... ... The nurse is caring for a child who is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show which characteristics? Bacteriuria and hematuria
Proteinuria and decreased specific gravity
Hematuria and proteinuria
Bacteriuria and increased specific gravity Hematuria and
proteinuria Rationale
Glomerulonephritis is an inflammation of the glomeruli of the kidneys. The clinical manifestation of glomerulonephritis is grossly bloody hematuria with mild-to-moderate proteinuria, and because the urine is concentrated, the specific gravity is increased. Bacteriuria is not present. A child with nephrotic syndrome is severely edematous. The primary health care provider has placed the child on bed rest. What is an
important nursing intervention for this child? Reposition the child every 2 hr.
Monitor blood pressure (BP) every 30 min.
Limit visitors.
Encourage fluids. Reposition the child every 2 hr. Rationale
A child with severe edema, on bed rest, is at risk for altered skin integrity. To prevent skin breakdown, the child should be repositioned every 2 hr. Vital signs are taken every 4 hr. Fluids need to be monitored and should not be
encouraged. The child needs social interaction, so visitors should not be limited. A child with nephrotic syndrome has been placed on prednisone. What will the nurse teach the parents about administration of prednisone for this syndrome? Infrequent
Daily for one week
Daily for 6 weeks and then alternate-day doses for 6 weeks
On a short-burst schedule Daily for 6 weeks and then
alternate-day doses for 6 weeks Rationale
Prednisone, a corticosteroid with anti-inflammatory action that is frequently used to treat nephrotic syndrome, is administered daily for 6 weeks and then in alternate-day doses for 6 weeks. Daily for one week, short-burst therapy, and infrequent dosing would not be effective for treating nephrotic syndrome. The nurse is caring for a child who has been admitted to the hospital unit with a
diagnosis of minimal change nephrotic syndrome (MCNS). What clinical manifestations are expected? Massive proteinuria and edema
Gross hematuria, albuminuria, and fever
Hematuria, bacteriuria, and weight loss
Hypertension, weight loss, and proteinuria Massive proteinuria and edema Rationale
Nephrotic syndrome is an alteration in kidney function secondary to increased glomerular basement membrane permeability to plasma protein. It is
characterized by massive proteinuria and edema. Because of the edema, a weight gain, not a weight loss, would be seen. Bacteriuria and fever are associated with urinary tract infections. Gross hematuria, albuminuria, and fever are associated with glomerulonephritis. While hematuria and hypertension might be present, they are not pronounced with MCNS. The nurse is caring for a child with nephrotic syndrome who is placed on corticosteroids.
The nurse should educate the family about which side effects of corticosteroids? Moon face
Impaired balance
Hair loss
Decreased appetite Moon face Rationale
Side effects of corticosteroids include moon face, hirsutism, and mood changes. A side effect of corticosteroids is hair growth, not hair loss. Impaired balance is not associated with corticosteroids. An increased appetite is associated with administration of corticosteroids.
The nurse is caring for a child who was diagnosed with acute poststreptococcal glomerulonephritis (ASPGN). The child is being discharged, and the nurse must provide discharge teaching. How long should the nurse tell the family that the child needs for full recovery? 4 weeks
1 week
3 weeks
2 weeks 3 weeks Rationale
A child diagnosed with ASPGN is expected to be fully recovered in 3 weeks. One or 2
weeks is not long enough for full recovery. Four weeks is longer than needed for full recovery. The nurse is caring for a child who is hospitalized with hemolytic-uremic syndrome (HUS). The nurse has just conducted dietary teaching to the child and family. Which statement by the family would indicate the need for further teaching? "My child will need a high protein diet."
"My child will need a fluid restricted diet."
"My child
will need a low phosphorus diet."
"My child will need a high calorie diet." "My child will need a high protein diet." Rationale
The diet of a child with HUS should include high calorie, high carbohydrate foods that are low in protein, sodium, potassium, and phosphorus. Additionally, fluids should be restricted in the diet of a child with HUS. A child with acute glomerulonephritis is in
the playroom and experiences blurred vision and headache. What actions should be taken by the nurse? Reassure the child and encourage bed rest until the headache improves.
Obtain serum electrolytes and send a urinalysis to the lab.
Check the urine to see if hematuria has increased.
