Download NURS366 Final Exam Questions and Answers: Urinary Tract Infections and Nephrotic Syndrome and more Exams Nursing in PDF only on Docsity!
NURS366 Final Exam Questions With
Verified Answers
- The bladder capacity of a 3-year-old is approximately how much?
- 1.5 fl. oz.
- 3 fl. oz.
- 4 fl. oz.
- 5 fl. oz. - ANSWER 4. 5 fl. oz.
*The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child's age in years.
- The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take?
- Notifies the physician because this urine output is too low.
- Encourages the child to increase oral intake to increase urine output.
- Records the child's urine output in the chart.
- Administers isotonic fluid intravenously to help with rehydration. - ANSWER 3. Records the child's urine output in the chart.
*Recording the child's urine output in the chart is the appropriate action because the urine output is within the expected range of 0.5-1 mL/kg/hr, or 75-150 mL for the 10-hour period.
- A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan?
- Urinalysis, urine culture, and VCUG.
- Evaluate for renal failure.
- Admit to the pediatric unit.
- Discharge home on an antibiotic. - ANSWER 1. Urinalysis, urine culture, and VCUG.
*Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to
determine the extent of urinary tract involvement when a child has a second UTI within 1 year.
- Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)?
- Avoiding constipation has no effect on the occurrence of UTIs.
- After urinating, always wipe from back to front to prevent fecal contamination.
- Hygiene is an important preventive measure and can be accomplished with frequent tub baths.
- Increasing fluids will help prevent and treat UTIs. - ANSWER 4. Increasing fluids will help prevent and treat UTIs.
*Increasing fluids will help flush the bladder of any organism, encourage urination, and prevent stasis of urine.
- Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)?
- A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats per minute.
- A 4-year-old female who states, "It hurts when I pee"; she has been urinating every 30 minutes; vital signs are within normal range.
- An 8-year-old male presenting with a finger laceration; mother states he had surgical reimplantation of his ureters 2 years ago.
- A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; oral temperature of 101.5°F (38.6°C). - ANSWER 3. An 8-year-old male presenting with a finger laceration; mother states he had surgical reimplantation of his ureters 2 years ago.
*Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time.
- Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)?
- Carefully cleanse the perineum from front to back, and apply a self-adhesive urine collection bag to the perineum.
- Insert an indwelling Foley catheter, obtain the sample, and wait for results.
- Place a sterile cotton ball in the diaper, and immediately obtain the sample with a syringe after the first void.
- Using a straight catheter, obtain the sample, and immediately remove the catheter
- Urine output is 190 mL in an 8-hour period and is the color of Coca-Cola.
- Complaining of a severe headache and photophobia.
- Refusing breakfast and lunch and stating he "just is not hungry." - ANSWER 3. Complaining of a severe headache and photophobia.
A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention.
- The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which is the nurse's best response?
- "Your child's urine output will increase, and the urine will become less tea-colored."
- "Your child will rest more comfortably as lab tests become more normal."
- "Your child's appetite will decrease as urine output increases."
- "Your child's laboratory values will become more normal." - ANSWER 1. "Your child's urine output will increase, and the urine will become less tea-colored."
- Which statement by a parent is most consistent with minimal change nephrotic syndrome (MCNS)?
- "My child missed 2 days of school last week because of a really bad cold."
- "After camping last week, my child's legs were covered in bug bites."
- "My child came home from school a week ago due to vomiting and stomach cramps."
- "We have a pet turtle but no one washes their hands after playing with the turtle." - ANSWER 1. "My child missed 2 days of school last week because of a really bad cold."
*An upper respiratory infection often precedes MCNS by a few days.
- The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due to which of the following?
- Chemical changes in the composition of albumin.
- Increased permeability of the glomeruli.
- Obstruction of the capillaries of the glomeruli.
- Loss of the kidney's ability to excrete waste and concentrate urine. - ANSWER 2. Increased permeability of the glomeruli.
*Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine.
- The parents of a child hospitalized with minimal change nephrotic syndrome (MCNS) ask why the last blood test revealed elevated lipids. Which is the nurse's best response?
