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Chapter 27: The Child with Genitourinary Dysfunction

MULTIPLE CHOICE
1. The nurse is conducting a staff in-service on renal ultrasounds. Which statement describes this

diagnostic test?
a. Computed tomography uses external radiation to visualize the renal system.
b. Visualization of the renal system is accomplished without exposure to radiation or

radioactive isotopes.
c. Contrast medium and x-rays allow for visualization of the renal system.
d. External radiation for x-ray films is used to visualize the renal system, before,

during, and after voiding.


ANS: A

A renal ultrasound transmits ultrasonic waves through the renal parenchyma allowing for
visualization of the renal system without exposure to external beam radiation or radioactive
isotopes. Computed tomography uses external radiation and sometimes contrast media to
visualize the renal system. An intravenous pyelogram uses contrast medium and external
radiation for x-ray films. The voiding cystourethrogram visualizes the renal system with
injection of a contrast media into the bladder through the urethral opening and use of x-ray
before, during, and after voiding.
PTS: 1
DIF: Cognitive Level: Understand
REF: 908
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
2. The nurse is admitting a school-age child in acute renal failure with reduced glomerular

filtration rate. Which urine test is the most useful clinical indication of glomerular filtration
rate?
a. pH
b. Osmolality
c. Creatinine
d. Protein level
ANS: C

The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a
substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The
pH and osmolality are not estimates of glomerular filtration. Although protein in the urine
demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.
PTS: 1
DIF: Cognitive Level: Understand
REF: 904
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
3. The nurse is conducting an assessment on a school-age child with urosepsis. Which

assessment finding should the nurse expect?


Fever with a positive blood culture
Proteinuria and edema
Oliguria and hypertension
Anemia and thrombocytopenia

a.
b.
c.
d.

ANS: A

Symptoms of urosepsis include a febrile UTI coexisting with systemic signs of bacterial
illness; blood culture reveals presence of urinary pathogen. Proteinuria and edema are
symptoms of minimal change nephrotic syndrome (MCNS). Oliguria and hypertension are
symptoms of acute glomerulonephritis (AGN). Anemia and thrombocytopenia are symptoms
of hemolytic uremic syndrome (HUS).
PTS: 1
DIF: Cognitive Level: Analyze
REF: 906
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
4. The nurse is teaching parents about prevention of urinary tract infections in children. Which

factor predisposes the urinary tract to infection?


Increased fluid intake
Short urethra in young girls
Prostatic secretions in males
Frequent emptying of the bladder

a.
b.
c.
d.

ANS: B

The short urethra in females provides a ready pathway for invasion of organisms. Increased
fluid intake and frequent emptying of the bladder offer protective measures against urinary
tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.
PTS: 1
DIF: Cognitive Level: Understand
REF: 908
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
5. Which should the nurse recommend to prevent urinary tract infections in young girls?
a. Wear cotton underpants.
b. Limit bathing as much as possible.
c. Increase fluids; decrease salt intake.
d. Cleanse perineum with water after voiding.
ANS: A

Cotton underpants are preferable to nylon underpants. No evidence exists that limiting
bathing, increasing fluids/decreasing salt intake, or cleansing the perineum with water after
voiding decrease urinary tract infections in young girls.
PTS: 1
DIF: Cognitive Level: Apply
REF: 910
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
6. The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which

finding in this newborn?


Absence of a urethral opening is noted.
Penis appears shorter than usual for age.
The urethral opening is along the dorsal surface of the penis.
The urethral opening is along the ventral surface of the penis.

a.
b.
c.
d.

ANS: D

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 refers to the urethral opening, not to the size of the penis. Urethral opening along
ventral surface of penis is known as epispadias.
PTS: 1
DIF: Cognitive Level: Understand
REF: 912
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
7. The nurse is conducting a staff in-service on newborn defects of the genitourinary system.

Which describes the narrowing of the preputial opening of the foreskin?


a. Chordee
b. Phimosis
c. Epispadias
d. Hypospadias
ANS: B

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.
PTS: 1
DIF: Cognitive Level: Remember
REF: 912
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
8. Which is an objective of care for a 10-year-old child with minimal change nephrotic

syndrome?
Reduce blood pressure.
Reduce excretion of urinary protein.
Increase excretion of urinary protein.
Increase ability of tissues to retain fluid.

a.
b.
c.
d.

