventions would the nurse most likely include?

A) Eliminate carbonated beverages, dairy products, citric foods, and caffeine.
B) Reduce the amount of carbohydrate and protein in the diet.
C) Reduce salt and fluid intake as well as reduce foods high in potassium.
D) Decrease intake of foods high in cholesterol, magnesium, and zinc.

Question 17

Which of the following problems most needs to be addressed at the same time as enuresis in order for the enuresis interventions to be successful?

A) low self-esteem
B) impaired skin integrity
C) sleep pattern disturbance
D) constipation

Question 18

Which of the following questions would be most important for the nurse to ask then assessing a child with enuresis?

A) What are the child's and family's feelings toward enuresis?
B) Is there a history of constipation or bowel movements that were large or painful?
C) Is there a family history of enuresis or encopresis in the last two generations?
D) At what age did you toilet-train the child, and how did the toilet training go?

Question 19

The nurse evaluating a family's progress in successfully dealing with the problem of nocturnal enuresis would consider that the family still needs help and monthly appointments until the child achieves which of the following goals?

A) one 24-hour period of being dry
B) remaining dry overnight at a friend's house
C) a 72-hour period remaining dry
D) 14 consecutive dry nights

Question 20

Why would the nurse advise a family trying to help a younger child overcome nocturnal enuresis to have the child practice using the alarm system with a doll or stuffed animal?

A) to help the child feel comfortable with the system
B) to make sure the child can operate the system independently
C) to ensure that the child won't throw the system out of the bed at night
D) to perfect the child's technique in using the system

Question 21

The nurse is assigned to work with a child who has a diagnosis of vesicoureteral reflux (VUR). The nurse is aware that this means the child has which of the following problems?

A) backflow of urine from the bladder up the ureter to the kidney
B) backflow of urine from the bladder up the ureter
C) a flow of urine between the bladder and the rectum
D) exchange of urine between the inner and outer layers of the bladder

Question 22

Parents ask the nurse to explain what it means then the pediatrician says that their child's vesicoureteral reflux is a grade I. Which of the following is the nurse's best response to explain the significance of the grade?

A) In grade I there is already some amount of renal scarring.
B) There is some loss of kidney function, but it is no more than 50%.
C) This grade of reflux is most likely to resolve spontaneously.
D) Grade I is the most serious grade of vesicoureteral reflux.

Question 23

The nonsurgical management for a child with vesicoureteral reflux focuses most on which one of the following goals?

A) Urine will be produced at 15-40 cubic centimeters per hour.
B) There will be no episodes of urinary tract infection.
C) Medication will be taken 100% of the time.
D) The child will remain in school 100% of the time.

Question 24

In hypospadias the urethral meatus is located in which of the following places?

A) on the dorsal side of the penis toward the distal end
B) at any point along the ventral side of the penis or on the scrotum or perineum
C) slightly under a larger-than-normal foreskin if uncircumcised or at the outer perimeter of the head of the penis if circumcised
D) at the end of the ventral side of the penis, near, but not on the head of, the penis

Question 25

Which of the following best describes chordee, a condition that can be associated with hypospadias?

A) downward curvature of the penis and an incomplete foreskin
B) the spermatic cord is twisted on itself and feels wormlike on palpation
C) double openings on the penis causing two streams of urine
D) a urinary meatus that is too small, requiring more effort to empty the bladder

Question 26

A nurse is instructing a caregiver about the side effects of testosterone cream applied to the penis of a child prior to surgery to correct hypospadias. The nurse will most likely tell the caregiver:

A) The testosterone may cause the child to have erections and possibly ejaculation, but then the cream is discontinued, the erections will stop.
B) The testosterone was used to increase the size of the penis to make surgery easier. This size and any pubic hair will go away then the cream is stopped.
C) The testosterone cream was used to thicken the skin of the penis to make surgery easier. This thickening will go away then the cream is stopped.
D) Sometimes the testosterone will cause the child to be more aggressive or agitated, but these behaviors will go away then the medication is stopped.

Question 27

The nurse is assigned to a child who had surgery for repair of hypospadias and the child has a bladder stent. Upon assessment, the nurse finds that the child is suffering bladder spasms. Which of the following medications ordered by the surgeon alleviates bladder spasm?

A) oxybutynin chloride (Ditropan)
B) dezocine (Dalgan)
C) guanadrel sulfate (Hylorel)
D) propranolol (Inderal)

Question 28

Which of the following best describes the problem of cryptorchidism?

A) there one testicle is greatly enlarged and hangs somewhat lower than the other testicle
B) there one, or in rare cases both, of the testes is twisted in the scrotal sac
C) a congenital anomaly in which one, or in rare cases both, of the testicles is absent
D) failure of one or both of the testes to descend through the inguinal canal into the scrotum

Question 29

Upon assessment of a child, the nurse finds a testis that has descended normally but easily retracts with physical examination. Which of the following terms describes this finding?

A) cryptorchidism
B) retractile testis
C) ectopic testis
D) torticollis

Question 30

The management of cryptorchidism usually involves which of the following interventions?

