Pediatric material

Question 1

In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)?

a. Trisomy 21 detected on amniocentesis
b. Family history of myocardial infarction
c. Father has type 1 diabetes mellitus
d. Older sibling born with Turner syndrome

Answer 1

ANS: A
A The incidence of congenital heart disease is approximately 50% in children with
trisomy 21 (Down syndrome).
B A family history of congenital heart disease, not acquired heart disease, increases
the risk of giving birth to a child with CHD.
C Infants born to mothers who are insulin dependent have an increased risk of
CHD.
D Infants identified as having certain genetic defects, such as Turner syndrome,
have a higher incidence of CHD. A family history is not a risk factor.

Question 2

In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)?

a. Trisomy 21 detected on amniocentesis
b. Family history of myocardial infarction
c. Father has type 1 diabetes mellitus
d. Older sibling born with Turner syndrome

Answer 2

ANS: A
Feedback
A The incidence of congenital heart disease is approximately 50% in children with
trisomy 21 (Down syndrome).
B A family history of congenital heart disease, not acquired heart disease, increases
the risk of giving birth to a child with CHD.
C Infants born to mothers who are insulin dependent have an increased risk of
CHD.
D Infants identified as having certain genetic defects, such as Turner syndrome,
have a higher incidence of CHD. A family history is not a risk factor.

Question 3

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect?

a. Pulmonary stenosis
b. Patent ductus arteriosus
c. Ventricular septal defect
d. Coarctation of the aorta

Answer 3

ANS: B
Feedback
A A systolic ejection murmur that may be accompanied by a palpable thrill is a
manifestation of pulmonary stenosis.
B The classic murmur associated with patent ductus arteriosus is a machinery-like
one that can be heard throughout both systole and diastole.
C The characteristic murmur associated with ventricular septal defect is a loud,
harsh, holosystolic murmur.
D A systolic murmur that is accompanied by an ejection click may be heard on
auscultation when coarctation of the aorta is present.

Question 4

When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure?

a. The right arm
b. The left arm
c. All four extremities
d. Both arms while the child is crying

Answer 4

ANS: C
Feedback
A Blood pressure measurements for upper and lower extremities are compared
during an assessment for CHDs.
B Discrepancies in blood pressure between the upper and lower extremities cannot
be determined if blood pressure is not measured in all four extremities.
C When a CHD is suspected, the blood pressure should be measured in all four
extremities while the child is quiet. Discrepancies between upper and lower
extremities may indicate cardiac disease.
D Blood pressure measurements when the child is crying are likely to be elevated;
thus the readings will be inaccurate. Also, all four extremities need to be
measured.

Question 5

For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?

a. To decrease inflammation
b. To control pain
c. To decrease respirations
d. To improve oxygenation

Answer 5

ANS: D
Feedback
A Prostaglandin E1 is used to maintain a patent ductus arteriosus, thus increasing
pulmonary blood flow.
B Prostaglandin E1 is administered to infants with a right-to-left shunt to keep the
ductus arteriosus patent, thus increasing pulmonary blood flow.
C Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus
arteriosus patent to increase pulmonary blood flow.
D Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus
arteriosus patent. This will improve oxygenation.

Question 6

As a nurse working in the newborn nursery, you notice an infant who is having circumoral cyanosis. Which CHD do you suspect the child may have? (Select all that apply.):

a. Patent ductus arteriosus (PDA)
b. Tetralogy of Fallot
c. Pulmonary atresia
d. Transposition of the great arteries
e. Ventricular septal defect

Answer 6

ANS: B, C, D
Feedback
Correct: Tetralogy of Fallot is a cyanotic lesion with decreased pulmonary blood
flow. The hypoxia results in baseline oxygen saturations as low as 75% to
85%. Even with oxygen administration, saturations do not reach the
normal range. Pulmonary atresia is a cyanotic lesion with decreased
pulmonary blood flow. The hypoxia results in baseline oxygen saturations
as low as 75% to 85%. Even with oxygen administration, saturations do
not reach the normal range. Transposition of the great arteries is a cyanotic
lesion with increased pulmonary blood flow.
Incorrect: PDA is failure of the fetal shunt between the aorta and the pulmonary
artery to close. PDA is not classified as a cyanotic heart disease.
Prostaglandin E1 is often given to maintain ductal patency in children with
cyanotic heart diseases. VSD is the most common type of cardiac defect.
The VSD is a left-to-right shunting defect; however, it may be
accompanied by other defects.

