Chapter 30: Alterations of Renal and Urinary Tract Function in Children My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 30: Alterations of Renal and Urinary Tract Function in Children

Test Bank

MULTIPLE CHOICE

1. Upon examination of a male infant, it is determined that the urethral meatus is located on the undersurface of the penis. The nurse will document this condition as:

a.

Hypospadias

b.

Epispadias

c.

Hydroureter

d.

Cryptorchidism

ANS: A

When the urethral meatus is located on the undersurface of the penis, it is referred to as hypospadias.

Epispadias occurs when the urethral meatus is on the dorsal surface of the penis.

Hydroureter is not associated with the urethra.

Cryptorchidism refers to undescended testes.

REF: p. 765

2. A newborn female has chronic renal failure caused by a lack of development of one of the kidneys. When a staff member asks what this condition is called, how should the nurse respond? This condition is called:

a.

Renal dysplasia

b.

Renal agenesis

c.

Hypoplastic kidney

d.

Renal aplasia

ANS: D

During embryologic development, the ureteric duct grows into the metanephric tissue, triggering the formation of the kidneys. If this growth does not occur, the kidney is absent, a condition called renal aplasia.

Renal dysplasia usually results from abnormal differentiation of the renal tissues.

Renal agenesis is the absence of one or both kidneys.

Hypoplastic kidney is small with a decreased number of nephrons.

REF: p. 766

3. A nurse is preparing to teach about renal agenesis. Which information should the nurse include? Infants who have bilateral renal agenesis:

a.

Die within 1 year of birth

b.

Can expect to have a normal, healthy life

c.

Are stillborn or die within a few hours of birth

d.

Have structural abnormalities that can be corrected with surgery

ANS: C

Bilateral renal agenesis is a rare disorder incompatible with extrauterine life.

Bilateral renal agenesis is a rare disorder incompatible with extrauterine life. The infant lives only a few hours.

Bilateral renal agenesis is a rare disorder incompatible with extrauterine life.

Bilateral renal agenesis is a rare disorder incompatible with extrauterine life.

REF: p. 766

4. An infant male experiences a constant dribbling of urine. His urethral opening is located behind the glans. Which of the following is the most likely diagnosis the nurse will observe on the chart?

a.

Anterior epispadias

b.

Posterior epispadias

c.

Extrophy of the bladder

d.

Bladder outlet obstruction

ANS: A

Anterior epispadias occurs when the urethral opening is small and situated behind the glans.

Posterior epispadias occurs when a fissure extends the entire length of the penis and into the bladder neck.

Extrophy of the bladder occurs when the bladder is exposed on the abdominal wall.

Bladder outlet obstruction occurs when urinary outflow is obstructed.

REF: p. 765

5. A newborn male dies shortly after birth. Physical examination reveals wide-set eyes, parrot-beak nose, low-set ears, and receding chin. The most likely diagnosis the nurse will see on the chart is:

a.

Unilateral renal agenesis

b.

Potter syndrome

c.

Renal aplasia

d.

Renal dysplasia

ANS: B

Potter syndrome is manifested by wide-set eyes, parrot-beak nose, low-set ears, and receding chin.

Unilateral renal agenesis occurs when one kidney is nonfunctioning, but it is not associated with other congenital anomalies, such as wide-set eyes and low-set ears.

Renal aplasia is the abnormal growth of one kidney, but is not associated with other anomalies.

Renal dysplasia is abnormal tissue growth in a kidney, but it is not associated with other anomalies.

REF: p. 766

6. A 15-year-old female presents with flank pain, irritability, malaise, and fever. Tests reveal glomerulonephritis. When the parents ask what could have caused this, how should the nurse respond?

a.

Poststreptococcal infection

b.

Nephropathy

c.

Nephrotic syndrome

d.

Potter syndrome

ANS: A

Glomerulonephritis is most likely related to a post-strep infection.

Glomerulonephritis is most likely related to a post-strep infection. It is not related to nephropathy.

Glomerulonephritis is most likely related to a post-strep infection. It is not related to nephrotic syndrome

Potter syndrome is incompatible with life.

REF: p. 766

7. A urologist is discussing nephritic syndrome. Which information should be included? If nephrotic syndrome is not caused initially by kidney disease, it is termed _____ nephrotic syndrome.

a.

Primary

b.

Secondary

c.

Tertiary

d.

