Renal

The nurse is caring for a patient who has undergone a cystoscopy. Which patient statement should be immediately reported to the primary health care provider? 1 - "My urine is bright red in color." 2 - "I feel the need to urinate frequently." 3 - "I have a burning sensation when urinating." 4 - "I'm passing a large amount of urine every time"

*1. "My urine is bright red in color."* A cystoscopy involves visualizing the interior of the bladder with a tubular lighted scope. The procedure may cause the urine to become pink in color due to procedure-related trauma, which is self-limiting and normal. However, a bright red color to the urine indicates major trauma and needs to be reported immediately. Increased frequency of urination, a burning sensation during urination, and passing large volumes of urine are normal symptoms after a cystoscopy.

A diabetic patient is waiting in the preoperative holding area for a hernia operation. The patient asks the nurse if the daily insulin dose should be taken. Which response is the most appropriate? 1: "I will check with the surgeon and let you know." 2: "Take half of the dose of insulin, since you are fasting." 3: "Replace the insulin with an oral drug." 4: "Avoid taking insulin as it may cause hypoglycemia."

1 - "I will check with the surgeon and let you know." If a diabetic patient on insulin is due for surgery, it is important to get clear instructions from the surgeon regarding the insulin administration. The surgeon may choose to avoid the dose or give an adjusted dose based on the blood sugar levels. The nurse should not suggest taking a reduced dose as it may cause a fluctuation in blood sugar levels. The insulin should not be replaced with oral drugs, unless advised by the surgeon. The insulin dose may be skipped if the surgeon advises that.

A nurse is giving dietary advice to a patient who is on continuous ambulatory peritoneal dialysis for chronic renal failure. Which dietary instructions are appropriate for this patient? Select all that apply. 1 : High-calorie foods 2 : High-protein foods 3 : High-potassium content 4 : High-phosphorus content 5 : High-fluid intake

1,2, A chronic renal failure patient on continuous ambulatory peritoneal dialysis is encouraged to have a high-calorie diet to meet the increased demands of the body. A good amount of protein should be consumed to replace that lost during dialysis. Foods containing high amounts of potassium and phosphorus should be avoided in patients with chronic renal failure. High potassium can cause hyperkalemia and related complications, especially cardiac complications. High phosphorus may deteriorate bone health. Usually there is a modest restriction of fluids when the patient is on dialysis.

When teaching a patient about techniques to manage urinary incontinence, which instructions should the nurse include as important? Select all that apply. 1 : Practice timed voiding. 2 : Drink a cup of coffee. 3 : Perform pelvic floor muscle training. 4 : Perform intermittent catheterization. 5 : Use incontinence protective pads.

1,3,5 Practicing timed voiding, ideally every 2-3 hours during waking hours, can help in emptying the bladder, thereby reducing the chances of incontinence. Pelvic floor muscle training is important to strengthen the pelvic floor muscles that control the relaxation of the urinary sphincters, and improved muscle control can reduce the complaints of incontinence. Incontinence protective pads are urine-containing assistive devices that can help in cases of mild to moderate urine incontinence. Coffee is a bladder irritant and will increase the urge to urinate, thus increasing the likelihood of incontinence. Intermittent catheterization is advised in cases of urinary retention, not in urinary incontinence.

The nurse is attending to a patient who is undergoing peritoneal dialysis. The dialysate solution is being infused to the patient. The nurse finds that the patient is developing symptoms of respiratory distress. What nursing interventions are necessary to prevent further respiratory complications? Select all that apply. 1 : Auscultate the lungs. 2 : Frequently reposition the patient. 3 : Promote deep-breathing exercises. 4 : Increase the rate of infusion of the dialysate. 5 : Place the patient in a low Fowler's position.

1,2,3 Auscultation is very important to find the cause of respiratory distress. Decreased areas of ventilation suggest the presence of atelectasis, whereas adventitious sounds may suggest fluid overload, retained secretions, or infection. Frequent positioning will promote equal ventilation to all parts of the lungs. Deep-breathing exercises could help to promote proper expansion of lungs. Rapid infusion would cause more pressure on the diaphragm. The patient should be placed in the semi-Fowler's position for peritoneal dialysis; this allows inflow of fluid while not impinging on the thoracic cavity.

A patient with end-stage kidney disease is to begin continuous ambulatory peritoneal dialysis (CAPD). What are the preparations to be done by the nurse before starting the catheter insertion for this patient? Select all that apply. 1 : Ask patient to empty the bladder and bowel. 2 : Note the patient's weight. 3 : Obtain a signed consent form. 4 : Monitor for abnormal cardiac signs and symptoms. 5 : Monitor for abnormal respiratory signs and symptoms.

1,2,3 Preparation of the patient for catheter insertion includes emptying the bladder and bowel, weighing the patient, and obtaining a signed consent form. The bladder should be emptied to prevent accidental puncture of the bladder by the needle. Weighing the patient before and after the procedure is important to determine the effectiveness of dialysis. Because it is an invasive procedure, the nurse should explain about the risks and benefits, and informed consent should be obtained. Other factors are not contraindications for CAPD. Monitoring of cardiac and respiratory signs is essential but does not directly affect the procedure.

When managing a female patient with active symptoms of urethritis, what actions should the nurse perform? Select all that apply. 1 : Provide a warm sitz bath. 2 : Obtain a urine sample for culture. 3 : Teach the patient to cleanse the perineal area. 4 : Suggest that the patient use a vaginal deodorant. 5 : Inform the patient that sexual intercourse can be continued

1,2,3 The nurse should provide a warm sitz bath , as it can help to temporarily relieve bothersome symptoms of urethritis. A urine sample should be collected and cultured to detect the causative organism of urethritis so that specific treatment can be planned. Teach patient to cleanse the perineal area by wiping from front to back to reduce the risk of infection from the anus. The patient should be instructed not to use vaginal deodorants, as these can further irritate the genital area. The nurse should inform the patient to avoid sexual intercourse until the symptoms subside.

