Renal Questions
Answer: C Rationale: A 24-hour urine collection is needed for the test. When the test begins, the first urine specimen is discarded and the time is noted. All other voided urine for the next 24 hours is collected in a container and kept cool. At the end of the 24 hours, the client should void one last time and add the specimen to the container. Blood is drawn to measure serum creatinine level in addition to urine creatinine. (Option A): An in-and-out catheter (straight catheter) is used for any test requiring a urine specimen when the client is unable to urinate or unable to follow the specimen collection procedure. (Option B): Clean catch or midstream urine samples are collected for urinalysis or urine culture and sensitivity testing. For a creatinine clearance test, all urine for the 24 hour period must be collected or the test must be started again. (Option D): The first AM void is preferable for a urinalysis or urine culture and sensitivity as an overnight specimen is more concentrated. 50% answered correctly
A client has been given instructions about collecting a urine specimen to test creatinine clearance. The client indicates correct understanding of the specimen collection procedure by making which statement? A) "A catheter is placed temporarily then removed after I void." B) "I must provide a midstream sample in a sterile container." C) "I will need to collect all my urine in a container for 24 hours." D) "The first AM specimen is best as it is more concentrated."
Answer: B Rationale: Furosemide is a potassium-depleting loop diuretic, and this client's potassium level is low. Hypokalemia can lead to heart palpitations and/or dysrhythmias. The nurse should initially hold the client's scheduled dose of furosemide. If the furosemide is administered, the client's potassium level could further decease, leading to worsening cardiac symptoms. (Option A): A low brief, focused assessment, including calculating intake and output, may be important before notifying the HCP. However, the first action is to hold the scheduled dose of furosemide based on the lab results. A low potassium level is justification for not administering the furosemide regardless of intake and output. (Option C): After assessing the client, the nurse should notify the HCP of the potassium level and reported heart palpitations. (Option D): A 12-lead ECG may be ordered when notifying the HCP; however, the priority action is to first hold the dose of furosemide. 62% answered correctly
The nurse is administering medications to a client experiencing heart palpitations who is scheduled to receive a dose of furosemide. Based on the client's laboratory results, what is the nurse's priority action? Potassium - 2.9 mEq/L Magnesium - 2.0 mEq/L Calcium - 8.9 mg/dL Sodium - 138 mEq/L A) Calculate total urinary output B) Hold the furosemide C) Notify the health care provider D) Obtain a 12-lead electrocardiogram (ECG)
Answer: C Rationale: Rhabdomyolysis occurs when muscle fibers are released into the blood, usually after an intense muscle injury from exercise, heat stroke, or physical trauma. Acute renal failure can occur when elevated myoglobin (protein found in muscle tissue) levels overwhelm the kidneys' filtration ability. The nurse's priority is to prevent kidney damage using rapid IV fluid resusitation to flush the damaging myoglobin pigment from the body. Common signs of rhabdomyolysis are dark, often times bloody urine, oliguria, and fatigue. (Option A): With muscle injury, intracellular potassium is released into the circulation, potentially causing dangerous arrythmias. Therefore, ECG and cardiac monitoring are needed. However, with IV fluid administration, potassium levels decreased rapidly. In addition, clients with rhabdomyolysis have extensive third spacing of the fluids into the injured muscles. Therefore, aggressive fluid resucitation is a high priority. **The general rule is that treatment/prevention of an underlying expected problem is a priority over testing to identify the problem** (Option B): Pain and symptom management should be a high priority but should not take precedence over preserving the client's kidney function (Option D): Although obtaining a urine specimen to assess the characteristics is important, laboratory testing would not take priority over treatment to preserve kidney function. 50% answered correctly
A 25 year old marathon runner is admitted for suspected rhabdomyolysis. The client has oliguria, dark amber urine, and muscle pain. The nurse should implement which prescription first? A) ECG B) IV morphine 2 mg C) Normal saline bolus D) Urine sample
Answer: A Rationale: Intravenous calcium gluconate is administered to hyperkalemic clients with ECG changes (eg, peaked T waves). Calcium gluconate itself does not decrease the serum potassium level but temporarily stabilizes the myocardium by raising the threshold for dysrhythmia occurrence. Once the nurse stabilizes the client by administering calcium gluconate, other prescriptions may then be implemented to decrease serum potassium level. (Option B): Intravenous regular insulin temporarily corrects hyperkalemia by shifting potassium into the cells. Dextrose is administered concurrently to prevent hypoglycemia. Although intravenous regular insulin will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias. (Option C): Sodium polystyrene sulfonate causes excretion of potassium from the body via the gastrointestinal tract. Although this will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias. (Option D): Although hemodialysis will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias. 28% answered correctly
