Chapter 16: Renal Disorders My Nursing Test Banks

Chapter 16: Renal Disorders

Multiple Choice

1. The father of a child with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. The nurse knows that:

1. The antibiotic therapy the child is receiving can influence increases in blood pressure.

2. The child can develop hypotension at any time because of the damage to the kidneys.

3. A child with this illness can have sudden increases in blood pressure without warning.

4. Blood pressure must be maintained within normal limits to make sure that the kidneys do not stop working.

ANS: 3

Feedback
1. Antibiotics do not cause increases in blood pressure unless an allergic reaction occurs.
2. The damage to the kidneys causes the blood pressure to increase drastically.
3. The illness can cause spikes in blood pressure without warning, causing concern about blood flow to the major organs of the body.
4. The goal is to maintain the blood pressure at a normal range, but the kidneys will not stop working if the blood pressure changes.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 16 | Type: Multiple Choice

2. Which of the following is the goal of care for a child with minimal change nephrotic syndrome?

1. Reducing the blood pressure

2. Decreasing the amount of protein in the urine

3. Lowering the sodium level within the blood

4. Increasing the permeability of the kidneys

ANS: 2

Feedback
1. Blood pressure will not be the main issue for the child at this time.
2. The kidney begins to break down and protein may be present. The goal is to stop the breakdown so that the kidney begins to function properly.
3. Sodium levels will not be an issue for a child with nephrotic syndrome.
4. Permeability is not the main concern at this point.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 |Type: Multiple Choice

3. A child with end-stage renal disease should have a diet consisting of:

1. High protein.

2. Ketogenics.

3. Low sodium and low protein.

4. Low carbohydrates and low potassium.

ANS: 3

Feedback
1. The kidneys cannot filter the protein, and thus should not be the prescribed diet.
2. A diet with low ketones is needed so that the kidneys do not need to work hard to filter material.
3. Low sodium and low protein will ensure that the kidneys do not need to work as hard to filter material out of the body.
4. Carbohydrates and potassium are not filtered within the kidney.

KEY: Content Area: Renal Disorders| Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 |Type: Multiple Choice

4. A child is having a cystoscopy procedure to:

1. Check kidney function.

2. Identify malformations of the ureters.

3. Visualize the bladder.

4. Measure urine output.

ANS: 3

Feedback
1. A cystoscopy looks at the lower renal tract.
2. The cystoscopy looks at the bladder and lower, not up to the ureters.
3. A cystoscopy views the bladder for any anomalies or injuries.
4. A cystoscopy is a visual procedure, not a collection procedure.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 |Type: Multiple Choice

5. A child has been scheduled for a cystourethrography. The nurse prepares the child by:

1. Following the order of NPO until after the procedure.

2. Assessing the childs allergies.

3. Discussing the IV insertion.

4. Discussing the placement of a Foley catheter.

ANS: 4

Feedback
1. The child does not need to be NPO for this procedure.
2. The procedure does not require medication, thus allergies are not a concern at this time.
3. An IV is not required for the procedure.
4. A Foley catheter will need to be placed to drain the urine. The procedure should be discussed with the child so he/she knows what to expect and can ask questions.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | REF: CHAPTER 16 |Type: Multiple Choice

6. A child with end-stage renal disease is being assessed by the nurse. The nurse notes crackles in the patients lungs. The nurse should:

1. Documents the lungs sounds.

2. Assess for shortness of breath and the respiratory rate.

3. Obtain a pulse oximetry reading.

4. All of the above should be done.

ANS: 4

Feedback
1. Documentation is needed for the comparison of the lung sounds at the next assessment.
2. Work of breathing can be an indicator as to how much fluid is building up in the body.
3. A pulse oximetry will notify the staff of the oxygenation status of the child.
4. All of the above steps should be done to ensure quality care for the patient.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 16 | Type: Multiple Choice

