Exam 2

After teaching a client with a history of renal calculi, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of teaching? a. "I should drink at least 3 L of fluid every day." b. "I will eliminate all dairy or sources of calcium from my diet." c. "Aspirin and aspirin-containing products can lead to stones." d. "The doctor can give me antibiotics at the first sign of a stone."

A Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the client is well hydrated, the calcium will be excreted without issues. Dehydration increases the risk for supersaturation of calcium in the urine, which contributes to stone formation. The nurse would encourage the client to drink more fluids, not decrease calcium intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics neither prevent nor treat a stone.

A nurse evaluates a client with acute glomerulonephritis (GN). Which assessment finding would the nurse recognize as a positive response to the prescribed treatment? a. The client lost 11 lb (5 kg) in the past 10 days. b. The client's urine specific gravity is 1.048. c. No blood is observed in the client's urine. d. The client's blood pressure is 152/88 mm Hg.

A Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating that the glomeruli are performingthe function of filtration. A urine specific gravity of 1.048 is high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of 152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.

A client is taking furosemide 40 mg/day for management of early chronic kidney disease (CKD). To assess the therapeutic effect of the medication, what action of the nurse is best? a. Obtain daily weights of the client. b. Auscultate heart and breath sounds. c. Palpate the client's abdomen. d. Assess the client's diet history.

A Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in patients with early stages of CKD. One kilogram of weight equals about 1 L of fluid retained in the client, so daily weights are necessary to monitor the response of the client to themedication. Heart and breath sounds would be assessed if there is fluid retention, as in heart failure. Palpation of the client's abdomen is not necessary, but the nurse would check for edema. The diet history of the client would be helpful to assess electrolyte replacement since potassium is lost with this diuretic, but this does not assess the effectiveness of the medication.

After teaching a client who has stress incontinence, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? a. "I will limit my total intake of fluids." b. "I must avoid drinking alcoholic beverages." c. "I must avoid drinking caffeinated beverages." d. "I shall try to lose about 10% of my body weight."

A Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence or cystitis. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence.

A nurse contacts the primary health care provider after reviewing a client's laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a serum creatinine of 1.0 mg/dL (88.4 mcmol/L). What collaborative care measure would the nurse recommend? a. Intravenous fluids b. Hemodialysisc c. Fluid restriction d. Urine culture and sensitivity

A Normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Normal creatinine is 0.6 to 1.2 mg/dL (53.0 to 106.1 mcmol/L) (males) or 0.5 to 1.1 mg/dL (44.2 to 97.2 mcmol/L) (females). Creatinine is more specific for kidney function than BUN, because BUN can beaffected by several factors (dehydration, high-protein diet, and catabolism). This client's creatinine is normal, which suggests a nonrenal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse would recommend giving the client more fluids, not placing the client on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity are not appropriate.

A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of most concern to the nurse? a. Albumin level of 2.5 g/dL (3.63 mcmol/L) b. Phosphorus level of 5 mg/dL (1.62 mmol/L) c. Sodium level of 135 mEq/L (135 mmol/L) d. Potassium level of 5.5 mEq/L (5.5 mmol/L)

A Protein restriction is necessary with CKD due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the client's metabolic needs. The electrolyte values are not related to the protein-restricted diet.

A nurse obtains the health history of a client with a suspected diagnosis of bladder cancer. Which question would the nurse ask when determining this client's risk factors? a. "Do you smoke cigarettes?" b. "Do you use any alcohol?" c. "Do you use recreational drugs?" d. "Do you take any prescription drugs?"

A Smoking is known to be a factor that greatly increases the risk of bladder cancer. Alcohol use, recreational drug use, and prescription drug use (except medications that contain phenacetin) are not known to markedly increase the risk of developing bladder cancer

The nurse delegates completing a bladder scan to assistive personnel (AP). Which action by the AP indicates that the nurse must provide additional instructions when delegating this task? a. Selecting the female icon for all female patients and male icon for all male patients b. Telling the client, "This test measures the amount of urine in your bladder." c. Applying ultrasound gel to the scanning head and removing it when finished d. Taking at least two readings using the aiming icon to place the scanning head

A The AP should use the female icon for women who have not had a hysterectomy. This allows the scanner to subtract the volume of the uterus from readings. If a woman has had a hysterectomy, the AP should choose the male icon. The AP should explain the procedure to the client, apply gel to the scanning head and clean it after use, and take at least two readings

A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum creatinine level of 2 mg/dL (176 mcmol/L), and a urine output of 350 mL/day. What is the best action by the nurse? a. Place the client on a cardiac monitor immediately. b. Teach the client to limit high-potassium foods. c. Continue to monitor the client's intake and output. d. Ask to have the laboratory redraw the blood specimen.

A The best action by the nurse would be to check the cardiac status with a monitor. High-potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.

A nurse teaches a young female client who is prescribed cephalexin for a urinary tract infection. Which statement would the nurse include in this client's teaching? a. "Use a second form of birth control while on this medication." b. "You will experience increased menstrual bleeding while on this drug." c. "You may experience an irregular heartbeat while on this drug." d. "Watch for blood in your urine while taking this medication."

A The client should use a second form of birth control because antibiotic therapy reduces the effectiveness of estrogen-containingcontraceptives. She should not experience increased menstrual bleeding, an irregular heartbeat, or blood in her urine while taking the drug.

A client with chronic kidney disease (CKD) has an elevated serum phosphorus level. What drug would the nurse anticipate to be prescribed for this client? a. Calcium acetate b. Doxycyline c. Magnesium sulfate d. Lisinopril

A The client with CKD often has a high phosphorus level which tends to lower the calcium level in an inverse relationship, andcauses osteodystrophy. To prevent this bone disease, the client needs to take a drug that can bind with phosphorus for elimination via the GI tract. When phosphorus is lowered to within normal limits, normal calcium levels may be restored.

A client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse? a. Discuss what the treatment regimen means to the client. b. Refer the client to a mental health nurse practitioner. c. Reschedule the appointments to another date and time. d. Discuss the option of peritoneal dialysis.

A The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options, assessment of the client's acceptance of the treatment would come first.

A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first when taking this client's history? a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?" b. "Do you have anyone in your family with renal failure?" c. "Have you had a diet that is low in protein recently?" d. "Has a relative had a kidney transplant lately?"

A There are some medications that are nephrotoxic, such as the non steroidal anti-inflammatory drugs ibuprofen, aspirin, andnaproxen. This would be a good question to initially ask the patient since both the serum creatinine and BUN are elevated, indicating some renal problems. A diet high in protein could be a factor in an increased BUN.

A nurse assesses a client who presents with renal calculi. Which question would the nurse ask? a. "Do any of your family members have this problem?" b. "Do you drink any cranberry juice?" c. "Do you urinate after sexual intercourse?" d. "Do you experience burning with urination?"

A There is a strong association between family history and stone formation and recurrence. Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask whether other family members have also had renal stones. The other questions donot refer to renal calculi but instead are questions that should be asked of a patient with a urinary tract infection.

A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is most appropriate? a. Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c. Teach the patient to drink 2 to 3 L of water daily. d. Perform an electrocardiogram.

A This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the patient to drink 2 to 3 L of water each day. An intravenous line may be needed later, after the patient's degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

After teaching a client with a history of renal calculi, the nurse assesses the client9s understanding. Which statement made by the client indicates a correct understanding of the teaching? A. I should drink at least 3 L of fluid every day.= B. I will eliminate all dairy or sources of calcium from my diet.= C. Aspirin and aspirin-containing products can lead to stones.= D. The doctor can give me antibiotics at the first sign of a stone.=

A ~ Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the client is well hydrated, the calcium will be excreted without issues. Dehydration increases the risk for supersaturation of calcium in the urine, which contributes to stone formation. The nurse would encourage the client to drink more fluids, not decrease calcium intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics neither prevent nor treat a stone

After teaching a client who has stress incontinence, the nurse assesses the client9s understanding. Which statement made by the client indicates a need for further teaching? A. I will limit my total intake of fluids.= B. I must avoid drinking alcoholic beverages.= C. I must avoid drinking caffeinated beverages.= D. I shall try to lose about 10% of my body weight.=

A ~ Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence or cystitis. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence.

