Midterm ch 26 Flashcards
A nurse is caring for a 6-year-old child diagnosed with nephrotic syndrome. Which of the following is the priority intervention?
A. Administering corticosteroids as prescribed
B. Monitoring for signs of infection
C. Encouraging high-protein snacks
D. Restricting fluids to prevent edema
B. Monitoring for signs of infection
Rationale: Children with nephrotic syndrome are at risk for infection due to immunosuppressive therapy (e.g., corticosteroids) and the loss of immunoglobulins in the urine. Therefore, monitoring for signs of infection is the priority intervention.
A pediatric nurse is teaching the parents of a child with acute post-streptococcal glomerulonephritis (APSGN) about the condition. Which of the following statements by the parent indicates a need for further teaching?
A. “We need to monitor for signs of high blood pressure.”
B. “I should watch for changes in my child’s urine color and amount.”
C. “Our child may need to follow a low-salt diet if edema worsens.”
D. “My child should avoid taking antibiotics in the future to prevent reinfection.”
D. “My child should avoid taking antibiotics in the future to prevent reinfection.”
Rationale: APSGN is typically a consequence of a previous streptococcal infection, and while treating the initial infection is crucial, the child does not need to avoid antibiotics for future infections. Proper antibiotic treatment is necessary to prevent further infections.
A child with nephrotic syndrome is receiving prednisone. The nurse should monitor for which of the following potential side effects of corticosteroid therapy?
A. Hypoglycemia
B. Increased risk for infection
C. Decreased blood pressure
D. Bradycardia
B. Increased risk for infection
Rationale: Corticosteroids suppress the immune system, which increases the risk of infections. Monitoring for signs of infection is essential.
A 5-year-old child with nephrotic syndrome is admitted with severe edema. The nurse should prioritize which of the following interventions?
A. Administering a diuretic
B. Monitoring blood glucose levels
C. Measuring abdominal girth daily
D. Limiting the child’s physical activity
C. Measuring abdominal girth daily
Rationale: Abdominal girth is a reliable indicator of ascites and abdominal edema in children with nephrotic syndrome. Measuring it daily helps assess the severity of fluid retention and the effectiveness of interventions.
A child with nephrotic syndrome is receiving furosemide for edema. Which of the following lab values would indicate a need for immediate intervention?
A. Potassium 3.0 mEq/L
B. Sodium 138 mEq/L
C. Blood urea nitrogen (BUN) 15 mg/dL
D. Hemoglobin 12 g/dL
A. Potassium 3.0 mEq/L
Rationale: Furosemide is a potassium-wasting diuretic, and a potassium level of 3.0 mEq/L is low, which increases the risk for arrhythmias. The nurse should intervene promptly to correct the potassium imbalance.
The nurse is preparing to administer a dose of corticosteroids to a child with nephrotic syndrome. Which of the following should the nurse teach the parents?
A. “You should stop the medication immediately if you notice swelling or weight gain.”
B. “The medication will need to be tapered off gradually to avoid withdrawal symptoms.”
C. “The child will need to avoid all vaccinations during corticosteroid therapy.”
D. “Your child will need to follow a high-salt diet to prevent fluid retention.”
B. “The medication will need to be tapered off gradually to avoid withdrawal symptoms.”
Rationale: Corticosteroids must be tapered gradually to prevent withdrawal symptoms and adrenal insufficiency. Abrupt discontinuation can lead to significant complications.
A nurse is monitoring a child with acute glomerulonephritis. The nurse understands that which of the following findings is most likely to be present?
A. Hematuria
B. Decreased blood pressure
C. Hyperkalemia
D. Hypercalcemia
A. Hematuria
Rationale: Acute glomerulonephritis commonly presents with hematuria (presence of blood in the urine), proteinuria, and edema. The urine may appear tea-colored due to the presence of red blood cells.
The nurse is educating a parent of a child with nephrotic syndrome about dietary changes. Which of the following dietary modifications is most appropriate?
A. High-protein, low-sodium diet
B. High-calcium, low-sodium diet
C. Low-protein, high-sodium diet
D. Low-calcium, high-protein diet
A. High-protein, low-sodium diet
Rationale: Nephrotic syndrome leads to significant protein loss, so a high-protein diet is necessary. A low-sodium diet helps control edema and fluid retention, which is common in nephrotic syndrome.