ANS: B

The objectives of therapy for the child with minimal change nephrotic syndrome include
reduction of the excretion of urinary protein, reduction of fluid retention, prevention of
infection, and minimization of complications associated with therapy. Blood pressure is
usually not elevated in minimal change nephrotic syndrome. Excretion of urinary protein and
fluid retention are part of the disease process and must be reversed.
PTS: 1
DIF: Cognitive Level: Apply
REF: 914
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
9. Which is instituted for the therapeutic management of minimal change nephrotic syndrome?
a. Corticosteroids
b. Antihypertensive agents
c. Long-term diuretics
d. Increased fluids to promote diuresis
ANS: A

Corticosteroids are the first line of therapy for minimal change nephrotic syndrome. 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.
PTS: 1
DIF: Cognitive Level: Apply
REF: 914
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
10. Which is a common side effect of short-term corticosteroid therapy?
a. Fever
b. Hypertension
c. Weight loss
d. Increased appetite
ANS: D

Side effects of short-term 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.
PTS: 1
DIF: Cognitive Level: Understand
REF: 914
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
11. The nurse closely monitors the temperature of a child with minimal change nephrotic

syndrome. The purpose of this assessment is to detect an early sign of which possible
complication?
a. Infection
b. Hypertension
c. Encephalopathy
d. Edema
ANS: A

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.
Temperature is not an indication of hypertension or edema. Encephalopathy is not a
complication usually associated with minimal change nephrotic syndrome. The child will
most likely have neurologic signs and symptoms.
PTS: 1
DIF: Cognitive Level: Understand
REF: 914
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
12. A hospitalized child with minimal change nephrotic syndrome is receiving high doses of

prednisone. Which is an appropriate nursing goal related to this?


Prevent infection.
Stimulate appetite.
Detect evidence of edema.
Ensure compliance with prophylactic antibiotic therapy.

a.
b.
c.
d.

ANS: A

High-dose steroid therapy has an immunosuppressant effect. These children are particularly
vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk
of infection by protecting the child from contact with infectious individuals. Appetite is
increased with prednisone therapy. The amount of edema should be monitored as part of the
disease process, not necessarily related to the administration of prednisone. Antibiotics would
not be used as prophylaxis.
PTS: 1
DIF: Cognitive Level: Apply
REF: 914
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
13. Which is included in the diet of a child with minimal change nephrotic syndrome?
a. High protein
b. Salt restriction
c. Low fat
d. High carbohydrate
ANS: B

Salt is usually restricted (but not eliminated) during the edema phase. The child has 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.
PTS: 1
DIF: Cognitive Level: Understand
REF: 914
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort
14. Which best describes acute glomerulonephritis?
a. Occurs after a urinary tract infection
b. Occurs after a streptococcal infection
c. Associated with renal vascular disorders
d. Associated with structural anomalies of genitourinary tract
ANS: B

Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal


infection with certain strains of the group A -hemolytic streptococcus. Acute
glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal
vascular disorders or genitourinary tract structural anomalies.
PTS: 1
DIF: Cognitive Level: Understand
REF: 915
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
15. A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis

during this acute phase to show:


bacteriuria, hematuria.
hematuria, proteinuria.
bacteriuria, increased specific gravity.
proteinuria, decreased specific gravity.

a.
b.
c.
d.

ANS: B

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

PTS: 1
DIF: Cognitive Level: Understand
REF: 915
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
16. A mother asks the nurse what would be the first indication that acute glomerulonephritis is

improving. The nurses best response should be that the:


blood pressure will stabilize.
the child will have more energy.
urine will be free of protein.
urinary output will increase.

a.
b.
c.
d.