A nurse obtains the health history of a client with a suspected diagnosis of bladder cancer. Which question would the nurse ask when determining this client9s risk factors? A. Do you smoke cigarettes?= B. Do you use any alcohol?= C. Do you use recreational drugs?= d. Do you take any prescription drugs?

A ~ Smoking is known to be a factor that greatly increases the risk of bladder cancer. Alcohol use, recreational drug use, and prescription drug use (except medications that contain phenacetin) are not known to markedly increase the risk of developing bladder cancer.

A nurse teaches a young female client who is prescribed cephalexin for a urinary tract infection. Which statement would the nurse include in this client9s teaching? A. Use a second form of birth control while on this medication.= B. You will experience increased menstrual bleeding while on this drug.= C. You may experience an irregular heartbeat while on this drug.= D. Watch for blood in your urine while taking this medication.=

A ~ The client should use a second form of birth control because antibiotic therapy reduces the effectiveness of estrogen-containing contraceptives. She should not experience increased menstrual bleeding, an irregular heartbeat, or blood in her urine while taking the drug

A nurse assesses a client who presents with renal calculi. Which question would the nurse ask? A. Do any of your family members have this problem?= B. Do you drink any cranberry juice?= C. Do you urinate after sexual intercourse?= D. Do you experience burning with urination?

A ~ There is a strong association between family history and stone formation and recurrence. Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask whether other family members have also had renal stones. The other questions do not refer to renal calculi but instead are questions that should be asked of a patient with a urinary tract infection

A nurse teaches a client about self-management after experiencing a urinary calculus treated by lithotripsy. Which statements would the nurse include in this client9s discharge teaching? (Select all that apply.) A. Finish the prescribed antibiotic even if you are feeling better.= B. Drink at least 3 L of fluid each day.= C. The bruising on your back may take several weeks to resolve.= D.Report any blood present in your urine.= E. It is normal to experience pain and difficulty urinating.=

A, B, C, ~ The client should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The client should drink at least 3 L of fluid daily to dilute potential stone-forming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the client should expect bruising that may take several weeks to resolve. The client should also experience blood in the urine for several days. The client should report any pain, fever, chills, or difficulty with urination to the primary health care provider as these may signal the beginning of an infection or the formation of another stone.

The nurse is caring for a client who is diagnosed with urinary tract infection (UTI). What common urinary signs and symptoms does the nurse expect? (Select all that apply.) a. Dysuria b. Frequency c. Burning d. Fever e. Chills f. Hematuria

A, B, C, F ~ Fever and chills may occur in clients who have a UTI if the infection has expanded beyond the bladder into the kidneys. However, these symptoms are not urinary signs and symptoms

A nurse assesses a client who has had two episodes of bacterial cystitis in the last 6 months. Which question(s) would the nurse ask? (Select all that apply.) A. How much water do you drink every day?= B. Do you take estrogen replacement therapy?= C. Does anyone in your family have a history of cystitis?= D. Are you on steroids or other immune-suppressing drugs?= E. Do you drink grapefruit juice or orange juice daily?

A, B, D ~ Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent cystitis. Family history is usually insignificant, and cranberry juice, not grapefruit or orange juice, has been found to increase the acidic pH and reduce the risk for bacterial cystitis.

1. A nurse reviews a client9s laboratory results. Which results from the client9s urinalysis would the nurse identify as normal? (Select all that apply.) A. pH: 6 B. Specific gravity: 1.015 C. Protein: 1.2 mg/dL D. Glucose: negative E. Nitrate: small F. Leukocyte esterase: positive

A, B, D ~The pH, specific gravity, and glucose are all within normal ranges. The other values are abnormal.

A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly paired with their description? (Select all that apply.) A. Stress incontinence4urine loss with physical exertion B. Urge incontinence4loss of urine upon feeling the need to void C. Functional incontinence4urine loss results from abnormal detrusor contractions D. Overflow incontinence4constant dribbling of urine E. Reflex incontinence4leakage of urine without lower urinary tract disorder

A, B, D ~ Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising. Urge incontinence presents with an abrupt and strong urge to void and usually has a large amount of urine released with each occurrence. Overflow incontinence occurs with bladder distention and results in a constant dribbling of urine. Functional incontinence is the leakage of urine caused by factors other than a disorder of the lower urinary tract. Reflex incontinence results from abnormal detrusor contractions from a neurologic abnormality.

A nurse prepares a client for a percutaneous kidney biopsy. What actions should the nurse take prior to this procedure? (Select all that apply.) A. Keep the client NPO for 4 to 6 hours. B. Review coagulation study results. C. Maintain strict bedrest in a supine position. D. Assess for blood in the client9s urine. E. Administer client9s antihypertensive medications.

A, B, E ~ Prior to a percutaneous kidney biopsy, the patient should be NPO for 4 to 6 hours. Coagulation studies should be completed to prevent bleeding after the biopsy. Blood pressure medications should be administered to prevent hypertension before and after the procedure. There is no need to keep the patient on bedrest or assess for blood in the client9s urine prior to the procedure; these interventions should be implemented after a percutaneous kidney biopsy.

A nurse plans care for an older adult patient. Which interventions should the nurse include in this client9s plan of care to promote kidney health? (Select all that apply.) A. Ensure adequate fluid intake. B. Leave the bathroom light on at night. C. Encourage use of the toilet every 6 hours. D. Delegate bladder training instructions to the assistive personnel (AP). E. Provide thorough perineal care after each voiding. F. Assess for urinary retention and urinary tract infection.

A, B, E, F ~ The nurse should ensure that the client receives adequate fluid intake and has adequate lighting to ambulate safely to the bathroom at night, encourage the client to use the toilet every 2 hours, provide thorough perineal care after each voiding, and assess for urinary retention and urinary tract infections. The nurse would not delegate any teaching to the AP, including bladder training instructions. The AP may participate in bladder training activities, including encouraging and assisting the client to the bathroom at specific times.

The nurse is preparing a client for a percutaneous kidney biopsy. Which laboratory tests results would the nurse review prior to the procedure? (Select all that apply.) A. Hemoglobin B. Hematocrit C. Sodium D. Potassium E. Platelet count F. Prothrombin time

A, B, E, F ~Kidneys are very vascular and the client is at risk for bleeding after a biopsy. Therefore, it is essential that the nurse review preprocedure laboratory test results for anemia and coagulation problems.

A client asks the nurse why she has urinary incontinence. What risk factors would the nurse recall in preparing to respond to the client9s question? (Select all that apply.) A. Diuretic therapy B. Anorexia nervosa C. Stroke D. Dementia E. Arthritis F. Parkinson disease

A, C, D, E, F ~ Drugs, such as diuretics, cause frequent voiding, often in large amounts. Diseases or disorders that limit mobility, such as stroke, arthritis, and Parkinson disease, can prevent an individual from getting to the bathroom in a timely manner. Mental/behavioral problems, such as dementia, impair cognition and the ability to recognize when he or she needs to void.

After treating several young women for urinary tract infections (UTIs), the college nurse plans an educational offering on reducing the risk of getting a UTI. What information does the nurse include? (Select all that apply.) A. Void before and after each act of intercourse. B. Consider changing to spermicide from birth control pills. C. Do not douche or use scented feminine products. D. Wear loose-fitting nylon panties. E. Wipe or clean the perineum from front to back.

A, C, E ~ Woman can reduce their risk of contracting UTIs by voiding before and after intercourse, not douching or using scented feminine products, and wiping from front to back. If spermicides are currently used, the woman should consider another form of birth control. Loose-fitting cotton underwear is best.

3. A nurse assesses a client recovering from a cystoscopy. Which assessment findings would alert the nurse to urgently contact the primary health care provider? (Select all that apply.) A. Decrease in urine output B. Tolerating oral fluids C. Prescription for metformin D. Blood clots present in the urine E. Burning sensation when urinating

A, D ~ The nurse would monitor urine output and contact the primary health care provider if urine output decreases or becomes absent. The nurse would also assess for blood in the client9s urine. The urine may be pink-tinged, but gross bleeding or blood clots should not be present. If bleeding is present, the nurse would urgently contact the primary health care provider. Tolerating oral fluids is a positive outcome and does not need intervention. Metformin would be a concern if the patient received dye; no dye is used in a cystoscopy procedure. The client may experience a burning sensation when urinating after this procedure; this would not require a call to the primary health care provider.

