Quiz 4 Med surg
A nurse teaches a client about self-care after experiencing a urinary calculus treated by lithotripsy. Which statements should the nurse include in this client's discharge teaching? (Select all that apply.) a. "Finish the prescribed antibiotic even if you are feeling better." b. "Drink at least 3 liters of fluid each day." c. "The bruising on your back may take several weeks to resolve." d. "Report any blood present in your urine." e. "It is normal to experience pain and difficulty urinating."
ANS: A, B, C The client should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The client should drink at least 3 liters of fluid daily to dilute potential stone-forming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the client should expect bruising that may take several weeks to resolve. The client should also experience blood in the urine for several days. The client should report any pain, fever, chills, or difficulty with urination to the provider as these may signal the beginning of an infection or the formation of another stone.
The client had surgery to remove a kidney stone. Which laboratory assessment data would warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L 2. A urinalysis that shows microscopic hematuria. 3. A creatinine level of 0.8 mg/100 mL. 4. A white blood cell count of 14,000 mm/dL.
Answer 4 1. This potassium level is within normal limits, 3.5 to 5.5 mEq/L. 2. Hematuria is not uncommon after removal of a kidney stone. 3. A normal creatinine level is 0.8 to 1.2 mg/100 mL. ***4. This white blood cell count is elevated; normal is 5,000-10,000 mm.
The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? 1. Fluid volume loss. 2. Knowledge deficit. 3. Impaired urinary elimination. 4. Pain.
Answer 4 ***4. Pain is priority. The pain can be so severe that a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin.
The client is scheduled to have a kidney, ureter, and bladder (KUB) radiograph. To prepare the client for this procedure, the nurse should explain to the client that: 1. Fluid and food will be withheld the morning of the examination. 2. A tranquilizer will be given before the examination. 3. An enema will be given before the examination. 4. No special preparation is required for the examination.
Answer 4. A KUB radiographic examination ordinarily requires no preparation. It is usually done while the client lies supine and does not involve the use of radiopaque substances.
Which statement indicates that the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1. "I should increase my fluid intake, especially in warm weather." 2. "I should eat foods that contain cocoa and chocolate." 3. "I will walk about a mile every week and not exercise often." 4. "I should take one vitamin a day that has extra calcium."
Answer 1 ***1. An increased fluid intake that ensures 2-3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate.
Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic? 1. Applying moist heat to the flank area. 2. Administering meperidine (Demerol). 3. Encouraging high fluid intake. 4. Maintaining complete bed rest.
Answer 2 During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics to control the pain. Application of heat, encouraging high fluid intake, and limitation of activity are important interventions, but they will not relieve the renal colic pain.
After teaching a client with a history of renal calculi, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I should drink at least 3 liters of fluid every day." b. "I will eliminate all dairy or sources of calcium from my diet." c. "Aspirin and aspirin-containing products can lead to stones." d. "The doctor can give me antibiotics at the first sign of a stone."
ANS: A Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the client is well hydrated the calcium will be excreted without issues. Dehydration increases the risk for supersaturation of calcium in the urine, which contributes to stone formation. The nurse should encourage the client to drink more fluids, not decrease calcium intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics neither prevent nor treat a stone.
Allopurinol (Zyloprim), 200 mg/ day, is prescribed for the client with renal calculi to take at home. The nurse should teach the client about which of the following adverse effects of this medication? 1. Retinopathy. 2. Maculopapular rash. 3. Nasal congestion. 4. Dizziness.
Answer 2
To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating : a. milk and cheese. b. sardines and liver. c. legumes and dried fruit. d. spinach, chocolate, and tea.
ANS: B Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.
A nurse assesses a client who presents with renal calculi. Which question should the nurse ask? a. "Do any of your family members have this problem?" b. "Do you drink any cranberry juice?" c. "Do you urinate after sexual intercourse?" d. "Do you experience burning with urination?"
ANS: A There is a strong association between family history and stone formation and recurrence. Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask whether other family members have also had renal stones. The other questions do not refer to renal calculi but instead are questions that should be asked of a client with a urinary tract infection.
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. Administer morphine sulfate 4 mg IV. b. Begin an infusion of metoclopramide (Reglan) 10 mg IV. c. Obtain a urine specimen for urinalysis. d. Start an infusion of 0.9% normal saline at 100 mL/hr.
ANS: A The intervention the nurse implements first for a client admitted with urolithiasis who reports "spasms of intense flank pain, nausea, and severe dizziness" is to administer morphine sulfate 4 mg IV. Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.An infusion of metoclopramide (Reglan) 10 mg IV would be begun after the client's pain is controlled. A urine specimen for urinalysis would be obtained and an infusion of 0.9% normal saline at 100 mL/hr would be started after the client's pain is controlled.