A nurse is caring for a child with nephrotic syndrome who has been receiving corticosteroids for several weeks. Which of the following is a priority assessment for the nurse?
A. Assessment for signs of infection
B. Monitoring for signs of hyperglycemia
C. Monitoring for signs of dehydration
D. Assessing for signs of anemia
A. Assessment for signs of infection
Rationale: Corticosteroid therapy suppresses the immune system, making the child more susceptible to infections. The nurse should prioritize infection surveillance.
A child with nephrotic syndrome is being discharged after treatment for severe edema. Which of the following instructions is most important for the nurse to include in the discharge teaching?
A. “Monitor your child’s blood glucose levels regularly.”
B. “Administer antibiotics as prescribed if your child develops a fever.”
C. “Increase your child’s sodium intake to promote fluid retention.”
D. “Check your child’s weight daily and report significant changes.”
D. “Check your child’s weight daily and report significant changes.”
Rationale: Monitoring weight daily helps detect fluid retention or loss, which is crucial for managing nephrotic syndrome. Significant weight changes should be reported to the healthcare provider promptly.
A nurse is caring for a 7-year-old child diagnosed with acute glomerulonephritis. The child’s urine is noted to be dark and tea-colored. Which of the following is the most likely cause of this finding?
A. Hematuria
B. Proteinuria
C. Hyaline casts
D. Pyuria
A. Hematuria
Rationale: The dark, tea-colored urine is most commonly due to hematuria, which is a hallmark sign of glomerulonephritis. The blood in the urine gives it a dark color, often described as “cola-colored” or “tea-colored.”
A nurse is educating the parents of a child with acute glomerulonephritis. Which statement made by the parent indicates a need for further teaching?
A. “I should monitor my child’s blood pressure regularly.”
B. “We need to limit our child’s fluid intake to reduce edema.”
C. “My child may experience swelling in the face, especially in the morning.”
D. “It’s important to ensure that my child gets enough protein in their diet.
D. “It’s important to ensure that my child gets enough protein in their diet.
Rationale: In glomerulonephritis, protein loss in the urine is common, and the diet may need to be adjusted to limit protein intake. The focus should be on managing symptoms, including edema and blood pressure, rather than increasing protein.
A child with acute glomerulonephritis is experiencing hypertension. Which of the following medications would most likely be prescribed to help control the blood pressure?
A. Furosemide
B. Lisinopril
C. Sodium bicarbonate
D. Morphine
B. Lisinopril
Rationale: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, which helps manage hypertension by relaxing blood vessels and reducing the workload on the heart, making it appropriate for children with glomerulonephritis and elevated blood pressure.
A nurse is preparing to assess a child with glomerulonephritis for complications. Which of the following is the most serious complication to monitor for in this child?
A. Pulmonary edema
B. Seizures
C. Acute renal failure
D. Diabetic ketoacidosis
C. Acute renal failure
Rationale: Acute renal failure is a serious complication of glomerulonephritis, often resulting from progressive damage to the glomeruli, which impairs kidney function. Early identification and intervention are critical to prevent irreversible kidney damage.
A child with glomerulonephritis is being discharged after a short hospital stay. Which of the following discharge instructions is most important for the nurse to include?
A. “Your child will need to be on a low-sodium diet to prevent fluid retention.”
B. “Ensure that your child avoids all physical activity for at least 6 months.”
C. “You should monitor for signs of infection and avoid immunizations for 6 months.”
D. “It is important to ensure your child consumes a high-protein diet to support healing.”
A. “Your child will need to be on a low-sodium diet to prevent fluid retention.”
Rationale: A low-sodium diet helps reduce fluid retention and edema, which is common in children with glomerulonephritis. Limiting salt intake is essential in managing the condition.
A nurse is assessing a child with glomerulonephritis for signs of fluid retention. Which of the following assessments would be most helpful in determining fluid status?