The nurse is planning health teaching for a client starting mirabegron for urinary incontinence. What health teaching would the nurse include? (Select all that apply.) A. Monitor blood tests carefully if you are prescribed warfarin.= B. Avoid crowds and individuals with infection.= C. Report any fever to your primary health care provider.= D. Take your blood pressure frequently at home.= E. Report palpitations or chest soreness that may occur.=

A,D ~ This drug can cause increase blood pressure and, therefore, the client9s blood pressure should be monitored. Mirabegron can increase the effect of warfarin causing bleeding or bruising. The client will need additional coagulation studies to ensure that the INR is within a therapeutic range.

A nurse reviews the laboratory findings of a client with a urinary tract infection (bacterial cystitis). The laboratory report notes a "shift to the left" in the client's white blood cell count. What action would the nurse take? a. Request that the laboratory perform a differential analysis on the white blood cells. b. Notify the primary health care provider and start an intravenous line for parenteral antibiotics c. Ask assistive personnel (AP) to strain the client's urine for renal calculi. d. Assess the client for a potential allergic reaction and anaphylactic shock.

B An increase in band cells creates a "shift to the left." A left shift most commonly occurs with urosepsis and is seen rarely with uncomplicated urinary tract infections. The nurse will be administering antibiotics, most likely via IV, so he or she would notify the primary health care provider and prepare to give the antibiotics. The shift to the left is part of a differential white blood cell count. The nurse would not need to strain urine for stones. Allergic reactions are associated with elevated eosinophil cells, not band cells.

A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by thenurse? a. Warm the dialysate solution in a microwave before instillation. b. Obtain a sample of the effluent and send to the laboratory. c. Flush the tubing with normal saline to maintain patency of the catheter. d. Check the peritoneal catheter for kinking and curling.

B An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse. Checking the catheter for obstruction is a viable option but will not treat the peritonitis.

After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I will take a laxative every night before going to bed." b. "I must increase my intake of dietary fiber and fluids." c. "I shall only use salt when I am cooking my own food." d. "I'll eat white bread to minimize gastrointestinal gas."

B Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. Laxatives would be used cautiously. Clients with PKD would be on a restricted salt diet, which includes not cooking with salt. White bread has a low-fiber count and would not be included in a high-fiber diet.

After delegating care to assistive personnel (AP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the AP's understanding. Which action indicates that the AP needs additional teaching? a. Toileting the client after breakfast b. Changing the client's incontinence brief when wet c. Encouraging the client to drink fluids d. Recording the client's incontinence episodes

B Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse should reeducate the AP on thetechnique of habit training. The AP should continue to toilet the client after meals, encourage the client to drink fluids, and record incontinent episodes.

After teaching a client with nephrotic syndrome and a normal glomerular filtration, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the diet therapy for this condition? a. "I must decrease my intake of fat." b. "I will increase my intake of protein." c. "A decreased intake of carbohydrates will be required." d. "An increased intake of vitamin C is necessary."

B In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss would be matched by increased intake of protein.

A nurse reviews a client's laboratory results. Which results from the client's urinalysis would the nurse recognize as abnormal? a. pH of 5.6 b. Ketone bodies present c. Specific gravity of 1.020 d. Clear and yellow color

B Ketone bodies are by-products of incomplete metabolism of fatty acids. Normally, no ketones are present in urine. Ketone bodiesare produced when fat sources are used instead of glucose to provide cellular energy. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030, and clear yellow urine are normal findings in a urinalysis.

The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse assess first upon initialrounding? a. Client with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c. Client with skin itching from head to toe d. Client with halitosis and stomatitis

B Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of CKD. The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs to lower serum pH. Hypertension is common in mostpatients with CKD, and skin itching increases with calcium-phosphate imbalances and elevations of nitrogenous wastes, another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis

A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in the last 6 months. The client asks, "I never have urinary tract infections. Why is this happening now?" How would the nurse respond?" a. "Your immune system becomes less effective as you age." b. "Low estrogen levels can make the tissue more susceptible to infection." c. "You should be more careful with your personal hygiene in this area." d. "It is likely that you have an untreated sexually transmitted disease."

B Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes, predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this reason. Although immune function does decrease with aging and sexually transmitted diseases are a known cause of urethritis, the most likely reason in this patient is low estrogen levels. Personal hygiene usually does not contribute to this disease

The nurse is assessing a group of clients for their risk of kidney disease. Which racial/ethnic group is at the greatest risk as they age? a. Latino Americans b. African Americans c. Jewish Americans d. Asian Americans

B Older African Americans have a greater age-related decrease in glomerular filtration rate when compared to other racial-ethnicgroups. In addition, blood flow decreases and sodium excretion is less effective in older hypertensive African Americans. These changes make this group most at risk for kidney disease.

A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding would alert the nurse to immediately contact the primary health care provider? a. Flank pain b. Periorbital edema c. Bloody and cloudy urine d. Enlarged abdomen

B Periorbital edema would not be a finding related to PKD and would be investigated further. Flank pain and a distended or enlargedabdomen occur in PKD because the kidneys enlarge and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or infection.

The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which condition would the nurse expect to find in the patient's recent history? a. Pyelonephritis b. Dehydration c. Bladder cancer d. Kidney stones

B Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are postrenal causes of AKIrelated to urine flow obstruction.

A nurse reviews the health history of a client with an oversecretion of renin. Which disorder would the nurse correlate with this assessment finding? a. Alzheimer disease b. Hypertension c. Diabetes mellitus d. Viral hepatitis

B Renin is secreted when special cells in the distal convoluted tubule, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume, blood pressure, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension. Renin has no impact on Alzheimer disease, diabetes mellitus, or viral hepatitis.

The nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question would the nurse ask first? a. "Are you drinking plenty of water?" b. "What medications are you taking?" c. "Have you tried laxatives or enemas?" d. "Has this type of thing ever happened before?"

B Some types of incontinence or other health problems are treated with anticholinergic medications. Anticholinergic side effectsinclude dry mouth, constipation, and urinary retention. The nurse needs to assess the client's medication list to determine whetherthe he or she is taking an anticholinergic medication. The other questions are not as helpful to understanding the current situation.

After teaching a client with hypertension secondary to renal disease, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I can prevent more damage to my kidneys by managing my blood pressure." b. "If I have increased urination at night, I need to drink less fluid during the day." c. "I need to see the registered dietitian to discuss limiting my protein intake." d. "It is important that I take my antihypertensive medications as directed."

B The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions, and would be assessed thoroughly for potential dehydration. Increased nocturnal voiding can be decreased byconsuming fluids earlier in the day. Blood pressure control is needed to slow the progression of renal dysfunction. When dietary protein is restricted, refer the client to the registered dietitian nutritionist as needed.

A nurse assesses a client who is recovering from extracorporeal shock-wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client's right lower back. What action would the nurse take? a. Administer fresh-frozen plasma. b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results.

B The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh-frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level of intervention. Changing the client's position will not decrease bleeding.

A nurse reviews the laboratory findings of a client with a urinary tract infection (bacterial cystitis). The laboratory report notes a <shift to the left= in the client9s white blood cell count. What action would the nurse take? A. Request that the laboratory perform a differential analysis on the white blood cells. B. Notify the primary health care provider and start an intravenous line for parenteral antibiotics. C. Ask assistive personnel (AP) to strain the client9s urine for renal calculi. D. Assess the client for a potential allergic reaction and anaphylactic shock.

B ~ An increase in band cells creates a <shift to the left.= A left shift most commonly occurs with urosepsis and is seen rarely with uncomplicated urinary tract infections. The nurse will be administering antibiotics, most likely via IV, so he or she would notify the primary health care provider and prepare to give the antibiotics. The shift to the left is part of a differential white blood cell count. The nurse would not need to strain urine for stones. Allergic reactions are associated with elevated eosinophil cells, not band cells.

After delegating care to assistive personnel (AP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the AP9s understanding. Which action indicates that the AP needs additional teaching? A. Toileting the client after breakfast B. Changing the client9s incontinence brief when wet C. Encouraging the client to drink fluids D. Recording the client9s incontinence episodes

B ~ Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse should reeducate the AP on the technique of habit training. The AP should continue to toilet the client after meals, encourage the client to drink fluids, and record incontinent episodes.

