NURS PEDS EXAM QUESTIONS WITH ANSWERS 2023 A+ QUESTIONS WITH ANSWERS GUARANTEED SUCCESS, Exams of Nursing

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Origin: Chapter 26, 1

1. The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess? A) The child has above-normal growth for his age. B) The child is active and playful. C) The skin is pink and healthy looking. D) It is difficult to keep the child awake. Ans: D Feedback: The parents may state, during the health history, that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable. Origin: Chapter 26, 2
2. The nurse is caring for an 8-year-old girl with hyperpituitarism. What ordered treatment will the nurse expect to perform? A) Give desmopressin acetate intranasally B) Inject octreotide acetate C) Give 1 mg/kg/day of methimazole D) Administer glipizide orally Ans: B Feedback: The nurse would give the child a subcutaneous injection of octreotide acetate every 12 hours as directed. Desmopressin is a synthetic antidiuretic hormone used to treat diabetes insipidus. Methimazole is an antithyroid drug used to treat hyperthyroidism. Glipizide is a hypoglycemic drug that assists insulin production in children with diabetes mellitus type 2. Origin: Chapter 26, 3
3. The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis? A) Deficient fluid volume related to dehydration B) Excess fluid volume related to edema C) Deficient knowledge related to fluid intake regimen D) Imbalanced nutrition, more than body requirements related to excess weight Ans: A

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Feedback: The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss. Origin: Chapter 26, 4

4. The nurse is assessing a 9-year-old girl with a history of tuberculosis at age 6 years. She has been losing weight and has no appetite. The nurse suspects Addison disease based on which assessment findings? A) Arrested height and increased weight B) Thin, fragile skin and multiple bruises C) Hyperpigmentation and hypotension D) Blurred vision and enuresis Ans: C Feedback: Hyperpigmentation and hypotension would point to Addison disease. Arrested height and increased weight are typical of acquired hypothyroidism; this girl has lost weight. Thin, fragile skin and multiple bruises are indicative of Cushing syndrome. Blurred vision, headaches, and enuresis would be complaints of a child with diabetes mellitus. Origin: Chapter 26, 5
5. The nurse is caring for a 13-year-old girl with delayed puberty. Based on the nurse's knowledge of this condition, the nurse would include which nursing diagnosis in the child's plan of care? A) Disabled family coping related to the child's disorder B) Imbalanced nutrition, less than body requirements related to the child's short stature C) Noncompliance related to the need for lifelong hormone therapy D) Deficient knowledge related to the administration of estradiol Ans: D

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Feedback: Deficient knowledge related to the administration of estradiol is an appropriate nursing diagnosis for this child. There are oral, transdermal, topical, injectable, and vaginal preparations available. Disabled family coping due to the child's disorder and noncompliance due to long-term therapy are not likely diagnoses because of the simplicity and brevity of the treatment for this disorder. Imbalanced nutrition evidenced by short stature would be appropriate for a child with growth hormone deficiency. Origin: Chapter 26, 6

6. The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. What would the nurse identify as the initial goal for the teaching plan? A) Developing management and decision-making skills B) Educating the parents about diabetes mellitus type 1 C) Developing a nutritionally sound, 30-day meal plan D) Promoting independence with self-administration of insulin Ans: A Feedback: Developing basic management and decision-making skills related to the diabetes is the initial goal of the teaching plan for this child and family. The nurse would have provided a basic description of the disorder after it was diagnosed. Development of a detailed monthly meal plan would come later, perhaps after consulting with a nutritionist. It is too soon to expect the boy to administer his own insulin. Origin: Chapter 26, 7
7. The nurse is caring for an 8-year-old girl with an endocrine disorder involving the posterior pituitary gland. What care would the nurse expect to implement? A) Instructing the parents to report adverse reactions to the growth hormone treatment B) Teaching the parents how to administer the desmopressin acetate C) Informing the parents that treatment stops when puberty begins D) Educating the parents to report signs of acute adrenal crisis Ans: B

