Chapter 28: The Child With a Genitourinary Condition My Nursing Test Banks

Chapter 28: The Child With a Genitourinary Condition

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. The nurse discussed strategies with a parent to prevent a recurrence of urinary tract infection in the child. The statement made by the parent indicating a need for further teaching is:

a.

My daughter should wash and wipe the perineal area from front to back.

b.

I am only going to have my daughter wear cotton underwear.

c.

It is acceptable to take frequent bubble baths.

d.

She needs to drink lots of fluids and void frequently.

ANS: C

Oils in bubble bath and similar products are known to irritate the urethra.

DIF: Cognitive Level: Application REF: Text Reference: 666, NCP 28-1

OBJ: Objective: N/A TOP: Topic: Acute Urinary Tract Infection

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Detection of Disease

2. When asked about correcting the hypospadias of their newborn, the nurse explains that with this condition:

a.

No intervention is necessary as the defect will correct itself over time.

b.

Surgical repair of the hypospadias is done before 18 months of age.

c.

Corrective surgery is usually delayed until the preschool period.

d.

Repairing the defect will increase the risk of testicular cancer.

ANS: B

Treatment of hypospadias consists of surgical repair and is usually performed before 18 months of age.

DIF: Cognitive Level: Comprehension REF: Text Reference: 662

OBJ: Objective: 8 TOP: Topic: Hypospadias

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

3. The initial sign of nephrosis that the nurse might note in the child would be:

a.

Raspberry-like rash

b.

Periorbital edema

c.

Temperature elevation

d.

Abdominal pain

ANS: B

The edema of nephrotic syndrome is generalized, and not readily noticed, even by the parents, but an early sign that can be assessed is periorbital edema.

DIF: Cognitive Level: Application REF: Text Reference: 662

OBJ: Objective: 2 TOP: Topic: Nephrotic Syndrome

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Detection of Disease

4. While a child is receiving prednisone to treat nephrotic syndrome, it is important for the nurse to assess the child for:

a.

Infection

b.

Urinary retention

c.

Easy bruising

d.

Hypoglycemia

ANS: A

Prednisone depresses the immune response and increases susceptibility to infection. Because steroids mask signs of infection, the child must be assessed for more subtle symptoms of illness.

DIF: Cognitive Level: Analysis REF: Text Reference: 663

OBJ: Objective: 2 TOP: Topic: Nephrotic Syndrome

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. During a physical assessment of a hospitalized 5-year-old, the nurse notes that the foreskin has been retracted and is very tight on the shaft of the penis; the nurse is unable to return it over the head of the penis. The nurse should:

a.

Forcibly push the foreskin down over the head of the penis.

b.

Place a warm compress on the penis.

c.

Notify the charge nurse.

d.

Wait a few hours and try again.

ANS: C

Notify the charge nurse of this occurrence of paraphimosis. The tight foreskin can impede blood flow to the penis; this should be remedied immediately.

DIF: Cognitive Level: Application REF: Text Reference: 662

OBJ: Objective: 1 TOP: Topic: Paraphimosis

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

6. A 7-year-old child with acute glomerulonephritis has gross hematuria and has been confined to bed. An appropriate nursing intervention for this child would be:

a.

Providing activities for the child on restricted activity

b.

Feeding the child a protein-restricted diet

c.

Carefully handling edematous extremities

d.

Observing the child for evidence of hypotension

ANS: A

Although children may feel well, activity is limited until hematuria resolves.

DIF: Cognitive Level: Application REF: Text Reference: 669

OBJ: Objective: 2 TOP: Topic: Acute Glomerulonephritis

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk

7. The nurse clarifies that the urinary diversion procedure that would be least damaging to the body image of the adolescent would be:

a.

Urostomy

b.

Ileal conduit

c.

Nephrostomy

d.

Suprapubic placement

ANS: B

The ileal conduit diverts urine to the colon, and the urine is excreted with the feces. There is no external appliance as is needed with the other diversion methods.

DIF: Cognitive Level: Analysis REF: Text Reference: 664, Table 28-2

OBJ: Objective: 8 TOP: Topic: Obstructive Uropathy-Urinary Diversions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. The nurse clarifies that while on prednisone, immunizations:

a.

Can interfere with the treatment for nephrosis

b.

Require that the child have antibiotic coverage

c.

Can be given in smaller, divided doses

d.

Should be delayed

ANS: D

No vaccinations or immunizations should be administered while the disease is active and during immunosuppressive therapy.