A 65 year old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia? A) Intravenous calcium gluconate B) Intravenous regular insulin with dextrose C) Oral sodium polystyrene sulfonate D) Transport to hemodialysis unit
Answer: C, D, E Rationale: Prior to dialysis, the nurse should assess the client's fluid status, vascular access, and vital signs (Option D). The amount of fluid removed (ultrafiltration) is determined by calculating the difference between the last post-dialysis weight and the client's current pre-dialysis weight (Option C). Arteriovenous fistulas are created by anastomosing an artery to a vein; a thrill can be felt when palpating the fistula, and a bruit can be heard during auscultation when the fistula is functioning properly (Option E). (Option A): After the client is connected to the dialysis machine, IV heparin is added to the blood from the client to prevent clotting that can occur when blood contacts a foreign substance. Giving subcutaneous heparin prior to initiation is not necessary. (Option B): During dialysis, excess fluid is removed, making the client prone to hypotension. In addition, medications are removed from the blood during hemodialysis, making them ineffective. Many medications that are taken once daily can be held until after the dialysis treatment to prevent their removal. If blood pressure medications are given prior to dialysis, the client can develop hypotension during the dialysis and then uncontrolled hypertension (decreased drug concentrations). 51% answered correctly
A client diagnosed with end-stage renal disease comes to the dialysis clinic for treatment. Which actions should the nurse take to prepare the client for hemodialysis? Select all that apply. A) Administer subcutaneous heparin to decrease clotting during dialysis B) Administer the client's morning doses of carvedilol and lisinopril C) Check the client's medical records to determine the last post-dialysis weight D) Obtain a set of client vital signs and the client's current weight E) Palpate the fistula in the client's arm for a thrill and auscultate for a bruit
Answer: B Rationale: A percutaneous nephrolithotripsy is a procedure to remove large kidney stones from the renal pelvis area. Post procedure, a nephrostomy tube may be placed to prevent obstruction by stone fragments and promote healing of injured tissue. The client is experiencing left flank pain and has no drainage from the nephrostomy tube, which may indicate obstruction to urine flow in the left kidney that can lead to kidney injury (pressure atrophy). Therefore, gentle irrigation of the nephrostomy tube with 5 mL sterile normal saline using aseptic technique is the appropriate intervention. If the tube patency cannot be established after irrigation, it will be necessary to notify the health care provider. (Option A and C): The indwelling urethral catheter is draining 42 mL/hr, so it is probably not kinked or obstructed. This urine flow is likely coming from a normally functioning right kidney. (Option D): The client is placed in the prone position for the procedure. Prone position does not facilitate drainage. 36% answered correctly
A client had a percutaneous nephrolithotripsy to remove left kidney stones 3 hours ago. Since then, the indwelling urethral catheter has drained 125 mL of urine, and the nephrostomy tube has drained 0 mL. The client now reports left flank pain radiating to the left groin and severe nausea. What is the appropriate nursing intervention? A) Assess the urethral catheter for kinks and obstruction B) Irrigate the nephrostomy tube with 5 mL of sterile normal saline as prescribed C) Irrigate the urethral catheter with 50 mL of sterile normal saline as prescribed D) Place the client in the prone position to facilitate urine drainage
Answer: C Rationale: A person with sudden kidney failure that will require immediate dialysis will have a central venous catheter placed. The catheter will be used until an AVG or AVF can be placed and is ready for use. The catheter should always be the last access option for long-term dialysis due to risk of infection and mechanical malfunction (eg, thrombosis) (Option A and B): An AVF or AVG will require several days to weeks to mature prior to first use. (Option D): Excess fluid and solutes are removed at a more gradual rate with peritoneal dialysis. This slower rate of metabolite removal is a disadvantage in sudden kidney failure. 28% answered correctly
A client requires immediate dialysis after suffering sudden kidney failure. What is the most appropriate procedure for which the nurse should prepare the client? A) Arteriovenous fistula (AVF) placement in the arm B) Arteriovenous graft (AVG) placement in the arm C) Central line placement in the groin area D) Peritoneal dialysis catheter placement in the abdomen
