MedSurg Chapter 54
What is an organic cause for erectile dysfunction?
Coronary artery disease
A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. Which of the following would be the best way to prevent this?
Encourage the child to take all the antibiotics if diagnosed with strep throat.
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:
Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue.
The main problem with acute glomerulonephritis is ....
Inflammation
Which of the following is used to decrease potassium level seen in acute renal failure?
Kayexalate
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:
There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:
fatigue and weakness
What is the normal urine output for the infant/child?
0.5 - 2ml/kg/hr
How many hours do you have to correct testicular torsion in order to save the testis?
6 hours
A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, you would want to prepare her to
A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.
All EXCEPT which patient teaching topic are appropriate to include for a patient with nephrosclerosis?
A. Low cholesterol, low sodium diet B. Smoking cessation C. Control blood glucose **D. Low calcium diet
Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis?
Azotemia
What is a treatment for prostate cancer most commonly used other than surgical removal?
Brachytherapy
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
Check for thrill or bruit over the access site.
Which is a prodromal symptom of hemolytic uremic syndrome in pediatric patients?
Diarrheal illness
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?
During the second phase, the oliguric phase, oliguria occurs. Diuresis occurs during the third or diuretic phase. Acute tubular necrosis (ATN) occurs during the first, or initiation, phase in which reduced blood flow to the nephrons leads to ATN. Restoration of glomerular function, if it occurs, occurs during the fourth, or recovery, phase.
During hemodialysis, excess water is removed from the blood by which of the following?
Excess water is removed from the blood by osmosis, in which water moves from an area of higher solute concentration in the blood toward an area of lower solute concentration into the dialysate
The nurse admits a client from a MVA. Which assessment could indicate possible renal trauma?
Hematuria
What s/s could point to renal or bladder cancer?
Hematuria
Which problems identified during prenatal care could represent potential renal problems during childhood?
Hydronephrosis Neural tube defect Oligohydramnios One umbilical artery
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur?
Hyperphosphatemia
While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate?
In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination.
PP Questions: A nephrostomy tube may be inserted for which reason?
Large kidney stone
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?
Oliguria
The nurse is teaching a group of nursing students about acute glomerulonephritis genitourinary conditions. A student asks the about a condition that occurs when there is a decreased volume of urine output. The condition the student is referring to is which of the following?
Oliguria is a subnormal volume of urine.
A 5-year-old child with acute renal failure develops hyperkalemia. Which of the following would the nurse expect to administer?
Polystyrene sulfonate (Kayexalate) is used to decrease potassium levels.
BPH meds
Proscar- liver testing, takes awhile to work, must not be handled by women or children Flomax- increase urine flow in BPH, can cause ortho-hypotension Surgery- TURP
What type of dietary restrictions should a patient with acute glomerulonephritis have?
Protein
A teacher sends a child to see the school nurse for irritability and bruising. Which of the following symptoms would be indicative of hemolytic uremic syndrome?
Signs of hemolytic uremic syndrome include oliguria, irritability, jaundice, bloody diarrhea, purpura, ecchymosis, and pallor 5 to 10 days after a prodromal illness. The child also usually experiences anorexia, slight fevers, and can become lethargic. Symptoms of polyuria, weight gain, high fever, and dysuria are not typically seen with hemolytic uremic syndrome.
What is the action of Phosphodiesterase inhibitors?
Smooth muscle relaxation
What is the most common type of cancer among men age 15-35? END PP QUESTIONS
Testicular
A nurse is providing postoperative care for a 5-year-old who had a hypospadias repair. Which of the following would the nurse expect for postoperative care of this child?
The child is usually hospitalized for under 24 hours with a hypospadias repair. Wheelchair kickball is an appropriate sport since typically the child is not in much pain after the surgery. This will help increase gross motor activity. The tubing should remain unclamped and free from obstruction at all times.
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure.
A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?
Urinary calculi
A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:
confusion, headache, and seizures.
The nurse is assessing a child with acute poststreptococcal glomerulonephritis. Which of the following would the nurse expect to assess? Select all answers that apply.
fatigue, lethargy, abdominal pain, hypertension, crackles, and anorexia.
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
fever
BPH s/s
hesitancy, decrease in size and force of urine stream, frequency, nocturia; retention- bladder sound will be dull on percussion
Which of the following is a characteristic of the intrarenal category of acute renal failure?
increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
risk for infection
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as:
Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is called oliguria. Polyuria is excessive urination. Hematuria is the presence of blood in the urine.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
Urine output of 20 ml/hour
The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder?
pH 7.20, PaCO2 36, HCO3 14-. Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders?
Acute glomerulonephritis- also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure- associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure- may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome- caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
The nurse is caring for a patient who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed which of the following?
After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis.
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?
Decrease in the blood flow through the kidneys
Which of the following is the hallmark of the diagnosis of nephrotic syndrome?
Proteinuria
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?
SpO2 at 90% with fine crackles in the lung bases
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl. normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl.
Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis?
Blurred vision. Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis.
An infant is diagnosed with a urinary tract infection. What would the nurse expect on assessment?
Failure to thrive
The nurse understands that common causes of acute glomerulonephritis in pediatric patients include:
Scarlet fever
With any process involving scrotal swelling, what nursing intervention can promote comfort?
Scrotal elevation
Which of the following nursing actions is most important in caring for the client following lithotripsy?
Strain the urine carefully for stone fragments.
A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant?
"She had surgery to repair a problem with her anus.". Risk factors associated with obstructive uropathy include prune belly syndrome, chromosome abnormalities, anorectal malformations, and ear defects.
