exam 7
A patient's urinalysis results are white blood cells (WBCs) 100+/hpf; RBCs 4/hpf; bacteria, moderate amount; nitrite, positive; specific gravity, 1.025; and urine, cloudy. How will the nurse report these findings to the health-care provider (HCP)
Urinary tract infection
The nurse is reviewing the laboratory results for a patient who has an elevated creatinine level. What information should the nurse collect as a result?
Urine output
? findings for stage 4 chronic kidney disease
glomerular filtration rate (GFR) 20 mL/min
begin hemodialysis/ ? include
hemodialysis returns a balance to blood electrolytes.
a kidney biopsy for postoperative complications/ ? causing the greatest risk
hemorrhage
(SATA) type 2 diabetes & will have excretory urography. ? actions for prior to the procedure
identify an allergy to seafood/ withhold metformin for 24 hr/ administer an enema/ monitor for asthma
? discharge instructions for a client who had spontaneous passage of a calcium phosphate renal calculus / ? include
limit intake of food high in animal protein/ reduce sodium intake/ report burning with urination to the provider/ increase fluid intake to 3 L/day
plan of care for undergo peritoneal dialysis/ ? actions
monitor blood glucose levels/ report cloudy dialysate return/ monitor for shortness of breath
Chronic Kidney Disease (CKD)/ ? include in the plan of care
monitor for pulmonary edema/ provide frequent mouth rinses/ restrict fluids based on urinary output/ monitor for weight gain trends
? urinalysis results indicates an UTI
positive for leukocyte esterase
postrenal AKI due to metastatic cancer/ blood creatinine of 5 mg/dL/ ? include in the plan
provide a high-protein diet/ monitor the urine for blood/ monitor for intermittent anuria
The nurse is catheterizing a patient after voiding to determine the amount of residual urine in the bladder. What should the nurse consider as being the normal amount of urine within the bladder after urination?
25 mL (Normally the bladder contains less than 50 mL after urination.)
Which patient is at the greatest risk for cancer of the kidney?
A 50-year-old male with a 20-year history of smoking who works in a chemical laboratory
Which of the following diagnostic test results would the nurse evaluate as being related to renal disease? Select all that apply. 1. Serum hematocrit: 39% 2. Serum potassium: 4 mEq/L 3. Serum uric acid: 2 ng/dL 4. Serum creatinine: 3 mg/dL 5. Blood urea nitrogen (BUN): 35 mg/dL 6. Urine specific gravity: 1.020
Answers: 1. 4,5
The nurse is providing care for a patient who has undergone placement of a suprapubic catheter. Which post-procedure nursing care is anticipated?
Apply a skin barrier to prevent skin breakdown
The nurse is providing care for a patient admitted for a suspected kidney disease. Which area of the body will the patient to identify as the location of pain?
Bilateral flanks
The nurse is collecting data from a male patient who reports hematuria and pelvic pain. The patient's history indicates a 20-year history of smoking and long-term employment in a metal machinery factory. Which specific test should the nurse expect the HCP to order?
Bladder tumor-associated antigen (BTA)
A female patient with a history of diabetes mellitus presents at the health-care provider's (HCP's) office with chills, a fever of 101.0°F (38.3°C), vomiting, and flank pain. What order should the nurse anticipate?
Clean-catch urinalysis
The nurse is reinforcing teaching provided to a patient with a history of calcium oxalate kidney stones. The nurse recognizes that teaching has been effective if the patient avoids which foods? (Select all that apply.)
Cocoa/ Spinach/ Instant coffee
The nurse is providing support for a client who just finished a hemodialysis session. Which findings are most concerning?
Crushing chest pain
The nurse is collecting information from an older adult patient in the HCP's office. The patient reports frequent urination. Which effect of aging does the nurse recognize?
Decreased bladder size and muscle tone
The nurse is testing the urine pH for a patient in the HCP's office. The test indicates a pH of 8.0. Which question does the nurse ask the client?
Do you have pain when you urinate? (A high pH is most commonly caused by an infection, renal disease, and vomiting. Burning occurs with an infection.)
The nurse is providing care for a patient who is diagnosed with urinary obstruction from a blockage of the urethra. An emergency surgery is scheduled. The nurse is most concerned with which finding?
Elevated creatinine level
An older male patient expresses frustration at the need to urinate often, dribbling of urine, and feelings of an inability to empty his bladder. Which suggestion by the nurse is most helpful to the patient?
Encourage an appointment with a urologist.
The nurse is making a visit to the home of a patient with a new concern of urinary incontinence. What should the nurse plan to include with the visit?
Encourage the patient to keep a daily diary of voiding.
The nurse is collecting data on a patient who experienced a blunt injury to the lower back area. Which finding is most concerning?
Flank edema and bloody urine
The formation of urine is a critical physiological function. The nurse is aware that multiple processes are involved. Which process does the nurse recognize as a part of the formation of urine?
Glomerular filtration
The nurse is preparing to reinforce teaching to a patient newly diagnosed with PKD. Which information does the nurse include? (Select all that apply.)
Grape-like cysts will replace normal, functioning structures./ Initial symptoms are dull heaviness in the flank area and hematuria./ Patients are at risk for brain aneurysms and diverticulosis in the colon./ The disease is likely to require additional treatment for hypertension and UTIs
A young adult patient reports flank pain and a decrease in urination. The nurse notices periorbital edema, and the urinalysis is very dark in color and contains protein. What question should the nurse ask?
Have you had a sore throat recently?
The nurse is providing care for a patient scheduled for surgery for the formation of an orthotopic bladder substitution. Which patient teaching is important for the nurse to review during the patient's recovery?
