Question 1

A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take?

Accepted Answer

The premonitory signs of encephalopathy are headache, dizziness, abdominal discomfort, and vomiting. If the condition progresses, there may be transient loss of vision or hemiparesis, disorientation, and generalized tonic-clonic seizures. The health care provider should be notified of these symptoms.

Question 2

The nurse is caring for a child with a urinary tract infection who is on intravenous gentamicin (Garamycin). What interventions should the nurse plan for this child with regard to this medication? (Select all that apply.)

Accepted Answer

Garamycin can cause renal toxicity and ototoxicity. Fluids should be encouraged and urinary output and serum peak and trough levels monitored. It is not necessary to monitor potassium sodium levels for patients taking this medication.

Question 3

Calculate the 24-hour maintenance fluid requirement for a child weighing 6 kg. Fill in the blank with ml/day. Record your answer in a whole number.
___________________

Accepted Answer

The answer of Calculate the 24-hour maintenance fluid requirement for...

Question 4

Parents of a child who will need hemodialysis ask the nurse, "What are the advantages of a fistula over a graft or external access device for hemodialysis?" What response should the nurse give? (Select all that apply.)

Accepted Answer

The creation of a subcutaneous (internal) arteriovenous fistula by anastomosing a segment of the radial artery and brachiocephalic vein produces dilation and thickening of the superficial vessels of the forearm to provide easy access for repeated venipuncture. Fewer complications and less restriction of activity are observed with the use of a fistula. Both the graft and the fistula require needle insertion at each dialysis. The fistula cannot be used immediately.

Question 5

Calculate the 24-hour maintenance fluid requirement for a child weighing 25 kg. Fill in the blank with ml/day. Record your answer in a whole number.
__________________

Accepted Answer

The answer of Calculate the 24-hour maintenance fluid requirement for...

Question 6

What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.)

Accepted Answer

The child with a kidney transplant who exhibits any of the following should be evaluated immediately for possible rejection: fever, diminished urinary output, and swelling and tenderness of graft area. Hypertension, not hypotension, and increased, not decreased, serum creatinine are signs of rejection.

Question 7

The nurse is preparing to admit a child to the hospital with a diagnosis of acute poststreptococcal glomerulonephritis. The nurse understands that the peak age at onset for this disease is what?

Accepted Answer

The peak age at onset for acute poststreptococcal glomerulonephritis is 5 to 7 years of age.

Question 8

What dietary instructions should the nurse give to parents of a child in the oliguria phase of acute glomerulonephritis with edema and hypertension? (Select all that apply.)

Accepted Answer

Dietary restrictions depend on the stage and severity of acute glomerulonephritis, especially the extent of edema. A regular diet is permitted in uncomplicated cases, but sodium intake is usually limited (no salt is added to foods). Moderate sodium restriction is usually instituted for children with hypertension or edema. Foods with substantial amounts of potassium are generally restricted during the period of oliguria. Protein restriction is reserved only for children with severe azotemia resulting from prolonged oliguria. A low-protein, high-fat diet with encouragement of fluids would not be recommended.

Question 9

What signs and symptoms are indicative of a urinary tract disorder in the childhood period (2 to 14 years)? (Select all that apply.)

Accepted Answer

Signs and symptoms of a urinary tract disorder in the childhood period are fatigue, growth failure, and blood in the urine. Edema is noted, not dehydration, and hypertension is present, not hypotension.

Question 10

A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show?

Accepted Answer

Urinalysis during the acute phase characteristically shows hematuria, proteinuria, and increased specific gravity. Proteinuria generally parallels the hematuria but is not usually the massive proteinuria seen in nephrotic syndrome. Gross discoloration of urine reflects its red blood cell and hemoglobin content. Microscopic examination of the sediment shows many red blood cells, leukocytes, epithelial cells, and granular and red blood cell casts. Bacteria are not seen, and urine culture results are negative.

Question 11

The nurse is caring for a child with acute renal failure. What laboratory findings should the nurse expect to find? (Select all that apply.)

Accepted Answer

A child with acute renal failure would have hyponatremia, hyperkalemia, and elevated blood urea nitrogen levels. The child would have metabolic acidosis, not alkalosis, and the plasma creatinine levels would be increased, not decreased.

Question 12

What signs and symptoms are indicative of a urinary tract disorder in the neonatal period (birth to 1 month)? (Select all that apply.)