- "If your child had just eaten a fatty meal, the lipids may have been falsely elevated."
- "It's not unusual to see elevated lipids in children because of the dietary habits of today."
- "Since your child is losing so much protein, the liver is stimulated and makes more lipids."
- "Your child's blood is very concentrated because of the edema, so the lipids are falsely elevated." - ANSWER 3. "Since your child is losing so much protein, the liver is stimulated and makes more lipids."
*In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver hypoalbuminemia.
- A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving Lasix twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema?
*Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema
- Which would the nurse most likely find in the history of a child with hemolytic uremic syndrome (HUS)?
- Frequent UTIs and possible vesicoureteral reflux (VUR).
- Vomiting and diarrhea before admission.
- Bee sting and localized edema of the site for 3 days.
- Previously healthy and no signs of illness. - ANSWER 2. Vomiting and diarrhea before admission.
*HUS is often preceded by diarrhea that may be caused by E. coli present in undercooked meat.
- The manifestations of hemolytic uremic syndrome (HUS) are due primarily to which event?
- The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia.
- There is a disturbance of the glomerular basement membrane, allowing large proteins to pass through.
- The red blood cell changes shape, causing it to obstruct microcirculation.
- There is a depression in the production of all formed elements of the blood. - ANSWER
- The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia.
- Which laboratory results besides hematuria are most consistent with hemolytic uremic syndrome (HUS)?
- Massive proteinuria, elevated blood urea nitrogen, and creatinine.
- Mild proteinuria, decreased blood urea nitrogen, and creatinine.
- Mild proteinuria, increased blood urea nitrogen, and creatinine.
- Massive proteinuria, decreased blood urea nitrogen, and creatinine. - ANSWER 3. Mild proteinuria, increased blood urea nitrogen, and creatinine.
- A child with hemolytic uremic syndrome (HUS) is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects administration of blood products and what else to be added to the plan of care?
- Initiation of dialysis.
- Close observation of the child's hemodynamic status.
- Diuretic therapy to force urinary output.
- Monitoring of urinary output. - ANSWER 1. Initiation of dialysis.
*Because the child is symptomatic, dialysis is the treatment of choice.
- Which needs to be present to diagnose hemolytic uremic syndrome (HUS)?
- Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure.
- Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure.
- Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure.
- Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure. - ANSWER 2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure.
*The triad in HUS includes decreased red blood cells (with a high reticulocyte count as
is the top priority of care.
- Which medication would most likely be included in the post-operative care of a child with repair of bladder exstrophy?
- Lasix.
- Mannitol.
- Meperidine.
- Oxybutynin. - ANSWER 4. Oxybutynin.
*Oxybutynin is used to control bladder spasms.
- The nurse is providing discharge instructions to the parents of an infant born with bladder exstrophy who had a continent urinary reservoir placed. Which statement should be included?
- "Allow your child to sleep on the abdomen to provide comfort during the immediate post-operative period."
- "As your child grows, be cautious around playgrounds because the surface could be a health hazard."
- "As your child grows, be sure to encourage many different foods because it is not likely that food allergies will develop."
- "Encourage your child's development, by having brightly colored objects around, such as balloons." - ANSWER 2. "As your child grows, be cautious around playgrounds because the surface could be a health hazard."
*Many children with urological malformations are prone to latex allergies. The surfaces of playgrounds are often made of rubber, which contains latex.
- Which causes the clinical manifestations of hydronephrosis?
- A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death.
- A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances.
- Decreased production of urine in one or both kidneys results in an electrolyte imbalance.
- Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate. - ANSWER 1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death.
- In addition to increased blood pressure, which findings would most likely be found in a child with hydronephrosis?
- Metabolic alkalosis, polydipsia, and polyuria.
- Metabolic acidosis, and bacterial growth in the urine.
- Metabolic alkalosis, and bacterial growth in the urine.
- Metabolic acidosis, polydipsia, and polyuria. - ANSWER 4. Metabolic acidosis, polydipsia, and polyuria.
