KEYWORDS
Albuminemia Bladder exstrophy Cryptorchidism Dialysate
Disequilibrium syndrome Enuresis
Epispadias Glomerulonephritis Hematuria
Hemodialysis
Hydronephrosis Hypospadias Inguinal hernia Peritoneal dialysis Phimosis
Proteinuria Reticulocyte Testicular torsion
ABBREVIATIONS
Acute renal failure (ARF) Chronic renal failure (CRF) Desmopressin acetate (DDAVP) Hemolytic uremic syndrome (HUS) Kilogram (kg)
Milliliter (mL)
Minimal change nephrotic syndrome (MCNS)
Urinary tract infection (UTI) Vesicoureteral reflux (VUR) Voiding cystourethrogram (VCUG)
QUESTIONS
1. The nurse is reviewing the basic anatomy and physiology of the genitourinary system.
e The nurse knows that the bladder capacity of a 3-year-old could be estimated to be approximately how much?
1. 1.5 oz.
2. 3 oz.
3. 4 oz.
4. 5 oz.
2. 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?
1. The nurse notifies the physician because this urine output is too low.
2. The nurse encourages the patient to increase oral intake in order to increase urine output.
3. The nurse records the patient’s urine output in the chart.
4. The nurse administers isotonic fluid intravenously to help with the rehydration process.
3. A 3-year-old has a recurrent UTI. She had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed results within normal range. The child has had no other problems until this visit. Choose the nurse’s best response.
1. The nurse should prepare for the following tests: urinalysis, urine culture, and VCUG.
2. Signs and symptoms of renal failure should be evaluated.
3. The nurse should prepare the child for likely admission to the pediatric unit.
4. Send the child home on an antibiotic and instruct the parent to offer the child lots of fluids.
4. The nurse is instructing a group of girls and parents about the importance of preventing UTIs. Which of the following should the nurse teach?
1. Avoiding constipation has no effect on the occurrence of UTIs.
2. After urinating, always wipe from back to front to prevent fecal contamination.
3. Hygiene is an important preventive measure and can be accomplished with frequent tub baths.
4. Increasing fluids will help prevent and treat UTIs.
5. The nurse is working in a pediatric urgent care clinic. Which of the following patients can be discharged without the need for a urinalysis to evaluate for a UTI?
1. A 4-month-old female who presents with a 2-day history of fussiness and poor appetite; her current vital signs include T 100.8°F (38.2°C) (axillary) and heart rate 120 beats per minute.
2. An 8-year-old male who presents with a finger laceration; his mother states he had surgical reimplantation of his ureters 2 years ago.
3. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; she has an oral temperature of 101.5°F (38.6°C).
4. A 4-year-old female who states “it hurts when I pee”; her parent states that she has been asking to urinate every 30 minutes; vital signs are within normal range.
6. An 8-month-old is being evaluated for a UTI. A urinalysis and urine culture are ordered. Which of the following is the best way to obtain the urine sample?
1. Carefully cleanse the perineum from front to back, and apply a self-adhesive urine collection bag to the perineum.
2. Insert an indwelling Foley catheter and begin antibiotic administration.
3. Place a sterile cotton ball in the diaper, and immediately obtain the sample with a syringe after the first void.
4. Using a straight catheter, obtain the sample, and immediately remove the catheter without waiting for the results of the urine sample.
7. On reviewing information about glomerulonephritis, the nurse knows that which of the following children is at risk for developing the disease?
1. A 10-year-old recovering from viral pneumonia.
2. A 6-year-old with new-onset type 1 diabetes.
3. A 3-year-old who had impetigo 1 week ago.
4. A 5-year-old with a history of five UTIs in the previous year.
8. The nurse is caring for a 7-year-old with glomerulonephritis. Which of the following combinations of signs is commonly associated with glomerulonephritis?
1. Massive proteinuria, hematuria, decreased urinary output, and lethargy.
2. Mild proteinuria, increased urinary output, and lethargy.
3. Mild proteinuria, hematuria, decreased urinary output, and lethargy.
4. Massive proteinuria, decreased urinary output, and hypotension.
9. The parents of a child with glomerulonephritis ask the nurse why the urine is such a funny color. What is the nurse’s best response?
1. “It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications.”
2. “There is blood in your child’s urine that causes it to be tea-colored.”
3. “Your child’s urine is very concentrated, so it appears to be discolored.”
4. “A ketogenic diet often causes the urine to be tea-colored.”
10. The nurse is caring for a 7-year-old with glomerulonephritis. Which of the following findings requires immediate attention?
1. The child sleeps most of the day and is very “cranky” when awake; blood pressure is 170/90.
2. The child’s urine output is 190 mL in an 8-hour period and is the color of Coca Cola.
3. The child complains of a severe headache and photophobia.
4. The child refuses breakfast and lunch and states that he “just is not hungry.”
11. The parents of a child with glomerulonephritis ask how will they know that the condition is improving after they take their child home. What is the nurse’s best response?
1. “Your child’s urine output will increase, and the urine will become less tea-colored.”
2. “Your child will rest more comfortably.”
3. “Your child’s appetite will decrease.”
