ch26 hesi Flashcards
A child who has difficulty passing urine, along with edema in the genital area, is scheduled for placement of a temporary percutaneous nephrostomy tube. Which diagnostic examination helps the nurse to determine dilation of the ureters and the bladder wall? 1 Scout film 2 Whitaker perfusion test 3 Testicular ultrasonography Correct4 Renal and bladder ultrasonography
Renal and bladder ultrasonography is helpful in visualization of renal parenchyma and dilation of the ureters and the bladder wall. A scout film is a radiograph examination of abdomen and pelvis that helps to detect renal outline and calculi. A Whitaker perfusion test helps to determine obstructions in the upper urinary tract. However, it does not determine dilation of ureter and bladder wall. Testicular ultrasonography helps in visualization of the bladder outline and urethra.
What causes primary reflux? 1 Trauma 2 Acquired infection 3 Acquired condition Correct4 Congenitally abnormal insertion of ureters into the bladder
Primary reflux occurs when a congenitally abnormal insertion of ureters into the bladder occurs. It is not caused by an acquired infection, acquired condition, or trauma.
Which is an important nursing consideration when caring for a child with end-stage renal disease (ESRD)?
1
The child with ESRD usually adapts well to the minor inconveniences of treatment.
2
The child with ESRD requires extensive support until he or she outgrows the condition.
3
Multiple stresses are placed on the child and family with ESRD until the illness is cured.
Correct4
Multiple stresses are placed on the child and family with ESRD because the child’s life is maintained by drugs and artificial means.
ESRD is a chronic, progressive disease with dependence on technology. Families need to arrange for continuing examinations and procedures that are painful and may require hospitalization. ESRD is a complex disease process that requires substantial medical intervention. ESRD cannot be outgrown or cured. Dialysis is necessary until renal transplantation is performed.
The intravenous pyelogram results of the patient indicate a urinary obstruction. Which treatment will be beneficial for the patient? 1 Orchiopexy 2 Circumcision Correct3 Nephrostomy 4 Renal transplantation
A nephrostomy is an artificial opening created between the kidney and the skin. The tube passes through the flank into the pelvis of the kidney, which allows for urinary diversion directly from the pelvis into an ostomy bag. Orchiopexy is a surgical treatment which helps in descending the testis through inguinal canal. Circumcision is treatment which helps to retract the foreskin and helps in voiding. The patient with chronic renal failure is a more likely candidate for kidney transplant.
What is the most common of the postinfectious renal diseases in childhood? 1 Obstructive neuropathy 2 Nephrotic syndrome Correct3 Acute glomerulonephritis 4 Hemolytic uremic syndrome
Acute glomerulonephritis is the most common postinfectious renal disease in childhood and the one for which a cause can be established in most cases. Wilms tumor is a common malignant renal and intraabdominal tumor of childhood. Nephrotic syndrome is a clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Hemolytic uremic syndrome is uncommon acute renal disease.
Which urine test result would be considered abnormal for an 8-year-old child? Correct1 pH of 4 2 Absence of protein 3 Absence of glucose 4 Specific gravity of 1.020
The expected pH of urine is 4.8 to 7.8.A specific gravity of 1.020 is within the normal range of 1.015 to 1.030. Protein should not be present in the urine; it indicates an abnormality in glomerular filtration. Glucose should not be present in the urine; it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.
Test-Taking Tip: Watch for grammatical inconsistencies. If one or more of the options is not grammatically consistent with the stem, the alert test taker can identify it as a probable incorrect option. When the stem is in the form of an incomplete sentence, each option should complete the sentence in a grammatically correct way.
What accounts for the increased incidence of bacteriuria in females? Correct1 Lower urinary tract 2 Higher urinary tract 3 Higher intake of fluids 4 Frequent emptying of the bladder
The lower urinary tract accounts for the increased incidence of bacteriuria in females. Females have a lower, not a higher, urinary tract, which increases the incidence for bacteriuria. Frequent emptying of the bladder and a higher intake of fluids help to prevent infections and are therefore not associated with an increased incidence of bacteriuria in females.
What is an advantage of continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis for adolescents who require dialysis?
1
Dietary restrictions are no longer necessary.
Correct2
Adolescents can carry out procedures themselves.
3
Hospitalization is only required several nights per week.
4
Insertion of a catheter does not require surgical placement.
Continuous cycling peritoneal dialysis (CCCD) and continuous ambulatory peritoneal dialysis (CAPD) provide the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves, and the procedure is usually performed at night, enabling the adolescent to live life more normally during the day. CCPD and CAPD can be performed at home. Dietary restrictions are still required but are less strict when an adolescent is undergoing CCPD or CAPD. The catheter is surgically implanted in the abdominal cavity for both CCPD and CAPD.
Test-Taking Tip: Answer every question because, on the NCLEX exam, you must answer a question before you can move on to the next question.
