Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?

Excess fluid volume

Imbalanced nutrition less than body requirements

Activity intolerance

Risk for infection

Risk for infection

When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group?

"We should expect problems with too much fluid in the brain because the kidneys are not able to keep the fluid in balance."

"The kidneys help control blood pressure, so our child's blood pressure needs to be checked often."

"Problems with the kidneys raise the risk for infection because there is a problem with producing white blood cells."

"The kidneys help get rid of carbon dioxide from the body, so kidney problems can affect our child's breathing."

"The kidneys help control blood pressure, so our child's blood pressure needs to be checked often."

Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. Therefore, monitoring blood pressure is important. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acids-bases. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli in the lungs. Cerebrospinal fluid circulates through the brain and spinal cord.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting?

The child has a urinary tract infection due to not bathing while on the fishing trip.

The child has been sexually abused, maybe on the fishing trip.

The child did not want to go on the fishing trip and is now retaliating against being made to go.

The child is out of the habit of waking himself up during the night to void.

The child has been sexually abused, maybe on the fishing trip.

Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse (child mistreatment) and should be further explored.

A 15-year-old client presents to the emergency room reporting an abrupt onset of severe, sudden pain on the right side of the scrotum while playing football. The nurse notes a blue-black swelling of the affected scrotum. Which action will the nurse complete next?

Have the client rate the pain.

Complete a head-to-toe assessment.

Monitor the client's urine output.

Notify the primary health care provider.

Notify the primary health care provider.

The nurse would suspect testicular torsion, which is a surgical emergency that necessitates immediate surgical correction to prevent testicular necrosis and possible gangrene. Therefore, the nurse would notify the health care provider immediately. The nurse would then have the client rate the pain, complete a head-to-toe assessment, and monitor urine output.

The nurse is caring for a 10-year-old child experiencing nocturnal enuresis with no physiologic cause. The child states, "I am embarrassed and I wish I could stop this right now!" How will the nurse respond?

"You can wear pull-ups to bed and, since they look like underwear, no one will know."

"You will grow out of this eventually; you just need to be patient."

"There are several things we can do to help you achieve this goal."

"You are not alone. There are almost 5 million people that have enuresis."

"There are several things we can do to help you achieve this goal."

The child wants to stop this problem immediately, so the nurse's most therapeutic response is to assure the child that enuresis is indeed solvable. For some children, learning about the high prevalence of the problem may provide consolation. However, this may not alleviate the child's embarrassment and it does not address the desire for solutions. Telling the child that he or she will "grow out of this" downplays the embarrassment and does not address the desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.

Which question would be most important for a nurse to ask when taking a history from a client who is suspected of having amenorrhea?

"When did you last see your medical provider?"

"Are you sexually active?"

"What foods do you eat?"

"How many times a week do you exercise?"

"Are you sexually active?"

Amenorrhea strongly suggests pregnancy in an adolescent and is the priority in a client with this diagnosis. Strenuous exercise can be a causative factor, but it is not the priority. Diet and medical visit history do not affect this current diagnosis.

Which clinical manifestation should a nurse recognize as most significant when assessing a client who is suspected of having female circumcision?

vaginal discharge

menses

redness and swelling

missing clitoris

missing clitoris

Clients who are assessed with a missing clitoris should receive further workup for female circumcision. Redness, swelling, and vaginal discharge can be indicated for infection. Menses is not affected in clients with female circumcision.

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this?

Tell parents to give ibuprofen if their child has a sore throat.

Prophylactic antibiotics after strep throat are important.

Encourage the child to take all the antibiotics if diagnosed with strep throat.

All children in the child's class should be tested for strep throat if one child has a positive test.

Encourage the child to take all the antibiotics if diagnosed with strep throat.

Encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community with whom the child came in contact unless they are symptomatic. Ibuprofen does not cure strep throat, and strep infection is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.

The nurse is caring for a 9-month-old with cryptorchidism noted on the medical record. In which manner will the nurse assess this condition?

Palpate the scrotum for the testes

Assess the upper extremity strength

Auscultate for bowel sounds

Note any bruising on the skin

Palpate the scrotum for the testes

Cryptorchidism occurs when the male gonads (testes) have not descended into the scrotum. Either one or both of the testes may not be in the scrotum. In most infants, the testes descend by the time the male is 1 year old. The nurse assesses the client's status by palpation of the scrotum.

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant?

