N165 Pediatrics Sherpath Week 3

A patient presents with sudden onset of gross hematuria, proteinuria and hypertension. In assessing this patient, what statement best supports the importance for the nurse to assess the presence of throat discomfort over the past two weeks?

Streptococcal pharyngitis can induce glomerulonephritis

A family brings their toddler to the clinic because of frothy urine and a swollen face. Serum analysis confirms hypoalbuminemia and elevated hematocrit levels. The child is normotensive. Based on this clinical data, what care measure should the nurse anticipate in managing this patient?

Immunosuppression with corticosteroids

Which set of clinical evidence will prompt a nurse to prepare for managing a patient with glomerulonephritis over nephrotic syndrome?

• Hematuria

• Hypertensive

• Abrupt onset edema

A patient with glomerulonephritis is receiving intravenous fluids to regulate hydration but begins to experience pulmonary edema and worsening hypertension. Blood serum analysis shows hyperkalemia and increased BUN. The hyperkalemia does not respond to interventions. These clinical data should be an indication for the nurse to prepare for which steps in the management of acute renal failure?

Dialysis

Patient 1: Born with grade V VUR that is unresolved; has received conservative treatments to correct the reflux. Patient has developed a GFR of 10% over the past two months.
Patient 2: Born with grade V VUR that is unresolved; has received conservative treatments to correct the reflux. Patient has a GFR of 50%.
How should the nurse classify each patient based on the information provided?

• Patient 1: End-stage renal disease

• Patient 2: Chronic kidney disease

What is the correct series of events for the progression from acute to end stage renal disease?

1) Patient has edema, is hypertensive & hyperkalemic, and GFR is estimated at 50%. Optimistic regarding the ability to regain renal function.

2) Patient is not responding to treatments for hyperkalemia, GFR is estimated at 50%. Dialysis included in treatment plan.

3) Patient has irreversible loss of kidney function. GFR is estimated to have fallen below 50% and patient has hypertension.

4) Patient develops osteodystrophy (rickets) and anemia. The patient has rising serum creatinine & BUN levels and hypertension

5) Patient has a GFR of less than 10%. Dialysis is continued. Kidney transplant is indicated.

Which statement helps to explain why immunosuppressive therapy is needed for kidney transplantation?

To prevent rejection of the transplanted organ

Which elements of a dietary regime are helpful in the therapeutic management of a child with CKD?

• Limit (regulate) fluid intake

• Include foods the child enjoys

• Individualize plan within restrictive parameters

A renal parenchymal histological report of a 2-year-old patient confirms evidence of rare bilateral Wilms tumors affecting the kidneys. As the surgeon prepares for surgery, why is palpating or putting pressure on the abdomen avoided?

Increased pressure may cause the tumor to rupture and cancer cells may spread throughout the abdominal cavity

A common cause of HUS is the bacteria E.coli. Upon infection of the upper gastrointestinal tract, the bacteria secrete a toxin (Shiga toxin) which damages the endothelial walls of the capillaries and causes inflammation. How does this relate to renal function?

Occlusion of the glomeruli by inflammation can decrease GFR

An 8-year-old patient comes to the clinic with symptoms of acute kidney injury. While discussing recent events with the patient, the nurse learns that the patient attended a family barbeque the day before. Which statement explains the importance of this information?

• The patient may have eaten improperly cooked meat

• The patient may have consumed contaminated dairy products

A patient has returned for a follow-up appointment for pharyngitis. The child now has altered electrolytes and an elevated ASO titer. The nurse notes facial edema and hypertension. Which finding confirms a diagnosis of acute poststreptococcal glomerulonephritis?

Elevated ASO titer

Why is it important to understand blood proteins in a patient with nephrotic syndrome?

• Proteins are filtered in the glomerulus and lost in the urine

• Synthesis of liver proteins cannot keep up with need and patient develops hypoalbuminemia.

Both nephrotic syndrome and glomerulonephritis have similar clinical manifestations. What evidence ca be used to distinguish between the two disease states?

• Hypertension

• Gross hematuria

• Normal serum albumin levels

• Normal serum electrolyte levels

Which statements help to clarify the main differences between peritoneal dialysis and hemodialysis?

• Efficiency of dialysis

• Time required for dialysis

• Location of catheterization

• Caregiver involvement in dialysis treatment

Which explanation describes the rationale for immunizing children prior to receiving a kidney transplant?

Immunosuppression that is required after transplant increases the risk for infections

Which combined clinical evidence should best warran t dialysis in the AKI patient?

