Peds: Final Exam NCLEX Questions

Peds: Final Exam NCLEX Questions

(Renal/Neuro/GI/Heme/Onc) Leave the first rating Students also studied Terms in this set (85) Science MedicinePaediatrics Save the child with a cardiovascular disor...26 terms Amanda_Armstrong12 Preview ATI RN Pediatric Nursing Online Pra...60 terms emilymbergers Preview pediatric genitourinary (nclex questi...22 terms Amanda_Armstrong12 Preview Pediatr 50 terms julie When performing a procedure related to a genitourinary (GU) problem, the nurse would anticipate that which of the following age groups would find it especially stressful?

• Infants
• Toddlers
• Preschoolers
• School-age children
• Preschoolers

In general, preschoolers have more fears because of their fantasies, contributing to fears of the simplest procedures. Castration fears also are prominent at this age and may be heightened by procedures related to GU problems. Typically, GU procedures do not create greater stress in infants, toddlers, and school-age children.When developing a teaching plan to prevent urinary tract infection, which of the following should be included?(Select all that apply.)

• Wearing underwear made of synthetic material such as

nylon

• Maintaining adequate fluid intake
• Keeping urine alkaline by avoiding acidic beverages
• Avoiding urination before and after intercourse
• Avoiding bubble baths and tight clothing
• Emptying bladder with each urination
• Maintaining adequate fluid intake
• Avoiding bubble baths and tight clothing
• Emptying bladder with each urination

Fluid intake helps dilute urine and minimize infection potential, bubble baths and tight clothing may act as irritants, and emptying the bladder fully with each urination prevents stasis. Children and teens should wear cotton underwear, keep their urine acidic, and void before and after intercourse (if sexually active).Which of the following organisms is the most common cause of urinary tract infection (UTI) in children?

• Staphylococcus
• Klebsiella
• Pseudomonas
• Escherichia coli
• Escherichia coli
• coli is the most common organism associated with the development of UTI.

Although Staphylococcus, Klebsiella, and Pseudomonas species may cause UTIs, the incidence of UTIs related to each is less than that for E. coli.

Which of the following would the nurse expect when assessing a child with cystitis?

• High fever
• Flank pain
• Costovertebral tenderness
• Dysuria
• Dysuria

Dysuria is a symptom of a lower urinary tract infection (UTI) such as cystitis. High fever, flank pain, and costovertebral tenderness are signs and symptoms of pyelonephritis, an upper UTI.Which of the following instructions would be included in a sexually active adolescent's preventive teaching plan about urinary tract infections?

• Wiping back to front
• Wearing nylon underwear
• Avoiding urinating before intercourse
• Drinking acidic juices
• Drinking acidic juices

Drinking acidic juices, such as cranberry juice, helps keep the urine at its desired acid pH and reduces the chance of infection. The client should wipe from front to back, wear cotton underwear, and void before and after intercourse.What is the most likely underlying pathophysiology of primary enuresis?

• Urinary tract infection
• Psychogenic stress
• Vesicoureteral reflux
• Delayed bladder maturation
• Delayed bladder maturation

The most likely cause of PE is delayed or incomplete maturation of the bladder.UTIs may cause either primary or secondary enuresis, but they are not the leading cause of PE. Psychogenic stress may cause either primary or secondary enuresis, but it is not the leading cause of PE. Vesicoureteral reflux may cause either primary or secondary enuresis, but it is not the leading cause of PE.Secondary vesicoureteral reflux usually results from which of the following?

• Congenital defects
• Infection
• Acidic urine
• Hydronephrosis
• Infection

Infection is the most common cause of secondary vesicoureteral reflux.Congenital defects cause primary vesicoureteral reflux. Acidic urine is normal and helps to prevent infection. Hydronephrosis may result from vesicoureteral reflux.Which of the following signs and symptoms are characteristic of minimal-change nephrotic syndrome?

• Gross hematuria, proteinuria, fever
• Hypertension, edema, hematuria
• Poor appetite, proteinuria, edema
• Hypertension, edema, proteinuria
• Poor appetite, proteinuria, edema

Clinical manifestations of nephrotic syndrome include loss of appetite due to edema of intestinal mucosa, proteinuria, and edema. Gross hematuria is not associated with nephrotic syndrome. Fever would occur only if infection also existed. Hypertension alone or accompanied by hematuria is associated with glomerulonephritis.For a child with recurring nephrotic syndrome, which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care?

