NCLEX Child with the Urinary System Health Problems Questions
Child with the Urinary System Health Problems NCLEX Practice Questions
Question 1.
A father brings his 4-week-old son to the clinic for a checkup, stating that he believes his son’s tes-ticle is missing. Which explanation would be most appropriate?
(a) “Although the testes should have descended by now, it’s not a cause for worry.”
(b) “It does appear that one of his testes has not descended. I’ll palpate his scrotum to check whether both testes are present.”
(c) “The testes are present in the scrotal sac at birth, but surgery can remedy the situation.”
(d) “Although the testes normally descend by 1 year of age, I can understand your concern.”
Answer:
(d) “Although the testes normally descend by 1 year of age, I can understand your concern.”
Explanation:
Normally, the testes descend by 1 year of age; failure to do so may indicate a problem with patency or a hormonal imbalance. By age 4 weeks, descent may not have occurred. However, telling the father that lack of descent is not a cause for worry is inappropriate and uncaring.
Additionally, a statement such as this may be false reassurance. By acknowledging the father’s concern, the nurse indi-cates acceptance of his feelings. If the testes have not descended, then they will not be palpable in the scrotal sac. Surgery is not discussed until after a full assessment is completed.
Question 2.
While preparing to examine a 6-week-old infant’s scrotal sac and testes for possible unde-scended testes, which would be most important for the nurse to do?
(a) Check the diaper for recent urination.
(b) Give the infant a pacifier.
(c) Ensure that the room is kept warm.
(d) Tap lightly on the left inguinal ring.
Answer:
(c) Ensure that the room is kept warm.
Explanation:
A cold environment can cause the testes to retract. Cold and touch stimulate the cremasteric reflex, which causes a normal retraction of the testes toward the body. Therefore, the nurse should warm the hands and make sure that the environment also is warm.
Checking the diaper for urination provides information about the infant’s voiding and urinary function, not information about the testes. Giving the infant a pacifier may help to calm the infant and possibly make the examination easier, but the concern here is with the temperature of the environ-ment. Tapping on the inguinal ring would not be helpful in assessing the infant.
Question 3.
While the nurse is examining the infant for presence of testes, the father paces around the room shaking his head. Which statement would be the most appropriate response by the nurse?
(a) “I am sure everything will work out for the best, and he will be fine.”
(b) “You seem upset; please tell me how you are feeling.”
(c) “Don’t worry; his testes will probably descend on their own.”
(d) “Would you like to talk with a parent of a child who has the same problem?”
Answer:
(b) “You seem upset; please tell me how you are feeling.”
Explanation:
The nurse needs more information about the father’s perceptions and feelings before providing any information or taking action. Determining the exact nature of the father’s concern rather than making an assumption about it is essential. Therefore, the nurse should identify what is observed and ask the father how he is feeling. Telling the father that everything will be fine or not to worry is inappropriate and provides false reassur-ance. It also devalues the father’s concern. Later on, it may be appropriate for the father to talk to a parent of a child with the same problem for support.
Question 4.
When assessing an infant with an undescended testis, the nurse should be alert for which symptom?
(a) abnormal lower extremity reflexes
(b) a history of frequent emesis
(c) a bulging in the inguinal area
(d) poor weight gain
Answer:
(c) a bulging in the inguinal area
Explanation:
When an anomaly is found in one system, such as the genitourinary system, that system requires a more focused assessment to reveal other conditions that also may be occurring. A bulging in the inguinal area may suggest an inguinal hernia. Also, hydrocele or an upper urinary tract anomaly may occur on the same side as the undescended testis.
A neuromuscular problem, not a genitourinary problem such as undescended testes, would most likely be the cause of abnormal lower extremity reflexes. A history of frequent emesis may be caused by pyloric stenosis or viral gastroenteritis. Poor weight gain might suggest a metabolic or a feeding problem.
Question 5.
When developing the preoperative teaching plan for a 14-month-old child with an undescended testis who is scheduled to have surgery, which method is most appropriate?
(a) Tell the child that his penis and scrotum will be “fixed.”
(b) Explain to the parents how the defect will be corrected.
(c) Tell the child that he will not see any incisions after surgery.
(d) Use an anatomically correct doll to show the child what will be “fixed.”
Answer:
(b) Explain to the parents how the defect will be corrected.
Explanation:
Preoperative teaching would be directed at the parents because the child is too young to under-stand the teaching. Telling the child that his penis and scrotum will be “fixed,” telling the child he will not see incisions after surgery, and using a doll to illustrate the surgery are appropriate interventions for a preschool-age child.
Question 6.
An adolescent with a history of surgical repair for an undescended testis comes to the clinic for a sports physical. Which anticipatory guidance for the parents and adolescent is most important?
(a) the adolescent’s sterility
(b) the adolescent’s future plans
(c) technique for monthly testicular self-examinations
(d) need for a lot of psychological support
Answer:
(c) technique for monthly testicular self-examinations
Explanation:
Because the incidence of testicular cancer is increased in adulthood among children who have had undescended testes, it is extremely important to teach the adolescent how to perform the testicular self-examination monthly. The undescended testicle is removed to reduce the risk of cancer in that testicle. Removal of a testis would not necessarily make the adolescent sterile because the other tes-ticle remains.
Although discussing the adolescent’s future plans is important, it is not the priority at this time. Because the adolescent has been dealing with the situation for a long time, the need for a sports physical at this time should not be a cause of emotional distress requiring a lot of psychological support.
Question 7.
During a clinic visit, the mother of an infant with hydrocele states that the infant’s scrotum is smaller now than when he was born. After teaching the mother about the infant’s condition, which state-ment by the mother indicates that the teaching has been effective?
(a) “I guess keeping his bottom up has helped.”
(b) “Massaging his groin area is working.”
(c) “It seems like the fluid is being reabsorbed.”
(d) “Keeping him quiet and in an infant seat has helped.”
Answer:
(c) “It seems like the fluid is being reabsorbed.”
Explanation:
A hydrocele is a collection of fluid in the tunica vaginalis of the testicle or along the spermatic cord that results from a patent processus vaginalis. As fluid is being absorbed, scrotal size decreases. Elevation of the infant’s bottom, massage, or keeping the infant quiet or in an infant seat would have no effect in promoting fluid reabsorption in hydrocele.
Question 8.
Shortly after an infant is returned to his room following hydrocele repair, the infant’s parent approaches the nurse in the hall to report that the child’s scrotum looks swollen and bruised. Which response by the nurse would be most appropriate?
