Chapter 25: The Child with Renal Dysfunction My Nursing Test Banks

Chapter 25: The Child with Renal Dysfunction

MULTIPLE CHOICE

1. Urinary tract anomalies are frequently associated with what irregularities in fetal development?

a.

Myelomeningocele

b.

Cardiovascular anomalies

c.

Malformed or low-set ears

d.

Defects in lower extremities

ANS: C

Although unexplained, there is a frequent association between malformed or low-set ears and urinary tract anomalies. During the newborn examination, the nurse should have a high suspicion about urinary tract structure and function if ear anomalies are present. Children who have myelomeningocele may have impaired urinary tract function secondary to the neural defect. When other congenital defects are present, there is an increased likelihood of other issues with other body systems. Cardiac and extremity defects do not have a strong association with renal anomalies.

DIF: Cognitive Level: Understanding REF: p. 1000

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

2. What urine test result is considered abnormal?

a.

pH 4.0

b.

WBC 1 or 2 cells/ml

c.

Protein level absent

d.

Specific gravity 1.020

ANS: A

The expected pH ranges from 4.8 to 7.8. A pH of 4.0 can be indicative of urinary tract infection or metabolic alkalosis or acidosis. Less than 1 or 2 white blood cells per milliliter is the expected range. The absence of protein is expected. The presence of protein can be indicative of glomerular disease. A specific gravity of 1.020 is within the anticipated range of 1.001 to 1.030. Specific gravity reflects level of hydration in addition to renal disorders and hormonal control such as antidiuretic hormone.

DIF: Cognitive Level: Analyzing REF: p. 1002

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

3. What diagnostic test allows visualization of renal parenchyma and renal pelvis without exposure to external-beam radiation or radioactive isotopes?

a.

Renal ultrasonography

b.

Computed tomography

c.

Intravenous pyelography

d.

Voiding cystourethrography

ANS: A

The transmission of ultrasonic waves through the renal parenchyma allows visualization of the renal parenchyma and renal pelvis without exposure to external-beam radiation or radioactive isotopes. Computed tomography uses external radiation, and sometimes contrast media are used. Intravenous pyelography uses contrast medium and external radiation for radiography. Contrast medium is injected into the bladder through the urethral opening. External radiation for radiography is used before, during, and after voiding in voiding cystourethrography.

DIF: Cognitive Level: Understanding REF: p. 1011

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

4. What name is given to inflammation of the bladder?

a.

Cystitis

b.

Urethritis

c.

Urosepsis

d.

Bacteriuria

ANS: A

Cystitis is an inflammation of the bladder. Urethritis is an inflammation of the urethra. Urosepsis is a febrile urinary tract infection with systemic signs of bacterial infection. Bacteriuria is the presence of bacteria in the urine.

DIF: Cognitive Level: Understanding REF: p. 1004

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

5. The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause?

a.

Poor hygiene

b.

Constipation

c.

Urinary stasis

d.

Congenital anomalies

ANS: C

Urinary stasis is the single most important host factor that influences the development of UTIs. Urine is usually sterile but at body temperature provides an excellent growth medium for bacteria. Poor hygiene can be a contributing cause, especially in females because their short urethras predispose them to UTIs. Urinary stasis then provides a growth medium for the bacteria. Intermittent constipation contributes to urinary stasis. A full rectum displaces the bladder and posterior urethra in the fixed and limited space of the bony pelvis, causing obstruction, incomplete micturition, and urinary stasis. Congenital anomalies can contribute to UTIs, but urinary stasis is the primary factor in many cases.

DIF: Cognitive Level: Applying REF: p. 1005

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

6. A girl, age 5 1/2 years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for what condition?

a.

School phobia

b.

Glomerulonephritis

c.

Urinary tract infection (UTI)

d.

Attention deficit hyperactivity disorder (ADHD)

ANS: C

Girls between the ages of 2 and 6 years are considered high risk for UTIs. This child is showing signs of a UTI, including incontinence in a toilet-trained child and possible urinary frequency or urgency. A physiologic cause should be ruled out before psychosocial factors are investigated. Glomerulonephritis usually manifests with decreased urinary output and fluid retention. ADHD can contribute to urinary incontinence because the child is distracted, but the first manifestation was incontinence, not distractibility.

DIF: Cognitive Level: Applying REF: p. 1008

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

7. What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls?

a.

Avoid public toilet facilities.

b.

Limit long baths as much as possible.

c.

Cleanse the perineum with water after voiding.

d.

Ensure clear liquid intake of 2 L/day.