A. Assessing for jaundice
B. Measuring blood pressure
C. Measuring the child’s daily weight
D. Monitoring blood glucose levels
C. Measuring the child’s daily weight
Rationale: Daily weight measurement is the most reliable indicator of fluid retention in children with glomerulonephritis. A rapid increase in weight may indicate fluid retention or worsening edema.
A child with glomerulonephritis is receiving a corticosteroid as part of their treatment plan. Which of the following is an important nursing consideration when administering corticosteroids?
A. Monitoring for signs of hyperkalemia
B. Administering the medication with food to minimize gastrointestinal irritation
C. Encouraging a high-sodium diet to manage fluid retention
D. Monitoring for signs of hypercalcemia
B. Administering the medication with food to minimize gastrointestinal irritation
Rationale: Corticosteroids can irritate the gastrointestinal tract, so it is important to administer them with food to reduce the risk of gastric upset. The child’s diet should not be high in sodium, as this can worsen fluid retention.
A 9-year-old child is diagnosed with glomerulonephritis following a recent streptococcal throat infection. Which of the following laboratory findings would be most indicative of the condition?
A. Elevated white blood cell count
B. Elevated antistreptolysin O (ASO) titer
C. Low hemoglobin level
D. Elevated liver enzymes
B. Elevated antistreptolysin O (ASO) titer
Rationale: An elevated ASO titer indicates a recent streptococcal infection, which is often a precursor to glomerulonephritis. This laboratory finding is an important diagnostic clue in children with a history of strep throat.
The nurse is caring for a child with glomerulonephritis and severe edema. Which of the following interventions would be most appropriate for managing the child’s edema?
A. Restricting fluid intake
B. Administering a high-protein diet
C. Restricting sodium intake
D. Administering diuretics as prescribed
C. Restricting sodium intake
Rationale: Restricting sodium intake is important in managing edema because sodium promotes fluid retention. In severe cases of edema, diuretics may also be prescribed to help eliminate excess fluid.
A nurse is monitoring a child with glomerulonephritis for complications. Which of the following findings should the nurse report to the healthcare provider immediately?
A. A positive urine dipstick for protein
B. Dark, tea-colored urine
C. Decreased urinary output
D. Sudden increase in blood pressure
D. Sudden increase in blood pressure
Rationale: A sudden increase in blood pressure could indicate worsening renal function or the development of hypertensive complications. This is a medical emergency that requires immediate intervention.
A nurse is caring for an infant diagnosed with a lower urinary tract infection (UTI). Which of the following clinical manifestations is most likely to be observed?
A. Costovertebral angle tenderness
B. Hematuria and dysuria
C. Poor feeding and foul-smelling diapers
D. Flank pain and dehydration
C. Poor feeding and foul-smelling diapers
Rationale: Infants with lower UTIs often present with nonspecific symptoms, such as poor feeding, irritability, foul-smelling diapers, and failure to gain weight.
A 5-year-old with a UTI presents with abdominal pain, dysuria, and enuresis. Which type of UTI is most consistent with these symptoms?
A. Upper UTI—pyelonephritis
B. Lower UTI—cystitis
C. Chronic UTI
D. Asymptomatic bacteriuria
B. Lower UTI—cystitis
Rationale: Lower UTIs are associated with symptoms such as abdominal pain, dysuria, and enuresis in preschool and school-age children.
A school-age child presents with flank pain, fever, and moderate dehydration. Which type of UTI does the nurse suspect?
A. Asymptomatic bacteriuria
B. Lower UTI—cystitis
C. Upper UTI—pyelonephritis
D. Chronic UTI
C. Upper UTI—pyelonephritis
Rationale: Upper UTIs (pyelonephritis) typically present with systemic symptoms like high fever, flank pain, nausea, and dehydration.
When educating parents about preventing UTIs in their child, which of the following statements indicates a need for further teaching?
A. “We should encourage frequent toileting to prevent urine retention.”
B. “It’s okay for my child to hold their urine if they’re busy playing.”
C. “My child should wipe from front to back after using the bathroom.”
D. “We will increase my child’s fluid intake to help flush out bacteria.”
B. “It’s okay for my child to hold their urine if they’re busy playing.”
Rationale: Holding urine can lead to stasis and increase the risk of developing a UTI. Frequent toileting is essential in prevention.