(a) “Let me see if the surgeon has prescribed aspirin for him. If he did, I’ll get it right away.”
(b) “Can you wait in his room? Then you can ask me any questions when I get there.”
(c) “What you are describing is unusual after this type of surgery. I will let the surgeon know.”
(d) “This is normal after this type of surgery. Let us look at it together just to be sure.”
Answer:
(d) “This is normal after this type of surgery. Let us look at it together just to be sure.”
Explanation:
Some swelling and bruising are normal postoperatively. By assessing the area with the mother, the nurse is conveying acceptance of the mother’s concern. In addition, the nurse needs to inspect the area to determine if what the mother is describing is accurate.
Doing so also provides an opportunity for teaching. Aspirin is not usually prescribed for children because of the link between aspirin and Reye syndrome. Acetaminophen is com-monly administered for fever or pain relief. Asking the mother to wait in the child’s room ignores the mother’s concerns. There is no need to notify the surgeon at this time.
Question 9.
The parents of a neonate with hypospadias and chordee wish to have him circumcised. Which explanation should the nurse incorporate into the discussion with the parents concerning the recom-mendation to delay circumcision?
(a) The associated chordee is difficult to remove during circumcision.
(b) The foreskin is used to repair the deformity surgically.
(c) The meatus can become stenosed, leading to urinary obstruction.
(d) The infant is too small to have a circumcision.
Answer:
(b) The foreskin is used to repair the deformity surgically.
Explanation:
The condition in which the urethral opening is on the ventral side of the penis or below the glans penis is referred to as hypospadias. Chordee refers to a ventral curvature of the penis that results from a fibrous band of tissue that has replaced normal tissue. Circumcision is delayed because the foreskin, which is removed with a circumcision, often is used to reconstruct the urethra.
The chordee is corrected when the hypospadias is repaired. Circumcision is performed at the same time. Urethral meatal stenosis, which can occur in circumcised infants, results from meatal ulceration, possibly leading to urinary obstruction. It is not associated with hypospadias or circumcision. The infant is not too small to have a circumcision, which is commonly performed on the first or the second day of life.
Question 10.
The nurse is caring for an infant with hypo-spadias. Identify the area where the nurse would assess for this condition.
Answer:
Explanation:
In hypospadias, the urethral opening is on the ventral side of the penis.
Question 11.
A 1-year-old child is scheduled for surgery to correct hypospadias and chordee. The nurse explains to the parents that this is the preferred time for surgical repair based on which factor?
(a) At this age, the child will experience less pain.
(b) The child is too young to have developed castration anxiety.
(c) The child will not remember the surgical experience.
(d) The repair is easier to perform after the child is toilet trained.
Answer:
(b) The child is too young to have developed castration anxiety.
Explanation:
The preferred time for surgery is between the ages of 6 and 18 months, before the child develops castration and body image anxiety. Children learn early on about society’s emphasis on the importance of genitals. Pain is different for each child and is not related to the preferred time for repair of the hypospadias or chordee. Although the child will probably not remember the experience, this is not the basis for having the surgery at this age. If the condition is not repaired, the child will have difficulty with toilet training because urine is not eliminated through the tip of the penis.
Question 12.
A 6-month-old child is discharged with a uri-nary stent after a procedure to repair a hypospadias. What instructions should the nurse give the parents?
(a) Avoid tub baths until the stent is removed.
(b) Measure output in the urinary bag.
(c) Avoid giving fruit juice.
(d) Clean the tip of the penis three times a day with soap and water.
Answer:
(a) Avoid tub baths until the stent is removed.
Explanation:
The parents should keep the penis as dry as possible until the stent is removed. Soaking in a tub bath is not recommended. Children this age typ-Iically go home voiding directly into a diaper. Infants may be started on juice at 6 months of age. Parents are advised to keep their child well hydrated after a hypospadias repair. Therefore, there is no reason to avoid juice. Cleaning the tip of the penis three times a day may cause unnecessary irritation.
Question 13.
After teaching the parents about the urethral catheter placed after surgical repair of their son’s hypospadias, the nurse determines that the teaching was successful when the mother states that the cath-eter in her child’s penis accomplishes which goal?
(a) decreases pain at the surgical site
(b) keeps the new urethra from closing
(c) measures his urine correctly
(d) prevents bladder spasms
Answer:
(a) decreases pain at the surgical site
Explanation:
The main purpose of the urethral catheter is to maintain patency of the reconstructed urethra. The catheter prevents the new tissue inside the urethra from healing on itself. However, the urethral catheter can cause bladder spasms. Recently, stents have been used instead of catheters. The urethral catheter will have no effect on the child’s pain level.
In fact, because bladder spasms are associated with its use, the child’s problems of pain may actually increase. Urine output can be measured through the suprapubic catheter because it provides an alterna-tive route for urinary elimination, thus keeping the bladder empty and pressure-free.
Question 14.
While assessing the penis of a child who has had surgery for repair of a hypospadias, the nurse observes the appearance of the penis. The nurse should report which aspect to the surgeon?
(a) swollen
(b) dusky blue at the tip
(c) somewhat misshapen
(d) pink
Answer:
(b) dusky blue at the tip
Explanation:
A dusky blue color at the tip of the penis may indicate a problem with circulation, and the nurse should notify the surgeon. Following surgery, it is normal for the penis to be swollen and pink. The penis may be misshapen and is unlikely to look normal even after reconstruction.
Question 15.
When developing the teaching plan for the parents of a 12-month-old infant with hypospadias and chordee repair, what information is most impor-tant to include?
(a) Assist the child to become familiar with his dressings so he will leave them alone.
(b) Encourage the child to ambulate as soon as possible by using a favorite push toy.
(c) Force fluids to at least 2,500 mL/day by offering his favorite juices.
(d) Prevent the child from disrupting the catheters by using soft restraints.
Answer:
(d) Prevent the child from disrupting the catheters by using soft restraints.
Explanation:
The most important consideration for a successful outcome of this surgery is maintenance of the catheters or stents. A 12-month-old infant likes to explore his environment but must be prevented from manipulating his dressings or catheters through the use of soft restraints. Allowing the infant to become familiar with the dressings will not prevent him from pulling at them.
After surgery, the child is allowed limited activity, possibly while sitting in the parent’s lap. A 12-month-old infant may or may not be walking. If he is, most likely he will be clumsy and possibly injure himself. Although increasing fluids is important, 2,500 mL/day is an excessive amount for a 12-month-old. Fluid requirements would be 115 mL/kg.
Question 16.