A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in the last 6 months. The client asks, <I never have urinary tract infections. Why is this happening now?= How would the nurse respond? A. Your immune system becomes less effective as you age.= B. Low estrogen levels can make the tissue more susceptible to infection.= C. You should be more careful with your personal hygiene in this area.= D. It is likely that you have an untreated sexually transmitted disease.=

B ~ Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes, predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this reason. Although immune function does decrease with aging and sexually transmitted diseases are a known cause of urethritis, the most likely reason in this patient is low estrogen levels. Personal hygiene usually does not contribute to this disease process.

The nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question would the nurse ask first? A. Are you drinking plenty of water?= B. What medications are you taking?= C. Have you tried laxatives or enemas? D. Has this type of thing ever happened before?

B ~ Some types of incontinence or other health problems are treated with anticholinergic medications. Anticholinergic side effects include dry mouth, constipation, and urinary retention. The nurse needs to assess the client9s medication list to determine whether the he or she is taking an anticholinergic medication.

A nurse assesses a client who is recovering from extracorporeal shock-wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client9s right lower back. What action would the nurse take? A. Administer fresh-frozen plasma. B. Apply an ice pack to the site. C. Place the client in the prone position. D. Obtain serum coagulation test results.

B ~ The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh-frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level of intervention. Changing the client9s position will not decrease bleeding.

A nurse cares for a client who is recovering from a closed percutaneous kidney biopsy. The client states, "My pain has suddenly increased from a 3 to a 10 on a scale of 0-10." Which action would the nurse take first? a. Reposition the client on the operative side. b. Administer the prescribed opioid analgesic. c. Assess the client's pulse rate and blood pressure. d. Examine the color of the client's urine.

C An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of possible internal hemorrhage. A change in vital signs (elevated pulse and decreased blood pressure) can indicate that hemorrhage is occurring

Due to the high risk for infection, intermittent catheterization should only be implemented when other interventions are not successful the following day, which question would the nurse ask the primary health care provider?a. "Do you want daily weights on this client?" b. "Will the client be able to return home?" c. "May we discontinue the indwelling catheter?" d. "Should we get another chest x-ray today?"

C An indwelling urinary catheter dramatically increases the risks of urinary tract infection and urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are medically needed. The nurse would inquire about removing the catheter.

A nurse cares for a client who has pyelonephritis. The client states, "I am embarrassed to talk about my symptoms." How would the nurse respond?a. "I am a professional. Your symptoms will be kept in confidence." b. "I understand. Elimination is a private topic and shouldn't be discussed." c. "Take your time. It is okay to use words that are familiar to you." d. "You seem anxious. Would you like a nurse of the same gender to care for you?"

C Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse would encourage the client to use language that is familiar to the client. The nurse must assess the client and cannot take the time to stop the discussion

A nurse cares for a middle-age female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, "What can I do to help prevent these infections?" How would the nurse respond? a. "Test your urine daily for the presence of ketone bodies and proteins." b. "Use tampons rather than sanitary napkins during your menstrual period." c. "Drink more water and empty your bladder more frequently during the day." d. "Keep your hemoglobin A1C under 9% by keeping your blood sugar controlled."

C Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH, and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client's sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A1C of 9% is too high.

A client with diabetes mellitus type 2 has been well controlled with metformin. The client is scheduled for magnetic resonance imaging (MRI) scan with contrast. What priority would the nurse take at this time? a. Teach the client about the purpose of the MRI. b. Assess the client's blood urea nitrogen and creatinine. c. Tell the client to withhold metformin for 24 hours before the MRI. d. Ask the client if he or she is taking antibiotics.

C Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be nephrotoxic and the client should not beexposed to two agents. Clients who have diabetes are already at risk for renal damage.

A nurse assesses a client with renal insufficiency and a low red blood cell count. The client asks, "Is my anemia related to my kidney problem?" How would the nurse respond? a. "Red blood cells produce erythropoietin, which increases blood flow to the kidneys." b. "Your anemia and kidney problem are related to inadequate vitamin D and a loss of bone density." c. "Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow." d. "Kidney insufficiency inhibits active transportation of red blood cells throughout the blood."

C Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency. The kidneys do not play a role in the transportation of red blood cells or any other cells in the blood.

A client is started on continuous venovenous hemofiltration (CVVH). Which finding would require immediate action by thenurse? a. Potassium level of 5.5 mEq/L (5.5 mmol/L) b. Sodium level of 138 mEq/L (138 mmol/L) c. Blood pressure of 76/58 mm Hg d. Pulse rate of 88 beats/min

C Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to maintain blood pressure. The nurse needs to monitor for ongoing fluid and electrolyte replacement. The sodium level is normal and the potassium level is slightlyelevated, which could be normal findings for someone with acute kidney injury. A pulse rate of 88 beats/min is within usual limits.

The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching? a. "I should leave the drainage bag above the level of my abdomen." b. "I could flush the tubing with normal saline if the flow stops." c. "I should take a stool softener every morning to avoid constipation." d. "My diet should have low fiber in it to prevent any irritation."

C Inflow and outflow problems of the dialysate are best controlled by preventing constipation. A daily stool softener is the best option for the client. The drainage bag should be below the level of the abdomen. Flushing the tubing will not help with the flow. A diet high in fiber will also help with a constipation problem.

A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200 mOsm/kg (1200 mmol/kg). Which action would the nurse take? a. Contact the primary health care provider to recommend a low-sodium diet. b. Prepare to administer an intravenous diuretic. c. Encourage the client to drink more fluids. d. Obtain a suction device and implement seizure precautions.

C Normal urine osmolality ranges from 300 to 900 mOsm/kg (300 to 900 mmol/kg). This client's urine is more concentrated,indicating dehydration. The nurse would encourage the client to drink more water. Dehydration can be associated with elevated serum sodium levels. Although a low-sodium diet may be appropriate for this client, this diet change will not have a significant impact on urine osmolality. A diuretic would increase urine output and decrease urine osmolality further. Low serum sodium levels, not elevated serum levels, place the client at risk for seizure activity. These options would further contribute to the client's dehydration or elevate the osmolality.

After teaching a client with bacterial cystitis who is prescribed phenazopyridine, the nurse assesses the client's understanding.Which statement made by the client indicates a correct understanding of the teaching? a. "I will not take this drug with food or milk." b. "I will have my partners tested for STIs." c. "An orange color in my urine should not alarm me." d. "I will drink two glasses of cranberry juice daily."

C Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients think that they have blood in their urine when they see this. In addition, the urine can permanently stain clothing. There are no dietary restrictions or needs while taking this medication

A client is placed on fluid restriction because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time? a. Decreased calcium levels b. Increased phosphorus levels c. No adventitious sounds in the lungs d. Increased edema in the legs

C The absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the client'sbody. Decreased calcium levels and increased phosphorus levels are common findings with CKD. Edema would indicate a fluid imbalance.

The nurse assesses a client who has possible bladder cancer. What common assessment finding associated with this type of cancer would the nurse expect? a. Urinary retention b. Urinary incontinence c. Painless hematuria d. Difficulty urinating

C The classic and most common finding in clients who have bladder cancer is painless and intermittent hematuria that can be with gross or microscopic. Dysuria, frequency, and urgency occur in clients who have bladder infection or obstruction.

A nurse reviews the laboratory values of a client who returned from kidney transplantation 12 hours ago:Sodium 136 mEq/L (135 mmol/L)Potassium 5 mEq/L (5 mmol/L) Blood urea nitrogen (BUN) 44 mg/dL (15.7 mmol/L) Serum creatinine 2.5 mg/dL (221 mcmol/L)What initial intervention would the nurse anticipate? a. Start hemodialysis immediately. b. Discuss the need for peritoneal dialysis. c. Increase the dose of immunosuppression. d. Return the client to surgery for exploration.

C The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute rejection of the transplanted kidney. The client does not need hemodialysis, peritoneal dialysis, or further surgery at this point

A nurse teaches a client who is starting urinary bladder training. Which statement would the nurse include in this client's teaching? a. "Use the toilet when you first feel the urge, rather than at specific intervals." b. "Initially try to use the toilet at least every half hour for the first 24 hours." c. "Try to consciously hold your urine until the scheduled toileting time." d. "The toileting interval can be increased once you have been continent for a week."

C The client should try to hold urine consciously until the next scheduled toileting time. Toileting should occur at specific intervals during the training. The interval can be increased once the client becomes comfortable with the interval.