Nurses have a major role in prevention of urinary tract infections (UTIs). Which guidelines can help prevent hospital-acquired UTIs? Select all that apply. 1 : Avoid unnecessary catheritization 2 : Wash hands before and after contact with each patient 3 : Routine and thorough perineal hygiene for all hospitalized patients 4 : Wash around catheter insertion site with betadine daily. 5 : Intermittent catheterization every four hours

1,2,3 The patient should not be catheterized unless absolutely necessary. Hand hygiene is the number one prevention method in spreading infection in the hospital setting. Routine perineal care daily with soap and water is evidenced-based practice to prevent UTI. Betadine should not be applied to the catheter insertion site daily. Intermittent catheterization places the patient at high risk for hospital-acquired UTIs.

A patient has undergone a lithotripsy procedure. When preparing this patient for the postoperative period, what does the nurse inform this patient to expect after the procedure? Select all that apply. 1 : Hematuria can be observed. 2 : A ureteral stent will be placed. 3 : There will be no pain. 4 : The ureteral stent is removed within 2 weeks. 5 : An open surgical procedure will be performed

1,2,4 Hematuria is common after lithotripsy procedures and during the initial postoperative period. In addition, the urine may appear bright red (hematuria). A ureteral stent will be placed after the procedure to facilitate passage of shattered stone particles and prevent sand buildup within the ureter, which might lead to obstruction. The ureteral stent is removed within 2 weeks, after the stone particles have possibly passed out. The patient may complain of moderate to severe colicky pain during the postoperative period. Surgery may be required only if a stone is large or positioned in the mid or distal ureter. Surgery may also be considered for patients with complications like pain, infection, and obstruction.

The nurse is assessing the risk factors for urinary tract calculi in a group of patients. What are the factors that the nurse knows contribute to the development of urinary tract calculi? Select all that apply. 1 : Low fluid intake 2 : Diet low in calcium 3 : Sedentary occupation 4 : Excessive intake of tea 5 : Adequate intake of dietary proteins

1,3,4 Low fluid intake increases urinary concentration and the chances of urinary tract calculi. A sedentary occupation can cause delayed urination and increased urinary stasis, which can lead to calculi. Excessive intake of tea can elevate urinary oxalate levels, which can cause oxalate renal stones. A diet low in calcium does not increase the risk of urinary calculi; instead, a high-calcium intake with lower fluid intake can predispose a woman to stone formation. Adequate intake of dietary proteins is recommended, but a large intake of dietary proteins can increase uric acid excretion and increases the risk of forming renal calculi.

When teaching a female patient about measures to prevent recurrent urinary tract infection (UTI), what instructions should the nurse include? Select all that apply. 1 : Wipe from front to back after urinating. 2 : Urinate every 6 hours. 3 : Empty the bladder before and after sexual intercourse. 4 : Use vaginal douches or sprays to clean the perineal area. 5 : Cleanse with warm soapy water after each bowel movement.

1,3,5 The nurse should instruct the patient to wipe from front to back after urinating to avoid contamination by other structures, as this can increase the risk of UTIs. Emptying the bladder before and after sexual intercourse will help to keep the perineum clean and reduce the risk of UTIs. Cleansing the perineum with warm soapy water after each bowel movement to clean the anal region will reduce the risk of UTIs. Regular urination may prevent bacteria from growing; therefore, the patient should be encouraged to void every 2-3 hours. Vaginal douches or sprays to clean the perineal area should be avoided, as these contain harsh chemicals and substances that can cause irritation and can increase the risk of urinary infection.

The nurse is assessing a patient with a diagnosis of upper urinary tract infection (UTI). Which symptoms should the nurse expect to find? Select all that apply. 1 : Fever 2 : Clear, yellow urine 3 : Chills 4 : Afebrile 5 : Flank pain

1,3,5 Upper UTI symptoms present with fever, chills, and flank pain. The patient will not be afebrile, and urine will likely be cloudy, not clear and yellow.

The nurse identifies that which bowel preparations are appropriate for a patient with kidney failure? Select all that apply. 1 : Castor oil 2 : Fleet enema 3 : Milk of Magnesia 4 : Magnesium citrate 5 : Bisacodyl (Dulcolax)

1,5 Castor oil and bisacodyl (Dulcolax) are the bowel preparations suitable for a patient with kidney failure since these preparations can easily be eliminated by the patient. Fleet enema, Milk of Magnesia, and magnesium citrate are not suitable bowel preparations for this patient because they contain magnesium that cannot be eliminated by a patient with kidney failure

Normal level for blood urea nitrogen (BUN)

15.3 to 76.3 mcmol/L

Normal level for serum creatinine

15.3 to 76.3 mcmol/L

A nurse should instruct a patient with nephrotic syndrome in which type of diet? 1: Low in fat 2: Low in protein 3: High in protein 4: High in carbohydrates

3: High in protein Most patients with nephrotic syndrome are advised to consume a high-protein diet to replace protein lost through the kidneys and to correct hypoalbuminemia. The dietary instructions in the other answer options are not specific recommendations related to nephrotic syndrome.

The patient is admitted with hypertension and severe headache. In performing the initial physical assessment, the nurse assesses for renal artery stenosis (narrowing of the renal artery) by 1: Auscultating for a bruit 2: Palpating the left kidney anteriorly 3: Using percussion to detect signs of tenderness 4: Palpating the empty bladder

1: Auscultating for a bruit Auscultate the abdominal aorta and renal arteries for a bruit (an abnormal murmur), which indicates impaired blood flow to the kidneys. The kidneys are posterior organs protected by the abdominal organs, the ribs, and the heavy back muscles. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it. Occasionally, the lower pole of the right kidney is palpable. Tenderness in the flank area may be detected by fist percussion (kidney punch). If costovertebral angle (CVA) tenderness and pain are present, it may indicate a kidney infection or polycystic kidney disease. A bladder is not normally percussible until it contains 150 mL of urine. If the bladder is full, dullness is heard above the symphysis pubis.

