CHAPTER 22: GENITOURINARY ALTERATIONS My Nursing Test Banks

CHAPTER 22: GENITOURINARY ALTERATIONS

MULTIPLE CHOICE

1.Which of the following makes it easy to palpate a full bladder on infants and children?

a.

Their skin is thinner than adults skin.

b.

Their bladders can be filled fuller than adults bladders.

c.

Their bladders are closer to the anterior abdominal wall.

d.

The bladder is oversized at birth.

ANS: C

Feedback

A

Incorrect. Thinner skin does not explain why it is easier to palpate a full bladder on infants and children.

B

Incorrect. Infants and children have smaller bladders than adults, this does not explain why it is easier to palpate a full bladder on infants and children.

C

Correct. The bladder presents itself in young children close to the anterior abdominal wall, and with growth, lowers into the pelvis. For these reasons it is easy to palpate a full bladder on infants and young children.

D

Incorrect. The bladder of infants and children is not oversized at birth, this does not explain why it is easier to palpate a full bladder on infants and children.

PTS: 1 REF: p. 698 Genitourinary Alterations OBJ: Cognitive Level: Knowledge

2.Which of the following makes the kidneys of a child more susceptible to trauma compared to those of an adult?

a.

The kidneys are less protected in the child due to unossified ribs and less fat padding.

b.

Backward falls are associated with direct compression of the kidneys.

c.

The kidneys are much smaller and closer to the surface.

d.

There are not as many renal tubules, and the kidneys themselves are not as thick as the adult kidneys.

ANS: A

Feedback

A

Correct. The kidneys of a child are more susceptible to trauma compared to those of an adult because the kidneys are less protected in the child due to unossified ribs, less fat padding, and larger size proportional to the abdomen.

B

Incorrect. The kidneys of a child are more susceptible to trauma from compression force to the abdomen, not from backward falls.

C

Incorrect. The kidneys of a child are more susceptible to trauma but not because they are smaller and closer to the surface.

D

Incorrect. The kidneys of a child are more susceptible to trauma but not because they are smaller. They have the same number of renal tubules as a mature kidney.

PTS:1REF:p. 698 Genitourinary Alterations

OBJ: Cognitive Level: Comprehension

3.The ability to concentrate urine varies between adults and newborns. Which of the following describes the ability of the newborn to concentrate urine when compared to the adult?

a.

better

c.

much more poorly

b.

about the same

d.

slightly less

ANS: C

Feedback

A

Incorrect. The ability of the newborn to concentrate urine when compared to the adult is not well developed and would not best be described as better.

B

Incorrect. The ability of the newborn to concentrate urine when compared to the adult is not well developed and would not best be described as about the same.

C

Correct. The ability of the newborn to concentrate urine when compared to the adult is not well developed and would best be described as much more poorly.

D

Incorrect. The ability of the newborn to concentrate urine when compared to the adult is not well developed and would not best be described as slightly less.

PTS:1REF:p. 698 Genitourinary Alterations

OBJ: Cognitive Level: Comprehension

4.The bladder capacity of a 4-year-old child is how many ounces?

a.

4

c.

8

b.

6

d.

10

ANS: B

Feedback

A

Incorrect. The bladder capacity expressed in ounces of a 4-year-old child is determined by the formula, 4 (age of the child in years) + 2 = 6 ounces, not 4.

B

Correct. The bladder capacity expressed in ounces of a 4-year-old child is determined by the formula, 4 (age of the child in years) + 2 = 6 ounces.

C

Incorrect. The bladder capacity expressed in ounces of a 4-year-old child is determined by the formula, 4 (age of the child in years) + 2 = 6 ounces, not 8.

D

Incorrect. The bladder capacity expressed in ounces of a 4-year-old child is determined by the formula, 4 (age of the child in years) + 2 = 6 ounces, not 10.

PTS: 1 REF: p. 698 Genitourinary Alterations OBJ: Cognitive Level: Knowledge

5.Which of the following statements is true regarding a urinary tract infection (UTI) in the newborn?

a.

The incidence is higher in female newborns.

b.

After the first year, the incidence is more common in boys.

c.

Boys who are uncircumcised are more likely to have a UTI.

d.

UTI is more common in African-American girls than in Caucasian girls.

ANS: C

Feedback

A

Incorrect. The incidence of urinary tract infection (UTI) is higher in male newborns.

B

Incorrect. After the first year, the incidence of urinary tract infection (UTI) is more common in girls.

C

Correct. Urinary tract infection (UTI) in the newborn is more common among boys who are uncircumcised.

D

Incorrect. Urinary tract infection (UTI) is more common in Caucasian girls than in African-American girls.

PTS:1REF:p. 698 Genitourinary Alterations

OBJ: Cognitive Level: Comprehension

6.Which of the following are the most common bacteria to infect the urinary tract?

a.

Escherichia coli

c.

Proteus species

b.

Enterobacter

d.

Pseudomonas

ANS: A

Feedback

A

Correct. The most common bacteria to infect the urinary tract are Escherichia coli.

B

Incorrect. Less commonly seen colonization occurs from Enterobacter.

C

Incorrect. Less commonly seen colonization occurs from Proteus species.

D

Incorrect. Less commonly seen colonization occurs from Pseudomonas.

PTS: 1 REF: p. 699 Anatomy and Physiology OBJ: Cognitive Level: Knowledge

7.The nurse assessing a child who has a urinary tract infection will suspect pyelonephritis rather than cystitis then the child exhibits which of the following symptoms?

a.

scant amounts of strong-smelling urine of a very dark orange or brown color

b.

fever greater than 38.3 degrees C (101 degrees F), chills, back pain, and appearing quite ill

c.

low-grade fever, urgency, hesitancy, burning on urination, and cloudy urine

d.

low specific gravity of urine, extreme thirst, and nausea and vomiting

ANS: B

Feedback

A

Incorrect. The nurse assessing a child who has a urinary tract infection will not suspect pyelonephritis rather than cystitis then the child exhibits scant amounts of strong-smelling urine of a very dark orange or brown color.

B

Correct. The nurse assessing a child who has a urinary tract infection will suspect pyelonephritis rather than cystitis then the child exhibits fever greater than 38.3 degrees C (101 degrees F), chills, back pain, and appears quite ill.

C

Incorrect. The nurse assessing a child who has a urinary tract infection will not suspect pyelonephritis rather than cystitis then the child exhibits low-grade fever, urgency, hesitancy, burning on urination, and cloudy urine. These are manifestations of cystitis.

D

Incorrect. The nurse assessing a child who has a urinary tract infection will not suspect pyelonephritis rather than cystitis then the child exhibits low specific gravity of urine, extreme thirst, and nausea and vomiting.

PTS:1REF:p. 711 Structural Defects

OBJ: Cognitive Level: Comprehension

8.Untreated urinary tract infections could most likely lead to which of the following problems?

a.

renal scarring

c.

septicemia

b.

loss of bladder capacity

d.

loss of bladder tone

ANS: A

Feedback

A

Correct. Untreated urinary tract infections can lead to a variety of complications including renal scarring.

B

Incorrect. Loss of bladder capacity is not the most likely complication of untreated urinary tract infections.

C

Incorrect. Septicemia is not the most likely complication of untreated urinary tract infections.

D

Incorrect. Loss of bladder tone is not the most likely complication of untreated urinary tract infections.

PTS:1REF:p. 709 Enuresis

OBJ: Cognitive Level: Comprehension

9.The nurse is assigned to work with a child who has a urinary tract infection. The child is having bladder spasms. Which of the following interventions would be best initially to try to relieve the bladder spasms?

a.

pain medication

b.

bladder massages

c.

ice packs, provided they do not induce chills

d.

warm, moist heat if it does not increase fever

ANS: D

Feedback

A

Incorrect. The best initial intervention then the nurse is working with a child who has a urinary tract infection and having bladder spasms is not pain medication.

