Chapter 31: Alterations of Renal and Urinary Tract Function in Children

Huether & McCance: Understanding Pathophysiology, 6th Edition

MULTIPLE CHOICE

1. Upon examination of a male infant, it is determined that the urethral meatus is located on the
undersurface of the penis. The nurse will document this condition as:
a. hypospadias.
b. epispadias.
c. hydroureter.
d. cryptorchidism.
ANS: A
When the urethral meatus is located on the undersurface of the penis, it is referred to as
hypospadias. Epispadias occurs when the urethral meatus is on the dorsal surface of the penis.
Hydroureter is not associated with the urethra. Cryptorchidism refers to undescended testes.

REF: p. 770

2. An infant male experiences a constant dribbling of urine. His urethral opening is located
behind the glans. Which of the following is the most likely diagnosis the nurse will observe on
the chart?
a. Anterior epispadias
b. Posterior epispadias
c. Exstrophy of the bladder
d. Bladder outlet obstruction
ANS: A
Anterior epispadias occurs when the urethral opening is small and situated behind the glans.
Posterior epispadias occurs when a fissure extends the entire length of the penis and into the
bladder neck. Exstrophy of the bladder occurs when the bladder is exposed on the abdominal
wall. Bladder outlet obstruction occurs when urinary outflow is obstructed.

REF: p. 771

3. What term is used to describe a chronic renal failure caused by a lack of development of one
of the kidneys?
a. Renal dysplasia
b. Renal agenesis
c. Hypoplastic kidney
d. Renal aplasia
ANS: D
During embryologic development, the ureteric duct grows into the metanephric tissue,
triggering the formation of the kidneys. If this growth does not occur, the kidney is absent, a
condition called renal aplasia. Renal dysplasia usually results from abnormal differentiation of
the renal tissues. Renal agenesis is the absence of one or both kidneys. Hypoplastic kidney is
small with a decreased number of nephrons.

REF: p. 772
4. The life expectancy of infants who are diagnosed with bilateral renal agenesis is expected to
be:
a. death within 1 year of birth.
b. a fairly normal, healthy life.
c. death within a few hours of birth.
d. good when anomalies are corrected with surgery.
ANS: C
Bilateral renal agenesis is a rare disorder incompatible with extrauterine life. The infant lives
only a few hours.

REF: p. 772

5. Physical examination of a newborn who dies shortly after birth reveals wide-set eyes, parrot-
beak nose, low-set ears, and receding chin. These abnormalities support which diagnosis?
a. Unilateral renal agenesis
b. Potter syndrome
c. Renal aplasia
d. Renal dysplasia
ANS: B
Potter syndrome is manifested by wide-set eyes, parrot-beak nose, low-set ears, and receding
chin. Neither unilateral renal agenesis, renal aplasia, nor renal dysplasia is associated with
other congenital anomalies.

REF: p. 772

6. A 15-year-old presents with flank pain, irritability, malaise, and fever and is diagnosed with
glomerulonephritis. What is the most likely cause of this condition?
a. Poststreptococcal infection
b. Nephropathy
c. Nephrotic syndrome
d. Potter syndrome
ANS: A
Glomerulonephritis is most likely related to a post-strep infection. It is not related to
nephropathy, nephrotic syndrome, or Potter syndrome.

REF: pp. 772-773

7. If nephrotic syndrome is not caused initially by kidney disease, it is termed _____ nephrotic
syndrome.
a. primary
b. secondary
c. tertiary
d. idiopathic
ANS: B
Nephrotic syndrome that is not initially caused by kidney disease is referred to a secondary,
not primary, nephrotic syndrome. Nephrotic syndrome is not generally associated with the
terms, tertiary or idiopathic.
 REF: p. 773

8. A 4-year-old male is diagnosed with nephrotic syndrome. Which of the following assessment
findings accompanies this condition?
a. Proteinuria
b. Decreased blood urea nitrogen (BUN)
c. Hematuria
d. Sodium loss
ANS: A
Proteinuria accompanies nephrotic syndrome. The BUN may be elevated. Foamy, not bloody,
urine accompanies nephrotic syndrome. Sodium loss does not accompany nephrotic
syndrome.

REF: p. 773

9. A 7-year-old is diagnosed with nephrotic syndrome. Which sign would support this diagnosis?
a. Constipation
b. Vesicular skin rash
c. Frothy urine
d. Jaundice
ANS: C
In the child with nephrotic syndrome, the parents may notice diminished, frothy, or foamy
urine output. Nephrotic syndrome is not associated with constipation, a vesicular skin rash, or
jaundice.

