part 6

The client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse?

167 drops/min

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which of these questions by the nurse to the interdisciplinary health care team will result in reducing client exposure? a. "Should we filter air circulation?" b. "Can we use less radiographic contrast dye?" c. "Should we add low-dose dopamine?" d. "Should we increase IV rates?"

"Can we use less radiographic contrast dye?" Correct: Contrast dye is severely nephrotoxic and other options can be used in its place.

When teaching the client who is to undergo kidney transplant surgery, the nurse includes which of these in the teaching session? a. "Your diseased kidneys will be removed at the same time the transplantation is performed." b. "The new kidney will be placed directly below one of your old kidneys." c. "It is essential for you to wash your hands and avoid people who are ill." d. "You will receive dialysis the day before surgery and for about a week after."

"It is essential for you to wash your hands and avoid people who are ill." Correct: Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential.

Discharge teaching has been provided for the client recovering from kidney transplantation. Which information indicates that the client understands the instructions? a. "I can stop my medications when my kidney function return to normal." b. "If my urine output is decreased, I should increase my fluids." c. "The anti-rejection medications will be taken for life." d. "I will drink 8 ounces of water with my medications."

"The anti-rejection medications will be taken for life." Correct: Immune suppressant therapy must be taken for life to prevent organ rejection.

The client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? a. "All of this is new. What can't you do?" b. "Are you afraid of dying?" c. "How are you doing this morning?" d. "What concerns do you have about your kidney disease?"

"What concerns do you have about your kidney disease?" Correct: This statement is open ended and specific to the client?s concerns.

The client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? a. "I'll talk to the doctor and have your name removed from the waiting list" b. "You sound frustrated with the situation." c. "You're right, the wait is endless for some people." d. "I'm sure you'll get a phone call soon that a kidney is available."

"You sound frustrated with the situation." Correct: This option reflects the feelings the client is having and offers assistance and support.

What is the appropriate range of urine output for the adult client weighing 110 lbs? _______ to _______ mL/hr

25 to 30 mL/hr Adult urine output expectations are 0.5 to 1 mL/kg/hr.

The client has returned form a captopril renal scan. Which teaching should the nurse provide when the client returns? A "Arise slowly and call for assistance when ambulating." B "I must measure your intake and output (I&O)." C "We must save your urine because it is radioactive." D "I must attach you to this cardiac monitor."

A

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? a. A client with chronic kidney failure who was just admitted with shortness of breath b. A client with kidney insufficiency who is scheduled to have an arteriovenous (AV) fistula inserted c. A client with azotemia whose blood urea nitrogen and creatinine are increasing d. A client receiving peritoneal dialysis who needs help changing the dialysate bag

A client with chronic kidney failure who was just admitted with shortness of breath Correct: This client's dyspnea may indicate pulmonary edema and should be assessed immediately.

The client is scheduled for intravenous urography. During the assessment, the nurse notes a previous reaction of urticaria, itching, and sneezing to contrast dye. Which precautions does the nurse take? Select all that apply. A Ensures that an antihistamine and a steroid are prescribed B Documents the reaction on the chart C Uses no contrast dye for the procedure D Cancels the procedure E Ensures that the health care provider is aware of the reaction

ABE

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? a. Abrupt decrease in urine output b. Blood-tinged urine c. Incisional pain d. Increase in urine output

Abrupt decrease in urine output Correct: An abrupt decrease in urine output may indicate complications such as rejection, acute tubular necrosis (ATN), thrombosis, or obstruction.

When assessing a client with pyelonephritis, the nurse recognizes that which of these conditions may predispose the client to the problem? a. Spinal cord injury b. Cardiomyopathy c. Hepatic failure{ d. Glomerulonephritis

a. Spinal cord injury Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones.

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen (BUN) requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? a. An RN who has floated from pediatrics for this shift b. An LPN/LVN with experience working on the medical unit c. An RN who usually works on the general surgical unit d. A new graduate RN who just finished a 6-week orientation

An RN who usually works on the general surgical unit Correct: The nurse with experience in taking care of surgical clients will be most capable of monitoring this older client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure.

The nurse carefully observes for toxicity of drugs excreted through the kidney. Which of these represents a sign or symptom of digoxin toxicity? a. Serum digoxin level of 1.2 ng/mL b. Polyphagia c. Anorexia d. Serum potassium of 5.0 mEq/L

Anorexia Correct: Anorexia, nausea, and vomiting are symptoms of digoxin toxicity.