The patient with type 2 diabetes has a second urinary tract infection (UTI) within one month of being treated for a previous UTI. Which medication should the nurse expect to teach the patient about taking for this infection? 1: Ciprofloxacin (Cipro) 2: Fosfomycin (Monurol) 3: Nitrofurantoin (Macrodantin) 4: Trimethoprim/sulfamethoxazole (Bactrim)

1: Ciprofloxacin This UTI is a complicated UTI because the patient has type 2 diabetes and the UTI is recurrent. Ciprofloxacin would be used for a complicated UTI. Fosfomycin, nitrofurantoin, and trimethoprim/sulfamethoxazole should be used for uncomplicated UTIs.

What advice should the nurse give to the patient collecting a urine sample for urinalysis? 1: Collect the first urine sample in the morning. 2: Collect the urine sample at any time during the day. 3: Collect the urine overnight. 4: Take the sample collected 1 hour after voiding a first sample.

1: Collect the first urine sample in the morning Although a specimen may be collected at any time of the day for a routine urinalysis, it is best to obtain the first specimen urinated in the morning. This concentrated specimen is more likely to contain abnormal constituents if they are present in the urine. The specimen should be examined within 1 hour of urinating. It is not necessary to collect the urine overnight.

Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which measure should the nurse first recommend in an attempt to resolve the woman's incontinence? 1: Kegel exercises 2: Use of adult incontinence pads 3: Intermittent self-catheterization 4: Dietary changes including fluid restriction

1: Kegel exercises Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.

A patient is scheduled to undergo peritoneal dialysis. What is the highest-priority action that the nurse should perform before starting dialysis? 1: Obtain the patient's weight 2: Administer pain medication to the patient 3: Place the patient in a high Fowler's position 4: Place the patient in the Trendelenburg position

1: Obtain the patient's weight The nurse must check the patient's weight before and after peritoneal dialysis (PD) to determine how much fluid has been removed. The patient should assume a position of comfort, such as a low Fowler's, unless there is difficulty with removing the effluent, in which case the nurse will position the patient to facilitate drainage. Administering pain medication is not a priority in regard to PD. There is no indication that the patient is experiencing pain. Placing the patient in a high Fowler's or Trendelenburg position is not recommended for patients during PD.

The nurse caring for a patient with heart failure notes the patient has decreased urine output of 200 mL/day. Which laboratory finding aids in the diagnosis of prerenal azotemia in this patient? 1: Elevated blood urea nitrogen (BUN) 2: Normal creatinine level 3: Decreased sodium level 4: Decreased potassium level

1: elevated BUN The patient with heart failure has a decreased circulating blood volume. This causes autoregulatory mechanisms to preserve blood flow to essential organs. Laboratory data for this patient will likely demonstrate an elevation in BUN, creatinine, and potassium. Prerenal azotemia results in a reduction in the excretion of sodium, increased sodium and water retention, and decreased urine output.

When obtaining a health history for the patient with chronic kidney disease, the nurse notes the following medications on the patient's medication list. The patient will need further education on which medication? 1: Ibuprofen 2: Tylenol 3: Calcium supplements 4: PhosLo

1: ibuprofen Ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDS), will cause further damage to the kidneys. Chronic kidney disease (CKD) patients should be taking Tylenol as prescribed for pain. CKD patients also could be consuming calcium supplements and PhosLo tablets as prescribed by the health care provider

What instructions should the nurse give to a patient who is about to have a renal computed tomography (CT) scan? Select all that apply. 1 : Fast overnight before the scan. 2 : No dietary restrictions are required. 3 : Rest for 6 hours before the test. 4 : No activity restrictions are required. 5 : No pain or discomfort will be felt during the test

2,4,5 When preparing the patient for a renal CT scan, the nurse should inform the patient that no dietary or activity restrictions are required. Also, no pain or discomfort should be felt during the test. The test does not require the patient to fast before the test or to restrict activities and rest.

A patient with increased edema, blurred vision, pruritus, and headache experiences an increase in body weight and blood pressure. The nurse anticipates that which body system will be tested further? 1: Urinary system 2: Immune system 3: Nervous system 4: Gastrointestinal system

1: urinary Edema, blurred vision, and pruritus are the specific manifestations observed in a patient with urinary system disorder. Headaches, along with an increase in body weight and blood pressure, are the general manifestations of a patient with urinary system disorder. Autoimmune disorders may cause fever, fatigue, and malaise in a patient. Gastrointestinal disorders may cause bloating, constipation, heartburn, and ingestion in a patient. Nervous system disorders may affect motor function or cause symptoms of mental illness in a patient.

A patient from a long-term care facility is admitted to the medical unit with pyelonephritis. What is a common cause of pyelonephritis for patients residing in long-term care facilities? 1: Urinary tract catheterization 2: Fever 3: Gram-positive bacilli 4: Gram-negative bacilli

1: urinary tract catheterization For residents of long-term care facilities, urinary tract catheterization is a common cause of pyelonephritis. Fever is a symptom of pyelonephritis, but does not cause it. Gram-negative bacilli causes urinary tract infections, not pyelonephritis. Urethral trauma from childbearing can cause urethral diverticula, not pyelonephritis.

A nurse is teaching a patient about measures to prevent the recurrence of urinary tract infections (UTIs). What instructions should the nurse include? Select all that apply. 1 : Drink lemon juice daily. 2 : Maintain an adequate daily fluid intake. 3 : Urinate regularly, approximately every 3-4 hours during the day. 4 : Wipe from back to front after having a bowel movement or urinating. 5 : Cleanse the perineal area with warm soapy water after each bowel movement

2,3,5 It is necessary to maintain an adequate fluid intake and to urinate regularly. Delaying urination when there is urge to urinate increases the chances of bacterial infection. Cleansing the perineal area with warm soapy water after a bowel movement reduces the risk of infection. It is important to wipe from front to back to avoid the risk of getting fecal matter near the urethra. Acidic foods and drinks like lemon juice, orange juice, and tomatoes irritate the bladder and should be avoided.

