Deck 25: The Child with Renal Dysfunction

Question 1

What name is given to inflammation of the bladder?

A) Cystitis
B) Urethritis
C) Urosepsis
D) Bacteriuria

Answer 1

Cystitis

Question 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

Answer 2

pH 4.0

Question 3

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

Answer 3

Reduction of edema

Question 4

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)

Question 5

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.

Question 6

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

Question 7

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

Question 8

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.

Question 9

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.

Question 10

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

Question 11

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

Question 12

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

Question 13

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

A) Admission blood pressure
B) Creatinine clearance
C) Amount of protein in urine
D) Response to steroid therapy

Question 14

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

Question 15

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

Question 16

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

Question 17

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

Question 18

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.

Question 19

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.

Question 20

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 nurse's 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.

Question 21

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.

Question 22

A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurse's best response?

A) Blood pressure will stabilize.
B) Your child will have more energy.
C) Urine will be free of protein.
D) Urine output will increase.

Question 23

What is the narrowing of preputial opening of foreskin called?

A) Chordee
B) Phimosis
C) Epispadias
D) Hypospadias

Question 24

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

Question 25

Surgery is performed on a child to correct cryptorchidism. The parents understand the reason for the surgery if they tell the nurse this was done to do what?

A) "Prevent damage to the undescended testicle."
B) "Prevent urinary tract infections."
C) "Prevent prostate cancer."
D) "Prevent an inguinal hernia."

Question 26

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

Question 27

What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema?

A) Place an ice pack on the scrotal area.
B) Place the child in an upright sitting position.
C) Elevate the scrotum with a rolled washcloth.
D) Place a warm moist pack to the scrotal area.

Question 28

A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone. The nurse realizes further teaching is required if the parents state what?

A) "We will keep our child away from anyone who is ill."
B) "We will be sure to administer the prednisone as ordered."
C) "We will encourage our child to eat a balanced diet, but we will watch his salt intake."
D) "We understand our child will not be able to attend school, so we will arrange for home schooling."

Question 29

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.

Question 30

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.

Question 31

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 children's lives are maintained by drugs and artificial means.

Question 32

Parents of a newborn with ambiguous genitalia want to know how long they will have to wait to know whether they have a boy or a girl. The nurse answers the parents based on what knowledge?

A) Chromosome analysis will be complete in 7 days.
B) A physical examination will be able to provide a definitive answer.
C) Additional laboratory testing is necessary to assign the correct gender.
D) Gender assignment involves collaboration between the parents and a multidisciplinary team.

Question 33

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

Question 34

The parents of a child born with ambiguous genitalia tell the nurse that family and friends are asking what caused the baby to be this way. Tests are being done to assist in gender assignment. What should the nurse's intervention include?

A) Explain the disorder so they can explain it to others.
B) Help parents understand that this is a minor problem.
C) Suggest that parents avoid family and friends until the gender is assigned.
D) Encourage parents not to worry while the tests are being done.

Question 35

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 child's meals."
C) "My child will not be able to participate in contact sports while receiving corticosteroid therapy."
D) "I should measure my child's urine after each void and report the 24-hour amount to the health care provider."

Question 36

An infant has been diagnosed with bladder obstruction. What do symptoms of this disorder include?

A) Renal colic
B) Strong urinary stream
C) Urinary tract infections
D) Posturination dribbling

Question 37

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.

Question 38

For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs?

A) Appetite increases and blood pressure is normal
B) Urinary tract infection is gone and edema subsides
C) Generalized edema subsides and blood pressure is normal
D) Diuresis occurs as urinary protein excretion diminishes

Question 39

The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son. The nurse replies based on what knowledge?

A) Most boys in the United States can be toilet trained at age 3 years.
B) Training can begin when he has sufficient bladder capacity.
C) Additional surgery may be necessary to achieve continence.
D) They should begin now because he will require additional time.

Question 40

What do the clinical manifestations of minimal change nephrotic syndrome include?

A) Hematuria, bacteriuria, and weight gain
B) Gross hematuria, albuminuria, and fever
C) Hypertension, weight loss, and proteinuria
D) Massive proteinuria, hypoalbuminemia, and edema

Question 41

A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take?

A) Check the urine to see if hematuria has increased.
B) Obtain the child's blood pressure and notify the health care provider.
C) Obtain serum electrolytes and send urinalysis to the laboratory.
D) Reassure the child and encourage bed rest until the headache improves.

Question 42

The nurse is caring for a child with a urinary tract infection who is on intravenous gentamicin (Garamycin). What interventions should the nurse plan for this child with regard to this medication? (Select all that apply.)

A) Encourage fluids.
B) Monitor urinary output.
C) Monitor sodium serum levels.
D) Monitor potassium serum levels.
E) Monitor serum peak and trough levels.

Question 43

Calculate the 24-hour maintenance fluid requirement for a child weighing 6 kg. Fill in the blank with ml/day. Record your answer in a whole number.
___________________

Question 44

Parents of a child who will need hemodialysis ask the nurse, "What are the advantages of a fistula over a graft or external access device for hemodialysis?" What response should the nurse give? (Select all that apply.)

A) It is ready to be used immediately.
B) There are fewer complications with a fistula.
C) There is less restriction of activity with a fistula.
D) It produces dilation and thickening of the superficial vessels.
E) The fistula does not require a needle insertion at each dialysis.

Question 45

Calculate the 24-hour maintenance fluid requirement for a child weighing 25 kg. Fill in the blank with ml/day. Record your answer in a whole number.
__________________

Question 46

What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.)