The health care provider (HCP) prescribes a urinalysis for a child who has undergone surgical repair of a hypospadias. Which results should the nurse report to the HCP?
(a) urine specific gravity of 1.017
(b) ten red blood cells per high-powered field
(c) twenty-five white blood cells per high-powered field
(d) urine pH of 6.0
Answer:
(c) twenty-five white blood cells per high-powered field
Explanation:
A normal white blood cell count in a urinalysis is 1 to 2 cells/mL. A white blood cell count of 25 per high-powered field indicates a urinary tract infection. A urine specific gravity of 1.017 is within the normal range of 1.002 to 1.030. After uro- logic surgery, it is not unusual for a small number of red blood cells to appear in the urine. The child’s urine pH is within the normal range of 4.6 to 8.
Question 17.
A teenage girl has been diagnosed with a urinary tract infection. The nurse recognizes the need for teaching when the client makes which statement?
(a) “I will not take bubble baths.”
(b) “I will drink plenty of water.”
(c) “I can drink coffee.”
(d) “I can drink cranberry juice.”
Answer:
(c) “I can drink coffee.”
Explanation:
Drinking coffee and other beverages that contain caffeine can irritate the bladder and should be avoided. Bubble baths, bath oils, and hot tubs can irritate the urethra and perineal area. Drinking plenty of water will keep urine flushed through the bladder. Cranberry juice helps to acidify the urine.
Question 18.
A preschool-aged client with a history of urinary reflux had bilateral urethral implant surgery 2 days ago. Which assessment finding is most concerning?
(a) intermittent bladder spasms
(b) small amounts of blood-tinged urine
(c) decreased oral intake
(d) continuous drainage from an indwelling catheter
Answer:
(c) decreased oral intake
Explanation:
Children with bilateral ureteral implants often have pain with urination due to bladder spasms. Some children will avoid drinking in order to avoid the pain associated with urination, thus putting the child at risk for dehydration. Intermittent bladder spasms are common after ureteral reimplant surgery and can be treated with oxybutynin to decrease discomfort. Small amounts of blood-tinged urine, bladder spasms, urinary frequency, and urinary incontinence are common following ureteral reimplant surgery.
Question 19.
The health care provider (HCP) has pre-scribed a sterile urine specimen for a 3-year-old boy with a history of recurrent urinary tract infections. The family is upset because the last time the child was catheterized, the procedure was very painful and traumatic. What is the nurse’s best response?
(a) “I’ll request a prescription for a sedative to help him relax.”
(b) “I can’t do anything to reduce the pain, but you can hold him during the procedure.”
(c) “I’ll get a prescription for a numbing lubricant to make the procedure more comfortable.”
(d) “I can apply a topical anesthetic 20 minutes before placing the catheter.”
Answer:
(c) “I’ll get a prescription for a numbing lubricant to make the procedure more comfortable.”
Explanation:
Two percent lidocaine lubricants have been found to significantly reduce the pain of urinary catheter insertion in children. If the unit does not have a standing protocol to use the lubricant, the nurse should request a prescription. A sedative would carry with it additional risks that could be avoided with the use of other methods to reduce pain. The parents should be encouraged to hold the child in addition to other pain relief methods. Frequent urination would make the use of topical anesthetics that must be left in place for a period of time impractical.
Question 20.
A recent history of which problem should alert the nurse to gather additional information about the possibility of a urinary tract infection in a toddler who is exhibiting fever and fussiness?
(a) abdominal pain
(b) swollen lymph glands C
(c) skin rash
(d) back pain
Answer:
(a) abdominal pain
Explanation:
Abdominal pain frequently accompanies urinary tract infection in children 2 years of age and older. Other associated signs and symptoms include decreased appetite, vomiting, fever, and irritability. The presence of swollen lymph glands (lymphade- nopathy) is unrelated to urinary tract infections. Lymphadenopathy is associated with a systemic infection or possibly cancer.
Skin rash is associated with exposure to allergens or irritants (e.g., poison ivy or harsh soaps); prolonged contact with urine (e.g., diaper dermatitis); or illnesses such as measles, rheumatic fever, or juvenile rheumatoid arthritis. Flank or back pain is associated with urinary tract infection in children older than 2 years of age and in adults.
Question 21.
A father of a child with a urinary tract infection calls the clinic and explains, “My wife and I are concerned because our child refuses to obey us concerning the preventions you told us about. Our child refuses to take the medication unless we buy a present. We do not want to use discipline because of the illness, but we are worried about the behavior.” Which response by the nurse is best?
(a) “I sympathize with your difficulties, but just ignore the behavior for now.”
(b) “I understand it’s hard to discipline a child who is ill, but things need to be kept as nor-mal as possible.”
(c) “I understand that things are difficult for you right now, but your child is ill and deserves special treatment.”
(d) “I understand your concern, but this type of behavior happens all the time; your child will get over it when feeling better.”
Answer:
(b) “I understand it’s hard to discipline a child who is ill, but things need to be kept as nor-mal as possible.”
Explanation:
To ensure appropriate psychosocial development, a child needs to have normal patterns maintained as much as possible during illness. It is tempting to give ill children special treatment and to relax discipline. However, family routines and discipline should be kept as normal as possible.
The child needs to know the limits to ensure feelings of secu-rity. When they are ill, children commonly attempt to stretch the rules and limits. If this occurs, returning to the previous well-behavior patterns will take time.
Question 22.
A nurse is teaching the parents of a child diagnosed with a urinary tract infection second¬ary to vesicoureteral reflux. How should the nurse explain how the reflux contributes to the infection?
(a) “It prevents complete emptying of the bladder.”
(b) “It causes urine backflow into the kidney.”
(c) “It results in painful bladder spasms.”
(d) “It causes painful urination.”
Answer:
(a) “It prevents complete emptying of the bladder.”
Explanation:
The reason that urinary tract infections are a problem in children with vesicoureteral reflux is that urine flows back up the ureter, past the incompetent valve, and back into the bladder after the child has finished voiding. This incomplete emptying of the bladder results in stasis of urine, providing a good medium for bacterial growth and subsequent infection. Vesicoureteral reflux does not cause bladder spasms or painful urination. However, the child may experience painful urination with a urinary tract infection.
Question 23.
An adolescent client has been diagnosed with acute glomerulonephritis and has been in the hospital for 1 day. Which finding requires immediate action?