Accepted Answer

Signs and symptoms of a urinary tract disorder in the neonatal period are frequent urination, poor urinary stream, and failure to gain weight. The respirations would be rapid, not slow, and dehydration, not edema, occurs.

Question 13

The nurse is caring for a child with a urinary tract infection who is on trimethoprim-sulfamethoxazole (Bactrim). What side effects of this medication should the nurse teach to the parents and the child? (Select all that apply.)

Accepted Answer

Side effects of Bactrim are rash, urticaria, and photosensitivity. Pneumonitis and renal toxicity are not side effects of Bactrim.

Question 14

What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply.)

Accepted Answer

The child with minimal change nephrotic syndrome maintains a regular diet, not soft. However, salt is restricted during periods of massive edema and while the patient is on corticosteroid therapy; no salt is added at the table, and foods with very high salt content are excluded. Although a low-sodium diet will not remove edema, its rate of increase may be reduced. Water is seldom restricted. A diet generous in protein is logical, but there is no evidence that it is beneficial or alters the outcome of the disease.

Question 15

A health care provider prescribes furosemide (Lasix), 10 mg intravenously (IV) now, for a child with acute glomerulonephritis. The medication label states: "Furosemide (Lasix) 20 mg/2 ml." The nurse prepares to administer the dose. How many milliliters will the nurse prepare to administer the dose? Fill in the blank. Record your answer in a whole number.
________________

Accepted Answer

The answer of A health care provider prescribes furosemide (Lasix),...

Question 16

What signs and symptoms are indicative of a urinary tract disorder in the infancy period (1-24 months)? (Select all that apply.)

Accepted Answer

Signs and symptoms of a urinary tract disorder in the infancy period are pallor, poor feeding, excessive thirst, and frequent urination. Hyperthermia is seen, not hypothermia.

Question 17

A child is hospitalized in acute renal failure and has a serum potassium greater than 7 mEq/L. What temporary measures that will produce a rapid but transient effect to reduce the potassium should the nurse expect to be prescribed? (Select all that apply.)

Accepted Answer

Several measures are available to reduce the serum potassium concentration, and the priority of implementation is usually based on the rapidity with which the measures are effective. Temporary measures that produce a rapid but transient effect are calcium gluconate, sodium bicarbonate, and glucose 50%, and insulin. Definitive but slower-acting measures are then implemented which include administration of a cation exchange resin such as sodium polystyrene sulfonate (Kayexalate), 1 g/kg, administered orally or rectally, and/or dialysis.

Question 18

The nurse is admitting a 9-year-old child with hemolytic uremic syndrome. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

Accepted Answer

Clinical manifestations of hemolytic uremic syndrome include anorexia; hypertension; and purpura, which persists for several days to 2 weeks. Gross hematuria is seen in acute glomerulonephritis. Substantial proteinuria and periorbital edema are common manifestations in nephrotic syndrome.

Question 19

What dietary instructions should the nurse give to parents of a child undergoing chronic hemodialysis? (Select all that apply.)

Accepted Answer

Dietary limitations are necessary in patients undergoing chronic dialysis to avoid biochemical complications. Fluid and sodium are restricted to prevent fluid overload and its associated symptoms of hypertension, cerebral manifestations, and congestive heart failure. Potassium is restricted to prevent complications related to hyperkalemia; phosphorus restriction helps prevent parathyroid hyperactivity and its attendant risk of abnormal calcification in soft tissues. Adequate protein, not high intake, is necessary to maximize growth potential. Fluid limitations are determined by residual urinary output and the need to limit intradialytic weight gain.

Question 20

The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what?

Accepted Answer

The peak age at onset for minimal change nephrotic syndrome is 2 to 3 years of age.

Quiz 25: The Child with Renal Dysfunction

A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take?

The nurse is caring for a child with a urinary tract infection who is on intravenous gentamicin (Garamycin) . What interventions should the nurse plan for this child with regard to this medication? (Select all that apply.)

Calculate the 24-hour maintenance fluid requirement for a child weighing 6 kg. Fill in the blank with ml/day. Record your answer in a whole number. ___________________

Parents of a child who will need hemodialysis ask the nurse, "What are the advantages of a fistula over a graft or external access device for hemodialysis?" What response should the nurse give? (Select all that apply.)

Calculate the 24-hour maintenance fluid requirement for a child weighing 25 kg. Fill in the blank with ml/day. Record your answer in a whole number. __________________