When caring for a group of clients, the nurse recognizes that which clients are at risk for acute kidney injury (AKI)? Select all that apply. a. Football player in preseason practice b. Client who underwent contrast dye radiology c. Accident victim recovering from a severe hemorrhage d. Accountant with diabetes e. Client in the intensive care unit on high doses of antibiotics f. Client recovering from gastrointestinal influenza

Answer: Football player in preseason practice; Client who underwent contrast dye radiology; Accident victim recovering from a severe hemorrhage; Client in the intensive care unit on high doses of antibiotics; Client recovering from gastrointestinal influenza Rationale: Urge all people to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis. Contrast media may cause acute renal failure (ARF), especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause acute kidney injury. Certain antibiotics may cause nephrotoxicity. Dehydration reduces kidney blood flow and may cause acute kidney injury.

When caring for the client with a left forearm arteriovenous (AV) fistula created for hemodialysis, the nurse must do which of these? Select all that apply. a. Check brachial pulses daily. b. Auscultate for a bruit each shift. c. Teach the client to palpate for a thrill over the site. d. Elevate the arm above heart level. e. Ensure that no blood pressures are taken in that arm.

Auscultate for a bruit each shift. Correct Teach the client to palpate for a thrill over the site. Correct Ensure that no blood pressures are taken in that arm. A bruit or swishing sound should be present, indicating patency of the fistula. A thrill or buzzing sensation upon palpation should be present, indicating patency of the fistula. No blood pressure, venipuncture, or compression such as lying on the fistula should occur.

The client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? a. Auscultate for pericardial friction rub. b. Assess for crackles. c. Monitor for decreased peripheral pulses. d. Determine whether the client is able to ambulate.

Auscultate for pericardial friction rub. Correct: The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST segment elevation.

Which teaching by the nurse will help the client prevent renal osteodystrophy? a. Low-calcium diet b. Avoiding peas, nuts, and legumes c. Drinking cola beverages only once daily d. Avoiding dairy enriched with vitamin D

Avoiding peas, nuts, and legumes Correct: Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes.

The client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? a. Avoiding venipuncture and blood pressure measurements in the affected arm b. Discussion on modifications to allow for complete arm rest c. Information on how to assess for bruit d. Information on proper nutrition

Avoiding venipuncture and blood pressure measurements in the affected arm Correct: Compression of vascular access causes decreased blood flow and may cause occlusion; dialysis will not be possible.

The nurse recognizes that which of these is the best indicator of kidney function? A BUN B Creatinine C AST D Alkaline phosphatase

B

When caring for the client with uremia, the nurse assesses for which of these symptoms? A Tenderness at the costovertebral angle (CVA) B Cyanosis of the skin C Nausea and vomiting D Insomnia

C

When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which of these? A Abdominal girth B Presence of urinary infection C History of hysterectomy D Hematuria

C

When caring for the client hoping to receive a kidney transplant, the nurse recognizes that which of these problems will exclude the client from transplantation? a. History of hiatal hernia b. Client with diabetes and HbA1c of 6.8 c. Basal cell carcinoma removed from nose 5 years ago d. Client with tuberculosis

Client with tuberculosis Correct: Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with immune suppressants required to prevent rejection.

To prevent prerenal acute kidney injury, which person is encouraged to increase fluid consumption? a. Construction worker b. Office secretary c. Schoolteacher d. Taxi cab driver

Construction worker Correct: Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place a construction worker at risk for dehydration and prerenal azotemia.

The nurse in the transplantation unit assesses for which of these signs and symptoms of rejection of the transplanted kidney. Select all that apply. a. Blood urea nitrogen (BUN) 21, creatinine 0.9 b. Crackles in lung fields c. Temperature 98.8 d. Blood pressure 164/98 e. +3 edema of lower extremities

Crackles in lung fields orrect Blood pressure 164/98 Correct +3 edema of lower extremities Signs and symptoms of fluid retention are symptoms of transplant rejection. Correct: Increased blood pressure is a symptom of transplant rejection. Correct: Signs and symptoms of fluid retention are symptoms of transplant rejection.

When planning an assessment of the urethra, what does the nurse do first? A. Examines the meatus B. Notes any unusual discharge C. Records the presence of abnormalities D. Dons gloves

D

The nurse recognizes that the client with end-stage kidney disease has difficulty adhering to the fluid restriction when which of these is found? a. Blood pressure 118/78 b. Weight loss of 3 lbs during hospitalization c. Dyspnea and anxiety at rest d. Central venous pressure (CVP) of 6 mm Hg

Dyspnea and anxiety at rest Correct: Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse assists the client in correlating symptoms of fluid overload with nonadherence to fluid restriction.

When assisting the client with kidney failure to restrict dietary protein to 40 g/day, the nurse recommends that the client select which of these proteins? a. Eggs b. Ham c. Eggplant d. Macaroni

Eggs Correct: Suggested protein-containing foods are milk, meat, and eggs.

