A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as:
answer
Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.
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Which nursing intervention should the nurse caring for the client with pyelonephritis implement?
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Teach client to increase fluid intake up to 3 liters per day.
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A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
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water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
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Select all of the following which are true about extracorporeal shock wave lithotripsy (ESWL).
answer
• Stones are shattered into smaller particles that are passed from the urinary tract.
• ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation.
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A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?
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Encourage use of incentive spirometer every 2 hours.
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The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?
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The kidneys can improve over a period of months.
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A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?
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Increase carbohydrates and limit protein intake.
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Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
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fever
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Which of the following is used to decrease potassium level seen in acute renal failure?
answer
Kayexalate
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A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
answer
Urine output of 250 ml/24 hours
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Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?
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Oliguria
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A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
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risk for infection
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A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
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Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl. normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl.
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Which of the following is the hallmark of the diagnosis of nephrotic syndrome?
answer
Proteinuria
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A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?
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Decrease in the blood flow through the kidneys
question
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
answer
Urine output of 20 ml/hour
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A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:
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confusion, headache, and seizures.
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A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?
answer
Urinary calculi
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The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?
answer
The kidneys can improve over a period of months, may take 3-6 months
question
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
answer
Check for thrill or bruit over the access site.
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Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis?
answer
Azotemia
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As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur?
answer
Hyperphosphatemia
question
An instructor is preparing a class on renal cancer for a group of students. Which of the following would the instructor include as a possible risk factor?
answer
age with most renal cancers occurring after age 60, male gender, tobacco use, occupational exposure to industrial chemicals, obesity, unopposed estrogen therapy, polycystic kidney disease, and treatment for renal failure.
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Which of the following is an integumentary manifestation of chronic renal failure?
answer
Gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.
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Which clinical finding should a nurse look for in a client with chronic renal failure?
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Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure.
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A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
answer
assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.
question
An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?
answer
Detects calculi, cysts, or tumors. Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions
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Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?
answer
SpO2 at 90% with fine crackles in the lung bases
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A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
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Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize.
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Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?
answer
Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
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A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for:
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cardiac arrhythmia.
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The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:
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There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
question
Which of the following occurs late in chronic glomerulonephritis?
answer
Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.
question
During hemodialysis, excess water is removed from the blood by which of the following?
answer
Excess water is removed from the blood by osmosis, in which water moves from an area of higher solute concentration in the blood toward an area of lower solute concentration into the dialysate
question
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
answer
group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV).
question
The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following?
answer
Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.
question
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?
answer
Acute glomerulonephritis- also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus.
Acute renal failure- associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney.
Chronic renal failure- may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications.
Nephrotic syndrome- caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
question
The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder?
answer
pH 7.20, PaCO2 36, HCO3 14-. Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid.
question
The nurse is caring for a patient who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed which of the following?
answer
After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis.
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Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:
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Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue.
question
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective?
answer
"Ultrafiltration methods take much longer than hemodialysis.".Ultrafiltration methods (CVVH, CVVHD) are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects.
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Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis?
answer
Blurred vision. Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis.
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Which of the following nursing actions is most important in caring for the client following lithotripsy?
answer
Strain the urine carefully for stone fragments.
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Which of the following is a characteristic of the intrarenal category of acute renal failure?
answer
increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.
question
The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply.
answer
• Calcium 7.5 mg/dL; hypotension and irritability
• Potassium 6.4 mEq/L; dysrhythmias and abdominal distention
• Phosphate 5.0 mg/dL; tachycardia and nausea and emesis
question
An investment banker, with chronic renal failure, informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?
answer
Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients
question
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:
answer
fatigue and weakness
question
The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?
answer
Location of discomfort
question
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
answer
The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
question
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
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The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
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A chronic renal failure client complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
answer
Hyperphosphatemia. Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone.
question
A client who is blind is admitted for treatment of gastroenteritis. Which nursing diagnosis takes highest priority for this client?
answer
Deficient fluid volume
question
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?
answer
White blood cell (WBC) count of 20,000/mm3. An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution.
question
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?
answer
During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.
