Chapters 53, 54, 55: Renal and Urinary Systems

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client?

Keep the dialysis supplies in a clean area, away from children and pets

A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action?

Place emergency medical equipment in the procedure room.

A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?

"Very few symptoms are associated with renal cancer."

A nurse is caring for a client with a fluid and electrolyte balance. What urine specific gravity would the nurse expect to measure?

1.018

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?

Hypertension

The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select?

Ileal conduit

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?

Less than 400 mL

Which is the correct term for the ability of the kidneys to clear solutes from the plasma?

Renal clearance

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

Urine output of 250 ml/24 hours

Which of the following is used to identify vesicoureteral reflux?

Voiding cystourethrography

The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions?

"I can resume my usual activities without restriction."

Which intervention would the nurse expect to implement following urologic endoscopy? Select all that apply.

Administer an antispasmodic agent. Provide privacy to promote bladder emptying.

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse?

Asses the patient's back and shoulder areas for signs of internal bleeding.

Which hormone causes the kidneys to reabsorb sodium?

Aldosterone

When describing the functions of the kidney to a client, which of the following would the nurse include? Select all that apply.

Control of water balance Secretion of the enzyme renin

Which information is important when teaching a client how to perform self-catheterization?

Catheterization should occur every 4 to 6 hours and before bedtime.

The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important?

Catheterize the client immediately after the client voids.

The nurse working with a client after an ileal conduit notices that the pouching system is leaking small amounts of urine. What is the appropriate nursing intervention?

Change the wafer and pouch.

Patient education regarding a fistulae or graft includes which of the following? Select all that apply.

Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing.

Which value does the nurse recognize as the best clinical measure of renal function?

Creatinine clearance

Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply.

Eat foods such as milk, fish, and eggs. Restrict sodium to 2,000 to 3,000 mg daily. Restrict fluid to daily urinary output plus 500 to 800 mL.

Which of the following would be least appropriate to suggest to a client with a urinary diversion to control odor?

Eat plenty of cheese and eggs.

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?

Encouraging intake of at least 2 L of fluid daily

The nurse recognizes which condition as an integumentary manifestation of chronic renal failure?

Gray-bronze skin color

The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client?

Hemodialysis

A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would the nurse expect to find? Select all that apply.

Hypertension Pain from retroperitoneal bleeding Polyuria

The wall of the bladder has four layers. Which of the following layers contains a membrane that prevents reabsorption of urine stored in the bladder?

Mucosal

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI?

Oliguria The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]).

Which of the following occurs late in chronic glomerulonephritis?

Peripheral neuropathy

Which of the following nursing actions is most important in caring for the client following lithotripsy?

Strain the urine carefully for stone fragments.

When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?

Tea-colored urine

Which nursing intervention should the nurse caring for the client with pyelonephritis implement?

Teach client to increase fluid intake up to 3 liters per day.

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse?

The client should not eat for at least 1 hour before an MRI. Alcohol, caffeine-containing beverages, and smoking should be avoided for at least 2 hours before an MRI. The client can take his or her usual medications except for iron supplements prior to the procedure.

A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude?

The pouch faceplate doesn't fit the stoma.

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client?

Use an aseptic technique during the procedure.

The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include:

WBC 50

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as:

anuria.

A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:

microorganism transfer.

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder?

pH 7.20, PaCO2 36, HCO3 14- Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.

A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing:

ureteral stones.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

weight loss.

Which of the following hormones is secreted by the juxtaglomerular apparatus?

Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus.

Rejection of a transplanted kidney within 24 hours after transplant is termed

hyperacute rejection.

The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition?

Detrusor muscle

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

"Increase your carbohydrate intake."

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?

"Increase your fluid intake to 2 to 3 L per day."

A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?

150

A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective?

Cipro

The nurse has been asked to provide health information to a female patient diagnosed with a urinary tract infection. What appropriate instructions will the nurse provide? Select all that apply.

Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. Drink liberal amounts of fluid to flush out bacteria. Void every 2-3 hours to prevent overdistention of the bladder

A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively?

Client's manual dexterity and vision

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?

Cola-colored urine Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.

A creatinine clearance test has been ordered. The nurse prepares to:

Collect the client's urine for 24 hours.

The nurse caring for a client is providing instructions for an upcoming renal angiography. Which nursing action, explained in the preoperative instructions, is essential in the postprocedure period?

Complete a pulse assessment of the legs and feet.

A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following?

Diabetes mellitus- Increased urinary glucose levels create an infection-prone environment in the urinary tract.

A nurse is preparing an education program about renal disease. Which risk factor should the nurse include when teaching? Select all that apply.

Immobility Spinal cord injury Sickle-cell anemia

Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease?

Incontinence

The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following?

Kidney stones

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?

Limiting fluid intake During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and IV fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema.

The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern?

New diagnosis of urosepsis- a systemic infection from microorganisms in the urinary tract invading the bloodstream

Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?

Oliguria

A client has been admitted for an outpatient cystoscopy because of a suspected interstitial cystitis. Which statement best describes the pathology of this disorder?

The bladder wall contains multiple pinpoint hemorrhagic areas that join and form larger hemorrhagic areas that may progress to fissuring and scarring of the bladder mucosa.