B

Incorrect. The best initial intervention then the nurse is working with a child who has a urinary tract infection and having bladder spasms is not bladder massages.

C

Incorrect. The best initial intervention then the nurse is working with a child who has a urinary tract infection and having bladder spasms is not ice packs. Ice packs would decrease blood flow and be counterproductive.

D

Correct. The application of warm moist heat to the abdomen helps to improve blood flow and decreases bladder spasms.

PTS:1REF:p. 711 Structural Defects

OBJ: Cognitive Level: Application

10.The nurse completed discharge teaching for the family of a child with a urinary tract infection. Which of the following statements by one of the caregivers would indicate an understanding of the nurses teaching about the antibiotics?

a.

We will stop the antibiotics then the child is fever free or the urine culture comes back negative.

b.

We will give the antibiotics until they are all gone, even if the child is feeling well and looks well.

c.

We will fill half the prescription for antibiotics and if there are still symptoms then those are gone, we will fill the other half.

d.

We will save a few of the antibiotic tablets and then the next time our child has this problem, we can start them early.

ANS: B

Feedback

A

Incorrect. The caregiver statement, We will stop the antibiotics then the child is fever free or the urine culture comes back negative, indicates that they have not understood the nurses teaching about the antibiotics.

B

Correct. Antibiotics are given to eradicate the infection. Caregivers need to be taught the importance of completing the full course of medication even if the child begins to feel better. When the caregivers say, We will give the antibiotics until they are all gone, even if the child is feeling well and looks well, best indicates understanding of the nurses teaching.

C

Incorrect. The caregiver statement, We will fill half the prescription for antibiotics and if there are still symptoms then those are gone, we will fill the other half, indicates that they have not understood the nurses teaching about the antibiotics.

D

Incorrect. The caregiver statement, We will save a few of the antibiotic tablets and then the next time our child has this problem, we can start them early, indicates that they have not understood the nurses teaching about the antibiotics.

PTS:1REF:p. 710 Structural Defects

OBJ: Cognitive Level: Application

11.The school nurse is talking with caregivers and school-aged girls about the prevention of urinary tract infections. Which of the following teachings will be most helpful in preventing urinary tract infections?

a.

Children will benefit from warm bubble baths to keep the external urinary openings clean.

b.

Have the children wear nylon underwear rather than cotton underwear.

c.

Girls should always wipe with the toilet tissue from front to back and never from back to front.

d.

Children can learn to hold their urine for 3-4 hours to strengthen the bladder muscle tone.

ANS: C

Feedback

A

Incorrect. Teaching the caregivers and school-aged girls about the prevention of urinary tract infections would not include taking warm bubble baths because they can irritate the childs urinary system.

B

Incorrect. Teaching the caregivers and school-aged girls about the prevention of urinary tract infections, the school nurse would teach that the girls would benefit from wearing cotton underwear, not nylon underwear.

C

Correct. Teaching the caregivers and school-aged girls about the prevention of urinary tract infections, Girls should always wipe with the toilet tissue from front to back and never from back to front, is the most helpful teaching.

D

Incorrect. Teaching the caregivers and school-aged girls about the prevention of urinary tract infections, the nurse would teach the girls to avoid urinary retention, not practice it.

PTS:1REF:p. 703 Enuresis

OBJ: Cognitive Level: Application

12.A parent asks the nurse to explain what is meant by a secondary enuretic, because the pediatrician referred to this parents child as a secondary enuretic. Which of the following statements by the nurse would best explain a secondary enuretic?

a.

A child who primarily has encopresis and secondarily has enuresis as a problem.

b.

In secondary enuresis the cause is not the structure of the urinary system but some pathogen or problem that has come into the system.

c.

Secondary enuretics have suffered enuresis in the past, and this is a repeat of the problem.

d.

A secondary enuretic is a child who has been dry for at least 3 to 6 months and then resumes wetting.

ANS: D

Feedback

A

Incorrect. Encopresis is fecal incontinence and is not necessarily related to enuresis, primary or secondary. This statement would not best explain a secondary enuretic.

B

Incorrect. Secondary enuresis occurs then a child has been dry for at least 3 to 6 months and then resumes wetting, and has nothing to do with the etiology. This statement would not best explain a secondary enuretic.

C

Incorrect. Secondary enuresis occurs then a child has been dry for at least 3 to 6 months and then resumes wetting, not that it is being repeated. This statement would not best explain a secondary enuretic.

D

Correct. Enuresis is defined as involuntary voiding of urine beyond the expected age at which voluntary control should be achieved, usually 6 years of age. Secondary enuresis occurs then a child has been dry for at least 3 to 6 months and then resumes wetting.

PTS:1REF:p. 705 Enuresis

OBJ: Cognitive Level: Application

13.When the nurse uses the terms enuresis and incontinence correctly, the nurse uses these terms keeping in mind which of the following facts?

a.

These terms mean the same thing.

b.

Incontinence is caused by a malformation of the urinary tract, and enuresis is not.

c.

Incontinence can occur anytime, while enuresis only occurs with bed-wetting at night.

d.

Incontinence is a term used only for adults, and enuresis is a term used only for children.

ANS: B

Feedback

A

Incorrect. Enuresis and incontinence do not mean the same thing.

B

Correct. Enuresis differs from incontinence in that incontinence results from a structural abnormality, usually an anatomic malformation.

C

Incorrect. Incontinence and enuresis can occur anytime.

D

Incorrect. Incontinence occurs in children and adults, enuresis is more likely to occur in children than adults.

PTS:1REF:p. 705 Enuresis

OBJ: Cognitive Level: Comprehension

14.In addition to oxybutynin chloride (Ditropan), which of the following medications is the one most commonly used to treat enuresis in children?

a.

imipramine hydrochloride (Tofranil)

c.

propranolol hydrochloride (Inderal)

b.

carbamazepine (Tegretol)

d.

tacrine (Cognex)

ANS: A

Feedback

A

Correct. The most commonly used medications to treat enuresis in children are oxybutynin chloride (Ditropan), desmopressin (DDAVP), and imipramine hydrochloride (Tofranil).

B

Incorrect. In addition to oxybutynin chloride (Ditropan), carbamazepine (Tegretol) is not used to treat enuresis in children.

C

Incorrect. In addition to oxybutynin chloride (Ditropan), propranolol hydrochloride (Inderal) is not used to treat enuresis in children.

D

Incorrect. In addition to oxybutynin chloride (Ditropan), tacrine (Cognex) is not used to treat enuresis in children.

PTS: 1 REF: p. 706 Enuresis OBJ: Cognitive Level: Knowledge

15.Which of the following is the most widely used form of treatment for enuresis?

a.

medication

c.

bed-wetting alarms

b.

surgery

d.

behavior modification

ANS: C

Feedback

A

Incorrect. Medication is not the most widely used form of treatment for enuresis.

B

Incorrect. Surgery is not the most widely used form of treatment for enuresis.

C

Correct. Bed-wetting alarms are the most widely used form of treatment for enuresis.

D

Incorrect. Behavior modification is not the most widely used form of treatment for enuresis.

PTS: 1 REF: p. 706 Enuresis OBJ: Cognitive Level: Knowledge

16.The nurse is working on dietary interventions in a care plan for a child who has enuresis. Which of the following interventions would the nurse most likely include?

a.

Eliminate carbonated beverages, dairy products, citric foods, and caffeine.

b.

Reduce the amount of carbohydrate and protein in the diet.

c.

Reduce salt and fluid intake as well as reduce foods high in potassium.

d.

Decrease intake of foods high in cholesterol, magnesium, and zinc.