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Feedback: The nurse would teach the parents how to administer desmopressin acetate, which treats diabetes insipidus, a disorder related to the posterior pituitary gland. Instructing parents to report adverse reactions to growth hormone is an intervention for growth hormone deficiency. Informing the parents that treatment stops at the normal time of puberty is a teaching intervention for precocious puberty. Educating the parents to report signs of an acute adrenal crisis is an intervention for congenital adrenal hyperplasia. All three of these other disorders are related to the anterior pituitary. Origin: Chapter 26, 8

8. The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with disorder? A) The parents report that their child had "a cold or flu" recently. B) Blood pressure is decreased when checking vital signs. C) The parents report that their son "can't drink enough water." D) Auscultation reveals Kussmaul breathing. Ans: C Feedback: Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes. Origin: Chapter 26, 9
9. The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. What information would the nurse include in the plan? A) Describing surgery to remove an anterior pituitary tumor B) Teaching her parents to give injections of growth hormone C) Explaining about the radioactive iodine procedure D) Showing her parents how to give DDAVP intranasally Ans: C Feedback: Explaining about the radioactive iodine procedure would be part of the teaching plan for a child with hyperthyroidism because this is a less invasive type of therapy for the disorder. Describing surgery to remove an anterior pituitary tumor would be included for a child with hyperpituitarism. Teaching a parent to give injections of growth hormone would be appropriate for a child with a growth hormone deficiency. Showing parents how to give DDAVP intranasally is appropriate for a child with diabetes insipidus.

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Origin: Chapter 26, 10

10. What finding would the nurse expect to assess in a child with hypothyroidism? A) Nervousness B) Heat intolerance C) Smooth velvety skin D) Weight gain Ans: D Feedback: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism. Origin: Chapter 26, 11
11. The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for evaluation because the child has had persistent vomiting. What finding would lead the nurse to suspect that the child is experiencing an acute adrenal crisis? A) Hypernatremia B) Bradycardia C) Hypertension D) Hyperkalemia Ans: D Feedback: Signs and symptoms of an acute adrenal crisis include hyperkalemia, hyponatremia, tachycardia, hypotension, persistent vomiting, dehydration, and shock. Origin: Chapter 26, 12
12. A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. What would the nurse do next? A) Administer a sliding-scale dose of insulin. B) Give 10 to 15 grams of a simple carbohydrate. C) Offer a complex carbohydrate snack. D) Administer glucagon intramuscularly. Ans: B

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Feedback: The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 grams of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent. Origin: Chapter 26, 13

13. A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy? A) Rapid weight gain B) Complaints of headaches C) Height increase of 4 inches D) Growth plate closure Ans: C Feedback: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close. Origin: Chapter 26, 14
14. After teaching the parents of a daughter with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching? A) "She needs to use the nasal spray once every day." B) "She'll start puberty again when the medication stops." C) "This medication will slow down the changes but not reverse them." D) "Once therapy is done, she'll need surgery." Ans: B Feedback: Treatment for central precocious puberty involves administering a gonadotropin- releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages. This analog can be given by depot injection every 3 to 4 weeks, a daily subcutaneous injection, or an intranasal spray two or three times per day. With GnRH analog treatment, secondary sexual development stabilizes or regresses. Surgery is indicated only if there is a tumor.

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Origin: Chapter 26, 15

15. A group of nursing students are reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state: A) Endocrine glands begin developing in the third trimester of gestation. B) At birth, the endocrine glands are completely functional. C) Infants have difficulty balancing glucose and electrolytes. D) A child's endocrine system has little effect on growth and development. Ans: C Feedback: Typically, most endocrine glands begin to develop during the first trimester of gestation, but their development is incomplete at birth. Thus, complete hormonal control is lacking during the early years of life, and the infant cannot appropriately balance fluid concentration, electrolytes, amino acids, glucose, and trace substances. Origin: Chapter 26, 16
16. A child is diagnosed with hyperthyroidism. Which agent would the nurse expect the physician to prescribe? A) Mineralocorticoid B) Methimazole C) Levothyroxine D) Dexamethasone Ans: B Feedback: Methimazole is an antithyroid drug that is used to treat hyperthyroidism. Mineralocorticoid is used to treat adrenal insufficiency. Levothyroxine is used to treat hypothyroidism. Dexamethasone is used to treat congenital adrenal hyperplasia. Origin: Chapter 26, 17
17. A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which condition? A) Syndrome of inappropriate antidiuretic hormone (SIADH) B) Thyroid storm C) Cushing syndrome D) Vitamin D toxicity Ans: A