• BUN >120 mg/dL

• Severe hypertension

• Patient has fluid overload

• Pulmonary crackles that do not clear with a cough

• Blood pH is low and not responsive to intervention

Which patient scenarios should the nurse anticipate care for dialysis or kidney transplant?

• Estimated GFR of ≤10%, hypertensive, anemic

• Severe hypertension and edema that are unresponsive to interventions

• Severe edema and congestive heart failure. Hypertension and increasing BUN levels

In which situation should peritoneal dialysis be favored over hemodialysis?

Infants who are hemodynamically unstable

Which 3 factors need to be considered when planning care for a patient diagnosed with ESRD?

• GFR

• Quality of life

• Serum creatinine and BUN levels

A 1-year-old child presents to the clinic with an abnormal abdominal bulge. The parents state the patient has been asymptomatic and the mass has not grown in size. The mass is also immobile. Upon close observation, the child also has unusual appearing eyes. Why are both an ophthalmology and renal referral necessary in this patient?

• The unusual appearing eyes, with missing or partial iris, are suggestive of Wilms tumor

• Renal referral is required because the large, immobile, abdominal mass in such a young child is indicative of Wilms tumor

What is the significance of thrombocytopenia in a patient with HUS?

• Thrombocytopenia potentiates small vessel occlusion and development of thrombi

• Thrombocytopenia develops as platelets occlude vessels and then decreases blood flow and GFR.

Which manifestations should the nurse likely anticipate for a patient diagnosed with HUS?

• Hematuria

• Hemolytic anemia

• Thrombocytopenia

• Stool culture that is positive for E.coli

After eating hamburgers at the state fair, a patient develops bloody diarrhea. At the emergency department, they are given IV antibiotics and fluids. During hospitalization, the nurse notes the patient is oliguric. Within a few days, the patient has copious amounts of dilute urine. Which is the most important complication for the nurse too assess for?

• Dehydration and electrolyte imbalance due to slow nephron tubule recovery

An 11-year-old boy acquired a testicular malignancy at the age of 10 years. An abdominal x-ray at the age of 6 months may have revealed which disorder?

Cryptorchidism

The neonatal nurse is expecting a patient born with bladder exstrophy. What feature may have been viewed in the antenatal sonogram?

The urinary bladder is located outside of the body.

A five-year-old boy presents to the emergency department with severe pain and scrotal swelling and is diagnosed with testicular torsion. The nurse should expect to prepare this patient for which treatment?

Emergency surgery

A child is diagnosed with pyelonephritis. Which should be a priority in caring for the patient?

Preventing sepsis

The nurse understands that a patient with hydronephrosis will be most predisposed to UTIs because of which change?

Increases urine stasis

A nurse is caring for the parents of an infant who is discovered to have hydronephrosis. The parents ask why the infant will need to be tested for a urinary tract infection (UTI) at birth. Which is the best response by the nurse?

“Infants with hydronephrosis can have urine flow back into the kidneys from the bladder, causing bacterial growth.”

A 3-year-old, uncircumcised male is seen in the emergency department for emesis that started 4 hours ago. His mother states he has grade IV vesicoureureteral reflux (VUR). Urinalysis was positive for ketones and urine culture was negative. PO challenge was tolerated with no further emesis. What information would be important to help the family prevent UTI in this patient?

• Increase frequency of voiding

• Proper cleaning of the prepuce

• Antibiotic prophylaxis would be beneficial

A 4-year-old female child has had several UTIs during the school year. The nurse knows that which bacteria is most likely causing the young girl’s UTIs?

Escherichia coli (E.coli)

A 6-month-old infant has dysuria, poor weight gain, and is irritable. The infant is nonfebrile. During the check-up you notice a foul smell from the urine in the diaper. A urinary tract infection (UTI) is suspected and a urine culture (UCS) is ordered. What evidence is used to differentiate UTI from pyelonephritis?

fever

What conclusion can be drawn when a febrile patient is positive for nitrites and has >500,000 CFU/ml after a clean catch urine culture?

UTI

What questions should help the nurse identify an underlying cause of enuresis?

• Is your child losing weight?

• Does your child currently have a fever?

• Has your child been dry at night until recently?

A three-year-old patient has recently developed enuresis at preschool. She has not had any urinary accidents for 8 months and does not have any episodes of bedwetting. Identify the classification of enuresis for this patient.