Deficient fluid volume related to fluid intake restrictions postoperatively

Constipation related to effects of administered drugs

Pain related to tissue rejection

Risk for infection related to immunocompromised state

Risk for infection related to immunocompromised state

Children are administered immunosuppressants following a transplant. These drugs lower the immune system response and help prevent rejection following the transplant. As a result, this leaves them susceptible to infection. The child may have pain from the surgical procedure but it does not occur from the rejection of the organ. Constipation may occur from the opioids used for pain management but it is not the priority nursing diagnosis. The fluid volume should return to normal once the transplanted kidney is functioning properly.

The home care nurse is conducting an in-home visit for a child who had corrective surgery for hypospadias 3 days prior. What would alert the home care nurse to provide additional teaching?

The parent indicates the child is fussy but calms down when held on the parent's hip.

The parent states, "I have had to buy more diapers since having to double diaper him."

The parent states, "I cannot wait until I can bathe him the tub again...he enjoys it so much."

The parent expresses relief that the child was not also diagnosed with cryptorchidism at birth.

The parent indicates the child is fussy but calms down when held on the parent's hip.

Hypospadias is a condition in which the urethral opening is on the ventral surface of the penis. Surgical repair involves a catheter or stent left in place for 3 to 7 days postoperatively. Activities or play that involves straddling (such a being carried on the parent's hip) are discouraged to prevent trauma to the surgical site and catheter or stent. The child should be double diapered to prevent stool from contaminating the catheter or stent and operative site and causing an infection. The child should not be bathed in a tub until the catheter or stent is removed. Cryptorchidism is a common diagnosis along with hypospadias.

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician?

presence of a thrill

presence of a bruit

absence of a thrill

dialysate without fibrin or cloudiness

absence of a thrill

The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill. Dialysate without fibrin or cloudiness is normal and is used with peritoneal dialysis, not hemodialysis.

Which instructions should a nurse give to a client who has a history of urinary tract infections to prevent recurrence? Select all that apply.

Limit bathing to once a week.

Use bubble bath to wash.

Wipe from front to back.

Encourage fluids throughout the day.

Finish all antibiotics prescribed.

Wipe from front to back.

Encourage fluids throughout the day.

Finish all antibiotics prescribed.

Teaching caregivers to wipe from front to back, encouraging fluids, and finishing all prescribed medications are vital principles in the prevention of recurring UTIs. The use of bubble bath is contraindicated because it can be a source of infection.

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?

hypothermia

hypertension

tachycardia

hypotension

hypertension

Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

A teenager comes to the clinic with fever, muscle pain, and a macular rash on the palms and soles of the feet. Based on these findings, what diagnosis would the nurse anticipate for this client?

premenstrual dysmorphic disorder

polycystic ovary syndrome (PCOS)

amenorrhea

toxic shock syndrome

toxic shock syndrome

Fever, severe muscle pain, and a sunburn-like rash on the palms and soles of the hands and feet are consistent with the diagnosis of toxic shock syndrome. Polycystic ovary syndrome, amenorrhea, and premenstrual dysmorphic disorder are not consistent with these symptoms.

A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition?

vaginal inflammation

vulvovaginitis

pelvic inflammatory disease (PID)

urinary tract infection (UTI)

vulvovaginitis

Vulvovaginitis is diagnosed with clients experiencing vaginal or vulval inflammation, pain odor, and pruritus. Pelvic inflammatory disease and urinary tract infection are not consistent with these symptoms

The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition?

"Our son will likely have a high risk of cancer in his teen years as a result of this condition."

"Our son's condition may resolve on its own."

"Our son may need surgery on his testes before we are discharged to go home."

"Our son may have to go through life without two testes."

"Our son's condition may resolve on its own."

Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended.

An adolescent asks the nurse how to best prevent vulvovaginitis. The nurse's best answer would be to:

wipe from front to back after urinating or defecating.

apply personal hygiene sprays if vaginal odor develops.

soak in a strong bubble bath solution to maintain hygiene.

use nylon rather than cotton underpants to decrease moisture.

wipe from front to back after urinating or defecating.

Vulvovaginitis may be caused by spread of Escherichia coli from the rectum to the vagina.

Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis?

The parent takes the client to the bathroom at night.

The client wets only when involved in an activity.

The client remains continent throughout the night.

The child wakes up once during the night for a glass of water.

The client remains continent throughout the night.