The nurse is caring for a child with minimal-change nephrotic syndrome (MCNS). Which nursing intervention in the plan of care is most important? 1 Providing adequate skin care 2 Keeping the child warm and dry Correct3 Monitoring fluid retention continuously 4 Formulating a nutritionally adequate diet
When caring for the child with MCNS, the nurse should monitor the child continuously for fluid retention and excretion. MCNS is characterized by proteinuria higher than 2+ on urine dipstick. Strict intake and output records are essential to determine filtration by the glomerulus. Application of collection bags is irritating to edematous skin that is readily subject to breakdown. The nurse should provide adequate skin care. Infection is a constant source of danger to edematous children and those receiving corticosteroid therapies. These children are particularly vulnerable to upper respiratory tract infection; therefore, they must be kept warm and dry, active, and protected from contact with infected individuals. Loss of appetite accompanies active nephrosis. The combined efforts of nurse, dietician, parents, and child are needed to formulate a nutritionally adequate and attractive diet.
What is the name of the defect in which the meatal opening is located on the dorsal surface of the penis? 1 Chordee Correct2 Epispadias 3 Hypospadias 4 Cryptorchidism
In epispadias, the meatal opening is located on the dorsal surface of the penis. Chordee is a ventral curvature of penis, often associated with hypospadias. In hypospadias, the urethral opening is located behind glans penis or anywhere the ventral surface of the penile shaft. Cryptorchidism is the failure of one or both testes to descend.
A 5-year-old child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to the child's parents, as a priority action, that the child be evaluated for which condition? 1 School phobia 2 Emotional causes Correct3 Urinary tract infection 4 Structural defects of the urinary tract
Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection. A physical cause of the problem needs to be eliminated before a psychologic cause is considered. Emotional causes should be investigated only once a physical cause has been ruled out. Structural defects would be explored as a cause after a urinary tract infection has been confirmed.
The parent of a child hospitalized with acute glomerulonephritis (AGN) asks the nurse why blood pressure readings are being taken so often. What is the most appropriate response by the nurse, drawing on knowledge of AGN?
Correct1
Acute hypertension must be anticipated and identified.
2
Hypotension leading to sudden shock can develop at any time.
3
Blood pressure fluctuations are a common side effect of antibiotic therapy.
4
Blood pressure fluctuations are a sign that the condition has become chronic
Vital signs, in particular the blood pressure, provide information about the severity of acute glomerular nephritis (AGN) and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations are not indicative of chronic disease. Most children with AGN fully recover. Hypertension, not hypotension, is more likely with AGN.
Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses.
The nurse is assessing a child with recurrent urinary tract infections. The health care provider has prescribed voiding cystourethrography to evaluate the vesicoureteral reflux. After assessing the child, the nurse suggests the health care provider to prescribe aradionuclide (nuclear) cystogram instead. What would be the rationale for this suggestion?
Incorrect1
The child displays symptoms of renal calculi.
2
The child presents with severe abdominal pain.
3
The child is unwilling to undergo catheterization.
Correct4
The child is allergic to intravenous contrast medium.
Voiding cystourethrography is used to visualize the bladder outline and urethra and check for reflux of urine into the ureters. It uses a contrast medium to visualize the bladder. If the child has an allergy to contrast material, then a radionuclide cystogram is used to evaluate vesicoureteral reflux. A radionuclide cystogram does not give clear anatomic details of the urinary system and thus cannot be used to detect renal calculi. These investigations do not aggravate abdominal pain. These investigations could be done once the pain is under control. Both these procedures involve catheterizing the patient.
Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option.
The nurse is reviewing the laboratory reports of a patient and notices a urine specific gravity of 1.030. What should the nurse interpret from this finding? Correct1 The patient has dehydration. 2 The patient has renal disease. 3 The patient has diabetes mellitus. 4 The patient has metabolic alkalosis.
The normal specific gravity of urine is 1.016 to 1.022. This patient’s urine specific gravity is 1.030, which means the urine is concentrated. This indicates that the patient has dehydration. The patient with renal disease will have a decrease in urine specific gravity. The presence of glucose in the urine indicates that the patient has diabetes mellitus. Diabetes mellitus is not associated with an increase in the specific gravity of urine. The increase in pH of urine indicates that the patient has metabolic alkalosis, but it is not associated with increase in specific gravity.
What finding in a child undergoing continuous ambulatory peritoneal dialysis requires immediate attention?
1
Clear dialysate draining from the child
Correct2
Cloudy dialysate draining from the child
3
Instillation of solution into the peritoneal cavity
4
Surgically implanted indwelling catheter tunneled subcutaneously and sutured into place
Cloudy dialysate draining from the child requires immediate attention, because this finding may indicate infection, which could lead to peritonitis. Instillation of solution into the peritoneal cavity is part of the procedure for peritoneal dialysis. A surgically implanted indwelling catheter tunneled subcutaneously and sutured into place is the proper means of instilling dialysate for peritoneal dialysis.