ANS: D

An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood
pressure is elevated, stabilization usually occurs with the improvement in renal function. The
child having more energy and the urine being free of protein are related to the improvement in
urinary output.
PTS: 1
DIF: Cognitive Level: Apply
REF: 916
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
17. The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute

glomerulonephritis. This is most likely the result of:


a. poor appetite.
b. increased potassium intake.
c. reduction of edema.
d. restriction to bed rest.
ANS: C

This amount of weight loss in this period is a result of the improvement of renal function and
mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8
pounds in 4 days. Foods with substantial amounts of potassium are avoided until renal
function is normalized.
PTS: 1
DIF: Cognitive Level: Understand
REF: 916
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
18. The nurse is teaching the parent about the diet of a child experiencing severe edema

associated with acute glomerulonephritis. Which information should the nurse include in the
teaching?
a. You will need to decrease the number of calories in your childs diet.
b. Your childs diet will need an increased amount of protein.
c. You will need to avoid adding salt to your childs food.
d. Your childs diet will consist of low-fat, low-carbohydrate foods.
ANS: C

For most children, a regular diet is allowed, but it should contain no added salt. The child
should be offered a regular diet with favorite foods. Severe sodium restrictions are not
indicated.

PTS: 1
DIF: Cognitive Level: Apply
REF: 916
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort
19. Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis?
a. Risk for Injury related to malignant process and treatment
b. Fluid Volume Deficit related to excessive losses
c. Fluid Volume Excess related to decreased plasma filtration
d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces
ANS: C

Glomerulonephritis has a decreased filtration of plasma, which 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.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 915
TOP: Integrated Process: Nursing Process: Nursing Diagnosis
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
20. The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding

associated with this tumor?


Abdominal swelling
Weight gain
Hypotension
Increased urinary output

a.
b.
c.
d.

ANS: A

The initial assessment finding with a Wilms (kidney) tumor is abdominal swelling. Weight
loss, not weight gain, may be a finding. Hypertension occasionally occurs with a Wilms
tumor. Urinary output is not increased, but hematuria may be noted.
PTS: 1
DIF: Cognitive Level: Understand
REF: 917
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
21. Which is the most common cause of acute renal failure in children?
a. Pyelonephritis
b. Tubular destruction
c. Urinary tract obstruction
d. Severe dehydration
ANS: D

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. Obstructive uropathy may cause
acute renal failure, but it is not the most common cause.
PTS: 1
DIF: Cognitive Level: Understand
REF: 919
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

22. The nurse is conducting an admission assessment on a school-age child with acute renal

failure. Which are the primary clinical manifestations the nurse expects to find with this
condition?
a. Oliguria and hypertension
b. Hematuria and pallor
c. Proteinuria and muscle cramps
d. Bacteriuria and facial edema
ANS: A

The principal feature of acute renal failure is oliguria; hypertension is a nonspecific clinical
manifestation. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial
edema are not principal features of acute renal failure.
PTS: 1
DIF: Cognitive Level: Understand
REF: 919
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
23. The nurse is caring for a child with acute renal failure. Which clinical manifestation should

the nurse recognize as a sign of hyperkalemia?


Dyspnea
Seizure
Oliguria
Cardiac arrhythmia

a.
b.
c.
d.

ANS: D

Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia
include electrocardiograph 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.
PTS: 1
DIF: Cognitive Level: Apply
REF: 920
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
24. When a child has chronic renal failure, the progressive deterioration produces a variety of

clinical and biochemical disturbances that eventually are manifested in the clinical syndrome
known as:
a. uremia.
b. oliguria.
c. proteinuria.
d. pyelonephritis.
ANS: A

Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is


diminished urinary output. Proteinuria is the presence of protein, usually albumin, in the urine.
Pyelonephritis is an inflammation of the kidney and renal pelvis.
PTS: 1
DIF: Cognitive Level: Remember
REF: 921
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

25. Which is a major complication in a child with chronic renal failure?


a. Hypokalemia
b. Metabolic alkalosis
c. Water and sodium retention
d. Excessive excretion of blood urea nitrogen
ANS: C

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.
PTS: 1
DIF: Cognitive Level: Understand
REF: 921
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
26. Which clinical manifestation would be seen in a child with chronic renal failure?
a. Hypotension
b. Massive hematuria
c. Hypokalemia
d. Unpleasant uremic breath odor
ANS: D

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 urinary output occurs. Hyperkalemia is a concern in
chronic renal failure.
PTS: 1
DIF: Cognitive Level: Understand
REF: 922
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
27. One of the clinical manifestations of chronic renal failure is uremic frost. Which best

describes this term?