The goal of therapy is for the client to be continent of urine throughout the night. The nurse should encourage the child to awaken and void and not have any fluids before bedtime. During an activity, the child should be encouraged to void before and after the activity to prevent incontinence.

A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema?

abdominal circumference

urine output, every shift

weight, daily

amount of protein in the urine

weight, daily

The classic sign of nephrotic syndrome is edema. It is usually generalized, but may be manifested as ascites or be periorbital depending on the seriousness of the disease. The easiest way to determine edema is by weighing the child. The child should be weighed on the same scale, at the same time daily, and with the same amount of clothing. The abdomen would only need to be measured if ascites was suspected or known. Measuring urine output will not determine edema, although it should be done to determine if urine is being produced in adequate amounts. Measuring the amount of protein in the urine will also not determine edema. The measurement is important to determine the progress of the disease, however.

Most urinary tract infections seen in children are caused by:

fungal infections.

intestinal bacteria.

hereditary causes.

dietary insufficiencies.

intestinal bacteria.

Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections.

The nurse is educating the parents of a child requiring renal replacement therapy The parents express concern because they live in a remote, rural area with no access to pediatric specialty dialysis units. Which would the nurse recommend to the parents?

Peritoneal dialysis

Renal transplant

In-home hemodialysis

Hemodialysis

Peritoneal dialysis

Peritoneal dialysis is performed in the home setting after proper training. Hemodialysis is completed several times a week at a dialysis center. Renal transplant would be a discussion if the child needed a kidney transplant.

A 4-year-old child with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing the child for this procedure, the nurse would want to prepare the child to:

void during the procedure.

drink three glasses of water during the procedure.

have a local anesthetic injected prior to the procedure.

anticipate a headache afterward.

void during the procedure.

At the start of the voiding cystourethrogram, a catheter is inserted into the bladder. The contrast medium is inserted through the catheter into the bladder. Fluoroscopy is performed to demonstrate the filling of the bladder and the collapsing of the bladder upon emptying. The assessment of emptying requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed. No anesthetic is required for this procedure. The fluid filling the bladder is inserted via the catheter so no drinking of water is required. A headache following the procedure would not be expected.

The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia?

pulse rate and rhythm

blood pressure

muscle tone

abdominal pain

pulse rate and rhythm

Hyperkalemia occurs when the potassium levels rise above normal laboratory values. Although it varies among laboratories, a normal potassium range is generally between 3.5 and 5 mEq/l (3.5 and 5 mmol/l). When the potassium levels rise, the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm, because potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmia occurs or the heart starts to fail.

A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate?

Kidneys, ureter, and bladder x-ray

Computed tomography scan

Urinalysis

Creatinine clearance rate

Creatinine clearance rate

The glomerular filtration rate is measured by creatinine clearance rate, or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.

The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents?

"She must severely restrict her sodium intake."

"Here is some written information from the dietitian."

"Let's meet with the dietitian and plan some meals."

"She should try to avoid protein."

"Let's meet with the dietitian and plan some meals."

Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.

The nurse is caring for a client newly diagnosed with acute glomerulonephritis? When receiving the pediatric client's history, which is anticipated?

fatigue from viral infection onset 3 days ago

increased thirst, sweating, and shakiness since yesterday

a sports injury to the kidney two weeks ago

onset of a streptococcus infection last week

onset of a streptococcus infection last week

The nurse is correct to anticipate a streptococcus infection 1 to 3 weeks prior to the diagnosis of acute glomerulonephritis. The presenting symptom is typically gross bloody urine. Acute glomerulonephritis is not related to a kidney infection, does not exhibit symptoms similar to diabetes, or a recent viral infection.

The nurse is caring for a 7-month-old female infant diagnosed with a urinary tract infection (UTI). The parents are upset as this is the infant's second UTI with a fever. Which instruction is most helpful? Select all that apply.

Change diapers promptly, especially after bowel movements.

UTI's are common in male infants at this age.

Female urethras are shorter and straighter than males.

After 3 days on antibiotics, the infection is clear.

A fever is commonly noted with a UTI.

A fever is commonly noted with a UTI.

Change diapers promptly, especially after bowel movements.

Female urethras are shorter and straighter than males.