7. The nurse is assessing a child with end-stage renal disease would anticipate the cardiac system to:

1. Be functioning as well as a child who is not ill.

2. Have decreased blood pressure.

3. Have a lower pulse in the lower extremities.

4. All of the above are correct.

ANS: 3

Feedback
1. The child will be sluggish and not have responses like a child who is well.
2. The blood pressure will increase because of the lack of kidney function to filter toxins out from the body.
3. A lower pulse will occur in the extremities because of the lack of blood flow.
4. Only one choice is the correct answer.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 16 | Type: Multiple Choice

8. Vomiting in a child with chronic kidney disease can indicate:

1. Gastroenteritis.

2. A urinary tract infection.

3. Fluid volume depletion.

4. Food poisoning.

ANS: 2

Feedback
1. Gastroenteritis and vomiting are common in healthy children, but in a child with chronic kidney disease, this indicates that the child may have a UTI.
2. A UTI may cause vomiting in a child with chronic kidney disease.
3. Fluid volume should be monitored closely, but will not cause total depletion.
4. Food poisoning is not a cause for vomiting in a child with chronic kidney disease.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 | Type: Multiple Choice

9. A teenage girl has come to the nurses office at school because the last three times she has urinated, the urine has had a lot of bubbles. The nurse should:

1. Assess the amount of protein the girl has consumed within the last 24 hours.

2. Assess the fluid intake of the last 24 hours.

3. Question the girl about recent sexual activity.

4. Call the parents immediately because the girl needs medical attention.

ANS: 1

Feedback
1. Large amounts of ingested protein will get excreted in the urine, causing the bubbling appearance.
2. Protein needs to be present to cause the bubbling.
3. Urine does not contain bubbles when a sexually transmitted disease is present.
4. The girl does not need immediate attention, but the parents should be notified of the situation.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 16 |Type: Multiple Choice

10. A mother has called the triage nurse to find out which fluids she should give her son that has been vomiting for the last 12 hours. Identify the fluid that would be appropriate to give the child.

1. Water

2. Red Kool-Aid

3. Diet Cola

4. Red or orange Gatorade

ANS: 1

Feedback
1. Water provides adequate hydration without sugar, sodium, or caffeine to obtain a balance in electrolytes.
2. Kool-Aid contains sugar. Red drinks should be avoided because if there is any type of GI bleed, the red color disguises it.
3. Diet soda contains sodium, which will cause further electrolyte damage.
4. The color of the Gatorade will make it difficult to assess the vomitus fluid.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 16 |Type: Multiple Choice

11. A child that weighs 55 pounds requires __________ of fluid per day.

1. 800 ml

2. 500 ml

3. 300 ml

4. 200 ml

ANS: 2

Feedback
1. Too high of an amount
2. He/she should take in 20ml/kg/day.
3. Too low of an amount
4. Too low of an amount

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Analysis | REF: CHAPTER 16 |Type: Multiple Choice

12. A child with known renal disease will:

1. Grow the same, on average, as other children.

2. Have adequate weight gain.

3. Have an increased risk of being obese.

4. Need a growth hormone to reach an average height.

ANS: 2

Feedback
1. The child will have poor weight gain because of the increased metabolism needed for the body to maintain a balance, which results in poor nutrient absorption. So, the child will not grow at the same rate as his peers.
2. The child will have poor weight gain because of the increased metabolism needed for the body to maintain a balance, which results in poor nutrient absorption. So, the child will not grow at the same rate as his peers.
3. The child will have difficulty with absorption of nutrients and have an increased metabolic rate, which does not put the child at risk for obesity.
4. A growth hormone is depleted in chronic renal failure, causing short stature and poor weight gain.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 16 | Type: Multiple Choice

13. Ascites in a child with known renal disease would cause:

1. A decrease in cardiac output.

2. The kidneys to quit functioning.

3. Concern for a malfunctioning lymphatic system.

4. Increased fluid output.

ANS: 3

Feedback
1. The ascites comes from the lymphatic system malfunctioning, so the fluid builds up in the body.
2. The kidneys will continue to function, but they are unable to pull out enough fluid.
3. When the lymphatic system malfunctions, it causes the fluid to fill in the body, create the ascites.
4. The fluid is within the lymphatic system and is retained in ascites, so the urine output will be lower.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 16 |Type: Multiple Choice