(a) large amount periorbital edema
(b) urine specific gravity of 1.030
(c) large amounts of red blood cells in the urine
(d) 24-hour output of 1,000 mL
Answer:
(b) urine specific gravity of 1.030
Explanation:
An adolescent with acute glomerulonephritis has a high urine specific gravity related to oliguria caused by inflammation of the glomeruli. The client will have periorbital edema, but not the generalized edema that occurs in nephrotic syndrome. In glomerulonephritis, there is some albumin in the urine, but there are large amounts of red blood cells, giving the urine a brown color. The urine in glo-merulonephritis is scanty, averaging about 400 mL in 24 hours, which leads to fluid volume excess and hypertension.
Question 24.
Which meal would be most appropriate for an adolescent with glomerulonephritis with severe hypertension?
(a) egg noodles, hamburger, canned peas, milk
(b) baked ham, baked potato, pear, canned carrots, milk
(c) baked chicken, rice, beans, orange juice
(d) hot dog on a bun, corn chips, pickle, cookie, milk
Answer:
(c) baked chicken, rice, beans, orange juice
Explanation:
The best selection of food would include no added salt or salty food. Because sodium cannot be excreted due to the oliguria and to avoid increasing the hypertension, a low-salt diet is recommended. Most canned foods have sodium added as a preservative. Ham, hot dogs, canned peas, canned carrots, corn chips, pickles, and milk are high in sodium.
Question 25.
A school-age child with glomerulonephritis reports a headache and blurred vision. What imme-diate action should the nurse take?
(a) Put the client to bed.
(b) Obtain the child’s blood pressure.
(c) Notify the health care provider (HCP).
(d) Administer acetaminophen.
Answer:
(b) Obtain the child’s blood pressure.
Explanation:
Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium: the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension.
Calling the HCP before confirming the cause of the symptoms would not facilitate his treatment. Putting the client to bed may help treat an elevated blood pressure, but first, the nurse must establish that high blood pressure is the cause of the symptoms. Administering acetaminophen for high blood pressure is not recommended.
Question 26.
Which question should the nurse ask first when obtaining a history from the parent of a school-age child with a fever, malaise, and swelling around the eyes?
(a) “Has the child had a sore throat recently?”
(b) “Is the child playing with friends as usual?”
(c) “Does the child urinate as much as usual?”
(d) “Is the urine pale in color?”
Answer:
(c) “Does the child urinate as much as usual?”
Explanation:
Most likely, the nurse suspects that the child is exhibiting signs and symptoms of glomeru-lonephritis, such as periorbital edema and fever. Other signs and symptoms include loss of appetite, dark-colored urine, pallor, headaches, and abdomi-nal pain. To confirm this suspicion, the nurse would ask about the child’s urinary elimination patterns.
Typically, the child with glomerulonephritis expe-riences a decrease in urine output. Asking about any recent sore throat would provide additional information to confirm the suspicion of glomerulo-nephritis because the most common type is acute poststreptococcal glomerulonephritis, which follows a strep throat by 10 to 14 days.
Frequently, the children have only mild cold symptoms and do not realize they have a streptococcal infection. Asking whether the child plays with friends as usual is important and gives the nurse information about how the child feels in general. However, this is a general question that would be appropriate to ask later on in the history. Although asking the mother about the color of the child’s urine is important, the nurse needs to determine whether there is any change in the child’s urinary output first.
Question 27.
A school-age client admitted to the hospital because of decreased urine output and periorbital edema is diagnosed with acute poststreptococcal glomerulonephritis. Which assessment gives the nurse the best indication of the child’s fluid balance?
(a) Assess vital signs every 4 hours.
(b) Monitor intake and output every 12 hours.
(c) Obtain daily weight measurements.
(d) Draw serum electrolyte levels daily.
Answer:
(c) Obtain daily weight measurements.
Explanation:
The child with acute poststreptococcal glo-merulonephritis experiences a problem with renal function that ultimately affects fluid balance. While intake and output, electrolytes, and vital signs all provide information about fluid status, weight is the best indicator of fluid balance.
Question 28.
When developing the plan of care for a school-age child with acute poststreptococcal glo-merulonephritis who has a fluid restriction of 1,000 mL/day, which fluid should the nurse consider as most appropriate for the client’s condition and effec-tive for preventing excessive thirst?
(a) diet cola
(b) ice chips
(c) lemonade
(d) tap water
Answer:
(b) ice chips
Explanation:
The most appropriate and effective choice would be ice chips because they help moisten the mouth and lips while keeping fluid intake low. However, ice chips must still be counted as intake with the fluid restriction. Sweet beverages, such as diet cola or lemonade, commonly increase thirst. Tap water effectively relieves thirst but does not help keep fluid intake low.
Question 29.
The nurse is planning interventions for a school-age child hospitalized with acute poststrep-tococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include?
(a) playing a card game with someone the same age
(b) putting together a puzzle with mother
(c) playing video games with a 4-year-old
(d) watching a movie with a younger brother
Answer:
(a) playing a card game with someone the same age
Explanation:
Generally, school-age children enjoy activities with their peers first, then family members, and lastly younger children. School-age children like to be busy but also to accomplish something. This helps to meet their task of industry versus inferiority, feeling good about what they are able to accomplish.
Question 30.
A school-age child hospitalized with acute poststreptococcal glomerulonephritis during the acute stage has elevated blood pressure and low urine output for 14 hours. What should the nurse do next?
(a) Assess the child’s neurologic status.
(b) Encourage the child to drink more water.
(c) Advise the child to eat a low-sodium breakfast.
(d) Help the client to ambulate in the hallway.
Answer:
(a) Assess the child’s neurologic status.
Explanation:
The nurse should assess the child’s neurologic status because hypertensive encephalopathy is a major potential complication of the acute phase of glomerulonephritis. Seizure precautions also should be instituted. Hypertensive encephalopathy can result in transient loss of vision, hemiparesis, disorientation, and grand mal seizures.
Encouraging the child to drink more water is inappropriate because the child has had a low urine output for 14 hours. Typically, in this situation, fluids would be restricted. Although a low-sodium diet is encour-aged, it is not the priority action at this time. Initially, bed rest, not ambulation, is advocated dur-ing the acute phase of glomerulonephritis.
Question 31.
When developing the discharge plan for a school-age child diagnosed with acute poststrepto-coccal glomerulonephritis, which instruction should the nurse plan to discuss?
(a) Restrict dietary protein.
(b) Monitor pulse rate and rhythm.
(c) Prevent respiratory infections.
(d) Restrict foods high in potassium.
Answer:
(c) Prevent respiratory infections.
