Question 1

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

Accepted Answer

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.

Question 2

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?

Accepted Answer

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.

Question 3

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

Accepted Answer

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.

Question 4

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

Accepted Answer

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.

Question 5

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?

Accepted Answer

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.

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?

Accepted Answer

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.

Question 7

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?

Accepted Answer

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.

Question 8

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

Accepted Answer

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.

Question 9

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

Accepted Answer

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.

Question 10

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

Accepted Answer

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.

Question 11

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

Accepted Answer

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.

Question 12

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?

Accepted Answer

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.

Question 13

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

Accepted Answer

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.

Question 14

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?

Accepted Answer

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.

Question 15

What urine test result is considered abnormal?

Accepted Answer

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.

Question 16

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

Accepted Answer

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.

Question 17

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

Accepted Answer

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.

Question 18

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

Accepted Answer

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.

Question 19

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

Accepted Answer

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.

Question 20

What name is given to inflammation of the bladder?

Accepted Answer

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.

Quiz 25: The Child With Renal Dysfunction

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

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?

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

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

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