Question 1

A female preschool patient with a urinary tract infection is scheduled to have a voiding cystourethrogram. What should the nurse include when teaching the patient about this procedure?

Accepted Answer

A voiding cystourethrogram is a study of the lower urinary tract and looks at the structure of the urethra and bladder and the presence of reflux into the ureters. After bladder catheterization, a radiopaque dye is injected into the bladder, and the catheter is then removed. The child is asked to void into a bedpan while serial X-ray films are taken. Being asked to void while being observed may be the most stressful part of the procedure for children because they have been taught voiding is a private act. Be sure children are told in advance that they will be asked to do this, and that it is alright if a stranger watches them. A headache is not a common occurrence after this procedure. A local anesthetic is not needed for this procedure. The patient will not be asked to drink water during the procedure.

Question 2

The nurse is caring for a female preschool-age patient with a urinary tract infection. What measures should the nurse teach the mother to prevent future infections?

Accepted Answer

Urinary tract infections occur more often in girls than boys because the urethra is shorter in girls and, because it is located close to the vagina and anus, vulvovaginitis or rectal bacteria can easily spread to the urethra. Girls should be taught early to wipe themselves from front to back after voiding and defecating to avoid contaminating the urethra. The child should be encouraged to drink more fluid to prevent concentrated urine. Activity level does not influence the development of urinary tract infections. There is a suggested correlation between the use of hot tubs and urinary tract infections in girls so use of these should be discouraged or minimized.

Question 3

The nurse is planning a community health program to improve awareness of renal disease as one of the 2020 National Health Goals. What information should the nurse include in this program? (Select all that apply.)

Accepted Answer

Nurses can help the nation achieve the 2020 National Health Goals for renal disease by educating parents to give antibiotics conscientiously for streptococcal throat infections and being active advocates for organ transplant procedures. Restricting fluids, recommending specific foods, and limiting the intake of milk and dairy products are not interventions to support the 2020 National Health Goals for renal disease.

Question 4

The nurse is providing a child with oxybutynin (Ditropan) as prescribed following surgical repair of a hypospadias. What should the nurse teach the patient about the purpose of this medication?

Accepted Answer

The child may notice painful bladder spasms as long as the catheter is in place after surgical repair of a hypospadias. An anticholinergic medication, which relieves bladders spasms such as oxybutynin (Ditropan), may be prescribed for pain relief. Oxybutynin (Ditropan) does not acidify the urine, stimulate kidney function, or prevent nausea and vomiting.

Question 5

The nurse instructs a school-age patient and the parents on continuous cycling peritoneal dialysis. Which statement indicates that teaching has been effective?

Accepted Answer

Cloudy drainage could indicate an infection such as peritonitis and should be reported to the health care provider. The solution should be infused at body temperature. Redness and warmth around the tube insertion site could indicate an infection and should be reported to the health care provider. Weight gain and a productive cough could indicate fluid retention and should be reported to the health care provider.

Question 6

The parents of child recovering from surgery to repair vesicoureteral reflux ask the nurse if they can do anything to help with the care of their child. What should the nurse encourage the parents to do at this time?

Accepted Answer

Be sure that the child and parents understand the importance of not raising the collection system above the child's bladder level when helping the child out of bed. This helps prevent potentially contaminated urine from flowing from the tubes back into the bladder or ureters. Tub baths are contraindicated until all surgical sites have healed. The child will not be on bed rest so diversional activities are not needed. The child will not be on a fluid restriction so hard candy is not needed to help with mouth dryness.

Question 7

The nurse is teaching manifestations of nephrotic syndrome to the parents of a child with the disorder. What should the nurse instruct the parents to monitor to determine if edema is increasing?

Accepted Answer

Edema tends to be dependent or occur in the lower parts of the body. Parents may notice clothing no longer fits a child around the waist because edematous fluid is beginning to collect in the abdominal cavity or ascites. This is what the parents should monitor in the child. Appetite and breathing rate will be affected later after a significant amount of ascites fluid accumulates. Edema in the feet is not a typical manifestation of this disorder.

Question 8

A school-age child is returning home after a renal biopsy. What teaching should the nurse provide to the patient and parents at this time? (Select all that apply.)