ANS: A

Feedback

A

Correct. Certain foods may be irritants to the bladder and increase a childs wetting problems. Eliminating foods or beverages that are known irritants may decrease the number of wetting episodes. Foods to eliminate include carbonated beverages, dairy products, beverages with artificial colorings, citric fruit, heavily sugared foods, and beverages with caffeine. Five to 10% of children who wet benefit from these changes.

B

Incorrect. Reducing the amount of carbohydrate and protein in the diet would not be the path recommended by the nurse.

C

Incorrect. Reducing salt and fluid intake as well as reduce foods high in potassium would not be the path recommended by the nurse.

D

Incorrect. Decreasing intake of foods high in cholesterol, magnesium, and zinc would not be the path recommended by the nurse.

PTS:1REF:p. 708 Enuresis

OBJ: Cognitive Level: Application

17.Which of the following problems most needs to be addressed at the same time as enuresis in order for the enuresis interventions to be successful?

a.

low self-esteem

c.

sleep pattern disturbance

b.

impaired skin integrity

d.

constipation

ANS: D

Feedback

A

Incorrect. Low self-esteem may be an issue, but not the problem that most needs to be addressed at the same time as enuresis to insure interventions to be successful.

B

Incorrect. Impaired skin integrity may be an issue, but not the problem that most needs to be addressed at the same time as enuresis to insure interventions to be successful.

C

Incorrect. Sleep pattern disturbance may be present, but not the problem that most needs to be addressed at the same time as enuresis to insure interventions to be successful.

D

Correct. Treatment for enuresis may not be successful if constipation management is not addressed at the same time. Children may show improvement with wetting once they are on a successful bowel program. To assess for constipation a rectal exam, X ray, or ultrasound of the abdomen can determine if the child has a large mass of stool.

PTS:1REF:p. 708 Enuresis

OBJ: Cognitive Level: Application

18.Which of the following questions would be most important for the nurse to ask then assessing a child with enuresis?

a.

What are the childs and familys feelings toward enuresis?

b.

Is there a history of constipation or bowel movements that were large or painful?

c.

Is there a family history of enuresis or encopresis in the last two generations?

d.

At what age did you toilet-train the child, and how did the toilet training go?

ANS: B

Feedback

A

Incorrect. The most important question for the nurse to ask then assessing a child with enuresis is not about the childs and familys feelings toward enuresis.

B

Correct. The most important question for the nurse to ask then assessing a child with enuresis is: is there a history of constipation, fecal soiling, large bowel movements, or painful bowel movements?

C

Incorrect. The most important question for the nurse to ask then assessing a child with enuresis is not about the family history of enuresis or encopresis in the last two generations.

D

Incorrect. The most important question for the nurse to ask then assessing a child with enuresis is not about the childs potty training.

PTS:1REF:p. 708 Enuresis

OBJ: Cognitive Level: Application

19.The nurse evaluating a familys progress in successfully dealing with the problem of nocturnal enuresis would consider that the family still needs help and monthly appointments until the child achieves which of the following goals?

a.

one 24-hour period of being dry

b.

remaining dry overnight at a friends house

c.

a 72-hour period remaining dry

d.

14 consecutive dry nights

ANS: D

Feedback

A

Incorrect. Monthly appointments may be necessary until the child achieves 14 consecutive dry nights, not one 24-hour period of being dry.

B

Incorrect. Monthly appointments may be necessary until the child achieves 14 consecutive dry nights, not upon remaining dry overnight at a friends house.

C

Incorrect. Monthly appointments may be necessary until the child achieves 14 consecutive dry nights, not a 72-hour period remaining dry.

D

Correct. Evaluation is based upon the familys report of the childs progress with the program. Families are instructed to follow up with the nurse by telephone 1 week after starting the program or sooner if problems develop. Monthly appointments may be necessary until the child achieves 14 consecutive dry nights.

PTS:1REF:p. 709 Enuresis

OBJ: Cognitive Level: Comprehension

20.Why would the nurse advise a family trying to help a younger child overcome nocturnal enuresis to have the child practice using the alarm system with a doll or stuffed animal?

a.

to help the child feel comfortable with the system

b.

to make sure the child can operate the system independently

c.

to ensure that the child wont throw the system out of the bed at night

d.

to perfect the childs technique in using the system

ANS: A

Feedback

A

Correct. Have younger children practice using the bed wetting alarm system with a doll or stuffed animal to help them feel comfortable with the system.

B

Incorrect. The nurse would advise a family to have the child practice using the alarm system with a doll or stuffed animal to assure to assure they are at ease with it, not to make sure the child can operate the system independently.

C

Incorrect. The nurse would advise a family to have the child practice using the alarm system with a doll or stuffed animal to assure to assure they are at ease with it, not to ensure that the child wont throw the system out of the bed at night.

D

Incorrect. The nurse would advise a family to have the child practice using the alarm system with a doll or stuffed animal to assure to assure they are at ease with it, not to perfect the childs technique in using the system.

PTS:1REF:p. 709 Enuresis

OBJ: Cognitive Level: Application

21.The nurse is assigned to work with a child who has a diagnosis of vesicoureteral reflux (VUR). The nurse is aware that this means the child has which of the following problems?

a.

backflow of urine from the bladder up the ureter to the kidney

b.

backflow of urine from the bladder up the ureter

c.

a flow of urine between the bladder and the rectum

d.

exchange of urine between the inner and outer layers of the bladder

ANS: A

Feedback

A

Correct. Vesicoureteral reflux (VUR) is defined as the backflow of urine from the bladder up the ureter to the kidney. VUR results then the ureterovesical/vesicoureteral junction fails to maintain a unidirectional flow of urine from the ureter to the bladder.

B

Incorrect. Vesicoureteral reflux (VUR) is not defined as the backflow of urine from the bladder up the ureter.

C

Incorrect. A flow of urine between the bladder and the rectum would indicate the presence of a fistula and is not indicative of vesicoureteral reflux (VUR).

D

Incorrect. An exchange of urine between the inner and outer layers of the bladder is not indicative of vesicoureteral reflux (VUR).

PTS: 1 REF: p. 709 Enuresis OBJ: Cognitive Level: Knowledge

22.Parents ask the nurse to explain what it means then the pediatrician says that their childs vesicoureteral reflux is a grade I. Which of the following is the nurses best response to explain the significance of the grade?

a.

In grade I there is already some amount of renal scarring.

b.

There is some loss of kidney function, but it is no more than 50%.

c.

This grade of reflux is most likely to resolve spontaneously.

d.

Grade I is the most serious grade of vesicoureteral reflux.

ANS: C

Feedback

A

Incorrect. Explaining to parents the meaning then the pediatrician says that their childs vesicoureteral reflux is a grade I, the nurses best response to explain the significance of the grade is not that in grade I there is already some amount of renal scarring.

B

Incorrect. Explaining to parents the meaning then the pediatrician says that their childs vesicoureteral reflux is a grade I, the nurses best response to explain the significance of the grade is not that there is some loss of kidney function, but it is no more than 50%.

C

Correct. Explaining to parents the meaning then the pediatrician says that their childs vesicoureteral reflux is a grade I, the nurses best response to explain the significance of the grade is the less severe the reflux (grades I and II), the greater likelihood it will resolve spontaneously.

D

Incorrect. Explaining to parents the meaning then the pediatrician says that their childs vesicoureteral reflux is a grade I, the nurses best response to explain the significance of the grade is not that grade I is the most serious grade of vesicoureteral reflux, it is the least serious.

PTS:1REF:p. 709 Enuresis

OBJ: Cognitive Level: Application

23.The nonsurgical management for a child with vesicoureteral reflux focuses most on which one of the following goals?

a.

Urine will be produced at 15-40 cubic centimeters per hour.

b.

There will be no episodes of urinary tract infection.

c.

Medication will be taken 100% of the time.

d.