Deposits of urea crystals in urine
Deposits of urea crystals on skin
Overexcretion of blood urea nitrogen
Inability of body to tolerate cold temperatures

a.
b.
c.
d.

ANS: B

Uremic frost is the deposition of urea crystals on the skin. The urea crystals are present 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.
PTS: 1
DIF: Cognitive Level: Understand
REF: 922
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
28. Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of

this is to:
a. prevent vomiting.
b. bind phosphorus.
c. stimulate appetite.

d. increase absorption of fat-soluble vitamins.


ANS: B

Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal


absorption and the serum levels of phosphate. Serum calcium levels are increased by the
calcium carbonate, and vitamin D administration is necessary to increase calcium absorption.
Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of
fat-soluble vitamins.
PTS: 1
DIF: Cognitive Level: Apply
REF: 922
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
29. Which should the nurse recommend for the diet of a child with chronic renal failure?
a. High in protein
b. Low in vitamin D
c. Low in phosphorus
d. Supplemented with vitamins A, E, and K
ANS: C

Dietary phosphorus is controlled by the reduction of protein and milk intake to prevent or
control the calcium-phosphorus imbalance. Protein should be limited in chronic renal failure
to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to
increase calcium absorption. Supplementation of vitamins A, E, and K is not part of dietary
management in chronic renal disease.
PTS: 1
DIF: Cognitive Level: Apply
REF: 922
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort
30. The nurse is caring for an adolescent who has just started dialysis. The child seems always

angry, hostile, or depressed. The nurse should recognize that this is most likely related to:
neurologic manifestations that occur with dialysis.
physiologic manifestations of renal disease.
adolescents having few coping mechanisms.
adolescents often resenting the control and enforced dependence imposed by
dialysis.

a.
b.
c.
d.

ANS: D

Older children and adolescents need control. The necessity of dialysis forces the adolescent
into a dependent relationship, which results in these behaviors. These are a function of the
childs age, not neurologic or physiologic manifestations of the dialysis. Feelings of anger,
hostility, and depression are functions of the childs age, not neurologic or physiologic
manifestations of the dialysis. Adolescents do have coping mechanisms, but they need to have
some control over their disease management.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 923
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance
31. Which is an advantage of peritoneal dialysis?
a. Treatments are done in hospitals.

b. Protein loss is less extensive.


c. Dietary limitations are not necessary.
d. Parents and older children can perform treatments.
ANS: D

Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish
to remain independent. Parents and older children can perform the treatments themselves.
Treatments can be done at home. Protein loss is not significantly different. The dietary
limitations are necessary, but they are not as stringent as those for hemodialysis.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 923
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
32. Which statement is descriptive of renal transplantation in children?
a. It is an acceptable means of treatment after age 10 years.
b. It is the preferred means of renal replacement therapy in children.
c. Children can receive kidneys only from other children.
d. The decision for transplantation is difficult because a relatively normal lifestyle is

not possible.
ANS: B

Renal transplant offers the opportunity for a relatively normal life and is the preferred means
of renal replacement therapy in end-stage renal disease. Renal transplantation can be done in
children as young as age 6 months. Both children and adults can serve as donors for renal
transplant purposes. Renal transplantation affords the child a more normal lifestyle than
dependence on dialysis.
PTS: 1
DIF: Cognitive Level: Understand
REF: 925
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
33. A preschool child is being admitted to the hospital with dehydration and a urinary tract

infection (UTI). Which urinalysis result should the nurse expect with these conditions?
WBC <1; specific gravity 1.008
WBC <2; specific gravity 1.025
WBC >2; specific gravity 1.016
WBC >2; specific gravity 1.030

a.
b.
c.
d.

ANS: D

WBC count in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary
tract inflammatory process. The urinalysis specific gravity for children with normal fluid
intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low
specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient
antidiuretic hormone secretion.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 907
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
34. The nurse is conducting teaching for an adolescent being discharged to home after a renal

transplant. The adolescent needs further teaching if which statement is made?

a.
b.
c.
d.

I will report any fever to my primary health care provider.


I am glad I only have to take the immunosuppressant medication for two weeks.
I will observe my incision for any redness or swelling.
I wont miss doing kidney dialysis every week.