Explanation:
Children recovering from glomerulonephritis need to avoid exposure to all types of infections. Glomerulonephritis is caused by group A beta hemolytic streptococcus, a common cause of sore throat. As the child recovers, he or she may be susceptible to a recurrence if exposed to the organ-ism again. During convalescence from glomerulone-phritis, fluid and dietary restrictions are no longer indicated because the kidneys are now functioning normally. There is no need for the parents to assess the child’s vital signs.
Question 32.
The nurse reviews the medical record of an adolescent with a history of losing weight and fatigue is admitted to the hospital with a diagnosis of stage I chronic renal failure (see exhibit).
Intake
- Day 1: Intake 1,850 mL
- Day 2: Intake 2,200 mL
Output:
- Output 1,550 mL
- Output 1,150 mL
Answer:
- Day 1: Intake 1,850 mL
- Output 1,550 mL
Explanation:
The nurse would expect a person with a normal glomerular filtration rate (GFR) to have approximately equal inputs and outputs. Chronic renal failure has five stages. In stage I, the GFR is approximately > 90 mL/min/1.73 m2. In stage II, the GFR decreases to approximately 60 to 89 mL/ min/1.73 m2.
The decreased urine output may indicate worsening disease and should be reported. Assessing the client’s intake and output is still important, but notifying the provider is the priority. Fluids are restricted based on decreased sodium. Clients are encouraged to drink to thirst. Therefore, there is not enough information to suggest increas-ing or restricting fluids.
Question 33.
A parent of a child with acute poststreptococcal glomerulonephritis (APSGN) asks how a strep infection caused the child to have a kidney problem. What is the nurse’s best response?
(a) “The streptococcal infection spread through the bloodstream to your child’s kidneys.”
(b) “Your child made excessive antibodies to fight the infection that are now attacking the kidneys.”
(c) "By-products of immune complexes that fought the infection are depositing in the kidneys.”
(d) “The strep infection weakened your child’s immune system, making him susceptible to a secondary infection.”
Answer:
(c) "By-products of immune complexes that fought the infection are depositing in the kidneys.”
Explanation:
APSGN is an immune complex disease. Large antigen-antibody complexes are formed that deposit in the glomerular capillary loops leading to obstruction. APSGN is considered an autoimmune disorder, not an infection. Antibodies do not attack the kidneys in this disorder.
Question 34.
A child with nephrosis is taking prednisone. The nurse should teach the caregivers to report which adverse effects? Select all that apply.
(a) increased urinary output
(b) hematemesis
(c) respiratory infection
(d) bleeding gums
(e) vision problems
Answer:
(b) hematemesis
(c) respiratory infection
(e) vision problems
Explanation:
(b), (c) (e) Adverse effects of steroid therapy include edema of the face and trunk, increased susceptibility to infection, gastric and intestinal mucosal bleeding, sodium and water retention, and hypertension. Steroid therapy can also cause vision problems. Urinary output is decreased due to the retention of sodium. Bleeding gums do not result from steroids.
Question 35.
The nurse is caring for a 5-year-old boy who is taking prednisolone for nephrotic syndrome. The child is at the 75th percentile for height and has a blood pressure of 114/73 mm Hg. The nurse com-pares the reading to the below blood pressure levels for boys age and height percentiles. The nurse determines that the blood pressure represents a change and notifies the health care pro-vider (HCP) of the which assessment?
(a) hypotension
(b) prehypertension
(c) hypertension
(d) hypertension stage II
Answer:
(c) hypertension
Explanation:
Readings at or above the 95th percentile are considered indicative of hypertension. Here, both the systolic and diastolic readings are at the 95th percentile for a boy who is at the 75th percentile for height. This blood pressure may be a side effect of the medication or part of the disease process and needs to be reported. The charts do not define hypotension.
Readings below the 90th percentile are considered normal. Blood pressures at the 90th percentile but below the 95th are considered prehy-pertension. Blood pressures at the 99th percentile are considered stage II hypertension and are most likely to need antihypertensive medications.
Question 36.
The charge nurse reviews the laboratory results of a child admitted with nephrotic syndrome with a nurse new to the pediatric unit. The nurse is aware that teaching is required when the new nurse states that which finding is expected with nephrotic syndrome?
(a) hyperalbuminemia
(b) elevated triglycerides
(c) elevated cholesterol
(d) proteinuria
Answer:
(a) hyperalbuminemia
Explanation:
The child with nephrotic syndrome would present with hypoalbuminemia not hyperalbumin- emia due to a decrease of albumin in the bloodstream and to the increase in the glomerular permeability. Nephrotic syndrome is characterized by edema, massive proteinuria, hypoalbuminemia, hypoprotein- emia, hyperlipidemia, and altered immunity.
Question 37.
Which statement by the parent of a toddler diagnosed with nephrotic syndrome indicates that the parent has understood the nurse’s teaching about this disease?
(a) “My child really likes chips and bologna. I guess we will have to find something else.”
(b) “We will have to encourage lots of liquids. Did you say about 4 L every day?”
(c) “We worry about the surgery. Do you think we should do direct donation of blood?”
(d) “We understand the need for antibiotics. I just wish the antibiotics could be given by mouth.”
Answer:
(a) “My child really likes chips and bologna. I guess we will have to find something else.”
Explanation:
Children with nephrotic syndrome usually require sodium restriction. Because potato chips and bologna are high in sodium, the mother’s statement about finding something else reflects understanding of this need. Although fluid intake is not restricted in children with nephrotic syndrome, 4 L is an excessive amount for a toddler. The typical fluid requirement for a toddler is 115 mL/kg. Surgical intervention and antibiotic therapy are not parts of the treatment plan for nephrotic syndrome.
Question 38.
A toddler diagnosed with nephrotic syn-drome has a fluid volume excess related to fluid accumulation in the tissues. Which measure should the nurse anticipate including in the child’s plan of care?
(a) Limit visitors to 2 to 3 hours a day.
(b) Maintain strict bed rest.
(c) Test urine specific gravity every shift.
(d) Weigh the child before breakfast.
Answer:
(d) Weigh the child before breakfast.
Explanation:
The best indicator of fluid balance is weight. Therefore, daily weight measurements help determine fluid losses and gains. Although limiting visitors to 2 to 3 hours per day or maintaining strict bed rest would help to ensure that the child gets adequate rest, this is unrelated to the child’s fluid balance. In nephrotic syndrome, urine is tested for protein, not specific gravity.
Question 39.
The parent of a toddler with nephrotic syn-drome asks the nurse what can be done about the child’s swollen eyes. Which is the best measure that the nurse should suggest?