The client is receiving immune suppressive therapy after kidney transplantation. Which measure is most important for the nurse to implement? a. Adherence to therapy b. Handwashing c. Monitoring for low-grade fever d. Strict clean technique

Handwashing Correct: The most important infection control measure is handwashing.

The client with chronic kidney disease presents with bradycardia, prolonged PR interval, and diminished bowel sounds. For which of these should the nurse monitor? a. Hyperchloremia b. Hypomagnesemia c. Hyperkalemia d. Hypercalcemia

Hyperkalemia Correct: Hyperkalemia may be present; electrocardiographic changes and paralytic ileus may develop.

Which clinical manifestation indicates the need for increased fluids in the client with kidney failure? a. Increased blood urea nitrogen b. Increased creatinine c. Pale urine d. Decreased sodium

Increased blood urea nitrogen Correct: An increase in blood urea nitrogen can be an indication of dehydration, and an increase in fluids is needed.

Which of the following represents a positive response to administration of erythropoietin (Epogen, Procrit)? a. Hematocrit of 26.7% b. Potassium within normal range c. Free from spontaneous fractures d. Less fatigue

Less fatigue Correct: Treatment of anemia with erythropoietin will result in increased (H&H) and decreased shortness of breath (SOB) and fatigue.

When administering medications to the client with chronic kidney disease, the nurse recognizes that which of these medications is most effective in slowing the progression of kidney failure? a. Diltiazem (Cardizem) b. Lisinopril (Zestril) c. Clonidine (Catapres) d. Doxazosin (Cardura)

Lisinopril (Zestril) Correct: Angiotensin-converting enzyme (ACE) inhibitors appear to be the most effective drugs to slow the progression of kidney failure.

The nurse teaches the client recovering from acute kidney disease to avoid which of these? a. Nonsteroidal anti-inflammatory drugs b. Angiotensin-converting enzyme (ACE) inhibitors c. Opiates d. Acetaminophen

Nonsteroidal anti-inflammatory drugs Correct: Nonsteroidal anti-inflammatory drugs may be nephrotoxic.

Which of these interventions is essential for the client in the oliguric phase of acute kidney injury (AKI)? a. Restrict fluids. b. Replace potassium. c. Administer blood transfusions. d. Monitor arterial blood gases (ABGs).

Restrict fluids. Correct: During the oliguric phase of AKI, the client will be at risk for fluid overload; fluid restriction is necessary to limit this problem .

The nurse assists the client with acute kidney injury (AKI) to modify the diet in which way? Select all that apply. a. Restricted protein b. Liberal sodium c. Fluid restriction d. Low potassium e. Low fat

Restricted protein Correct Fluid restriction Correct Low potassium Breakdown of protein leads to azotemia and increased blood urea nitrogen (BUN). Correct: Fluid is restricted during the oliguric stage. Correct: Potassium intoxication may occur; dietary potassium is restricted.

When caring for the client with acute kidney injury and a temporary subclavian hemodialysis catheter, which of these should the nurse report to the provider? a. Crackles at lung bases b. Temperature 100.8 c. +1 ankle edema d. Anorexia

Temperature 100.8 Correct: Infection is a major complication of temporary catheters. Report all symptoms of infection, including fever, to the provider. The catheter may have to be removed.

When caring for a client who receives peritoneal dialysis (PD), which of these findings must the nurse report to the provider immediately? a. Pulse oximetry reading of 95% b. Sinus bradycardia, rate of 58 c. Blood pressure of 148/90 d. Temperature of 101.2

Temperature of 101.2 Correct: Peritonitis is the major complication of PD caused by intra-abdominal catheter site contamination; use meticulous aseptic technique when caring for PD equipment.

When taking the health history of a client with acute glomerulonephritis, the nurse questions the client about which related cause of the problem? a. Recent respiratory infection b. Hypertension c. Unexplained weight loss d. Neoplastic disease

a. Recent respiratory infection An infection often occurs before the kidney manifestations of acute glomerulonephritis (GN). The onset of symptoms is about 10 days from the time of infection.

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. What information does a nurse provide to this client about taking her prescribed trimethoprim/sulfamethoxazole (Bactrim)? Select all that apply. a. "Be certain to wear sunscreen and protective clothing." b. "Drink at least 3 liters of fluids every day." c. "Take this drug with 8 ounces of water." d. "Try to urinate frequently to keep your bladder empty." e. "You will need to take all of this drug to get the benefits."

a. "Be certain to wear sunscreen and protective clothing." b. "Drink at least 3 liters of fluids every day." c. "Take this drug with 8 ounces of water." e. "You will need to take all of this drug to get the benefits." (a) Wearing sunscreen and protective clothing is important to do while on this drug. Increased sensitivity to the sun can lead to severe sunburn. (b, c) Sulfamethoxazole can form crystals that precipitate in the kidney tubules. Fluid intake prevents this complication. (e) Clients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. INCORRECT: (d)Emptying the bladder is important-but not keeping it empty-as is stated here. The client should be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.