A) observation while awaiting spontaneous descent of the testes in the first year after birth
B) large doses of testosterone given daily
C) orchiopexy surgery performed as soon as possible after detection of the cryptorchidism
D) downward massaging of the testis involved to encourage downward migration

Question 31

After assessing a child with cryptorchidism and assessing the child's family, the nurse writes a diagnosis of anxiety (caregiver). Which of the following concerns would the anxiety most likely be related to in addition to the child's increased risk of malignancy?

A) fear that the child will suffer pain
B) child's risk of decreased fertility
C) fear of the child having gender confusion
D) guilt

Question 32

The nurse is teaching the parents of a child who had surgery for cryptorchidism. At what age would the nurse recommend that the child begin to perform monthly testicular self-exams?

A) 6 years
B) 9 years
C) at the time of puberty
D) upon becoming sexually active

Question 33

Upon examining a child, the nurse found a bulge or swelling in the groin and suspected an inguinal hernia. Which of the following tests will the nurse use to verify that this is a hernia?

A) "Strain or push down as if you were trying hard to pee or poop."
B) "Take as deep a breath as you can, and hold it as long as you can."
C) "Stand up and jump up and down several times."
D) "Lie down with your knees bent, and try to bring them up to your tummy."

Question 34

On finding an inguinal hernia in a child, the nurse in the pediatric clinic will teach the mother that until the child has surgery for the hernia, the mother should do which of the following if the child has pain and intense inconsolable irritability, with or without vomiting and abdominal distension?

A) Make an appointment with the physician as soon as possible.
B) Apply ice to the groin area for 30 minutes on and 30 minutes off for 8 hours.
C) Contact the physician immediately, or take the child to the emergency room.
D) Keep the child on bed rest to see if the symptoms subside.

Question 35

Which of the following statements best describes a hydrocele?

A) an outpouching on the scrotum that contains water
B) a collection of water or fluid in the foreskin
C) an inguinal hernia containing fluid
D) a collection of fluid in the scrotal sac

Question 36

Parents of a child admitted to the pediatric ward ask the nurse to tell them what causes acute glomerulonephritis because the pediatrician has mentioned this as a possible diagnosis. The correct answer by the nurse would be to tell the family that acute glomerulonephritis is an inflammation of glomeruli within the kidney caused by which of the following?

A) a bacterial or viral agent invading the child's system
B) habitual failure to flush the kidneys with sufficient fluid
C) an uncommon genetic defect involving a renin deficiency
D) failure of the adrenal glands to produce sufficient aldosterone

Question 37

You are the nurse assigned to care for a child with acute glomerulonephritis. After receiving report and doing an initial assessment, you check the lab reports. You would not be surprised to find which of the following signs and symptoms consistent with the diagnosis of acute glomerulonephritis?

A) pale yellow urine in copious amounts, low specific gravity, increased glomerular filtration rate
B) hypotension, dry skin, decreased serum sodium levels, and decreased potassium
C) hematuria, dependent edema, elevated serum sodium, diminished glomerular filtration rate, proteinuria
D) ketone bodies in the urine, diminished serum sodium, orthostatic hypotension

Question 38

The nurse is assigned to work with a child diagnosed with nephrotic syndrome. The nurse knows that this renal problem is characterized by massive proteinuria and hypoalbuminemia, which tells the nurse to assess for which of the following signs or symptoms?

A) level of consciousness
B) orientation
C) edema and hyperlipidemia
D) dehydration and weight loss

Question 39

Which of the following causes primary nephrotic syndrome?

A) glomerular disease of the kidney
B) hepatitis
C) lead poisoning
D) childhood cancer or its therapies

Question 40

The nurse is monitoring the lab results of a child with nephrotic syndrome. The child now has elevated serum cholesterol and triglyceride levels and falling serum protein levels. The IgG levels are diminished. Red blood cell and platelet concentrations are increased. The nurse realizes that the lab reports indicate this child is at risk for:

A) anemia
B) coagulation or clotting problems
C) bleeding problems
D) infection

Question 41

Which treatment is the mainstay for nephrotic syndrome?

A) antibiotic therapy
B) blood transfusions
C) high-protein diet
D) corticosteroid therapy

Question 42

You are the nurse assigned to work with a child with nephrotic syndrome. By following the prescribed treatment regimen, the child experiences a remission. You are now checking to make sure the child does not have a relapse. Which finding would most lead you to the conclusion that a relapse was happening?

A) a temperature of 37.8 degrees C (100 degrees F), flank pain, burning, frequency, urgency on voiding, and cloudy urine
B) a urine dipstick measurement of 2+ proteinuria or more for 3 days, or the child found to have 3-4+ proteinuria plus edema
C) elevated temperature, cough, sore throat, changing complete blood count (CBC) with differential
D) the urine dipstick showing glucose in the urine for 3 days, extreme thirst, increase in urine output, and a moon face

Question 43

You are the nurse assigned to work with a child with nephrotic syndrome. The parents ask you about why their child is in reverse isolation. Which of the following is your best response?