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Feedback: SIADH, although rare in children, is a potential complication of excessive administration of vasopressin. Thyroid storm may result from overadministration of levothyroxine (thyroid hormone replacement). Cushing syndrome is associated with corticosteroid use. Vitamin D toxicity may result from the use of vitamin D as treatment of hypoparathyroidism. Origin: Chapter 26, 18

18. The nurse is reviewing the laboratory test results of a child with Addison disease. What would the nurse expect to find? A) Hypernatremia B) Hyperkalemia C) Hyperglycemia D) Hypercalcemia Ans: B Feedback: With Addison disease, the child would exhibit hyperkalemia, hyponatremia, and hypoglycemia. Hypercalcemia would be associated with hyperparathyroidism. Origin: Chapter 26, 19
19. A nurse is teaching the parents of an infant with congenital adrenal hyperplasia about the signs and symptoms of adrenal crisis. The nurse determines that the teaching was successful when the parents correctly identify what sign of adrenal crisis? A) Bradycardia B) Constipation C) Fluid overload D) Persistent vomiting Ans: D Feedback: Signs and symptoms of acute adrenal crisis include persistent vomiting, dehydration, hyponatremia, hyperkalemia, hypotension, tachycardia, and shock. Origin: Chapter 26, 20
20. A group of students are reviewing information about the various types of insulin used to treat type 1 diabetes. The students demonstrate understanding of the information when they identify which of these insulins as having the longest duration? A) Lispro

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B) Regular C) NPH D) Glargine Ans: D Feedback: Of the insulins listed, glargine (Lantus) has the longest duration of action, that is, 12 to 24 hours. Lispro lasts approximately 3 to 5 hours; regular lasts 5 to 8 hours; and NPH lasts approximately 10 to 16 hours. Origin: Chapter 26, 21

21. A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control? A) 9.0% B) 8.2% C) 7.3% D) 6.9% Ans: B Feedback: For a child 6 years of age and younger, the target HbA1C level should be less than 8.5% but greater than 7.5%. For children between the ages of 6 to 12 years, the target HbA1C level is less than 8%. For children and adolescents between 13 to 19 years of age, the target HbA1C level would be less than 7.5%. Origin: Chapter 26, 22
22. The parents of a 7-year-old girl with type 1 diabetes has been recording her blood glucose measurements before meals and at bedtime for the past 4 days; they are as follows: Monday Tuesday Wednesday Thursday B: 120 mg/dL 135 mg/dL 124 mg/dL 200 mg/dL L: 110 mg/dL 120 mg/dL 140 mg/dL 220 mg/dL D: 90 mg/dL 140 mg/dL 130 mg/dL 200 mg/dL Bed: 110 mg/dL 110 mg/dL 160 mg/dL 240 mg/dL The parents bring the child in for a follow-up visit and show the nurse the results. Based on the results, the nurse would need to obtain additional information from the parents and child about which day? A) Monday B) Tuesday

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C) Wednesday D) Thursday Ans: D Feedback: Blood glucose levels for a child who is 7 years of age should range from 90 to 180 mg/dL before meals and from 100 to 180 mg/dL before bedtime. On Thursday, the results for each testing were above normal. Therefore, the nurse needs to gather additional information about this day. Origin: Chapter 26, 23

23. The nurse is administering 10 units of NPH insulin to a child at 8 a.m. The nurse would expect this insulin to begin acting at which time? A) By 8:15 a.m. B) Between 8:30 and 9 a.m. C) Between 9 and 11 a.m. D) Around 12 noon Ans: C Feedback: NPH insulin has an onset of action of 1 to 3 hours, so the drug would begin to act between 9 and 11 a.m. A rapid-acting insulin would begin to act by 8:15 a.m.; regular insulin would begin to act between 8:30 and 9 a.m. No type of insulin would begin acting around 12 noon. Origin: Chapter 26, 24
24. The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on what findings? Select all that apply. A) Blurred vision B) Dry, flushed skin C) Diaphoresis D) Slurred speech E) Fruity breath odor F) Tachycardia Ans: C, D, F