REF: p. 773

10. Which of the following clusters of symptoms would support a childs diagnosis of
glomerulonephritis?
a. Pyuria, fever, and abdominal pain
b. Proteinuria, hypotension, and ascites
c. Dysuria, urinary frequency, and abdominal tenderness
d. Gross hematuria, edema, and hypertension
ANS: D
The child with glomerulonephritis typically experiences gross or microscopic hematuria,
proteinuria, edema, renal insufficiency, flank pain, and hypertension. Pyuria and abdominal
pain are typically not present while dysuria and urinary frequency are symptoms of cystitis.

REF: p. 773

11. A 5-year-old male was diagnosed with glomerulonephritis. History reveals that he had an
infection 3 weeks before the onset of this condition. The infection was most likely located in
the:
a. bone.
b. gastrointestinal (GI) tract.
c. respiratory tract.
d. ear.
 ANS: C
The location of the infection leading to glomerulonephritis is the respiratory tract, not the
bone, GI tract, or the ear.

REF: p. 772

12. A 10-year-old male is diagnosed with glomerulonephritis. Tests reveal the deposition of
immunoglobulin IgA in the glomerular capillaries. The nurse will monitor for recurrent:
a. infections.
b. hematuria.
c. vomiting.
d. enuresis.
ANS: B
Recurrent hematuria is associated with glomerulonephritis that is complicated by the presence
of immunoglobulin IgA. Neither recurrent infections, vomiting, nor enuresis is associated
with this condition.

REF: p. 773

13. When a child is admitted with acute renal failure, a clinician realizes the most common cause
of acute renal failure is:
a. glomerulonephritis.
b. obstruction.
c. nephrotic syndrome.
d. hemolytic uremic syndrome (HUS).
ANS: D
HUS is the most common cause of acute renal failure in children. Glomerulonephritis can lead
to renal failure, but it is not the most common. While either obstruction or nephrotic syndrome
could contribute to renal failure, neither is not the most common cause.

REF: p. 773

14. What term is used to describe a retrograde flow of urine from the urinary bladder into the
ureters that is the cause of recurrent urinary tract infections (UTIs)?
a. Vesicoureteral reflux (VUR)
b. Vesicourethral reflux
c. Vesicoureteral influx
d. Hydronephrosis
ANS: A
VUR is the retrograde flow of urine from the bladder into the kidney or ureters, or both.
The condition is ureteral, not urethral. It results in reflux, not influx. Reflux could lead to
pyelonephritis, not hydronephrosis.

REF: p. 775

15. A nurse observes on the chart that a patient is admitted with Wilms tumors. A nurse knows the
tumors are found in the:
a. kidneys.
b. ureters.
 c. bladder.
d. urethra.
ANS: A
Wilms tumor is found in the kidneys. Its location is not associated with the ureters, bladder, or
the urethra.

REF: p. 774

16. A 6-year-old male diagnosed with vesicoureteral reflux is experiencing urine reflux from the
urinary bladder into a grossly dilated ureter and calyces. This condition would be graded:
a. I.
b. II.
c. III.
d. IV.
ANS: D
The patient has symptoms of grade IV reflux. Grade I involves a nondilated ureter.
Grade II does not involve dilation. Grade III does not involve gross dilation.

REF: p. 775

17. A 2-year-old male is diagnosed with Wilms tumor. Which clinical condition is often
associated with this disease?
a. Cystic disease of the liver
b. Aniridia
c. Anemia
d. Hypothyroidism
ANS: B
Children with Wilms tumor often have other congenital anomalies, including aniridia, a lack
of an iris in the eye. Wilms tumor is not associated with cystic liver, anemia, or
hypothyroidism.

REF: p. 774

18. A 7-year-old male presents to his primary care provider for incontinence. His mother indicates
that he has never been continent before. This history supports which form of enuresis?
a. Nocturnal
b. Diurnal
c. Primary
d. Secondary
ANS: C
Primary incontinence (enuresis) means the child has never been continent. Nocturnal enuresis
is nighttime incontinence while diurnal would indicate during the day. With secondary
incontinence, the child would have had a period of continence, which this child did not.

REF: p. 776

MULTIPLE RESPONSE
1. In addition to a mass, the child with Wilms tumor may also exhibit which assessment finding?
(select all that apply)
a. Abdominal pain
b. Enuresis
c. Hematuria
d. Weight gain
e. Fever
ANS: A, C, E
In addition to an abdominal mass, other presenting complaints include vague abdominal pain,
hematuria, and fever. Enuresis and weight gain do not occur.

REF: p. 774