The nurse is caring for a client who has chronic pyelonephritis. What assessment finding would the nurse expect? a. Fever b. Flank pain c. Hypertension d. Nausea and vomiting

C The client who has chronic pyelonephritis has renal damage and therefore has hypertension. The other assessment findings commonly occur in clients with acute pyelonephritis.

The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has acute kidney injury (AKI). 24-hour urinary output is 120 mL. How much fluid would the client be allowed to have over the next 24 hours? a. 380 mL b. 500 mL c. 620 mL d. 750 mL

C The general principle for fluid restriction for clients is that they may have a daily fluid intake of 500 mL plus the amount of theirurinary output. In this case, 120 mL urinary output plus 500 mL equals 620 mL fluid allowance.

The nurse is caring for a client with urinary incontinence. The client states, "I am so embarrassed. My bladder leaks like a young child's bladder." How would the nurse respond? a. "I understand how you feel. I would be mortified." b. "Incontinence pads will minimize leaks in public." c. "I can teach you strategies to help control your incontinence." d. "More people experience incontinence than you might think."

C The nurse would accept and acknowledge the client's concerns, and assist the client to learn techniques that will allow control of urinary incontinence. The nurse would not diminish the client's concerns with the use of pads or stating statistics about the occurrence of incontinence.

The charge nurse is orienting a new nurse about care for an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? a. Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c. Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left arm

C The nurse would not use the arm with the AV fistula for intravenous infusion, blood pressure readings, or venipuncture.Compression and infection can result in the loss of the AV fistula. The AV fistula would be monitored by auscultating or palpating the access site. Checking the distal pulse would be an appropriate assessment.

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this patient's care? a. Edema and pain b. Cardiac and respiratory status c. Electrolyte and fluid imbalance d. Mental health status

C This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client's cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

A client with pneumonia and dementia is admitted with an indwelling urinary catheter in place. During interprofessional rounds the following day, which question would the nurse ask the primary health care provider? A. Do you want daily weights on this client?= B. Will the client be able to return home?= C. May we discontinue the indwelling catheter?= D. Should we get another chest x-ray today?

C ~ An indwelling urinary catheter dramatically increases the risks of urinary tract infection and urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are medically needed. The nurse would inquire about removing the catheter. All other questions might be appropriate, but because of client safety, this question takes priority.

After teaching a client with bacterial cystitis who is prescribed phenazopyridine, the nurse assesses the client9s understanding. Which statement made by the client indicates a correct understanding of the teaching? A. I will not take this drug with food or milk.= B. I will have my partners tested for STIs.= C. An orange color in my urine should not alarm me.= D. I will drink two glasses of cranberry juice daily.=

C ~ Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients think that they have blood in their urine when they see this. In addition, the urine can permanently stain clothing. There are no dietary restrictions or needs while taking this medication.

The nurse assesses a client who has possible bladder cancer. What common assessment finding associated with this type of cancer would the nurse expect? A. Urinary retention B. Urinary incontinence C. Painless hematuria D. Difficulty urinating

C ~ The classic and most common finding in clients who have bladder cancer is painless and intermittent hematuria that can be with gross or microscopic. Dysuria, frequency, and urgency occur in clients who have bladder infection or obstruction.

A nurse teaches a client who is starting urinary bladder training. Which statement would the nurse include in this client9s teaching? A. Use the toilet when you first feel the urge, rather than at specific intervals.= B. Initially try to use the toilet at least every half hour for the first 24 hours.= C. Try to consciously hold your urine until the scheduled toileting time.= D. The toileting interval can be increased once you have been continent for a week.

C ~ The client should try to hold urine consciously until the next scheduled toileting time. Toileting should occur at specific intervals during the training. The interval can be increased once the client becomes comfortable with the interval.

A nurse reviews the urinalysis of a client and notes the presence of glucose. What action would the nurse take? a. Document findings and continue to monitor the client. b. Contact the primary health care provider and recommend a 24-hour urine test. c. Review the client9s recent dietary selections over 3 days. d. Perform a finger stick blood glucose assessment.

D

The nurse is admitting a client who has acute glomerulonephritis caused by beta streptococcus. What drug therapy would the nurseexpect to be prescribed for this client? a. Antihypertensives b. Antilipidemics c. Antidepressants d. Antibiotics

D Beta streptococcus is a bacterium that can cause acute glomerulonephritis, so antibiotic therapy is indicated.

The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates that more teaching is needed? a. "I will probably lose weight by cutting out potato chips." b. "I will cut out bacon with my eggs every morning." c. "My cooking style will change by not adding salt." d. "I am thrilled that I can continue to eat fast food."

D Fast-food restaurants usually serve food that is high in sodium. This statement indicates that more teaching needs to occur. Theother statements show a correct understanding of the teaching

A nurse teaches a client with functional urinary incontinence. Which statement would the nurse include in this client's teaching? a. "You must clean around your catheter daily with soap and water." b. "You will need to be on your drug therapy for life." c. "Operations to repair your bladder are available, and you can consider these." d. "You might want to get pants with elastic waistbands."

D Functional urinary incontinence occurs as the result of problems not related to the client's bladder, such as trouble ambulating or difficulty accessing the toilet. One desired outcome is that the client will be able to manage his or her clothing independently. Elastic waistband slacks that are easy to pull down and back up can help the client get on the toilet in time to void. The other instructions do not relate to functional urinary incontinence.

A nurse reviews the urinalysis of a client and notes the presence of glucose. What action would the nurse take? a. Document findings and continue to monitor the client. b. Contact the primary health care provider and recommend a 24-hour urine test. c. Review the client's recent dietary selections over 3 days. d. Perform a finger stick blood glucose assessment.

D Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL (12.2 mmol/L), which means that a person whose blood glucose is less than 220 mg/dL (12.2 mmol/L) will not have glucose in the urine. A positive finding for glucose on urinalysis indicates high blood sugar. The most appropriate action would be to perform a blood glucose assessment. The client needs further evaluation for this abnormal result; therefore, documenting and continuing to monitor are not appropriate. Requesting a 24-hour urine test or reviewing the client's dietary selections will not assist the nurse to make a clinical decision related to this abnormality.

A nurse plans care for a client with overflow incontinence. Which intervention does the nurse include in this client's plan of care to assist with elimination? a. Stroke the medial aspect of the thigh. b. Use intermittent catheterization. c. Provide digital anal stimulation. d. Use the Valsalva maneuver.

D In patients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure, such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh or providing digital anal stimulation requires the reflex arc to be intact to initiate elimination.

A nurse cares for a client with a urine specific gravity of 1.040. What action would the nurse take? a. Obtain a urine culture and sensitivity. b. Place the client on restricted fluids. c. Assess the client's creatinine level. d. Increase the client's fluid intake.

D Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with dehydration, decreased kidney bloodflow (often because of dehydration), and presence of antidiuretic hormone. Increasing the client's fluid intake would be a beneficial intervention. Assessing the creatinine or obtaining a urine culture would not provide data necessary for the nurse to make a clinical decision.

A nurse cares for a client who has kidney stones from gout ricemia. Which medication does the nurse anticipate administering? a. Phenazopyridine b. Doxycyline c. Tolterodine d. Allopurinol

D Stones caused by hyperuricmia caused by gout or other reason respond to allopurinol. Phenazopyridine is given to clients withurinary tract infections. Doxycycline is an antibiotic. Tolterodine is an anticholinergic with smooth muscle-relaxant properties.

The nurse teaches a client who has stress incontinence methods to regain more urinary continence. Which health teaching is the most important for the nurse to include for this client? a. What type of incontinence pads to use? b. What types of liquids to drink and when? c. Need to perform intermittent catheterizations. d. How to do Kegel exercises to strengthen muscles?

D The client who has stress incontinence needs to strengthen the muscles of the pelvic floor using Kegel exercises. Catheterizationswould not help with incontinence. Incontinence pads may need to be used by this client but that is not the most important thing to teach, and it does not help the client regain more control over his or her bladder.

A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary health care provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client starts to develop shortness of breath. What is the nurse's priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the client's pulse. d. Decrease the rate of the IV infusion.

D The nurse would assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter would evaluate the client's hemodynamic status, but this would not be the initial or priority action by the nurse. Vital signs are also important after adjusting the intravenous infusion.

A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client's blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. What action would the nurse take? a. Position the client to lay on the surgical incision. b. Measure the specific gravity of the client's urine. c. Administer intravenous pain medications. d. Assess the rate and quality of the client's pulse.

