1.

7-year-old Damon has cystitis; which of the following would Nurse Elena expect when
assessing the child?

A. Dysuria
B. Costovertebral tenderness
C. Flank pain
D. High fever

2. Niklaus was born with hypospadias; which of the following should be avoided when a child
has such condition?

A. Surgery
B. Circumcision
C. Intravenous pyelography (IVP)
D. Catheterization

3. Stefan was diagnosed with secondary vesicoureteral reflux; such condition usually results
from which of the following?

A. Acidic urine
B. Congenital defects
C. Hydronephrosis
D. Infection

4. When educating parents regarding known antecedent infections in acute

glomerulonephritis, which of the following should the nurse cover?

A. Scabies
B. Impetigo
C. Herpes simplex
D. Varicella
5. Alaric was diagnosed with minimal-change nephrotic syndrome; which of the following
signs and symptoms are characteristics of the said disorder?

A. Hypertension, edema, hematuria

B. Hypertension, edema, proteinuria
C. Gross hematuria, fever, proteinuria
D. Poor appetite, edema, proteinuria

6. Preferred nurses at the Nurseslabs Medical Center are about to perform a procedure
related to a genitourinary (GU) problem to a group of pediatric patients. Which of the
following groups would find it especially extra stressful?

A. Infants
B. Toddlers
C. Preschoolers
D. School-age children

7. Which of the following organisms is the most common cause of urinary tract infection (UTI)
in children?

A. Klebsiella
B. Staphylococcus
C. Escherichia coli
D. Pseudomonas

8. Patient S is a sexually active adolescent; which of the following instructions would be

included in the preventive teaching plan about urinary tract infections?

A. Drinking acidic juices

B. Avoiding urinating before intercourse
C. Wearing nylon underwear
D. Wiping back to front

9. What is most likely the underlying physiology of primary enuresis?

A. Psychogenic stress
B. Delayed bladder maturation
C. Urinary tract infection
D. Vesicoureteral reflux

10. Which of the following should be included when developing a teaching plan to prevent
urinary tract infection? Select all that apply.

A. Maintaining adequate fluid intake

B. Avoiding urination before and after intercourse
C. Emptying bladder with urination
D. Wearing underwear made of synthetic material such as nylon
E. Keeping urine alkaline by avoiding acidic beverages
F. Avoiding bubble baths and tight clothing

11. 12-year-old Caroline has recurring nephrotic syndrome; which of the following areas of
potential disturbances should be a prime consideration when planning ongoing nursing care?

A. Body image
B. Sexual maturation
C. Muscle coordination
D. Intellectual development

12. The nurse is aware that the following laboratory values support a diagnosis of
pyelonephritis?
A. Myoglobinuria
B. Ketonuria
C. Pyuria
D. Low white blood cell (WBC) count

13. Nurse Jeremy is evaluating a client’s fluid intake and output record. Fluid intake and urine
output should relate in which way?

A. Fluid intake should be double the urine output.

B. Fluid intake should be approximately equal to the urine output.
C. Fluid intake should be half the urine output.
D. Fluid intake should be inversely proportional to the urine output.

14. The following are considered functions of the Urinary System EXCEPT: (Select all that
apply).

A. Vitamin D synthesis
B. Regulation of red blood cell synthesis
C. Excretion
D. Absorption of digested molecules
E. Regulation of blood volume and pressure

15. Nurse Kai is evaluating a female child with acute post-streptococcal glomerulonephritis

for signs of improvement. Which finding typically is the earliest sign of improvement?

A. Increased urine output

B. Increased appetite
C. Increased energy level
D. Decreased diarrhea

Answers and Rationale

1. Answer: A. Dysuria

 A: Dysuria is a symptom of a lower urinary tract infection (UTI) such as cystitis.

 B, C, D: Costovertebral tenderness, flank pain, and high fever are signs and
symptoms of pyelonephritis, an upper UTI.

2. Answer: B. Circumcision

 B: 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.
 A: 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.
 C: IVP is contraindicated if the child has an allergy to iodine or shellfish.
 D: Catheterization may be used to ensure urinary elimination.

3. Answer: D. Infection

 D: Infection is the most common cause of secondary vesicoureteral reflux.

 A: Acidic urine is normal and helps to prevent infection.
 B: Congenital defects cause primary vesicoureteral reflux.
 C: Hydronephrosis may result from vesicoureteral reflux.