Idiopathic

ANS: B

Secondary nephrotic syndrome is not caused initially by kidney disease.

Secondary, not primary, nephrotic syndrome is not caused initially by kidney disease.

Secondary, not tertiary, nephrotic syndrome is not caused initially by kidney disease.

Secondary, not idiopathic, nephrotic syndrome is not caused initially by kidney disease.

REF: p. 767

8. A 4-year-old male is diagnosed with nephrotic syndrome. Which of the following assessment findings accompanies this condition?

a.

Proteinuria

b.

Decreased blood urea nitrogen (BUN)

c.

Hematuria

d.

Sodium loss

ANS: A

Proteinuria accompanies nephrotic syndrome.

Proteinuria accompanies nephrotic syndrome. The BUN may be elevated.

Proteinuria, not hematuria, accompanies nephrotic syndrome.

Proteinuria, not sodium loss, accompanies nephrotic syndrome.

REF: p. 767

9. A 7-year-old female is diagnosed with nephrotic syndrome. Which of the following should the nurse ask the parents if they or the child has noticed recently?

a.

Sunken fontanelles

b.

Vesicular skin rash

c.

Frothy urine

d.

Jaundice

ANS: C

In the child with nephrotic syndrome, the parents may notice diminished, frothy, or foamy urine output.

Parents may notice diminished, frothy, or foamy urine output, not sunken fontanelles.

Parents may notice diminished, frothy, or foamy urine output, not a vesicular skin rash.

Parents may notice diminished, frothy, or foamy urine output, not jaundice.

REF: p. 767

10. Which of the following clusters of symptoms would make a clinician suspect a child has developed glomerulonephritis?

a.

Pyuria, fever, and abdominal pain

b.

Proteinuria, hypotension, and ascites

c.

Dysuria, urinary frequency, and abdominal tenderness

d.

Gross hematuria, flank pain, and hypertension

ANS: D

The child with glomerulonephritis typically experiences gross or microscopic hematuria, proteinuria, edema, renal insufficiency, flank pain, and hypertension.

The child typically has gross or microscopic hematuria, proteinuria, edema, and renal insufficiency. Pyuria and abdominal pain are typically not present.

The child may experience proteinuria, but also experiences hematuria.

Dysuria and frequency are symptoms of cystitis.

REF: p. 767

11. A 5-year-old male was diagnosed with glomerulonephritis. History reveals that he had an infection 3 weeks before the onset of this condition. The infection was most likely located in the:

a.

Bone

b.

Gastrointestinal (GI) tract

c.

Respiratory tract

d.

Ear

ANS: C

The location of the infection leading to glomerulonephritis is the respiratory tract.

The location of the infection leading to glomerulonephritis is the respiratory tract, not the bone.

The location of the infection leading to glomerulonephritis is the respiratory tract, not the GI tract.

The location of the infection leading to glomerulonephritis is the respiratory tract, not the ear.

12. When a child is admitted with acute renal failure, a clinician realizes the most common cause of acute renal failure is:

a.

Glomerulonephritis

b.

Obstruction

c.

Nephrotic syndrome

d.

Hemolytic uremic syndrome (HUS)

ANS: D

HUS is the most common cause of acute renal failure in children.

HUS is the most common cause of acute renal failure in children. Glomerulonephritis can lead to renal failure, but it is not the most common.

HUS is the most common cause of acute renal failure in children. Obstruction is not a common cause.

HUS is the most common cause of acute renal failure in children. Nephrotic syndrome could contribute to renal failure, but it is not the most common cause.

REF: pp. 767-768

13. A 10-year-old male is diagnosed with glomerulonephritis. Tests reveal the deposition of immunoglobulin IgA in the glomerular capillaries. The nurse will monitor for recurrent:

a.

Infections

b.

Hematuria

c.

Vomiting

d.

Enuresis

ANS: B

The child with immunoglobulin associated with glomerulonephritis will have recurrent hematuria.

The child with immunoglobulin associated with glomerulonephritis will have recurrent hematuria; infections do not reoccur.

The child with immunoglobulin associated with glomerulonephritis will have recurrent hematuria, not vomiting.

The child with immunoglobulin associated with glomerulonephritis will have recurrent hematuria, not enuresis.

REF: p. 767

14. When a newborn is admitted with urinary tract infections (UTIs), which type of infection will the nurse look for in the newborn?

a.