14. A normal urine output for a child that weighs 40 pounds would be________.

Convert 40 pounds to kilograms = 18.18 kg

18.18 kg x 50 ml/day = 909 ml/day

909ml/24 hours = 37.8 ml/hour

1. 909 ml/hour

2. 40 ml/hour

3. 1000 ml/hour

4. 800 ml/hour

ANS: 1

Feedback
1. The correct calculation for a 40-pound child.
2. Too low of an amount
3. Too high of an amount
4. Too low of an amount

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 16 | Type: Multiple Choice

15. A child with renal disease is exhibiting muscle cramping. This is mostly likely caused by:

1. Hypercalcemia.

2. Hyponatremia.

3. Hyperkalemia.

4. All of the above choices are correct.

ANS: 2

Feedback
1. A child with renal disease is at a higher risk for hypocalcemia
2. A child is at risk for hyponatremia because of the inadequate absorption in the kidneys.
3. A child with renal disease is at a higher risk for hyperkalemia.
4. A child is at risk for hyponatremia because of the inadequate absorption in the kidneys.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 16 | Type: Multiple Choice

16. A 3 year old exhibits a high fever, flank pain, hematuria, and vomiting. The nurse should anticipate which order?

1. A urinalysis

2. A CBC

3. A BMP

4. CRP

ANS: 1

Feedback
1. The urinalysis provides markers for identifying infection because the child is presenting with common symptoms of a urinary tract infection. Nitrate and protein markers will help with the diagnostics.
2. A CBC does not contain the nitrate and protein markers commonly seen in a child with the presenting symptoms of a urinary tract infection.
3. A BMP will not identify an infection. The child is exhibiting symptoms of a urinary tract infection.
4. A CRP will identify that there is an infection, but is not able to identify where the infection is present. The patient is exhibiting symptoms common with a urinary tract infection.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 16 | Type: Multiple Choice

17. Kali is a 5 year old patient with a history of spina bifida. Kali is at increased risk for ________ due to her neurogenic bladder issues.

1. Hirschsprungs Disease

2. Vomiting

3. Ileus

4. Urinary tract infections

ANS: 4

Feedback
1. Hirschsprungs disease affects the GI tract, not the GU tract.
2. Vomiting is not a risk for this child.
3. An ileus is more common in a child with issues with the GI tract rather than the GU tract.
4. The child is at risk for urinary tract infections because of the urinary stasis and lack of completely emptying the bladder. The child needs to have intermittent urinary catheterizations to decrease the risk.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 | Type: Multiple Choice

18. A childs urine analysis returns with indications of a urinary tract infection.  Identify the result that would lead to the diagnosis.

1. Negative glucose

2. Nitrates are present

3. A creatinine clearance of 72

4. Specific gravity of 1.010

ANS: 2

Feedback
1. A normal finding
2. An abnormal finding and indicates a UTI
3. A normal finding for children
4. A normal finding

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 16 | Type: Multiple Choice

19. Vesicoureteral reflux occurs in young girls because of:

1. The lack of knowledge about wiping front to back.

2. A childs inability to void completely.

3. Structural issues within the urethra.

4. The fact that children hold their urine until the last possible moment.

ANS: 3

Feedback
1. Vesicoureteral reflux is caused by structural issues and is not related to the cleansing of the periarea.
2. Vesicoureteral reflux is a structural issue. The structure can cause an increase in urinary tract infections because of the lack of fully voiding.
3. The structural issues do not allow for full emptying of the bladder.
4. Vesicoureteral reflux is a structural issue. Children who hold their urine are at higher risk for urinary tract infections.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 16 |Type: Multiple Choice

20. Vesicoureteral reflux is closely related to:

1. Chronic glomerulonephritis.

2. Kidney damage.

3. High protein in the urine.

4. Nephrotic syndrome.

ANS: 2

Feedback
1. Chronic glomerulonephritis is not closely related to vesicoureteral reflux because the issue stems from structural damage.
2. Hydronephrosis and renal scarring closely relate with vesicoureteral reflux.
3. High protein in the urine can be a result of the vesicoureteral reflux, but it is not related.
4. Nephrotic syndrome is a result, not a cause, of vesicoureteral reflux. The two are not related.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 | Type: Multiple Choice

21. A child weighing 67 pounds has been admitted with a severe urinary tract infection and is receiving Ceftriaxone 75 mg/kg/day in three doses. The correct amount per dose would be __________

1. 760 mg/dose.