Obtain a blood pressure (BP) on the child; notify the health care provider. Obtain a blood pressure (BP) on the child; notify the health care provider. Rationale
Blurred
vision and headache could be signs of encephalopathy, a serious complication of acute glomerulonephritis. A blood pressure (BP) should be obtained and the health care provider notified. The health care provider might decide to order an antihypertensive to bring down the BP. Delay in treatment to check urine for hematuria or to check electrolytes could lead to lethargy and seizures. Reassurance and bed rest do not directly address the potential problem of encephalopathy.
A 4-year-old child with acute poststreptococcal glomerulonephritis has an elevated blood pressure and proteinuria. He is requesting a fast-food hamburger and french fries for lunch. Why does the nurse offer alternative choices? Potassium needs to be increased.
Intake of sodium and protein should be limited.
The child should eat only fruits and vegetables.
Calcium intake should be limited. Intake of sodium
and protein should be limited. Rationale
Intake of sodium should be reduced because of the elevated blood pressure. Protein should also be limited due to proteinuria. There is no need to limit calcium in the child's diet. Potassium intake should not be increased in a child with acute poststreptococcal glomerulonephritis. The child can have a variety of healthful foods; they should not be limited to only fruits and vegetables. The nurse
is caring for a child with acute poststreptococcal glomerulonephritis (APSGN). Which intervention would be most appropriate when caring for this child? Screen family members for strep throat.
Monitor the child for hyperactivity.
Offer a high protein diet.
Maintain strict fluid restrictions. Screen family members for strep throat. Rationale
Acute poststreptococcal glomerulonephritis most commonly occurs after a streptococcal infection.
All family members should be screened for strep throat, and the child should be monitored for any neurologic changes. The child with ASPGN should have a diet low in protein with no added salt. Strict fluid restriction is usually not necessary, although monitoring of intake and output is essential. Children with acute poststreptococcal glomerulonephritis have accompanying fatigue. Hyperactivity is not an issue The nurse is assessing a
preschool-age child who may have a urinary tract infection (UTI). Which set of symptoms does the nurse expect to find upon assessment of this child? Severe flank pain, nausea, and headache
Headache, hematuria, and vertigo
Urgency, dysuria, and fever
Foul-smelling urine, elevated blood pressure (BP), and hematuria Urgency, dysuria, and fever Rationale
While foul-smelling urine and hematuria can be present, there is no elevated BP.
There could be flank pain, although the preschooler might be unable to describe it. There will be no complaints of headache. Nausea is not a common symptom for a preschooler. Hematuria might be present, but there will be no complaints of headache or vertigo. Clinical manifestations of a UTI in a preschool-age child include fever, urgency, and dysuria. Identify independent nursing interventions for a school-age girl seen in the clinic with
a urinary tract infection (UTI). Select the apply
1. Give acetaminophen (Tylenol) for fever.
2. Teach the child to wipe front to back after voiding.
3. Encourage voiding every 2 hr while awake.
4. Administer antibiotics.
5. Provide a tepid sponge bath for fever. 2, 3, 5 Rationale
A tepid sponge bath will aid in controlling fever. Antibiotics must be ordered by the health care provider, so administration is not independent.
Encouraging frequent voiding is an independent nursing action effective in treating and preventing infection. The nurse cannot independently give acetaminophen for fever. Teaching the child proper technique for personal hygiene is an appropriate independent intervention. The nurse is caring for a child following the surgical repair of hypospadias. What actions comprise nursing care following repair of hypospadias? Select all that
apply.
1. Position the infant to avoid pressure on the surgical site.
2. Limit intake to reduce the kidneys' workload.
3. Record intake and output.
4. Provide a tub bath for elevated temperature.
5. Use the double-diapering technique to maintain stent cleanliness. 1, 3, 5 Rationale
Intake and output should be measured to monitor kidney function. The child should not have a tub bath in the immediate postoperative period. Double
diapering prevents stool contamination of the stent and is recommended. Intake should not be limited; however, intake and output should be monitored. Positioning is important to prevent strain and pressure on the suture line. A nurse is preparing to admit a child with possible obstructive uropathy. Which lab manifestations would the nurse expect upon review of the medical record? An elevated partial thromboplastin time (PTT)
A low
platelet count
Elevated creatinine level
A positive blood culture Elevated creatinine level Rationale
A low platelet count is seen with a bleeding disorder. Creatinine is a serum lab test for kidney function. Obstructive uropathy is a structural or functional abnormality of the urinary system that interferes with urine flow and results in urine backflow into the kidneys; therefore, the creatinine will be elevated. A positive blood culture
occurs when an infectious process is suspected. An elevated partial thromboplastin time (PTT) is noted with a bleeding disorder. The nurse is providing discharge teaching to the parents of a child who has a urinary tract infection (UTI). Which statement would demonstrate to the nurse that the parents need more extensive teaching? "Urinary tract infections always cause renal scarring."