The child will remain in school 100% of the time.

ANS: B

Feedback

A

Incorrect. The nonsurgical management for a child with vesicoureteral reflux focuses most on UTI prevention and management, not urine production.

B

Correct. The nonsurgical management for a child with vesicoureteral reflux focuses most on UTI prevention and management.

C

Incorrect. The nonsurgical management for a child with vesicoureteral reflux focuses most on UTI prevention and management, not medication alone but also other means of UTI prevention and management.

D

Incorrect. The nonsurgical management for a child with vesicoureteral reflux focuses most on UTI prevention and management, not the ability of the child to remain in school.

PTS:1REF:p. 710 Structural Defects

OBJ: Cognitive Level: Comprehension

24.In hypospadias the urethral meatus is located in which of the following places?

a.

on the dorsal side of the penis toward the distal end

b.

at any point along the ventral side of the penis or on the scrotum or perineum

c.

slightly under a larger-than-normal foreskin if uncircumcised or at the outer perimeter of the head of the penis if circumcised

d.

at the end of the ventral side of the penis, near, but not on the head of, the penis

ANS: B

Feedback

A

Incorrect. Hypospadias is present then the urethral meatus is on the ventral surface (underside), not the dorsal side of the penis toward the distal end.

B

Correct. Hypospadias is a common congenital malformation in which the urethral meatus is on the ventral surface (underside) of the penis. The position of the urethral opening may vary, occurring at any point along the ventral surface of the penis or on the scrotum or perineum.

C

Incorrect. Hypospadias is a common congenital malformation in which the urethral meatus is on the ventral surface (underside) of the penis, not slightly under a larger-than-normal foreskin if uncircumcised or at the outer perimeter of the head of the penis if circumcised.

D

Incorrect. Hypospadias is a common congenital malformation in which the urethral meatus is on the ventral surface (underside) of the penis, not at the end of the ventral side of the penis, near, but not on the head of, the penis.

PTS:1REF:p. 711 Structural Defects

OBJ: Cognitive Level: Comprehension

25.Which of the following best describes chordee, a condition that can be associated with hypospadias?

a.

downward curvature of the penis and an incomplete foreskin

b.

the spermatic cord is twisted on itself and feels wormlike on palpation

c.

double openings on the penis causing two streams of urine

d.

a urinary meatus that is too small, requiring more effort to empty the bladder

ANS: A

Feedback

A

Correct. A condition that can be associated with hypospadias is chordee, described as a downward curvature of the penis and an incomplete foreskin.

B

Incorrect. Chordee is not best described as the spermatic cord being twisted on itself and feels wormlike on palpation.

C

Incorrect. Chordee is not best described as double openings on the penis causing two streams of urine.

D

Incorrect. Chordee is not best described as a urinary meatus that is too small, requiring more effort to empty the bladder.

PTS:1REF:p. 711 Structural Defects

OBJ: Cognitive Level: Comprehension

26.A nurse is instructing a caregiver about the side effects of testosterone cream applied to the penis of a child prior to surgery to correct hypospadias. The nurse will most likely tell the caregiver:

a.

The testosterone may cause the child to have erections and possibly ejaculation, but then the cream is discontinued, the erections will stop.

b.

The testosterone was used to increase the size of the penis to make surgery easier. This size and any pubic hair will go away then the cream is stopped.

c.

The testosterone cream was used to thicken the skin of the penis to make surgery easier. This thickening will go away then the cream is stopped.

d.

Sometimes the testosterone will cause the child to be more aggressive or agitated, but these behaviors will go away then the medication is stopped.

ANS: B

Feedback

A

Incorrect. The side effects of testosterone cream applied to the penis of a child prior to surgery to correct hypospadias will not include erections and possibly ejaculation.

B

Correct. On occasion, the size of the penis is augmented preoperatively with testosterone cream or injections to allow for growth of the tissue and hence facilitate surgery. Localized acne and pubic hair may appear. Caregivers should be instructed that these side effects will resolve then the cream is discontinued.

C

Incorrect. The testosterone cream was used to enlarge not thicken the penis.

D

Incorrect. The side effects of testosterone cream applied to the penis of a child prior to surgery to correct hypospadias will not more aggressive or agitated behaviors.

PTS:1REF:p. 711 Structural Defects

OBJ: Cognitive Level: Application

27.The nurse is assigned to a child who had surgery for repair of hypospadias and the child has a bladder stent. Upon assessment, the nurse finds that the child is suffering bladder spasms. Which of the following medications ordered by the surgeon alleviates bladder spasm?

a.

oxybutynin chloride (Ditropan)

c.

guanadrel sulfate (Hylorel)

b.

dezocine (Dalgan)

d.

propranolol (Inderal)

ANS: A

Feedback

A

Correct. Anticholinergics such as oxybutynin chloride (Ditropan) may be administered to alleviate bladder spasms while the urethral stent is in place.

B

Incorrect. Dezocine (Dalgan) is not indicated to alleviate bladder spasms while the urethral stent is in place.

C

Incorrect. Guanadrel sulfate (Hylorel) is not indicated to alleviate bladder spasms while the urethral stent is in place.

D

Incorrect. Propranolol (Inderal) is not indicated to alleviate bladder spasms while the urethral stent is in place.

PTS:1REF:p. 712 Structural Defects

OBJ: Cognitive Level: Comprehension

28.Which of the following best describes the problem of cryptorchidism?

a.

there one testicle is greatly enlarged and hangs somewhat lower than the other testicle

b.

there one, or in rare cases both, of the testes is twisted in the scrotal sac

c.

a congenital anomaly in which one, or in rare cases both, of the testicles is absent

d.

failure of one or both of the testes to descend through the inguinal canal into the scrotum

ANS: D

Feedback

A

Incorrect. Cryptorchidism or undescended testis (UDT) is not best defined there one testicle is greatly enlarged and hangs somewhat lower than the other testicle.

B

Incorrect. Cryptorchidism or undescended testis (UDT) is not defined there one, or in rare cases both, of the testes is twisted in the scrotal sac.

C

Incorrect. Cryptorchidism or undescended testis (UDT) is not defined as a congenital anomaly in which one, or in rare cases both, of the testicles is absent.

D

Correct. Cryptorchidism or undescended testis (UDT) is defined as failure of one or both testes to descend through the inguinal canal into the scrotum.

PTS: 1 REF: p. 712 Structural Defects OBJ: Cognitive Level: Knowledge

29.Upon assessment of a child, the nurse finds a testis that has descended normally but easily retracts with physical examination. Which of the following terms describes this finding?

a.

cryptorchidism

c.

ectopic testis

b.

retractile testis

d.

torticollis

ANS: B

Feedback

A

Incorrect. Cryptorchidism is failure of one or both testes to descend into the scrotum.

B

Correct. A retractile testis is one that has descended normally but easily retracts with physical stimulation and exam.

C

Incorrect. An ectopic testis is one that is found outside the normal path of descent; it may be in the groin, perineum, or abdominal wall.

D

Incorrect. A torticollis is an abnormal condition in which the head is inclined to one side as a result of contraction of muscles on that side of the neck.

PTS:1REF:p. 712 Structural Defects

OBJ: Cognitive Level: Comprehension

30.The management of cryptorchidism usually involves which of the following interventions?

a.

observation while awaiting spontaneous descent of the testes in the first year after birth

b.

large doses of testosterone given daily

c.

orchiopexy surgery performed as soon as possible after detection of the cryptorchidism

d.

downward massaging of the testis involved to encourage downward migration

ANS: A

Feedback

A

Correct. The management of cryptorchidism usually involves observation while awaiting spontaneous descent of the testes during the first year of life.

B

Incorrect. The management of cryptorchidism does not usually involve large doses of testosterone given daily, instead human chorionic gonadotropin may be used to stimulate the natural production of testosterone.