2. 1675 mg/dose.

3. 2283.75 mg/dose.

4. 5025 mg/dose.

ANS: 1

Feedback
1. The correct dose
2. The incorrect dose
3. The incorrect dose
4. The incorrect dose

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Analysis | REF: CHAPTER 16 | Type: Multiple Choice

22. A doctor has ordered amoxicillin to be given to a child with a known urinary tract infection. The nurse knows this antibiotic:

1. Should not be given to children because it has a high occurrence of allergic reactions.

2. Is too strong of an antibiotic for a child.

3. Should be reserved for only severe cases.

4. Is appropriate for this infection, and all doses should be taken as prescribed to be effective.

ANS: 4

Feedback
1. Amoxicillin is a broad spectrum antibiotic that has few side effects and a low allergic reaction rate.
2. Amoxicillin is a mild antibiotic and has few side effects for children.
3. Amoxicillin is a broad spectrum antibiotic commonly used in children.
4. Amoxicillin is a broad spectrum antibiotic that has few side effects and a low allergic reaction rate. Teaching the family/patient to take the entire prescribed medication will increase the effectiveness of the treatment.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 16 | Type: Multiple Choice

23. Identify the number one hospital-acquired infection in children.

1. Influenza

2. Urinary tract infections

3. Common cold

4. Pneumonia

ANS: 2

Feedback
1. Influenza commonly affects children in school and within the community.
2. Urinary tract infections are the most common hospital-acquired infection in children because of the lack of good hand hygiene, lack of good aseptic techniques, and the frequency of using indwelling Foley catheters.
3. A common cold is usually acquired in public settings.
4. Pneumonia is commonly acquired in public settings.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 | Type: Multiple Choice

24. A nurse assessing a child for a third urinary tract infection within the last six months without a known etiology should:

1. Notify the doctor.

2. Ask if sexual abuse is occurring.

3. Ask the family if all the medication is being taken correctly.

4. All of the above should be considered.

ANS: 4

Feedback
1. The doctor should be notified of the previous infections to help determine proper treatment.
2. Reoccurring UTIs in a short time span without a known etiology can be sign of sexual abuse.
3. Completion of the antibiotic therapy is needed to successfully decrease the occurrence of an infection.
4. The doctor should be notified of the previous infections to help determine proper treatment. Reoccurring UTIs in a short time span without a known etiology can be sign of sexual abuse. Completion of the antibiotic therapy is needed to successfully decrease the occurrence of an infection.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Analysis | REF: CHAPTER 16 | Type: Multiple Choice

25. A child has been diagnosed with nephrolithiasis. The nurse taking care of the child will need to:

1. Strain the urine for crystals.

2. Measure accurate urinary output.

3. Provide pain management.

4. All of the above will need to occur.

ANS: 4

Feedback
1. Straining for crystals is needed for continued treatment.
2. Measuring output will determine if the crystals are causing blockage of the urine.
3. The crystals cause blockage, which causes inflammation and buildup of urine, causing the pain.
4. Straining for crystals is needed for continued treatment. Measuring output will determine if the crystals are causing blockage of the urine. The crystals cause blockage, which causes inflammation and buildup of urine, causing the pain.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 16 | Type: Multiple Choice

26. Acute renal failure in a child will exhibit:

1. Generalized edema.

2. Dysuria.

3. Hypotension.

4. Low heart rate.

ANS: 1

Feedback
1. The generalized edema occurs gradually and is an indication that the kidneys are not able to filter water.
2. Oliguria occurs in children with acute renal failure.
3. Hypertension is more likely than hypotension in ARF.
4. The heart rate may be raised due to the electrolyte imbalances and hypertension issues.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 |Type: Multiple Choice