Urinary tract infections are common in females in the "diaper age" because the female urethras are shorter and straighter than in the males. This poses a potential for infection. Males have a higher rate of UTI's in the first 4 months. A fever is common with this diagnosis. Changing the diapers promptly eliminates the time that the infant is exposed to E-coli. The infant may feel better after 3 days of antibiotic use but it takes a full course of antibiotics to clear an infection.

The nurse is caring for a 3-year-old child with the surgical repair of hypospadias. The preschooler returned from the postanesthesia care unit with an indwelling urinary catheter. What parental teaching is most helpful?

The child must be reevaluated at puberty for testicular function.

The catheter insertion site will leave only a minimal scar.

Back pressure from such drainage may result in nephrotic syndrome.

The child will always have tenderness on penile erection.

The catheter insertion site will leave only a minimal scar.

Hypospadias is a urethral defect in which the opening is on the ventral surface rather than at the end of the penis. If left untreated, it may mean the boy will not be able to void standing as the aim will be different; in addition, it will cause interference with the deposition of sperm during intercourse. The completed surgery requires the use of a catheter. The catheter, along with the penis, is taped to the abdomen to reduce pressure on the urethral sutures. The tube insertion site will leave only a minimal scar, if any. A hypospadias repair should have no long-term consequences.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history?

The child had a congenital heart defect.

The child is being treated for asthma.

The child has a sibling with the same diagnosis.

The child recently had an ear infection.

The child recently had an ear infection.

In the child with acute glomerulonephritis, presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.

A 14-year-old girl visits her gynecologist and is found to have vaginal candidiasis. She is obese, claims to not be sexually active, and is not on oral contraceptive pills. Which intervention should be considered for this client?

Prescription for oral contraceptive pills

Insertion of antifungal tablets or creams in the morning

Test her urine for glucose to rule out diabetes mellitus

Prescription of an antibiotic

Test her urine for glucose to rule out diabetes mellitus

Candidiasis is a vaginal infection spread by the fungus Candida, an organism which thrives on glycogen. Because oral contraceptive pills produce a pseudopregnancy state, adolescents using OCPs tend to have frequent vaginal candidal infections. If being treated with an antibiotic for another infection (which destroys normal vaginal flora and lets fungal organisms grow more readily), they are also particularly susceptible to this infection. Thus, neither prescription of OCPs or prescription of an antibiotic would be appropriate in this case. Incidence is also strongly associated with immune suppression and diabetes mellitus because hyperglycemia provides the perfect glucose-rich environment for candidal growth. If a girl has frequent candidal infections, her urine should be tested for glucose to rule out diabetes mellitus. Teach women to insert antifungal tablets or creams at bedtime, not in the morning, so the drug does not drain from the vagina immediately afterward.

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present?

Abdominal mass

Purulent drainage from the penis

Swollen testes

Enlarged inguinal glands

Abdominal mass

An abdominal mass indicates hydronephrosis. Enlarged inguinal glands are not associated with hydronephrosis. Purulent drainage from the penis is not associated with hydronephrosis. Swollen testes are not associated with hydronephrosis.

The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis:

The child can live a more normal lifestyle.

Therapy is only 3 to 4 days per week.

The child must go into a facility to get peritoneal dialysis.

There are strict diet and fluid restrictions.

The child can live a more normal lifestyle.

The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review?

dirty green-colored urine, elevated erythrocyte sedimentation, and depressed serum complement level

hemolytic anemia, thrombocytopenia, and acute renal failure

thrombocytopenia, hemolytic anemia, and nocturia several times each night

hemolytic anemia, acute renal failure, and hypotension

hemolytic anemia, thrombocytopenia, and acute renal failure

Hemolytic uremic syndrome is defined by all three particular features—hemolytic anemia, thrombocytopenia, and acute renal failure. Dirty green-colored urine, elevated erythrocyte sedimentation, and depressed serum complement level are indicative of acute glomerulonephritis. Hypertension, not hypotension, would be seen and the child would have decreased urinary output, which would not cause nocturia.

The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child?

Sacrum

Eyes

Fingers

Abdomen

Eyes

The symptoms of nephrotic syndrome include periorbital edema upon awakening with progressive edema throughout the day in all extremities and abdomen. Ascites can develop in the abdomen and the nurse should assess the child regularly for this development. The child with nephrotic syndrome generally does not have sacral edema, unless the edema is extreme and has not been treated.