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Feedback: Manifestations of hypoglycemia include behavioral changes, confusion, slurred speech, belligerence, diaphoresis, tremors, palpitation, and tachycardia. Blurred vision; dry, flushed skin; and fruity breath odor suggest hyperglycemia. Origin: Chapter 26, 25

25. A nurse is preparing a presentation for a group of parents with children diagnosed with diabetes type 1. The children are all adolescents. What issues would the nurse need to address? Select all that apply. A) Self-monitoring of blood glucose levels B) Feelings of being different C) Deficient decision-making skills D) Body image conflicts E) Struggle for independence Ans: C, D, E Feedback: Adolescents are undergoing rapid physical, emotional, and cognitive growth. Working toward a separate identity from parents and the demands of diabetic care can hinder this. This struggle for independence can lead to nonadherence of the diabetic care regimen. Conflicts develop with self-management, body image, and peer group acceptance. Teens may acquire the skills to perform tasks related to diabetic care but may lack decision- making skills needed to adjust treatment plan. Teens do not always foresee the consequences of their activities. Self-monitoring of blood glucose levels and feelings of being different are issues common to school-age children. Origin: Chapter 26, 26
26. A group of nursing students are reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify what as the primary function of this system? A) Regulation of water balance B) Hormonal secretion C) Cellular metabolism D) Growth stimulation Ans: B

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Feedback: The endocrine system consists of various glands, tissues, or clusters of cells that produce and release hormones. Hormones are chemical messengers that stimulate and/or regulate the actions of other tissues, organs, or endocrine glands that have specific receptors to a hormone. Along with the nervous system, the endocrine milieu influences all physiologic effects such as growth and development, metabolic processes related to fluid and electrolyte balance and energy production, sexual maturation and reproduction, and the body's response to stress. The release patterns of the hormones vary, but the level in the body is maintained within specified limits to preserve health. Origin: Chapter 26, 27

27. A child has been prescribed growth hormone. When collecting data from this patient, which report is of the greatest concern? A) "I sometimes have headaches." B) "I feel tired." C) "My hips often hurt." D) "I take this medication with food." Ans: C Feedback: Limping or complaints of hip pain are of concern. This may signal issues with the epiphysis and warrants further evaluation. Headaches and fatigue are not associated with medication. Taking this medication with food is not contraindicated. Origin: Chapter 26, 28
28. A 6-year-old child has been diagnosed with growth hormone deficiency. The child's mother requests more information about this condition. Which statements should be included in the nurse's response? Select all that apply. A) "The majority of children who have this condition are born of normal weight and length." B) "There are several potential causes of this condition." C) "This condition is most likely related to dwarfism in past generations of your family." D) "Most children with this condition are nutritionally deprived." E) "Your child most likely does not eat adequate amounts of protein." Ans: A, B

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Feedback: Growth hormone deficiency can result from a variety of causes. These causes may include genetic mutations, tumors, infection and birth trauma. Some cases have not identifiable causes. Most children diagnosed with this condition are of normal length and weight at birth but in childhood fall behind in growth. A small proportion of children may have nutritional concerns. Origin: Chapter 26, 29

29. The nurse is caring for a 9-year-old patient newly diagnosed with diabetes. The patient has polyuria, polydipsia, and weight loss. Which nursing diagnoses will the nurse include in the care plan? Select all that apply. A) Imbalanced nutrition: less than body requirements B) Deficient fluid volume C) Deficient knowledge regarding disease process D) Noncompliance E) Delayed growth and development Ans: A, B, C Feedback: Polyuria (excessive urination), polydipsia (excessive thirst), and weight loss support the diagnoses of Deficient fluid volume and Imbalanced nutrition: less than body requirements. Being newly diagnosed with the disease at the age of 9 supports the diagnosis of Deficient knowledge regarding disease process. There is no data to support Noncompliance or Delayed growth and development. Origin: Chapter 26, 30
30. A teenage girl diagnosed with polycystic ovary syndrome tells the nurse, "I refuse to take oral contraceptives since I am not sexually active." What is the best response to the girl? A) "It's important for you to take the pills even if you're not sexually active in order to prevent unwanted symptoms of the disease." B) "The doctor has prescribed these for you because it is an effective treatment method for the disease." C) "I know it's hard remembering to take those pills every day. Tell me more about what is making you not want to take the oral contraceptives." D) "Do your parents know that you are not taking the treatment medication your doctor prescribed?" Ans: C

