Chapter 29: The Child with a Genitourinary Condition Nursing School Test Banks

Chapter 29: The Child with a Genitourinary Condition

MULTIPLE CHOICE

1. The nurse discussed strategies with a parent to prevent a recurrence of urinary tract infection in the child. Which statement made by the parent indicates a need for further teaching?
a. My daughter should wash and wipe the perineal area from front to back.
b. I am only going to have my daughter wear cotton underwear.
c. It is acceptable to take frequent bubble baths.
d. She needs to drink lots of fluids and void frequently.
ANS: C
Oils in bubble bath and similar products are known to irritate the urethra.

DIF: Cognitive Level: Comprehension REF: Page 675, Nursing Tip
OBJ: N/A TOP: Acute Urinary Tract Infection
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. When asked about correcting the hypospadias of a newborn, what does the nurse explain about this condition?
a. No intervention is necessary as the defect will correct itself over time.
b. Surgical repair of the hypospadias is done before 18 months of age.
c. Corrective surgery is usually delayed until the preschool age.
d. Repairing the defect will increase the risk of testicular cancer.
ANS: B
Treatment of hypospadias consists of surgical repair and is usually performed before 18 months of age.

DIF: Cognitive Level: Comprehension REF: Page 673 OBJ: 4
TOP: Hypospadias KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

3. What is an initial sign of nephrosis that the nurse might note in a child?
a. Raspberry-like rash
b. Periorbital edema
c. Temperature elevation
d. Abdominal pain
ANS: B
The edema of nephrotic syndrome is generalized and not readily noticed, even by the parents, but an early sign that can be assessed is periorbital edema.

DIF: Cognitive Level: Knowledge REF: Page 675 OBJ: 5
TOP: Nephrotic Syndrome KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. What is it important to assess in a child receiving prednisone to treat nephrotic syndrome?
a. Infection
b. Urinary retention
c. Easy bruising
d. Hypoglycemia
ANS: A
Prednisone depresses the immune response and increases susceptibility to infection. Because steroids mask signs of infection, the child must be assessed for more subtle symptoms of illness.

DIF: Cognitive Level: Comprehension REF: Page 677 OBJ: 5
TOP: Nephrotic Syndrome KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity

5. During a physical assessment of a hospitalized 5-year-old, the nurse notes that the foreskin has been retracted and is very tight on the shaft of the penis; the nurse is unable to return it over the head of the penis. What action should the nurse implement?
a. Forcibly push the foreskin down over the head of the penis.
b. Place a warm compress on the penis.
c. Notify the charge nurse.
d. Wait a few hours and try again.
ANS: C
Notify the charge nurse of this occurrence of paraphimosis. The tight foreskin can impede blood flow to the penis; this should be remedied immediately.

DIF: Cognitive Level: Application REF: Page 672 OBJ: 1
TOP: Paraphimosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk

6. A 7-year-old child with acute glomerulonephritis has gross hematuria and has been confined to bed. What is the most appropriate nursing intervention for this child?
a. Providing activities for the child on restricted activity
b. Feeding the child a protein-restricted diet
c. Carefully handling edematous extremities
d. Observing the child for evidence of hypotension
ANS: A
Although children may feel well, activity is limited until hematuria resolves.

DIF: Cognitive Level: Application REF: Page 678 OBJ: 7
TOP: Acute Glomerulonephritis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Reduction of Risk

7. Which urinary diversion procedure is the least damaging to the body image of the adolescent?
a. Urostomy
b. Ileal conduit
c. Nephrostomy
d. Suprapubic placement
ANS: B
The ileal conduit diverts urine to the colon, and the urine is excreted with the feces. There is no external appliance, as is needed with the other diversion methods.

DIF: Cognitive Level: Comprehension REF: Page 674, Table 29-2
OBJ: 10 TOP: Obstructive UropathyUrinary Diversions
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone?
a. Can interfere with the treatment for nephrosis
b. Require that the child have antibiotic coverage
c. Can be given in smaller, divided doses
d. Should be delayed
ANS: D
No vaccinations or immunizations should be administered while the disease is active and during immunosuppressive therapy.