How to perform an intermittent catheterization
The nurse is reinforcing teaching provided to a patient about caring for a new AV fistula in the left arm for dialysis. Which patient statements indicate correct understanding? (Select all that apply.)
I should not sleep on my arm./ I should wear loose clothing on my left arm./ I will avoid carrying heavy things with my left arm
The nurse is reinforcing teaching to a client who is preparing to perform intermittent self-catheterization at home. Which comment by the patient requires additional instruction?
If I go out, I'll wear a urinary incontinence pad
The nurse is collecting data on a patient admitted for symptoms of renal insufficiency. Which factor will cause the nurse to suspect prerenal injury?
Impaired blood flow to the kidneys
The nurse is providing care for a patient with glomerulonephritis. Which form of kidney injury should the nurse realize has occurred with this patient?
Intrarenal
<QB> The major function of the kidneys is to remove waste products from the blood. What additional functions does the kidney have?
Manage hydrogen or bicarbonate for acid-base balance.
The nurse is planning care for a patient diagnosed with chronic renal failure. The nurse notes that the patient's output is 620 mL for the last 24 hours. The patient has periorbital edema and crackles in all lung fields upon auscultation. Which intervention is most important for the nurse to implement during care of this patient?
Obtain daily weights.
The nurse is providing care for a patient with a thoracic spinal cord injury. Which urinary concern does the nurse have for this patient?
Overflow incontinence
The nurse is reinforcing teaching about the most serious side effect of peritoneal dialysis with a patient scheduled for the first treatment. Which side effect stated by the patient indicates correct understanding?
Peritonitis (The major cause of peritonitis is poor technique when connecting the bag of dialyzing solution to the peritoneal catheter.)
The nurse is reviewing the results of a patient's urinalysis. Which components does the nurse identify as being abnormal in urine? (Select all that apply.)
Protein/ RBCs (are NOT normally found in urine and can indicate renal dysfunction from injury or disease.)
A patient shares a long-standing problem of urinary incontinence with the nurse. Which intervention does the nurse recognize as taking priority?
Providing caring support to the patient
The nurse is providing care for a patient who is scheduled for the formation of access for hemodialysis. Which important action does the nurse take with this patient?
Refrains from drawing blood or placing IV lines in the nondominant arm
The nurse is providing care for a patient admitted with severe flank pain identified as renal colic. Urinalysis is positive for microscopic hematuria. Which action should the nurse take?
Strain urinary output and observe for stones.
The nurse is providing care for a patient with a diagnosis of kidney disease. The patient's last laboratory result indicates metabolic acidosis. Which kidney activity is causing this condition?
The kidneys are unable to excrete hydrogen ions.
The nurse is providing care for a patient scheduled for cystogram. What should the nurse report to the HCP prior to the exam?
The patient has an elevated creatinine level. (A cytogram uses contrast media, which is nephrotoxic. An elevated creatinine level indicates kidney dysfunction and should be reported.)
A patient with pneumonia has a blood urea nitrogen (BUN) level of 32 mg/dL and a creatinine level of 0.8 mg/dL. What should the nurse realize is the most probable explanation for this finding?
The patient is dehydrated.
The nurse is visiting a patient who performs peritoneal dialysis at home. The nurse is evaluating the patient's technique. Which finding requires additional teaching?
The patient uses clean technique when instilling the dialysate
The nurse is providing care for older adult clients in an extended care facility. Which patient should be monitored for signs of urosepsis?
The patient who has an indwelling catheter for a urinary tract infection (UTI)
The nurse is preparing a patient for a cystectomy and the creation of a neobladder. What benefits will this provide?
Voiding occurs through the urethra
The nurse is providing postoperative care for a patient with a newly formed ileal conduit for a diagnosis of bladder cancer. Which collaborative team member should be included with care
Wound, ostomy, and continence (WOC) nurse
left renal calculus & indwelling urinary catheter/ ? findings is the priority to report to the provider
absent urine output for 1 hr
prerenal acute kidney injury following abdominal aortic aneurysm repair/ urinary output is 60mL in the past 2 hr, and BP is 92/58 mm Hg. / ? interventions
administer a fluid challenge
UTI/ ? priority intervention
administer an antibiotic
a female client has frequent UTI/ ? include
avoid sitting in a wet bathing suit/ empty the bladder when there is an urge to void/ take a shower instead of a bath.
discharge instructions for a client who had spontaneous PASSED of a calcium phosphate renal calculus/ to decrease the chance of recurrence the nurse should instruct the client to avoid ?
black tea/ spinach
received hemodialysis/ ? include
check BUN & blood creatinine/ administer medications the nurse withheld prior to dialysis/ observe for findings of hypovolemia/ monitor the access site for bleeding
develops disequilibrium syndrome after receiving hemodialysis/ ? actions
determine level of consciousness.
renal calculi/ ? findings
diaphoresis
preparing to begin a 24-hr urine collection/ ? actions
discard the first voiding when beginning the test .
plan of care for chronic pyelonephritis/ ? include
recommend a referral for nutrition counseling/ palpate the costovertebral angle/ monitor urinary output/ administer antibiotics
prerenal AKI/ ? findings
reduced urine output/ elevated blood creatinine
acute kidney injury & is scheduled for hemodialysis/ ? actions
review the medications the client currently tasks/ check the AV fistula for a bruit/ measure the client's weight/ check serum electrolytes.
following a CT scan of the kidneys with IV contrast./ ? an allergic reaction to the contrast material
skin hives
glomerulonephritis/ ? findings
smoky-color urine/ flank pain/ visual disturbances
extracorporeal shock wave lithotripsy (ESWL)/ ? understanding of the instructions
straining my urine following the procedure is important
(ATI book) x-ray of the kidneys, ureters, and bladder./ ? include
the procedure determines whether you have a kidney stone.