The ideal timing for kidney transplantation in children with end-stage renal disease is

Correct Answer: C

Rationale: In pediatric patients with end-stage renal disease (ESRD), the ideal timing for kidney transplantation is as soon as feasible once the diagnosis is made (Option C). This is the correct answer because early transplantation offers several advantages in children, including better growth, cognitive development, and quality of life compared to long-term dialysis. Early transplantation also reduces the risk of complications associated with dialysis, such as infections and cardiovascular issues. Option A, after reaching adult height, is incorrect because delaying transplantation until adult height is achieved can lead to significant negative impacts on a child's overall health and well-being. Option B, when dialysis becomes ineffective, is also incorrect as waiting for dialysis to become ineffective may expose the child to unnecessary risks and complications associated with prolonged dialysis. Option D, after resolution of comorbidities, is incorrect because it is not always possible to completely resolve all comorbidities before transplantation. In many cases, transplantation can actually help improve or stabilize certain comorbid conditions in pediatric patients with ESRD. Educationally, understanding the optimal timing for kidney transplantation in children with ESRD is crucial for healthcare providers caring for these patients. Early transplantation not only improves outcomes but also enhances the overall quality of life for pediatric patients with kidney disease. This knowledge is essential for nurses, physicians, and other healthcare professionals involved in the care of children with genitourinary disorders, preparing them to make informed decisions and provide the best possible care for their young patients.

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: C

Rationale: The correct answer is C) A treatment option that will free the child from dialysis. In pediatric genitourinary disorders, renal transplantation is a well-established treatment for end-stage renal disease. It is considered a definitive treatment that eliminates the need for ongoing dialysis. This option is correct because a successful renal transplant can restore kidney function, allowing the child to live without the burden of regular dialysis sessions. Option A is incorrect because while renal transplantation can significantly improve the child's quality of life and eliminate the need for dialysis, it may not necessarily be a curative procedure in all cases. Option B is incorrect because a history of dialysis noncompliance would not make renal transplantation an ideal option. Compliance with post-transplant care, including medication regimens and follow-up appointments, is crucial for a successful outcome. Option D is incorrect because renal transplantation has been performed in pediatric patients for many years and is not a very new treatment option for this population. Educationally, understanding the role of renal transplantation in pediatric genitourinary disorders is essential for nursing students preparing for the NCLEX exam. It highlights the importance of this intervention in improving the quality of life for children with end-stage renal disease and the need for ongoing monitoring and support post-transplant.

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.