DIF: Cognitive Level: Comprehension REF: Page 677 OBJ: 7
TOP: Nephrotic Syndrome KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Reduction of Risk

9. Diuresis has not occurred on a child with nephrotic syndrome after a month on corticosteroids. What protocol can the nurse encourage to bring about diuresis?
a. Ibuprofen, an anti-inflammatory agent
b. Furosemide (Lasix), a diuretic
c. Ciprofloxacin (Cipro), an antibiotic
d. Cyclophosphamide (Cytoxan), an antisuppressant
ANS: D
A potent antisuppressant such as Cytoxan can bring about diuresis when corticosteroids have proven ineffective.

DIF: Cognitive Level: Application REF: Page 677 OBJ: 6
TOP: Nephrotic Syndrome KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. What foods does the nurse recommend the child with acute glomerulonephritis avoid to prevent hyperkalemia?
a. Dairy products
b. Whole-grain cereals
c. Organ meats
d. Bananas
ANS: D
Bananas are very high in potassium and should be avoided.

DIF: Cognitive Level: Comprehension REF: Page 678 OBJ: 6
TOP: AGN KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk

11. Which physical assessment technique will the nurse omit when caring for a 2-year-old diagnosed with Wilms tumor?
a. Performing range-of-motion exercises on lower extremities
b. Palpating the abdomen
c. Assessing for bowel sounds
d. Percussing ankle and knee reflexes
ANS: B
Palpation of the abdomen could disturb the tumor and cause the malignancy to spread.

DIF: Cognitive Level: Application REF: Page 679, Safety Alert
OBJ: 8 TOP: Wilms Tumor
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Reduction of Risk

12. Parents are speaking with the urologist about their sons undescended testicle. Which statement by the childs father causes the nurse to determine he understands the information presented?
a. An undescended testicle can reduce fertility.
b. The testicle usually descends spontaneously during the first month of life.
c. Surgical correction reduces the risk for testicular tumors.
d. The optimal time to surgically correct the condition is at diagnosis.
ANS: A
Although orchiopexy improves the condition, the fertility rate among patients may be reduced even when only one testis is undescended.

DIF: Cognitive Level: Application REF: Page 681 OBJ: 1
TOP: Cryptorchidism KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. A parent tells the nurse that her child is scheduled for an x-ray of the bladder and urethra that is done while the child is urinating. What is this test known as?
a. Cystometrogram
b. Cystoscopy
c. Voiding cystourethrogram
d. Intravenous pyelogram
ANS: C
An x-ray examination of the bladder and urethra before and during micturition is called a voiding cystourethrogram.

DIF: Cognitive Level: Comprehension REF: Page 675 OBJ: 1
TOP: Diagnostic Procedures KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

14. A 6-year-old child with daytime enuresis complains of dysuria and urgency. What does the nurse recognize these signs and symptoms indicate?
a. Urinary tract infection
b. Nephrotic syndrome
c. Acute glomerulonephritis
d. Vesicoureteral reflux
ANS: A
Urinary frequency and pain during micturition are symptoms of acute urinary tract infection.

DIF: Cognitive Level: Comprehension REF: Page 674 OBJ: N/A
TOP: Acute Urinary Tract Infection KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. What is an appropriate intervention for the edematous child with reduced mobility related to nephrotic syndrome?
a. Reach the child to minimize body movements.
b. Change the childs position frequently.
c. Keep the head of the childs bed flat.
d. Keep edematous areas moist and covered.
ANS: B
The child should be turned frequently to prevent respiratory tract infection and to prevent pressure on delicate skin.

DIF: Cognitive Level: Application REF: Page 677 OBJ: 6
TOP: Nephrotic Syndrome KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk

16. Which statement made by a parent of a child with nephrotic syndrome indicates an understanding of discharge teaching?
a. I will make sure he gets his measles vaccine as soon as he gets home.
b. He can stop taking his medication next week.
c. I should check his urine for protein when he goes to the bathroom.
d. He should eat a low-protein diet for the next few weeks.
ANS: C
The parents should be instructed to keep a daily record of the childs urinary proteins.

DIF: Cognitive Level: Application REF: Page 675 OBJ: 6
TOP: Nephrotic Syndrome KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

17. A 5-year-old boy is admitted to the hospital with acute glomerulonephritis. In taking the childs history, what does the nurse recognize as the probable cause?
a. Recovery from German measles 2 months ago
b. Dysuria since the previous night
c. A history of allergy
d. A sore throat 2 weeks ago
ANS: D
Acute glomerulonephritis develops from 1 to 3 weeks after a streptococcal infection, which causes an allergic-type response that alters the effectiveness of the glomeruli.

