Renal
A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure? "You might have pink-tinged urine and burning after your cystoscopy." Correct "You'll need to refrain from eating or drinking after midnight the day before the test." "The morning of the test, you will drink some water that contains a contrast solution." "You'll require a urinary catheter inserted before the cystoscopy, and it will be in place for a few days."
Pink-tinged urine, burning, and frequency are common after a cystoscopy. The patient does not need to be NPO before the test, and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.
When a patient reports acute, severe, renal colic pain in the lower abdomen, the nurse suspects that the patient is most likely to have an obstruction at which area? Kidney Urethra Bladder Ureterovesical junction Correct
The ureterovesical junction is the narrowest part of the urethra and easily obstructed by urinary calculi. With a stone in the kidney or at the ureteropelvic junction, the pain may be dull costovertebral flank pain. Stones in the bladder do not cause obstruction or symptoms unless they are staghorn stones. The urethra seldom has obstruction related to stones.
The nurse prepares a patient for discharge after a cystoscopy. It is most important for the nurse to provide additional information in response to which patient statement? "I should drink plenty of fluids to prevent complications." "If my urine is cloudy, I should contact my health care provider." "Bright red bleeding is normal for a few days after the procedure." Correct "Sitz baths and acetaminophen will help to reduce my discomfort." Incorrect
Bright red bleeding after a cystoscopy is not normal and should be reported immediately. Other complications include urinary retention, bladder infection, and perforation of the bladder. Patients should drink plenty of fluids and expect burning on urination, pink-tinged urine, and urinary frequency. Warm sitz baths, heat, and mild analgesics may be used to relieve discomfort.
The nurse is caring for a 73-yr-old male patient with a history of benign prostatic hyperplasia and symptoms of a urinary tract infection. Which diagnostic finding would support this diagnosis? White blood cell count is 7500 cells/µL. Antistreptolysin-O (ASO) titer is 106 Todd units/mL. Glucose, protein, and ketones are present in the urine. Nitrites and leukocyte esterase are present in the urine. Correct
A diagnosis of urinary tract infection is suspected if there are nitrites (indicating bacteriuria), white blood cells (WBCs), and leukocyte esterase (an enzyme present in WBCs indicating pyuria). The presence of glucose and ketones indicate uncontrolled diabetes mellitus. An elevated WBC count (>11,000 cells/µL) indicates a bacterial infection. AASO titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria.
The nurse is preparing a patient for an intravenous pyelogram (IVP). What is a priority action by the nurse? a. Administer a cathartic or enema. Correct b. Assess patient for allergies to penicillin. Incorrect c. Keep the patient NPO for 4 hours preprocedure. d. Advise the patient that a metallic taste may occur during procedure.
A: Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity; keep the patient NPO for 8 hours before the procedure; and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.
The nurse is caring for a patient after a right kidney biopsy. Which position would be the most appropriate for this patient immediately after the procedure? Right lateral side-lying position Correct Reverse Trendelenburg position Supine with lower extremities elevated Incorrect High Fowler's position with arms supported
After a renal biopsy, a pressure dressing should be applied. The patient should be kept on the affected side for 30 to 60 minutes to apply additional pressure from the patient's own body weight and then on bed rest for 24 hours. High Fowler's position with arms supported is a position for a patient in respiratory distress. Reverse Trendelenburg position is used to maintain circulation to the legs in peripheral artery insufficiency. Supine with legs elevated puts excessive pressure on the diaphragm and should generally be avoided.
A nurse is caring for a patient with a history of chronic obstructive pulmonary disease (COPD) admitted for pneumonia. What laboratory finding would be consistent with decreased kidney function in this patient? Serum uric acid of 5.2 mg/dL Urine specific gravity of 1.040 Serum creatinine 2.3 of mg/dL Correct Blood urea nitrogen (BUN) of 10 mg/dL
An expected assessment finding related to decreased kidney function in the aging process is an increased serum creatinine. Other expected assessments include an elevated BUN and inability to concentrate urine (with urine specific gravity fixed at 1.010). Uric acid is used as a screening test for disorders of purine metabolism or kidney disease; values depend on renal function, rate of purine metabolism, and dietary intake of food rich in purines. Normal reference intervals: serum creatinine, 0.6 to 1.3 mg/dL; BUN, 6 to 20 mg/dL; urine specific gravity, 1.003 to 1.030; and serum uric acid, 2.3 to 6.6 mg/dL (female) or 4.4 to 7.6 mg/dL (male).