A) "Isolation is necessary to keep your child from passing an infection on to others."
B) "This is mainly to keep your child from overexerting and getting an infection."
C) "This isolation is to protect your child from getting an infection from others."
D) "This is the usual practice with children who are on steroids."

Question 44

A child is recovering at home from nephrotic syndrome and is on a regimen of prednisone and antibiotics. The child's parents call the pediatric clinic and tell the nurse that their child is gaining a lot of weight. The nurse will first suspect which of the following possible causes of the weight gain?

A) ravenous appetite as a side effect of steroid therapy
B) sodium retention and concurrent retention of water
C) edema associated with steroid therapy
D) worsening or relapse of the nephrotic syndrome

Question 45

In which of the following groups is hemolytic uremic syndrome, although rare, most often found?

A) industrialized nations
B) children ages 6 months to 3 years old
C) male children
D) female children

Question 46

Which of the following causes is associated with hemolytic uremic syndrome?

A) Escherichia coli and other pathogens
B) hypothalamic-pituitary-adrenal axis disorders
C) septicemia and associated tricuspid valve vegetation
D) inherited tendency

Question 47

Which of the following are prodromal symptoms of hemolytic uremic syndrome?

A) frequency, urgency, pain, and burning on urination with gross blood in a cloudy urine
B) chills, fever, flank pain, elevated blood pressure, pulse, and respirations
C) gastrointestinal symptoms with diarrhea and vomiting or an upper respiratory infection
D) headache, dizziness, loss of energy, edema in dependent parts of the body

Question 48

Which of the following are the clinical manifestations of hemolytic uremic syndrome?

A) renal failure, thrombocytopenia, and anemia
B) blood in the urine and increased blood pressure
C) frost on the skin and increasing disorientation
D) left-sided heart failure and 4+ pitting edema

Question 49

The nurse caring for a child with hemolytic uremic syndrome notices that the child's lab reports indicate a worsening anemia and a falling hematocrit and platelet count. The nurse will most need to plan some interventions to deal with which of the following problems that the child is most at risk of developing based on these changes in lab values?

A) edema and electrolyte imbalance
B) bruising, bleeding, and purpura
C) altered levels of consciousness and seizures
D) congestive heart failure

Question 50

Which of the following conditions is the most frequent cause of acute renal failure in children?

A) chronic urinary tract infections
B) nephrotic syndrome
C) hemolytic uremic syndrome
D) acute glomerulonephritis

Question 51

Which of the following indicates the type(s) of acute renal failure?

A) one type: acute
B) two types: acute and subacute
C) three types: prerenal, intrarenal, and postrenal
D) four types: hemorrhagic with and without clotting, and nonhemorrhagic with and without clotting

Question 52

You are the nurse working with a child who has acute renal failure with diminished renal function. The physician orders two new antibiotics to be given stat to this child. What would you do now?

A) Get the antibiotics right away from the pharmacy, and give them immediately.
B) Find out if these drugs are detoxified and excreted by the kidneys and, if so, check with the physician and your supervisor about the safety of giving these drugs.
C) Determine if the child has been taking these same drugs or similar drugs without problems.
D) Weigh the benefits of the medication and the need for it against the risks of the medication being nephrotoxic and doing harm to the kidneys.

Question 53

The nurse is teaching a child and his family about medications for the child, who is getting dialysis. The nurse will teach the family which of the following?

A) If urine output diminishes, call the health care provider prior to giving the medication.
B) Give all medication with at least 8 ounces of water, and maintain water intake at 8 to 10 glasses per day.
C) Give all medication ordered to be given daily about 30 minutes prior to the dialysis treatment.
D) Any medication given during dialysis should be given with a glass of juice unless juice is contraindicated with that medication.

Question 54

The nurse is instructing a child and the child's family about dietary needs while the child is undergoing dialysis treatments at home. The nurse will instruct the family to provide which of the following types of diet?

A) soft
B) pureed
C) low protein
D) high fat

Question 55

A child with acute renal failure will have the diagnosis reclassified to chronic renal failure then which of the following conditions is met?

A) There is renal scarring, and the condition is not responding to vigorous treatment for 2 weeks.
B) About 50% of the renal function remains, and the condition has lasted several months or more.
C) The condition has not responded to three courses of medication.
D) There is no commonly used set of conditions, and this is a medical judgment.

Question 56

Male children are less susceptible to urinary tract infections (UTIs). Which of the following rationales provide(s) evidence to support this finding? Select all that apply.

A) longer urethra
B) secretions from the prostate
C) testosterone providing active immunity to bacteria
D) bacterial contamination being less common in males

Question 57

An infant presents to the emergency room for evaluation for vague symptoms of discomfort. The infant's parent expresses concern that the infant has a urinary tract infection (UTI). Which of the following symptoms are indicative of a UTI in infants?

A) vomiting
B) diarrhea
C) irritability
D) loss of appetite

Question 58

A nurse is providing education to the parents of a child with enuresis. The nurse is discussing the elimination of foods and beverages that are known irritants to the bladder. Which of the following should the nurse encourage the family to consider limiting? Select all that apply.

A) milk and cheese
B) colas and teas
C) oranges and grapefruits
D) grains