The client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? a. "Because the kidneys cannot get rid of fluid, blood pressure goes up." b. "The damaged kidneys no longer release a hormone that prevents high blood pressure." c. "The waste products in the blood interfere with other mechanisms that control blood pressure." d. "This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."

a. "Because the kidneys cannot get rid of fluid, blood pressure goes up." In chronic kidney disease, fluid levels increase in the circulatory system.

The client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease? a. "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." b. "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." c. "If my children have the ADPKD gene, they will have cysts by the age of 30." d. "My children have a 50% chance of inheriting the ADPKD gene that causes the disease."

a. "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." There is no way to prevent ADPKD, although early detection and management of hypertension may slow the progression of kidney damage. Limiting salt intake can help control blood pressure.

The school nurse is counseling a teenage student about how to prevent renal trauma. Which statement by the student indicates a need for further teaching? a. "I can't play any type of contact sports because my brother had kidney cancer." b. "I avoid riding motorcycles." c. "I always wear pads when playing football." d. "I always wear a seat belt in the car."

a. "I can't play any type of contact sports because my brother had kidney cancer." Contact sports and high-risk activities should be avoided if a person has only one kidney. A family history of kidney cancer does not prohibit this type of activity.

A nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences of them. Which client statement shows correct understanding of what the nurse has taught? a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." b. "It is a good idea for me to reduce germs by taking a tub bath daily." c. "Trying to get to the bathroom to urinate every 6 hours is important for me." d. "Urinating 1000 mL on a daily basis is a good amount for me."

a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day.

A nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply. a. Dysuria b. Enuresis c. Frequency d. Nocturia e. Urgency f. Polyuria

a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." c. Frequency d. Nocturia e. Urgency (a) Dysuria-painful urination-is a symptom of a UTI. (c) Frequency-frequent urinating and in small amounts-is a sign of a UTI. (d) Nocturia-urinating at night-is (or can be) a symptom of a UTI. (e) Urgency-having the urge to urinate quickly-is a symptom of a UTI. INCORRECT: (b) Enuresis-bed-wetting-is not a sign of a UTI. (f) Polyuria-increased amounts of urine production-is not a sign of a UTI.

The nurse is questioning the female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction? a. "I take my medication only when I have symptoms." b. "I always wipe front to back." c. "I don't use bubble baths and other scented bath products." d. "I try to drink 3 liters of fluid a day."

a. "I take my medication only when I have symptoms." Clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent.

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. She is started on antibiotics and sent home. She returns to the clinic 3 days later-with the same symptoms. When asked about the previous UTI and medication regimen, she states, "I only took the first dose because after that, I felt better." How does the nurse respond? a. "Not completing your medication can lead to return of your infection." b. "That means your treatment will be prolonged with this new infection." c. "This means you will now have to take two drugs instead of one." d. "What you did was okay; however, let's get you started on something else."

a. "Not completing your medication can lead to return of your infection." Not completing the drug regimen can lead to recurrence of an infection and to bacterial drug resistance.

Which client with a long-term urinary problem does the nurse refer to community resources and support groups? Select all that apply. a. 32-year-old with a cystectomy b. 44-year-old with a Kock pouch c. 48-year-old with urinary calculi d. 78-year-old with urinary incontinence e. 80-year-old with dementia

a. 32-year-old with a cystectomy b. 44-year-old with a Kock pouch d. 78-year-old with urinary incontinence (a) The client with a cystectomy would benefit from community resources and support groups. Others who have had their bladders removed are good sources for information and for help in establishing coping mechanisms. (b) The client with a Kock pouch would benefit from community resources and support groups. Others who have had their bladders removed and are using an alternate method for urinating are good sources for information and for help in establishing coping mechanisms. (d) The older adult client with urinary incontinence would benefit from community resources and support groups. Others who have had this problem can provide methods of living with the problem or methods of curing (or minimizing) it.

When caring for the client with nephrotic syndrome, which of the following should be included in the plan of care? a. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss b. Administering heparin to prevent deep vein thrombosis (DVT) c. Providing antibiotics to decrease infection d. Providing transfusion of clotting factors

a. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss ACE inhibitors can decrease protein loss in the urine.

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? a. Administers morphine sulfate 4 mg IV b. Begins an infusion of metoclopramide (Reglan) 10 mg IV c. Obtains a urine specimen for urinalysis d. Starts an infusion of 0.9% normal saline at 100 mL/hr

a. Administers morphine sulfate 4 mg IV Morphine administered IV will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.