What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy?Select all that apply. a. "Your urine will be strained after the procedure." b. "Be sure to finish all of your antibiotics." c. "Immediately call the primary health care provider if you notice bruising." d. "Remember to drink at least 3 liters of fluid a day to promote urine flow." e. "You will need to change the incisional dressing once a day."
ANS: A, B, D The nurse tells the client scheduled for an extracorporeal shock wave, "Your urine will be strained after the procedure," "Be sure to finish all of your antibiotics," and "Remember to drink at least 3 liters of fluid a day to promote urine flow."After lithotripsy, urine is strained to monitor the passage of stone fragments. clients must finish the entire antibiotic prescription to decrease the risk of developing a urinary tract infection. Drinking at least 3 L of fluid a day dilutes potential stone-forming crystals, prevents dehydration, and promotes urine flow.Bruising on the flank of the affected side is expected after lithotripsy as a result of the shock waves that break the stone into small fragments. The client must notify the primary health care provider if he or she develops pain, fever, chills, or difficulty with urination because these signs and symptoms may signal the beginning of an infection or the formation of another stone. There is no incision with extracorporeal shock wave lithotripsy. There may be a small incision when intracorporeal lithotripsy is performed.
A nurse teaches a client with a history of calcium phosphate urinary stones. Which statements should the nurse include in this client's dietary teaching? (Select all that apply.) a. "Limit your intake of food high in animal protein." b. "Read food labels to help minimize your sodium intake." c. "Avoid spinach, black tea, and rhubarb." d. "Drink white wine or beer instead of red wine." e. "Reduce your intake of milk and other dairy products."
ANS: A, B, E Clients with calcium phosphate urinary stones should be taught to limit the intake of foods high in animal protein, sodium, and calcium. Clients with calcium oxalate stones should avoid spinach, black tea, and rhubarb. Clients with uric acid stones should avoid red wine.
A patient with renal calculi is hospitalized with gross hematuria and severe colicky left flank pain. Which nursing action will be of highest priority at this time? a. Encourage oral fluid intake. b. Administer prescribed analgesics. c. Monitor temperature every 4 hours. d. Give antiemetics as needed for nausea.
ANS: B Although all of the nursing actions may be used for patients with renal lithiasis, the patient's presentation indicates that management of pain is the highest priority action. If the patient has urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of infection or nausea.DIF: Cognitive Level: Application REF: 1137-1138 | 1139-1141 | 1140
A nurse assesses a male client who is recovering from a urologic procedure. Which assessment finding indicates an obstruction of urine flow? a. Severe pain b. Overflow incontinence c. Hypotension d. Blood-tinged urine
ANS: B The most common manifestation of urethral stricture after a urologic procedure is obstruction of urine flow. This rarely causes pain and has no impact on blood pressure. The client may experience overflow incontinence with the involuntary loss of urine when the bladder is distended. Blood in the urine is not a manifestation of the obstruction of urine flow.
A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client's right lower back. Which action should the nurse take? a. Administer fresh-frozen plasma .b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results.
ANS: B The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh-frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level of intervention. Changing the client's position will not decrease bleeding.
A patient has been diagnosed with urinary tract calculi that are high in uric acid. Which foods will the nurse teach the patient to avoid (select all that apply)? a. Milk b. Liver c. Spinach d. Chicken e. Cabbage f. Chocolate
ANS: B, D Meats contain purines, which are metabolized to uric acid. The other foods might be restricted in patients who have calcium or oxalate stones.
After a ureterolithotomy, a female patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care? a. Provide teaching about home care for both catheters. b. Apply continuous steady tension to the ureteral catheter. c. Call the health care provider if the ureteral catheter output drops suddenly. d. Clamp the ureteral catheter off when output from the urethral catheter stops.
ANS: C The health care provider should be notified if the ureteral catheter output decreases because obstruction of this catheter may result in an increase in pressure in the renal pelvis. Tension on the ureteral catheter should be avoided in order to prevent catheter displacement. To avoid pressure in the renal pelvis, the catheter is not clamped. Because the patient is not usually discharged with a ureteral catheter in place, patient teaching about both catheters is not needed.
The nurse teaches a 64-year-old woman to prevent the recurrence of renal calculi by: a. using a filter to strain all urine. b. avoiding dietary sources of calcium. c. choosing diuretic fluids such as coffee. d. drinking 2000 to 3000 mL of fluid a day.
ANS: D A fluid intake of 2000 to 3000 mL daily is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with renal calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones.
To prevent the recurrence of renal calculi, the nurse teaches the patient to: a. use a filter to strain all urine. b. avoid dietary sources of calcium. c. drink diuretic fluids such as coffee. d. have 2000 to 3000 mL of fluid a day.