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Feedback: This response shows empathy to the client and encourages her to further discuss the reasons they are non-compliant with the prescribed treatment regimen. "It's important for you to take the pills even if you're not sexually active...," and "The doctor has prescribed these for you because it is an effective treatment..." are accurate statements, but they are not methods of therapeutic communication and do not lead to further discussion about the noncompliance. Asking if the parents know she isn't taking the medications leads to mistrust of the nurse. Origin: Chapter 21, 1 gu

1. The nurse is caring for a child who is experiencing an acute renal transplant rejection and is to receive muromonab-CD3. What would the nurse most likely expect to assess after the first dose is administered? A) Fever with chills, chest tightness B) Cough, hyperkalemia C) Photosensitivity, gastrointestinal (GI) upset D) Urinary retention, decreased appetite Ans: A Feedback: The first dose of muromonab-CD3 can cause fever, chills, chest tightness, wheezing, nausea, and vomiting. Cough and hyperkalemia are associated with angiotensin- converting enzyme inhibitors. Photosensitivity and GI upset are often associated with diuretics. Urinary retention and decreased appetite are associated with imipramine. Origin: Chapter 21, 2
2. The nurse is visually inspecting a urine specimen from a 12-year-old boy. The nurse documents gross hematuria with a specimen of which color? A) Cloudy yellow B) Cola colored C) Pale to almost clear urine D) Light orange to moderately yellow colored Ans: B Feedback: Gross hematuria causes the urine to appear tea, cola, or even dirty green colored. Cloudy urine is typically a sign of infection. Normal urine ranges from moderately yellow to pale or almost clear. Orange-colored urine can occur because of medication.

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Origin: Chapter 21, 3

3. The nurse is caring for a 4-year-old with a suspected urinary tract infection. What would be most appropriate when obtaining a urine specimen from the child? A) "I will need a urine sample." B) "Let your mom help you tinkle in this cup." C) "Please tinkle in this cup right now." D) "Please void in this cup instead of the toilet." Ans: B Feedback: The nurse needs to use familiar terms to explain to the child what is needed and to gain cooperation. The most positive approach would be to let the child's mother help rather than demanding that he tinkle right now. Using the terms "urine sample" or "void" is not appropriate for a 4-year-old. Origin: Chapter 21, 4
4. The nurse is providing postsurgical care for an infant who has undergone a hypospadias repair. Which action by the nurse would be most important to help keep the area clean while maintaining proper position of the drainage tubing? A) Keeping the drainage tube taped in an upright position B) Administering antibiotics as ordered C) Administering analgesics as prescribed D) Using a double-diapering technique Ans: D Feedback: Double diapering is a method used to protect a child's urethra and stent or catheter after surgery and additionally helps to keep the area clean and free from infection. Keeping the drainage tube taped in an upright position, administering antibiotics, and administering analgesics are also important, but double diapering keeps the area clean and helps prevent infection. Origin: Chapter 21, 5
5. The nurse is caring for an infant with bladder exstrophy. As part of the infant's preoperative plan of care, the nurse monitors for abdominal skin excoriation. Which action would be most appropriate for promoting healing and preventing further skin breakdown? A) Cleaning the area well with a scented diaper wipe B) Applying a barrier/healing cream or paste on skin

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C) Keeping the bladder moist and covered with a sterile bag D) Covering the area with sterile gauze pads after tub baths Ans: B Feedback: The nurse should use a barrier/healing cream or paste on surrounding skin to promote healing and prevent further skin breakdown. Diaper wipes that contain fragrance or alcohol can sting if used on nonintact skin and can worsen skin breakdown. It is important to protect the bladder, but this will not address the skin excoriation. Meticulous attention to cleanliness is important, but the nurse should sponge-bathe the infant rather than immerse him in water to prevent pathogens from the water possibly entering the bladder. Origin: Chapter 21, 6