• Muscle coordination
• Sexual maturation
• Intellectual development
• Body image
• Body image

Because of the edema associated with nephrotic syndrome, potential self- concept and body image disturbances related to changes in appearance and social isolation should be considered. Muscle coordination, sexual maturation, and intellectual function are not affected.

When teaching parents about known antecedent infections in acute glomerulonephritis, which of the following should the nurse cover?

• Herpes simplex
• Scabies
• Varicella
• Impetigo
• Impetigo

Impetigo, a bacterial infection of the skin, may be caused by streptococci and may precede acute glomerulonephritis. Although most streptococcal infections do not cause acute glomerulonephritis, when they do, a latent period of 10 to 14 days occurs between the infection, usually of the skin (impetigo) or upper respiratory tract, and the onset of clinical manifestations. Herpes, scabies, and varicella are not associated with acute glomerulonephritis.Which of the following should be avoided if the child has hypospadias?

• Circumcision
• Catheterization
• Surgery
• Intravenous pyelography (IVP)
• Circumcision

Hypospadias refers to a condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface (underside) of the penile shaft. The ventral foreskin is lacking, and the distal portion gives an appearance of a hood. Early recognition is important so that circumcision is avoided; the foreskin is used for the surgical repair. Catheterization may be used to ensure urinary elimination. Surgery is the procedure of choice to improve the child's ability to stand when urinating, improve the appearance of the penis, and preserve sexual adequacy. IVP is contraindicated if the child has an allergy to iodine or shellfish.The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis?

• "I'm so glad they didn't find any protein in his urine."
• "I noticed his urine was the color of coca-cola lately."
• "His health care provider said his kidneys are working

well."

• "The nurse who admitted my child said his blood

pressure was low."

• "I noticed his urine was the color of coca-cola lately."

Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis.Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common due to fluid volume overload secondary to the kidneys not working properly.The nurse performing an admission assessment on a 2- year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome?

• Hypertension
• Generalized edema
• Increased urinary output
• Frank, bright red blood in the urine
• Generalized edema

Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.The nurse is planning care for a child with hemolytic- uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure?

• Restrict fluids as prescribed.
• Care for the arteriovenous fistula.
• Encourage foods high in potassium.
• Administer analgesics as prescribed.
• Restrict fluids as prescribed.

Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis).

A 7-year-old child is seen in a clinic, and the health care provider documents a diagnosis of primary nocturnal enuresis. The nurse should provide which information to the parents?

• Primary nocturnal enuresis does not respond to

treatment.

• Primary nocturnal enuresis is caused by a psychiatric

problem.

• Primary nocturnal enuresis requires surgical

intervention to improve the problem.

• Primary nocturnal enuresis is usually outgrown without

therapeutic intervention.

• Primary nocturnal enuresis is usually outgrown without therapeutic intervention.

Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan?

• "Caution should be used when straddling the infant on

a hip."

• "Vital signs should be taken daily to check for bladder

infection."

• "Catheterization will be necessary when the infant does

not void."

• "Circumcision has been delayed to save tissue for

surgical repair."

• "Circumcision has been delayed to save tissue for surgical repair."

Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant should not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. Options 1, 2, and 3 are unrelated to this disorder.The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention?

• Cover the bladder with petroleum jelly gauze.
• Cover the bladder with a nonadhering plastic wrap.
• Apply sterile distilled water dressings over the bladder

mucosa.

• Keep the bladder tissue dry by covering it with dry

sterile gauze.

• Cover the bladder with a nonadhering plastic wrap.

In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The use of petroleum jelly gauze should be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucosa when removed.Which question should the nurse ask the parents of a child suspected of having glomerulonephritis?

• "Did your child fall off a bike onto the handlebars?"
• "Has the child had persistent nausea and vomiting?"
• "Has the child been itching or had a rash anytime in the

last week?"

• "Has the child had a sore throat or a throat infection in

the last few weeks?"

• "Has the child had a sore throat or a throat infection in the last few weeks?"

Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The assessment data in options 1, 2, and 3 are unrelated to a diagnosis of glomerulonephritis.