DIF: Cognitive Level: Comprehension REF: Page 677 OBJ: 7
TOP: Acute Glomerulonephritis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. The nurse is explaining to a 17-year-old female the actions to prevent urinary tract infection. Which is the best beverage for the nurse to recommend to keep urine acidic?
a. Milk
b. Grape juice
c. Apple juice
d. Orange juice
ANS: C
Juices such as apple or cranberry help maintain acidity of urine.

DIF: Cognitive Level: Comprehension REF: Page 676, NCP 29-1
OBJ: N/A TOP: Acute Urinary Tract Infection
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

19. The 6-year-old scheduled for an orchiopexy shyly asks the nurse, What are they going to do to me down there? What is the nurses best response?
a. They are going to fix you up down there.
b. They will move your testicle from your abdomen to your scrotum.
c. What do you think your doctor is going to do?
d. You shouldnt worry. Your doctor knows exactly what to do.
ANS: C
Encourage the patient to talk about what he knows and what feelings he has about the surgery. School-age children have a fear of bodily harm.

DIF: Cognitive Level: Application REF: Page 681 OBJ: 10
TOP: Orchiopexy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

20. What will the nurse caution the parents of a child who has had a nephrectomy that he will have to avoid?
a. Contact sports
b. Horseback riding
c. Alcohol
d. Diuretic medications
ANS: A
Children who have only one kidney should avoid contact sports to prevent injury to that remaining organ.

DIF: Cognitive Level: Comprehension REF: Page 679 OBJ: 10
TOP: Postnephrectomy Instruction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

21. The parents of a newborn are concerned that their sons scrotum is enlarged and swollen on one side. What is the nurses best response?
a. It is very common in the newborn that one gonad is larger than the other.
b. Birth trauma caused bruising to the scrotum. It will reduce in size in a few days.
c. It is a collection of fluid that will most likely correct itself in a year.
d. The doctor will drain this collection of blood before your baby is discharged.
ANS: C
These signs are indicative of a hydrocele, a collection of fluid in the scrotum that usually corrects itself in a year.

DIF: Cognitive Level: Comprehension REF: Page 680 OBJ: 4
TOP: Hydrocele KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. The nurse is providing information to parents of a child born with bilateral cryptorchidism. What information is accurate to include?
a. This is the most common form.
b. Fertility will be unaffected.
c. Surgical intervention is not recommended.
d. An inguinal hernia may be present.
ANS: D
When one or both testes fail to lower into the scrotum, the condition is termed cryptorchidism. The unilateral form is more common. Because the testes are warmer in the abdomen than in the scrotum, the sperm cells begin to deteriorate. If both testes are affected, sterility results. Inguinal hernia often accompanies this condition. Occasionally, a testis or the testes spontaneously descend during the first year of life. An operation called an orchiopexy may be performed.

DIF: Cognitive Level: Comprehension REF: Page 681 OBJ: 9
TOP: Cryptorchidism KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. An adolescent male is admitted to the ED with severe acute scrotal pain. When documenting medical history the nurse notes cryptorchidism at birth. What diagnosis does the nurse expect?
a. Urinary tract infection
b. Nephrosis
c. Torsion
d. Phimosis
ANS: C
When one or both testes fail to lower into the scrotum, the condition is termed cryptorchidism. Acute scrotal pain may indicate a testicular torsion (twisting), which necessitates immediate surgery to preserve testicular function.

DIF: Cognitive Level: Comprehension REF: Page 681 OBJ: 1
TOP: Torsion KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

24. A 7-year-old child has a BUN of 25 mg/dL. What is the nurse aware this lab value might indicate? (Select all that apply.)
a. Dehydration
b. Renal disease
c. Need for steroid therapy
d. Diabetes
e. Pituitary malfunction
ANS: A, B, C
Increased BUN can indicate dehydration, renal disease, and/or need for steroid therapy.

DIF: Cognitive Level: Analysis REF: Page 672, Table 29-1
OBJ: 3 TOP: Diagnostic Tests
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

25. What will the nurse caring for a newborn with exstrophy of the bladder include in the care? (Select all that apply.)
a. Diaper infant tightly.
b. Protect skin around bladder.
c. Position infant on back.
d. Prepare for surgical closure.
e. Cover exposed bladder with shield.
ANS: B, C, D, E
The infant is kept on his back or side with special attention to the skin around the exposed bladder, which is constantly bathed with urine. These infants are diapered loosely, if at all. Surgical closure is done as quickly as possible.