C

Incorrect. The management of cryptorchidism does not usually involve immediate surgery, instead the choice is usually to wait until the child is between 1 and 2 years of age.

D

Incorrect. The management of cryptorchidism does not involve downward massaging of the testis involved to encourage downward migration.

PTS:1REF:p. 713 Structural Defects

OBJ: Cognitive Level: Comprehension

31.After assessing a child with cryptorchidism and assessing the childs family, the nurse writes a diagnosis of anxiety (caregiver). Which of the following concerns would the anxiety most likely be related to in addition to the childs increased risk of malignancy?

a.

fear that the child will suffer pain

b.

childs risk of decreased fertility

c.

fear of the child having gender confusion

d.

guilt

ANS: B

Feedback

A

Incorrect. The caregivers anxiety will be about decreased fertility and an increased risk of malignancy, not the fear that the child will suffer pain.

B

Correct. After assessing a child with cryptorchidism and assessing the childs family, the nurse writes a diagnosis of anxiety (caregiver). The caregiver will be anxious about both decreased fertility and an increased risk of malignancy.

C

Incorrect. The caregivers anxiety will be about decreased fertility and an increased risk of malignancy, not the fear of the child having gender confusion.

D

Incorrect. The caregivers anxiety will be about decreased fertility and an increased risk of malignancy, not guilt.

PTS:1REF:p. 713 Structural Defects

OBJ: Cognitive Level: Application

32.The nurse is teaching the parents of a child who had surgery for cryptorchidism. At what age would the nurse recommend that the child begin to perform monthly testicular self-exams?

a.

6 years

c.

at the time of puberty

b.

9 years

d.

upon becoming sexually active

ANS: C

Feedback

A

Incorrect. Teaching the parents of a child who had surgery for cryptorchidism, the nurse would not recommend that the child begin to perform monthly testicular self-exams at 6 years of age.

B

Incorrect. Teaching the parents of a child who had surgery for cryptorchidism, the nurse would not recommend that the child begin to perform monthly testicular self-exams at 9 years of age.

C

Correct. Teaching the parents of a child who had surgery for cryptorchidism, the nurse would recommend that the child begin to perform monthly testicular self-exams once he reaches puberty.

D

Incorrect. Teaching the parents of a child who had surgery for cryptorchidism, the nurse would not recommend that the child begin to perform monthly testicular self-exams upon becoming sexually active.

PTS:1REF:p. 713 Structural Defects

OBJ: Cognitive Level: Comprehension

33.Upon examining a child, the nurse found a bulge or swelling in the groin and suspected an inguinal hernia. Which of the following tests will the nurse use to verify that this is a hernia?

a.

Strain or push down as if you were trying hard to pee or poop.

b.

Take as deep a breath as you can, and hold it as long as you can.

c.

Stand up and jump up and down several times.

d.

Lie down with your knees bent, and try to bring them up to your tummy.

ANS: A

Feedback

A

Correct. Finding a bulge or swelling in the groin and suspecting an inguinal hernia, the nurse will ask the child to increase intra-abdominal pressure to confirm her suspicions. This may be accomplished by asking the child to: Strain or push down as if you were trying hard to pee or poop.

B

Incorrect. Finding a bulge or swelling in the groin and suspecting an inguinal hernia, the nurse will not ask the child to: Take as deep a breath as you can, and hold it as long as you can.

C

Incorrect. Finding a bulge or swelling in the groin and suspecting an inguinal hernia, the nurse will not ask the child to: Stand up and jump up and down several times.

D

Incorrect. Finding a bulge or swelling in the groin and suspecting an inguinal hernia, the nurse will not ask the child to: Lie down with your knees bent, and try to bring them up to your tummy.

PTS:1REF:p. 714 Structural Defects

OBJ: Cognitive Level: Application

34.On finding an inguinal hernia in a child, the nurse in the pediatric clinic will teach the mother that until the child has surgery for the hernia, the mother should do which of the following if the child has pain and intense inconsolable irritability, with or without vomiting and abdominal distension?

a.

Make an appointment with the physician as soon as possible.

b.

Apply ice to the groin area for 30 minutes on and 30 minutes off for 8 hours.

c.

Contact the physician immediately, or take the child to the emergency room.

d.

Keep the child on bed rest to see if the symptoms subside.

ANS: C

Feedback

A

Incorrect. On finding an inguinal hernia in a child, the nurse will teach the mother that until the child has surgery for the hernia, the mother should observe for pain and intense inconsolable irritability, with or without vomiting and abdominal distension, and treat this as an emergency. Do not settle for an appointment as soon as the physician can see you.

B

Incorrect. On finding an inguinal hernia in a child, the nurse will teach the mother that until the child has surgery for the hernia, the mother should observe for pain and intense inconsolable irritability, with or without vomiting and abdominal distension, and treat this as an emergency. Do not apply ice to the groin area for 30 minutes on and 30 minutes off for 8 hours.

C

Correct. On finding an inguinal hernia in a child, the nurse will teach the mother that until the child has surgery for the hernia, the mother should observe for pain and intense inconsolable irritability, with or without vomiting and abdominal distension, and treat this as an emergency. Contact the physician immediately, or take the child to the emergency room.

D

Incorrect. On finding an inguinal hernia in a child, the nurse will teach the mother that until the child has surgery for the hernia, the mother should observe for pain and intense inconsolable irritability, with or without vomiting and abdominal distension, and treat this as an emergency. Do not keep the child on bed rest to see if the symptoms subside.

PTS:1REF:p. 714 Structural Defects

OBJ: Cognitive Level: Application

35.Which of the following statements best describes a hydrocele?

a.

an outpouching on the scrotum that contains water

b.

a collection of water or fluid in the foreskin

c.

an inguinal hernia containing fluid

d.

a collection of fluid in the scrotal sac

ANS: D

Feedback

A

Incorrect. A hydrocele is best described as a collection of fluid in the scrotal sac, not an outpouching on the scrotum that contains water.

B

Incorrect. A hydrocele is best described as a collection of fluid in the scrotal sac, not a collection of water or fluid in the foreskin.

C

Incorrect. A hydrocele is best described as a collection of fluid in the scrotal sac, not an inguinal hernia containing fluid.

D

Correct. A hydrocele is best described as a collection of fluid in the scrotal sac.

PTS: 1 REF: p. 714 Structural Defects OBJ: Cognitive Level: Knowledge

36.Parents of a child admitted to the pediatric ward ask the nurse to tell them what causes acute glomerulonephritis because the pediatrician has mentioned this as a possible diagnosis. The correct answer by the nurse would be to tell the family that acute glomerulonephritis is an inflammation of glomeruli within the kidney caused by which of the following?

a.

a bacterial or viral agent invading the childs system

b.

habitual failure to flush the kidneys with sufficient fluid

c.

an uncommon genetic defect involving a renin deficiency

d.

failure of the adrenal glands to produce sufficient aldosterone

ANS: A

Feedback

A

Correct. Acute glomerulonephritis (AGN) is an inflammation of glomeruli within the kidney. This inflammation results in acute renal failure. The etiology is usually an infectious agent (bacterial or viral) that has been present in the body for at least 2 or 3 weeks prior to the clinical renal manifestations.

B

Incorrect. Answering the question from the parents of a child admitted to the pediatric ward about the cause of acute glomerulonephritis, the nurse would not say: habitual failure to flush the kidneys with sufficient fluid.

C

Incorrect. Answering the question from the parents of a child admitted to the pediatric ward about the cause of acute glomerulonephritis, the nurse would not say: an uncommon genetic defect involving a renin deficiency.

D

Incorrect. Answering the question from the parents of a child admitted to the pediatric ward about the cause of acute glomerulonephritis, the nurse would not say: failure of the adrenal glands to produce sufficient aldosterone.