Normal serum calcium levels

2.25 to 2.75 mmol/L

Which patient is most likely to develop chronic kidney disease (CKD) and should be taught preventive measures by the nurse? 1: A 50-year-old white female with hypertension 2: A 61-year-old Aboriginal male with diabetes 3: A 40-year-old Hispanic-Canadian female with cardiovascular disease 4: A 28-year-old Asian-Canadian female with a urinary tract infection

2: A 61-year-old Aboriginal male with diabetes It is especially important that the nurse should teach CKD prevention to the 61-year-old Aboriginal Canadian with diabetes. This patient is at highest risk because diabetes causes about 50% of CKD. This patient is the oldest and Aboriginal Canadian with diabetes develop CKD more frequently than other ethnic groups. Hypertension causes about 25% of CKD. A urinary tract infection (UTI) will not cause CKD unless it is not treated or occurs recurrently.

Two important functions of the distal convoluted tubules are final regulation of water balance and acid-base balance. What is required for water reabsorption in the kidney and is important in water balance? 1: Chloride ions 2: Antidiuretic hormone (ADH) 3: Sodium ions 4: Aldosterone

2: ADH Two important functions of the distal convoluted tubules are final regulation of water balance and acid-base balance. ADH is required for water reabsorption in the kidney and is important in water balance. ADH makes the distal convoluted tubules and the collecting ducts permeable to water. This allows water to be reabsorbed into the peritubular capillaries and eventually returned to the circulation. Chloride and sodium ions are reabsorbed, but do not allow reabsorption. Aldosterone causes reabsorption of sodium ions and water.

A patient has been catheterized with an indwelling urinary catheter. What nursing action should the nurse perform for catheter care? 1: Change the catheter routinely. 2: Anchor the catheter using a securement device. 3: Remove the catheter to obtain a urine sample. 4: Apply powder around the perineal area to keep the area dry.

2: Anchor the catheter Catheters should be anchored to the upper thigh in women and to the lower abdomen in men to prevent catheter movement and urethral tension. Catheters should not be changed routinely. The patient should be monitored for indications of obstruction or complications before changing the catheter. The catheter should not be removed to collect a urine sample. Instead, small volumes of urine should be aspirated from the urinary port by means of a sterile syringe and a needle when needed. Perineal care should be provided by cleaning the meatus-catheter junction with soap and water. Use of lotions or powder near the catheter may lead to infection.

A patient is brought to the emergency department with penetrating renal trauma due to a motor vehicle accident. What should be the immediate nursing action? 1: Monitor intake and output of fluid. 2: Assess the cardiovascular system and monitor for signs of shock. 3: Provide pain relief and comfort measures. 4: Assess for hematuria and myoglobinuria

2: Assess the cardiovascular system Because the patient may have suffered significant blood loss following this accident, assessment of the cardiovascular system and monitoring the patient for signs of shock are the most urgent actions that the nurse should perform. Other interventions can be performed once the patient is stable.

A patient who is prone to urinary tract infections asks the nurse about herbal preparations that may prevent UTIs. What at-home remedy should the nurse suggest to this patient? 1: Aloe 2: Cranberry 3: Garlic 4: Ginger

2: Cranberry Cranberry has been found to be useful in preventing urinary tract infection. Aloe is used to prevent constipation. Garlic may decrease cholesterol and low-density proteins. Ginger is used in management of nausea and vomiting during pregnancy.

A patient with bladder cancer is scheduled for surgery to create an ileal conduit. How should the nurse explain the ileal conduit? 1: It is a temporary procedure that can be reversed later. 2: It conveys urine from the ureters to a stoma opening on the abdomen. 3: It diverts urine into the sigmoid colon, where it is expelled through the rectum. 4: It provides a bladder opening that allows urine to drain into an external pouch

2: It conveys urine from the ureters to a stoma opening on the abdomen. An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected with one end of the segment closed. The ureters are surgically attached to the segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form a stoma. The patient must wear a pouch to collect the urine that continuously flows through the conduit. An ileal conduit is a permanent urinary diversion procedure. An ileal conduit does not divert urine into the sigmoid colon or create an opening in the bladder allowing urine to drain into an external pouch.

The patient has undergone renal biopsy. After the procedure the nurse should 1: Apply pressure dressing and lay the patient on the unaffected side 2: Obtain serial urine specimens and assess the patient's hematocrit 3: Restart patient's aspirin as soon as possible 4: Ambulate the patient after 60 minutes

2: Obtain specimens After procedure: Apply pressure dressing and keep patient on affected side for 30 to 60 minutes. Bed rest for 24 hours. Vital signs every 5 to 10 minutes the first hour. Assess for flank pain, hypotension, decreasing hematocrit, elevated temperature, chills, urinary frequency, dysuria, and serial urine specimens (gross or microscopic hematuria). Urine dipstick can be used to test for bleeding in urine. Inspect biopsy site for bleeding. Instruct patient to avoid lifting heavy objects for five to seven days and to not take anticoagulant drugs until allowed by the health care provider.