Blood-borne infections

b.

Infections caused by bacteria from the gastrointestinal (GI) tract

c.

Yeast infections

d.

Viral infections

ANS: A

UTIs are rare in newborns, and when they do occur, they are usually caused by bacteria from the bloodstream that have settled in the urinary tract.

UTIs are rare in newborns, and when they do occur, they are usually caused by bacteria from the bloodstream that have settled in the urinary tract. Older children might have bacteria from the GI tract, but not newborns.

UTIs are rare in newborns, and when they do occur, they are usually caused by bacteria from the bloodstream that have settled in the urinary tract. Older children might have UTIs associated with yeast, but not newborns.

UTIs are rare in newborns, and when they do occur, they are usually caused by bacteria from the bloodstream that have settled in the urinary tract. Newborns will not have infections secondary to viral infections.

REF: p. 768

15. A 3-year-old female presents with recurrent urinary tract infections (UTIs), fever, poor growth and development, and feeding problems. Tests reveal a retrograde flow of urine from the urinary bladder into the ureters. When giving report to the oncoming shift, the nurse will call this condition:

a.

Vesicoureteral reflux (VUR)

b.

Vesicourethral reflux

c.

Vesicoureteral influx

d.

Hydronephrosis

ANS: A

VUR is the retrograde flow of urine from the bladder into the kidney or ureters, or both.

VUR is the retrograde flow of urine from the bladder into the kidney or ureters, or both. It is ureteral, not urethral.

VUR is the retrograde flow of urine from the bladder into the kidney or ureters, or both. It is reflux, not influx.

VUR is the retrograde flow of urine from the bladder into the kidney or ureters, or both. Reflux could lead to pyelonephritis, not hydronephrosis.

REF: p. 768

16. A nurse observes on the chart that a patient is admitted with Wilms tumors. A nurse knows the tumors are found in the:

a.

Kidneys

b.

Ureters

c.

Bladder

d.

Urethra

ANS: A

Wilms tumor is found in the kidneys.

Wilms tumor is found in the kidneys, not the ureters.

Wilms tumor is found in the kidneys, not the bladder.

Wilms tumor is found in the kidneys, not the urethra.

REF: p. 769

17. A 6-year-old male is experiencing urine reflux from the urinary bladder into a grossly dilated ureter and calyces. He was diagnosed with vesicoureteral reflux. This condition would be graded:

a.

I

b.

II

c.

III

d.

IV

ANS: D

The patient has symptoms of grade IV reflux.

Grade I involves a non-dilated ureter.

Grade II does not involve dilation.

Grade III does not involve gross dilation.

REF: p. 769

18. A 2-year-old male is diagnosed with Wilms tumor. Which of the following clinical conditions is often associated with this disease?

a.

Cystic disease of the liver

b.

Aniridia

c.

Anemia

d.

Hypothyroidism

ANS: B

Children with Wilms tumor often have other congenital anomalies, including aniridia, a lack of an iris in the eye.

Children with Wilms tumor often have other congenital anomalies, including aniridia, a lack of an iris in the eye. They could have other anomalies, but cystic liver is not one.

Children with Wilms tumor often have other congenital anomalies, including aniridia. They do not experience anemia.

Children with Wilms tumor often have other congenital anomalies, including aniridia. They do not experience hypothyroidism.

REF: p. 770

19. A 7-year-old male presents to his primary care provider for incontinence. His mother indicates that he has never been continent. Which of the following is the most likely diagnosis the nurse will observe on the chart?

a.

Nocturnal enuresis

b.

Diurnal enuresis

c.

Primary enuresis

d.

Secondary enuresis

ANS: C

Primary incontinence (enuresis) means the child has never been continent.

Nocturnal enuresis is nighttime incontinence.

Since the child has never been continent, the child has primary enuresis.

With secondary incontinence the child would have had a period of continence, which this child did not; thus, he has primary enuresis.

REF: p. 770

MULTIPLE RESPONSE

1. In addition to a mass, the child with Wilms tumor may also exhibit which assessment finding? (Select all that apply.)

a.

Abdominal pain

b.

Enuresis

c.

Hematuria

d.

Weight gain

e.

Fever

ANS: A, C, E

In addition to an abdominal mass, other presenting complaints include vague abdominal pain (37%), hematuria (18%), and fever (22%). Enuresis and weight gain do not occur.

REF: p. 770

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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