*The blood pressure is increased as the body attempts to compensate for the decreased glomerular filtration rate. Metabolic acidosis is caused by a reduction in hydrogen ion secretion from the distal nephron. Polydipsia and polyuria occur as the kidney's ability to concentrate urine decreases. There is bacterial growth in the urine due to the urinary stasis caused by the obstruction.
- Which should be included in the plan of care for a child diagnosed with hydronephrosis?
- Intake and output as well as vital signs should be strictly monitored.
- Fluids and sodium in the diet should be limited.
- Steroids should be administered as ordered.
- Which protrusion into the groin of a female most likely causes inguinal hernias?
- Bowel.
- Fallopian tube.
- Large thrombus formation.
- Muscle tissue. - ANSWER 2. Fallopian tube.
*Fallopian tube or an ovary is the most common tissue to protrude into the groin in females.
- The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. Which is the nurse's best response?
- "The terms are used interchangeably and mean the same thing."
- "The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, whereas a hydrocele is a fluid-filled mass in the scrotum."
- "A hydrocele is the term used when an inguinal hernia occurs in females."
- "A hydrocele presents in a manner similar to that of an inguinal hernia but causes
increased concern because it is often malignant." - ANSWER 2. "The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin, whereas a hydrocele is a fluid-filled mass in the scrotum."
- The nurse evaluates the parents' understanding of the teaching about an inguinal hernia as successful when they say which of the following?
- "There are no risks associated with waiting to have the hernia reduced; surgery is done for cosmetic reasons."
- "It is normal to see the bulge in the baby's groin decrease with a bowel movement."
- "We will wait for surgery until the baby is older because narcotics for pain control will
be required for several days."
- "It is normal for the bulge in the baby's groin to look smaller when the baby is asleep."
- ANSWER 4. "It is normal for the bulge in the baby's groin to look smaller when the baby is asleep."
*The hernia often appears smaller when the child is asleep.
- The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response?
- "Circumcision is a fading practice and is now contraindicated in most children."
- "Circumcision in children with hypospadias is recommended because it helps prevent infection."
- "Circumcision is an option, but it cannot be done at this time."
- "Circumcision can never be performed in a child with hypospadias." - ANSWER 3. "Circumcision is an option, but it cannot be done at this time."
*It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.
- An infant is scheduled for a hypospadias and chordee repair. The parent tells the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse's best response?
- "I understand your concern. Parents do not want their children to undergo extra surgery."
- "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages."
- "The repair is done to optimize sexual functioning when he is older."
- "This is the best time to repair the chordee because he will be having surgery anyway." - ANSWER 3. "The repair is done to optimize sexual functioning when he is older."
- Which would the nurse expect to find on assessment in a child with Wilms tumor?
- Decreased blood pressure, increased temperature, and a firm mass located in one flank area.
- Increased blood pressure, normal temperature, and a firm mass located in one flank area.
- Increased blood pressure, normal temperature, and a firm mass located on one side of the midline of the abdomen.
- Decreased blood pressure, normal temperature, and a firm mass located on one side or the other of the midline of the abdomen. - ANSWER 3. Increased blood pressure, normal temperature, and a firm mass located on one side of the midline of the abdomen.
*The blood pressure may be increased if there is renal damage. The mass will be located on one side or the other of the midline of the abdomen. There is no reason for the child's temperature to be affected.
- A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs. The parent asks the nurse the reason for this test as a Wilms tumor involves the kidney, not the lung. Which is the nurse's best response?
- "I'm not sure why your child is going for this test. I will check and get back to you."
- "It sounds like we made a mistake. I will check and get back to you."
- "The test is done to check to see if the disease has spread to the lungs."
- "We want to check the lungs to make sure your child is healthy enough to tolerate surgery." - ANSWER 3. "The test is done to check to see if the disease has spread to the lungs."
- The parents overhear the health-care team refer to their child's disease as in stage III. The parents ask the nurse what this means. Which is the nurse's best response?
- The tumor is confined to the abdomen, but it has spread to the lymph nodes or
peritoneal area; the prognosis is poor.
- The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is very good.
- The tumor has been found in three other organs beyond the peritoneal area; the prognosis is good.