ANS: D

Adequate fluid intake minimizes urinary stasis. The recommended fluid intake is 50 ml/kg or 100 ml/lb per day. The average 5- to 6-year-old weighs approximately 18 kg (40 lb), so she should drink 2 L/day of fluid. There is no evidence that using public toilet facilities increases UTIs. Long baths are not associated with increased UTIs. Proper hand washing and perineal cleansing are important, but no evidence exists that these decrease UTIs in young girls.

DIF: Cognitive Level: Applying REF: p. 1010

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

8. In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information?

a.

Limit fluids to reduce reflux.

b.

Give cranberry juice twice a day.

c.

Have siblings examined for VUR.

d.

Surgery is indicated to reverse scarring.

ANS: C

Siblings are at high risk for VUR. The incidence of reflux in siblings is approximately 36%. The other children should be screened for early detection and to potentially reduce scarring. Fluids are not reduced. The efficacy of cranberry juice in reducing infection in children has not been established. Surgery may be necessary for higher grades of VUR, but the scarring is not reversible.

DIF: Cognitive Level: Applying REF: p. 1010

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

9. What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis?

a.

Infarction of renal vessels

b.

Immune complex formation and glomerular deposition

c.

Bacterial endotoxin deposition on and destruction of glomeruli

d.

Embolization of glomeruli by bacteria and fibrin from endocardial vegetation

ANS: B

After a streptococcal infection, antibodies are formed, and immune-complex reaction occurs. The immune complexes are trapped in the glomerular capillary loop. Infarction of renal vessels occurs in renal involvement in sickle cell disease. Bacterial endotoxin deposition on and destruction of glomeruli is not a mechanism for postinfectious glomerulonephritis. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation is the pathology of renal involvement with bacterial endocarditis.

DIF: Cognitive Level: Understanding REF: p. 1013

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

10. The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss?

a.

Poor appetite

b.

Reduction of edema

c.

Restriction to bed rest

d.

Increased potassium intake

ANS: B

This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 lb in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

DIF: Cognitive Level: Understanding REF: p. 1014

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

11. What measure of fluid balance status is most useful in a child with acute glomerulonephritis?

a.

Proteinuria

b.

Daily weight

c.

Specific gravity

d.

Intake and output

ANS: B

A record of daily weight is the most useful means to assess fluid balance and should be kept for children treated at home or in the hospital. Proteinuria does not provide information about fluid balance. Specific gravity does not accurately reflect fluid balance in acute glomerulonephritis. If fluid is being retained, the excess fluid will not be included. Also proteinuria and hematuria affect specific gravity. Intake and output can be useful but are not considered as accurate as daily weights. In children who are not toilet trained, measuring output is more difficult.

DIF: Cognitive Level: Analyzing REF: p. 1015 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

12. The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. What knowledge should influence the nurses reply?

a.

The antibiotic therapy contributes to labile blood pressure values.

b.

Hypotension leading to sudden shock can develop at any time.

c.

Acute hypertension is a concern that requires monitoring.

d.

Blood pressure fluctuations indicate that the condition has become chronic.

ANS: C

Blood pressure monitoring is essential to identify acute hypertension, which is treated aggressively. Antibiotic therapy is usually not indicated for glomerulonephritis. Hypertension, not hypotension, is a concern in glomerulonephritis. Blood pressure control is essential to prevent further renal damage. Blood pressure fluctuations do not provide information about the chronicity of the disease.

DIF: Cognitive Level: Applying REF: p. 1015

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

13. What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome?

a.

Low specific gravity

b.

Decreased hemoglobin

c.

Normal platelet count

d.

Reduced serum albumin

ANS: D

Total serum protein concentrations are reduced, with the albumin fractions significantly reduced. Specific gravity is high and proportionate to the amount of protein in the urine. Hemoglobin and hematocrit are usually normal or elevated. The platelet count is elevated as a result of hemoconcentration.

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TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

14. What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)?

a.

Reduce blood pressure.

b.

Lower serum protein levels.

c.

Minimize excretion of urinary protein.

d.

Increase the ability of tissue to retain fluid.

ANS: C

The objectives of therapy for the child with MCNS include reducing the excretion of urinary protein, reducing fluid retention, preventing infection, and minimizing complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Serum protein levels are already reduced as part of the disease process. This needs to be reversed. The tissue is already retaining fluid as part of the edema. The goal of therapy is to reduce edema.

DIF: Cognitive Level: Understanding REF: p. 1017 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

15. A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child?

a.

Stimulate appetite.

b.