27. The priority nursing assessment in a child with acute renal failure should be:

1. Heart rate.

2. Calculating the urine output per hour.

3. Monitoring blood pressure.

4. Assessing for edema.

ANS: 3

Feedback
1. The heart rate increases are a concern, but the rapidly changing blood pressure is the priority.
2. Maintaining strict I/O is important for the measuring of edema, but this takes several hours. The blood pressure changes rapidly and can cause major issues.
3. Blood pressure can change rapidly in ARF, causing a hypertension crisis.
4. Edema should be monitored, but it changes gradually, unlike blood pressure.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 16 | Type: Multiple Choice

28. A child with acute renal failure wants to drink a bottle of Gatorade because he is thirsty. The nurse must explain that:

1. Gatorade has electrolytes in it, so it is a healthy drink for you.

2. Water would be a better alternative because it does not contain electrolytes.

3. The balance of how much fluid the child can have per day has to be regulated, and a whole bottle of Gatorade would be too much.

4. Milk would be a better choice because of the calcium concentration.

ANS: 3

Feedback
1. The entire bottle of Gatorade could put the child into fluid overload. The child must have a strict I/O.
2. Water can cause the same issue of fluid overload and would need to be monitored closely. This does not address the childs wants and would not be an appropriate response.
3. Explaining about needing a fluid balance and offering a particular amount may satisfy the childs wants and still maintain the I/O balance.
4. Milk is a nutritionally better option, but does not address the wants of the child. Excessive milk can cause issues with the I/O balance as well.

KEY: Content Area: Renal Disorders | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 16 | Type: Multiple Choice

29. Which child is most at risk for nephrotic syndrome?

1. A 4 year old recovering from pneumonia

2. A 7 year old with group A beta-hemolytic strep throat infection

3. A 2 year old with leukemia

4. A 16 year old with a sexually transmitted disease

ANS: 2

Feedback
1. A child with pneumonia does not carry the common bacteria that increases the risk for nephrotic syndrome.
2. Group A beta-hemolytic strep will attach to the kidneys if the bacteria is not treated effectively.
3. A child with leukemia is at risk for kidney dysfunction, but usually is closely monitored, decreasing the risk for nephrotic syndrome.
4. An STD does not increase the risk for nephrotic syndrome because of the type of bacteria.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 16 | Type: Multiple Choice

30. A nurse needs to clarify an order for a child with Nephrotic syndrome. Identify the incorrect order.

1. Provide a diet low in sodium and high in protein.

2. Check for ketones and protein in each void.

3. A weight check is needed every three days.

4. Check blood pressure every four hours.

ANS: 3

Feedback
1. Low sodium and high protein is needed to decrease the chance for edema and provide the correct amount of calories.
2. Checking for both will demonstrate the work the kidneys need to perform in order to maintain function.
3. A weight check is needed every day.
4. A blood pressure check is needed frequently because of the instability in kidney function to prevent further damage.

KEY: Content Area: Renal Disorders | Integrated Processes: Communication/Documentation | Client Need: Physiological Integrity | Cognitive Level: Evaluation | REF: CHAPTER 16 | Type: Multiple Choice

31. A nurse assessing a child with nephrotic syndrome would anticipate:

1. Hematuria, generalized edema, hypertension, and proteinuria.

2. Oliguria, hypotension, and hypolipidemia.

3. Hyperlipidemia, hypoalbuminemia, edema, and proteinuria.

4. Hematuria, hypertension, abdominal pain, and proteinuria.

ANS: 3

Feedback
1. Hematuria and proteinuria are not present in a child with nephrotic syndrome.
2. None are signs or symptoms seen in children with nephrotic syndrome.
3. All are present signs and symptoms for a child with nephrotic syndrome.
4. Hematuria, abdominal pain, and proteinuria are not signs and symptoms usually seen in nephrotic syndrome patients.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 16 | Type: Multiple Choice

32. A child is receiving Prednisone to help manage his nephrotic syndrome. What type of education should the family receive about the administration of prednisone?