ANS: B

The immunosuppressant medications are taken indefinitely after a renal transplant, so they
should not be discontinued after two weeks. Reporting a fever and observing an incision for
redness and swelling are accurate statements. The adolescent is correct in indicating dialysis
will not need to be done after the transplant.
PTS: 1
DIF: Cognitive Level: Apply
REF: 925
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
35. The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of

recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement


indicates the parents have understood the teaching?
a. These injections will help with the hypertension.
b. Were glad the injections only need to be given once a month.
c. The red blood cell count should begin to improve with these injections.
d. Urine output should begin to improve with these injections.
ANS: C

Anemia in children with CRF is related to decreased production of erythropoietin.


Recombinant human erythropoietin (rHuEPO) is being offered to these children as thriceweekly or weekly subcutaneous injections and is replacing the need for frequent blood
transfusions. The parents understand the teaching if they say that the red blood cell count will
begin to improve with these injections.
PTS: 1
DIF: Cognitive Level: Apply
REF: 916 | 923
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
36. A school-age child with chronic renal failure is admitted to the hospital with a serum

potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to
administer?
a. Spironolactone (Aldactone)
b. Sodium polystyrene sulfonate (Kayexalate)
c. Lactulose (Cephulac)
d. Calcium carbonate (Calcitab)
ANS: B

Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene
sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium
sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is
administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may
be prescribed as a calcium supplement, but it will not reduce serum potassium levels.
PTS: 1
DIF: Cognitive Level: Apply
REF: 920
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

MULTIPLE RESPONSE
1. The nurse is caring for an infant with a suspected urinary tract infection. Which clinical

manifestations should be expected? (Select all that apply.)


a. Vomiting
b. Jaundice
c. Failure to gain weight
d. Swelling of the face
e. Back pain
f. Persistent diaper rash
ANS: A, C, F

Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations
observed in an infant with a UTI.
PTS: 1
DIF: Cognitive Level: Understand
REF: 909
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
2. A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria.

Which dietary menu items should be allowed for this child? (Select all that apply.)
Apples
Bananas
Cheese
Carrot sticks
Strawberries

a.
b.
c.
d.
e.

ANS: A, D, E

Moderate sodium restriction and even fluid restriction may be instituted for children with
acute glomerulonephritis. Foods with substantial amounts of potassium are generally
restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items
low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium.
Those items would be restricted.
PTS: 1
DIF: Cognitive Level: Apply
REF: 916
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
3. A school-age child has been admitted to the hospital with an exacerbation of nephrotic

syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that
apply.)
a. Weight loss
b. Facial edema
c. Cloudy smoky brown-colored urine
d. Fatigue
e. Frothy-appearing urine
ANS: B, D, E

A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing
urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy
smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic
syndrome because there is no gross hematuria associated with nephrotic syndrome.
PTS: 1
DIF: Cognitive Level: Apply
REF: 914
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
4. A 6-year-old child is scheduled for an IV urography (IVP) in the morning. Which preparatory

interventions should the nurse plan to implement? (Select all that apply.)
a. Clear liquids in the morning before the procedure
b. Cathartic in the evening before the procedure
c. Soapsuds enema the morning of the procedure
d. Insertion of a Foley catheter before the procedure
e. Teaching with regard to insertion of an intravenous catheter before the procedure
ANS: B, C, E

The IV urography is a test done to provide information about the integrity of the kidneys,
ureters, and bladder. It requires an IV injection of a contrast medium with X-ray films made 5,
10, and 15 minutes after injection. Delayed films (30, 60 minutes, and so on) are also
obtained. The preparation for children ages 2 to 14 years includes cathartic on the evening
before examination, nothing orally after midnight, and an enema (soapsuds) on the morning of
examination. Teaching about the insertion of an intravenous catheter should be part of the
preoperative preparation. Insertion of a Foley catheter is not part of the preparation for an IVP.
PTS: 1
DIF: Cognitive Level: Apply
REF: 905
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
SHORT ANSWER
1. The nurse is performing a pH dipstick test on a urine specimen. Which is the average pH

expected for this test? (Record your answer in a whole number.)


ANS:

6
The average pH for urine is 6. The normal range is 4.8 to 7.8. Abnormal pH levels are
associated with urinary infection and metabolic alkalosis or acidosis.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 907
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation