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Silvestri Chapter 34 Ed#55E

Silvestri Chapter 34 Ed#55E

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Published by Linda Kuglarz

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Published by: Linda Kuglarz on Oct 14, 2008
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Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 034 (edited file)—"Renal and Urinary Disorders"10/14/08, Page 1 of 9, 1 Figure(s), 0 Table(s), 2 Box(es)
34: Renal and Urinary Disorders
PRACTICE QUESTIONS
1. A nurse is reviewing the health record of a child recently diagnosed with glomerulonephritis.Which finding noted in the child’s record is associated with the diagnosis of glomerulonephritis?1. Streptococcal throat infection 2 weeks prior to diagnosis2. Child fell off a bike onto the handlebars3. Nausea and vomiting for the last 24 hours4. Urticaria and itching for 1 week prior to diagnosisAnswer: 1Rationale: Group A beta-hemolytic streptococcal infection is a cause of glomerulonephritis.Often, the child becomes ill with streptococcal infection of the upper respiratory tract and thendevelops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2weeks. The data in options 2, 3, and 4 are unrelated to a diagnosis of glomerulonephritis.Test-Taking Strategy: Use knowledge regarding the causes of glomerulonephritis and the process of elimination to answer the question. Option 2 relates to a kidney injury. Options 3 and4 are not related to the diagnosis of glomerulonephritis. Review the causes of glomerulonephritis if you had difficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: Child HealthReference: Price, D., & Gwin, J. (2005).
Thompson’s pediatric nursing 
(9th ed.). Philadelphia:W.B. Saunders, p. 245. 2. A nurse is assigned to care for a child suspected of having glomerulonephritis. The nursereviews the child’s record and notes that which finding is associated with the diagnosis of glomerulonephritis?1. Low blood urea nitrogen (BUN) level2. Hypotension3. Low urinary specific gravity4. Red-brown urineAnswer: 4Rationale: Gross hematuria resulting in dark, smoky, cola-colored or red-brown urine is a classicsymptom of glomerulonephritis. Hypertension is also common. BUN levels may be elevated. Amid to high urinary specific gravity is associated with glomerulonephritis.Test-Taking Strategy: Use the process of elimination. Eliminate options 2 and 3 first becausehypertension and a high specific gravity is most likely to occur in this kidney disorder. Recallingthat BUN levels elevate will assist in directing you to option 4 from the remaining options. If you had difficulty with this question, review the clinical manifestations associated withglomerulonephritis.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data Collection
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 034 (edited file)—"Renal and Urinary Disorders"10/14/08, Page 2 of 9, 1 Figure(s), 0 Table(s), 2 Box(es)
Content Area: Child HealthReference: Price, D., & Gwin, J. (2005).
Thompson’s pediatric nursing 
(9th ed.). Philadelphia:W.B. Saunders, p. 245.3. A nurse is assisting in developing a plan of care for a 7-year-old child diagnosed with acuteglomerulonephritis. The nurse includes which intervention in the plan of care?1. Encourage limited activity and provide safety measures.2. Catheterize the child to strictly monitor intake and output.3. Force intake of oral fluids to prevent hypovolemic shock.4. Encourage classmates to visit and to keep the child informed of school events.Answer: 1Rationale: Activity is limited and most children, because of fatigue, voluntarily restrict their activities during the active phase of the disease. Catheterization may cause a risk of infection.Fluids should not be forced. Visitors should be limited to allow for adequate rest.Test-Taking Strategy: Use the process of elimination. Eliminate option 4 because rest is the priority over socialization. Eliminate option 2 next. Although monitoring I&O is essential, therisk of infection could occur with catheterization. From the remaining options, eliminate option3 because of the words “force fluids.” Review the appropriate nursing interventions for the childwith glomerulonephritis, if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/PlanningContent Area: Child HealthReference: Price, D., & Gwin, J. (2005).
Thompson’s pediatric nursing 
(9th ed.). Philadelphia:W.B. Saunders, p. 246.4. A nurse is assisting in performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome. The nurse collects data knowing that a commoncharacteristic associated with nephrotic syndrome is:1. Generalized edema2. Frank bright red blood in the urine3. Increased urinary output4. HypotensionAnswer: 1Rationale: Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, and edema.Urine is dark, foamy, and frothy, but microscopic hematuria may be present; frank bright red blood in the urine does not occur. Urine output is decreased and the blood pressure is normal or slightly decreased.Test-Taking Strategy: Use the process of elimination. Eliminate option 3 first, because urineoutput is most likely to be decreased in a renal disorder. From the remaining options, associateedema with nephrotic syndrome because this will be helpful to you if you encounter a similar question. If you had difficulty with this question, review the characteristics of nephroticsyndrome.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data Collection
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 034 (edited file)—"Renal and Urinary Disorders"10/14/08, Page 3 of 9, 1 Figure(s), 0 Table(s), 2 Box(es)
Content Area: Child HealthReference: Price, D., & Gwin, J. (2005).
Thompson’s pediatric nursing 
(9th ed.). Philadelphia:W.B. Saunders, p. 247.5. A 7-year-old child is seen in the clinic and the primary health care provider documents adiagnosis of primary nocturnal enuresis. The mother asks the nurse about the diagnosis. Thenurse bases the response of the fact that primary nocturnal enuresis:1. Requires surgical intervention to improve the problem2. Is caused by a psychiatric problem3. Is common and most children will outgrow bed-wetting without therapeutic intervention4. Does not respond to treatmentAnswer: 3Rationale: Primary nocturnal enuresis occurs in a child that has never been dry at night for extended periods. It is common in children and most children will eventually outgrow bed-wetting without therapeutic intervention. The child is not able to sense a full bladder and doesnot awaken to void. The child may have delayed maturation of the central nervous system(CNS). It is not caused by a psychiatric problem.Test-Taking Strategy: Use the process of elimination. Note the relationship between the words“enuresis” in the question and “bed-wetting” in the correct option. If you had difficulty with thisquestion, review the characteristics associated with enuresis.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/PlanningContent Area: Child HealthReference: Leifer, G. (2005).
Maternity nursing 
(9th ed.). Philadelphia: W.B. Saunders, p. 431.6. A nurse is caring for an 8-month-old infant. A urinalysis has been ordered and the nurse plans to collect the specimen. The nurse implements which appropriate method to collect thespecimen?1. Catheterizes the infant, using a No. 5 French Foley2. Obtains the specimen from the diaper, using a syringe, after the infant voids3. Attaches a urinary collection device to the infant’s perineum4. Monitors the urinary patterns and prepares to collect the specimen into a cup when the infantvoidsAnswer: 3Rationale: Although many methods have been used to collect urine from an infant, the mostreliable method is the urine collection device. This device is a plastic bag that has an openinglined with adhesive so that it may be attached to the perineum. Urine for certain tests, such asspecific gravity, may be obtained from a diaper. Urinary catheterization is not to be done unlessspecifically prescribed, because of the risk of infection. It is not reasonable to monitor urinary patterns and attempt to collect the specimen in a cup when the infant voids.Test-Taking Strategy: Use the process of elimination. Eliminate option 4, because this isunrealistic. Eliminate option 1, because catheterization is not prescribed and the risk of infectionexists with this procedure. Eliminate option 2 because only certain tests can be done on the urinein a diaper. Review the procedure for collecting urine specimens from an infant if you haddifficulty with this question.

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