1. Corticosteroid therapy begins after the BUN and serum creatinine elevation occurs.

2. Prednisone should be administered orally once daily for the next three weeks.

3. The child will be put on taper with a dose of prednisone, changing after six weeks to a decreased dosage.

4. The child will need to be discontinued quickly so that his growth and development is not hindered.

ANS: 3

Feedback
1. Corticosteroid therapy will not influence the BUN or creatinine levels.
2. Prednisone can be given in IV form.
3. Tapering of prednisone will be the most effective treatment management for the disease process.
4. Discontinuing the therapy quickly can cause the body to perform life-threating events.

KEY: Content Area: Renal Disorders | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: CHAPTER 16 | Type: Multiple Choice

33. A child with the diagnosis of acute postinfectious glomerulonephritis may exhibit:

1. Anorexia.

2. Abdominal pain.

3. Malaise.

4. All of the above.

ANS: 4

Feedback
1. The child may have anorexia because of the illness.
2. Abdominal pain may be present because of the inflammation process.
3. Malaise is common because of the metabolic needs during a time of infection.
4. All answer choices are correct.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 | Type: Multiple Choice

34. Laboratory tests have returned for a child with questionable acute postinfectious glomerulonephritis. The labs are: BUN 20, WBC 24 g/dl, ESR 19 mm/hr. The nurse knows that with results like this, she will need to:

1. Call the doctor with the results to receive further orders since the diagnosis is confirmed with the laboratory results, along with an update on the child.

2. Inform the patient that the lab results are back.

3. Have the charge nurse call the doctor to ask for an order.

4. Call the doctor after the child has rested.

ANS: 1

Feedback
1. The high WBC and ESR counts give an indication of inflammation in the kidneys. The BUN is at the high end of normal for a pediatric patient.
2. The patient should be informed about the laboratory results returning, but the doctor will need to explain the results.
3. The doctor needs to know that the results of the laboratory tests to be able to give further treatment instructions.
4. The rest period should not be an indication for when the doctor receives laboratory results.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Evaluation | REF: CHAPTER 16 | Type: Multiple Choice

35. A child with acute postinfectious glomerulonephritis is exhibiting a change in the level of consciousness. The nurse should:

1. Provide seizure precautions for the patient.

2. Document the findings and reassess in one hour.

3. Notify the physician immediately, request an order for Lorazepam, and provide seizure precautions.

4. Anticipate that this is the normal healing process.

ANS: 3

Feedback
1. The change in LOC is a medical emergency, and the doctor should immediately be notified and seizure precautions should be taken.
2. The situation is a medical emergency and requires immediate interventions.
3. The change in LOC is a medical emergency requiring doctor notification, a request for an antiepileptic medication, and seizure precautions.
4. Changes in LOC are not a normal part of healing and require immediate medical attention.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 16 | Type: Multiple Choice

36. A nurse is instructing the parents on signs and symptoms of hyperkalemia. Her instructions should include all of the following except:

1. Nausea.

2. Muscle weakness.

3. Tingling sensations.

4. A positive Chvosteks sign

ANS: 4

Feedback
1. Nausea is a common symptom for hyperkalemia.
2. Muscle weakness is a common symptom for hyperkalemia.
3. Tingling sensations are a common symptom for hyperkalemia.
4. Demonstrated in patients with hypocalcaemia.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 16 | Type: Multiple Choice

37. A nurse is assessing a child with Henoch Schonlein purpura. Which of the following orders should be clarified with the doctor?

1. C-reactive protein lab

2. Abdominal ultrasound

3. A cystoscopy procedure

4. CBC lab

ANS: 3

Feedback
1. A CRP will give information about the amount of inflammation in the body.
2. An abdominal ultrasound enables the nurse to have views of the kidneys.
3. A cystoscopy only views the bladder. Information is needed about the kidneys.
4. A CBC will help identify if an infection is present.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 16 | Type: Multiple Choice

38. A mother of a child with Henoch Schonlein purpura asks the nurse how long it will be before the rash disappears. Identify the best response by the nurse.