The nurse is caring for a client newly diagnosed with acute glomerulonephritis? When receiving the pediatric client's history, which is anticipated?

increased thirst, sweating, and shakiness since yesterday

a sports injury to the kidney two weeks ago

fatigue from viral infection onset 3 days ago

onset of a streptococcus infection last week

onset of a streptococcus infection last week

The nurse is correct to anticipate a streptococcus infection 1 to 3 weeks prior to the diagnosis of acute glomerulonephritis. The presenting symptom is typically gross bloody urine. Acute glomerulonephritis is not related to a kidney infection, does not exhibit symptoms similar to diabetes, or a recent viral infection.

The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider?

Urine culture positive for contaminants

White blood cells: 8,000/µL (8.0 ×109/L)

Positive culture for group A streptococcus

Negative for respiratory syncytial virus (RSV)

Positive culture for group A streptococcus

Acute glomerulonephritis may result as an autoimmune response to the invasion of group A streptococcus. This group of streptococci affect the glomeruli of the kidneys. This would be addressed by the health care provider and is the most important of the laboratory results presented. If there is an active strep infection, it would need to be treated with an antibiotic. The white blood cell count is within normal limits. It is good to be negative for respiratory syncytial virus. The urine culture would have to be redone due to contamination. It does not provide an accurate status of the child's urine.

A 10-year-old child in renal failure is on continuous cycling peritoneal dialysis (CCPD). What would be important to teach the parents?

Severe cramping and pain should not occur with an infusion.

Dialysis solution must be infused over a period of 30 minutes.

The return solution will be cloudy because of urea in it.

Slight bleeding from the exchange catheter is to be expected.

Severe cramping and pain should not occur with an infusion.

Continuous cycling peritoneal dialysis (CCPD) allows a child to go to school or participate in other activities while receiving dialysis . With CCPD, a permanent dialysis catheter is inserted and sutured into place at the abdomen. Although commercial devices may be used, for the simplest method, the child or parent attaches a bag of dialysis fluid and tubing to this and infuses a prescribed dialysis solution by gravity drainage; the bag and tubing are then rolled into a compact square under the child's clothes. The infused solution remains in the child for 4 to 6 hours during the day (8 hours at night); the dialysate bag is then lowered, and the solution drains from the peritoneal cavity into it. The bag and fluid are then discarded and a new bag of dialysate solution is attached and raised, and new solution is infused.

. The child should be assessed for toleration of the fluid volume instilled into the peritoneum. The abdomen will remain distended while the fluid is indwelling. The child may be slightly uncomfortable from the pressure but should not experience severe cramping or pain. The return flow should be clear. A cloudy return flow or severe pain or cramping suggests infection. The dialysate solution will fill from gravity so there is no specified time frame for instillation and will also be affected by the amount of dialysate solution to be instilled.

When developing the preoperative plan of care for an infant with bladder exstrophy, which intervention would the nurse least likely include?

Placing the infant in a side-lying position

Covering the bladder with a sterile plastic bag

Sponge-bathing instead of tub bathing

Changing soiled diapers immediately

Placing the infant in a side-lying position

When providing care to an infant with bladder exstrophy, the nurse would keep the infant in the supine position, cover the bladder with a sterile plastic bag, change soiled diapers immediately to prevent contamination, and sponge-bathe the infant rather than immersing him or her in bath water.

The nurse is conducting a routine wellness examination of a 13-year-old client. Which question would be best to ask first when opening a discussion on sexual behavior?

"Are you curious about sex?"

"Do any of your siblings have sexual relationships?"

"Do you talk to your parents about sex?"

"What do you like to do on the weekend?"

"What do you like to do on the weekend?"

The best approach is to start with questions about friends and social life, moving the conversation toward sexual behavior. The direct approach is less effective with adolescents.

The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately?

Empty the old dialysate.

Weigh the old dialysate.

Start the process over with a fresh bag.

Weigh the new dialysate.

Weigh the old dialysate.

The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.

A nurse caring for a client diagnosed with Chlamydia trachomatis can expect which subsequent tests?

syphilis

gonorrhea

trichomoniasis

candidiasis

gonorrhea

Since there is a strong association between gonorrhea and a chlamydial infection, the client would be tested for gonorrhea as well.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to:

contact the necessary authorities to report a suspected case of sexual abuse.

take the child to a private room and interview her regarding her sexual history and partners.

take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity.

talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted infection and discuss the importance of safe sex practices.

take the child to a private room and interview her regarding her sexual history and partners.

Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.