Med-Surgical: Renal & Urinary

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that the dialysate output is less than the input, and the client's abdomen is distended. Which of the following actions should the nurse take? A.Administer pain medication to the client B.Change the client's position C. Place the drainage bag above the client's abdomen. D. Insert an indwelling urinary catheter.

B.Change the client's position The client is retaining the dialysate solution after the dwell time. The nurse should ensure that the clamp is open and the tubing is not kinked, and reposition the client to facilitate the drainage of the solution from the peritoneal cavity.

A nurse is collecting data from a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider? a. Cloudy, yellow drainage b. WBC 6,000 c. Potassium 4.0 mEq/L d. Report of abdominal fullness

A. Cloudy, yellow drainage Cloudy, yellow drainage is an early manifestation of peritonitis and the nurse should report this finding to the provider. Other manifestations include fever and abdominal tenderness.

A nurse is collecting data from a client who is postoperative following a transurethral resection of the prostate (TURP). After the nurse discontinues the client's urinary catheter, which of the following findings should the nurse report to the provider? a. Decreased urine output b. Report of burning upon urination c. Pink-tinged urine d. Stress incontinence

A. Decreased urine output A decreased urine output after a TURP indicates obstruction to urine flow by a clot or residual prostatic tissue and should be reported to the provider.

A nurse is reinforcing teaching about collecting a 24-hour urine specimen for creatinine clearance with a newly licensed nurse. Which of the following instructions should the nurse include a. Place signs in the bathroom as a reminder about the test in progress b. Discard the last voided specimen at the end of the collection period. c. Instruct the client to increase exercise during 24-hour period. d. Include the first voided specimen at the start of the collection period.

A. Place signs in the bathroom as a reminder about the test in progress The nurse should place signs in the bathroom and alert family members of the test in progress so that everyone saves the specimens appropriately throughout the test.

A nurse is collecting a.data from a client who is postoperative following extracorporeal shockwave lithotripsy (ESWL). The nurse should identify that which of the following findings is the priority? a. Report of Palpitations b. bruising on the flank area c. stone fragments in the urine d. pink-tinged urine

A. Report of Palpitations The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning - having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life, and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority-setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority-setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. ESWL is the application of sound, laser, or dry shock wave energies to break a kidney stone into small pieces. The shock waves are initiated during the R wave of the ECG to prevent dysrhythmias. When using the airway, breathing, circulation approach to client care, the nurse should determine report of palpitations is a manifestation of dysrhythmias and is the priority finding

A nurse is reinforcing teaching with a newly licensed nurse about caring for a client who has a new left arteriovenous fistula. Which of the following statements should the nurse make? a.Instruct the client to restrict movement of his left arm b.Avoid taking blood pressures on the client's left arm c. Check the fistula daily for a vibration d. Instruct the client to sleep on his left side.

B. Avoid Taking blood pressure's on the client's left arm. The nurse should avoid taking blood pressure measurements on the client's left arm, which can decrease blood flow and cause clotting.

A nurse is reinforcing teaching with a client who is preoperative prior to a transurethral resection of the prostate (TURP). Which of the following statements indicates an understanding of the information. a. I will expect my urine to be cloudy after having this procedure b. I will feel the urge to urinate following this procedure. c. I will not need to have a urinary catheter following this procedure. d. At least I won't have leakage of urine after having this procedure.

B. I will feel the urge to urinate following this procedure. After a TURP, the client will feel the urge to urinate. The nurse should reassure him that he will receive analgesics to help relieve this discomfort.

A nurse is reinforcing teaching with a client prior to renal biopsy. Which of the following statements should the nurse make? A. "A creatinine clearance is needed prior to the procedure." B. "You will be NPO for 8 hours following the procedure." C. "You will need to be on bed rest following the procedure." D. "An allergy to shellfish is a contraindication for this procedure." .

C. "You will need to be on bed rest following the procedure." A renal biopsy involves a tissue biopsy through needle insertion into the lower lobe of the kidney. The client should maintain bed rest in a supine position with a back roll for support for 2 to 24 hr following the procedure to reduce the risk for bleeding. The nurse can elevate the head of the bed.

A nurse is caring for a client who is receiving peritoneal dialyisis. The nurse should monitor the client for which of the following adverse effects? a. Increased serum albumin b. Hypoglycemia c. Respiratory Distress d. Diarrhea

C. Respiratory Distress Respiratory Distress can occur during peritoneal dialysis due to fluid overload.

A nurse is reinforcing dietary teaching with a client who has late-stage chronic kidney disease (CKD). Which of the following nutrients should the nurse instruct the client to increase in her diet? A. Phosphorous B. Calcium C. Sodium D. Potassium

C. Sodium A client who has CKD can develop hypocalcemia due to the reduced production of active vitamin D, which is needed for calcium absorption. The client should supplement her diet with dietary calcium.