Which of the following nursing diagnoses is most appropriate for a child with a UTI who has frequent episodes of enuresis and foul-smelling urine?
A. Risk for Deficient Fluid Volume
B. Ineffective Family Health Management
C. Urinary Retention
D. Impaired Urinary Elimination
D. Impaired Urinary Elimination
Rationale: Impaired Urinary Elimination is an appropriate diagnosis for a child experiencing frequent urination, enuresis, and foul-smelling urine.
The most common causative organism of urinary tract infections in children is:
A. Escherichia coli
B. Streptococcus pyogenes
C. Staphylococcus aureus
D. Klebsiella pneumoniae
A. Escherichia coli
Rationale: Most UTIs in children are caused by Escherichia coli, which is part of the normal flora of the gastrointestinal tract.
Which of the following is the priority intervention for a child admitted with suspected pyelonephritis?
A. Administer antipyretics for fever
B. Obtain a urine sample for culture and sensitivity
C. Encourage fluid intake to maintain hydration
D. Administer prescribed antibiotics
B. Obtain a urine sample for culture and sensitivity
Rationale: Obtaining a urine sample is the priority to identify the causative organism and ensure the appropriate antibiotic is prescribed.
When collecting a urine sample from an infant for suspected UTI, the nurse should:
A. Use a sterile cotton swab to obtain a sample from the diaper.
B. Perform a clean-catch midstream urine collection.
C. Use a sterile collection bag adhered to the perineum.
D. Perform an in-and-out catheterization.
C. Use a sterile collection bag adhered to the perineum.
Rationale: For infants, a sterile collection bag is often used to obtain a sample. Catheterization may be necessary if contamination is suspected.
Which clinical finding is most concerning in a child with a UTI?
A. Low-grade fever
B. Enuresis
C. Foul-smelling urine
D. Costovertebral angle tenderness
D. Costovertebral angle tenderness
Rationale: Costovertebral angle tenderness indicates upper urinary tract involvement (pyelonephritis), which is more severe than a lower UTI.
A child is prescribed antibiotics for a UTI. The nurse explains the importance of completing the entire course of antibiotics. What is the main reason for this instruction?
A. To reduce the risk of drug resistance
B. To prevent reinfection of the bladder
C. To minimize side effects of the medication
D. To improve the child’s immune system
A. To reduce the risk of drug resistance
Rationale: Completing the prescribed course of antibiotics ensures all bacteria are eradicated and reduces the risk of developing antibiotic resistance.
A nurse suspects dehydration in a child with a UTI. Which of the following findings supports this assessment?
A. Cloudy urine
B. Poor skin turgor and dry mucous membranes
C. Costovertebral angle tenderness
D. Foul-smelling urine
B. Poor skin turgor and dry mucous membranes
Rationale: Poor skin turgor and dry mucous membranes are key indicators of dehydration.
A parent asks how to prevent recurrent UTIs in their child. Which recommendation is most appropriate?
A. “Avoid bubble baths and irritants in the perineal area.”
B. “Limit fluid intake to reduce urination frequency.”
C. “Encourage tight-fitting underwear to protect the perineal area.”
D. “Give cranberry juice daily to treat existing infections.”
A. “Avoid bubble baths and irritants in the perineal area.”
Rationale: Bubble baths and irritants can increase the risk of UTIs by irritating the urethra.
A nurse is assessing the hydration status of a child with pyelonephritis. Which finding is the best indicator of improved hydration?
A. Increased urinary output
B. Moist mucous membranes
C. Stable weight
D. Normal blood pressure
A. Increased urinary output
Rationale: Urinary output is the most reliable indicator of improved hydration status.
The parent of a child with a UTI asks why their child needs antibiotics for a bacterial infection but not for viral illnesses. The best response by the nurse is:
A. “Viral infections usually resolve on their own without treatment.”
B. “Antibiotics work for bacterial infections, not viral infections.”
C. “UTIs can become serious if not treated with antibiotics.”
D. “Antibiotics boost the immune system to fight infections.”
B. “Antibiotics work for bacterial infections, not viral infections.”
Rationale: Antibiotics are effective only against bacteria and not viruses. Educating parents helps reduce antibiotic misuse.