When preparing a client for nephrostomy tube insertion, it is essential for the nurse to monitor which of these before the procedure? a. BUN and creatinine b. Hemoglobin and hematocrit (H&H) c. Intake and output (I&O) d. Prothrombin time (PT) and international normalized ratio (INR)

a. BUN and creatinine Nephrostomy tubes are placed to prevent and treat kidney damage; this is important but is not essential before the procedure.

The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse? a. Blood pressure is 98/56; heart rate is 118. b. Urine output over the past hour was 80 mL. c. Pain is at a level 4 (on a 0 to 10 scale). d. Dressing has a 1-cm area of bleeding.

a. Blood pressure is 98/56; heart rate is 118. Bleeding is a complication of radical nephrectomy; tachycardia and hypotension may indicate impending hypovolemic or hemorrhagic shock. Notify the surgeon immediately and plan to administer fluids, check the complete blood count (CBC), and administer blood if necessary.

When caring for the client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which assessment should be made next? a. Check the vital signs. b. Notify the surgeon. c. Continue to monitor. d. Insert a nasogastric (NG) tube

a. Check the vital signs. The client's abdomen may be distended from bleeding. Hemorrhage or adrenal insufficiency causes hypotension, so vital signs should be taken to see if a change in blood pressure has occurred.

Which of the following findings does the nurse expect in the client with kidney cancer? Select all that apply. a. Erythrocytosis b. Hypokalemia c. Hypercalcemia d. Hepatic dysfunction e. Increased sedimentation rate

a. Erythrocytosis c. Hypercalcemia d. Hepatic dysfunction e. Increased sedimentation rate (a) Erythrocytosis alternating with anemia may occur. (c) Parathyroid hormone produced by tumor cells can cause hypercalcemia. (d) Hepatic dysfunction with elevated liver enzymes may occur. (e) Elevation in sedimentation rate may occur in paraneoplastic syndromes. INCORRECT: Potassium levels are not altered in kidney cancer; hypercalcemia is present.

When caring for the client with polycystic kidney disease, the nurse recognizes that which of these goals is most important? a. Preventing progression of the disease b. Performing genetic testing c. Assessing for related causes d. Consulting with the dialysis unit

a. Preventing progression of the disease Preventing complications and progression is the goal.

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instructions does the nurse provide for postprocedure home care? a. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." b. "Do not share your toilet with family members for the next 24 hours." c. "Please be sure to stand when you are urinating." d. "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."

b. "Do not share your toilet with family members for the next 24 hours." The toilet should not be shared for 24 hours following the procedure because others using the toilet could be infected with the live virus that was instilled into the client. If the toilet must be shared, then specific cleaning precautions need to be taken each time the client uses the toilet. The best scenario is for the client not to share the toilet.

Which statement by the client with diabetic nephropathy indicates a need for further education about the disease? a. "Diabetes is the leading cause of kidney failure." b. "I need less insulin, so I am getting better." c. "I may need to reduce my insulin." d. "I must call my provider if the urine dipstick shows protein."

b. "I need less insulin, so I am getting better." When kidney function is reduced, the insulin is available for a longer time and thus less of it is needed. Unfortunately, many clients believe this means that their diabetes is improving.

A nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? a. "A small-lumen catheter will help prevent injury to my urethra." b. "I will use a new, sterile catheter each time I do the procedure." c. "My family members can be taught to help me if I need it." d. "Proper handwashing before I start the procedure is very important."

b. "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and re-used. Proper handwashing and cleaning of the catheter have shown no increase in bacterial complications. Catheters are replaced when they show signs of deteriorating.

The client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? a. "Don't worry, no one else will know." b. "Take your time. What is bothering you the most?" c. "Why are you hesitant?" d. "You need to tell me so we can determine what is wrong."

b. "Take your time. What is bothering you the most?" This statement is patient and understanding and tries to identify the client's problem.

A nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? a. 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) b. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours c. 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy d. 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

b. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client may be oversedated and may not be aware of any discomfort caused by bladder distention.

The nurse anticipates that the client who develops hypotension and oliguria post nephrectomy may need addition of which of these to the regimen? a. Increase in analgesics b. Addition of a corticosteroid c. Administration of a diuretic d. A course of antibiotic therapy

b. Addition of a corticosteroid Loss of water and sodium occurs in clients with adrenal insufficiency; this is followed by hypotension and oliguria; corticosteroids may be needed.