4. Answer: B. Impetigo

 B: 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 occur
between the infection, usually of the skin (impetigo) or upper respiratory tract, and
the onset of clinical manifestations.
  A, C, D: Scabies, herpes simplex, and varicella are not associated with acute
glomerulonephritis.

5. Answer: D. Poor appetite, edema, proteinuria

 D: Clinical manifestations of nephrotic syndrome include loss of appetite due to

edema of intestinal mucosa, proteinuria, and edema.
 A, B: Hypertension alone or accompanied by hematuria is associated with
glomerulonephritis.
 C: Gross hematuria is not associated with nephrotic syndrome. Fever will occur only
if infection also existed.

6. Answer: C. Preschoolers

 C: In general, preschoolers have more fears because of their fantasies, contributing
to fears of the simplest procedures. Castration fears are also prominent at this age
and may be heightened by procedures related to GU problems.
 A, B, D: Typically, GU procedures do not create greater stress in infants, toddlers,
and school-age children.

7. Answer: C. Escherichia coli

 C: E. coli is the most common organism associated with the development of UTI.
 A, B, D: Although Klebsiella, Staphylococcus, and Pseudomonas species may cause
UTI’s, the incidence of UTI’s related to each is less than that for E. coli.

8. Answer: A. Drinking acidic juices

 A: Drinking acidic juices, such as cranberry juice, helps keep the urine at its desired
pH and reduces the chance of infection.
 B, C, D: The client should wipe from front to back, wear cotton underwear, and void
before and after intercourse.
9. Answer: B. Delayed bladder maturation

 B: The most likely cause of primary enuresis is delayed or incomplete maturation of

the bladder.
 A: Psychogenic stress may cause either primary or secondary enuresis, but it is not
the leading cause of primary enuresis.
 C: UTIs may cause either primary or secondary enuresis, but they are not the leading
cause of primary enuresis.
 D: Vesicoureteral reflux may cause either primary or secondary enuresis, but is not
the leading cause of primary enuresis.

10. Answer: A,C,F

 A: Fluid intake helps dilute urine and minimize infection potential.

 C: Emptying the bladder fully with each urination prevents stasis.
 F: Bubble baths and tight clothing may act as irritants.
 B, D, E: Children and teens should wear cotton underwear, keep their urine acidic,
and void before and after intercourse (if sexually active).

11. Answer: A. Body image

 A: Because of edema associated with nephrotic syndrome, potential self-concept and

body image disturbances related to changes in appearance and social isolation
should be considered.
 B, C, D: Sexual maturation, muscle coordination, and intellectual function are not
affected.

12. Answer: C. Pyuria

 C: Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria,

and bacteriuria.
 B: Ketonuria indicates a diabetic state.
  D: The client exhibits fever, chills, and flank pain. Because there is often a septic
picture, the WBC count is more likely to be high rather than low.

13. Answer: B. Fluid intake should be approximately equal to the urine output.

 B: Normally, fluid intake is approximately equal to the urine output. Any other
relationship signals an abnormality.
 A: Fluid intake that is double the urine output indicates fluid retention
 C: Fluid intake that is half the urine output indicates dehydration.
 D: Normally, fluid intake isn’t inversely proportional to the urine output.

14. Answer: D. Absorption of digested molecules

 D: This is a function of the Digestive System. The small molecules that result from
digestion are absorbed through the walls of the intestine for use in the body.
 A: This is a function of the Urinary System. The kidneys play an important role in
controlling blood levels of Ca2+ by regulating the synthesis of vitamin D.
 B: This is a function of the Urinary System. The kidneys secrete a hormone,
erythropoietin, which regulates the synthesis of red blood cells in bone marrow.
 C: This is a function of the Urinary System. The kidneys are the major excretory
organs of the body. They remove waste products, many of which are toxic, from the
blood.
 E: This is a function of the Urinary System. The kidneys play a major role in
controlling the extracellular fluid volume in the body by producing either a large
volume of dilute urine or a small volume of concentrated urine.

15. Answer:  A. Increased urine output

 A: Increased urine output, a sign of improving kidney function, typically is the first
sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is
improving.
 B, C, D: Increased appetite, an increased energy level, and decreased diarrheaare not
specific to APSGN.