Question 7

Before preparing a teaching plan for the parents of an infant with ductus arteriosus, it is important that the nurse understands this condition. Which statement best describes patent ductus arteriosus?

a. Patent ductus arteriosus involves a defect that results in a right-to-left shunting of blood in the heart.
b. Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close.
c. Patent ductus arteriosus is a stenotic lesion that must be surgically corrected at birth.
d. Patent ductus arteriosus causes an abnormal opening between the four chambers of the heart.

Answer 7

ANS: B
Feedback
A Patent ductus arteriosus allows blood to flow from the high-pressure aorta to the
low-pressure pulmonary artery, resulting in a left-to-right shunt.
B Patent ductus arteriosus is failure of the fetal shunt between the aorta and the
pulmonary artery to close.
C Patent ductus arteriosus is not a stenotic lesion. Patent ductus arteriosus can be
closed both medically and surgically.
D Atrioventricular defect occurs when fetal development of the endocardial
cushions is disturbed, resulting in abnormalities in the atrial and ventricular septa
and the atrioventricular valves.

Question 8

Which CHD results in increased pulmonary blood flow?

a. Ventricular septal defect
b. Coarctation of the aorta
c. Tetralogy of Fallot
d. Pulmonary stenosis

Answer 8

ANS: A
Feedback
A Ventricular septal defect causes a left-to-right shunting of blood, thus increasing
pulmonary blood flow.
B Coarctation of the aorta is a stenotic lesion that causes increased resistance to
blood flow from the proximal to distal aorta.
C The defects associated with tetralogy of Fallot result in a right-to-left shunting of
blood, thus decreasing pulmonary blood flow.
D Pulmonary stenosis causes obstruction of blood flow from the right ventricle to
the pulmonary artery. Pulmonary blood flow is decreased.

Question 9

Which defect results in increased pulmonary blood flow?

a. Pulmonic stenosis
b. Tricuspid atresia
c. Atrial septal defect
d. Transposition of the great arteries

Answer 9

ANS: C
Feedback
A Pulmonic stenosis is an obstruction to blood flowing from the ventricles.
B Tricuspid atresia results in decreased pulmonary blood flow.
C The atrial septal defect results in increased pulmonary blood flow. Blood flows
from the left atrium (higher pressure) into the right atrium (lower pressure) and
then to the lungs via the pulmonary artery.
D Transposition of the great arteries results in mixed blood flow.

Question 10

A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic?

a. Place the infant in a knee-chest position.
b. Administer oxygen.
c. Administer morphine sulfate.
d. Calm the infant.

Answer 10

ANS: D
Feedback
A Placing the infant in a knee-chest position will decrease venous return so that
smaller amounts of highly saturated blood reach the heart. This should be done
after calming the infant.
B Administering oxygen is indicated after placing the infant in a knee-chest
position.
C Administering morphine sulfate calms the infant. It may be indicated some time
after the infant has been calmed.
D Calming the crying infant is the first response. An infant with unrepaired
tetralogy of Fallot who is crying and agitated may eventually lose consciousness.

Question 11

What is an expected assessment finding in a child with coarctation of the aorta?

a. Orthostatic hypotension
b. Systolic hypertension in the lower extremities
c. Blood pressure higher on the left side of the body
d. Disparity in blood pressure between the upper and lower extremities

Answer 11

ANS: D
Feedback
A Orthostatic hypotension is not present with coarctation of the aorta.
B Systolic hypertension may be detected in the upper extremities.
C The left arm may not accurately reflect systolic hypertension because the left
subclavian artery can be involved in the coarctation.
D The classic finding in children with coarctation of the aorta is a disparity in
pulses and blood pressures between the upper and lower extremities.