The nurse is performing an assessment for a patient and preparing to palpate the kidneys. How should the nurse position the patient for this assessment? a. Prone b. Supine c. Seated at the edge of the bed Incorrect d. Standing, facing away from the nurse
B: To palpate the right kidney, the patient is positioned supine, and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it.
An older male patient visits his primary care provider because of burning on urination and production of foul-smelling urine. What contributing factor should the health care provider consider? High-purine diet Incorrect Sedentary lifestyle Benign prostatic hyperplasia (BPH) Correct Recent use of broad-spectrum antibiotics
BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, but a diet high in purines is associated with renal calculi.
The nurse is caring for an older adult patient taking bumetanide. What age-related changes does the nurse inform the patient that may be experienced? Benign enlargement of prostatic tissues Decreased sensation of bladder capacity Incorrect Decreased function of the loop of Henle Correct Less absorption in the Bowman's capsule
Bumetanide (Bumex) is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus, the circulating levels of drugs are increased and their effects prolonged. The benign enlargement of prostatic tissue, decreased sensation of bladder capacity, and loss of concentrating ability do not directly affect the action of loop diuretics.
In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which physiologic processes are performed by the kidneys (select all that apply.)? Production of renin Correct Activation of vitamin D Correct Carbohydrate metabolism Erythropoietin production Correct Hemolysis of old red blood cells (RBCs)
In addition to urine formation, the kidneys release renin to maintain blood pressure, activate vitamin D to maintain calcium levels, and produce erythropoietin to stimulate RBC production. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are performed by the kidneys.
The nurse obtained a urine specimen from a patient. What result should the nurse recognize as an abnormal finding? pH of 6.0 Amber yellow color Specific gravity of 1.025 White blood cells (WBCs) 9/hpf Correct
Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average; amber yellow is normal coloration, and the reference range for specific gravity is 1.003 to 1.030.
Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? Help the patient cope with the rapid progression of the disease. Incorrect Suggest genetic counseling resources for the children of the patient. Correct Expect the patient to have polyuria and poor concentration ability of the kidneys. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.
PKD is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.
A patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should the nurse document this abnormal assessment finding? Anuria Dysuria Correct Oliguria Enuresis
Painful and difficult urination is characterized as dysuria. Whereas anuria is an absence of urine production, oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.
The nurse provides nutritional counseling for a 45-yr-old man with nephrotic syndrome. The nurse determines teaching has been successful if the patient selects which breakfast menu? Scrambled eggs, milk, yogurt, and sliced ham Incorrect Oatmeal, nondairy creamer, banana, and orange juice Correct Cottage cheese, peanut butter, white bread, and coffee Waffle, bacon strips, tomato juice, and canned peaches
Patients with nephrotic syndrome should follow a low-sodium (2-3 g/day), low- to moderate-protein (0.5-0.6 g/kg/day) diet. Ham, milk products, peanut butter, and bacon are high in sodium. Eggs, milk products, and peanut butter are high in protein.
The nurse is providing care for a patient admitted to the hospital for treatment of nephrotic syndrome. What are the priority nursing assessments? Assessment of pain and level of consciousness Assessment of serum calcium and phosphorus levels Blood pressure and assessment for orthostatic hypotension Daily weights and measurement of the patient's abdominal girth Correct
Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the diagnosis of nephrotic syndrome.
A 21-yr-old female patient came to the clinic for instruction to prevent recurrence of urinary tract infections. Which patient statement indicates that teaching was effective? "I will urinate before and after having intercourse." Correct "I will use vinegar as a vaginal douche every week." "I should drink three 8-oz glasses of water daily." "I can stop the antibiotics when symptoms disappear."
The woman should empty her bladder before and after sexual intercourse. She should avoid vaginal douches and maintain adequate oral fluid intake (15 mL per pound of body weight). All of the antibiotics should be taken as prescribed even if symptoms are no longer present.
A nurse is admitting a patient with advanced renal carcinoma. Which clinical manifestations represent the "classic triad" observed in patients with renal cancer? Fever, chills, and flank pain Hematuria, flank pain, and palpable mass Correct Hematuria, proteinuria, and palpable mass Flank pain, palpable abdominal mass, and proteinuria Incorrect
There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.