6. The nurse is caring for a 4-year-old girl with vulvovaginitis. After explaining to the girl's mother how to help prevent subsequent episodes, which statement by the mother indicates a need for additional teaching? A) "She needs to wipe from front to back." B) "I will make sure she changes her underwear every day." C) "She should probably avoid bubble baths." D) "I will help supervise her wiping after bowel movements." Ans: A Feedback: At the age of 4, the mother should not assume that the girl will wipe properly. The mother will need to supervise her wiping in order to train her properly. Making sure the child changes her underwear daily, avoiding bubble baths, and supervising her wiping after bowel movements indicate that the mother has understood the instructions. Origin: Chapter 21, 7
7. A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test? A) Checking with the parents for any allergies B) Ensuring adequate hydration C) Giving the girl an enema D) Screening her for pregnancy Ans: A

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Feedback: It is important to double-check whether the girl has any allergies. The test is contraindicated in children allergic to shellfish or iodine. Adequate hydration is also important, but the check for allergies is a priority. Only females of reproductive age must be screened for pregnancy. An enema is not necessary at all institutions. Origin: Chapter 21, 8

8. A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication? A) Weight loss B) Hypotension C) Signs of infection D) Hair loss Ans: C Feedback: The parents should be especially alert for signs of infection as cyclosporine is an immunosuppressant drug. Weight gain instead of weight loss, hypertension instead of hypotension, and increased facial hair instead of hair loss are some other potential side effects. Origin: Chapter 21, 9
9. The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response would alert the nurse to a confirmed risk factor for this condition? A) "She has been very healthy up to now." B) "He just got over a head cold with laryngitis." C) "My child is just 18 months old." D) "My child has not been sick at all." Ans: B Feedback: Known risk factors include a recent episode of pharyngitis or other streptococcal infection, age older than 2 years, and male sex.

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Origin: Chapter 21, 10

10. The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A) "Let's put you in touch with some other girls who are also having the same body changes." B) "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C) "Your real friends do not care about your appearance and just want you to get well." D) "You are beautiful in your own way; what matters is what is on the inside." Ans: A Feedback: It is important to introduce the girl to other youngsters with chronic renal conditions so she does not feel so isolated. Adolescents need interaction with peers. Telling the girl that this is a temporary condition, her real friends don't care about her appearance, and she is beautiful in her own way dismisses the girl's concerns and does not offer solutions. Nephrotic syndrome is a chronic condition, so telling her the condition is temporary also is inaccurate. Origin: Chapter 21, 11
11. An 8-year-old girl is scheduled for a renal ultrasound. What would the nurse include in the plan of care when preparing the child for this test? A) Withholding food and fluids after midnight B) Checking the child for allergies to shellfish C) Ensuring the child has a full bladder D) Informing the child she should feel no discomfort Ans: D Feedback: The nurse should inform the child that she should feel no discomfort during the test. No fasting is required and no dye is used, so allergies are not a concern. A full bladder is needed for urodynamic studies. Origin: Chapter 21, 12
12. The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). What would the nurse encourage the parents to avoid? A) Liberal fluid intake B) Caffeine C) Cranberry juice

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D) Cotton underwear Ans: B Feedback: Caffeine is an irritant to the bladder and should be avoided. Liberal fluid intake and cranberry juice should be encouraged. The child should wear cotton underwear to avoid perineal irritation. Origin: Chapter 21, 13

13. The mother of a child with end-stage renal disease asks the nurse why her son is getting an injection of erythropoietin. When responding to the mother, the nurse explains this as the rationale. A) To treat low calcium levels B) To stimulate growth in stature C) To stimulate red blood cell growth D) To correct acidosis Ans: C Feedback: Erythropoietin is given to stimulate red blood cell growth. Vitamin D and calcium are used to correct hypocalcemia. Growth hormone is used to stimulate growth in stature. Bicitra or sodium bicarbonate tablets are used to correct acidosis. Origin: Chapter 21, 14
14. A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding? A) Decreased blood urea nitrogen (BUN) and creatinine B) Decreased platelets and leukocytosis C) Hypernatremia and hypokalemia D) Respiratory acidosis and proteinuria Ans: B Feedback: The child with HUS typically exhibits severe thrombocytopenia (decreased platelets) and leukocytosis. BUN and creatinine are elevated. Hyponatremia, hyperkalemia, metabolic acidosis, and proteinuria also may be noted.