PTS:1REF:p. 715 Structural Defects

OBJ: Cognitive Level: Comprehension

37.You are the nurse assigned to care for a child with acute glomerulonephritis. After receiving report and doing an initial assessment, you check the lab reports. You would not be surprised to find which of the following signs and symptoms consistent with the diagnosis of acute glomerulonephritis?

a.

pale yellow urine in copious amounts, low specific gravity, increased glomerular filtration rate

b.

hypotension, dry skin, decreased serum sodium levels, and decreased potassium

c.

hematuria, dependent edema, elevated serum sodium, diminished glomerular filtration rate, proteinuria

d.

ketone bodies in the urine, diminished serum sodium, orthostatic hypotension

ANS: C

Feedback

A

Incorrect. The following signs and symptoms are not consistent with acute glomerulonephritis: the color of the urine will be not be pale yellow, urine output is lower, the specific gravity is higher, the glomerular filtration rate is decreased.

B

Incorrect. The following signs and symptoms are not consistent with acute glomerulonephritis: hypotension, decreased serum sodium levels and decreased potassium.

C

Correct. The clinical manifestations of acute glomerulonephritis are hematuria, dependent and periorbital edema, diminished urinary output, proteinuria, hypertension, fatigue, diminished glomerular filtration rate, elevated serum sodium levels, and elevated potassium.

D

Incorrect. The following signs and symptoms are not consistent with acute glomerulonephritis: ketone bodies in the urine, decreased serum sodium, and hypertension, not orthostatic hypotension.

PTS:1REF:p. 715 Structural Defects

OBJ: Cognitive Level: Comprehension

38.The nurse is assigned to work with a child diagnosed with nephrotic syndrome. The nurse knows that this renal problem is characterized by massive proteinuria and hypoalbuminemia, which tells the nurse to assess for which of the following signs or symptoms?

a.

level of consciousness

c.

edema and hyperlipidemia

b.

orientation

d.

dehydration and weight loss

ANS: C

Feedback

A

Incorrect. Working with a child diagnosed with nephrotic syndrome, the nurse knows that this renal problem is characterized by massive proteinuria and hypoalbuminemia which guides the nurse to not assess the child for level of consciousness.

B

Incorrect. Working with a child diagnosed with nephrotic syndrome, the nurse knows that this renal problem is characterized by massive proteinuria and hypoalbuminemia which guides the nurse to not assess the child for orientation.

C

Correct. Nephrotic syndrome (NS) is a clinical entity characterized by massive proteinuria and hypoalbuminemia (low levels of albumin in the blood) leading to edema and hyperlipidemia.

D

Incorrect. Working with a child diagnosed with nephrotic syndrome, the nurse knows that this renal problem is characterized by massive proteinuria and hypoalbuminemia which guides the nurse to not assess the child for dehydration and weight loss.

PTS:1REF:p. 716 Acute Glomerulonephritis

OBJ: Cognitive Level: Comprehension

39.Which of the following causes primary nephrotic syndrome?

a.

glomerular disease of the kidney

c.

lead poisoning

b.

hepatitis

d.

childhood cancer or its therapies

ANS: A

Feedback

A

Correct. Primary, or idiopathic, nephrotic syndrome results from glomerular disease of the kidney.

B

Incorrect. Primary nephrotic syndrome does not result from hepatitis.

C

Incorrect. Primary nephrotic syndrome does not result from lead poisoning.

D

Incorrect. Primary nephrotic syndrome does not result from childhood cancer or its therapies.

PTS:1REF:p. 716 Acute Glomerulonephritis

OBJ: Cognitive Level: Comprehension

40.The nurse is monitoring the lab results of a child with nephrotic syndrome. The child now has elevated serum cholesterol and triglyceride levels and falling serum protein levels. The IgG levels are diminished. Red blood cell and platelet concentrations are increased. The nurse realizes that the lab reports indicate this child is at risk for:

a.

anemia

c.

bleeding problems

b.

coagulation or clotting problems

d.

infection

ANS: B

Feedback

A

Incorrect. These lab results are not evident with anemia.

B

Correct. Elevated serum cholesterol and triglyceride levels, falling serum protein levels, IgG levels diminished, red blood cell and platelet concentrations are increased, the net result is a slowing of the blood flow and ultimately the clumping or clotting of red blood cells and platelets. That coupled with the protein losses puts the child at risk for coagulation or clotting problems.

C

Incorrect. These lab results are not evident with bleeding problems.

D

Incorrect. These lab results are not evident with infection.

PTS:1REF:p. 721 Nephrotic Syndrome

OBJ: Cognitive Level: Application

41.Which treatment is the mainstay for nephrotic syndrome?

a.

antibiotic therapy

c.

high-protein diet

b.

blood transfusions

d.

corticosteroid therapy

ANS: D

Feedback

A

Incorrect. Antibiotic therapy is not the mainstay for nephrotic syndrome.

B

Incorrect. Blood transfusions are not the mainstay for nephrotic syndrome.

C

Incorrect. A high-protein diet is contraindicated for nephrotic syndrome.

D

Correct. Corticosteroid therapy is the mainstay for nephrotic syndrome.

PTS:1REF:p. 721 Nephrotic Syndrome

OBJ: Cognitive Level: Comprehension

42.You are the nurse assigned to work with a child with nephrotic syndrome. By following the prescribed treatment regimen, the child experiences a remission. You are now checking to make sure the child does not have a relapse. Which finding would most lead you to the conclusion that a relapse was happening?

a.

a temperature of 37.8 degrees C (100 degrees F), flank pain, burning, frequency, urgency on voiding, and cloudy urine

b.

a urine dipstick measurement of 2+ proteinuria or more for 3 days, or the child found to have 3-4+ proteinuria plus edema

c.

elevated temperature, cough, sore throat, changing complete blood count (CBC) with differential

d.

the urine dipstick showing glucose in the urine for 3 days, extreme thirst, increase in urine output, and a moon face

ANS: B

Feedback

A

Incorrect. A relapse of nephrotic syndrome is not identified by these symptoms: a temperature of 37.8 degrees C (100 degrees F), flank pain, burning, frequency, urgency on voiding, and cloudy urine.

B

Correct. A relapse of nephrotic syndrome is defined as: a urine dipstick measurement of 2+ proteinuria or more for 3 days, or the child is found to have 3-4+ proteinuria plus edema.

C

Incorrect. A relapse of nephrotic syndrome is not identified by these symptoms: elevated temperature, cough, sore throat, changing complete blood count (CBC) with differential.

D

Incorrect. A relapse of nephrotic syndrome is not identified by these symptoms: the urine dipstick showing glucose in the urine for 3 days, extreme thirst, increase in urine output, and a moon face.

PTS:1REF:p. 721 Nephrotic Syndrome

OBJ: Cognitive Level: Application

43.You are the nurse assigned to work with a child with nephrotic syndrome. The parents ask you about why their child is in reverse isolation. Which of the following is your best response?

a.

Isolation is necessary to keep your child from passing an infection on to others.

b.

This is mainly to keep your child from overexerting and getting an infection.

c.

This isolation is to protect your child from getting an infection from others.

d.

This is the usual practice with children who are on steroids.

ANS: C

Feedback

A

Incorrect. The child is shielded from others, hence reverse isolation, not isolation, shielding others from the child.

B

Incorrect. The issue is getting an infection, not protecting the child from overexertion.

C

Correct. The child with nephrotic syndrome should be protected from visitors, personnel, or other clients who may have infections. Hence, reverse isolation.

D

Incorrect. Reverse isolation is not usually appropriate then a child is taking steroids.