Secondary, diurnal enuresis

A school-age child is having urinary frequency and urgency. What should be included in the diagnostic evaluation of this child?

• urinalysis

• urine culture

• evaluation for pinworms

• evaluation of psychological state

• evaluation for voiding dysfunction

A 2-month-old boy was born prematurely and has bilateral cryptorchidism. What information should the nurse give the parents regarding immediate treatment?

Patient will be observed for spontaneous descent of the testes which is common in the first 6 months of life

Match the disorder with management options.

• Hydrocele in newborn

  • Surgery

• Phimosis (mild)

  • Observation

• Testicular torsion

  • Emergency surgery

• Bladder exstrophy

  • Cleaning and manual retraction

Which other conditions should the nurse assess for in a patient with hypospadias?

Patients with hypospadias might also have inguinal hernias.

A nurse is working at a urology clinic and arrives at work to an assignment caring for four young children:

Child A: 3-year-old with urethritis

Child B: 15-year-old with cystitis

Child C: newborn with suspected VUR

Child D: 7-year-old with pyelonephritis

Child D

Immediately after delivery, the nurse notices signs of possible UTI in the neonate. what is the likely bacterial route of the infection?

Blood

A nurse is caring for a 7 year old male who is not circumcised. The child has had recurrent UTIs. What information should the nurse share with the child to help reduce the likelihood of repeat UTIs?

“Make sure to clean your foreskin carefully each time you go to the bathroom.”

What assumption regarding urinary system anatomy can be made if a child is born with hydronephrosis?

Ureter obstruction

What is a likely consequence of urine reflux?

Urine reflux increases urine stagnation.

A 16-year-old female returns to the clinic with symptoms of UTI. This is her second UTI in 6 months since she has become sexually active. What is the most important information the nurse should provide to aid in the prevention of future UTIs?

Urinate after sexual intercourse

The nurse is caring for a 6-year-old patient with a UTI. The nurse should anticipate which items may be included in treatment?

• Nitrofurantoin

• Cephalosporins

• Trimethoprim-sulfamethoxazole

What is the next step in diagnosis of UTI when urine dipstick shows nitrites and urinalysis show hematuria and WBCs?

Urine culture

A child presents to the ED and is diagnosed with secondary enuresis. Which factors should the nurse consider when suspecting stress-induced secondary enuresis in a young child?

• self-esteem

• sexual abuse

• recent changes in family dynamics

The pediatric nurse is reviewing the record of a child for an office visit. prior to assessing the child, the nurse notes documentation that the child has diurnal enuresis. based on this diagnosis finding, the nurse plans to include which question during the assessment?

“Do you wet yourself during the day while you’re awake?”

A 4 year old has one accident a week at night. She has not gone more than 6 months without an accident. She really wants to fix the problems so she can feel “normal”. What type of management should be suggested in this case?

Behavioral conditioning

The nurse is caring for a child who presents with abdominal distention and currant jelly stools. Since admission, the patient’s blood pressure has decreased and the patient has become lethargic. Which is the priority nursing action for this patient?

Notify the health care provider

When assessing a child treated for intussusception, which behavioral finding would indicate the expected outcomes had been met for that child?

Knocking over blocks

The nurse is caring for a child with intussusception who presented with vomiting and diarrhea. Laboratory values reveal elevated serum sodium and elevated hematocrit. Which priority action should the nurse take to achieve the expected outcomes for this patient?

Administer intravenous (IV) normal saline

The nurse is caring for a child with pyloric stenosis. The nurse notes that the abdomen is distended, skin turgor is poor, and fontanels are sunken. Which action would the nurse take?

Provide an intravenous (IV) normal saline bolus

During feeding, an infant with pyloric stenosis begins to cough and wheeze. Which is the priority nursing action?

Elevate the infant’s head

The nurse is providing discharge teaching to the parents of a child with pyloric stenosis. Which statements, made by the parents, indicate that teaching was effective?

Select all that apply.

• “After surgery, I will be allowed to change my child’s diapers.”

• “This condition will affect the way my child absorbs my breast milk.”

• “I have the number for the support group the social worker gave me this morning, and I will call today.”

During abdominal assessment, the nurse notes hypoactive bowel sounds, abdominal distention, vomiting, and currant jelly stools. Which interventions would the nurse expect to provide for this patient?

Select all that apply.

• Barium enema

• IV normal saline

• Intravenous antiemetic

• Abdominal ultrasonography

Which nursing actions should be implemented to ensure bowel patency is maintained for an infant with intussusception?