question
Which of the following would a nurse classify as a prerenal cause of acute renal failure?
answer
Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.
question
PP Questions:
A nephrostomy tube may be inserted for which reason?
answer
Large kidney stone
question
With a patient with a foley catheter and a nephrostomy tube, how would you record urine output?
answer
Record foley and nephrostomy separate
question
What s/s could point to renal or bladder cancer?
answer
Hematuria
question
The nurse admits a client post ileal conduit. What is the top priority?
answer
Vital signs
question
The nurse admits a client from a MVA. Which assessment could indicate possible renal trauma?
answer
Hematuria
question
Which assessment is a symptom of nephrosclerosis?
answer
Hypertension
question
All EXCEPT which patient teaching topic are appropriate to include for a patient with nephrosclerosis?
answer
A. Low cholesterol, low sodium diet
B. Smoking cessation
C. Control blood glucose
**D. Low calcium diet
question
The hallmark sign of nephrotic syndrome is...
answer
Proteinuria
question
The main problem with acute glomerulonephritis is ....
answer
Inflammation
question
What type of dietary restrictions should a patient with acute glomerulonephritis have?
answer
Protein
question
The nurse understands that common causes of acute glomerulonephritis in pediatric patients include:
answer
Scarlet fever
question
A child diagnosed with pyelonephritis has a fever of 104.2. Which antipyretic should the nurse administer?
answer
Acetaminophen
question
Which is a prodromal symptom of hemolytic uremic syndrome in pediatric patients?
answer
Diarrheal illness
question
Which assessment finding is common in children diagnosed with nephrotic syndrome?
answer
Periorbital edema
question
Which problems identified during prenatal care could represent potential renal problems during childhood?
answer
Hydronephrosis
Neural tube defect
Oligohydramnios
One umbilical artery
question
What is the normal urine output for the infant/child?
answer
0.5 - 2ml/kg/hr
question
When obtaining a urine specimen from a school age child, what method is preferred?
answer
Clean catch specimen
question
What is an organic cause for erectile dysfunction?
answer
Coronary artery disease
question
What is the action of Phosphodiesterase inhibitors?
answer
Smooth muscle relaxation
question
A persistent painful erection is called....
answer
Praprism
question
Priapism can also be caused by what other process?
answer
Sickle cell disease
question
With prostatitis, what foods should be avoided until the inflammation has resolved?
answer
Alcohol
Caffeine
question
What is a treatment for prostate cancer most commonly used other than surgical removal?
answer
Brachytherapy
question
With any process involving scrotal swelling, what nursing intervention can promote comfort?
answer
Scrotal elevation
question
How many hours do you have to correct testicular torsion in order to save the testis?
answer
6 hours
question
What is the most common type of cancer among men age 15-35? END PP QUESTIONS
answer
Testicular
question
Which of the following would be included in the plan of care of someone in Stage 4 renal failure?
answer
Growth hormone injections daily
question
The nurse is teaching a group of nursing students about acute glomerulonephritis genitourinary conditions. A student asks the about a condition that occurs when there is a decreased volume of urine output. The condition the student is referring to is which of the following?
answer
Oliguria is a subnormal volume of urine.
question
A nurse is providing postoperative care for a 5-year-old who had a hypospadias repair. Which of the following would the nurse expect for postoperative care of this child?
answer
The child is usually hospitalized for under 24 hours with a hypospadias repair. Wheelchair kickball is an appropriate sport since typically the child is not in much pain after the surgery. This will help increase gross motor activity. The tubing should remain unclamped and free from obstruction at all times.
question
While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate?
answer
In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination.
question
A 5-year-old child with acute renal failure develops hyperkalemia. Which of the following would the nurse expect to administer?
answer
Polystyrene sulfonate (Kayexalate) is used to decrease potassium levels.
question
An infant is diagnosed with a urinary tract infection. What would the nurse expect on assessment?
answer
Failure to thrive
question
You care for a 3-year-old with hypospadias. After a surgical repair, he has a urethral urinary catheter inserted. You would want to teach his parents that
answer
the catheter insertion site will leave only a minimal scar.