Question 12

For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?

a. To decrease inflammation
b. To control pain
c. To decrease respirations
d. To improve oxygenation

Answer 12

ANS: D
Feedback
A Prostaglandin E1 is used to maintain a patent ductus arteriosus, thus increasing
pulmonary blood flow.
B Prostaglandin E1 is administered to infants with a right-to-left shunt to keep the
ductus arteriosus patent, thus increasing pulmonary blood flow.
C Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus
arteriosus patent to increase pulmonary blood flow.
D Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus
arteriosus patent. This will improve oxygenation.

Question 13

Chapter 45 – The Child with a Respiratory Alteration

The parent of a toddler calls the nurse, asking about croup. What is a distinguishing
manifestation of spasmodic croup?
a. Wheezing is heard audibly.
b. It has a harsh, barky cough.
c. It is bacterial in nature.
d. The child has a high fever.

Answer 13

ANS: B
Feedback
A Wheezing is not a distinguishing manifestation of croup. It can accompany
conditions such as asthma or bronchiolitis.
B Spasmodic croup is viral in origin; is usually preceded by several days of
symptoms of upper respiratory tract infection; often begins at night; and is
marked by a harsh, metallic, barky cough; sore throat; inspiratory stridor; and
hoarseness.
C Spasmodic croup is viral in origin.
D A high fever is not usually present.

Question 14

Which intervention for treating croup at home should be taught to parents?

a. Have a decongestant available to give the child when an attack occurs.
b. Have the child sleep in a dry room.
c. Take the child outside.
d. Give the child an antibiotic at bedtime.

Answer 14

ANS: C
Feedback
A Decongestants are inappropriate for croup, which affects the middle airway level.
B A dry environment may contribute to symptoms.
C Taking the child into the cool, humid, night air may relieve mucosal swelling and
improve symptoms.
D Croup is caused by a virus. Antibiotic treatment is not indicated.

Question 15

Which type of croup is always considered a medical emergency?

a. Laryngitis
b. Epiglottitis
c. Spasmodic croup
d. Laryngotracheobronchitis (LTB)

Answer 15

ANS: B
Feedback
A Laryngitis is a common viral illness in older children and adolescents, with
hoarseness and URI symptoms.
B Epiglottitis is always a medical emergency that requires antibiotics and airway
support for treatment.
C Spasmodic croup is treated with humidity.
D LTB may progress to a medical emergency in some children.

Question 16

The mother of a 20-month-old child tells the nurse that the child has a barking cough at night. The child’s temperature is 37 °C (98.6 °F). Based on the nurse’s knowledge of upper respiratory infections, this is a symptom of croup. What should the nurse instruct the mother to do?
A. Control the fever with acetaminophen and call if the cough gets worse tonight.
B. Try a cool-mist vaporizer at night and watch for signs of difficulty breathing.
C. Try over-the-counter cough medicine and come to the clinic tomorrow if there is no improvement.
D. Take the child to the hospital in case epiglottitis occurs.

Answer 16

B. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief.

Question 17

A 5-year-old child is brought to the emergency department with copious drooling and a
croaking sound on inspiration. Her mother states that the child is very agitated and only
wants to sit upright. What should be the nurse’s first action in this situation?
a. Prepare intubation equipment and call the physician.
b. Examine the child’s oropharynx and call the physician.
c. Obtain a throat culture for respiratory syncytial virus (RSV).
d. Obtain vital signs and listen to breath sounds.

Answer 17

ANS: A
Feedback
A This child has symptoms of epiglottitis, is acutely ill, and requires emergency
measures.
B If epiglottitis is suspected, the nurse should not examine the child’s throat.
Inspection of the epiglottis is only done by a physician, because it could trigger
airway obstruction.
C A throat culture could precipitate a complete respiratory obstruction.
D Vital signs can be assessed after emergency equipment is readied.