The nurse reviews the laboratory results of a patient with renal failure. Which findings correspond with the patient's diagnosis? 1: Phosphorus 0.96 mmol/L; Potassium 4.2 mmol/L 2: Phosphorus 1.94 mmol/L; Potassium 6.2 mmol/L 3: Phosphorus 0.90 mmol/L; Potassium 3.9 mmol/L 4: Phosphorus 1.16 mmol/L; Potassium 4.5 mmol/L

2: Phosphorus 1.94 mmol/L; Potassium 6.2 mmol/L In a normal patient, phosphorus levels are between 0.97-1.45 mmol/L, and potassium levels are between 3.5 and 5.0 mmol/L. The nurse will find abnormally high levels of phosphorus and potassium in the laboratory reports of the patient. This is because the kidneys of the patient with renal failure do not adequately excrete phosphorus and potassium. Thus, an elevated phosphorus level of 1.94 mmol/L and an elevated potassium level of 6.2 mmol/L correspond with the diagnosis. Phosphorous levels of 2.8, 3.0, and 3.6 mg/dL are within normal limits. Potassium levels of 0.96, 0.90, and 1.16 mmol/L are within normal limits.

A 22-year-old female patient had a physical for a new job. Her blood pressure was 110/68. At the health fair two months later, her blood pressure is 154/96. What renal problem should the nurse be aware of that could contribute to this abrupt rise in blood pressure? 1: Renal trauma 2: Renal artery stenosis 3: Renal vein thrombosis 4: Benign nephrosclerosis

2: Renal artery stenosis Renal artery stenosis contributes to an abrupt rise in blood pressure, especially in people under 30 or over 50 years of age. Renal trauma usually has hematuria. Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome. Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension.

The patient complains of incontinence of urine while coughing or sneezing during the physical assessment. The nurse explains to the patient that this is defined as: 1: Overflow incontinence 2: Stress incontinence 3: Reflex incontinence 4: Trauma incontinence

2: Stress incontinence Stress incontinence occurs when the patient coughs or sneezes. In stress incontinence, the leakage is in small amounts and may not be daily. Overflow incontinence occurs when the pressure of urine in an overfull bladder overcomes sphincter control. This usually occurs frequently throughout the day and night. Reflex incontinence is a condition that occurs when no warning or stress precedes periodic involuntary urination. Urination is frequent, is moderate in volume, and occurs equally during the day and night. Trauma incontinence occurs when a fistula develops as result of trauma or surgery.

The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving prescriptions, what should the nurse do? 1: Keep the patient on bed rest 2: Use 5 mL of sterile saline to irrigate 3: Use 30 mL of water to gently irrigate 4: Have the patient turn from side to side

2: Use 5 mL of sterile saline to irrigate With a nephrostomy tube, if the tube is occluded and irrigation is prescribed, the nurse should use 5 mL or less of sterile saline to irrigate it gently. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency.

The nurse is caring for a patient who has undergone a renal biopsy. The nurse ensures that the patient lies on the affected area for 30 to 60 minutes, conducts urine serial urine test using a dipstick, and measures the vital parameters frequently. The nurse performs the interventions to assess for and prevent which complication? 1: Infection 2: Bleeding 3: Urinary retention 4: Hypersensitivity

2: bleeding A renal biopsy may cause flank plain, an increase in body temperature, and internal bleeding. Therefore, to ensure safety the nurse should monitor the vital parameters frequently and perform the urine dipstick test to detect presence of blood in the urine. The nurse also ensures that the patient lies on the affected side for 30 to 60 minutes after the procedure. Asking the patient to lie in a side-lying position cannot prevent infection and urinary retention. Renal biopsy does not involve use of contrast media; therefore, hypersensitivity reaction may not occur.

The nurse instructs a female patient to collect a clean catch midstream urine sample for a culture. Which patient action may contaminate the urine sample? 1: The patient collects the urine sample in a sterile specimen cup. 2: The patient cleans the urinary meatus in a back-to-front motion. 3: The patient uses three sponges saturated with cleansing solution for cleaning. 4: The patient starts urinating and then continues urinating in the sample container.

2: cleaning back to front A clean catch midstream urine sample is ideal for obtaining a urine culture because it is the method that is least likely to be contaminated. However, if the patient cleans the meatus in a back-to-front motion, the urine may get contaminated with microorganisms from the anal area. Therefore, the patient should be instructed to clean the meatus in a front-to-back motion. The urine sample should be collected in a sterile specimen container for accurate culture results. The patient should use at least three sponges saturated with a cleansing solution to clean the meatus because this helps to prevent contamination of the urine sample. After the cleaning, the patient starts voiding, and then continues voiding into the sample container. This midstream collection helps to ensure that the sample is without any contaminants.

The nurse reviews lab tests that have been prescribed for a patient in acute renal failure. Which is the best indicator of renal function? 1: Potassium 2: Creatinine 3: BUN (blood urea nitrogen) 4: ALT (alanine aminotransferase)

2: creatinine Creatinine is the best indicator of renal function. Creatinine is a waste product of the skeletal muscles and is excreted through the kidneys. In renal failure, the kidneys are unable to excrete creatinine, leading to a serum level greater than the normal range of 15.3 to 76.3 mcmol/L. Potassium excretion and regulation is impaired in acute renal failure, and potassium may therefore be increased. However, potassium may be increased for reasons other than renal disease, whereas increased creatinine is specific to renal disease. Blood urea nitrogen (BUN) is also used to measure kidney function, but other disorders such as dehydration may cause an increase in BUN. Alanine aminotransferase (ALT) is related to liver dysfunction, not renal dysfunction

Which assessment finding of a patient with chronic kidney disease indicates to the nurse that hemodialysis is having the desired effect? 1: Decreased hematocrit and diuresis 2: Decreased serum creatinine and weight loss 3: Increased potassium level and improved appetite 4: Decreased white blood cell count and diaphoresis

2: decreased serum creatinine and weight loss One of the main purposes of hemodialysis is removal of creatinine, other waste products, and water. Fluid loss may be measured by weighing the patient before and after the dialysis treatment and also by measuring the serum creatinine. The other answer options are inaccurate and/or incomplete. Hemodialysis will decrease potassium. It may also increase hematocrit and improve appetite. Hemodialysis will not produce diuresis, and has no direct effect on WBC count or diaphoresis.