Answer: C Rationale: Dialysis disequilibrium syndrome (DDS) is a rare but potentially life-threatening complication that can occur in clients during the initial stages of hemodialysis; it can be prevented by slowing the rate of dialysis. During HD, solutes (ie, urea) are removed more quickly from the blood than from the brain cells and cerebrospinal fluid, creating a concentration gradient that can lead to excess fluid in the brain cells and increased intracranial pressure. Characteristic neurologic manifestations include nausea and vomiting, headache, restlessness, change in mentation, and seizure activity. If DDS is suspected, the health care provider should be contacted immediately. If severe, DDS can progress to coma and death. If DDS is identified during treatment, the rate of dialysis should be slowed or stopped. Treatment focuses on interventions to decrease cerebral edema and manage symptoms. (Option A): Antihypertensives are withheld prior to HD to minimize the risk for hypotension. If the client is not hypotensive after HD, prescribed antihypertensives should be administered but are not the priority intervention for a client with DDS. (Option B): Antiemetics should be administered to treat nausea associated with DDS, but they are not the priority intervention. (Option D): Trendelenburg position may increase cerebral edema and would be inappropriate for a client with DDS. 49% answered correctly
A client returns to the unit after receiving hemodialysis for the first time. The client vomits once, reports headache, and appears restless and disoriented. What is the priority intervention? A) Administer antihypertensives that were held prior to dialysis B) Administer PRN ondansetron to relieve nausea C) Contact the health care provider D) Place the client in Trendelenburg position
Answer: A Rationale: IV administration of 50 mL 50% dextrose with 10 units of regular insulin is the priority intervention as it is the most effective in reducing the potassium level quickly. The insulin temporarily shifts the potassium from the extracellular fluid back into the intracellular fluid. The dextrose prevents hypoglycemia associated with the increase of insulin in the body and can be eliminated if the client has hyperglycemia. If the client has ECG changes (eg, tall peaked T waves), calcium gluconate should be given before insulin/dextrose. This will stabilize the cardiac muscle until the potassium level can be reduced with insulin/dextrose. (Option B): Furosemide increases the renal excretion of potassium and is usually prescribed for clients with fluid overload. However, administration of furosemide would take time to be effective and is not the priority. (Option C): Sodium polystyrene sulfonate (Kayexalate) is administered by mouth or enema to remove potassium from the body by exchanging sodium for potassium ions in the intestines; these are then excreted in feces. This is not the priority due to the delayed onset of potassium control. (Option D): Hemodialysis is an invasive procedure that can be initiated if more conservative, noninvasive therapies are ineffective in reducing the potassium level. Placement of the catheter will delay treatment. 26% answered correctly
A client with advanced kidney disease has serum potassium of 7.1 mEq/L and creatinine of 4.5 mg/dL. What is the priority prescribed intervention? A) Administer IV 50% dextrose and regular insulin B) Administer IV furosemide C) Administer oral sodium polystyrene sulfonate D) Prepare the client for hemodialysis catheter placement
Answer: C, D, E Rationale: The major complications of an AVF are infection (especially in end-stage kidney disease and diabetes), stenosis, thrombosis, and hemorrhage. Clients are taught the following preventative interventions: -Report numbness or tingling of the extremity to the HCP to prevent neuromuscular damage (Option A) -Do not allow anyone (other than dialysis personnel) to draw blood or take blood pressure measurements on the extremity to prevent thrombosis (Option B) -Avoid wearing restrictive clothing or jewelry to prevent thrombosis -Do not use the arm with vascular access to carry heavy objects (more than 5lbs); however, exercises to increase strength could include squeezing a soft ball or sponge several times a day (Option C) -Check the function of the vascular access several times a day by feeling for vibration to assess for patency, stenosis, and clotting (Option D) -Do not sleep on the arm with vascular access or use creams or lotions on the site (Option E) -Monitor for signs of infection and bleeding after dialysis and report immediately -Keep the site clean to help prevent infection 68% answered correctly
A client with chronic kidney disease has a subcutaneous arteriovenous fistula (AVF) placed in the nondominant left wrist for hemodialysis. Which of the following statements indicate the client understands how to care for the fistula properly? Select all that apply. A) "I don't need to call my health care provider if I have numbness or tingling in my left arm." B) "I will make sure I always have my blood pressure taken in my nondominant (left) arm." C) "I will squeeze a small sponge with my left hand several times a day." D) "I will touch the site and feel for a vibration several times a day." E) "I will try not to sleep on my left arm."