A) Fever
B) Hypotension
C) Diminished urinary output
D) Decreased serum creatinine
E) Swelling and tenderness of graft area

Question 47

The nurse is preparing to admit a child to the hospital with a diagnosis of acute poststreptococcal glomerulonephritis. The nurse understands that the peak age at onset for this disease is what?

A) 2 to 4 years
B) 5 to 7 years
C) 8 to 10 years
D) 11 to 13 years

Question 48

What dietary instructions should the nurse give to parents of a child in the oliguria phase of acute glomerulonephritis with edema and hypertension? (Select all that apply.)

A) High fat
B) Low protein
C) Encouragement of fluids
D) Moderate sodium restriction
E) Limit foods high in potassium

Question 49

What signs and symptoms are indicative of a urinary tract disorder in the childhood period (2 to 14 years)? (Select all that apply.)

A) Fatigue
B) Dehydration
C) Hypotension
D) Growth failure
E) Blood in the urine

Question 50

A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show?

A) Bacteriuria and hematuria
B) Hematuria and proteinuria
C) Bacteriuria and increased specific gravity
D) Proteinuria and decreased specific gravity

Question 51

The nurse is caring for a child with acute renal failure. What laboratory findings should the nurse expect to find? (Select all that apply.)

A) Hyponatremia
B) Hyperkalemia
C) Metabolic alkalosis
D) Elevated blood urea nitrogen level
E) Decreased plasma creatinine level

Question 52

What signs and symptoms are indicative of a urinary tract disorder in the neonatal period (birth to 1 month)? (Select all that apply.)

A) Edema
B) Bradypnea
C) Frequent urination
D) Poor urinary stream
E) Failure to gain weight

Question 53

The nurse is caring for a child with a urinary tract infection who is on trimethoprim-sulfamethoxazole (Bactrim). What side effects of this medication should the nurse teach to the parents and the child? (Select all that apply.)

A) Rash
B) Urticaria
C) Pneumonitis
D) Renal toxicity
E) Photosensitivity

Question 54

What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply.)

A) Soft diet
B) High protein
C) Fluid restricted
D) No salt added at the table
E) Restriction of foods high in sodium

Question 55

A health care provider prescribes furosemide (Lasix), 10 mg intravenously (IV) now, for a child with acute glomerulonephritis. The medication label states: "Furosemide (Lasix) 20 mg/2 ml." The nurse prepares to administer the dose. How many milliliters will the nurse prepare to administer the dose? Fill in the blank. Record your answer in a whole number.
________________

Question 56

What signs and symptoms are indicative of a urinary tract disorder in the infancy period (1-24 months)? (Select all that apply.)

A) Pallor
B) Poor feeding
C) Hypothermia
D) Excessive thirst
E) Frequent urination

Question 57

A child is hospitalized in acute renal failure and has a serum potassium greater than 7 mEq/L. What temporary measures that will produce a rapid but transient effect to reduce the potassium should the nurse expect to be prescribed? (Select all that apply.)

A) Dialysis
B) Calcium gluconate
C) Sodium bicarbonate
D) Glucose 50% and insulin
E) Sodium polystyrene sulfonate (Kayexalate)

Question 58

The nurse is admitting a 9-year-old child with hemolytic uremic syndrome. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Hematuria
B) Anorexia
C) Hypertension
D) Purpura
E) Proteinuria
F) Periorbital edema

Question 59

What dietary instructions should the nurse give to parents of a child undergoing chronic hemodialysis? (Select all that apply.)

A) High protein
B) Fluid restriction
C) High phosphorus
D) Sodium restriction
E) Potassium restriction

Question 60

The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what?

A) 2 to 3 years
B) 4 to 5 years
C) 6 to 7 years
D) 8 to 9 years

Question 61

Calculate the 24-hour maintenance fluid requirement for a child weighing 12 kg. Fill in the blank with ml/day. Record your answer in a whole number.
___________________

Question 62

MATCHING
Match the classification of urinary tract infections of inflammations to its definition.

Inflammation of the upper urinary tract and kidneys

A)Persistent urinary tract infection
B)Cystitis
C)Urethritis
D)Pyelonephritis
E)Urosepsis

Question 63

MATCHING
Match the classification of urinary tract infections of inflammations to its definition.

Inflammation of the urethra

A)Persistent urinary tract infection
B)Cystitis
C)Urethritis
D)Pyelonephritis
E)Urosepsis

Question 64

MATCHING
Match the classification of urinary tract infections of inflammations to its definition.

Persistence of bacteriuria despite antibiotic treatment

A)Persistent urinary tract infection
B)Cystitis
C)Urethritis
D)Pyelonephritis
E)Urosepsis

Question 65

A health care provider prescribes Osmitrol (mannitol), 0.5 g/kg intravenously (IV) now, for a child with minimal change nephrotic syndrome. The child weighs 10 kg. The medication label states: "Osmitrol (mannitol) 20 g/100 ml." The nurse prepares to administer the dose. How many milliliters will the nurse prepare to administer the dose? Fill in the blank. Record your answer in a whole number.
________________

Question 66

MATCHING
Match the classification of urinary tract infections of inflammations to its definition.

Inflammation of the bladder

A)Persistent urinary tract infection
B)Cystitis
C)Urethritis
D)Pyelonephritis
E)Urosepsis

Question 67

MATCHING
Match the classification of urinary tract infections of inflammations to its definition.

Febrile urinary tract infection coexisting with systemic signs of bacterial illness

A)Persistent urinary tract infection
B)Cystitis
C)Urethritis
D)Pyelonephritis
E)Urosepsis