Select all that apply.

• Perform an occult blood test

• Evaluate the consistency of the stool

• Take a gastrointestinal history

The nurse walks into a patient’s room shortly after surgical correction of intussusception and notices that the patient is very lethargic. Which nursing action is a priority?

Call the rapid response team

The nurse is preparing a child for pyloromyotomy. The child has a plasma CO₂ of 30 mEq/L. Which nursing actions are appropriate before surgery?

Select all that apply.

• Place a nasogastric tube

• Assess serum electrolytes

• Withhold oral food and fluids

An infant with pyloric stenosis has a nasogastric tube in place. Which assessment finding would be of most concerning to the nurse?

Respirations are rapid and shallow

A nurse is preparing the family of an infant who has undergone a pyloromyotomy for discharge. The infant is currently receiving electrolyte solution during feedings. Which statements by the parent suggest successful patient teaching to ensure an optimum outcome for the infant after surgery?

Select all that apply.

• “I will offer my baby full-strength breast milk in a few days.”

• “I will report gastrointestinal issues to the primary health care provider.”

When assessing an infant with a tracheoesophageal fistula, which findings would be expected?

Select all that apply.

• Gagging during bottle feeding

• Blue discoloration around the mouth

• Coughing after latching onto breast for feeding

The nurse is teaching a parent how to care for a child’s gastrostomy tube. Which statement, made by the parent, indicates successful patient teaching?

Select all that apply.

• “I will apply antimicrobial ointment if indicated.”

• “If crusty drainage appears, I will use half-strength hydrogen peroxide.”

The nurse is caring for a child with esophageal atresia who has been diagnosed with failure to thrive. Which assessment findings indicate the expected outcomes have been met for this patient?

Select all that apply.

• weight gain

• Increased head circumference

• Normal urine specific gravity

The caregivers of a child with cleft lip ask the nurse how to decrease feeding difficulties associated with the condition. Which is the best response from the nurse regarding optimizing feeding of the child?

“use a long nipple for feeding your child”

A nurse is providing patient teaching to a couple whose infant has just had surgery for cleft lip. What information does the nurse provide regarding feeding to ensure the child receives adequate nutrition?

Select all that apply.

• “Stop feeding frequently to burp.”

• “Feed the infant in an upright position.”

• “Use a syringe with a rubber tip for feedings.”

The nurse is evaluating how a couple is coping with their young child’s diagnosis of cleft lip. For which signs does the nurse look to determine whether effective coping is taking place?

Parents plan and organize all special care appointments

A 4-year-old patient is diagnosed with congenital diaphragmatic hernia. What are appropriate nursing outcomes for this patient?

Select all that apply.

• The patient’s mucosa will appear pink.

• The patient will have regular breath sounds

Which action can exacerbate respiratory distress in a patient with congenital diaphragmatic hernia?

Using a facemask or bag valve mask for ventilatory support

Which intervention should the nurse use to reduce anxiety in parents of a child with congenital diaphragmatic hernia?

Select all that apply:

• Provide discharge teaching.

• Refer parents to a support group.

• Inform the parents about the procedure.

• Teach the parents standardized feeding techniques.

The nurse is assessing a child with a tracheoesophageal fistula who has been coughing and choking during feeding. The child is in the 45th percentile for weight, and vital signs are normal. Which nursing intervention is appropriate to ensure that the expected outcome is achieved for this patient?

Place child on a chalasia board

A parent is reporting that the child has redness and pus around the gastrostomy tube site. Which statement indicates that the parent has an adequate understanding of gastrostomy tubes?

“I should apply antibiotics to the gastrostomy tube.”

A child is diagnosed with esophageal atresia and is not gaining weight as expected. Which finding on a follow-up examination indicates that the expected outcomes for this patient have not been met?

Decreased urinary output

The nurse is evaluating a patient with cleft lip to determine whether collaborative care was able to achieve the expected outcome. Which action should the nurse take to determine whether a child with cleft lip and palate is achieving adequate nutrition?

Measure height and weight.

The nurse is demonstrating appropriate oral hygiene for a repaired cleft lip before patient discharge. Which actions does the nurse demonstrate to protect the repair site from complications or infection while it is healing?

Use a cotton swab to clean the mouth.

A child has been diagnosed with cleft palate, and the nurse is meeting with the caregivers. What are appropriate interventions by the nurse?

Select all that apply.

• Listen to the caregivers’ questions.

• Teach the effectiveness of verbalizing concerns.