(a) Apply cool compresses to the child’s eyes.
(b) Elevate the head of the child’s bed.
(c) Apply eye drops every 8 hours.
(d) Limit the child’s television watching.
Answer:
(b) Elevate the head of the child’s bed.
Explanation:
The child’s swollen eyes are caused by fluid accumulation. Elevating the head of the bed allows gravity to increase the downward flow of fluids in the body, away from the face. Applying cool compresses or eye drops, or limiting television, may be comforting but will not relieve the swelling.
Question 40.
The nurse determines that interventions for decreasing fluid retention have been effective when the nurse makes which assessment in a child with nephrotic syndrome?
(a) decreased abdominal girth
(b) increased caloric intake
(c) increased respiratory rate
(d) decreased heart rate
Answer:
(a) decreased abdominal girth
Explanation:
Fluid accumulates in the abdomen and interstitial spaces owing to hydrostatic pressure changes. Increased abdominal fluid is evidenced by an increase in abdominal girth. Therefore, decreased abdominal girth is a sign of reduced fluid in the third spaces and tissues. When fluid accumulates in the abdomen and interstitial spaces, the child does not feel hungry and does not eat well.
Although increased caloric intake may indicate decreased intestinal edema, it is not the best and most accurate indicator of fluid retention. Increased respiratory rate may be an indication of increasing fluid in the abdomen (ascites) causing pressure on the dia-phragm. Heart rate usually stays in the normal range even with excessive fluid volume.
Question 41.
The toddler with nephrotic syndrome exhibits generalized edema. Which measure should the nurse institute for this child with impaired skin integrity related to edema?
(a) Ambulate every shift while awake.
(b) Apply lotion on opposing skin surfaces.
(c) Apply powder to skinfolds.
(d) Separate opposing skin surfaces with soft cloth.
Answer:
(d) Separate opposing skin surfaces with soft cloth.
Explanation:
Placing soft cloth between opposing skin surfaces absorbs moisture and keeps the area dry, thus preventing any further breakdown. The child with nephrotic syndrome and severe edema is usually maintained on bed rest. Therefore, ambulation is not appropriate. Applying lotion or powder to edematous surfaces that touch increases moisture and can lead to maceration, causing further breakdown.
Question 42.
A child with nephrosis is placed on predni-sone. The dose is 2 mg/kg/day to be administered twice a day. The child weighs 25 lb (11.3 kg). How many milligrams will the child receive at each dose? Record your answer using one decimal place.
Answer:
11.3mg
Explanation:
11.3 kg x 2 mg = 22.7 mg/day 22.7 mg -H 2 = 11.3 mg per dose
Question 43.
The toddler with nephrotic syndrome responds to treatment and is ready to go home. When helping the family plan for home care, the nurse should include which instruction in the teaching?
(a) Administer pain medication as needed.
(b) Keep the child away from others with an infection.
(c) Notify the health care provider (HCP) if there is an increase in the child’s urine output.
(d) Administer acetaminophen daily.
Answer:
(b) Keep the child away from others with an infection.
Explanation:
A child recovering from nephrotic syndrome should be protected from infection. Therefore, the nurse would teach the parents to keep the child away from others with an infection. Because pain is not associated with this disorder, pain medication typically is not needed. The HCP m should be notified if urine output decreases, not increases. In children recovering from nephrotic syndrome, there is no reason to administer acetaminophen daily.
Question 44.
The nurse is planning care with the parents of a child who requires continuous peritoneal dialysis. Which finding should be discussed with the health care provider (HCP)?
(a) The family lives a long distance from the medical facility.
(b) The child attends a large public school.
(c) The child reports having a previous surgery for a ruptured appendix.
(d) The family feels the child cannot self-regulate to wake at night and change bags.
Answer:
(c) The child reports having a previous surgery for a ruptured appendix.
Explanation:
A client who has had a ruptured appendix may have peritoneal scarring that may alter the effectiveness of treatment. Living a long distance from a medical facility is typically a reason to select peritoneal dialysis. Attending a large school is not a problem, but the school nurse needs to be included as part of the health care team. Typically, the treatment schedule can be planned to allow for uninterrupted sleep at night.
Question 45.
The nurse teaches the family of school-age child with acute renal failure about continuous ambulatory peritoneal dialysis. Which statement indicates that the family needs more teaching about peritoneal dialysis?
(a) “Dialysate bags should be weighed before filling and after draining.”
(b) “Sterile technique must be used when changing dialysate bags.”
(c) “Our child should remain quite during dialy sate dwell stage.”
(d) “We will instill dialysate at bedtime using a peritoneal dialysis machine.”
Answer:
(c) “Our child should remain quite during dialy sate dwell stage.”
Explanation:
One of the advantage of using continuous ambulatory peritoneal dialysis is that clients have more mobility. Fluid is manually filled into the abdomen and dwells for 3 to 6 hours. During the dwell phase the client may be mobile and participate in activities. The fluid is manually drained into the dialysate bag by gravity following the dwell phase. Dialysate bags are weighed before filling and after draining to determine the amount of fluid removal.
All forms of peritoneal dialysis carry the risk for infection, so sterile technique must be maintained with catheter care, dressing changes, and dialysate bag changes. A peritoneal dialysis machine is used with continuous cyclical peritoneal dialysis. This method is done at night and requires that the client remain in bed.
Question 46.
While performing daily peritoneal dialysis and catheter exit site care with the mother of a child with chronic renal failure, which information would be an important step to emphasize to the mother?
(a) Apply an occlusive dressing after cleaning the site.
(b) Change the dressing when the peritoneal space is dry.
(c) Examine the site for signs of infection while cleaning the area.
(d) Pull on the catheter to hold taut while cleaning the skin.
Answer:
(c) Examine the site for signs of infection while cleaning the area.
Explanation:
Until it heals, the catheter exit site is particularly vulnerable to invasion by pathogenic organisms. Therefore, the site must be monitored for signs of infection. An occlusive dressing is not needed because there is no danger of air being sucked in or out of the peritoneal space.
Furthermore, the catheter used is designed with a cuff so that the skin grows around the catheter, sealing off the area. Site care may be done at any time, but the child may experience abdominal discomfort if the peritoneal space is dry during site care. Holding the catheter taut or pulling on it may cause irritation of the skin at the exit site, which could lead to infection.
Question 47.
When developing the discharge teaching plan for a child with chronic renal failure and the family, the nurse should emphasize restriction of which nutrient?