"If our child gets a fever, that could be a sign
of a UTI."
"Our child may need to be on prophylactic antibiotics."
"The urine can cause bacterial growth when the bladder is not emptied completely." "Urinary tract infections always cause renal scarring." Rationale
Urinary infections do not always cause renal scarring, which is noted most often in hydronephrosis. Urine that is returned to the bladder, primarily because of vesicoureteral reflux, creates a reservoir for bacterial
growth. Fever may be a sign of a UTI. Prophylactic antibiotics may be ordered until all radiologic tests are completed and a specific diagnosis is made. What education should be included when teaching the family of a child with nocturnal enuresis? Limit daytime fluids.
Administer laxatives daily.
Refer the child to counseling immediately.
Ensure that the child has emptied the bladder before bed. Ensure
that the child has emptied the bladder before bed. Rationale
The child with nocturnal enuresis may have a small bladder, lack of bladder neuromuscular maturation, or difficulty arousing from sleep. Having the child void before bed is an important part of the care plan. Providing daily laxatives does not control enuresis, though it is important to ensure that the child is not constipated because constipation can increase issues with daytime and nighttime enuresis. Fluids should be limited
in the evening hours. Limiting daytime fluids may contribute to dehydration. Counseling is not usually indicated for nocturnal enuresis. The nurse is conducting discharge education for a child who has been hospitalized as part of the treatment for enuresis. The nurse teaches the parents that the anticholinergic drug that has been prescribed for treatment is: Imipramine (Tofranil)
Oxybutynin (Ditropan)
Desmopressin acetate
(DDAVP)
Spironolactone (Aldactone) Oxybutynin (Ditropan) Rationale
Desmopressin acetate (DDAVP), as the name implies, is a vasopressin. Oxybutynin (Ditropan) is an anticholinergic that relaxes the smooth muscle of the bladder, allowing for an increase in bladder capacity and a delay in the initial desire to void. Imipramine (Tofranil) is a tricyclic antidepressant. Spironolactone (Aldactone) is a potassium-sparing diuretic.
The nurse is discussing the goals of surgical repair with the parents of an infant with hypospadias. Which goal of the surgery should not be included in the teaching session with the parents? Enabling future sexual function
Releasing the chordee to straighten the penis
Lowering the pressure within the collecting system, which reduces renal damage
Placing the urethral meatus to allow the child to void in a standing position
Lowering the pressure within the collecting system, which reduces renal damage Rationale
One goal of surgical repair of a hypospadias is to position the urethral meatus to allow the child to void in a standing position. One goal of surgical repair of a hypospadias is to release the chordee to straighten the penis. One goal of surgical repair of a hypospadias is to enable future sexual function by straightening the penis. Lowering the pressure within the collecting
system and reducing renal damage is one of the goals of surgery for obstructive uropathy, not for hypospadias. The nurse is caring for a child with pyelonephritis. The family asks the nurse about the plan of care. What does the nurse include when teaching this family? Select all that apply.
1. Intravenous (IV) antibiotics until the child is afebrile
2. Intravenous (IV) fluids for rehydration
3. Oral antibiotics for 7 days
4.
An analgesic for pain
5. An antipyretic for fever 1, 2, 4, 5 Rationale
Intravenous (IV) antibiotics will be prescribed until the child is afebrile, usually for 24 to 36 hr. Once IV antibiotics are discontinued, the child is transitioned to oral antibiotics for 10 to 14 days. The nurse should prepare the family for the need for IV fluids to rehydrate the child. An antipyretic such as acetaminophen will be ordered to treat the child's fever. An
analgesic will be ordered to address any pain the child is having that is associated with the pyelonephritis. A 5-year-old child arrives at the community health clinic exhibiting signs of a urinary tract infection (UTI), including fever of 101ºF, strong-smelling urine, and irritability. The nurse suspects that the urine culture will be positive for: Ketones
Glucose
A gram-negative enteric bacterium
Protein
A gram-negative enteric bacterium Rationale
The majority of UTIs are caused by gram-negative enteric bacterium such as Escherichia coli. Glucose, protein, and ketones are tested by a urine dipstick, not a urine culture. The parent of a child with repeated urinary tract infections (UTIs) is asking the nurse why her daughter has had so many UTIs. Which statement would not be a correct response? "Urinary tract
infections may be the result of poor hygiene practices with toileting."