• Ensure consent forms for surgery have been signed.

A nurse is concerned that a child with an upper gastrointestinal hernia is experiencing an imbalance in nutrition. Which symptom should the nurse document?

Vomiting

The nurse is caring for a patient diagnosed with a hiatal hernia. Which assessments should be performed to determine that treatment has been effective?

Select all that apply.

• Monitor intake and output.

• Assess the patient for vomiting.

The nurse notices that the parents of a child admitted with congenital diaphragmatic hernia are not holding the child. Which nursing intervention is appropriate to assist in resolution of the problem?

Educate the parents about the condition and the treatment.

The nurse is evaluating a patient with encopresis. Which findings would the nurse expect on assessment after taking patient history?

Select all that apply.

• Child has fecal stains in the underwear.

• Child plays video games for hours alone.

• Urinalysis reveals the child’s fourth urinary tract infection in 16 months.

Which patient findings indicate to the nurse that treatment of encopresis complications has been effective?

Select all that apply.

• Child talks about the condition with the nurse.

• The child’s skin is clean, dry, and free of excoriation.

• Parents report the child has a bowel movement every 6 to 8 hours.

Several patients with encopresis are receiving bowel training. Which patient demonstrates successful use of this treatment method?

The child who sits on the toilet for 10 minutes during each visit to the bathroom.

When at home, which intervention is the most important for a child with gastroenteritis?

Encouraging frequent sips of water every few minutes

An infant with gastroenteritis presents with severe diarrhea and vomiting. Which assessment finding is most concerning?

Two wet diapers in the last 12 hours

Which action should the nurse take to decrease the spread of infection from a patient with Clostridium difficile infection?

Select all that apply.

• Enforce hand washing

• Enforce contact precautions

A parent of a 6-month-old infant calls the nurse hotline and reports that an infant has had loose stools for the past 12 hours. Which question is most pertinent in the nurse’s assessment?

Can you describe the number and character of the stools?

The nurse is caring for a 3-month-old infant diagnosed with gastroenteritis. The parents report vomiting, diarrhea, poor skin turgor, and lethargy. Which additional finding supports the diagnosis of moderate dehydration?

Sunken or depressed fontanel

The nurse is caring for a child with gastroesophageal reflux disease (GERD). The child is feeding and begins to cough and gag. Which action should the nurse take first?

Stop the feeding

An infant with gastroesophageal reflux disease (GERD) vomits after every feeding. Which provider orders would the nurse anticipate?

Select all that apply.

• Thicken formula feedings

• Daily abdominal assessment

• Refer infant for respiratory therapy

The nurse is caring for an infant with gastroesophageal reflux disease (GERD). Which action by a parent, observed by the nurse, indicates teaching was effective?

A pacifier is clipped to the infant’s car seat.

The parents of a 2-month-old girl bring her in for treatment. The infant has had infrequent bowel movements since birth, and the parents describe the recent appearance of ribbon-like-foul smelling stools when changing her diaper. What other clinical manifestation might the nurse observe?

Abdominal distention

The nurse is caring for a child with Hirschsprung disease who has abdominal distention and hard, dry stools. Which food choices would be most appropriate?

Select all that apply.

• Grapes and apple slices

• Boiled cabbage and broccoli

• Cinnamon raisin granola bars

After surgery to create a colostomy, a child who is still on NPO (nothing by mouth) status requests a meal. Which response is appropriate for the nurse?

“You cannot eat until I can hear your belly gurgle when I listen to it or when you pass gas.”

A nurse is caring for a child recently diagnosed with celiac disease. Which lunch selections are most appropriate?

Select all that apply.

• Chicken stir-fry with white rice, carrots, onions, and broccoli

• Fresh ham on a corn tortilla with mashed potatoes and mandarin oranges.

A child with celiac disease presents with severe diarrhea, a thready pulse, and low blood pressure. Which actions should the nurse take?

Select all that apply.

• Administer intravenous saline

• Obtain serum electrolyte levels

The nurse is caring for a child with celiac disease who requires fluid resuscitation. Which assessment findings would the nurse anticipate after treatment has begun?

Select all that apply.

• Supple skin

• Skin elasticity

The nurse is teaching the parents of a child with encopresis about potential symptoms. Which statement by the parents indicates teaching was effective?

“Our child’s feces will have a very foul odor most of the time”

Which dietary modification should be made for a child with encopresis?

Select all that apply.

• Eat granola bars

• Increase water intake

• Eat whole-grain cereals