Answer: A Rationale: The diet for a client with chronic kidney disease may need to be restricted in fluids, sodium, potassium, and phosphorus. Dairy products (eg, milk, yogurt) and certain fruits (eg, bananas, oranges, coconuts, watermelons, and avocados) contain high potassium levels. Dairy products also contain high phosphorus levels. Examples of allowable foods for CKD clients include apples, pears, grapes, pineapple, blackberries, blueberries, and plums. (Option B): Avocados are high in potassium; the chips may be high in sodium (Options C and D): Pudding and yogurt contain dairy products and are high in phosphorous and potassium. Oranges are also high in potassium. 28% answered correctly
A client with chronic kidney disease has blood laboratory results as shown: Sodium - 150 mEq/L Potassium - 6.0 mEq/L Chloride - 100 mEq/L Calcium - 9.0 mg/dL Magnesium - 2.0 mg/dL Phosphorus - 5.8 mg/dL What is the best afternoon snack to provide to this client? A) Apple slices with caramel dip B) Chips and avocado dip C) Nonfat yogurt with orange slices D) Vanilla pudding with strawberries
Answer: D Rationale: Because this client has low pH coupled with low bicarbonate, the most likely diagnosis is primary metabolic acidosis. Respiratory alkalosis is the body's natural compensation for metabolic acidosis. Respiratory alkalosis is achieved by blowing more CO2 off from the system through rapid breathing. (Option A): Decreased bicarbonate reabsorption would produce metabolic acidosis; this would occur as a compensation for primary respiratory alkalosis. (Option B): When the respiratory rate is decreased, PaCO2 would increase, creating a respiratory acidosis; this would occur in response to a primary metabolic alkalosis. (Option C): Increased bicarbonate reabsorption would produce metabolic alkalosis; this would occur as a compensation for primary respiratory acidosis. 37% answered correctly
A client's arterial blood gases (ABGs) are: pH -- 7.25 PO2 -- 79mmHg PaCO2 -- 35mmHg HCO3 -- 12mEq/L The nurse would expect which finding to demonstrate that the client is compensating for the ABGs? A) Decrease in bicarbonate reabsorption B) Decrease in respiratory rate C) Increase in bicarbonate reabsorption D) Increase in respiratory rate
Answer: D Rationale: This client's urinalysis reveals that the client is most likely dehydrated. Amber color indicates concentrated urine. The specific gravity evaluates the ability of the kidneys to concentrate solutes in the urine. The normal urine specific gravity value ranges from 1.003-1.030. Causes of increased specific gravity include fluid deficit. (Option A): Glucose should be absent in the urine. Its presence is suspicious for diabetes mellitus. (Option B): Dysuria (burning or difficulty urinating) may be indicative of infection or inflammation. The number of white blood cells (WBCs) should be very few (0-5 per high power field), as seen in this client. Increased numbers indicate infection or inflammation. (Option C): Hematuria is indicative of possible renal trauma. The normal range for red blood cells is 0-4 per high power field. None are present on this client's urinalysis results. 75% answered correctly
After reviewing the urinalysis report data on a client, which question is most appropriate for the nurse to ask? Color - Amber Specific gravity - 1.031 RBC - none WBC - rare Protein - none Glucose - absent A) "Do you have a family history of diabetes?" B) "Do you have any burning or difficulty urinating?" C) "Have you suffered any recent kidney trauma?" D) "What has your fluid intake been for the last 24 hours?"