D The nurse would first fully assess the client for signs of volume depletion and shock, and then notify the primary health care provider. The extensive nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Repositioning the patient, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.

The nurse administers epoetin alfa to a client who has chronic kidney disease (CKD). Which laboratory test value would the nurse monitor to determine this drug's effectiveness? a. Potassium b. Sodium c. Renin d. Hemoglobin

D The purpose of giving epoetin alfa to a client with CKD is to manage anemia by stimulating the bone marrow to produce more red blood cells. Therefore, monitoring the client's hemoglobin, hematocrit, and red blood cell count would indicate if the drug was effective.

A nurse teaches a client with functional urinary incontinence. Which statement would the nurse include in this client9s teaching? A. You must clean around your catheter daily with soap and water.= B. You will need to be on your drug therapy for life.= C. Operations to repair your bladder are available, and you can consider these.= D. You might want to get pants with elastic waistbands.=

D ~ Functional urinary incontinence occurs as the result of problems not related to the client9s bladder, such as trouble ambulating or difficulty accessing the toilet. One desired outcome is that the client will be able to manage his or her clothing independently. Elastic waistband slacks that are easy to pull down and back up can help the client get on the toilet in time to void. The other instructions do not relate to functional urinary incontinence.

A nurse cares for a client who has kidney stones from gout ricemia. Which medication does the nurse anticipate administering? a. Phenazopyridine b. Doxycyline c. Tolterodine d. Allopurinol

D ~ Stones caused by hyperuricmia caused by gout or other reason respond to allopurinol. Phenazopyridine is given to clients with urinary tract infections. Doxycycline is an antibiotic. Tolterodine is an anticholinergic with smooth muscle-relaxant properties.

The nurse teaches a client who has stress incontinence methods to regain more urinary continence. Which health teaching is the most important for the nurse to include for this client? A. What type of incontinence pads to use? B. What types of liquids to drink and when? C. Need to perform intermittent catheterization. D. How to do Kegel exercises to strengthen muscles?

D ~ The client who has stress incontinence needs to strengthen the muscles of the pelvic floor using Kegel exercises. Catheterizations would not help with incontinence. Incontinence pads may need to be used by this client but that is not the most important thing to teach, and it does not help the client regain more control over his or her bladder.

The nurse is caring for a client with urinary incontinence. The client states, A. I am so embarrassed. My bladder leaks like a young child9s bladder.= How would the nurse respond? B. I understand how you feel. I would be mortified.= C. Incontinence pads will minimize leaks in public.= D. I can teach you strategies to help control your incontinence.= E. More people experience incontinence than you might think

D ~ The nurse would accept and acknowledge the client9s concerns, and assist the client to learn techniques that will allow control of urinary incontinence. The nurse would not diminish the client9s concerns with the use of pads or stating statistics about the occurrence of incontinence.

A nurse plans care for a client with overflow incontinence. Which intervention does the nurse include in this client9s plan of care to assist with elimination? A. Stroke the medial aspect of the thigh. B. Use intermittent catheterization. C. Provide digital anal stimulation. D. Use the Valsalva maneuver.

D ~In patients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure, such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh or providing digital anal stimulation requires the reflex arc to be intact to initiate elimination. Due to the high risk for infection, intermittent catheterization should only be implemented when other interventions are not successful.

5. A nurse contacts the primary health care provider after reviewing a client9s laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a serum creatinine of 1.0 mg/dL (88.4 mcmol/L). What collaborative care measure would the nurse recommend? a. Intravenous fluids b. Hemodialysis c. Fluid restriction d. Urine culture and sensitivity

a

The nurse delegates completing a bladder scan to assistive personnel (AP). Which action by the AP indicates that the nurse must provide additional instructions when delegating this task? a. Selecting the female icon for all female patients and male icon for all male patients b. Telling the client, <This test measures the amount of urine in your bladder.= c. Applying ultrasound gel to the scanning head and removing it when finished d. Taking at least two readings using the aiming icon to place the scanning head

a

A nurse evaluates a client with acute glomerulonephritis (GN). Which assessment finding would the nurse recognize as a positive response to the prescribed treatment? a. The client lost 11 lb (5 kg) in the past 10 days. b. The client9s urine specific gravity is 1.048. c. No blood is observed in the client9s urine. d. The client9s blood pressure is 152/88 mm Hg.

a ~ Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of 152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.

A client is taking furosemide 40 mg/day for management of early chronic kidney disease (CKD). To assess the therapeutic effect of the medication, what action of the nurse is best? a. Obtain daily weights of the client. b. Auscultate heart and breath sounds. c. Palpate the client9s abdomen. d. Assess the client9s diet history.

a ~ Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in patients with early stages of CKD. One kilogram of weight equals about 1 L of fluid retained in the client, so daily weights are necessary to monitor the response of the client to the medication. Heart and breath sounds would be assessed if there is fluid retention, as in heart failure. Palpation of the client9s abdomen is not necessary, but the nurse would check for edema. The diet history of the client would be helpful to assess electrolyte replacement since potassium is lost with this diuretic, but this does not assess the effectiveness of the medication.

A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of most concern to the nurse? a. Albumin level of 2.5 g/dL (3.63 mcmol/L) b. Phosphorus level of 5 mg/dL (1.62 mmol/L) c. Sodium level of 135 mEq/L (135 mmol/L) d. Potassium level of 5.5 mEq/L (5.5 mmol/L)

a ~ Protein restriction is necessary with CKD due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the client9s metabolic needs. The electrolyte values are not related to the protein-restricted diet.

A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum creatinine level of 2 mg/dL (176 mcmol/L), and a urine output of 350 mL/day. What is the best action by the nurse? a. Place the client on a cardiac monitor immediately. b. Teach the client to limit high-potassium foods. c. Continue to monitor the client9s intake and output. d. Ask to have the laboratory redraw the blood specimen.

a ~ The best action by the nurse would be to check the cardiac status with a monitor. High-potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.

A client with chronic kidney disease (CKD) has an elevated serum phosphorus level. What drug would the nurse anticipate to be prescribed for this client? a. Calcium acetate b. Doxycyline c. Magnesium sulfate d. Lisinopril

a ~ The client with CKD often has a high phosphorus level which tends to lower the calcium level in an inverse relationship, and causes osteodystrophy. To prevent this bone disease, the client needs to take a drug that can bind with phosphorus for elimination via the GI tract. When phosphorus is lowered to within normal limits, normal calcium levels may be restored.

A client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse? a. Discuss what the treatment regimen means to the client. b. Refer the client to a mental health nurse practitioner. c. Reschedule the appointments to another date and time. d. Discuss the option of peritoneal dialysis.

a ~ The initial action for the nurse is to assess anxiety, coping styles, and the client9s acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options, assessment of the client9s acceptance of the treatment would come first.

A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first when taking this client9s history? a. Have you been taking any aspirin, ibuprofen, or naproxen recently?= b. Do you have anyone in your family with renal failure?= c. Have you had a diet that is low in protein recently?= d. Has a relative had a kidney transplant lately?

a ~ There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the patient since both the serum creatinine and BUN are elevated, indicating some renal problems. A diet high in protein could be a factor in an increased BUN.

A marathon runner comes into the clinic and states <I have not urinated very much in the last few days.= The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is most appropriate? a. Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c. Teach the patient to drink 2 to 3 L of water daily. d. Perform an electrocardiogram.

a ~ This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the patient to drink 2 to 3 L of water each day. An intravenous line may be needed later, after the patient9s degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for postrenal acute kidney injury (AKI)? (Select all that apply.) a. Client with prostate cancer b. Client with blood clots in the urinary tract c. Client with ureterolithiasis d. Client with severe burns e. Client with lupus

a, b, c ~ Urine flow obstruction, such as prostate cancer, blood clots in the urinary tract, and kidney stones (ureterolithiasis), causes postrenal AKI. Severe burns would be a prerenal cause. Lupus would be an intrarenal cause for AKI.

The nurse is assessing a client with acute pyelonephritis. What assessment findings would the nurse expect? (Select all that apply.) a. Fever b. Chills c. Tachycardia d. Tachypnea e. Flank or back pain f. Fatigue

a, b, c, d, e, f ~ All of these assessment findings commonly occur in clients who have acute pyelonephritis because this health problem is a kidney infection.