"Urinary tract infections may be the result of taking bubble baths."
"Urinary tract infections occur when a child voids more than six times a day."
"Urinary tract infections may be the result of constipation." "Urinary tract infections occur when a child voids more than six times a day." Rationale
Constipation is a precipitating factor in the development of
urinary tract infections. A child who voids at least six times a day is less likely to develop urinary tract infections than a child who voids less than that. Improper wiping from back to front can cause urinary tract infections. Bubble baths are a precipitating factor in the development of urinary tract infections. The nurse is caring for a pediatric client in the emergency department (ED) who has been diagnosed with a urinary tract
infection (UTI). The child is experiencing pain. The nurse teaches the client and the family to expect which of the following medications for the treatment of pain? Select all that apply.
1. Pyridium
2. Amoxicillin clavulante
3. Vancomycin
4. Acetaminophen
5. Sulfamethoxazole-trimethoprim 1, 4 Rationale
Acetaminophen is a medication that can be utilized to treat the pain and fever that are commonly associated with UTIs. Pyridium
is a medication that is used to treat the painful spasms that are associated with UTIs. Sulfamethoxazole-trimethoprim and amoxicillin clavulante are antibiotics that are commonly used in the treatment of UTIs, but they would not be prescribed for the treatment of pain. Vancomycin is an antibiotic and would not be appropriate in the treatment of pain. An 11-month-old male child returns to the pediatric unit after repair of a hypospadias. When
planning nursing care for this child, what is the priority nursing intervention? Bathe the infant in a warm tub.
Protect the urinary stent after surgery.
Offer sips of water every 3 hr.
Ensure the penis is pointed down. Protect the urinary stent after surgery. Rationale
The stent, which is placed to maintain the patency of the urethral canal, needs to be protected so that it can remain in place. Double diapering is a technique that is
helpful in protecting the stent. Hydration is important. Fluids should be encouraged to maintain adequate urinary output. The penis should be pointed up toward the head, flat against the abdomen, to prevent kinking of the stent or urethral catheter. Sponge baths are imperative until the catheter is removed; tub baths are contraindicated immediately after surgery. Parents of an infant born with hypospadias express concern that their infant
will not look like other males as he grows. Which statement would not provide accurate information? "Surgery will probably be performed before your child is 1 year old, so he will not remember looking different."
"The goal of repair is to give the penis a satisfactory cosmetic appearance."
"Your child's urinary and sexual functions should be normal after surgery."
"Your child will need many surgeries, but he will look like other males afterward."
"Your child will need many surgeries, but he will look like other males afterward." Rationale
Hypospadias surgery is usually completed in a single operation before the child is 1 year old. Goals of repair are to give the penis a satisfactory cosmetic appearance, allow the child to void in a standing position, enable future sexual function, and give the penis a satisfactory cosmetic appearance.
Which intervention would be included in the plan of care for a child with nephrotic syndrome?
Nursing interventions for a child with nephrotic syndrome are: Monitoring fluid intake and output. Accurately monitor and document intake and output; weigh the child at the same time every day, on the same scale in the same clothing; measure the child's abdomen daily at the level of the umbilicus.
What are the management of nephrotic syndrome?
Immune system-suppressing medications.
Medications to control the immune system, such as corticosteroids, can decrease the inflammation that accompanies some of the conditions that can cause nephrotic syndrome. Medications include rituximab (Rituxan), cyclosporine and cyclophosphamide.
What are the main goals of treatment management for nephrotic syndrome?
OBJECTIVES OF SYMPTOMATIC TREATMENT: The goal is to maintain quality of life, prevent immediate complications (thromboembolic events, infection, drug reactions), prevent late complications related to atherosclerosis, and limit the progression of the chronic renal failure.
What are the prevention of nephrotic syndrome?
You can't prevent some causes of nephrotic syndrome. But you can take action to avoid damage to your glomeruli: Manage high blood pressure and diabetes, if you have them. Be sure to get vaccines for common infections, especially if you work around people who have hepatitis or other diseases.
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