Accepted Answer

If a renal biopsy is done on an ambulatory basis, children can be discharged 2 to 4 hours after the procedure if vital signs are stable and they have voided. Encourage children to drink a glass of fluid every hour while awake during the first 24 hours to keep urine flowing freely and prevent blood from clotting in the kidney tubules and blocking urine flow. The first voiding after renal biopsy is invariably blood-tinged. Instruct parents how to keep serial urine samples, comparing each specimen with the previous one, to detect whether hematuria is becoming more or less marked. The dressing should not be disturbed. Parents should keep the child on restricted activity for 24 hours or until no more hematuria is present.

Question 9

The parents of a child with acute glomerulonephritis ask the nurse to explain the cause of the disease. What organism should the nurse instruct the parents as being the cause for the disorder?

Accepted Answer

Glomerulonephritis usually occurs in children as an immune complex disease after infection with group A beta-hemolytic streptococci. Acute glomerulonephritis is not caused by group B streptococci, rhinoviruses, or Staphylococcus viridans.

Question 10

The nurse is teaching the parent of a child with chronic renal failure on high-potassium foods that should be restricted. Which foods will the nurse include in this teaching? (Select all that apply.)

Accepted Answer

Foods that are high in potassium include bananas, carrots, nuts, and milk. Broccoli, wheat, bran, chicken, fish, and green beans are not high in potassium and do not need to be restricted.

Question 11

The nurse is prescribed to infuse 75 ml/kg of dialysate for a child's peritoneal dialysis treatment. The child weighs 77 lb. At the conclusion of the treatment, the nurse measures 3,000 ml of dialysate outflow. How much of the outflow should the nurse document as peritoneal fluid?

Accepted Answer

The nurse needs to first determine the patient's weight in kilograms by dividing 77 lb by
2.2 or 77 / 2.2 = 35. Then the nurse should multiply the prescribed volume of dialysate by the patient's weight in kilograms or 75 ml × 35 = 2,625 ml. This is the volume that the nurse will provide for the dialysate inflow. Next, the nurse needs to subtract the total inflow volume from the outflow volume or 3,000 ml - 2,625 ml = 375 ml. This is the volume of peritoneal fluid that the nurse should document.

Question 12

The nurse is caring for a child experiencing hyperkalemia from renal failure. What should the nurse prepare to administer to this patient?

Accepted Answer

Administration of intravenous glucose and insulin helps to remove excess potassium. The insulin helps the glucose move into the cells, and potassium moves along with it. Intravenous calcium gluconate, and not milk, can also be used to remove excess potassium. Fruit juice has no effect on potassium level and might cause it to increase. Sodium bicarbonate, and not sodium, and increased fluid also help to remove excess potassium.

Question 13

A child with chronic renal failure does not want to take the prescribed aluminum hydroxide gel because of the taste. What should the nurse tell the patient about the purpose of this medication?

Accepted Answer

Children with chronic renal failure are generally placed on a diet to prevent rapid urea and phosphate buildup. Children may be prescribed aluminum hydroxide gel to take with meals to bind phosphorus in the intestines and prevent absorption of phosphorus from foods. This medication is not being given to the patient to prevent an upset stomach. This medication does not assist with the absorption of calcium or the elimination of potassium.

Question 14

The nurse is concerned that a school-age child receiving intranasal desmopressin acetate (DDAVP) for enuresis is experiencing an adverse effect of the medication. What did the nurse assess in this patient? (Select all that apply.)

Accepted Answer

Adverse effects of desmopressin acetate (DDAVP) include nausea, flushing, and a headache. Thirst and itchy skin are not identified as adverse effects of this medication.

Question 15

The nurse is caring for a child recovering from a kidney transplant. Which nursing diagnosis should the nurse identify as the priority to guide the care for this patient?

Accepted Answer

After renal transplantation, children are cared for in an environment that is as sterile as possible as they are placed on immunosuppressive therapy to reduce the possibility of kidney rejection. Immunosuppressive therapy increases the patient's risk of developing an infection. The priority nursing diagnosis at this time is the risk for infection. Tissue rejection would not be immediate. The patient's pain would be from the surgical site. There is no information to support that the patient's medication will cause constipation. It is unlikely that the patient will be on a fluid restriction after surgery since there is a need to evaluate the functioning of the transplanted kidney.

Quiz 46: Nursing Care of a Family When a Child Has a Renal or Urinary Tract Disorder