Chapter 44 The Child with a Genitourinary Alteration

Chapter 44  The Child with a Genitourinary Alteration

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. Which statement by a school-age girl indicates the need for further teaching about the

prevention of urinary tract infections (UTIs)?
a. “I always wear cotton underwear.”
b. “I really enjoy taking a bubble bath.”
c. “I go to the bathroom every 3 to 4 hours.”
d. “I drink four to six glasses of fluid every day.”

ANS: B
Bubble baths should be avoided because they tend to cause urethral irritation, which leads to
UTI. It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in
moisture and promote bacterial growth, whereas cotton absorbs moisture. Children should
be encouraged to urinate at least four times a day. An adequate fluid intake prevents the
buildup of bacteria in the bladder.

PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating
REF: p. 1009 OBJ: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance

2. 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

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

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 1016 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

3. The 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 explains that
casts in the urine indicate
a. glomerular injury.
b. glomerular healing.
c. recent streptococcal infection.

d. excessive amounts of protein in the urine.

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

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 1016 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

4. Which clinical finding warrants further intervention for the child with acute post

streptococcal 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

ANS: 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. Weight
loss is an indication that the child is responding to treatment. The urine output of 1 mL/kg/hr
is acceptable. A positive ASO titer indicates the presence of antibodies to streptococcal
bacteria; it is used to aid in diagnosis of acute post streptococcal glomerulonephritis. This is
an expected finding if the child has this acute illness.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 1016 OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

5. Which diagnostic finding is present when a child has primary nephrotic syndrome?

a. Hyperalbuminemia
b. Positive ASO titer
c. Leukocytosis
d. Proteinuria

ANS: D
Large amounts of protein are lost through the urine as a result of an increased permeability
of the glomerular basement membrane. Hypoalbuminemia is present because of loss of
albumin through the defective glomerulus and the liver’s inability to synthesize proteins to
balance the loss. ASO titer is negative in a child with primary nephrotic syndrome.
Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 1018 | Nursing Quality Alert Box
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity