Chapter 49: Genitourinary Dysfunction

Question 1

1. Which diagnostic test provides images of the renal parenchyma and renal pelvis without exposing them to external beam radiation or radioactive isotopes?
   a. Renal ultrasound
   b. Computed tomography
   c. Intravenous pyelography
   d. Voiding cystourethrography

Answer 1

ANS: A
The transmission of ultrasonic waves through the renal parenchyma allows for visualization of the renal parenchyma and renal pelvis without exposing them to external beam radiation or radioactive isotopes. Computed tomography uses external radiation and sometimes a contrast medium. Intravenous pyelography uses contrast medium and external radiation for x-ray films, with contrast medium injected into the bladder through the urethral opening. External radiation for x-ray films is used before, during, and after voiding.

Question 2

2. What is the term for inflammation of the bladder? a. Cystitis
   b. Urosepsis
   c. Urethritis
   d. Bacteriuria

Answer 2

ANS: A
Cystitis is an inflammation of the bladder. Urosepsis is a febrile urinary tract infection with systemic signs of bacterial infection. Urethritis is an inflammation of the urethra. Bacteriuria is the presence of bacteria in the urine.

Question 3

3. Which factor predisposes the urinary tract to infection?
   a. Increased fluid intake
   b. A short urethra in young girls
   c. Prostatic secretions in males
   d. Frequent emptying of the bladder

Answer 3

ANS: B
The short urethra in females provides a ready pathway for invading organisms. Increased fluid intake and frequent bladder emptying offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.

Question 4

4. What should the nurse recommend to prevent urinary tract infections in young girls?
   a. Wear cotton underpants.
   b. Limit bathing as much as possible.
   c. Increase fluids and decrease salt intake.
   d. Cleanse the perineum with water after voiding.

Answer 4

ANS: A
Cotton underpants are preferable to nylon ones. No evidence exists that limiting bathing, increasing fluids, decreasing salt intake, or cleansing the perineum with water decreases the incidence of urinary tract infections in young girls.

Question 5

5. What is hypospadias?
   a. Absence of a urethral opening
   b. Penis shorter than usual for age
   c. Urethral opening along dorsal surface of penis
   d. Urethral opening along ventral surface of penis

Answer 5

ANS: D
Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis, not at the glans. Hypospadias does not refer to the size of the penis. When the urethral opening is along the dorsal surface of the penis, it is known as epispadias.

Question 6

6. What is the narrowing of the preputial opening of the foreskin called? a. Chordee
   b. Phimosis
   c. Epispadias
   d. Hypospadias

Answer 6

ANS: B
Phimosis is the narrowing or stenosis of the foreskin’s preputial opening. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

Question 7

7. What is an important objective of care for a child with nephrosis?
   a. Reduce blood pressure.
   b. Reduce excretion of urinary protein.
   c. Increase excretion of urinary protein.
   d. Increase the ability of tissues to retain fluid.

Answer 7

ANS: B
The objectives of therapy for a child with nephrosis include reducing the excretion of urinary protein, reducing fluid retention, preventing infection, and minimizing complications associated with therapy. Blood pressure is usually not elevated in nephrosis. Increased urinary protein excretion and increased fluid retention are part of the disease process and must be reversed.

Question 8

8. Which is included in the therapeutic management of nephrosis?
   a. Corticosteroids
   b. Antihypertensive agents
   c. Long-term diuretics
   d. Increased fluids to promote diuresis

Answer 8

ANS: A
Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that restricts fluid and salt may be indicated.

Question 9

9. What is a common adverse effect of corticosteroid therapy?
   a. Fever
   b. Hypertension
   c. Weight loss
   d. Increased appetite

Answer 9

ANS: D
A common adverse effect of corticosteroid therapy is an increased appetite. Fever is not an adverse effect of this therapy—it may be an indication of infection. Hypertension is not usually associated with this therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

Question 10

10. What is usually different about the diet of a child with nephrosis?
    a. High protein
    b. Salt restriction
    c. Low fat
    d. High carbohydrate

Answer 10

ANS: B
Salt is usually restricted (but not eliminated) during the edema phase. The child has very little appetite during the acute phase. Favourite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.

Question 11

11. A child is admitted with acute glomerulonephritis. What does the nurse expect the urinalysis to show during this acute phase?
    a. Bacteriuria, hematuria
    b. Hematuria, proteinuria
    c. Bacteriuria, increased specific gravity
    d. Proteinuria, decreased specific gravity

Answer 11

ANS: B
Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

Question 12

12. What is the most appropriate nursing diagnosis for a child with acute glomerulonephritis?
    a. Risk for injury related to malignant process and treatment
    b. Deficient fluid volume related to excessive losses
    c. Excess fluid volume related to decreased plasma filtration
    d. Excess fluid volume related to fluid accumulation in tissues and third spaces

Answer 12

ANS: C
Glomerulonephritis causes decreased filtration of plasma. This decrease results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. There is often a fluid volume excess, but its accumulation is secondary to the decreased plasma filtration.

Question 13

13. Where are Wilms’ tumours (nephroblastomas) located?
    a. Bone
    b. Brain
    c. Kidney
    d. Lymphatic system

Answer 13

ANS: C
Wilms’ tumour or nephroblastoma is the most common malignant renal and intra-abdominal tumour of childhood. It is a primary renal tumour.