ANS: D A fluid intake of 2000 to 3000 mL daily is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with renal calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones.
When the nurse is caring for a patient who has had left-sided extracorporeal shock wave lithotripsy, which assessment finding is most important to report to the health care provider? a. Blood in urine b. Left flank pain c. Left flank bruising d. Drop in urine output
ANS: D Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is important to report a drop in urine output. Left flank pain, bruising, and hematuria are common after lithotripsy. DIF: Cognitive Level: Application REF: 1138-1139
The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? a. "I am so relieved that I can continue eating my fried fish meals every week." b. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." c. "My wife will be happy to know that I can keep enjoying her liver and onions recipe." d. "I will no longer be able to have red wine with my dinner."
ANS: D Teaching about low purine diets to a client with urolithiasis consisting of uric acid is effective when the client says, "I will no longer be able to have red wine with my dinner." Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client needs to decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming.Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stones consist of calcium oxalate.
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 primary health care provider before the ESWL procedure begins? a. "Blood in my urine has become less noticeable, so 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."
ANS: D For a client admitted for ESWL, it is most critical for the nurse to report to the primary health care provider that the client takes over-the-counter naproxen twice a day for joint pain. Because a high risk for bleeding during ESWL has been noted, clients would not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.Blood in the client's urine would be reported to the primary health care provider but will not require rescheduling of the procedure because blood is frequently present in the client's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. The client's taking cephalexin (Keflex) and the fact that the client has had several previous ESWL procedures would be reported, but will not require rescheduling of the procedure.
A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan? 1. Increase daily fluid intake to at least 2 to 3 L. 2. Strain urine at home regularly. 3. Eliminate dairy products from the diet. 4. Follow measures to alkalinize the urine.
Answer 1
Because a client's renal stone was found to be composed of uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications? 1. Milk, apples, tomatoes, and corn. 2. Eggs, spinach, dried peas, and gravy. 3. Salmon, chicken, caviar, and asparagus. 4. Grapes, corn, cereals, and liver.
Answer 1 Because a high-purine diet contributes to the formation of uric acid, a low-purine diet is advocated. An alkaline-ash diet is also advocated because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Foods allowed on an alkaline-ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.
A client has been prescribed allopurinol (Zyloprim) for renal calculi that are caused by high uric acid levels. Which of the following indicate the client is experiencing adverse effect( s) of this drug? Select all that apply. 1. Nausea. 2. Rash. 3. Constipation. 4. Flushed skin. 5. Bone marrow depression.
Answer 1, 2, 5. Common adverse effects of allopurinol (Zyloprim) include gastrointestinal distress, such as anorexia, nausea, vomiting, and diarrhea. A rash is another potential adverse effect. A potentially life-threatening adverse effect is bone marrow depression. Constipation and flushed skin are not associated with this drug.
The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. 1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. 4. Insert a Foley catheter in client after having the client empty the bladder. 5. Post notices on the client's door to save all urine output.
Answer 1,2,3,5 ***1. The health-care provider may order certain foods and medications when obtaining 24- hour urine collection to evaluate for calcium oxalate or uric acid. ***2. When the collection begins, the client should completely empty the bladder and discard that urine. ***3. All urine for 24 hours should be saved and put in a container with preservative, refrig- erated, or put on ice as indicated. Not following specific instructions will result in an inaccurate test result. 4. The urine is obtained in some type of urine collection device such as a bedpan, bedside commode, or commode hat. The client is not catheterized. ***5. Posting signs will help ensure that all the urine is saved during the 24-hour period. If any urine is discarded, the test may result in inaccurate information or the need to start the test over.
In addition to nausea and severe flank pain, a female client with renal calculi has pain in the groin and bladder. The nurse should assess the client further for signs of: 1. Nephritis. 2. Referred pain. 3. Urine retention. 4. Additional stone formation
Answer 2 The pain associated with renal colic due to calculi is commonly referred to the groin and bladder in female clients and to the testicles in male clients. Nausea, vomiting, abdominal cramping, and diarrhea may also be present. Nephritis or urine retention is an unlikely cause of the referred pain. The type of pain described in this situation is unlikely to be caused by additional stone formation.
A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to: 1. Irrigate the catheter with 30 mL of normal saline every 8 hours. 2. Ensure that the catheter is draining freely. 3. Clamp the catheter every 2 hours for 30 minutes. 4. Ensure that the catheter drains at least 30 mL/ hour.
Answer 2 The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the physician. The catheter is never clamped. The client's total urine output (ureteral catheter plus voiding or indwelling urinary catheter output) should be 30 mL/ hour.
Which intervention is most important for the nurse to implement for the client diagnosed with rule out renal calculi? 1. Assess the client's neurological status every 2 hours.2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client's creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview.
