The MOST accurate study in a child with suspected renal stone is

Correct Answer: C

Rationale: In pediatric patients suspected of having renal stones, the most accurate study is an unenhanced spiral CT scan (Option C). This is because CT scans have high sensitivity and specificity for detecting renal stones, providing detailed imaging of the size, location, and composition of the stone. This information is crucial for guiding treatment decisions. Option A, renal ultrasound, may not be as sensitive as a CT scan for detecting small stones or stones located in certain areas of the urinary tract. Plain radiograph of the abdomen (Option B) is not as sensitive as CT for detecting all types of renal stones. Radioisotope studies (Option D) are not typically used as the initial imaging modality for diagnosing renal stones in children. Educationally, understanding the appropriate imaging modalities for diagnosing renal stones in pediatric patients is essential for nurses and healthcare providers working in pediatrics. By knowing the advantages and limitations of each imaging study, healthcare professionals can make informed decisions to ensure accurate diagnosis and appropriate management of pediatric patients with genitourinary issues.

Correct Answer: A

Rationale: In pediatric patients with vesicoureteral reflux (VUR), the presence of renal parenchymal scarring is best determined by a DMSA (dimercaptosuccinic acid) scan. This is because a DMSA scan is a sensitive and specific imaging modality that can detect renal parenchymal scarring early on, even before it is visible on other imaging studies. Renal ultrasonography (Option B) is useful for evaluating the anatomy of the kidneys and detecting hydronephrosis, but it is not as accurate in detecting renal scarring compared to a DMSA scan. VCUG (voiding cystourethrogram - Option C) is important for diagnosing VUR itself by assessing the flow of contrast from the bladder back up into the ureters during voiding, but it does not directly assess for renal scarring. A CT scan (Option D) may provide detailed anatomical information, but it is not the first-line imaging modality for evaluating renal parenchymal scarring in the context of VUR in pediatric patients due to concerns about radiation exposure. In an educational context, understanding the appropriate imaging modalities for different clinical scenarios is crucial for healthcare providers, especially those working with pediatric patients. By knowing the strengths and limitations of each imaging study, providers can make informed decisions to ensure accurate diagnosis and appropriate management for their patients.

Correct Answer: A

Rationale: In this NCLEX Pediatric Genitourinary Practice Question, the most likely diagnosis for the patient is polycystic renal disease. Polycystic renal disease is a genetic disorder characterized by the development of multiple cysts in the kidneys, leading to impaired kidney function over time. Option A is correct because polycystic renal disease fits the description of a patient with multiple kidney cysts, which is a key feature of this condition. Option B, multicystic renal disease, is characterized by the presence of non-communicating cysts that do not connect with the renal pelvis, unlike the interconnected cysts seen in polycystic renal disease. Option C, segmental hypoplasia, refers to underdevelopment of a segment of the kidney, not the presence of multiple cysts as seen in polycystic renal disease. Option D, renal infarction, involves the loss of blood supply to a part of the kidney leading to tissue death, which is different from the cystic changes seen in polycystic renal disease. For educational context, understanding these different pediatric genitourinary conditions is crucial for nurses and healthcare providers caring for pediatric patients with renal issues. Recognizing the distinct features of each condition is essential for accurate diagnosis and appropriate management.

Correct Answer: D

Rationale: Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and sometimes up to the kidneys. The correct answer, option D, "Asymptomatic bacteriuria," is not associated with VUR because it refers to the presence of bacteria in the urine without any symptoms of a urinary tract infection. This condition is not directly linked to the structural abnormality seen in VUR. Option A, "contralateral kidney of pair with unilateral dysplasia," is incorrect as it describes a scenario where one kidney is abnormal while the other kidney has vesicoureteral reflux, which can happen in some cases of congenital anomalies. Option B, "ureteral duplication," is incorrect as it is a structural abnormality where an individual has two ureters draining one kidney. This abnormality can contribute to VUR due to the complex anatomy of the urinary tract. Option C, "familial inheritance," is incorrect as VUR can have a genetic component, with a higher risk of occurrence in family members. Understanding these associations is crucial for healthcare professionals caring for pediatric patients with genitourinary conditions. Educationally, it is important for nursing students preparing for the NCLEX to grasp the pathophysiology and associated factors of pediatric genitourinary conditions like VUR. By understanding these relationships, nurses can provide better care, education, and support to pediatric patients and their families affected by these conditions.

Correct Answer: D

Rationale: In this question, the correct answer is D) nephron. The glomerular endothelial cell, basement membrane, and podocytes collectively form the filtration membrane within the nephron. Understanding this concept is crucial in pharmacology as it relates to drug excretion and renal function. Explanation of why the other options are incorrect: A) Glomerulus: The glomerulus is a tuft of capillaries located within the nephron that plays a role in filtration, but it does not encompass all three components mentioned in the question. B) Filtration membrane: This is a partial answer as it describes the structure formed by the glomerular endothelial cell, basement membrane, and podocytes, but it lacks the specificity of identifying the entire functional unit. C) Juxtamedullary nephron: This term refers to a specific type of nephron located near the medulla, not the structure formed by the glomerular components mentioned. Educational context: Understanding the structure and function of the nephron is essential in pharmacology, especially when considering drugs that are excreted through the renal system. Knowing how filtration occurs in the nephron helps pharmacists and healthcare providers understand drug clearance mechanisms and potential implications for dosing in pediatric patients with genitourinary conditions.