A nurse teaches a client with polycystic kidney disease (PKD). Which statements would the nurse include in this client9s discharge teaching? (Select all that apply.) a. Take your blood pressure every morning.= b. Weigh yourself at the same time each day.= c. Adjust your diet to prevent diarrhea.= d. Contact your provider if you have visual disturbances.= e. Assess your urine for renal stones.

a, b, d ~ A client who has PKD would measure and record his or her blood pressure and weight daily, limit salt intake, and adjust dietary selections to prevent constipation. The client should notify the primary health care provider if urine smells foul or has blood in it, as these are signs of a urinary tract infection or glomerular injury. The client should also notify the provider if visual disturbances are experienced, as this is a sign of a possible berry aneurysm, which is a complication of PKD. Diarrhea and renal stones are not manifestations or complications of PKD; therefore, teaching related to these concepts would be inappropriate.

A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are correct regarding PD? (Select all that apply.) a. You will not need vascular access to perform PD.= b. There is less restriction of protein and fluids.= c. You will have no risk for infection with PD.= d. You have flexible scheduling for the exchanges.= e. It takes less time than hemodialysis treatments.=

a, b, d ~ PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is no need for vascular access. Protein is lost in the exchange, which allows for more protein and fluid in the diet. There is flexibility in the time for exchanges, but the treatment takes a longer period of time compared to hemodialysis. There still is risk for infection with PD, especially peritonitis.

A client is undergoing hemodialysis. The client9s blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions would the nurse perform to maintain blood pressure? (Select all that apply.) a. Adjust the rate of extracorporeal blood flow. b. Place the patient in the Trendelenburg position. c. Stop the hemodialysis treatment. d. Administer a 250-mL bolus of normal saline. e. Contact the primary health care provider.

a, b, d ~ Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Modest decreases in blood pressure, as is the case with this client, can be maintained with rate adjustment, Trendelenburg positioning, and a fluid bolus. If the blood pressure drops considerably after two boluses and cooling dialysate, the hemodialysis can be stopped and the primary health care provider contacted.

A nurse assesses a client with nephrotic syndrome. Which assessment findings would the nurse expect? (Select all that apply.) a. Proteinuria b. Hypoalbuminemia c. Dehydration d. Lipiduria e. Dysuria f. Costovertebral angle (CVA) tenderness

a, b, d ~ Nephrotic syndrome is caused by glomerular damage and is characterized by proteinuria (protein level higher than 3.5 g/24 hr), hypoalbuminemia, edema, and lipiduria. Fluid overload leading to edema and hypertension is common with nephrotic syndrome; dehydration does not occur. Dysuria is present with cystitis. CVA tenderness is present with inflammatory changes in the kidney.

The nurse is reviewing the results of a client9s urinalysis. The client has a diagnosis of acute glomerulonephritis. Which urine findings would the nurse expect? (Select all that apply.) a. Presence of protein b. Presence of red blood cells c. Presence of white blood cells d. Acidic urine e. Dilute urine

a, c, d ~ The nurse would expect all of these findings except that the urine is usually concentrated with a high specific gravity.

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse would prompt immediate action to prevent acute kidney injury? (Select all that apply.) a. Urine output of 100 mL in 4 hours b. Urine output of 500 mL in 12 hours c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg

a, c, e ~ The low urine output, sediment, and blood pressure would be reported to the primary health care provider. Postoperatively, the nurse would measure intake and output, check the characteristics of the urine, and report sediment, hematuria, and urine output of less than 0.5 mL/kg/hr for 3 to 4 hours. A urine output of 100 mL is low, but a urine output of 500 mL in 12 hours would be within normal limits. Perfusion to the kidneys is compromised with low blood pressure. The amber odorless urine is normal.

A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client9s spouse about the renal-specific formulation for the enteral solution compared to standard formulas. What components would be discussed in the teaching plan? (Select all that apply.) a. Lower sodium b. Higher calcium c. Lower potassium d. Higher phosphorus e. Higher calories

a,c,e ~ Many clients with AKI are too ill to meet caloric goals and require tube feedings with renal-specific formulas that are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formulas.

6. The nurse is assessing a group of clients for their risk of kidney disease. Which racial/ethnic group is at the greatest risk as they age? a. Latino Americans b. African Americans c. Jewish Americans d. Asian Americans

b

A nurse reviews a client9s laboratory results. Which results from the client9s urinalysis would the nurse recognize as abnormal? a. pH of 5.6 b. Ketone bodies present c. Specific gravity of 1.020 d. Clear and yellow color

b

A nurse reviews the health history of a client with an over secretion of renin. Which disorder would the nurse correlate with this assessment finding? a. alzheimer disease b. hypertension c. diabetes mellitus d. viral hepatitis

b

A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse? a. Warm the dialysate solution in a microwave before instillation. b. Obtain a sample of the effluent and send to the laboratory. c. Flush the tubing with normal saline to maintain patency of the catheter. d.Check the peritoneal catheter for kinking and curling.

b ~ An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse. Checking the catheter for obstruction is a viable option but will not treat the peritonitis.

After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client9s understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I will take a laxative every night before going to bed.= b. I must increase my intake of dietary fiber and fluids.= c. I shall only use salt when I am cooking my own food.= d. I'll eat white bread to minimize gastrointestinal gas

b ~ Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. Laxatives would be used cautiously. Clients with PKD would be on a restricted salt diet, which includes not cooking with salt. White bread has a low-fiber count and would not be included in a high-fiber diet.

After teaching a client with nephrotic syndrome and a normal glomerular filtration, the nurse assesses the client9s understanding. Which statement made by the client indicates a correct understanding of the diet therapy for this condition? a. I must decrease my intake of fat.= b. I will increase my intake of protein.= c. A decreased intake of carbohydrates will be required.= d. An increased intake of vitamin C is necessary.=

b ~ In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss would be matched by increased intake of protein. The client would not need to adjust fat, carbohydrates, or vitamins based on this disorder.

The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse assess first upon initial rounding? a. Client with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c. Client with skin itching from head to toe d. Client with halitosis and stomatitis

b ~ Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of CKD. The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs to lower serum pH. Hypertension is common in most patients with CKD, and skin itching increases with calcium3phosphate imbalances and elevations of nitrogenous wastes, another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.

A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding would alert the nurse to immediately contact the primary health care provider? a. Flank pain b. Periorbital edema c. Bloody and cloudy urine d. Enlarged abdomen

b ~ Periorbital edema would not be a finding related to PKD and would be investigated further. Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or infection.

The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which condition would the nurse expect to find in the patient9s recent history? a. Pyelonephritis b. Dehydration c. Bladder cancer d. Kidney stone

b ~ Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are postrenal causes of AKI related to urine flow obstruction

After teaching a client with hypertension secondary to renal disease, the nurse assesses the client9s understanding. Which statement made by the client indicates a need for additional teaching? a. <I can prevent more damage to my kidneys by managing my blood pressure.= b. If I have increased urination at night, I need to drink less fluid during the day.= c. I need to see the registered dietitian to discuss limiting my protein intake.= d. It is important that I take my antihypertensive medications as directed.=

b ~ The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions, and would be assessed thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by consuming fluids earlier in the day. Blood pressure control is needed to slow the progression of renal dysfunction. When dietary protein is restricted, refer the client to the registered dietitian nutritionist as needed.

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.) a. I can continue to take antacids to relieve heartburn.= b. I need to ask for an antibiotic when scheduling a dental appointment.= c. I'll need to check my blood sugar often to prevent hypoglycemia.= d. The dose of my pain medication may have to be adjusted.= e. I should watch for bleeding when taking my anticoagulants.=

b, c, d, e ~ In discharge teaching, the nurse must emphasize that the client needs to have an antibiotic prophylactically before dental procedures to prevent infection. There may be a need for dose reduction in medications if the kidney is not excreting them properly (antacids with magnesium, antibiotics, antidiabetic drugs, insulin, opioids, and anticoagulants).

The nurse is caring for a client with a new diagnosis of chronic kidney disease. Which priority complications would the nurse anticipate? (Select all that apply.) a. Dehydration b. Anemia c. Hypertension d. Dysrhythmias e. Heart failure

b, c, d, e ~ The client who has CKD has fluid overload and electrolyte imbalances, especially hyperkalemia, that can cause hypertension, heart failure, and dysrhythmias. Anemia results because erythropoietin production by the kidneys is decreased.