(a) ascorbic acid
(b) calcium
(c) magnesium
(d) phosphorus
Answer:
(d) phosphorus
Explanation:
With minimal or absent kidney function, the serum phosphate level rises, and the ionized calcium level falls in response. This causes increased secretion of parathyroid hormone, which releases calcium from the bones. Therefore, the intake of foods high in phosphorus is restricted. Because renal failure results in decreased erythropoietin production, an increase in ascorbic acid intake is needed. Because magnesium is minimally affected by renal failure, its intake need not be restricted.
Question 48.
After the nurse emphasizes to an adolescent with renal failure the importance of maintaining a positive self-concept, which behavior by the adoles-cent should the nurse identify as an indicator that the plan is working?
(a) reports of headaches, abdominal pain, and nausea
(b) insistence on making diet choices even if the foods chosen are restricted
(c) verbalization of plans to quit all after-school activities when returning home
(d) demonstration of desire to do the dressing changes and take care of the medications
Answer:
(d) demonstration of desire to do the dressing changes and take care of the medications
Explanation:
Demonstration of desire to do the dressing changes and manage medications implies compliance with the medical regimen and acceptance of the condition, thereby indicating a positive selfimage. Diffuse somatic symptoms could indicate anxiety or problems with coping, with a negative effect on self-concept.
Insistence on choosing restricted foods implies that the adolescent has not accepted the diagnosis and is noncompliant, possibly indicating a negative self-concept. Social withdrawal from activities may indicate depression, possibly negatively affecting the self-concept.
Question 49.
Which diet plan would be appropriate for the nurse to discuss with the family of a child with acute renal failure?
(a) high carbohydrate and protein
(b) high fat and carbohydrate
(c) low fat and protein
(d) low carbohydrate and fat
Answer:
(b) high fat and carbohydrate
Explanation:
The child with acute renal failure needs extra calories to reduce tissue catabolism, metabolic acidosis, and uremia. Using a high-fat and high-car-bohydrate diet helps to supply the necessary extra calories. If the child is able to tolerate oral foods, concentrated food sources that are high in carbo-hydrate and fat but low in protein, potassium, and sodium may be provided.
Question 50.
An adolescent with chronic renal failure is scheduled to go home with a peritoneal dialysis catheter in place. When developing the discharge teaching plan for the client and the family focusing on psychosocial needs, the nurse should include which area as a priority?
(a) advantages of limiting social activities and contacts for the first few months
(b) not disclosing information about the peritoneal dialysis to people outside the family
(c) possible effect on body image of the presence of an abdominal catheter
(d) importance of relying on parents to do the dialysis and dressing changes
Answer:
(c) possible effect on body image of the presence of an abdominal catheter
Explanation:
For an adolescent, body image is a major concern. The presence of an abdominal catheter can greatly affect the client’s body image. The adolescent needs opportunities to discuss feelings about altered body image due to the catheter. Adolescents need to be with their peers and to maintain social activities and contacts in order to meet the developmental tasks for this age group.
The adolescent client may choose to confide in friends for both psychological health and physical safety. Because peers are most important to adolescents, they will confide in their peers before confiding in family members. Another major developmental need of the adolescent is achieving independence. Relying on the parents would interfere with the adolescent’s ability to do so.
Question 51.
During a home visit, the public health nurse assesses the peritoneal catheter exit site of a child with chronic renal failure. Which finding should lead the nurse to determine a client has an infection?
(a) dialysate leakage
(b) granulation tissue
(c) increased time for drainage
(d) tissue swelling
Answer:
(d) tissue swelling
Explanation:
Tissue swelling, pain, redness, and exudate indicate infection. Dialysate leakage is associated with improper catheter function, incomplete healing at the insertion site, or excessive instillation of dialysate. Granulation tissue indicates healing around the exit site, not infection. Increased time for drainage may indicate that the tube is kinked, suggesting an obstruction
Question 52.
After teaching the parent of a young child with a peritoneal catheter about the signs and symp-toms of peritonitis, the nurse determines that the parent has understood the teaching when she identi-fies which finding as an important sign?
(a) cloudy dialysate drainage return
(b) distended abdomen
(c) shortness of breath
(d) weight gain of 3 lb (1.36 kg) in 2 days
Answer:
(a) cloudy dialysate drainage return
Explanation:
Normally, dialysate drainage return should be clear. With peritonitis, large numbers of bacteria, white blood cells, and fibrin cause the dialysate to appear cloudy. Abdominal distention is unrelated to peritonitis. However, it might suggest an obstruction. Weight gain and shortness of breath are associ¬ated with fluid excess, not infection.
Question 53.
The nurse assesses the child with chronic renal failure who is receiving peritoneal dialysis for edema. Which finding is expected for this child?
(a) absence of pulmonary crackles
(b) increased dialysate outflow
(c) normal blood pressure
(d) pallor
Answer:
(d) pallor
Explanation:
With edema, pallor can occur owing to hemodilution as intestinal fluid moves to the vascular space. The child would exhibit pulmonary crackles secondary to pulmonary congestion and edema. Dialysate outflow would decrease, not increase, as the body attempts to conserve fluid. The child’s blood pressure would be increased because of excessive fluid volume.
Question 54.
The parent of a child with chronic renal failure who is receiving peritoneal dialysis at home asks the nurse what she can do if both inflow and drain times are increased. Which instructions would be most appropriate for the nurse to include when responding to the parent?
(a) Assess the child for constipation.
(b) Decrease the amount of dialysate infused for each dwell.
(c) Incorporate the increased inflow and drain times into the dialysis schedule.
(d) Monitor the child for shoulder pain during inflow and drain times.
Answer:
(a) Assess the child for constipation.
Explanation:
Accumulation of hard stool in the bowel can cause the distended intestine to block the holes of the catheter. Consequently, the dialysate cannot flow freely through the catheter. Decreasing the dialysate infusion may make the dialysis less effective. Altering fluid, electrolyte, and waste product removal can cause fluid and electrolyte imbalance and increased levels of blood urea nitrogen and creatinine.
Incorporating the increased times into the dialysis may make the dialysis less effective because fewer cycles can be scheduled. Shoulder pain, which may occur occasionally, can be caused by air in the peritoneal space and diaphragmatic irritation. However, it is unrelated to inflow and drain times.
Question 55.
The nurse determines that the parent under-stands the diet restrictions for a child with chronic renal failure who is receiving peritoneal dialysis when the parent reports providing a diet involving which components?