A 24-year-old female donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is experiencing a lot of pain and refuses to get up to walk. How should the nurse handle this situation? 1: Have the transplant psychologist convince her to walk. 2: Encourage even a short walk to avoid complications of surgery. 3: Tell the patient that no other patients have ever refused to walk. 4: Tell the patient she is lucky she did not have an open nephrectomy.

2: encourage even a short walk Because ambulating will improve bowel, lung, and kidney function with improved circulation, even a short walk with assistance should be encouraged after pain medication. The transplant psychologist or social worker's role is to determine if the patient is emotionally stable enough to handle donating a kidney, while postoperative care is the nurse's role. Trying to shame the patient into walking by telling her that other patients have not refused and telling the patient she is lucky she did not have an open nephrectomy (implying how much more pain she would be having if it had been open) will not be beneficial to the patient or her postoperative recovery.

A nurse planning care for a patient with acute renal failure recognizes that the interventions of highest priority are directly related to: 1: Ineffective coping 2: Excess fluid volume 3: Impaired gas exchange 4: Imbalanced nutrition: less than body requirements

2: excess fluid volume The issue of excess fluid volume is the primary problem of acute renal failure and the highest priority for the nurse in this situation. The major problem with acute renal failure is altered fluid and electrolyte balance, which, if not managed, can lead to permanent renal damage, cardiac complications, and death. The nursing diagnosis of Ineffective Coping is due to the acute severity of the illness. The nursing diagnosis of Impaired Gas Exchange is related to Excess Fluid Volume, such as in the development of pulmonary edema. The nursing diagnosis of Imbalanced Nutrition, less than body requirements, is due to a decrease in appetite as a result of the acute renal failure.

The nurse in a primary health care facility has collected a urine specimen from a patient for a urinalysis. The lab where the specimen is to be examined is 2 hours away from the facility. What should the nurse do now? 1: Discard the urine specimen. 2: Refrigerate the urine specimen. 3: Send the specimen to the lab immediately. 4: Store the specimen at 25 degrees Celsius.

2: refrigerate Ideally, the specimen for urinalysis should be examined within 1 hour of urinating. If immediate analysis is not possible, the urine sample should be refrigerated. If the urine sample is not refrigerated, bacteria will start multiplying. The red blood cells tend to hemolyze, casts would disintegrate, and the urine would become alkaline as a result of urea-splitting bacteria. There is no reason for the specimen to be discarded. Storing the specimen at 25 degrees Celsius would still likely cause bacteria to multiply.

A male patient is admitted with extreme left flank pain. During the admission interview, the nurse learns that the patient is training for a marathon and is on a high-protein diet consisting of a lot of chicken, beef, and seafood. He states he drinks a lot of milk and avoids sodas and caffeine. He states that he often gets up once a night to urinate, but denies incontinence. The nurse suspects that the patient's pain may be because of 1: Muscle strain 2: Renal calculi 3: Urinary tract infection (UTI) 4: Excessive nocturnal urination

2: renal calculi Dehydration may contribute to UTIs, calculi formation, and kidney failure. Large intake of particular foods, such as dairy products or foods high in proteins, also may lead to calculi formation. Because the patient is athletic, muscle strain is probably not the primary cause of his symptoms. Caffeine, alcohol, carbonated beverages, some artificial sweeteners, or spicy foods often aggravate urinary inflammatory diseases. The patient avoids sodas so this would not be as great a concern. Up to one episode of nocturia is considered normal in younger adults, and up to two episodes are acceptable among adults ages 65 years or older.

The patient with end stage renal disease (ESRD) has decided to terminate dialysis treatments. Which is the best response by the nurse? 1: "I respect your decision. Would you like me to ask the health care provider for a palliative care consult?" 2: "I respect your decision, but believe you need to discuss options with your health care provider. Would you like me to page the health care provider to come speak with you?" 3: "You cannot stop now, you have so much to live for." 4: "Are you sure this is the right decision? How about if I ask a psychiatrist to come speak with you."

2: respect decision, talk to health care provider The patient has the right to end treatment. This decision must be made with the health care provider. Telling the patient he or she has too much to live for may be giving false reassurance. The nurse has no right questioning the decision or calling a psychiatrist at this point.

The nurse reviews the assessment findings of a patient with a renal disorder that is scheduled for a renal biopsy. Which parameter will result in the cancellation of the procedure? 1: Elevated cholesterol 2: Uncontrolled hypertension 3: Elevated serum albumin 4: Increased serum creatinine

2: uncontrolled hypertension A renal biopsy is contraindicated in a patient with uncontrolled hypertension; therefore, the patient should be assessed for high blood pressure. Cholesterol levels are assessed for a patient with heart disease. Serum albumin levels are assessed in a patient with chronic kidney disease. Serum creatinine levels are assessed in a patient with renal disorders.

The nurse reviews a patient's medication history and notes that the patient is on a combination therapy of phenazopyridine (Pyridium) and nitrofurantoin (Macrodantin) therapy. Which information should the nurse include when providing education about these medications? 1: The patient may experience frequent urination. 2: The urine may appear orange in color. 3: A small amount of blood may be present in the urine. 4: The patient may experience a burning sensation during urination.

2: urine may appear orange Phenazopyridine (Pyridium) is a urinary anesthetic that causes urine discoloration, resulting in orange-colored urine. A patient who is taking phenazopyridine (Pyridium) may be anxious about this urine discoloration, so the nurse should educate the patient in order to prevent unnecessary stress. Unlike diuretics, nitrofurantoin (Macrodantin) is an antibiotic and does not increase urinary frequency or urinary outflow. Unlike anticoagulants, nitrofurantoin (Macrodantin) does not cause hematuria, so the nurse will not need to warn the patient about the potential for blood in the urine. Nitrofurantoin (Macrodantin) does not increase the pH of the urine, so it's unlikely the patient will have a burning sensation during urination.