A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings would alert the nurse to urgently contact the primary health care provider? (Select all that apply.) a. Clear drainage b. Bloody drainage at site c. Patient reports headache d. Foul-smelling drainage e. Urine draining from site

b, d, e ~ After a nephrostomy, the nurse would assess the client for complications and urgently notify the primary health care provider if drainage decreases or stops, drainage is cloudy or foul smelling, the nephrostomy site leaks blood or urine, or the client has back pain. Clear drainage is normal. A headache would be an unrelated finding.

A nurse assesses a client who has a family history of polycystic kidney disease (PKD). Which assessment findings would the nurse expect? (Select all that apply.) a. Nocturia b. Flank pain c. Increased abdominal girth d. Dysuria e. Hematuria f. Diarrhea

b. c. e ~ Clients with PKD experience abdominal distention that manifests as flank pain and increased abdominal girth. Bloody urine is also present with tissue damage secondary to PKD. Clients with PKD often experience constipation, but would not report nocturia or dysuria.

4. A nurse assesses a client with renal insufficiency and a low red blood cell count. The client asks, <Is my anemia related to my kidney problem?= How would the nurse respond? a. Red blood cells produce erythropoietin, which increases blood flow to the kidneys.= b. Your anemia and kidney problem are related to inadequate vitamin D and a loss of bone density.= c. Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow.= d. Kidney insufficiency inhibits active transportation of red blood cells throughout the blood.

c

A nurse cares for a client who is recovering from a closed percutaneous kidney biopsy. The client states, <My pain has suddenly increased from a 3 to a 10 on a scale of 0-10.= Which action would the nurse take first? a. Reposition the client on the operative side. b. Administer the prescribed opioid analgesic. c. Assess the client9s pulse rate and blood pressure. d. Examine the color of the client9s urine.

c

A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200 mOsm/kg (1200 mmol/kg). Which action would the nurse take? a. Contact the primary health care provider to recommend a low-sodium diet. b. Prepare to administer an intravenous diuretic. c. Encourage the client to drink more fluids. d. Obtain a suction device and implement seizure precautions.

c

A nurse cares for a client who has pyelonephritis. The client states, <I am embarrassed to talk about my symptoms.= How would the nurse respond? a. I am a professional. Your symptoms will be kept in confidence.= b. I understand. Elimination is a private topic and shouldn9t be discussed.= c. Take your time. It is okay to use words that are familiar to you.= d. You seem anxious. Would you like a nurse of the same gender to care for you?

c ~ Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse would encourage the client to use language that is familiar to the client. The nurse must assess the client and cannot take the time to stop the discussion or find another nurse to complete the assessment.

A nurse cares for a middle-age female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, <What can I do to help prevent these infections?= How would the nurse respond? a. Test your urine daily for the presence of ketone bodies and proteins.= b. Use tampons rather than sanitary napkins during your menstrual period.= c. Drink more water and empty your bladder more frequently during the day.= d. Keep your hemoglobin A1C under 9% by keeping your blood sugar controlled

c ~ Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH, and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client9s sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A1C of 9% is too high.

A client with diabetes mellitus type 2 has been well controlled with metformin. The client is scheduled for magnetic resonance imaging (MRI) scan with contrast. What priority would the nurse take at this time? a. Teach the client about the purpose of the MRI. b. Assess the client9s blood urea nitrogen and creatinine. c. Tell the client to withhold metformin for 24 hours before the MRI. d. Ask the client if he or she is taking antibiotics.

c ~ Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be nephrotoxic and the client should not be exposed to two agents. Clients who have diabetes are already at risk for renal damage.

A client is started on continuous venovenous hemofiltration (CVVH). Which finding would require immediate action by the nurse? Potassium level of 5.5 mEq/L (5.5 mmol/L) Sodium level of 138 mEq/L (138 mmol/L) Blood pressure of 76/58 mm Hg Pulse rate of 88 beats/min

c ~ Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to maintain blood pressure. The nurse needs to monitor for ongoing fluid and electrolyte replacement. The sodium level is normal and the potassium level is slightly elevated, which could be normal findings for someone with acute kidney injury. A pulse rate of 88 beats/min is within usual limits.

The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching? a. I should leave the drainage bag above the level of my abdomen.= b. I could flush the tubing with normal saline if the flow stops.= c. I should take a stool softener every morning to avoid constipation.= d. My diet should have low fiber in it to prevent any irritation.

c ~ Inflow and outflow problems of the dialysate are best controlled by preventing constipation. A daily stool softener is the best option for the client. The drainage bag should be below the level of the abdomen. Flushing the tubing will not help with the flow. A diet high in fiber will also help with a constipation problem

A client is placed on fluid restriction because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client9s fluid balance is stable at this time? a. Decreased calcium levels b. Increased phosphorus levels c. No adventitious sounds in the lungs d. Increased edema in the legs

c ~ The absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the client9s body. Decreased calcium levels and increased phosphorus levels are common findings with CKD. Edema would indicate a fluid imbalance.

The nurse is caring for a client who has chronic pyelonephritis. What assessment finding would the nurse expect? a. Fever b. Flank pain c. Hypertension d. nausea and vomiting

c ~ The client who has chronic pyelonephritis has renal damage and therefore has hypertension. The other assessment findings commonly occur in clients with acute pyelonephritis

The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has acute kidney injury (AKI). The client9s 24-hour urinary output is 120 mL. How much fluid would the client be allowed to have over the next 24 hours? a. 380 mL b. 500 mL c. 620 mL d. 750 mL

c ~ The general principle for fluid restriction for clients is that they may have a daily fluid intake of 500 mL plus the amount of their urinary output. In this case, 120 mL urinary output plus 500 mL equals 620 mL fluid allowance.

The charge nurse is orienting a new nurse about care for an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? a. Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c. Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left arm

c ~ The nurse would not use the arm with the AV fistula for intravenous infusion, blood pressure readings, or venipuncture. Compression and infection can result in the loss of the AV fistula. The AV fistula would be monitored by auscultating or palpating the access site. Checking the distal pulse would be an appropriate assessment.

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this patient9s care? a. Edema and pain b. Cardiac and respiratory status c. Electrolyte and fluid imbalance d. Mental health status

c ~ This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client9s cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

A nurse cares for a client with a urine specific gravity of 1.040. What action would the nurse take? a. Obtain a urine culture and sensitivity. b. Place the client on restricted fluids. c. Assess the client9s creatinine level. d. Increase the client9s fluid intake.

d

The nurse is admitting a client who has acute glomerulonephritis caused by beta streptococcus. What drug therapy would the nurse expect to be prescribed for this client? a. Antihypertensives b. Antilipidemics c. Antidepressants d. Antibiotics

d ~ Beta streptococcus is a bacterium that can cause acute glomerulonephritis, so antibiotic therapy is indicated.

The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates that more teaching is needed? a. I will probably lose weight by cutting out potato chips.= b. I will cut out bacon with my eggs every morning.= c. My cooking style will change by not adding salt.= d. I am thrilled that I can continue to eat fast food.

d ~ Fast-food restaurants usually serve food that is high in sodium. This statement indicates that more teaching needs to occur. The other statements show a correct understanding of the teaching.

A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary health care provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client starts to develop shortness of breath. What is the nurse9s priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the client9s pulse. d. Decrease the rate of the IV infusion

d ~ The nurse would assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter would evaluate the client9s hemodynamic status, but this would not be the initial or priority action by the nurse. Vital signs are also important after adjusting the intravenous infusion.

A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client9s blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. What action would the nurse take? a. Position the client to lay on the surgical incision. b. Measure the specific gravity of the client9s urine. c. Administer intravenous pain medications. d. Assess the rate and quality of the client9s pulse.

d ~ The nurse would first fully assess the client for signs of volume depletion and shock, and then notify the primary health care provider. The extensive nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Repositioning the patient, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.

20. The nurse administers epoetin alfa to a client who has chronic kidney disease (CKD). Which laboratory test value would the nurse monitor to determine this drug9s effectiveness? a. Potassium b. Sodium C. renin D. hemoglobin

d ~ The purpose of giving epoetin alfa to a client with CKD is to manage anemia by stimulating the bone marrow to produce more red blood cells. Therefore, monitoring the client9s hemoglobin, hematocrit, and red blood cell count would indicate if the drug was effective.