Module 7 - Assignment

The charge nurse must rearrange room assignments to admit a new patient. Which two patients would be best suited to be roommates? Select 2 from the list below. A 24-year-old patient with acute pyelonephritis and severe flank pain. A 58-year-old patient with urothelial cancer receiving multiagent chemotherapy. A 76-year-old patient with urge incontinence and a urinary tract infection. A 63-year-old patient with kidney stones who has just undergone open ureterolithotomy.

A 24-year-old patient with acute pyelonephritis and severe flank pain. A 76-year-old patient with urge incontinence and a urinary tract infection. Both of these patients will need frequent assessments and medications. The patient receiving chemotherapy and the patient who has just undergone surgery should not be exposed to any patient with infection.

The charge nurse would assign the nursing care of which patient to an LPN/LVN, working under the supervision of an RN? A 72-year-old patient with urinary incontinence who needs bladder training. A 48-year-old patient with cystitis who is taking oral antibiotics. A 64-year-old patient with kidney stones who has a new order for lithotripsy. A 52-year-old patient with pyelonephritis who has severe acute flank pain.

A 48-year-old patient with cystitis who is taking oral antibiotics. The patient with cystitis who is taking oral antibiotics is in stable condition with predictable out-comes and caring for this patient is therefore appropriate to the scope of practice of an LPN/LVN under the supervision of an RN. The patient with a new order for lithotripsy will need teaching about the procedure, which should be accomplished by the RN. The patient in need of bladder training will need the RN to plan this intervention. The patient with flank pain needs a careful and skilled assessment by the RN.

Which patient will the charge nurse assign to an RN floated to the acute care unit from the surgical intensive care unit (SICU)?

A patient who has just undergone surgery for renal stent placement.

A patient diagnosed with acute kidney failure had a urine output of 1560 mL for the past 8 hours. The LPN/LVN who is caring for this patient under the RN's supervision asks how a patient with kidney failure can have such a large urine output. What is the RN's best response? "With that much urine output, there must have been a mistake in the patient's diagnosis." "An increase in urine output like this is an indicator that the patient is entering the recovery phase of acute kidney failure." "The patient's kidney failure was caused by hypovolemia, and we have given him IV fluids to correct the problem." "Acute kidney failure patients go through a diuretic phase when their kidneys begin to recover and may put out as much as 10 L of urine per day."

"Acute kidney failure patients go through a diuretic phase when their kidneys begin to recover and may put out as much as 10 L of urine per day." Patients with acute kidney failure usually go through a diuretic phase 2 to 6 weeks after the onset of the oliguric phase. The diuresis can result in an output of up to 10 L/day of dilute urine. During this phase, it is important to monitor for electrolyte and fluid imbalances. This is followed by the recovery phase. A patient with acute kidney failure caused by hypovolemia would receive IV fluids to correct the problem; however, this would not necessarily lead to the onset of diuresis.

A patient with incontinence will be taking oxybutynin chloride 5 mg by mouth three times a day after dis-charge. Which information would the nurse be sure to teach this patient before discharge? "Drink fluids or use hard candy when you experience a dry mouth." "If necessary, your HCP can increase your dose up to 40 mg/day." "Be sure to notify your health care provider (HCP) if you experience a dry mouth." "You should take this medication with meals to avoid stomach ulcers."

"Drink fluids or use hard candy when you experience a dry mouth." Oxybutynin is an anticholinergic agent, and these drugs often cause an extremely dry mouth. The maximum dosage is 20 mg/day. Oxybutynin should be taken between meals because food interferes with ab-sorption of the drug.

A 28-year-old married female patient with cystitis requires instruction about how to prevent future urinary tract infections (UTIs). The supervising RN has assigned this teaching to a newly graduated nurse. Which statement by the new graduate requires that the supervising RN intervene? "Drinking cranberry juice daily will decrease the number of bacteria in your bladder." "You should always drink 2 to 3 L of fluid every day." "It's okay to soak in the tub with bubble bath because it will keep you clean." "Empty your bladder regularly even if you do not feel the urge to urinate."