Answer 2 ***2. Passing a renal stone may negate the need for the client to have lithotripsy or a surgi- cal procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone.
Which clinical manifestations would the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1. Dull, aching flank pain and microscopic hematuria. 2. Nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and dull suprapubic pain with voiding. 4. No symptoms.
Answer 2 1. Dull flank pain and microscopic hematuria are manifestations of a renal stone in the kidney. ***2. The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and suprapubic pain when voiding are manifestations of a stone in the bladder. 4. Kidney stones and bladder stones may produce no signs/symptoms, but a ureteral stone always causes pain on the affected side because a ureteral spasm occurs when the stone obstructs the ureter.
The client diagnosed with renal calculi is admitted to the medical unit. Which inter- vention should the nurse implement first? 1. Monitor the client's urinary output. 2. Assess the client's pain and rule out complications. 3. Increase the client's oral fluid intake. 4. Use a safety gait belt when walking the client.
Answer 2 1. The client's urinary output should be monitored, but it is not the first nursing intervention. ***2. Assessment is the first part of the nursing process and is always priority. The intensity of the renal colic pain can be so intense it can cause a vasovagal response, with result- ing hypotension and syncope. 3. Increased fluid increases urinary output, which will facilitate movement of the renal stone through the ureter and help decrease pain, but it is not the first intervention. 4. Ambulation will help facilitate movement ofthe renal stone through the ureter and safety is important, but it is not the first intervention.
The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1. Increase water intake for the next 24 hours. 2. Take two Tylenol to help decrease the temperature. 3. Come to the clinic and give a urinalysis specimen. 4. Use a sterile 4 4 gauze to strain the client's urine.
Answer 3 ***3. A urinalysis can assess for hematuria (red blood cells in the urine), the presence of white blood cells, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI.
The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which of the following measures would be most important for the nurse to include in pretest preparation? 1. Ensuring adequate fluid intake on the day of the test. 2. Preparing the client for the possibility of bladder spasms during the test. 3. Checking the client's history for allergy to iodine. 4. Determining when the client last had a bowel movement.
Answer 3 A client scheduled for an IVP should be assessed for allergies to iodine and shellfish. Clients with such allergies may be allergic to the IVP dye and be at risk for an anaphylactic reaction. Adequate fluid intake is important after the examination. Bladder spasms are not common during an IVP. Bowel preparation is important before an IVP to allow visualization of the ureters and bladder, but checking for allergies is most important.
The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? 1. Beer and colas. 2. Asparagus and cabbage. 3. Venison and sardines. 4. Cheese and eggs.
Answer 3 1. Beer and colas are foods high in oxalate, which can cause calcium oxalate stones. 2. Asparagus and cabbage are foods high in oxalate, which can cause calcium oxalate stones. ***3. Venison, sardines, goose, organ meats, and herrings are high purine foods, which should be eliminated from the diet to help prevent uric acid stones. 4. Cheese and eggs are foods that help acidify the urine and do not cause the development of uric acid stones.
The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1. Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2. Explain the importance of not drinking water two (2) hours before bedtime. 3. Discuss the importance of limiting vitamin D-enriched foods. 4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).
Answer 3 1. This would be appropriate for the client who has uric acid stones. 2. The nurse should recommend drinking one to two glasses of water at night to prevent concentration of urine during sleep. ***3. Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract. 4. This is a treatment for an existing renal stone, not a discharge teaching intervention for a client who has successfully passed a renal calculus.
The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? 1. Ask if the client is allergic to shell fish or iodine. 2. Keep the client NPO eight (8) hours prior to the ultrasound. 3. Ensure the client has a signed informed consent form. 4. Explain the test is noninvasive and there is no discomfort.
Answer 4 ***4. No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied that produces sound waves that produce a picture.
The nurse is reviewing laboratory reports for a client who is taking allopurinol (Zyloprim). Which of the following indicate that the drug has had a therapeutic effect? 1. Decreased urine alkaline phosphatase level. 2. Increased urine calcium excretion. 3. Increased serum calcium level. 4. Decreased serum uric acid level.
Answer 4. By inhibiting uric acid synthesis, allopurinol (Zyloprim) decreases its excretion. The drug's effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, nor does it affect urine calcium excretion or the serum calcium level.
A nurse cares for a client who has kidney stones from secondary hyperoxaluria. Which medication should the nurse anticipate administering? a. Phenazopyridine (Pyridium) b. Propantheline (Pro-Banthine) c. Tolterodine (Detrol LA) d. Allopurinol (Zyloprim)
Answer D Stones caused by secondary hyperoxaluria respond to allopurinol (Zyloprim). Phenazopyridine is given to clients with urinary tract infections. Propantheline is an anticholinergic. Tolterodine is an anticholinergic with smooth muscle relaxant properties.