Answer: B Rationale: The flow of urine is dependent on gravity. In order to maintain gravity flow, the drainage bag should be hung below the level of the bladder. (Option A): Catheters placed in the kidney pelvis are irrigated using gentle pressure and small amounts of sterile saline solution (< or = 5 mL at one time) to avoid damaging renal tissues. (Option C): Securing an indwelling urinary catheter by taping it to a client's leg is acceptable to maintain gravity flow and present kinks and occlusions. (Option D): Fluid intake of 3,000 mL per day should be encouraged in clients after surgery involving the urinary system. 73% answered correctly
The charge nurse is making rounds and should immediately intervene when making which observation? A) A new nurse is using gentle pressure to flush a kidney pelvis catheter with 5 mL of fluid B) A nursing assistant is hanging a urinary drainage bag on the back of a wheelchair when transporting a client C) Indwelling urinary catheter is taped to a male client's inner thigh D) Total oral fluid intake in 24 hours for a client with a urinary diversion device is 2,800 mL
Answer: B, D, E Rationale: Metabolic acidosis is due to an increase in the production or retention of acid or the depletion of bicarbonate via the kidneys or gastrointestinal tract. Common causes of metabolic acidosis include: -GI bicarbonate losses (diarrhea) -Ketoacidosis (diabetes, alcoholism, starvation) -Lactic acidosis (sepsis, hypoperfusion) -Renal failure (hemodialysis with inaccessible arteriovenous shunt) -Salicylate toxicity (Option A): A client with claustrophobia who was stuck in an elevator is at risk for an anxiety attack, which leads to hyperventilation and respiratory alkalosis. (Option C): A client with excessive vomiting is at risk for metabolic alkalosis due to loss of stomach acid. 22% answered correctly
The emergency department nurse cares for 5 clients. Which of the clients below are at risk for developing metabolic acidosis? Select all that apply. A) 25 year old client with claustrophobia who was stuck in an elevator for 2 hours B) 36 year old client with food poisoning and severe diarrhea for the past 3 days C) 40 year old client with 3-day history of chemotherapy-induced vomiting D) 75 year old client with pyelonephritis and hypotension E) 82 year old client due for hemodialysis with clotted arteriovenous shunt
Answer: A Rationale: Following placement of an arteriovenous fistula, it is important to monitor for patency. A palpable thrill (vibration) over the fistula or an auscultated bruit (blowing or swooshing sound caused by turbulent blood flow) indicates a patent fistula. Absence of the thrill or bruit can indicate potential clot formation in the fistula. Client reports of numbness or tingling as well as decreased capillary refill can also signal potential clotting. (Option B): Capillary refill of <3 seconds is considered normal and indicates acceptable blood flow to the area. (Option C): Daily hand exercises such as squeezing handgrips or a rubber ball are performed to help properly mature the fistula. (Option D): A dry surgical incision without redness, warmth, and induration is an optimal finding. Sterile skin closures (eg, Steri-Strips) are used to help hold the incision together as it heals. 88% answered correctly
The nurse assesses a client diagnosed with chronic kidney disease who had an internal arteriovenous fistula performed on the left arm yesterday. Which assessment finding would require immediate follow-up? A) A bruit cannot be auscultated over the fistula site B) Capillary refill of 2 seconds is assessed on the left hand C) Client reports squeezing a rubber ball with the left hand several times a day D) Incision is dry with no redness and has sterile skin closures in place
Answer: A, B, E Rationale: Cloudy outflow (effluent), tachycardia, and low-grade fever are signs of peritonitis, an infection of the peritoneal cavity and a major concern with PD. Bloody fluid can indicate intestinal perforation or that the client may be menstruating. Brown effluent can indicate fecal contamination from perforation. All these findings need to be reported to the HCP. (Option C): Oliguria (very low urine output) is associated with acute or chronic kidney failure and is the reason the client is receiving peritoneal dialysis. It does not indicate a complication of PD. (Option D): Pruritus (itching) is a common finding in clients with kidney failure, and may occur due to dry skin, neuropathy, or skin deposits of waste products (eg, urea, calcium-phosphate) that are normally removed via the kidney. PD can help relieve this symptom of kidney failure by filtering waste products. 23% answered correctly