DIF: Cognitive Level: Comprehension REF: Text Reference: 668

OBJ: Objective: 2 TOP: Topic: Nephrotic Syndrome

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk

9. When diuresis has not occurred after a month on corticosteroids, the nurse explains to the parents of a child with nephrotic syndrome that diuresis can be brought about by a protocol of:

a.

Ibuprofen, an antiinflammatory agent

b.

Lasix, a diuretic

c.

Cipro, an antibiotic

d.

Cytoxan, an antisuppressant

ANS: D

A potent antisuppressant such as Cytoxan can bring about diuresis when corticosteroids have proven ineffective.

DIF: Cognitive Level: Analysis REF: Text Reference: 667

OBJ: Objective: 2 TOP: Topic: Nephrotic Syndrome

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. Because of the hyperkalemia associated with acute glomerulonephritis, the nurse recommends that the child avoid such foods as:

a.

Dairy products

b.

Whole-grain cereals

c.

Organ meats

d.

Bananas

ANS: D

Bananas are very high in potassium and should be avoided.

DIF: Cognitive Level: Application REF: Text Reference: 669

OBJ: Objective: 2 TOP: Topic: AGN KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

11. The physical assessment that the nurse would omit in caring for a 2-year-old who has a Wilms tumor is:

a.

Performing ROM on lower extremities

b.

Palpating the abdomen

c.

Assessing for bowel sounds

d.

Percussing ankle and knee reflexes

ANS: B

Palpation of the abdomen could disturb the tumor and cause spread of the malignancy.

DIF: Cognitive Level: Application REF: Text Reference: 669

OBJ: Objective: 7 TOP: Topic: Wilms Tumor

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk

12. Parents are speaking with the urologist about their sons undescended testicle. The nurse determines the childs father understands the information presented when he states:

a.

An undescended testicle can reduce fertility.

b.

The testicle usually descends spontaneously during the first month of life.

c.

Surgical correction reduces the risk for testicular tumors.

d.

The optimal time to surgically correct the condition is at diagnosis.

ANS: A

Although orchiopexy improves the condition, the fertility rate among patients may be reduced even when only one testis is undescended.

DIF: Cognitive Level: Analysis REF: Text Reference: 672

OBJ: Objective: 9 TOP: Topic: Cryptorchidism

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. A parent tells the nurse her child is scheduled for an x-ray of the bladder and urethra that is done while the child is urinating. The nurse recognizes this description as a(n):

a.

Cystometrogram

b.

Cystoscopy

c.

Voiding cystourethrogram

d.

Intravenous pyelogram

ANS: C

An x-ray examination of the bladder and urethra before and during micturition is called a voiding cystourethrogram.

DIF: Cognitive Level: Comprehension REF: Text Reference: 661

OBJ: Objective: 4 TOP: Topic: Diagnostic Procedures

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

14. A 6-year-old child with daytime enuresis complains of dysuria and urgency; the nurse recognizes these as signs and symptoms of:

a.

Urinary tract infection

b.

Nephrotic syndrome

c.

Acute glomerulonephritis

d.

Vesicoureteral reflux

ANS: A

Urinary frequency and pain during micturition are symptoms of acute urinary tract infection.

DIF: Cognitive Level: Analysis REF: Text Reference: 665

OBJ: Objective: N/A TOP: Topic: Acute Urinary Tract Infection

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Detection of Disease

15. An appropriate intervention for the child with minimal change nephrotic syndrome who is edematous would be to:

a.

Teach the child to minimize body movements.

b.

Change the childs position frequently.

c.

Keep the head of the childs bed flat.

d.

Keep edematous areas moist and covered.

ANS: A

The child should be turned frequently to prevent respiratory tract infection and to prevent pressure on delicate skin.

DIF: Cognitive Level: Analysis REF: Text Reference: 667

OBJ: Objective: 5 TOP: Topic: Nephrotic Syndrome

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

16. The statement made by a parent of a child with nephrotic syndrome indicating an understanding of discharge teaching is:

a.

I will make sure he gets his measles vaccine as soon as he gets home.

b.

He can stop taking his medication next week.

c.

I should check his urine for protein when he goes to the bathroom.

d.

He should eat a low-protein diet for the next few weeks.

ANS: C

The parents should be instructed to keep a daily record of the childs urinary proteins.