Question 18

Which type of croup is always considered a medical emergency?

a. Laryngitis
b. Epiglottitis
c. Spasmodic croup
d. Laryngotracheobronchitis (LTB)

Answer 18

ANS: B
Feedback
A Laryngitis is a common viral illness in older children and adolescents, with
hoarseness and URI symptoms.
B Epiglottitis is always a medical emergency that requires antibiotics and airway
support for treatment.
C Spasmodic croup is treated with humidity.
D LTB may progress to a medical emergency in some children.

Question 19

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of

a. Bronchitis
b. Bronchiolitis
c. Viral-induced asthma
d. Acute spasmodic laryngitis

Answer 19

ANS: A
Feedback
A Bronchitis is characterized by these symptoms and occurs in children older than
6 years.
B Bronchiolitis is rare in children older than 2 years.
C Asthma is a chronic inflammation of the airways that may be exacerbated by a
virus.
D Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

Question 20

Which intervention is appropriate for the infant hospitalized with bronchiolitis?

a. Position on the side with neck slightly flexed.
b. Administer antibiotics as ordered.
c. Restrict oral and parenteral fluids if tachypneic.
d. Give cool, humidified oxygen.

Answer 20

ANS: D
Feedback
A The infant should be positioned with the head and chest elevated at a 30- to
40-degree angle and the neck slightly extended to maintain an open airway and
decrease pressure on the diaphragm.
B The etiology of bronchiolitis is viral. Antibiotics are only given if there is a
secondary bacterial infection.
C Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are
given parenterally to prevent dehydration.
D Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible
fluid loss from tachypnea.

Question 21

The infant with bronchopulmonary dysplasia (BPD) who has RSV bronchiolitis is a candidate for which treatment?

a. Pancreatic enzymes
b. Cool humidified oxygen
c. Erythromycin intravenously
d. Intermittent positive pressure ventilation

Answer 21

ANS: B
Feedback
A Pancreatic enzymes are used for patients with cystic fibrosis.
B Humidified oxygen is delivered if the oxygen saturation level drops to less than
90%.
C Antibiotics are ineffective against viral illnesses. Oxygen can be administered by
hood, facemask, or nasal cannula.
D Assisted ventilation is not necessary in the treatment of RSV infections.

Question 22

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests

a. Asthma
b. Pneumonia
c. Bronchiolitis
d. Foreign body in trachea

Answer 22

ANS: A
Feedback
A Children with asthma usually have these chronic symptoms.
B Pneumonia appears with an acute onset and fever and general malaise.
C Bronchiolitis is an acute condition caused by RSV.
D Foreign body in the trachea will occur with an acute respiratory distress or failure
and maybe stridor.

Question 23

Which statement indicates that a parent of a toddler needs more education about
preventing foreign body aspiration?
a. “I keep objects with small parts out of reach.”
b. “My toddler loves to play with balloons.”
c. “I won’t permit my child to have peanuts.”
d. “I never leave coins where my child could get them.”

Answer 23

ANS: B
Feedback
A Keeping toys with small parts and other small objects out of reach can prevent
foreign body aspiration.
B Latex balloons account for a significant number of deaths from aspiration every
year.
C Peanuts are just one of the foods that pose a choking risk if given to young
children.
D Small objects, such as coins, need to be put out of the small child’s reach.

Question 24

Excessive blood loss after childbirth can have several causes; the most common is:

a. Vaginal or vulvar hematomas.
b. Unrepaired lacerations of the vagina or cervix.
c. Failure of the uterine muscle to contract firmly.
d. Retained placental fragments.

Answer 24

ANS: C
Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distention. Although vaginal or vulvar hematomas, unpaired lacerations of the vagina or cervix, and retained placental fragments are possible causes of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause.