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. What is an expected assessment finding for this patient during this early stage of recovery? 1: Hypokalemia 2: Hyponatremia 3: Large urine output 4: Leukocytosis with cloudy urine output

3 - Large urine output Patients frequently experience diuresis (a large volume of urine output) in the hours and days immediately following a kidney transplant. Hypokalemia, hyponatremia, and signs of infection are unexpected findings that warrant prompt intervention.

The nurse is teaching a patient who recently had an episode of urolithiasis with calcium oxalate stones about nutritional therapy. What instructions should the nurse include? Select all that apply. 1 : Increase intake of milk. 2 : Increase consumption of coffee. 3 : Take in at least 3 L of fluid daily. 4 : Limit intake of dried fruits and nuts

3,4 Patients should take in at least 3 L of fluid daily to produce a urine output of at least 2 L per day. High urine output helps to dilute the urine and promotes excretion of minerals within the urine, thus preventing stone formation. Intake of dried fruits and nuts should be limited, as they contain high amounts of calcium and the patient had suffered from calcium oxalate stones. Increasing the intake of milk is not recommended, as milk contains high amounts of calcium and the patient had suffered from calcium oxalate stones. Consumption of coffee should be restricted, as it contains substances such as cocoa oxalate that increase the risk of recurring renal calculi.

When managing a patient with urinary calculi, which conditions associated with renal stones would indicate a need for lithotripsy? Select all that apply. 1 : Stones causing occasional nausea. 2 : Stones that are 3 mm in diameter. 3 : Stones that are 9 mm in diameter. 4 : Stones causing impaired renal function. 5 : Stones associated with symptomatic infection.

3,4,5 Stones that are greater than 7 mm are too large for spontaneous passage. Stones causing impaired renal function should be removed as soon as possible to avoid damage to the kidneys. Stones associated with a symptomatic infection increase the risk of renal damage, and lithotripsy should be considered. Stones causing occasional nausea can be treated with medications. Stones that cause persistent nausea, pain, or a paralytic ileus should be considered for lithotripsy. Stones that are 3 mm in diameter are small enough to be passed spontaneously. Pharmaceutical treatment should be considered first.

What is the normal level for serum Potassium

3.5 to 5.0 mmol/L

The patient with a severe urinary tract infection (UTI) has a prescription for cefepine (Maxipime) 2 g intravenous (IV) q6h. The vial in the patient's medication drawer has been reconstituted and is labeled as having a concentration of 200 mg/mL. How many milliliters of solution should be added to the IV bag? 1: 2 mL 2: 5 mL 3: 10 mL 4: 15 mL

3: 10 mL Two grams is equal to 2000 mg. Using ratio and proportion, multiply 200 by x and multiply 2000 × 1 to yield 200x = 2000. Divide 2000 by 200 to yield 10 mL.

When assessing the mental status of a patient in acute renal failure, the nurse recognizes that abnormal findings are most likely caused by: 1: Anger related to denial of chronic illness 2: Delirium related to hypoxia of brain cells 3: Confusion related to an increased urea level 4: Aggression related to possible underlying comorbidities

3: Confusion related to an increased urea level In renal disease, urea is not filtered out of the blood by the kidneys and therefore accumulates in the blood. This results in toxicity to brain tissue, causing confusion. Anger is a possible emotional reaction, but it does not manifest as a change of mental status. Delirium related to hypoxia of brain cells is not a complication seen with acute renal failure. Aggression is not necessarily related to acute renal failure.

During the physical assessment of a patient, where should a nurse palpate to locate the kidneys? 1: Anteriorly on the abdomen below the rib cage 2: Anteriorly on the abdomen near the umbilicus 3: In the angle formed by the rib cage and the vertebral column 4: In the angle formed by the first rib and the vertebral column

3: In the angle formed by the rib cage and the vertebral column The costovertebral angle (CVA) is the landmark to locate the kidneys. It is formed by the rib cage and the vertebral column. Pain and CVA tenderness may indicate a kidney infection or polycystic kidney disease. Kidneys are posterior organs and may not be palpated anteriorly, either below the rib cage or near the umbilicus. The angle formed by the first rib and the vertebral column is too high, as the kidneys are located at a lower position in the abdomen.

A nurse is performing a physical examination on a patient suspected of having urinary tract calculi. What primary manifestation should the nurse be observant for during the assessment? 1: Fever 2: Abdominal distension 3: Sharp pain in the flanks 4: Bacteria on a urine analysis

3: Sharp pain in the flanks The first symptom of a kidney stone is usually severe pain in the flank area, back, or lower abdomen. Abdominal distension and fever may occur later in the course of the disease. Bacteria on urine analysis is not a predictor of urinary calculi but is observed when a patient has a urinary tract infection.

The patient called the clinic with manifestations of burning on urination, dysuria, and frequency. What is the best advice for the nurse to give the patient? 1: "Drink less fluid so you don't have to void so often." 2: "Take some acetaminophen to decrease the discomfort." 3: "Come in so we can check a clean catch urine specimen." 4: "Avoid caffeine and spicy food to decrease inflammation."

3: come in The patient's symptoms are typical of a urinary tract infection (UTI). 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.

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do for the patient? 1: Administer hypertonic saline 2: Administer a blood transfusion 3: Decrease the rate of fluid removal 4: Administer antiemetic medications

3: decrease the rate The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea, but would not help the hypovolemia.

Which effect of aging on the urinary system is most likely to affect the action of bumetanide (Bumex)? 1: Benign enlargement of prostatic tissues 2: Decreased sensation of bladder capacity 3: Decreased function of the loop of Henle 4: Less absorption in the Bowman's capsule

3: decreased function in loop of Henle Bumetanide 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 affect directly the action of loop diuretics.