A nurse is reinforcing teaching with a client who has a history of urinary tract infections (UTIs). Which of the following statements should indicate to the nurse the need for additional instructions? a. "I will use a vaginal douche daily." b. "I will empty my bladder every 2 to 4 hours." c. "I will drink 2 liters of fluids per day." d. "I will wear cotton underwear."

a. "I will use a vaginal douche daily." The client should avoid vaginal douches, bubble baths, and any substances that can increase the risk for UTIs. The client should use mild soap and water to wash the perineal area.

A nurse is collecting data from a client who has an injury to the lower abdomen following a motor-vehicle crash. The nurse should identify that which of the following findings is a manifestations of bladder trauma? a. Hematuria b. Pyuria c. Fever d. Stress incontinence

a. Hematuria Manifestations of bladder trauma include hematuria, or blood in the urine; blood at the urinary meatus; pelvic pain; and anuria, or the absence of urine.

A nurse is reinforcing teaching with a client who has acute pyelonephritis. Which of the following instructions should the nurse include in the teaching? a. "You should drink 1,000 milliliters of fluid per day." b. "You should complete the entire cycle of antibiotic therapy." c. "You should maintain complete bed rest until manifestations decrease." d. "You should avoid taking NSAIDs for pain."

b. "You should complete the entire cycle of antibiotic therapy." The client should complete the full prescription of the antibiotic therapy to decrease the chance of regrowth of the causative organism.

A nurse is reinforcing teaching about urinary tract infections (UTI) with a client. Which of the following manifestations should the nurse include? a. Vaginal discharge b. Weight gain c. Back pain d. Muscle cramps

c. Back pain Back pain and flank pain are manifestations of a UTI. Other manifestations include frequency, urgency, and cloudy, foul-smelling urine.

A nurse is reinforcing teaching about the prostate-specific antigen (PSA) test with a client. Which of the following statements should the nurse make? a. "Expected PSA values will decrease as you get older." b. "Annual PSA screening should begin at age 40." c. "You should not ejaculate for 24 hours after the PSA test." d. "You should fast for 8 hours prior to the PSA test."

d. "You should fast for 8 hours prior to the PSA test." PSA is a glycoprotein that is manufactured in the prostate and is used to screen for prostate cancer. The client should not eat for 8 hr prior to this procedure.

A nurse is collecting data from a client who is 1 week postoperative following a living donor kidney transplant. Which of the following findings should indicate to the nurse that the client is experiencing acute kidney rejection? a. Urinary output 100 mL/hr b. Sodium 137 mg/dL c. Creatinine 0.8 mg/dL d. Blood pressure 160/90 mm Hg

d. Blood pressure 160/90 mm Hg Due to the kidney's role in fluid and blood pressure regulation, a client who is experiencing rejection can have hypertension.

A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney injury. The client report diarrhea, a dull headache, palpitations, and muscle tingling and weakness. Which of the following actions should the nurse take first? a. Administer an analgesic to the client. b. Measure the client's weight. c. Restrict the client's protein intake. d. Check the client's electrolyte values.

d. Check the client's electrolyte values. The nurse should apply the urgent versus non-urgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The nurse should check the client's most recent potassium value because these findings are manifestations of hyperkalemia, which can lead to cardiac dysrhythmias; therefore, this is the priority action.

A nurse is reinforcing teaching with a client prior to a cystoscopy. Which of the following statements should the nurse make? a. Expect to be on bed rest for 24 hours after this procedure. -you will need to keep the sutures clean after this procedure -you will be placed on your left side for this procedure -expect to have pink-tinged urine after this procedure

d. Expect to have pink-tinged urine after this procedure. A cystoscopy is a procedure in which a scope is inserted into the urethra to diagnose or treat bladder problems. Following this procedure, pink-tinged urine is expected.

A nurse is reinforcing teaching with a client who has chronic kidney disease (CKD). which of the following instructions should the nurse include? a. Eat a diet high in protein. b. Limit caloric intake c. Eat a diet high in phosphorus. d. Limit fluid intake.

d. Limit fluid intake. A client who has CKD should limit fluid intake to prevent hypervolemia, or excessive fluid overload.

A nurse is caring for a client who has diagnosis of renal calculi and reports severe flank pain. Which of the following is the priority nursing action? a. Monitor the client's I&O. b. Strain the client's urine. c. Encourage the client to increase fluid intake. d. Relieve the client's pain.

d. Relieve the client's pain. The nurse should apply the urgent versus non-urgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The pain associated with renal calculi is severe and can lead to shock; therefore, this is the nurse's priority action.