Question 14

14. What is the most common cause of acute renal failure in children?
    a. Pyelonephritis
    b. Tubular destruction
    c. Urinary tract obstruction
    d. Severe dehydration

Answer 14

ANS: D
The most common cause of acute renal failure in children is severe dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure in children. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

Question 15

15. What are the primary clinical manifestations of acute renal failure?
    a. Oliguria and hypertension
    b. Hematuria and pallor
    c. Proteinuria and muscle cramps
    d. Bacteriuria and facial edema

Answer 15

ANS: A
The principal features of acute renal failure are oliguria accompanied by hypertension. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure.

Question 16

16. The nurse is caring for a child with acute renal failure. What clinical manifestation should the nurse recognize as a sign of hyperkalemia?
    a. Dyspnea
    b. Seizure
    c. Oliguria
    d. Cardiac arrhythmia

Answer 16

ANS: D
Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiograph anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia.

Question 17

17. When a child has chronic renal failure (chronic kidney disease), which is the name of the clinical syndrome that is caused by progressive deterioration that produces a variety of clinical and biochemical disturbances?
    a. Uremia
    b. Oliguria
    c. Proteinuria
    d. Pyelonephritis

Answer 17

ANS: A
Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urine output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.

Question 18

18. What is a major complication in a child with chronic kidney disease?
    a. Hypokalemia
    b. Metabolic alkalosis
    c. Water and sodium retention
    d. Excessive excretion of blood urea nitrogen

Answer 18

ANS: C
Chronic kidney disease leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic kidney disease.

Question 19

19. Which clinical manifestation is seen in a child with chronic kidney disease?
    a. Hypotension
    b. Massive hematuria
    c. Hypokalemia
    d. Unpleasant “uremic” breath odour

Answer 19

ANS: D
Children with chronic kidney disease have a characteristic breath odour resulting from the retention of waste products. Hypertension may be a complication. With chronic kidney disease, little or no urine output occurs, and hyperkalemia is a concern.

Question 20

20. One of the clinical manifestations of chronic kidney disease is uremic frost. What is the best description of this term?
    a. Deposits of urea crystals in urine
    b. Deposits of urea crystals on skin
    c. Overexcretion of blood urea nitrogen
    d. Inability of body to tolerate cold temperatures

Answer 20

ANS: B
Uremic frost is the deposition of urea crystals on the skin, not in the urine. The kidneys are unable to excrete blood urea nitrogen, leading to elevated levels. There is no relation between cold temperatures and uremic frost.

Question 21

21. What is the purpose of administering calcium carbonate with meals to a child with chronic kidney disease?
    a. It prevents vomiting.
    b. It decreases serum phosphate levels.
    c. It stimulates the appetite.
    d. It increases the absorption of fat-soluble vitamins.

Answer 21

ANS: B
Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate; serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of fat-soluble vitamins.

Question 22

22. Which is characteristic of the diet of a child with chronic kidney disease?
    a. High in protein
    b. Low in vitamin D
    c. Low in phosphorus
    d. Supplemented with vitamins A, E, and K

Answer 22

ANS: C
Dietary phosphorus is regulated to prevent or control the calcium–phosphorus imbalance by reducing the intake of protein and milk. Protein should be limited to decrease the intake of phosphorus. Vitamin D therapy is administered to increase calcium absorption; supplementation with vitamins A, E, and K is not part of the dietary management of chronic kidney disease.

Question 23

23. The nurse is caring for an adolescent who has just started dialysis. The child seems to always be angry, hostile, or depressed. The nurse should recognize that this is most likely related to what issue?
    a. Neurological manifestations that occur with dialysis
    b. Physiological manifestations of renal disease
    c. Adolescents have few coping mechanisms.
    d. Adolescents often resent the control and enforced dependence imposed by
    dialysis.

Answer 23

ANS: D
Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviours. Neurological manifestations that occur with dialysis and physiological manifestations of renal disease are a function of the age of the child, they are not manifestations of dialysis. Adolescents do have coping mechanisms, but they need to have some control over their disease management.

Question 24

24. What is one advantage of peritoneal dialysis?
    a. Treatments are done in hospitals.
    b. Protein loss is less extensive.
    c. Dietary limitations are not necessary.
    d. Parents and older children can perform treatments.

Answer 24

ANS: D
Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves, and they can be done at home. Protein loss is not significantly different. Dietary limitations are necessary, but they are not as stringent as those for hemodialysis.

Question 25

25. Which statement describes renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is the preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult since a relatively normal lifestyle is not possible.

Answer 25

ANS: B Renal transplantation offers the opportunity for a relatively normal lifestyle rather than dependence on dialysis and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes.

Question 26

26. The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestation does she observe? a. Vomiting b. Jaundice c. Back pain d. Swelling of the face

Answer 26

ANS: A Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a urinary tract infection. Jaundice, swelling of the face, and back pain would not be observed in an infant with a urinary tract infection.

Question 27

1. Order the sequence of events see in nephrotic syndrome. Express answer with small letters followed by a comma and a space—e.g., a, b, c. a. b. c. d. e. Hypoproteinemia Edema Proteinuria Renal glomerular damage Decreased oncotic pressure

Answer 27

ANS: d, c, a, e, b The sequence of events seen in nephrotic syndrome begins with renal glomerular damage and progresses to massive proteinuria, hypoproteinemia, decreased oncotic pressure, and edema. Hypoproteinemia leads to increased hepatic synthesis of proteins and lipids, progressing to hyperlipidemia. Decreased oncotic pressure leads to hypovolemia.