4. “Your child’s laboratory test values will become more normal.”
12. A 5-year-old is hospitalized with MCNS. The nurse obtains a history from the parents. Which statement by the parents is most consistent with MCNS?
1. “Our child missed 2 days of school last week because of a really bad cold.”
2. “We went camping last week, and our child’s legs were covered in bug bites.”
3. “Our child came home from school a week ago due to vomiting and stomach cramps.”
4. “Our child has a pet turtle but does not wash hands after playing with the turtle.”
13. The nurse is teaching the family about MCNS and explains that the clinical manifestations are due to which of the following?
1. Chemical changes in the composition of albumin.
2. Increased permeability of the glomeruli.
3. Obstruction of the capillaries of the glomeruli because of antibody-antigen complex formation.
4. Loss of the kidney’s ability to excrete waste and concentrate urine.
14. The parents of a child hospitalized with MCNS ask why the last blood test revealed elevated lipids. What is the nurse’s best response?
1. “If your child had just eaten a fatty meal, the lipids may have been falsely elevated.”
2. “It’s not unusual to see elevated lipids in children because of the dietary habits of today.”
3. “Since your child is losing so much protein, the liver is stimulated and ends up making more lipids.”
4. “Your child’s blood is very concentrated because of the edema, so the lipids are falsely elevated.”
15. The nurse is caring for a 2-year-old hospitalized with MCNS. The edema has pro-gressed from periorbital to generalized. 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. In order to reduce edema, which of the following does the nurse expect to be included in the treatment plan?
1. An increase in the amount and frequency of Lasix.
2. Addition of a second diuretic, such as mannitol.
3. Administration of intravenous albumin.
4. Elimination of all fluids and sodium from the child’s diet.
16. A 3-year-old returns to the pediatric clinic after having had MCNS. His parents ask the nurse how to prevent the child from having it again. What is the nurse’s best response?
1. “It is very rare for a child to have a relapse after having fully recovered.”
2. “Unfortunately, many children have cycles of relapses, and there is very little that can be done to prevent it.”
3. “Your child is much less likely to get sick again if sodium is avoided in his diet.”
4. “Try to keep your child away from sick children because relapses have been associated with infectious illnesses.”
17. The nurse is caring for a newborn male with hypospadias. His parents ask if circumcision is an option. Which is the nurse’s best response?
1. “Circumcision is a fading practice and is now contraindicated in most children.”
2. “Circumcision in children with hypospadias is recommended because it helps prevent infection.”
3. “Circumcision is an option, but it cannot be done at this time.”
4. “Circumcision can never be performed in a child with hypospadias.”
18. A 6-week-old male 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?” What is the nurse’s best response?
1. “I understand your concern. Parents do not want their children to undergo extra surgery.”
2. “The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages.”
3. “The repair is done to optimize his sexual function when he is older.”
4. “This is the best time to repair the chordee because he will be having surgery anyway.”
19. A 13-month-old is being discharged following the repair of his epispadias. Which of the following statements made by the parents indicate that they understand the discharge teaching?
1. “If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage.”
2. “If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing.”
3. “We will make sure the dressing is loosely applied to increase the toddler’s comfort.”
4. “If we notice any yellow drainage, we will know that everything is healing well.”
20. A 2-year-old is admitted to the pediatric floor with a diagnosis of HUS. Which of the following would the nurse likely find in the child’s history?
1. The child has a history of frequent UTIs and possible VUR.
2. The child and parents had vomiting and diarrhea, but the parents believe it was due to “probably something that they ate.”
3. The child was stung by a bee and experienced localized edema to the site for 3 days.
4. The child had previously been healthy and did not show any signs of illness until this admission.
21. The nurse is reviewing the pathophysiology of HUS. The manifestations of the disease are due primarily to which of the following events?
1. The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia.
2. There is a disturbance of the glomerular basement membrane, allowing large proteins to pass through.
3. The red blood cell changes shape, causing it to obstruct microcirculation.
4. There is a depression in the production of all formed elements of the blood.
22. A 16-month-old with HUS has had blood and urine samples sent to the laboratory.
Which of the following results are most consistent with his HUS?
1. Hematuria, massive proteinuria, elevated blood urea nitrogen, and creatinine.
2. Hematuria, mild proteinuria, decreased blood urea nitrogen, and creatinine.
3. Hematuria, mild proteinuria, increased blood urea nitrogen, and creatinine.
4. Ketonuria, proteinuria, elevated blood urea nitrogen, and creatinine.
23. A 3-year-old is admitted to the pediatric unit with a diagnosis of HUS. The child is very pale and lethargic. Stools have progressed from watery to bloody diarrhea.
Blood work indicates low hemoglobin and low hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects which of the following to be added to the plan of care?
1. Administration of blood products and initiation of dialysis.
2. Administration of blood products and close observation of the child’s hemodynamic status.
3. Administration of blood products followed by diuretic therapy to force urinary output.
4. Administration of clotting factors to diminish blood loss and continued monitoring of urinary output.
24. The nurse knows that which of the following need to be present to diagnose HUS?
1. Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure.
2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure.
3. Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure.
4. Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure.