"It's okay to soak in the tub with bubble bath because it will keep you clean." Women should avoid irritating substances such as bubble baths, nylon underwear, and scented toilet tissue to prevent UTIs. Adequate fluid intake, consumption of cranberry juice, and regular voiding are all good strategies for preventing UTIs.

The nurse is caring for a patient with renal cell carcinoma (adenocarcinoma of the kidney). While serving as preceptor for a new nurse orienting to the unit, the nurse is asked why this patient is not receiving chemotherapy. What is the best response? "The prognosis for this form of cancer is very poor, and we will be providing only comfort measures." "Radiofrequency ablation is a minimally invasive procedure that is the best way to treat renal cell carcinoma." "Nephrectomy is the preferred treatment because chemotherapy has been shown to have only limited effectiveness against this type of cancer." "Research has shown that the most effective means of treating this form of cancer is with radiation therapy."

"Nephrectomy is the preferred treatment because chemotherapy has been shown to have only limited effectiveness against this type of cancer." Chemotherapy has limited effectiveness against renal cell carcinoma. This form of cancer is usually treated surgically with nephrectomy.

The RN is supervising a nurse orientating to the acute care unit who is discharging a patient admitted with kidney stones and who underwent lithotripsy. Which statement by the orienting nurse to the patient re-quires that the supervising RN intervene?

"Report any signs of bruising to your health care provider (HCP) immediately because this indicates bleeding."

The RN is supervising a new graduate nurse who is orientating to the unit. The new nurse asks why the patient with uncomplicated cystitis is being discharged with a prescription for ciprofloxacin 250 mg twice a day for only 3 days. What is the RN's best response?

"Research has shown that a 3-day course of ciprofloxacin is effective for uncomplicated cystitis and there is increased patient adherence to the plan of care."

A male patient must undergo intermittent catheterization. The nurse is preparing to insert a catheter to assess the patient for postvoid residual. Correctly place the options below in the correct sequence for intermittent catheter insertion.

1. Assist the patient to the bathroom and ask the patient to attempt to void 2. Position the patient supine in bed or with the head slightly elevated 3. Open the catheterization kit and put on sterile gloves 4. Retract the foreskin and hold the penis at a 60- to 90-degree angle 5. Cleanse the glans penis starting at the meatus and working outward 6. Lubricate the catheter and insert it through the meatus of the penis 7. Drain all the urine present in the bladder into a container 8. Remove the catheter, clean the penis, and measure the amount of urine returned

The nurse is caring for a patient admitted with de-hydration secondary to deficient antidiuretic hormone (ADH). Which specific gravity value supports this diagnosis? 1.010 1.035 1.020 1.002

1.002 A patient with dehydration as a result of deficient ADH would have dilute urine with a de-creased urine specific gravity. Normal urine specific gravity ranges from 1.003 to 1.030. A specific gravity of 1.035 would indicate urine that is concentrated.

The nurse is teaching a patient how to prevent renal trauma after an injury that required a left nephrectomy. Which points would the nurse include in the teaching plan? Select all that apply. Avoid contact sports. Always wear a seat belt. Wear protective clothing if you participate in con-tact sports. Use caution when riding a bicycle. Practice safe walking habits. Always avoid use of drugs that may damage the kidney.

Avoid contact sports. Always wear a seat belt. Use caution when riding a bicycle. Practice safe walking habits. A patient with only one kidney should avoid all contact sports and high-risk activities to protect the remaining kidney from injury and preserve kidney function. Protective clothing may not be enough to protect the patient's remaining kidney. Drugs that may cause kidney damage may still be pre-scribed, especially to save a patient's life. All of the other points are key to preventing renal trauma.

A patient on the medical-surgical unit with acute kidney failure is to begin continuous arteriovenous hemofiltration (CAVH) as soon as possible. What is the priority collaborative action at this time? Notify the health care provider (HCP) that the patient's mean arterial pressure is 68 mm Hg. Assist the patient with morning bath and mouth care before transfer. Develop a teaching plan for the patient that focuses on CAVH. Call the charge nurse and arrange to transfer the patient to the intensive care unit.