The nurse is caring for a 62-yr-old woman taking tolterodine (Detrol) to treat urinary urgency and incontinence. Which instruction should be included in the discharge plan? "Stop smoking for 2 to 3 weeks before starting to take this medication." "Suck on sugarless candy or chew sugarless gum if you develop a dry mouth." Correct "Have your vision checked every 6 months because this drug can cause cataracts." "Ask your physician to prescribe an extended-release form if you have loose stools."
Dry mouth is a common side effect of tolterodine. Patients can suck on hard candy or ice chips or chew gum if dry mouth occurs. Tobacco use does not affect the initiation of this medication. Visual changes (but not cataracts) can occur while taking this medication. Constipation may occur as a side effect of this medication.
A patient was admitted 2 weeks ago after multiple traumatic injuries in a motor vehicle collision. The patient now has a serum creatinine at 3.9 mg/dL and blood urea nitrogen (BUN) of 100 mg/dL. Which medication, if ordered by the health care provider, should the nurse question? Gentamicin Correct Nitrofurantoin Acetaminophen Morphine sulfate Incorrect
Elevated serum creatinine and BUN indicate renal insufficiency or acute kidney injury. Medications (e.g., prescribed, over-the-counter, and herbs) should be evaluated for nephrotoxic potential. Many drugs are known to be nephrotoxic (see Table 44-3); gentamicin is a potential nephrotoxic agent.
The nurse counsels a 64-yr-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the patient avoid? Venison, crab, and liver Correct Spinach, cabbage, and tea Incorrect Milk, yogurt, and dried fruit Asparagus, lentils, and chocolate
Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to prevent oxalate calculi formation (see Table 45-12).
A patient in the intensive care unit is receiving gentamicin for treatment of pneumonia from Pseudomonas aeruginosa. What assessment results should the nurse report to the health care provider? Decreased weight Increased appetite Increased urinary output Elevated creatinine level Correct
Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the physician because it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have side effects of anorexia
A patient underwent a surgical procedure has a urinary catheter. Eight hours after catheter removal and drinking fluids, the patient has not been able to void. What is the nurse's first action to assess for urinary retention? Bladder scan Correct Cystometrogram Residual urine test Kidneys, ureters, bladder (KUB) x-ray
If the patient is unable to void, the bladder may be palpated for distention or percussed for dullness if it is full, or a bladder scan may be done to determine the approximate amount of urine in the bladder. A cystometrogram visualizes the bladder and evaluates vesicoureteral reflux. A KUB x-ray delineates size, shape, and positions of kidneys and possibly a full bladder. Neither of these would be useful in this situation. A residual urine test requires urination before catheterizing the patient to determine the amount of urine left in the bladder, so this assessment would not be helpful for this patient.
A patient with suspected renal insufficiency is scheduled for a creatinine clearance diagnostic test. Which instructions would be appropriate for the nurse to provide to the patient? "Empty your bladder and discard the urine; then save all urine for 24 hours." Correct "Your blood creatinine level will be tested after you eat a high-protein meal." "This test should not be performed if you have allergies to iodine or shellfish." "A sterile container must be used to store the urine during the collection period. Incorrect
The patient should discard the first urination when this test is started. Urine should be saved from all subsequent urinations for 24 hours. Creatinine clearance testing does not involve the injection of contrast dye. A serum creatinine is determined during the 24-hour period and used in the calculation to determine creatinine clearance. Consumption of a high-protein meal is not indicated. Sterile containers would be indicated if cultures are performed to determine the presence of microorganisms.
A patient informs the nurse that they are having burning on urination, dysuria, and frequency. What is the best response by the nurse? "Drink less fluid so you don't have to void so often." "Take some acetaminophen to decrease the discomfort." "Come in so we can check a clean-catch urine specimen." Correct "Avoid caffeine and spicy food to decrease inflammation."
The patient's symptoms are typical of a urinary tract infection. To verify this, a clean-catch urine specimen must be obtained for a specimen of urine to culture. Drinking less fluid will not improve the symptoms. Acetaminophen would not decrease the discomfort; an antibiotic would be needed. Avoiding caffeine and spicy food may decrease bladder inflammation but will not affect these symptoms.