Question 25

Chapter 43 –The child with a gastrointestinal alteration

The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF).
Nursing care should include
a. Elevating the head but give nothing by mouth
b. Elevating the head for feedings
c. Feeding glucose water only
d. Avoiding suction unless infant is cyanotic

Answer 25

ANS: A
Feedback
A When a newborn is suspected of having TEF, the most desirable position is
supine with the head elevated on an incline plane of at least 30 degrees. It is
imperative that any source of aspiration be removed at once; oral feedings are
withheld.
B Feedings should not be given to infants suspected of having TEF.
C Feedings should not be given to infants suspected of having TEF.
D The oral pharynx should be kept clear of secretion by oral suctioning. This is to
avoid cyanosis that is usually the result of laryngospasm caused by overflow of
saliva into the larynx.

Question 26

A nurse is teaching a group of parents about TEF. Which statement made by the nurse is accurate about TEF?
a. This defect results from an embryonal failure of the foregut to differentiate into
the trachea and esophagus.
b. It is a fistula between the esophagus and stomach that results in the oral intake
being refluxed and aspirated.
c. An extra connection between the esophagus and trachea develops because of
genetic abnormalities.
d. The defect occurs in the second trimester of pregnancy.

Answer 26

ANS: A
Feedback
A When the foregut does not differentiate into the trachea and esophagus during
the fourth to fifth week of gestation, a TEF occurs.
B TEF is an abnormal connection between the esophagus and trachea.
C There is no connection between the trachea and esophagus in normal fetal
development.
D This defect occurs early in pregnancy during the fourth to fifth week of gestation.

Question 27

What maternal assessment is related to an infant’s diagnosis of TEF?

a. Maternal age more than 40 years
b. First term pregnancy for the mother
c. Maternal history of polyhydramnios
d. Complicated pregnancy

Answer 27

ANS: C
Feedback
A Advanced maternal age is not a risk factor for TEF.
B The first term pregnancy is not a risk factor for an infant with TEF.
C A maternal history of polyhydramnios is associated with TEF.
D Complicated pregnancy is not a risk factor for TEF.

Question 28

What maternal assessment is related to an infant’s diagnosis of TEF?

a. Maternal age more than 40 years
b. First term pregnancy for the mother
c. Maternal history of polyhydramnios
d. Complicated pregnancy

Answer 28

ANS: C
Feedback
A Advanced maternal age is not a risk factor for TEF.
B The first term pregnancy is not a risk factor for an infant with TEF.
C A maternal history of polyhydramnios is associated with TEF.
D Complicated pregnancy is not a risk factor for TEF.

Question 29

What is the most important action to prevent the spread of gastroenteritis in a daycare setting?

a. Administering prophylactic medications to children and staff
b. Frequent handwashing
c. Having parents bring food from home
d. Directing the staff to wear gloves at all times

Answer 29

ANS: B
Feedback
A Prophylactic medications are not helpful in preventing gastroenteritis.
B Handwashing is the most the important measure to prevent the spread of
infectious diarrhea.
C Bringing food from home will not prevent the spread of infectious diarrhea.
D Gloves should be worn when changing diapers, soiled clothing, or linens. They
do not need to be worn for interactions that do not involve contact with
secretions. Handwashing after contact is indicated.

Question 30

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of

a. Protein intolerance
b. Parasitic infection
c. Fat malabsorption
d. Bacterial gastroenteritis

Answer 30

ANS: D
Feedback
A Protein intolerance is suspected in the presence of eosinophils.
B Parasitic infection is indicated by eosinophils.
C Fat malabsorption is indicated by foul-smelling, greasy, bulky stools.
D Neutrophils and red blood cells in stool indicate bacterial gastroenteritis.

Question 31

What information should the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy?

a. The infant will be in the hospital for a week.
b. The surgical procedure is routine and “no big deal.”
c. The prognosis for complete correction with surgery is good.
d. They will need to ask the physician about home care nursing.

Answer 31

ANS: C
Feedback
A The infant will remain in the hospital for a day or two postoperatively.
B Although the prognosis for surgical correction is good, telling the parents that
surgery is “no big deal” minimizes the infant’s condition.
C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good
with few complications. These comments reassure parents.
D Home care nursing is not necessary after a pyloromyotomy.