1. The rash will last for several weeks and may cause some scarring.

2. The rash is temporary and will go away by itself.

3. The rash will need to have corticosteroid cream applied daily and may take several weeks to disappear.

4. Make sure to cleanse the rash every day with soap, and then apply corticosteroid cream nightly to decrease the scarring.

ANS: 2

Feedback
1. The rash is temporary and does not cause scarring.
2. The rash is temporary and will not scar the child.
3. The cream is not effective, and the rash disappears in a matter of a few days.
4. Soap and the cream may dry the skin and cause further irritation.

KEY: Content Area: Renal Disorders | Integrated Processes: Communication/Documentation | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 16 | Type: Multiple Choice

39. The dietician is speaking to the nurse about a patient with hemolytic uremic syndrome. Identify the types of food that should be provided for the patient.

1. Peanut butter on wheat toast

2. Canned chicken noodle soup

3. Salted pretzels with cheese

4. Bananas and peanut butter sandwiches

ANS: 1

Feedback
1. The protein from peanut butter has a higher calorie count and the carbohydrate of wheat toast will not cause electrolyte imbalances because the kidneys will not store excessive amounts from these foods.
2. Canned soup has a higher rate of sodium, putting the patient at risk for hypernatremia.
3. The sodium from the pretzels presents a risk for hypernatremia
4. The patient should not have foods with higher concentrations of potassium, like bananas, because the kidneys will have a buildup, eventually causing cardiac issues.

KEY: Content Area: Renal Disorders | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 16 | Type: Multiple Choice

40. A child has arrived to the emergency room after a motor vehicle accident. The nurse is assessing for any renal injuries. Identify the signs that would indicate such an injury.

1. Seizures and hematuria

2. Proteinuria and bladder spasms

3. Dysuria, proteinuria, and nausea

4. Nausea, vomiting, and dysuria

ANS: 1

Feedback
1. Seizures and blood in the urine are indications that a kidney injury may have occurred.
2. Proteinuria may be present because of damage, but bladder spasms are not likely.
3. Dysuria will not be likely, but oliguria is usually seen. Proteinuria will likely not be seen.
4. Nausea/vomiting may be present, but dysuria will not be present.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 16 | Type: Multiple Choice

41. A child with a known diagnosis of acute renal failure is assessed. The nurse knows that the most immediate threat to this childs life is:

1. Hypocalcaemia.

2. Hyperkalemia.

3. Hyponatremia.

4. Hyperglycemia.

ANS: 2

Feedback
1. A low level of calcium does not cause a high threat of acute renal failure.
2. The buildup of potassium causes cardiac arrhythmias and difficulty breathing.
3. High levels of sodium cause threats to the body in a patient with acute renal failure, not low levels.
4. Hyperglycemia can affect kidney function, but is not as much of an immediate threat.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 16 | Type: Multiple Choice

42. A nurse is assessing a 27-week, premature neonate. The nurse notes that the premies testicles are not descended. The nurse should anticipate which order?

1. Genetic testing

2. A pediatric urologist consultation

3. Preparing the child for immediate surgery

4. Testing for cancer

ANS: 2

Feedback
1. Genetic testing will not identify structural issues for the undescended testicles.
2. A consultation will help identify if there are structural issues.
3. Undescended testicles are not a surgical emergency.
4. Undescended testicles do not present a risk for testicular cancer in premie babies.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 16 | Type: Multiple Choice

43. A newborn has been brought to the neonatal intensive care unit because of bladder exstrophy. The nurse should immediately:

1. Apply sterile gauze to the area.

2. Cover the area with petroleum jelly.

3. Cover the area with film wrap.

4. Place a Foley catheter.

ANS: 3

Feedback
1. The gauze will cause inflammation to the mucosa.
2. The jelly will cause inflammation to the mucosa.
3. The film wrap will help keep the mucosa moist and protected.
4. A Foley catheter is not used because of the increased risk of infection.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 16 | Type: Multiple Choice

44. A 14-year-old girl is preparing to have hemodialysis performed due to end-stage renal disease. The patient asks what a fistula provides during the procedure. Identify the correct reason for the use of the fistula.