The RN is working with a nursing assistant in caring for a group of clients. Which of these actions will be best for the RN to delegate to the nursing assistant? a. Assess the vital signs for a client who was just admitted with blunt flank trauma and hematuria. b. Assist a client who had a radical nephrectomy 2 days ago to turn in bed. c. Help the physician with a kidney biopsy for a client admitted with acute glomerulonephritis. d. Palpate for bladder distention on a client recently admitted with a ureteral stricture.

b. Assist a client who had a radical nephrectomy 2 days ago to turn in bed. The nursing assistant would be working within legal guidelines when assisting a client to turn in bed.

When assessing the client with acute glomerulonephritis, of which of these findings does the nurse notify the provider? a. Purulent wound on leg b. Crackles throughout the lung fields c. History of diabetes d. Cola-colored urine

b. Crackles throughout the lung fields Crackles indicate fluid overload resulting from kidney damage; shortness of breath (SOB) and dyspnea are typically associated. The provider should be notified.

Which clinical manifestation in the client with pyelonephritis indicates that treatment has been effective? a. Decreased urine output b. Decreased urine white blood cells c. Increased red blood cell count d. Increased urine specific gravity

b. Decreased urine white blood cells A decreased presence of white blood cells indicates the eradication of infection.

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence and is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? Select all that apply. a. Administer the drug at bedtime. b. Encourage increased fluids. c. Increase fiber. d. Limit the intake of dairy products. e. Offer hard candy for "dry" mouth.

b. Encourage increased fluids. c. Increase fiber. e. Offer hard candy for "dry" mouth. (b) Anticholinergics cause constipation. Increasing fluids will help with this problem. (c) Anticholinergics cause constipation. An increase in daily fiber in the client's diet will help. (e) Anticholinergics cause extreme dry mouth. INCORRECT: (a) Taking the drug at night will not have an effect on the complications encountered-dry mouth and constipation. The drug is usually taken three to four times a day. (d) Limiting dairy products does not have an effect on the complications encountered-dry mouth and constipation.

The nurse receives report on a client with hydronephrosis. Which laboratory study should the nurse monitor? a. Hemoglobin and hematocrit (H&H) b. White blood cell (WBC) count c. Blood urea nitrogen and creatinine d. Lipid levels

c. Blood urea nitrogen and creatinine With back pressure on the kidney, glomerular filtration is reduced or absent resulting in permanent kidney damage; BUN and creatinine are kidney function tests.

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. The health care provider prescribes the drug, estrogen (Premarin). Which risks does the nurse tell the client to expect? Select all that apply. a. Dry mouth b. Endometrial cancer c. Increased intraocular pressure d. Thrombophlebitis e. Vaginitis

b. Endometrial cancer d. Thrombophlebitis (b) Estrogen use can increase the risk for endometrial cancer. (d) Estrogen use can increase the risk for thrombophlebitis. Women who smoke-especially-should not use this drug. INCORRECT: (a) Dry mouth is not a side effect of estrogen use. (c) Increased intraocular pressure is not a side effect of estrogen use. It is a problem with anticholinergic use. (e) Vaginitis is not a side effect of estrogen use. However, clients should report any unusual vaginal bleeding.

Which factor is an indicator for a diagnosis of hydronephrosis? a. History of nocturia b. History of urinary stones c. Recent weight loss d. Urinary incontinence

b. History of urinary stones Causes of hydronephrosis or hydroureter include tumors, stones, trauma, structural defects, and fibrosis.

Which interventions are helpful in preventing bladder cancer? Select all that apply. a. Drinking 2½ liters of fluid a day b. Showering after working with or around chemicals c. Stopping the use of tobacco d. Using pelvic floor muscle exercises e. Wearing a lead apron when working with chemicals f. Wearing gloves and a mask when working around chemicals and fumes

b. Showering after working with or around chemicals c. Stopping the use of tobacco f. Wearing gloves and a mask when working around chemicals and fumes (b)Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Bathing after exposure to them is advisable. (c) Tobacco use is one of the highest if not the highest risk factor in the development of bladder cancer. (f) Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. INCORRECT: (a) Increasing fluid intake is helpful for some urinary problems such as urinary tract infection (UTI), but no correlation has been noted between fluid intake and bladder cancer risk. (d) Using pelvic floor muscle strengthening exercises (Kegel) is helpful with certain types of incontinence; but no data show that these exercises prevent bladder cancer. (e) Precautions should be taken when working with chemicals; however, lead aprons are used to protect from radiation.

Which sign or symptom when found in the client with chronic glomerulonephritis warrants a call to the health care provider? a. Mild proteinuria b. Third heart sound c. Serum potassium 5.0 mEq/L d. Itchy skin

b. Third heart sound S3 indicates fluid overload secondary to failing kidney; the physician should be notified and instructions obtained.