Question 32

What is the best response to parents who ask why their infant has a nasogastric tube to intermittent suction before abdominal surgery for hypertrophic pyloric stenosis?

a. “The nasogastric tube decompresses the abdomen and decreases vomiting.”
b. “We can keep a more accurate measure of intake and output with the nasogastric
tube. “
c. “The tube is used to decrease postoperative diarrhea.”
d. “Believe it or not, the nasogastric tube makes the baby more comfortable after
surgery. “

Answer 32

ANS: A
Feedback
A The nasogastric tube provides decompression and decreases vomiting.
B A nursing responsibility when a patient has a nasogastric tube is measurement of
accurate intake and output, but this is not why nasogastric tubes are inserted.
C Nasogastric tube placement does not decrease diarrhea.
D The presence of a nasogastric tube can be perceived as a discomfort by the
patient.

Question 33

What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception?
a. “I will call the physician when the baby passes his first stool.”
b. “I am going to dilate the anal sphincter with a gloved finger to help the baby pass
the barium.”
c. “I would like you to save all the soiled diapers so I can inspect them.”
d. “Add cereal to the baby’s formula to help him pass the barium.”

Answer 33

ANS: C
Feedback
A The physician does not need to be notified when the infant passes the first stool.
B Dilating the anal sphincter is not appropriate for the child after a barium enema.
C The nurse needs to inspect diapers after a barium enema because it is important
to document the passage of barium and note the characteristics of the stool.
D After reduction, the infant is given clear liquids and the diet is gradually
increased.

Question 34

Which description of a stool is characteristic of intussusception?

a. Ribbon-like stools
b. Hard stools positive for guaiac
c. “Currant jelly” stools
d. Loose, foul-smelling stools

Answer 34

ANS: C
Feedback
A Ribbon-like stools are characteristic of Hirschsprung disease.
B With intussusception, passage of bloody mucus stools occurs. Stools will not be
hard.
C Pressure on the bowel from obstruction leads to passage of “currant jelly” stools.
D Loose, foul-smelling stools may indicate infectious gastroenteritis

Question 35

Chapter 44: The Child with a Genitourinary Alteration

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition?

a. Hypocalciuria
b. Nephrotic syndrome
c. Glomerulonephritis
d. UTI

Answer 35

ANS: D
Feedback
A An excessive loss of calcium in the urine (hypercalciuria) can be associated with
complaints of painful urination, urgency, frequency, and wetting.
B Nephrotic syndrome is not usually associated with complaints of dysuria or
urgency.
C Glomerulonephritis is not a likely cause of dysuria or urgency.
D Complaints of dysuria or urgency from a child with secondary enuresis suggest
the possibility of a UTI.

Question 36

A true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system is that
a. The young infant’s kidneys can more effectively concentrate urine than an adult’s
kidneys.
b. After 6 years of age, kidney function is nearly like that of an adult.
c. Unlike adults, most children do not regain normal kidney function after acute
renal failure.
d. Young children have shorter urethras, which can predispose them to UTIs.

Answer 36

ANS: D Feedback
A The young infant’s kidneys cannot concentrate urine as efficiently as those of
older children and adults because the loops of Henle are not yet long enough to
reach the inner medulla, where concentration and reabsorption occur.
B By 6 to 12 months of age, kidney function is nearly like that of an adult.
C Unlike adults, most children with acute renal failure regain normal function.
D Young children have shorter urethras, which can predispose them to UTIs.

Question 37

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what condition? Select all that apply.

a. Hypocalciuria
b. Nephrotic syndrome
c. Glomerulonephritis
d. UTI
e. Diabetes mellitus

Answer 37

ANS: D, E
Feedback
Correct Complaints of dysuria or urgency from a child with secondary enuresis
suggest the possibility of a UTI. If accompanied by excessive thirst and
weight loss, these symptoms may indicate the onset of diabetes mellitus.
Incorrect An excessive loss of calcium in the urine (hypercalciuria) can be
associated with complaints of painful urination, urgency, frequency, and
wetting. Nephrotic syndrome is not usually associated with complaints of
dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or
urgency.