question
A child is getting a diagnostic work-up for nephrotic syndrome. Which of the following lab results would the nurse expect to see?
answer
Proteinuria, hypoalbuminemia, and hypercholesterolemia are diagnostic of a child with nephritic syndrome. The child will also present symptomatically with a sudden onset of edema. Hematuria is typically seen with glomerulonephritis.
question
The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them.
answer
When performing double diapering, the nurse cuts a hole or a cross-shaped slit in the front of the smaller diaper and then unfolds both diapers, placing the smaller diaper (with the hole) inside the larger one. Next, the nurse places both diapers under the child and carefully brings the penis (if applicable) and catheter/stent through the hole in the smaller diaper, closing the diaper. Finally, the nurse closes the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.
question
A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant?
answer
"She had surgery to repair a problem with her anus.". Risk factors associated with obstructive uropathy include prune belly syndrome, chromosome abnormalities, anorectal malformations, and ear defects.
question
The nurse is caring for a child admitted with a urinary tract infection. In addition to foul smelling urine, which of the following clinical manifestations would likely have been noted in the child with this diagnosis?
answer
In children, the symptoms or a urinary tract infection may be fever, nausea, vomiting, foul-smelling urine, weight loss, and increased urination. Occasionally there is little or no fever. Vomiting is common, and diarrhea may occur.
question
The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. When interviewing the caregivers, which of the following questions would be most important for the nurse to ask?
answer
Gather information about the current illness: when the fever started and its course thus far, signs of pain or discomfort on voiding, recent change in feeding pattern, presence of vomiting or diarrhea, irritability, lethargy, abdominal pain, unusual odor to urine, chronic diaper rash, and signs of febrile convulsions. Toilet training and bathing habits would be of importance, but they are not the most important to ask.
question
When caring for a child who has a urinary tract infection, which of the following nursing interventions would be most appropriate. (select all that apply)
answer
• The nurse observes for signs of pain or burning on urination.
• The nurse monitors intake and output.
• The nurse administers antipyretics as needed.
question
A teacher sends a child to see the school nurse for irritability and bruising. Which of the following symptoms would be indicative of hemolytic uremic syndrome?
answer
Signs of hemolytic uremic syndrome include oliguria, irritability, jaundice, bloody diarrhea, purpura, ecchymosis, and pallor 5 to 10 days after a prodromal illness. The child also usually experiences anorexia, slight fevers, and can become lethargic. Symptoms of polyuria, weight gain, high fever, and dysuria are not typically seen with hemolytic uremic syndrome.
question
A nurse is performing postoperative care on a child with a ureteral stent. Which of the following interventions will help manage tube patency?
answer
Monitor output.
question
The nurse is assessing a child diagnosed with nephritic syndrome and observes generalized edema. The nurse documents this as which of the following?
answer
Anasarca refers to generalized edema.
Enuresis refers to continued incontinence of urine past the age of toilet training.
Hydronephrosis refers to a condition in which the pelvis and calyces of the kidney are dilated.
Phimosis refers to a condition in which the foreskin of the penis cannot be retracted.
question
A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, you would want to prepare her to
answer
A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.
question
To determine if ascites is increasing in amount in a child with nephrotic syndrome, which measurements would be most appropriate?
answer
Abdominal circumference
question
The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is which of the following?
answer
In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen.
question
A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. Which of the following would be the best way to prevent this?
answer
Encourage the child to take all the antibiotics if diagnosed with strep throat.
question
The nurse is assessing a child with acute poststreptococcal glomerulonephritis. Which of the following would the nurse expect to assess? Select all answers that apply.
answer
fatigue, lethargy, abdominal pain, hypertension, crackles, and anorexia.
question
BPH s/s
answer
hesitancy, decrease in size and force of urine stream, frequency, nocturia; retention- bladder sound will be dull on percussion
question
BPH meds
answer
Proscar- liver testing, takes awhile to work, must not be handled by women or children
Flomax- increase urine flow in BPH, can cause ortho-hypotension
Surgery- TURP
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