Chapter 31 Caring for the Child With a Genitourinary Condition

Chapter 31  Caring for the Child With a Genitourinary Condition

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. An infant appears dehydrated. Laboratory results indicate a serum sodium of 143 mEq/L. Which fluid would the nurse use for IV replacement?
A.
0.45% normal saline
B.
0.9% normal saline
C.
3% normal saline
D.
D5W with 20 mEq KCL

ANS: B
This child has an isotonic dehydration, in which fluids and solutes are lost in balanced proportions, as evidenced by the normal serum sodium level. The child needs an isotonic IV solution, which would be 0.9% normal saline. The 0.45% normal saline (“half normal saline”) is hypotonic, as is D5W, with or without potassium. The 3% normal saline is hypertonic.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

2. A school-age female child has a urinary tract infection (UTI). The culture has come back positive for Escherichia coli. Which teaching measure is most important for the nurse to include in the teaching plan?
A.
Avoid bubble baths and nylon panties.
B.
Offer the child fluids frequently.
C.
Place the child on a voiding schedule.
D.
Teach the child to wipe from front to back.

ANS: D
All items are appropriate to teach when a child has a UTI. However, E. coli infection stems from contamination with fecal material. The female child should be taught to wipe from front to back to prevent this cross-contamination.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

3. An infant has poor feeding, fever, and malodorous urine. The parents do not want the nurse to catheterize the child. Which response by the nurse is the most appropriate?
A.
Apply a urine collection bag on the baby.
B.
Explain how this procedure obtains the best results.
C.
Give the baby acetaminophen (Tylenol) for fever.
D.
Inform the health-care provider of the refusal.

ANS: B
Parents can be understandably distraught at the thought of their baby having an invasive procedure. The nurse should ensure that the parents understand why the catheterized urine sample or a suprapubic aspirated urine sample is the best choice for obtaining the most accurate urinalysis results. If the parents still refuse, the nurse should document their refusal, inform the provider, and apply a collection bag. The nurse should also treat the baby’s fever with acetaminophen, but this option is not directly related to the question.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

4. An acutely ill child is admitted for a suspected severe urinary tract infection (UTI). Which is the priority action by the nurse?
A.
Administer broad-spectrum antibiotics as ordered.
B.
Obtain a urine sample for culture and sensitivity.
C.
Start an IV line for aggressive fluid resuscitation.
D.
Teach the parents how to prevent future UTIs.

ANS: B
Antibiotics need to be started as soon as possible, but it is imperative to obtain a urine sample for a culture and sensitivity to guide medication choices first. While awaiting the results, the nurse will administer a broad-spectrum antibiotic. The child does need an IV, but there is no indication that the child needs aggressive fluid resuscitation. Teaching is always an important task, but does not take priority over obtaining the sample for urinalysis.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

5. The parents of a child diagnosed with vesicoureteral reflux (VUR) want to know why their child’s kidneys appear large on an abdominal x-ray. Which response by the nurse is the most appropriate?
A.
Enlarged due to urine backup
B.
Genetic defect causing VUR
C.
Multiple tumors
D.
Unrelated finding

ANS: A
In VUR, urine backflows into the kidneys, causing hydronephrosis, or distention of the kidneys. The other answers are incorrect.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1