The nurse has obtained an early morning urine specimen for a urinalysis, but is unable to get it to the laboratory within the one-hour time frame. The nurse should 1: Discard the urine and be sure to obtain an evening specimen 2: Place the specimen on the laboratory shelf for collection in the next hour 3: Refrigerate the specimen and arrange for the earliest possible pickup/delivery 4: Keep the specimen warm until the next scheduled laboratory pickup

3: refrigerate Although a specimen may be collected at any time of the day for a routine urinalysis, it is best to obtain the first specimen urinated in the morning. This concentrated specimen is more likely to contain abnormal constituents if they are present in the urine. The specimen should be examined within one hour of urinating. Otherwise, bacteria multiply rapidly, red blood cells (RBCs) hemolyze, casts (molds of renal tubules) disintegrate, and the urine becomes alkaline as a result of urea-splitting bacteria. If it is not possible to send the specimen to the laboratory immediately, refrigerate it. However, to obtain the best results, coordinate specimen collection with routine laboratory hours.

The nurse preparing to administer a dose of calcium acetate (PhosLo) to a patient with chronic kidney disease (CKD) should know that this medication should have a beneficial effect on which laboratory value? 1: Sodium 2: Potassium 3: Magnesium 4: Phosphorus

4 - Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. PhosLo will not have an effect on sodium, potassium, or magnesium levels.

A patient is being administered 15 g sodium polystyrene sulfonate (Kayexalate) orally for hyperkalemia. Which intervention should the nurse perform? 1: Observe the patient for iron overload. 2: Inform the patient that constipation is an expected side effect. 3: Provide magnesium-containing antacids. 4: Report peaked T waves in electrocardiogram (ECG).

4 - Report peaked T waves in ECG The nurse should report changes to the health care provider in the ECG, such as peaked T waves and widened QRS complexes; dialysis may be required to remove excess potassium. Monitoring for iron overload is a consideration for blood transfusions, but not for administration of sodium polystyrene sulfonate. The nurse should warn the patient that this treatment will often cause diarrhea because the preparation contains sorbitol, a sugar alcohol that has an osmotic laxative action. Magnesium-containing antacids should not be prescribed for patients with chronic kidney disease because magnesium is excreted by the kidneys.

A geriatric patient reports non-localized abdominal pain and malaise. The nurse reviews the patient's laboratory report and notes a uric acid level of 309 mmol/L and urinary white blood cell count of 6/hpf. How should the nurse interpret the findings? 1: The patient has gout. 2: The patient has renal calculi. 3: The patient has diabetes mellitus. 4: The patient has a urinary tract infection.

4: UTI The presence of white blood cells in the urine indicates that the patient has a urinary tract infection. Malaise and non-localized abdominal discomfort are the characteristic symptoms of urinary tract infections in older patients. The normal uric acid levels in the blood are 180-420 mmol/L, so the patient's uric acid level of 309 mmol/L does not indicate gout. Renal calculi or kidney stones can form from excess uric acid and they are associated with hematuria. Presence of glucose in the urine indicates that the patient has diabetes mellitus.

A patient with chronic kidney disease has an arteriovenous (AV) graft in the right forearm. What is the nurse's priority in determining the patency of the graft? 1: Determine the range of motion of the right arm and shoulder 2: Observe for clubbing of the fingers on the right hand of the AV graft site 3: Compare radial pulses by checking the right and left pulses simultaneously 4: Check for a bruit by listening over the right arm AV graft site with a stethoscope

4: check for a bruit The arteriovenous (AV) graft is an artificial connection between an artery and vein to provide access for hemodialysis. Thrombosis may occur; therefore the need to determine patency is an essential assessment. Palpation of the site should indicate a thrill, which also indicates that the graft is patent. Listening over the AV graft should reveal a bruit sound, indicating patency. A bruit sounds similar to the impulse beat heard when measuring blood pressure. The arm that has the AV graft site should not be put through range-of-motion movements or exercises. Clubbing is not a complication observed in the fingers of a patient with an AV graft. Comparing the left radial pulse with the pulse on the AV graft site is not an accurate patency assessment procedure.

The nurse provides a patient who is prone to urinary tract infections with a list of recommended food and beverage choices to increase the patient's urine acidity. What type of juice should the nurse include on the list? 1: Apple 2: Carrot 3: Prune 4: Cranberry

4: cranberry Cranberry juice has high acidity and is recommended most often. Foods that promote urine acidity are also referred to as "acid-ash." Apple juice, carrot juice, and prune juice are not considered part of an acid-ash diet.

Because almost all creatinine in the blood is excreted normally by the kidneys, which is the most accurate indicator of renal function. 1: Urinalysis 2: Composite urine collection 3: Blood urea nitrogen (BUN) 4: Creatinine clearance

4: creatinine clearance Because almost all creatinine in the blood is excreted normally by the kidneys, creatinine clearance is the most accurate indicator of renal function. It is a commonly used test to analyze renal function and urinary system disorders. The result of a creatinine clearance test closely approximates that of the glomerular filtration rate. Urinalysis is a general examination of urine to establish baseline information. Composite urine collection measures specific components, such as electrolytes, glucose, protein, 17-ketosteroids, catecholamines, creatinine, and minerals. BUN is used to detect renal problems, but is not as reliable as creatinine clearance.

A patient with chronic kidney failure has a hemoglobin (Hgb) level of 80 mmol/L. What should the nurse infer about the reason for this laboratory result? 1: The patient has renal hypertension. 2: The patient has altered bone metabolism. 3: The patient has excessive renin production. 4: The patient has a deficiency of erythropoietin.

4: deficiency of erythropoietin Erythropoietin is a hormone produced by the kidneys, which promotes red blood cell (RBC) production in the bone marrow. In kidney failure, the kidneys are unable to produce erythropoietin, resulting in a decreased production of RBCs and anemia. Patients with kidney failure may have renal hypertension; however, renal hypertension does not cause anemia. Patients with kidney failure have altered bone metabolism due to a lack of vitamin D, active metabolite, and tubule dysfunction. However, altered bone metabolism does not result in anemia. Excessive renin production in kidney failure causes hypertension but is unrelated to anemia