When assessing the client with pyelonephritis, which finding does the nurse anticipate will be present? Select all that apply. a. Suprapubic pain b. Vomiting c. Chills d. Dysuria e. Oliguria

b. Vomiting c. Chills d. Dysuria (b) Nausea and vomiting are symptoms of pyelonephritis. (c) Chills along with fever may occur. (d) Burning (dysuria), urgency, and frequency are symptoms of pyelonephritis. INCORRECT: (a) Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). (e) This is related to kidney impairment from severe or long-standing pyelonephritis.

A nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? a. "I must avoid drinking carbonated beverages." b. "I need to douche vaginally once a week." c. "I should drink 2½ liters of fluid every day." d. "I will not drink fluids after 8 PM each evening."

c. "I should drink 2½ liters of fluid every day." Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis.

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? a. "They can relieve your anxiety associated with incontinence." b. "They help your bladder to empty." c. "They may be used to improve urethral resistance." d. "They decrease your bladder's tone."

c. "They may be used to improve urethral resistance." Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance.

A nurse is educating a female about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do? a. "Douche-but only once a month." b. "Use only white toilet paper." c. "Wipe from your front to your back." d. "Wipe with the softest toilet paper available."

c. "Wipe from your front to your back." Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection.

After receiving the change-of-shift report on the urology unit, which of these clients should the nurse assess first? a. A client post radical nephrectomy whose temperature is 99.8° F (37.6° C) b. A client with glomerulonephritis who has cola-colored urine c. A client who was involved in a motor vehicle accident and has hematuria d. A client with nephrotic syndrome who has gained 2 kg since yesterday

c. A client who was involved in a motor vehicle accident and has hematuria The nurse should be aware of the risk for kidney trauma after a motor vehicle accident. The client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria.

A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration should be cared for by which staff member? a. An RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma b. An RN who is caring for a client who just returned after having renal artery balloon angioplasty c. An RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy d. An RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

c. An RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy This RN is caring for the most stable client and will have time to do the frequent monitoring and interventions that are needed for the newly admitted client.

A cognitively impaired client has urge incontinence. Which method for achieving continence does a nurse include in the client's care plan? a. Bladder training b. Credé method c. Habit training d. Kegel exercises

c. Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.

The nurse is teaching a client with diabetes the importance of preventing kidney damage. Which information suggests that the client may be in early stages of kidney damage? a. Elevation in blood urea nitrogen (BUN) b. Oliguria c. Microalbuminuria d. Painless hematuria

c. Microalbuminuria Microlevels of albumin are first detected in the urine. Progressive kidney damage occurs before dipstick procedures can detect protein in the urine.

The certified wound, ostomy, continence nurse (CWOCN) or enterostomal therapist (ET) teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? a. Nutritional and dietary care b. Respiratory care c. Stoma and pouch care d. Wiping from front to back (asepsis)

c. Stoma and pouch care The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms.

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? a. Functional b. Overflow c. Stress d. Urge

c. Stress Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence.

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the nurse expect the health care provider to prescribe? a. Nitrofurantoin after intercourse b. Premarin c. Trimethoprim/sulfamethoxazole d. Trimethoprim with intercourse

c. Trimethoprim/sulfamethoxazole Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole or fosfomycin is effective in treating uncomplicated, community-acquired UTI in women.

When caring for a client who had a nephrostomy tube inserted 4 hours ago, which is essential to report to the physician? a. Dark pink-colored urine b. Small amount of urine leaking around the catheter c. Tube has stopped draining d. Creatinine 1.8

c. Tube has stopped draining Notify the provider when a nephrostomy tube does not drain; it could be obstructed or dislodged.

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? a. "Blood in my urine has become less noticeable; maybe I don't need this procedure." b. "I have been taking cephalexin (Keflex) for an infection." c. "I previously had several ESWL procedures performed." d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain." Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.

The nurse is performing discharge teaching for the client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective? a. "Because renal cell carcinoma usually affects both kidneys, I'll need to be watched closely." b. "I'll eventually require some type of renal replacement therapy." c. "I'll need to decrease my fluid intake to prevent stress to my remaining kidney." d. "My remaining kidney should provide me with normal kidney function."

d. "My remaining kidney should provide me with normal kidney function." After a nephrectomy, the second kidney is expected to provide adequate kidney function, but this may take days or weeks.

An older adult woman confides to a nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? a. "Don't worry about it. You need them." b. "Shop at night-when stores are less crowded." c. "Tell everyone that they are for your husband." d. "That is tough. What do you think might help?"

d. "That is tough. What do you think might help?" This response acknowledges the client's concerns and attempts to help the client think of methods to solve her problem.

A nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? a. "For the best effect, perform all your exercises while you are seated on the toilet." b. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." c. "Results should be visible to you within 72 hours." d. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

d. "You know that you are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used.