Detect evidence of edema.

c.

Minimize risk of infection.

d.

Promote adherence to the antibiotic regimen.

ANS: C

High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

DIF: Cognitive Level: Analyzing REF: p. 1019 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

16. The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need?

a.

Consuming a regular diet

b.

Increasing protein

c.

Restricting fluids

d.

Decreasing calories

ANS: C

During the edematous stage of active nephrosis, the child has restricted fluid and sodium intake. As the edema subsides, the child is placed on a diet with increased salt and fluids. A regular diet is not indicated. There is no evidence that a diet high in protein is beneficial or has an effect on the course of the disease. Calories sufficient for growth and tissue healing are essential. With the child having little appetite and the fluid and salt restrictions, achieving adequate nutrition is difficult.

DIF: Cognitive Level: Applying REF: p. 1019

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

17. A child is admitted for minimal change nephrotic syndrome (MCNS). The nurse recognizes that the childs prognosis is related to what factor?

a.

Admission blood pressure

b.

Creatinine clearance

c.

Amount of protein in urine

d.

Response to steroid therapy

ANS: D

Corticosteroids are the drugs of choice for MCNS. If the child has not responded to therapy within 28 days of daily steroid administration, the likelihood of subsequent response decreases. Blood pressure is normal or low in MCNS. It is not correlated with prognosis. Creatinine clearance is not correlated with prognosis. The presence of significant proteinuria is used for diagnosis. It is not predictive of prognosis.

DIF: Cognitive Level: Analyzing REF: p. 1019 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

18. A 12-year-old child is injured in a bicycle accident. When considering the possibility of renal trauma, the nurse should consider what factor?

a.

Flank pain rarely occurs in children with renal injuries.

b.

Few nonpenetrating injuries cause renal trauma in children.

c.

Kidneys are immobile, well protected, and rarely injured in children.

d.

The amount of hematuria is not a reliable indicator of the seriousness of renal injury.

ANS: D

Hematuria is consistently present with renal trauma. It does not provide a reliable indicator of the seriousness of the renal injury. Flank pain results from bleeding around the kidney. Most injuries that cause renal trauma in children are of the nonpenetrating or blunt type and usually involve falls, athletic injuries, and motor vehicle accidents. In children, the kidneys are more mobile, and the outer borders are less protected than in adults.

DIF: Cognitive Level: Applying REF: p. 1018

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

19. What condition is the most common cause of acute renal failure in children?

a.

Pyelonephritis

b.

Tubular destruction

c.

Severe dehydration

d.

Upper tract obstruction

ANS: C

The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

DIF: Cognitive Level: Understanding REF: p. 1022

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

20. A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication?

a.

Propranolol (Inderal)

b.

Calcium gluconate

c.

Mannitol (Osmitrol) or furosemide (Lasix) (or both)

d.

Sodium, chloride, and potassium

ANS: C

In ARF, if hydration is adequate, mannitol or furosemide (or both) is administered to provoke a flow of urine. If glomerular function is intact, an osmotic diuresis will occur. Propranolol is a beta-blocker; it will not produce a rapid flow of urine in ARF. Calcium gluconate is administered for its protective cardiac effect when hyperkalemia exists. It does not affect diuresis. Electrolyte measurements must be done before administration of sodium, chloride, or potassium. These substances are not given unless there are other large, ongoing losses. In the absence of urine production, potassium levels may be elevated, and additional potassium can cause cardiac dysrhythmias.

DIF: Cognitive Level: Analyzing REF: p. 1027 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

21. What major complication is associated with a child with chronic renal failure?

a.

Hypokalemia

b.

Metabolic alkalosis

c.

Water and sodium retention

d.

Excessive excretion of blood urea nitrogen

ANS: C

Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

DIF: Cognitive Level: Analyzing REF: p. 1030

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

22. What diet is most appropriate for the child with chronic renal failure (CRF)?

a.

Low in protein

b.

Low in vitamin D

c.

Low in phosphorus

d.

Supplemented with vitamins A, E, and K

ANS: C

Dietary phosphorus may need to be restricted by limiting protein and milk intake. Substances that bind phosphorus are given with meals to prevent its absorption, which enables a more liberal intake of phosphorus-containing protein. Protein is limited to the recommended daily allowance for the childs age. Further restriction is thought to negatively affect growth and neurodevelopment. Vitamin D therapy is administered in children with CRF to increase calcium absorption. Supplementation of vitamins A, E, and K, beyond normal dietary intake, is not advised in children with CRF. These fat-soluble vitamins can accumulate.