DIF: Cognitive Level: Analysis REF: Text Reference: 667

OBJ: Objective: N/A TOP: Topic: Nephrotic Syndrome

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Detection of Disease

17. A 5-year-old boy is admitted to the hospital with acute glomerulonephritis. In taking the childs history, the nurse recognizes the probable cause of this condition as:

a.

Recovered from German measles 2 months ago

b.

Dysuria since the previous night

c.

A history of allergy

d.

A sore throat 2 weeks ago

ANS: D

Acute glomerulonephritis develops from 1 to 3 weeks after a streptococcal infection, which causes an allergic-type response that alters the effectiveness of the glomeruli.

DIF: Cognitive Level: Analysis REF: Text Reference: 668

OBJ: Objective: 2 TOP: Topic: Acute Glomerulonephritis

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. The nurse is explaining to a 17-year-old female the actions to prevent urinary tract infection. The nurse determines the adolescent understands the information when she says a good drink to keep urine acidic is:

a.

Milk

b.

Grape juice

c.

Apple juice

d.

Orange juice

ANS: C

Juices such as apple or cranberry help maintain acidity of urine.

DIF: Cognitive Level: Analysis REF: Text Reference: 666, NCP 28-1

OBJ: Objective: N/A TOP: Topic: Acute Urinary Tract Infection

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Detection of Disease

19. The 6-year-old scheduled for an orchiopexy shyly asks the nurse, What are they going to do to me down there? The nurses best response would be:

a.

They are going to fix you up down there

b.

They will move your testicle from your abdomen to your scrotum.

c.

What do you think your doctor is going to do?

d.

You shouldnt worry. Your doctor knows exactly what to do.

ANS: C

Encourage the patient to talk about what he knows and what feelings he has about the surgery. School-age children have a fear of bodily harm.

DIF: Cognitive Level: Analysis REF: Text Reference: 672

OBJ: Objective: 8 TOP: Topic: Orchipexy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

MULTIPLE RESPONSE

1. The nurse caring for a newborn with exstrophy of the bladder will include in the care:

Select all that apply.

a.

Diaper infant tightly.

b.

Protect skin around bladder.

c.

Position infant on back.

d.

Prepare for surgical closure.

e.

Cover exposed bladder with shield.

ANS: B, C, D, E

The infant is kept on his back or side with special attention to the skin around the exposed bladder, which is constantly bathed with urine. These infants are diapered loosely, if at all. Surgical closure is done as quickly as possible.

DIF: Cognitive Level: Analysis REF: Text Reference: 663

OBJ: Objective: N/A TOP: Topic: Exstrophy of the Bladder

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

2. The nurse caring for a child with nephrotic syndrome is alert to the classic symptoms of this disorder, which are:

Select all that apply.

a.

Proteinuria

b.

Grossly bloody urine

c.

Hyperalbuminemia

d.

Fatigue

e.

Generalized edema

ANS: A, B, D, E

All options listed are those of nephrotic syndrome with the exception of hyperalbuminemia. The nephrotic child has hypoalbuminemia, as most of the protein has been spilled in the urine.

DIF: Cognitive Level: Analysis REF: Text Reference: 665-666

OBJ: Objective: 2 TOP: Topic: Nephrotic Syndrome

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

COMPLETION

1. The nurse explains that the test that measures the pressure and volume of the urine stream is called the ____________________.

ANS: uroflowmeter

DIF: Cognitive Level: Knowledge REF: Text Reference: 661

OBJ: Objective: 4 TOP: Topic: Uroflowmeter

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

NOT: Rationale: The test that specifically measures the dynamics of micturition is the uroflowmeter

2. The nurse uses a diagram to show how the ____________________, the working unit of the kidney, filters and regulates fluids.

ANS: nephron

DIF: Cognitive Level: Comprehension REF: Text Reference: 664

OBJ: Objective: 3 TOP: Topic: Nephron

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

NOT: Rationale: The nephron is the working unit of the kidney that filters and regulates fluids in the body. There are roughly 1 million nephrons in each kidney.

3. When a childs ureter becomes completely obstructed from scarring, the nurse explains that urinary diversion may be necessary to prevent the reflux back into the renal pelvis from causing ____________________.

ANS: hydronephrosis

DIF: Cognitive Level: Comprehension REF: Text Reference: 664

OBJ: Objective: 1 TOP: Topic: Hydronephrosis

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

NOT: Rationale: Hydronephrosis occurs when the urine is unable to pass through the ureter into the bladder; the urine refluxes back into the renal pelvis, causing dilation and swelling of the kidney.

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