PTS:1REF:p. 722 Nephrotic Syndrome

OBJ: Cognitive Level: Application

44.A child is recovering at home from nephrotic syndrome and is on a regimen of prednisone and antibiotics. The childs parents call the pediatric clinic and tell the nurse that their child is gaining a lot of weight. The nurse will first suspect which of the following possible causes of the weight gain?

a.

ravenous appetite as a side effect of steroid therapy

b.

sodium retention and concurrent retention of water

c.

edema associated with steroid therapy

d.

worsening or relapse of the nephrotic syndrome

ANS: B

Feedback

A

Incorrect. Taking a call from a childs parents, and hearing nephrotic syndrome, taking prednisone and antibiotics with a sudden weight gain, the nurse will not first suspect a ravenous appetite as a side effect of steroid therapy.

B

Correct. Taking a call from a childs parents, and hearing nephrotic syndrome, taking prednisone and antibiotics with a sudden weight gain, the nurse will first suspect sodium retention and concurrent retention of water, i.e., edema. Edema is usually the first clinical feature.

C

Incorrect. Taking a call from a childs parents, and hearing nephrotic syndrome, taking prednisone and antibiotics with a sudden weight gain, the nurse will not first suspect edema associated with steroid therapy.

D

Incorrect. Taking a call from a childs parents, and hearing nephrotic syndrome, taking prednisone and antibiotics with a sudden weight gain, the nurse will not first suspect worsening or relapse of the nephrotic syndrome.

PTS:1REF:p. 721 Nephrotic Syndrome

OBJ: Cognitive Level: Application

45.In which of the following groups is hemolytic uremic syndrome, although rare, most often found?

a.

industrialized nations

c.

male children

b.

children ages 6 months to 3 years old

d.

female children

ANS: B

Feedback

A

Incorrect. Hemolytic uremic syndrome, although rare, is most often found in developing countries, not industrialized nations.

B

Correct. Hemolytic uremic syndrome, although rare, is most often found in children ages 6 months to 3 years old.

C

Incorrect. Hemolytic uremic syndrome, although rare, is found in equal numbers in both sexes.

D

Incorrect. Hemolytic uremic syndrome, although rare, is found in equal numbers in both sexes.

PTS:1REF:p. 723 Nephrotic Syndrome

OBJ: Cognitive Level: Comprehension

46.Which of the following causes is associated with hemolytic uremic syndrome?

a.

Escherichia coli and other pathogens

b.

hypothalamic-pituitary-adrenal axis disorders

c.

septicemia and associated tricuspid valve vegetation

d.

inherited tendency

ANS: A

Feedback

A

Correct. Escherichia coli and other pathogens are primary causes of hemolytic uremic syndrome.

B

Incorrect. Hemolytic uremic syndrome is not linked with hypothalamic-pituitary-adrenal axis disorders.

C

Incorrect. Hemolytic uremic syndrome is not linked with septicemia and associated tricuspid valve vegetation.

D

Incorrect. Hemolytic uremic syndrome is not an inherited tendency.

PTS:1REF:p. 723 Nephrotic Syndrome

OBJ: Cognitive Level: Comprehension

47.Which of the following are prodromal symptoms of hemolytic uremic syndrome?

a.

frequency, urgency, pain, and burning on urination with gross blood in a cloudy urine

b.

chills, fever, flank pain, elevated blood pressure, pulse, and respirations

c.

gastrointestinal symptoms with diarrhea and vomiting or an upper respiratory infection

d.

headache, dizziness, loss of energy, edema in dependent parts of the body

ANS: C

Feedback

A

Incorrect. Hemolytic uremic syndrome results in a diminished urine output, not the symptoms offered; but, most obvious is diarrhea, vomiting, upper respiratory issues.

B

Incorrect. Hemolytic uremic syndrome manifests an enlarged liver and spleen, edema, hypertension, congestive heart failure, abdominal tenderness or pain; but, most obvious is diarrhea, vomiting, upper respiratory issues.

C

Correct. Gastrointestinal symptoms with diarrhea and vomiting or an upper respiratory infection are prodromal symptoms of hemolytic uremic syndrome.

D

Incorrect. Hemolytic uremic syndrome manifests irritability, paleness, dehydration, and lethargic; but, most obvious is diarrhea, vomiting, upper respiratory issues.

PTS:1REF:p. 724 Hemolytic Uremic Syndrome

OBJ: Cognitive Level: Comprehension

48.Which of the following are the clinical manifestations of hemolytic uremic syndrome?

a.

renal failure, thrombocytopenia, and anemia

b.

blood in the urine and increased blood pressure

c.

frost on the skin and increasing disorientation

d.

left-sided heart failure and 4+ pitting edema

ANS: A

Feedback

A

Correct. The clinical manifestations of hemolytic uremic syndrome are a triad of symptoms which include renal failure, thrombocytopenia, and anemia.

B

Incorrect. The clinical manifestations of hemolytic uremic syndrome are not blood in the urine and increased blood pressure (suspect acute glomerulonephritis).

C

Incorrect. The clinical manifestations of hemolytic uremic syndrome are not frost on the skin and increasing disorientation (suspect renal failure).

D

Incorrect. The clinical manifestations of hemolytic uremic syndrome are not left-sided heart failure and 4+ pitting edema.

PTS:1REF:p. 724 Hemolytic Uremic Syndrome

OBJ: Cognitive Level: Comprehension

49.The nurse caring for a child with hemolytic uremic syndrome notices that the childs lab reports indicate a worsening anemia and a falling hematocrit and platelet count. The nurse will most need to plan some interventions to deal with which of the following problems that the child is most at risk of developing based on these changes in lab values?

a.

edema and electrolyte imbalance

b.

bruising, bleeding, and purpura

c.

altered levels of consciousness and seizures

d.

congestive heart failure

ANS: B

Feedback

A

Incorrect. Noticing that the childs lab reports indicate a worsening anemia and a falling hematocrit and platelet count, the nurse caring for a child with hemolytic uremic syndrome, will not most need to plan interventions to deal with edema and electrolyte imbalance.

B

Correct. Once the hemolytic process starts, the child becomes progressively more irritable, lethargic, and anorectic, as the diarrhea and vomiting continue from a few days to 2 weeks. Soon, the child experiences anemia, and, as it worsens pallor increases, the hematocrit falls, and urine output diminishes. As the platelet count falls, there is an increased chance of bleeding, bruising, and purpura. As the urinary system becomes more restricted with clot formation, the blood pressure rises leading to hypertension.

C

Incorrect. Noticing that the childs lab reports indicate a worsening anemia and a falling hematocrit and platelet count, the nurse caring for a child with hemolytic uremic syndrome, will not most need to plan interventions to deal with altered levels of consciousness and seizures.

D

Incorrect. Noticing that the childs lab reports indicate a worsening anemia and a falling hematocrit and platelet count, the nurse caring for a child with hemolytic uremic syndrome, will not most need to plan interventions to deal with congestive heart failure.

PTS:1REF:p. 723 Nephrotic Syndrome

OBJ: Cognitive Level: Application

50.Which of the following conditions is the most frequent cause of acute renal failure in children?

a.

chronic urinary tract infections

c.

hemolytic uremic syndrome

b.

nephrotic syndrome

d.

acute glomerulonephritis

ANS: C

Feedback

A

Incorrect. Acute renal failure in children is not most often associated with chronic urinary tract infections.

B

Incorrect. Acute renal failure in children is not most often associated with nephrotic syndrome.

C

Correct. Acute renal failure in children is most often associated with an underlying infection or secondary to hemolytic uremic syndrome.

D

Incorrect. Acute renal failure in children is not most often associated with acute glomerulonephritis.

PTS:1REF:p. 724 Hemolytic Uremic Syndrome

OBJ: Cognitive Level: Comprehension

51.Which of the following indicates the type(s) of acute renal failure?

a.

one type: acute

b.

two types: acute and subacute

c.

three types: prerenal, intrarenal, and postrenal

d.

four types: hemorrhagic with and without clotting, and nonhemorrhagic with and without clotting

ANS: C

Feedback

A

Incorrect. One type: acute is not the three types of acute renal failure.