- The tumor has spread to other organs beyond the peritoneal area; the prognosis is poor. - ANSWER 2. The tumor is confined to the abdomen, but it has spread to the lymph nodes or peritoneal area; the prognosis is very good.
- The nurse is caring for a child due for surgery on a Wilms tumor. The child's procedure will consist of which of the following?
- Only the affected kidney will be removed.
- Both the affected kidney and the other kidney will be removed in case of recurrence.
- The mass will be removed from the affected kidney.
- The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected kidney will be done. - ANSWER 1. Only the affected kidney will be removed.
- The parents of a 7-year-old tell the nurse they do not understand the difference between chronic renal failure (CRF) and acute renal failure (ARF). Which is the nurse's best response?
- "There really is not much difference because the terms are used interchangeably."
- "Most children experience ARF. It is highly unusual for a child to experience CRF."
- "CRF tends to occur suddenly and is irreversible."
- "ARF is often reversible, whereas CRF results in permanent deterioration of kidney function." - ANSWER 4. "ARF is often reversible, whereas CRF results in permanent deterioration of kidney function."
- A child had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago due to post-operative hemorrhage. The parent noted that her child was "swallowing a lot and finally began vomiting large amounts of blood." The child's vital signs are as
- 350 mL of oral and intravenous fluids.
- 1000 mL of oral and intravenous fluids.
- 2000 mL of oral and intravenous fluids. - ANSWER 2. 350 mL of oral and intravenous fluids.
*350 mL is approximately a third of the daily fluid requirement and is recommended for the child in the oliguric phase of ARF. If the child were febrile, the fluid intake would be increased.
- The nurse is caring for a 1-year-old diagnosed with acute renal failure (ARF). Edema is noted throughout the child's body, and the liver is enlarged. The child's urine out- put is less than 0.5 mL/kg/hr, and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is noted to have nasal flaring and retractions with inspiration. The lung sounds are coarse throughout. Despite receiving oral Kayexalate, the child's serum potassium continues to rise. Which treatment will provide the most benefit to the child?
- Additional rectal Kayexalate.
- Intravenous furosemide.
- Endotracheal intubation and ventilatory assistance.
- Placement of a Tenckhoff catheter for peritoneal dialysis. - ANSWER 4. Placement of a Tenckhoff catheter for peritoneal dialysis.
*Placement of a Tenckhoff catheter for peritoneal dialysis is needed when the child's condition deteriorates despite medical treatment.
- The parent of a child diagnosed with acute renal failure (ARF) asks the nurse why peritoneal dialysis was selected instead of hemodialysis. Which is the nurse's best response?
- "Hemodialysis is not used in the pediatric population."
- "Peritoneal dialysis has no complications, so it is a treatment used without hesitation."
- "Peritoneal dialysis removes fluid at a slower rate than hemodialysis, so many complications are avoided."
- "Peritoneal dialysis is much more efficient than hemodialysis." - ANSWER 3. "Peritoneal dialysis removes fluid at a slower rate than hemodialysis, so many complications are avoided."
- The nurse is caring for a 12-year-old receiving peritoneal dialysis. The nurse notes the return to be cloudy, and the child is complaining of abdominal pain. The child's parents ask what the next step will likely be. Which is the nurse's best response?
- "We will probably place antibiotics in the dialysis fluid before the next dwell time."
- "Many children experience cloudy returns. We do not usually worry about it."
- "We will probably give your child some oral antibiotics just to make sure nothing else develops."
- "The abdominal pain is likely due to the fluid going in too slowly. We will increase the rate of administration with the next fill." - ANSWER 1. "We will probably place antibiotics in the dialysis fluid before the next dwell time."
*Cloudy returns and abdominal pain are signs of peritonitis and are usually treated with the administration of antibiotics in the dialysis fluid.
- A child receiving peritoneal dialysis has not been having adequate volume in the return. The child is currently edematous and hypertensive. Which would the nurse anticipate the physician to do?
- Increase the glucose concentration of the dialysate.
- Decrease the glucose concentration of the dialysate.
- Administer antihypertensives and diuretics but not change the dialysate concentration.
- Decrease the dwell time of the dialysate. - ANSWER 1. Increase the glucose concentration of the dialysate.