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Origin: Chapter 21, 15

15. After teaching the parents of a child with a hydrocele a fluid-filled sac around a testicle, about this condition, which statement indicates that the teaching was successful? A) "If this gets worse and we don't treat it, our son could become infertile." B) "This condition should gradually go away on its own." C) "The surgeon is going to operate on him immediately." D) "It's going to be difficult putting ice packs on his scrotum." Ans: B Feedback: Hydrocele requires watchful waiting because it will usually resolve spontaneously on its own. Hydrocele is not associated with the development of infertility; a varicocele, if left untreated, can lead to infertility. Immediate surgery is warranted for testicular torsion. Ice packs to the scrotum are helpful in relieving pain associated with epididymitis. Origin: Chapter 21, 16
16. A nurse is conducting a physical examination of an infant and observes the urethral opening on the dorsal side of the penis. The nurse documents this finding as: A) hypospadias. B) epispadias. C) varicocele. D) hydrocele. Ans: B Feedback: Epispadias is a urethral defect in which the opening is on the dorsal surface of the penis. Hypospadias is a urethral defect in which the opening is on the ventral surface of the penis rather than at the end. Varicocele is a venous varicosity along the spermatic cord manifested as a scrotal swelling. Hydrocele is a benign condition in which fluid accumulates in the scrotal sac. Origin: Chapter 21, 17
17. A 15-year-old boy comes to the emergency department accompanied by his parents. The boy reports an abrupt onset of sudden pain on the right side of his scrotum. When asked to rate his pain on a scale of 1 to 10, with 10 being the most severe, the boy states, "It's a 12." Further assessment reveals a blue-black swelling on the affected side. The nurse suspects testicular torsion and immediately notifies the physician because: A) the condition is a surgical emergency. B) the boy is at risk for sepsis.

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C) intravenous antibiotics need to be initiated. D) renal failure is imminent. Ans: A Feedback: Testicular torsion is a surgical emergency that necessitates immediate surgical correction to prevent testicular necrosis and possible gangrene. There is no infection with testicular torsion, intravenous antibiotics are not used to treat this condition, and renal failure is not imminent. Origin: Chapter 21, 18

18. The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find? A) Hyperlipidemia B) Hypoalbuminemia C) Decreased blood urea nitrogen (BUN) D) Hypoproteinemia Ans: C Feedback: With nephrotic syndrome, proteinuria, hyperlipidemia, decreased serum protein levels (hypoproteinemia), and decreased serum albumin levels (hypoalbuminemia) are present. BUN typically becomes elevated. Origin: Chapter 21, 19
19. The nurse is applying a urine bag to a 15-month-old boy to collect a urine specimen. Which action would the nurse take first? A) Apply benzoin to the scrotal area. B) Tuck the bag downward inside the diaper. C) Pat the perineal area dry after cleaning. D) Apply the narrow portion of the bag on the perineal space. Ans: C

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Feedback: When applying a urine bag, the nurse would first cleanse the perineal area well and pat it dry. If a culture was to be obtained, the nurse would cleanse the genital area with povidone–iodine or according to institutional protocol. Next the nurse would apply benzoin around the scrotum and allow it to dry. Then the nurse would apply the urine bag, making sure that the penis is fully inside the bag, tucking it downward inside the diaper to discourage leaking. Origin: Chapter 21, 20

20. A group of students are reviewing information about renal failure in children. The students demonstrate a need for additional teaching when they identify which agent as a potential contributor to renal failure? A) Vancomycin B) Gentamicin C) Co-trimoxazole D) Amoxicillin Ans: D Feedback: Amoxicillin is a penicillin and is not associated with nephrotoxicity leading to renal failure. Vancomycin, gentamicin (an aminoglycoside), and co-trimoxazole (a sulfonamide) are nephrotoxic. Origin: Chapter 21, 21
21. A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause? A) Klebsiella B) Escherichia coli C) Staphylococcus aureus D) Pseudomonas Ans: B Feedback: E. coli most commonly causes UTI. Other less common causative organisms include Klebsiella, S. aureus , and Pseudomonas.