DIF: Cognitive Level: Analyzing REF: p. 1030

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

23. What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD)?

a.

Children with ESRD usually adapt well to minor inconveniences of treatment.

b.

Children with ESRD require extensive support until they outgrow the condition.

c.

Multiple stresses are placed on children with ESRD and their families until the illness is cured.

d.

Multiple stresses are placed on children with ESRD and their families because childrens lives are maintained by drugs and artificial means.

ANS: D

Stressors on the family are often overwhelming because of the progressive deterioration. The child progresses from renal insufficiency to uremia to dialysis and transplantation, each of which requires intensive therapy and supportive care. The treatment of ESRD is intense and requires multiple examinations, dietary restrictions, and medications. Adherence to the regimen is often difficult for children and families because of the progressive nature of the renal failure. ESRD has an unrelenting course that has no known cure. Children do not outgrow the renal failure.

DIF: Cognitive Level: Analyzing REF: p. 1033 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

24. The nurse is caring for an adolescent who has just started dialysis. The child always seems angry, hostile, or depressed. The nurse should recognize that this is most likely related to what underlying cause?

a.

Physiologic manifestations of renal disease

b.

The fact that adolescents have few coping mechanisms

c.

Neurologic manifestations that occur with dialysis

d.

Resentment of the control and enforced dependence imposed by dialysis

ANS: D

Older children and adolescents need to feel in control. Dialysis forces the adolescent into a dependent relationship, which results in these behaviors. Being angry, hostile, or depressed are functions of the age of the child, not neurologic or physiologic manifestations of the dialysis.

DIF: Cognitive Level: Analyzing REF: p. 1037

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

25. What statement is an advantage of peritoneal dialysis compared with hemodialysis?

a.

Protein loss is less extensive.

b.

Dietary limitations are not necessary.

c.

It is easy to learn and safe to perform.

d.

It is needed less frequently than hemodialysis.

ANS: C

Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis. Treatments are needed more frequently but can be done at home.

DIF: Cognitive Level: Analyzing REF: p. 1036 TOP: Nursing Process: Evaluation

MSC: Client Needs: Physiological Integrity

26. What statement is descriptive of renal transplantation in children?

a.

It is an acceptable means of treatment after age 10 years.

b.

Children can receive kidneys only from other children.

c.

It is the preferred means of renal replacement therapy in children.

d.

The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

ANS: C

Renal transplantation offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

DIF: Cognitive Level: Understanding REF: p. 1038

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

27. The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching?

a.

My child needs to stay home from school for at least 1 more month.

b.

I should not add additional salt to any of my childs meals.

c.

My child will not be able to participate in contact sports while receiving corticosteroid therapy.

d.

I should measure my childs urine after each void and report the 24-hour amount to the health care provider.

ANS: B

Children with MCNS can be treated at home after the initial phase with appropriate discharge instructions, including a salt restriction of no additional salt to the childs meals. The child may return to school but should avoid exposure to infected playmates. Participation in contact sports is not affected by corticosteroid therapy. The parent does not need to measure the childs urine on a daily basis but may be instructed to test for albumin.

DIF: Cognitive Level: Applying REF: p. 1019

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

28. What is the narrowing of preputial opening of foreskin called?

a.

Chordee

b.

Phimosis

c.

Epispadias

d.

Hypospadias

ANS: B

Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

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TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

29. Identification and treatment of cryptorchid testes should be done by age 2 years. What is an important consideration?

a.

Medical therapy is not effective after this age.

b.

Treatment is necessary to maintain the ability to be fertile when older.

c.

The younger child can tolerate the extensive surgery needed.

d.

Sexual reassignment may be necessary if treatment is not successful.

ANS: B

The longer the testis is exposed to higher body heat, the greater the likelihood of damage. To preserve fertility, surgery should be done at an early age. Surgical intervention is the treatment of choice. Simple orchiopexy is usually performed as an outpatient procedure. The surgical procedure restores the testes to the scrotum. This helps the boy to have both testes in the scrotum by school age. Sexual reassignment is not indicated when the testes are not descended.

DIF: Cognitive Level: Understanding REF: p. 1041

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

30. Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what?

a.

Minimize separation anxiety.

b.

Prevent urinary complications.

c.

Increase acceptance of hospitalization.

d.

Promote development of normal body image.

ANS: D

Promoting development of normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Proper preprocedure preparation can facilitate coping with these issues. Preventing urinary complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible.

DIF: Cognitive Level: Analyzing REF: p. 1043 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

31. The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at bir