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective?
"Ultrafiltration methods take much longer than hemodialysis.".Ultrafiltration methods (CVVH, CVVHD) are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects.
Which nursing intervention should the nurse caring for the client with pyelonephritis implement?
Teach client to increase fluid intake up to 3 liters per day.
To determine if ascites is increasing in amount in a child with nephrotic syndrome, which measurements would be most appropriate?
Abdominal circumference
A child diagnosed with pyelonephritis has a fever of 104.2. Which antipyretic should the nurse administer?
Acetaminophen
The nurse is assessing a child diagnosed with nephritic syndrome and observes generalized edema. The nurse documents this as which of the following?
Anasarca refers to generalized edema. Enuresis refers to continued incontinence of urine past the age of toilet training. Hydronephrosis refers to a condition in which the pelvis and calyces of the kidney are dilated. Phimosis refers to a condition in which the foreskin of the penis cannot be retracted.
A client who is blind is admitted for treatment of gastroenteritis. Which nursing diagnosis takes highest priority for this client?
Deficient fluid volume
With prostatitis, what foods should be avoided until the inflammation has resolved?
Alcohol Caffeine
The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following?
Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis.
When obtaining a urine specimen from a school age child, what method is preferred?
Clean catch specimen
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?
Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?
Location of discomfort
A nurse is performing postoperative care on a child with a ureteral stent. Which of the following interventions will help manage tube patency?
Monitor output.
When caring for a child who has a urinary tract infection, which of the following nursing interventions would be most appropriate. (select all that apply)
• The nurse observes for signs of pain or burning on urination. • The nurse monitors intake and output. • The nurse administers antipyretics as needed.
Which of the following would be included in the plan of care of someone in Stage 4 renal failure?
Growth hormone injections daily
An investment banker, with chronic renal failure, informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?
Once a treatment choice has been selected by the client, the nurse should support the client in that decision. Continuous cyclic peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients
Which assessment finding is common in children diagnosed with nephrotic syndrome?
Periorbital edema
A persistent painful erection is called....
Praprism
The hallmark sign of nephrotic syndrome is...
Proteinuria
With a patient with a foley catheter and a nephrostomy tube, how would you record urine output?
Record foley and nephrostomy separate
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
Urine output of 250 ml/24 hours
The nurse admits a client post ileal conduit. What is the top priority?
Vital signs
A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for:
cardiac arrhythmia.
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?
White blood cell (WBC) count of 20,000/mm3. An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution.
An instructor is preparing a class on renal cancer for a group of students. Which of the following would the instructor include as a possible risk factor?
age with most renal cancers occurring after age 60, male gender, tobacco use, occupational exposure to industrial chemicals, obesity, unopposed estrogen therapy, polycystic kidney disease, and treatment for renal failure.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.
You care for a 3-year-old with hypospadias. After a surgical repair, he has a urethral urinary catheter inserted. You would want to teach his parents that
the catheter insertion site will leave only a minimal scar.
Which assessment is a symptom of nephrosclerosis?
Hypertension
An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?
Detects calculi, cysts, or tumors. Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions
A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?
Encourage use of incentive spirometer every 2 hours.
The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. When interviewing the caregivers, which of the following questions would be most important for the nurse to ask?
Gather information about the current illness: when the fever started and its course thus far, signs of pain or discomfort on voiding, recent change in feeding pattern, presence of vomiting or diarrhea, irritability, lethargy, abdominal pain, unusual odor to urine, chronic diaper rash, and signs of febrile convulsions. Toilet training and bathing habits would be of importance, but they are not the most important to ask.
Which of the following is an integumentary manifestation of chronic renal failure?
Gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.
A chronic renal failure client complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
Hyperphosphatemia. Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone.
The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is which of the following?
In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen.
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?
Increase carbohydrates and limit protein intake.
Which of the following would a nurse classify as a prerenal cause of acute renal failure?
Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure.
A child is getting a diagnostic work-up for nephrotic syndrome. Which of the following lab results would the nurse expect to see?
Proteinuria, hypoalbuminemia, and hypercholesterolemia are diagnostic of a child with nephritic syndrome. The child will also present symptomatically with a sudden onset of edema. Hematuria is typically seen with glomerulonephritis.
Priapism can also be caused by what other process?
Sickle cell disease
The nurse is caring for a child admitted with a urinary tract infection. In addition to foul smelling urine, which of the following clinical manifestations would likely have been noted in the child with this diagnosis?
In children, the symptoms or a urinary tract infection may be fever, nausea, vomiting, foul-smelling urine, weight loss, and increased urination. Occasionally there is little or no fever. Vomiting is common, and diarrhea may occur.
Which of the following occurs late in chronic glomerulonephritis?
Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?
The kidneys can improve over a period of months, may take 3-6 months
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure?
The kidneys can improve over a period of months.
The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them.
When performing double diapering, the nurse cuts a hole or a cross-shaped slit in the front of the smaller diaper and then unfolds both diapers, placing the smaller diaper (with the hole) inside the larger one. Next, the nurse places both diapers under the child and carefully brings the penis (if applicable) and catheter/stent through the hole in the smaller diaper, closing the diaper. Finally, the nurse closes the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV).
The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply.
• Calcium 7.5 mg/dL; hypotension and irritability • Potassium 6.4 mEq/L; dysrhythmias and abdominal distention • Phosphate 5.0 mg/dL; tachycardia and nausea and emesis
Select all of the following which are true about extracorporeal shock wave lithotripsy (ESWL).
• Stones are shattered into smaller particles that are passed from the urinary tract. • ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation.