Question 38

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? Select all that apply.

a. Change in urine odor or color
b. Enuresis
c. Fever or hypothermia
d. Voiding urgency
e. Poor weight gain

Answer 38

ANS: A, C, E
Feedback
Correct The signs of a UTI in an infant include fever or hypothermia, irritability,
dysuria as evidenced by crying when voiding, change in urine odor or
color, poor weight gain, and feeding difficulties.
Incorrect Enuresis and voiding urgency should be assessed in an older child.

Question 39

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert
for which finding?
a. Increased urine output
b. Hypotension
c. Tea-colored urine
d. Weight gain

Answer 39

ANS: C
Feedback
A In acute poststreptococcal glomerulonephritis the urine output may be decreased.
B In acute poststreptococcal glomerulonephritis blood pressure may be increased.
C Acute poststreptococcal glomerulonephritis is characterized by hematuria,
proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of
hematuria.
D Edema may be noted around the eyelids and ankles in patients with acute
poststreptococcal glomerulonephritis; however, weight gain is associated with
nephrotic syndrome.

Question 40

Which clinical finding warrants further intervention for the child with acute
poststreptococcal glomerulonephritis?
a. Weight loss to within 1 lb of the preillness weight
b. Urine output of 1 mL/kg/hr
c. A positive antistreptolysin O (ASO) titer
d. Inspiratory crackles

Answer 40

ANS: D
Feedback
A This is an indication that the child is responding to treatment.
B This is an acceptable urine output and indicates that the child is responding to
treatment.
C A positive ASO titer indicates the presence of antibodies to streptococcal
bacteria; it is used to aid in diagnosis of acute poststreptococcal
glomerulonephritis. This is an expected finding if the child has this acute illness.
D Children with excess fluid volume may have pulmonary edema. Inspiratory
crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening
complication.

Question 41

he mother of a child who was recently diagnosed with acute glomerulonephritis asks the
nurse why the physician keeps talking about “casts” in the urine. The nurse’s response is
based on the knowledge that the presence of casts in the urine indicates
a. Glomerular injury
b. Glomerular healing
c. Recent streptococcal infection
d. Excessive amounts of protein in the urine

Answer 41

ANS: A
Feedback
A The presence of red blood cell casts in the urine indicates glomerular injury.
B Casts in the urine are abnormal findings and are indicative of glomerular injury,
not glomerular healing.
C A urinalysis positive for casts does not confirm a recent streptococcal infection.
D Casts in the urine are unrelated to proteinuria.

Question 42

A child is admitted with acute glomerulonephritis. The nurse expects the urinalysis during
this acute phase to show
a. Bacteriuria and hematuria
b. Hematuria and proteinuria
c. Bacteriuria and increased specific gravity
d. Proteinuria and decreased specific gravity

Answer 42

ANS: B
Feedback
A Bacteriuria and changes in specific gravity are not usually present during the
acute phase.
B Urinalysis during the acute phase characteristically shows hematuria and
proteinuria.
C Bacteriuria and changes in specific gravity are not usually present during the
acute phase.
D Bacteriuria and changes in specific gravity are not usually present during the
acute phase.

Question 43

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is

a. Risk for Injury related to malignant process and treatment
b. Deficient Fluid Volume related to excessive losses
c. Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration
d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces

Answer 43

ANS: C
Feedback
A No malignant process is involved in acute glomerulonephritis.
B Excess fluid volume is found.
C Glomerulonephritis has a decreased filtration of plasma. The resulting decrease
in plasma filtration results in an excessive accumulation of water and sodium
that expands plasma and interstitial fluid volumes, leading to circulatory
congestion and edema.
D The fluid accumulation is secondary to the decreased plasma filtration.