1. A fistula is responsible for filtering during the hemodialysis.

2. The fistula contains a vein and artery, which allows the blood access so the hemodialysis can be performed.

3. A fistula is a hole where the dialysis team can monitor laboratory tests easier.

4. A fistula is placed in the peritoneal area, and the patient can be hooked up to it at night.

ANS: 2

Feedback
1. The filtering occurs in the dialysis machine.
2. The vein and artery provide easy access for the needle used for hemodialysis.
3. The fistula is an access site, not a hole.
4. The fistula is normally placed on the forearm of a child. Peritoneal dialysis uses the peritoneal area.

KEY: Content Area: Renal Disorders | Integrated Processes: Teaching/Learning| Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 16 | Type: Multiple Choice

True/False

45. Circumcised males have a higher incidence of urinary tract infections than uncircumcised males.

ANS: F

Feedback
1. Proper cleaning of the foreskin and penis do not cause an increased risk for urinary tract infections.
2. Proper cleaning of the foreskin and penis do not cause an increased risk for urinary tract infections.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 16 | Type: True/False

Multiple Response

46. A nurse is preparing discharge planning papers for a child with a urinary tract infection. The instructions should include: (Select all that apply.)

1. Taking all of the medication until gone.

2. Scheduling a follow-up urinalysis.

3. Encouraging increased liquid intake.

4. Promoting regular voiding times.

5. Prophylactically treating the entire family.

ANS: 1, 2, 3, 4

Feedback
1. Taking the entire prescribed dose helps to destroy the bacteria causing the infection.
2. A follow-up urinalysis will be required to make sure the antibiotic course was effective.
3. Increasing fluids will increase voiding and decrease the risk for urinary stasis, which promotes bacterial growth.
4. Regular voiding times will decrease the risk for urinary stasis, which promotes bacterial growth.
5. Teaching about cleansing the proper voiding habits will help decrease the risk for urinary tract infections, not prophylactically treating the family.

KEY: Content Area: Renal Disorders | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: CHAPTER 16 |Type: Multiple Response

47. Hemolytic uremic syndrome can lead to the need for: (Select all that apply.)

1. Peritoneal dialysis.

2. Hemodialysis.

3. Blood transfusions.

4. Antiepileptic medications.

5. Antihypertensive medications.

ANS: 2, 3, 4, 5

Feedback
1. This type of dialysis is more invasive than what the patient will need to treat this disease.
2. Hemodialysis will be needed to filter out waste products for the patient.
3. A blood transfusion may be needed because the patient is at risk for anemia.
4. The patient is at risk for seizures, so preventative measures may be needed.
5. Close monitoring of blood pressure is required because of the vascular changes which occur with the disease.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 16 |Type: Multiple Response

48. The mother of a baby boy with hypospadias asks the nurse about why her newborn son should not be circumcised like her other son. The nurse recognizes that this procedure should not occur because: (Select all that apply.)

1. The urethral meatus is located in the midpenile area, not the head.

2. The circumcision could damage the urethral meatus.

3. A circumcision is a chosen procedure, and the child is put at more risk when having it done.

4. Surgical repair needs to occur prior to the circumcision.

5. The child may be chastised by his peers later in life.

ANS: 1, 2

Feedback
1. The location of the urethral meatus has a risk of laceration during a circumcision, thus creating damage to the urethral opening.
2. The damage to the urethral meatus will cause intense bleeding and require significant repair.
3. The circumcision is not an option for this child because of the further damage that could occur to the urethral meatus.
4. A circumcision should not be done after the repair because of the risk for further damage.
Many males are not circumcised, and this should be discussed with the mother.

KEY: Content Area: Renal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 16 |Type: Multiple Response

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