Question 1

A child is admitted to the hospital with suspected hemolytic uremic syndrome (HUS).Laboratory results indicate elevated BUN,creatinine,and potassium.Which action by the nurse takes priority?
A)Administer antibiotics.
B)Apply cardiac monitoring.
C)Insert a urinary catheter.
D)Obtain a stool sample.

Accepted Answer

An elevated potassium can cause serious,even fatal,dysrhythmias.The nurse applies cardiac monitoring first for patient safety.Inserting a urinary catheter and sending a stool sample are appropriate but do not take priority.Antibiotics are not given in HUS because they exacerbate the condition.

Question 2

The pediatric clinic nurse calls a parent to report urinalysis findings for her child including microscopic hematuria.Which question by the nurse is most appropriate?
A)"Has your child recently had strep throat?"
B)"Has your child been in a bike or car crash?"
C)"Has your child started menstruating yet?"
D)"Has your child taken lots of bubble baths?"

Accepted Answer

The most common causes of microscopic hematuria include UTI,poststreptococcal glomerulonephritis,hypercalciuria,and structural abnormalities.Trauma would more likely cause gross hematuria.The other two questions are appropriate depending on the age and sex of the child,but do not assess for the most common reasons for this finding.

Question 3

The parents of a child diagnosed with vesicoureteral reflux (VUR)want to know why their child's kidneys appear large on an abdominal x-ray.Which response by the nurse is the most appropriate?
A)Enlarged due to urine backup
B)Genetic defect causing VUR
C)Multiple tumors
D)Unrelated finding

Accepted Answer

In VUR,urine backflows into the kidneys,causing hydronephrosis,or distention of the kidneys.The other answers are incorrect.

Question 4

A nurse is obtaining a bagged urine collection on an infant.Which action by the nurse is most important?
A)Clean and powder the skin prior to bagging.
B)Remove the bag as soon as it contains urine.
C)Send the sample to the laboratory as soon as possible.
D)Use universal precautions,including gloves.

Accepted Answer

For infection control,the nurse uses universal precautions,including wearing gloves when collecting urine samples.The baby's skin should be clean and dry;powder will cause the bag to not adhere.The other answers are appropriate,but infection control and safety come first.

Question 5

An infant has poor feeding,fever,and malodorous urine.The parents do not want the nurse to catheterize the child.Which response by the nurse is the most appropriate?
A)Apply a urine collection bag on the baby.
B)Explain how this procedure obtains the best results.
C)Give the baby acetaminophen (Tylenol)for fever.
D)Inform the health-care provider of the refusal.

Accepted Answer

Parents can be understandably distraught at the thought of their baby having an invasive procedure.The nurse should ensure that the parents understand why the catheterized urine sample or a suprapubic aspirated urine sample is the best choice for obtaining the most accurate urinalysis results.If the parents still refuse,the nurse should document their refusal,inform the provider,and apply a collection bag.The nurse should also treat the baby's fever with acetaminophen,but this option is not directly related to the question.

Question 6

A child presents to the pediatric clinic,where the parent reports that the child has had bloody diarrhea and joint pain.Which diagnostic test does the nurse prepare the child and parent for first?
A)Echocardiogram
B)Skin assessment
C)Serum renal studies
D)Urinalysis

Accepted Answer

The classic signs of Henoch-Schönlein purpura are rash,gastrointestinal complaints (often bloody diarrhea),hematuria,and arthritis.The nurse needs to assess the child's skin for a rash.The diagnosis is usually made by clinical findings,as there is no specific diagnostic test.

Question 7

A 6-year-old child is scheduled for a voiding cystourethrogram.Which action by the nurse is the most appropriate?
A)Ask the parents about shellfish or iodine allergies.
B)Give the child a preprocedure cleansing enema.
C)Instruct the parents to give the child clear liquids afterward.
D)Provide developmentally appropriate teaching.

Accepted Answer

Because this test uses iodinized contrast material,it is important to assess for allergies to this substance or to iodine,which is often found in shellfish.Teaching would be provided but does not take priority over this important safety measure.There is no need for an enema.After the procedure,the child resumes a normal diet.

Question 8

A child is brought to the pediatric clinic,where the parent reports that the child has tea-colored urine and puffy eyes.Which diagnostic test does the nurse prepare the parent and child for based on the assessment findings?
A)BUN and creatinine
B)Intravenous pyelogram
C)Suprapubic aspiration
D)Voiding cystourethrogram

Accepted Answer

This child has manifestations of possible glomerulonephritis.To assess kidney function,the patient needs a BUN and creatinine.A pyelogram is used when kidney stones are suspected.Suprapubic aspiration is one way of collecting a sterile urine sample,but is very invasive.A voiding cystourethrogram is used to assess for reflux.