DIF: Cognitive Level: Application REF: Page 673 OBJ: 4
TOP: Exstrophy of the Bladder KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

26. The nurse caring for a child with nephrotic syndrome is alert to which classic symptoms of this disorder? (Select all that apply.)
a. Proteinuria
b. Grossly bloody urine
c. Hyperalbuminemia
d. Fatigue
e. Generalized edema
ANS: A, B, D, E
All options listed are those of nephrotic syndrome with the exception of hyperalbuminemia. The nephrotic child has hypoalbuminemia, as most of the protein has been spilled in the urine.

DIF: Cognitive Level: Knowledge REF: Page 675 OBJ: 6
TOP: Nephrotic Syndrome KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

27. The nurse is aware that genitourinary surgery is especially stressful for preschool children. What factor(s) lend to this stress? (Select all that apply.)
a. They may perceive the treatment as punishment.
b. They are especially prone to separation anxiety.
c. They are sexually curious and developmentally fixated on their genitals.
d. They have a fear of castration.
e. They fear death.
ANS: A, B, C, D
All options, except fear of death, are especially stressful for preschool children undergoing genitourinary surgery. Children in this age group do not have an understanding of the concept of death.

DIF: Cognitive Level: Comprehension REF: Page 681 OBJ: 10
TOP: Topic: Impact of Surgery on Preschoolers
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

28. What special considerations are related to long-term prednisone therapy in preschoolers? (Select all that apply.)
a. Delayed immunization
b. Hypertension
c. Enlargement of the sex organs
d. Alteration in nutrition
e. Increased risk for infection
ANS: A, E
Delayed immunization and greater risk for infection are concerns relative to long-term prednisone therapy.

DIF: Cognitive Level: Comprehension REF: Page 677 OBJ: 8
TOP: Long-Term Prednisone Therapy KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

COMPLETION

29. The nurse explains that the device that measures the pressure and volume of the urine stream is called the _________________.

ANS:
uroflowmeter

The device that specifically measures the dynamics of micturition is the uroflowmeter.

DIF: Cognitive Level: Knowledge REF: Page 671 OBJ: 3
TOP: Uroflowmeter KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

30. The nurse uses a diagram to show how the _______________, the working unit of the kidney, filters and regulates fluids.

ANS:
nephron

The nephron is the working unit of the kidney that filters and regulates fluids in the body. There are roughly 1 million nephrons in each kidney.

DIF: Cognitive Level: Comprehension REF: Page 669 OBJ: 2
TOP: Nephron KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

31. When a childs ureter becomes completely obstructed from scarring, the nurse explains that urinary diversion may be necessary to prevent the reflux back into the renal pelvis from causing ____________________.

ANS:
hydronephrosis

Hydronephrosis occurs when the urine is unable to pass through the ureter into the bladder; the urine refluxes back into the renal pelvis, causing dilation and swelling of the kidney.

DIF: Cognitive Level: Comprehension REF: Page 673 OBJ: 1
TOP: Hydronephrosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

32. The strong urge to void, often despite the inability to do so, is known as _______________.

ANS:
urgency

Urgency is the term that describes the strong urge to void, often despite the inability to do so.

DIF: Cognitive Level: Knowledge REF: Page 672 OBJ: 1
TOP: Urgency KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

33. The nurse is measuring ouput on an infant on the pediatric unit. When weighing the diaper and subtracting the weight of the dry diaper, the nurse records 30 grams and documents this as _________ mL.

ANS:
30

Diapers may be weighed on a gram scale before application and after removal (1 g = 1 mL).

DIF: Cognitive Level: Analysis REF: Page 677 OBJ: N/A
TOP: Urinary Output KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Data Collection Techniques

34. ________________ is a narrowing of the preputial opening of the foreskin, which prevents the foreskin from being retracted over the penis.

ANS:
Phimosis

Phimosis is a narrowing of the preputial opening of the foreskin, which prevents the foreskin from being retracted over the penis.

DIF: Cognitive Level: Knowledge REF: Page 672 OBJ: 1
TOP: Phimosis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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