25. A 5-year-old is being discharged from the hospital following the diagnosis of HUS.
The child has been free of diarrhea for 1 week, and renal function has returned. The parent asks the nurse when the child can return to school. What is the nurse’s best response?
1. “Immediately, as your child is no longer contagious.”
2. “It would be best to keep your child home for a few more weeks because the immune system is weak, and there could be a relapse of HUS.”
3. “Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet.”
4. “It would be best to keep your child home to monitor urinary output.”
26. A newborn is diagnosed with bladder exstrophy that includes a malformed pelvis.
Which of the following is a priority of care?
1. Change the diaper frequently and assess for skin breakdown.
2. Keep the exposed bladder open in a warm and dry environment to avoid any heat loss.
3. Immediately administer a dextrose-containing solution intravenously to avoid any possibility of hypoglycemia.
4. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair.
27. Which of the following medications would most likely be included in the postoperative care of a child with repair of bladder exstrophy?
1. Lasix.
2. Mannitol.
3. Meperidine.
4. Oxybutynin.
28. The nurse is providing discharge instructions to the parents of an infant born with bladder exstrophy who had a continent urinary reservoir placed. Which of the following statements should be included?
1. “Allowing your child to sleep on the abdomen will provide comfort during the immediate postoperative period.”
2. “As your child grows, be cautious around playgrounds because the surface could be a health hazard.”
3. “As your child grows, be sure to encourage many different foods because it is not likely that food allergies will develop.”
4. “In order to encourage your child’s development, keep the environment stimulating by having brightly colored things around, such as balloons.”
29. The nurse understands that the clinical manifestations in hydronephrosis are due to which of the following?
1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death.
2. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances.
3. Decreased production of urine in one or both kidneys, resulting in an electrolyte imbalance.
4. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate.
30. A 20-month-old is admitted with hydronephrosis. The nurse notes which of the following findings?
1. Increased blood pressure, metabolic alkalosis, polydipsia, and polyuria.
2. Increased blood pressure, metabolic acidosis, and bacterial growth in the urine.
3. Increased blood pressure, metabolic alkalosis, and bacterial growth in the urine.
4. Increased blood pressure, metabolic acidosis, polydipsia, polyuria, and bacterial growth in the urine.
31. A 16-month-old is admitted to the pediatric unit with a diagnosis of hydronephrosis.
Which of the following should be included in the plan of care?
1. Intake and output as well as vital signs should be strictly monitored.
2. Fluids and sodium in the diet should be limited.
3. Steroids should be administered as ordered.
4. The child’s contact with other people should be limited to avoid infection.
32. The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The patient’s parent states the child has had several daytime “accidents.” The nurse knows that this is referred to as which of the following?
1. Primary enuresis.
2. Secondary enuresis.
3. Diurnal enuresis.
4. Nocturnal enuresis.
33. At a well-child health screening, the parent of a 7-year-old voices concern over the child’s continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. What is the nurse’s best response about what the parent should do next?
1. “There is a medication called DDAVP that decreases the volume of the urine.
The physician thinks that will work for your child.”
2. “When your child wakes up wet, be very firm, and indicate how displeased you are. Have your child change the sheets to see how much work is involved.”
3. “Limit fluids in the evening, and start a reward system in which your child can choose a reward after a certain number of dry nights.”
4. “Bed-wetting alarms are readily available, and most children do very well with them.”
34. The nurse receives a call from the parent of a 15-year-old male. The son woke up complaining of intense pain and swelling to the scrotal area. He has vomited twice and is also complaining of abdominal pain. Which of the following should the nurse suggest?
1. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the emergency room.
2. Bring him to the pediatrician’s office for evaluation.
3. Bring him to the emergency room immediately.
4. Encourage him to rest; apply ice to the scrotal area, and go to the emergency room if the pain does not improve.
35. The nurse knows that which of the following causes the symptoms seen in testicular torsion?
1. Twisting of the spermatic cord interrupts the blood supply.
2. Swelling of the scrotal sac leads to testicular displacement.
3. Unmanaged undescended testes cause testicular displacement.
4. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.
36. The day surgery nurse knows that the parent of a 13-year-old male understands postoperative teaching for a repair of testicular torsion by saying which the following?
1. “We will encourage him to rest for a few days, but he can return to football practice in a week.”
2. “We will keep him in bed for 4 days and let him gradually increase his activity after that.”
3. “We will seek therapy as he ages because he is now infertile.”
4. “We will make sure he knows how to do testicular self-examination on a monthly basis.”
37. The nurse is caring for a 3-week-old female diagnosed with an inguinal hernia. The nurse knows that which of the following protruding into the groin most likely caused the inguinal hernia?
1. Bowel.
2. Fallopian tube.
3. Large thrombus formation.
4. Muscle tissue.
38. The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia and a hydrocele. What is the nurse’s best response?
1. “The terms are used interchangeably and mean the same thing.”
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 groin.”
3. “A hydrocele is the term used when an inguinal hernia occurs in females.”
4. “A hydrocele presents in a manner similar to that of an inguinal hernia but causes
4. “A hydrocele presents in a manner similar to that of an inguinal hernia but causes