(a) sodium and water restrictions
(b) high protein and carbohydrates
(c) high potassium and iron
(d) protein and phosphorous restrictions
Answer:
(d) protein and phosphorous restrictions
Explanation:
Regulation of the diet is the most effective means, besides dialysis, for reducing renal excretion. Dietary phosphorus is restricted, which reduces the protein load on the kidneys. Clients are also given substances to bind phosphorus in the intestines to prevent absorption. Limited protein in the diet should include foods high in essential amino acids. Foods high in fat and carbohydrate are used to increase caloric intake. Sodium and water may not be restricted because of the continual loss of sodium and water through the dialysate. Iron-rich foods are commonly high in protein.
Question 56.
A toddler receiving chemotherapy after sur-gery for a Wilms’ tumor has developed neutropenia. The parent is trying to encourage the child to eat by bringing extra foods to the room. Which food would the nurse discourage for this child?
(a) fudge
(b) French fries
(c) fresh strawberries
(d) a milk shake
Answer:
(c) fresh strawberries
Explanation:
When a client receiving chemotherapy develops neutropenia, eating uncooked fruits and vegetables may pose a health risk due to possible bacterial contamination. All other foods are either cooked or pasteurized and would not produce a health risk.
Question 57.
When the nurse assesses a toddler with Wilms’ tumor, what should the nurse avoid?
(a) measuring the child’s chest circumference
(b) palpating the child’s abdomen
(c) placing the child in an upright position
(d) measuring the child’s occipitofrontal circumference
Answer:
(b) palpating the child’s abdomen
Explanation:
The abdomen of the child with Wilms’ tumor should not be palpated because of the danger of disseminating tumor cells. Techniques such as measuring the occipitofrontal circumference (which is done in children younger than 18 months of age because the anterior fontanelle closes between 12 and 18 months of age), upright positioning, and measuring chest circumference are not necessarily contraindicated; however, the child with Wilms’ tumor should always be handled gently and carefully.
Question 58.
Which statement by the parent of a child with Wilms’ tumor tells the nurse that the parent understands what stage II tumor means?
(a) “The tumor has extended beyond the kidney but was completely removed.”
(b) “Although the tumor was in the kidney, it has spread to the lung, liver, and bone.”
(c) “The tumor has extended outside the kidney to the lungs and the liver.”
(d) “The tumor was solely located in the kidney, but it was totally removed.”
Answer:
(a) “The tumor has extended beyond the kidney but was completely removed.”
Explanation:
A stage II tumor is one that extends beyond the kidney but is completely resected. The tumor staging is verified during surgery to maximize treat-ment protocols. The following criteria for staging are commonly used: stage I, tumor is limited to the kid-ney and completely resected; stage II, tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis occurs, with deposits beyond stage III (lung, bone and brain, liver); and stage V, bilateral renal involvement is present at diagnosis.
Question 59.
A child diagnosed with Wilms’ tumor under-goes successful surgery for removal of the diseased kidney. When the child returns to the room, the nurse should place the child in which position?
(a) modified Trendelenburg
(b) Sims’
(c) semi-Fowler’s
(d) supine
Answer:
(c) semi-Fowler’s
Explanation:
The child who has undergone abdominal surgery is usually placed in a semi-Fowler’s position to facilitate draining of abdominal contents and promote pulmonary expansion. The modified Trendelenburg position is used for clients in shock. The Sims’ position is likely to be uncomfortable for this child because of the large transabdominal inci-sion. The supine position, without the head ele-vated, puts the child at increased risk for aspiration.
Question 60.
After a child undergoes nephrectomy for a Wilms' tumor, the nurse should assess the child postoperatively for which early sign of a complication?
(a) increased abdominal distention
(b) elevated blood pressure
(c) increased respiratory rate
(d) increased urine output
Answer:
(a) increased abdominal distention
Explanation:
Children who have undergone abdominal surgery are at risk for intestinal obstruction from a dynamic ileus. Indications of intestinal obstruction include abdominal distention, decreased or absent bowel sounds, and vomiting. Later signs of intestinal obstruction include tachycardia, fever, hypotension, increased respirations, shock, and decreased urinary output.
Question 61.
When developing the discharge plan for a child who had a nephrectomy for a Wilms’ tumor, the nurse identifies outcomes to prevent damage to the child’s remaining kidney and to accomplish which goal?
(a) Minimize pain.
(b) Prevent dependent edema.
(c) Prevent urinary tract infection.
(d) Minimize sodium intake.
Answer:
(c) Prevent urinary tract infection.
Explanation:
Because the child has only one kidney, measures should be recommended to prevent urinary tract infection and injury to the remaining kidney. Severe pain and dependent edema are not associated with surgery for Wilms’ tumor. Dietary sodium is not restricted because function in the remaining kidney is not impaired.
Question 62.
The nurse reads the new medication pre-scriptions for a 4-year-old child with nephrotic syndrome (see exhibit). What action should the nurse take?
(a) Discontinue the prednisolone 40 mg and give the 30-mg dose today.
(b) Check the medication record first to see when the last dose of prednisolone was given.
(c) Start the 30-mg dose tomorrow.
(d) Contact the prescriber for clarification.
Answer:
(d) Contact the prescriber for clarification.
Explanation:
There are many problems with this medication prescription. The abbreviation QOD is ambiguous and open to various interpretations. The abbreviation D/C may be interpreted as “dis-continue” or “discharge.” The prescriber should have specifically stated when to start the lower dose because the nurse could reason beginning the medication that day, the next, or even the day after that. The only safe thing to do is call for clarification
Question 63.
The parent of an 18-year-old with chronic renal disease states, “My son has so many problems. I’m really worried that he won’t get the right care if he gets sick at college.” What is the nurse’s best response?
(a) “I can have his records sent to the school’s health center.”
(b) “Make sure your son always carries his nephrologist’s phone number.”
(c) “Your son can make an electronic history to facilitate his care if he gets sick away from home.”
(d) “Your son is going to need to learn to manage his own disease.”
Answer:
(c) “Your son can make an electronic history to facilitate his care if he gets sick away from home.”
Explanation:
Access to a well-constructed electronic history will facilitate care if the adolescent becomes ill while at college. Because the client is 18, legally the nurse cannot transfer the records to the school without permission. Also, the adolescent may need to seek treatment in facilities other than the health center.
Instructing the adolescent to always carry the nephrologist’s phone number is not bad advice, but compliance may vary, and there is no guarantee the provider will be available in all instances. Telling the parent that the son must learn to manage his own disease does not address the parent’s concern.
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