Call the charge nurse and arrange to transfer the patient to the intensive care unit. CAVH is a continuous renal replacement therapy that is prescribed for patients with kidney failure who are critically ill and do not tolerate the rapid shifts in fluids and electrolytes that are associated with hemodialysis. The patient will need careful in-depth monitoring in a critical care setting during this procedure. A teaching plan is not urgent at this time. A patient must have a mean arterial pressure (MAP) of at least 60 mm Hg or more for CAVH to be of use. The HCP should be notified about this patient's MAP; it is a priority but not the highest priority. When a patient urgently needs a procedure, morning care does not take priority and may be deferred until later in the day.

The nurse is admitting a patient with nephrotic syndrome. Which assessment finding supports this diagnosis? Flank pain Edema formation Hypotension Increased urine output

Edema formation The underlying pathophysiology of nephrotic syndrome involves increased glomerular permeability, which allows larger molecules to pass through the membrane into the urine and be removed from the blood. This process causes massive loss of protein, edema formation, and decreased serum albumin levels. Key features include hypertension and renal insufficiency (decreased urine output) related to concurrent renal vein thrombosis, which may be a cause or an effect of nephrotic syndrome. Flank pain is seen in patients with acute pyelonephritis.

The nurse is admitting a 66-year-old male patient suspected of having a urinary tract infection (UTI). Which part of the patient's medical history supports this diagnosis?

Followed for prostate disease for 2 years.

The nurse is providing care for a patient after a kidney biopsy. Which actions should the nurse delegate to an experienced assistive personnel (AP)? Select all that apply. Measure and record urine output. Teach the patient to resume normal activities after 24 hours if there is no bleeding. Check vital signs every 4 hours for 24 hours. Assess the dressing site for bleeding and check complete blood count results. Remind the patient about strict bed rest for 2 to 6 hours. Reposition the patient by log-rolling with supporting backroll.

Measure and record urine output. Check vital signs every 4 hours for 24 hours. Remind the patient about strict bed rest for 2 to 6 hours. Reposition the patient by log-rolling with supporting backroll.

The nurse is creating a care plan for older adult patients with incontinence. For which patient will a bladder-training program be an appropriate intervention?

Patient with urge incontinence and abnormal detrusor muscle contractions.

The nurse is providing care for a patient with reflex urinary incontinence. Which action could be appropriately assigned to a new LPN/LVN? Reinforcing the importance of proper hand washing to prevent infection. Discussing when to report the side effects of bethanechol chloride to the health care provider (HCP). Teaching the patient bladder emptying by the Credé method. Demonstrating how to perform intermittent self-catheterization.

Reinforcing the importance of proper hand washing to prevent infection. Teaching about bladder emptying, self-catheterization, and when to notify the HCP about medication side effects requires additional knowledge and training and is appropriate to the scope of practice of the RN. The LPN/LVN can reinforce information that has already been taught to the patient.

The patient is receiving IV piggyback doses of gentamicin every 12 hours. Which would be the nurse's priority for monitoring during the period that the patient is receiving this drug? Serum creatinine and blood urea nitrogen (BUN) levels. Temperature every 4 hours. Intake and output every shift. Patient weight every morning

Serum creatinine and blood urea nitrogen (BUN) levels. Gentamicin can be a highly nephrotoxic sub-stance. The nurse would monitor creatinine and BUN levels for elevations indicating possible nephrotoxicity. All of the other measures are important but are not specific to gentamicin therapy.

The nurse is caring for a patient at risk for kidney dis-ease for whom a urinalysis has been ordered. What time would the nurse instruct the assistive personnel is best to collect this sample? Immediately Before any meal At bedtime With first morning void

With first morning void Urinalysis is a part of any complete physical examination and is especially useful for patients with suspected kidney or urologic disorders. Ideally, the urine specimen is collected at the morning's first voiding. Specimens obtained at other times may be too dilute.