Question 9

A school-age female child has a urinary tract infection (UTI).The culture has come back positive for Escherichia coli.Which teaching measure is most important for the nurse to include in the teaching plan?
A)Avoid bubble baths and nylon panties.
B)Offer the child fluids frequently.
C)Place the child on a voiding schedule.
D)Teach the child to wipe from front to back.

Accepted Answer

All items are appropriate to teach when a child has a UTI.However,E.coli infection stems from contamination with fecal material.The female child should be taught to wipe from front to back to prevent this cross-contamination.

Question 10

A child is being treated for nephrotic syndrome.Which assessment finding indicates that an important goal for this child is being met?
A)Decreased abdominal girth
B)Diminished urine output
C)Improved rash
D)Increased weight over a week

Accepted Answer

The combination of fluid retention and protein loss through the urine produces ascites,or a swollen belly.Decreasing abdominal girth signifies that the disease is being successfully treated.Urine output is already diminished in nephrotic syndrome.There is no rash.Increasing weight means increased fluid retention,which would not be an improvement.

Question 11

A child has glomerulonephritis and hypertension.Which dietary modification is most appropriate for the nurse to suggest?
A)High fiber
B)High potassium
C)Low saturated fat
D)Low sodium

Accepted Answer

Hypertension in glomerulonephritis is usually due to fluid overload,and a sodium-restricted diet can help this problem.If the patient is on loop diuretics (often prescribed for hypertension in these patients),potassium is important.High fiber and low saturated fat are healthy diets for nearly everyone.

Question 12

A child is prescribed gentamycin (Garamycin)and develops acute kidney injury.Which etiology is the most likely cause of the child's acute kidney injury?
A)Intrarenal
B)Postrenal
C)Prerenal
D)Streptococcal

Accepted Answer

Gentamycin is one of the aminoglycoside antibiotics,which are known to be nephrotoxic,leading to intrarenal kidney injury.Prerenal kidney injury is due to decreased perfusion.Postrenal kidney injury is obstructive in nature.Strep infections can cause damage to body systems,but there is no indication this child had a strep infection.Gentamycin is directly related to an intrarenal injury.

Question 13

An infant is born with exstrophy of the bladder but otherwise appears healthy.Which nursing diagnosis is the priority for this infant?
A)Altered family processes
B)Fluid volume deficit
C)Hypothermia
D)Risk for infection

Accepted Answer

In this condition,the bladder is open on the abdominal wall,and priority interventions revolve around preventing infection.There is no indication that the child has fluid volume deficit or hypothermia.Altered family processes might be a diagnosis,but physical diagnoses take priority over psychosocial ones.

Question 14

A school-age child has renal disease and the parent wants to know how this could cause the child's hypertension.Which response by the nurse is the most appropriate?
A)"The high blood pressure caused the kidney disease."
B)"The kidneys regulate renin,which controls blood pressure."
C)"The medication your child takes often raises blood pressure."
D)"The renal diet includes a lot of sodium,which raises blood pressure."

Accepted Answer

The kidneys regulate renin,a hormone that controls blood pressure.Kidney abnormalities often affect renin,leading to hypertension.In a child this young,the kidney disease most likely came first;in adults,long-standing hypertension is a frequent cause of renal disease.Medications are not the reason.The typical renal diet is low in sodium.

Question 15

A child has acute kidney injury following a serious motor vehicle crash.Which intervention takes priority?
A)Administer IV fluids and blood products.
B)Insert an indwelling urinary catheter.
C)Monitor hourly urine output measurements.
D)Place the child on a low-sodium diet.

Accepted Answer

Hypovolemia,blood loss,and shock all can lead to prerenal kidney injury.The priority interventions include administering fluids and blood products if needed.An indwelling urinary catheter will be important for hourly urine output measurements,but this will not actively help the problem.A low-sodium diet may or may not be appropriate.

Question 16

An infant appears dehydrated.Laboratory results indicate a serum sodium of 143 mEq/L.Which fluid would the nurse use for IV replacement?
A)0.45% normal saline
B)0.9% normal saline
C)3% normal saline
D)D5W with 20 mEq KCL

Accepted Answer

This child has an isotonic dehydration,in which fluids and solutes are lost in balanced proportions,as evidenced by the normal serum sodium level.The child needs an isotonic IV solution,which would be 0.9% normal saline.The 0.45% normal saline ("half normal saline")is hypotonic,as is D5W,with or without potassium.The 3% normal saline is hypertonic.