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Origin: Chapter 21, 22

22. A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant? A) "She's been constipated quite a few times." B) "We've noticed that her bed is wet in the morning." C) "She had surgery to repair a problem with her anus." D) "She had a bacterial skin infection about a week ago." Ans: C Feedback: Risk factors associated with obstructive uropathy include prune belly syndrome, chromosome abnormalities, anorectal malformations, and ear defects. The statement about surgery to repair an anal problem suggests an anorectal malformation. Constipation is a risk factor for urinary tract infections. Bedwetting suggests enuresis. A bacterial skin infection is associated with acute glomerulonephritis. Origin: Chapter 21, 23
23. The nurse is assessing a child with acute poststreptococcal glomerulonephritis. What would the nurse expect to assess? Select all that apply. A) Irritability B) Abdominal pain C) Hypertension D) Crackles E) Polyphagia Ans: B, C, D Feedback: Assessment findings associated with acute poststreptococcal glomerulonephritis include fatigue, lethargy, abdominal pain, hypertension, crackles, and anorexia. Origin: Chapter 21, 24
24. A nurse identifies a nursing diagnosis of impaired urinary elimination related to urinary tract infection. When developing the plan of care, what would be most important for the nurse to do first? A) Develop a schedule for bladder emptying. B) Encourage fluid intake. C) Assess usual voiding patterns. D) Monitor intake and output.

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Ans: C Feedback: The first action would be to assess the child's usual voiding patterns to establish a baseline to develop an appropriate schedule for bladder emptying. Encouraging fluid intake and monitoring intake and output would be appropriate, but these would not be the first action. Origin: Chapter 21, 25

25. While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate? A) "Girls have a smaller bladder size than boys do." B) "A girl's urethra is closer to the rectal opening." C) "A girl's urethra is longer than a boy's urethra." D) "Her kidneys are less well protected." Ans: B Feedback: In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination. Bladder size does not differ between boys and girls. The kidneys are less well protected in the abdomen, increasing the risk for injury but not UTIs. Origin: Chapter 21, 26
26. A child returns from surgery in which a stoma was created in the abdominal wall to the bladder. The nurse identifies this as a: A) vesicostomy. B) ureteral stent. C) continent urinary diversion. D) bladder augmentation. Ans: A Feedback: A vesicostomy refers to a stoma created in the abdominal wall to the bladder. A ureteral stent is a thin catheter temporarily placed in the ureter to drain urine. A continent urinary diversion uses a piece of the intestine to create a bladder that can be catheterized. Bladder augmentation involves the use of a piece of the stomach or intestine to enlarge bladder capacity.

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Origin: Chapter 21, 27

27. The nurse is preparing an 8-year-old girl for a cystoscopy. Which instruction would be most appropriate to give to the child? A) "You need to make sure that you don't go to the bathroom before the test." B) "You might feel some burning when you go to the bathroom afterward." C) "I'm going to have to put a tube into your bladder to empty it." D) "I have to put a thick tight rubber band around your arm to get a blood specimen." Ans: B Feedback: Cystoscopy is an endoscopic visualization of the urethra and bladder. The nurse would instruct the child that she might experience some burning when she voids after the procedure. A full bladder is needed for urodynamic studies. Putting a tube into the bladder describes a catheterization. Putting a thick tight rubber band suggests a tourniquet, which is used to obtain blood specimens. Origin: Chapter 21, 28
28. The nurse is assessing a 5-year-old child's genitourinary system. Which findings would the nurse document as normal? Select all that apply. A) Labial fusion B) Round abdomen C) Positive bowel sounds D) Dullness over the spleen E) Undescended testicles Ans: B, C, D Feedback: Normal findings include a round abdomen, positive bowel sounds, dullness over the spleen, and descended testicles. Labial fusion, a distended abdomen, and undescended testicles are abnormal findings. Origin: Chapter 21, 29
29. The nurse is providing instruction to the parents of a newborn boy. The parents have decided not to circumcise the child. What information should be included in the discussion? Select all answers that apply. A) The foreskin should be pulled back for cleaning at least once per day. B) The foreskin should be pulled back gently with each diaper change. C) Clean the penis gently with soap and water.