B

Incorrect. Two types: acute and subacute are not the three types of acute renal failure.

C

Correct. Acute renal failure (ARF) is a sudden onset of impaired renal function. Most children with ARF regain renal function. ARF is classified according to the part of the renal system that is affected, the three types: prerenal, intrarenal or postrenal.

D

Incorrect. Four types: hemorrhagic with and without clotting, and nonhemorrhagic with and without clotting are not the three types of acute renal failure.

PTS:1REF:p. 724 Hemolytic Uremic Syndrome

OBJ: Cognitive Level: Knowledge

52.You are the nurse working with a child who has acute renal failure with diminished renal function. The physician orders two new antibiotics to be given stat to this child. What would you do now?

a.

Get the antibiotics right away from the pharmacy, and give them immediately.

b.

Find out if these drugs are detoxified and excreted by the kidneys and, if so, check with the physician and your supervisor about the safety of giving these drugs.

c.

Determine if the child has been taking these same drugs or similar drugs without problems.

d.

Weigh the benefits of the medication and the need for it against the risks of the medication being nephrotoxic and doing harm to the kidneys.

ANS: B

Feedback

A

Incorrect. Prior to administering new antibiotics child who has acute renal failure with diminished renal function, you would not get the antibiotics right away from the pharmacy, and give them immediately.

B

Correct. Many medications such as some forms of antibiotics, aminoglycosides, for example, are detoxified and excreted through the kidneys. These medications, then given in the presence of diminished renal function, can be nephrotoxic. Always question the health care practitioner then a medication should be given if renal output is low.

C

Incorrect. Prior to administering new antibiotics child who has acute renal failure with diminished renal function, you would not determine if the child has been taking these same drugs or similar drugs without problems.

D

Incorrect. Prior to administering new antibiotics child who has acute renal failure with diminished renal function, you would not weigh the benefits of the medication and the need for it against the risks of the medication being nephrotoxic and doing harm to the kidneys.

PTS:1REF:p. 726 Renal Failure

OBJ: Cognitive Level: Application

53.The nurse is teaching a child and his family about medications for the child, who is getting dialysis. The nurse will teach the family which of the following?

a.

If urine output diminishes, call the health care provider prior to giving the medication.

b.

Give all medication with at least 8 ounces of water, and maintain water intake at 8 to 10 glasses per day.

c.

Give all medication ordered to be given daily about 30 minutes prior to the dialysis treatment.

d.

Any medication given during dialysis should be given with a glass of juice unless juice is contraindicated with that medication.

ANS: A

Feedback

A

Correct. For the child and family undergoing dialysis, teaching regarding medications is necessary. They must be aware that if the urine output diminishes from what they have come to accept as normal, the health care provider should be called prior to medication administration.

B

Incorrect. For the child and family undergoing dialysis, teaching regarding medications is necessary. The nurse will not teach the family the following: give all medication with at least 8 ounces of water, and maintain water intake at 8 to 10 glasses per day.

C

Incorrect. For the child and family undergoing dialysis, teaching regarding medications is necessary. The nurse will not teach the family the following: give all medication ordered to be given daily about 30 minutes prior to the dialysis treatment.

D

Incorrect. For the child and family undergoing dialysis, teaching regarding medications is necessary. The nurse will not teach the family the following: any medication given during dialysis should be given with a glass of juice unless juice is contraindicated with that medication.

PTS:1REF:p. 723 Nephrotic Syndrome

OBJ: Cognitive Level: Application

54.The nurse is instructing a child and the childs family about dietary needs while the child is undergoing dialysis treatments at home. The nurse will instruct the family to provide which of the following types of diet?

a.

soft

c.

low protein

b.

pureed

d.

high fat

ANS: C

Feedback

A

Incorrect. Instructing a child and the childs family about dietary needs while the child is undergoing dialysis treatments at home, the nurse will not instruct the family to provide a soft diet.

B

Incorrect. Instructing a child and the childs family about dietary needs while the child is undergoing dialysis treatments at home, the nurse will not instruct the family to provide a pureed diet.

C

Correct. Instructing a child and the childs family about dietary needs while the child is undergoing dialysis treatments at home, the nurse will instruct the family to provide a low protein diet.

D

Incorrect. Instructing a child and the childs family about dietary needs while the child is undergoing dialysis treatments at home, the nurse will not instruct the family to provide a high fat diet.

PTS:1REF:p. 728 Renal Failure

OBJ: Cognitive Level: Comprehension

55.A child with acute renal failure will have the diagnosis reclassified to chronic renal failure then which of the following conditions is met?

a.

There is renal scarring, and the condition is not responding to vigorous treatment for 2 weeks.

b.

About 50% of the renal function remains, and the condition has lasted several months or more.

c.

The condition has not responded to three courses of medication.

d.

There is no commonly used set of conditions, and this is a medical judgment.

ANS: B

Feedback

A

Incorrect. Acute renal failure is reclassified to chronic renal failure then 50% of renal function remains and has persisted for several months, not then there is renal scarring, or the condition is not responding to vigorous treatment for 2 weeks.

B

Correct. Chronic renal failure is a progressive disease. The damage that is done to the renal system in some cases is irreversible. This condition is considered chronic then approximately 50% of the renal function remains and the condition has lasted for at least several months.

C

Incorrect. Acute renal failure is reclassified to chronic renal failure then 50% of renal function remains and has persisted for several months, not then the condition has not responded to three courses of medication.

D

Incorrect. Acute renal failure is reclassified to chronic renal failure then 50% of renal function remains and has persisted for several months, not then there is no commonly used set of conditions, and this is a medical judgment.

PTS:1REF:p. 728 Renal Failure

OBJ: Cognitive Level: Comprehension

MULTIPLE RESPONSE

1.Male children are less susceptible to urinary tract infections (UTIs). Which of the following rationales provide(s) evidence to support this finding? Select all that apply.

a.

longer urethra

b.

secretions from the prostate

c.

testosterone providing active immunity to bacteria

d.

bacterial contamination being less common in males

ANS: A, B

Feedback

Correct

Male children are less susceptible to UTIs due to the presence of a longer urethra. Secretions from the prostate provide antibacterial properties.

Incorrect

Testosterone has not been associated with male childrens susceptibility to UTIs.

Bacterial contamination potential has not been associated with male childrens susceptibility to UTIs.

PTS:1REF:p. 699 Anatomy and Physiology

OBJ: Cognitive Level: Application

2.An infant presents to the emergency room for evaluation for vague symptoms of discomfort. The infants parent expresses concern that the infant has a urinary tract infection (UTI). Which of the following symptoms are indicative of a UTI in infants?

a.

vomiting

c.

irritability

b.

diarrhea

d.

loss of appetite

ANS: A, B, C, D

Feedback

Correct

Children with UTIs can present with vague signs and symptoms, including vomiting, diarrhea, irritability, and loss of appetite.

Incorrect

All answers are correct.

PTS:1REF:p. 699 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

3.A nurse is providing education to the parents of a child with enuresis. The nurse is discussing the elimination of foods and beverages that are known irritants to the bladder. Which of the following should the nurse encourage the family to consider limiting? Select all that apply.

a.

milk and cheese

c.

oranges and grapefruits

b.

colas and teas

d.

grains

ANS: A, B, C

Feedback

Correct

Dairy products are known bladder irritants.

Caffeinated beverages and teas are known bladder irritants.

Citrus fruits are known bladder irritants.

Incorrect

Grains would not need to be limited.

PTS:1REF:p. 708 Enuresis

OBJ: Cognitive Level: Comprehension

Leave a Reply