Question 17

An acutely ill child is admitted for a suspected severe urinary tract infection (UTI).Which is the priority action by the nurse?
A)Administer broad-spectrum antibiotics as ordered.
B)Obtain a urine sample for culture and sensitivity.
C)Start an IV line for aggressive fluid resuscitation.
D)Teach the parents how to prevent future UTIs.

Accepted Answer

Antibiotics need to be started as soon as possible,but it is imperative to obtain a urine sample for a culture and sensitivity to guide medication choices first.While awaiting the results,the nurse will administer a broad-spectrum antibiotic.The child does need an IV,but there is no indication that the child needs aggressive fluid resuscitation.Teaching is always an important task,but does not take priority over obtaining the sample for urinalysis.

Question 18

A practicing nurse explains to a nursing student that which is the most common cause of acute renal failure in children?
A)Congenital renal problems
B)Glomerulonephritis
C)Hemolytic uremic syndrome
D)Tylenol (acetaminophen)overdose

Accepted Answer

Hemolytic uremic syndrome is most often associated with children eating undercooked meat and is the most common cause of acute renal failure in the pediatric population.Tylenol overdose is associated with liver failure.

Question 19

An adolescent on the cross-country track team had a urinalysis during a school physical that showed proteinuria.Which action by the nurse is the most appropriate?
A)Advise the teen not to run for 48 hours and repeat the test.
B)Collaborate with the provider to order kidney imaging tests.
C)Explain the finding is insignificant and does not need follow-up.
D)Take the teen's blood pressure on three separate occasions.

Accepted Answer

Proteinuria can be a benign finding,especially if it is noted after heavy exercise or fever.The teen should avoid exercise for 48 hours and repeat the test.At this point,further testing is not warranted.

Question 20

A child is in the emergency department following a car crash.Which finding noted by the nurse warrants immediate intervention?
A)Complains "I hurt all over."
B)Grey-Turner's sign
C)Increased WBCs
D)Tachycardia

Accepted Answer

Grey-Turner's sign is bruising in the flank area and can indicate a renal injury.The other signs would be expected after a traumatic event.

Quiz 31: Caring for the Child With a Genitourinary Condition

A child is admitted to the hospital with suspected hemolytic uremic syndrome (HUS) .Laboratory results indicate elevated BUN,creatinine,and potassium.Which action by the nurse takes priority?

The pediatric clinic nurse calls a parent to report urinalysis findings for her child including microscopic hematuria.Which question by the nurse is most appropriate?

The parents of a child diagnosed with vesicoureteral reflux (VUR) want to know why their child's kidneys appear large on an abdominal x-ray.Which response by the nurse is the most appropriate?

A nurse is obtaining a bagged urine collection on an infant.Which action by the nurse is most important?

An infant has poor feeding,fever,and malodorous urine.The parents do not want the nurse to catheterize the child.Which response by the nurse is the most appropriate?

A child presents to the pediatric clinic,where the parent reports that the child has had bloody diarrhea and joint pain.Which diagnostic test does the nurse prepare the child and parent for first?

A 6-year-old child is scheduled for a voiding cystourethrogram.Which action by the nurse is the most appropriate?

A child is brought to the pediatric clinic,where the parent reports that the child has tea-colored urine and puffy eyes.Which diagnostic test does the nurse prepare the parent and child for based on the assessment findings?

A school-age female child has a urinary tract infection (UTI) .The culture has come back positive for Escherichia coli.Which teaching measure is most important for the nurse to include in the teaching plan?

A child is being treated for nephrotic syndrome.Which assessment finding indicates that an important goal for this child is being met?

A child has glomerulonephritis and hypertension.Which dietary modification is most appropriate for the nurse to suggest?

A child is prescribed gentamycin (Garamycin) and develops acute kidney injury.Which etiology is the most likely cause of the child's acute kidney injury?

An infant is born with exstrophy of the bladder but otherwise appears healthy.Which nursing diagnosis is the priority for this infant?

A school-age child has renal disease and the parent wants to know how this could cause the child's hypertension.Which response by the nurse is the most appropriate?

A child has acute kidney injury following a serious motor vehicle crash.Which intervention takes priority?

An infant appears dehydrated.Laboratory results indicate a serum sodium of 143 mEq/L.Which fluid would the nurse use for IV replacement?

An acutely ill child is admitted for a suspected severe urinary tract infection (UTI) .Which is the priority action by the nurse?

A practicing nurse explains to a nursing student that which is the most common cause of acute renal failure in children?

An adolescent on the cross-country track team had a urinalysis during a school physical that showed proteinuria.Which action by the nurse is the most appropriate?

A child is in the emergency department following a car crash.Which finding noted by the nurse warrants immediate intervention?