A child had a urinary tract infection (UTI) 3 months ago, treated with an oral antibiotic; follow-up urinalysis was normal. Now, the child is diagnosed with another UTI. Which is the most appropriate plan?

Correct Answer: A

Rationale: The most appropriate plan for a child diagnosed with another UTI after a recent episode is to choose option A, which includes urinalysis, urine culture, and a voiding cystourethrogram (VCUG). The rationale for choosing option A is that urinalysis and urine culture will help confirm the presence of infection and identify the causative organism. The VCUG is essential to evaluate for any underlying structural abnormalities in the genitourinary tract that may be predisposing the child to recurrent UTIs. This diagnostic approach is crucial in pediatric patients to prevent long-term complications like renal scarring and reflux nephropathy. Option B, evaluating for renal failure, is not the most appropriate initial step in the management of a child with a recurrent UTI. UTIs are more commonly due to bacterial infections rather than renal failure, so this step would not be the primary focus at this stage. Option C, admitting to the pediatric unit, may not be necessary unless the child shows signs of severe illness, such as sepsis or dehydration. In uncomplicated cases of UTI, outpatient management is often appropriate. Option D, discharging home on an antibiotic, without further investigation, would be premature as it does not address the underlying cause of recurrent UTIs or evaluate for potential complications. In an educational context, understanding the rationale behind each diagnostic step is crucial for nurses and healthcare providers caring for pediatric patients with genitourinary disorders. Proper assessment and management can prevent complications and improve outcomes for children with UTIs.

Correct Answer: D

Rationale: In pediatric genitourinary disorders, hydronephrosis is characterized by the dilation of the renal pelvis and calyces due to an obstruction in the urinary tract. The correct answer, option D, includes metabolic acidosis, polydipsia (excessive thirst), and polyuria (excessive urination), which are commonly associated with hydronephrosis. Metabolic acidosis can occur due to impaired kidney function in hydronephrosis, leading to an accumulation of acid in the body. Polydipsia and polyuria are common symptoms seen in hydronephrosis due to the kidneys' inability to concentrate urine properly. Option A (metabolic alkalosis, polydipsia, and polyuria) is incorrect because metabolic alkalosis is not typically associated with hydronephrosis. Option B (metabolic acidosis and bacterial growth in the urine) is incorrect as bacterial growth in the urine is not a direct consequence of hydronephrosis. Option C (metabolic alkalosis and bacterial growth in the urine) is also incorrect because metabolic alkalosis is not a usual finding in hydronephrosis. Understanding the specific clinical manifestations of pediatric genitourinary disorders like hydronephrosis is crucial for nurses, nurse practitioners, and other healthcare professionals caring for pediatric patients. Recognizing the signs and symptoms allows for early identification, appropriate intervention, and optimal management to prevent complications and improve outcomes.

Correct Answer: A

Rationale: In hemolytic uremic syndrome (HUS), the manifestations are primarily due to the swollen lining of small blood vessels damaging red blood cells, leading to anemia. This is the correct answer because HUS is characterized by the destruction of red blood cells, low platelet count, and acute kidney injury. The damaged red blood cells can lead to anemia, thrombocytopenia, and kidney damage. Option B, disturbance of the glomerular basement membrane, is incorrect because while kidney damage is a feature of HUS, it is not the primary event driving the manifestations of the syndrome. Option C, sickle-shaped red blood cells obstructing microcirculation, is incorrect as sickle cell disease is a separate condition with its own pathophysiology. Option D, depressed production of all blood cells, is incorrect as it does not align with the characteristic features of HUS. Educationally, understanding the pathophysiology of pediatric genitourinary disorders like HUS is crucial for nurses and healthcare professionals caring for pediatric patients. Recognizing the specific mechanisms underlying the manifestations of HUS can aid in early identification, intervention, and management of this serious condition.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Placement of a Tenckhoff catheter for peritoneal dialysis. Peritoneal dialysis is the most suitable treatment for the 1-year-old with acute renal failure (ARF) who is edematous, has minimal urine output, and is experiencing a rise in serum potassium levels despite oral Kayexalate. Peritoneal dialysis helps remove waste, excess fluids, and electrolytes from the body when the kidneys are not functioning properly. Option A) Additional rectal Kayexalate is not the best choice because the child is not responding to oral Kayexalate, which indicates the need for a more aggressive intervention like dialysis. Option B) Intravenous furosemide may exacerbate the child's fluid and electrolyte imbalance, leading to further complications. Option C) Endotracheal intubation and ventilatory assistance are not directly addressing the underlying cause of the ARF and high potassium levels. Educationally, understanding the appropriate management of pediatric genitourinary disorders is crucial for nurses, especially when caring for critically ill children. Recognizing the signs and symptoms of renal failure, understanding the principles of dialysis, and knowing when to escalate treatment are essential skills for pediatric nurses to ensure safe and effective care for their patients.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Be cautious on playgrounds because many surfaces contain latex, which can cause an allergic reaction. This instruction is crucial because patients with bladder exstrophy who have undergone continent urinary reservoir placement are at risk of latex allergies due to the frequent exposure to latex-containing medical products during their care. Educating the parents and caregivers about the potential sources of latex exposure, such as playground surfaces, is essential to prevent allergic reactions in the child. Option A) allowing the child to sleep on the abdomen for comfort is incorrect as it does not address the specific health concern related to the continent urinary reservoir or latex allergies. Option C) encouraging a wide variety of foods to prevent allergies is not relevant to the child's condition with bladder exstrophy and urinary reservoir placement. Option D) providing brightly colored objects to enhance development is also unrelated to the specific care needs of a child with bladder exstrophy and a continent urinary reservoir. In an educational context, it is crucial for healthcare providers to provide tailored and specific discharge instructions to parents and caregivers of pediatric patients with complex medical conditions. Understanding the unique needs and potential risks associated with the child's condition is essential for promoting optimal health outcomes and preventing complications. By explaining the rationale behind each instruction, caregivers can better comprehend the importance of following these guidelines for the child's well-being.