Question 1

What major complication is noted in a child with chronic renal failure?

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 the term used to identify when the meatal opening is located on the dorsal surface of the penis?

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 3

A child is admitted with acute glomerulonephritis.The nurse would expect the urinalysis during this acute phase to show:

Accepted Answer

Urinalysis during the acute phase characteristically shows hematuria and proteinuria.Bacteriuria and changes in specific gravity are not usually present during the acute phase.

Question 4

Which factor predisposes a child to urinary tract infections?

Accepted Answer

The short urethra in females provides a ready pathway for invasions of organisms.Increased fluid intake and frequent bladder emptying offer protective measures against urinary tract infections.Prostatic secretions have antibacterial properties that inhibit bacteria.

Question 5

What intervention is a component of the therapeutic management of nephrosis?

Accepted Answer

Corticosteroids are the first line of therapy for nephrosis.Response is usually seen within 7 to 21 days.Antihypertensive agents and long-term diuretic therapy are usually not necessary.A diet that has fluid and salt restrictions may be indicated.

Question 6

The nurse,caring for a child with acute renal failure,should recognize event as a sign of hyperkalemia?

Accepted Answer

Hyperkalemia is the most common threat to the life of the child.Signs of hyperkalemia include electrocardiographic anomalies such as prolonged QRS complex,depressed ST segments,peaked T waves,bradycardia,or heart block.Dyspnea,seizure,and oliguria are not manifestations of hyperkalemia.

Question 7

The nurse understands that hypospadias refers to what urinary anomaly?

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,but not at the glans.Hypospadias does not refer to the size of the penis.When the urethral opening is along the dorsal surface of the penis,it is known as epispadias.

Question 8

Which clinical manifestation would be seen in a child with chronic renal failure?

Accepted Answer

Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products.Hypertension may be a complication of chronic renal failure.With chronic renal failure,little or no urine output occurs.Hyperkalemia is a concern in chronic renal failure.

Question 9

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

Accepted Answer

Prophylactic antibiotics are used to prevent urinary tract infections (UTIs)in a child with vesicoureteral reflux,although this treatment plan has become controversial.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 10

The nurse closely monitors the temperature of a child diagnosed with nephrosis.The purpose of this is to detect an early sign of what undesirable outcome?

Accepted Answer

Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy.An increased temperature could be an indication of an infection,but it is not an indication of hypertension or edema.Encephalopathy is not a complication usually associated with nephrosis.The child will most likely have neurologic signs and symptoms.

Question 11

What is the most common cause of acute renal failure in children?

Accepted Answer

The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume.Pyelonephritis and tubular destruction are not common causes of acute renal failure in children.Obstructive uropathy may cause acute renal failure,but it is not the most common cause.

Question 12

An objective of care for the child with nephrosis is what desired outcome?

Accepted Answer

The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein,reduction of fluid retention,prevention of infection,and minimizing of complications associated with therapy.Blood pressure is usually not elevated in nephrosis.Increased excretion of urinary protein and increased ability of tissues to retain fluid are part of the disease process and must be reversed.

Question 13

What is a common side effect of corticosteroid therapy?

Accepted Answer

Side effects of corticosteroid therapy include an increased appetite.Fever is not a side effect of therapy.It may be an indication of infection.Hypertension is not usually associated with initial corticosteroid therapy.Weight gain,not weight loss,is associated with corticosteroid therapy.

Question 14

When a child diagnosed with chronic renal failure,the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as what?

Accepted Answer

Uremia is the retention of nitrogenous products,producing toxic symptoms.Oliguria is diminished urine output.Proteinuria is the presence of protein,usually albumin,in the urine.Pyelonephritis is an inflammation of the kidney and renal pelvis.

Question 15

What should the nurse recommend to prevent urinary tract infections in young girls?

Accepted Answer

Cotton underpants are preferable to nylon underpants.No evidence exists that limiting bathing,increasing fluids,decreasing salt intake,or cleansing the perineum with water decreases urinary tract infections in young girls.

Question 16

What is the most appropriate nursing diagnosis for the child with acute glomerulonephritis?

Accepted Answer

Glomerulonephritis has a decreased filtration of plasma.The decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes,leading to circulatory congestion and edema.No malignant process is involved in acute glomerulonephritis.A fluid volume excess is found.The fluid accumulation is secondary to the decreased plasma filtration,not fluid accumulation.

Question 17

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

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 18

The diet of a child with nephrosis usually includes requirement?

Accepted Answer

Salt is usually restricted (but not eliminated)during the edema phase.The child has very little appetite during the acute phase.Favorite foods are provided (with the exception of high-salt ones)in an attempt to provide nutritionally complete meals.

Question 19

One of the clinical manifestations of chronic renal failure is uremic frost.Which best describes this term?

Accepted Answer

Uremic frost is the deposition of urea crystals on the skin,not in the urine.The kidneys are unable to excrete blood urea nitrogen,leading to elevated levels.There is no relation between cold temperatures and uremic frost.

Question 20

Which diagnostic test allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes?

Accepted Answer

The transmission of ultrasonic waves through the renal parenchyma allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes.Computed tomography uses external radiation,and sometimes contrast media are used.Intravenous pyelography uses contrast medium and external radiation for x-ray films.Contrast medium is injected into the bladder through the urethral opening for voiding cystourethrography.External radiation for x-ray films is used before,during,and after voiding.

Quiz 45: The Child With Genitourinary Dysfunction