A health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? a. "It will act as an antibacterial drug." b. "This drug will treat your infection, not the symptoms of it." c. "You need to take the drug on an empty stomach." d. "Your urine will turn red or orange while on the drug."

d. "Your urine will turn red or orange while on the drug." Phenazopyridine (Pyridium) will turn the client's urine red or orange. Care should be taken because it will stain undergarments. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed.

Which client does the nurse manager on a medical unit assign to an experienced LPN/LVN? a. 42-year-old with painless hematuria who needs an admission assessment b. 46-year-old scheduled for cystectomy who needs help in selecting a stoma site c. 48-year-old receiving intravesical chemotherapy for bladder cancer d. 55-year-old with incontinence who has intermittent catheterization prescribed

d. 55-year-old with incontinence who has intermittent catheterization prescribed Insertion of catheters is within the education and legal scope of practice for LPNs/LVNs.

Which of these staff members should be assigned to a client who has benign prostatic hyperplasia and hydronephrosis and needs an indwelling catheter inserted? a. An RN float nurse who has 10 years of experience with pediatric clients b. An LPN/LVN who has worked in the hospital's kidney dialysis unit until recently c. An RN without recent experience who has just completed an RN refresher course d. An LPN/LVN with 5 years of experience in an outpatient urology surgery center

d. An LPN/LVN with 5 years of experience in an outpatient urology surgery center Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center.

What does the nurse teach the client to prevent the risk for urinary tract infection (UTI)? a. Limit fluid intake. b. Increase caffeine consumption. c. Limit sugar intake. d. Drink about 3 liters of fluid daily.

d. Drink about 3 liters of fluid daily. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs.

Which goal for the client with diabetes will best help to prevent diabetic nephropathy? a. Heed the urge to void. b. Avoid carbohydrates in the diet. c. Take insulin at the same time every day. d. Maintain HbA1c

d. Maintain HbA1c Maintaining long-term control of blood glucose will help prevent the progression of diabetic nephropathy.

When caring for the client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which of these does the nurse anticipate should be used? a. Fresh-frozen plasma b. Platelet infusions c. 5% dextrose in water d. Normal saline solution

d. Normal saline solution Isotonic solutions and crystalloid solutions are administered for volume expansion; 0.9% sodium chloride (NSS) and 5% dextrose in 0.45% sodium chloride may be used.

The client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? a. Decreases bacterial count b. Destroys white blood cells c. Enhances the action of antibiotics d. Provides comfort

d. Provides comfort Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis.

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? a. Encouraging them to drink fluids b. Irrigating all catheters daily with sterile saline c. Recommending catheters should be placed in all clients d. Re-evaluating periodically the need for indwelling catheters

d. Re-evaluating periodically the need for indwelling catheters Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTI in the hospital setting.

A client who is 6 months pregnant comes to the Prenatal Clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? a. Discharges the client to her home for strict bedrest for the duration of the pregnancy b. Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria c. Recommends that the client refrain from having sexual intercourse until after she has delivered her baby d. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up

d. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up Pregnant women with UTI require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor-with adverse effects for the fetus.

A nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by a health care provider, for a client with a urinary tract infection (UTI) does the nurse question? a. Bactrim b. Cipro c. Noroxin d. Tegretol

d. Tegretol Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin and Tegretol. The former is used for UTI, and the latter is prescribed as an oral anticonvulsant.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection (UTI). Which nursing action can the home health RN delegate to a home health aide (unlicensed assistive personnel [UAP])? a. Assisting the client in developing a schedule for when to take prescribed antibiotics b. Inserting a straight catheter as necessary if the client is unable to empty the bladder c. Teaching the client how to use the Credé maneuver to empty the bladder more fully d. Using a bladder scanner (with training) to check residual bladder volume after the client voids

d. Using a bladder scanner (with training) to check residual bladder volume after the client voids Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill.

During discharge teaching for the client with kidney disease, what does the nurse teach the client to do? a. Drink 2 liters of fluid and urinate. b. Eat breakfast and go to bed. c. Check blood sugar and do a urine dipstick test. d. Weigh yourself and take your blood pressure.

d. Weigh yourself and take your blood pressure. Regular weight assessment monitors fluid restriction control. Blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction

A nurse is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? a. Children's terms that are easily understood b. Slang words and terms that are heard "socially" c. Technical and medical terminology d. Words that the client uses

d. Words that the client uses The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client.

A nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates correct understanding of these procedures? a. "If I restrict my oral intake of fluids, the adjustment will be easier." b. "I must go to the restroom more often because my urine will be excreted through my anus." c. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." d."I will have to drain my pouch with a catheter."

d."I will have to drain my pouch with a catheter." For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.