The nurse assesses a client receiving peritoneal dialysis. Which assessment findings are most important for the nurse to report to the health care provider? Select all that apply. A) Cloudy outflow B) Low-grade fever C) Oliguria D) Pruritus E) Tachycardia
Answer: D Rationale: The kidney has extensive vasculature (similar to the liver); therefore, bleeding from the biopsy site is the major complication following a percutaneous kidney biopsy. After the procedure, the nurse should monitor vital signs at least every 15 minutes for the first hour as tachycardia, tachypnea, and hypotension can indicate blood loss. The nurse should also assess the puncture site dressing for bleeding. (Option A): BUN and creatinine levels would not change significantly within 30-60 minutes. These are usually measured once every 24 hours and rarely every 12 hours. (Option B): Insertion of an indwelling catheter is not necessary to perform a kidney biopsy and is not part of the usual protocol. (Option C): Post-procedure, the client should be positioned on the affected side for 30-60 minutes to provide pressure and help prevent bleeding. 64% answered correctly
The nurse cares for a client scheduled for a percutaneous left kidney biopsy as an outpatient. Which intervention should the nurse include in the client's post-procedure care plan? A) Compare pre- and post-procedure BUN and creatinine levels B) Insert and maintain the patency of an indwelling catheter C) Maintain prone position for a least 30 minutes D) Monitor vital signs every 15 minutes for the first hour
Answer: A Rationale: Portable ultrasonic bladder scanners are used at the bedside to determine the amount of residual urine in the bladder. Amounts of >100 mL should be reported as the client may be experiencing urinary retention. (Option B): A cystoscope is inserted through the urethra to directly visualize the bladder wall and urethra. Irritation of the urethral and bladder lining from the insertion and manipulation of the cystoscope may cause a slight burning sensation with voiding for a day or two. (Britt says: "tell them this is normal and to drink lots of water. If there is any blood in their urine, retention, or they start running a fever, they need to call us to come in and see the dr asap") (Option C): Renal arteriogram is a radiologic test performed to visualize renal blood vessels to detect abnormalities (renal artery stenosis or aneurysm). A contrast medium is injected into the femoral artery; therefore, the client should be taught to increase fluid intake after the procedure to flush the dye from the body. Increased output is an expected finding. (Option D): Urine is sterile, but the urethra contains bacteria and a few white blood cells. Less than 10,000 organisms/mL is a normal value for urine cultures. Values of >10,000 indicate UTI. 50% answered correctly
The nurse caring for multiple clients who underwent renal system diagnostic testing should report which post-procedure finding to the health care provider? A) 150 mL residual urine on bladder scan B) Burning sensation when voiding after cystoscopy C) Increased urinary output after arteriogram D) Less than 10,000 organisms/mL on urine culture
Answer: D Rationale: Nutritional deficiencies (eg, zinc, protein, vitamin C) and dehydration can impair wound healing. Dehydration (loss of free water) can increase serum sodium levels. The normal value for serum sodium is 135-145 mEq/L. Increased serum sodium has an osmotic action that causes water to be pulled from the interstitial spaces into the vascular system. Remember that "water goes where salt is". This action decreases wound healing at a cellular level, reducing the nutrients cells need for repair. (Option A): Elevated BUN may indicate dehydration and could impair wound healing. However, the BUN value of 15 mg/dL is normal. Normal BUN values are 6-20 mg/dL. (Option B): Malnutrition can impair wound healing. Serum albumin and prealbumin levels are obtained to assess nutritional status. The normal value for albumin is 3.5-5.0 g/dL. (Option C): The normal value for serum potassium is 3.5-5.0 mEq/L. 63% answered correctly
The nurse evaluates the results of laboratory tests completed on a client admitted for a non-healing wound. Which of the following values would be a priority for the nurse? A) BUN of 15 mg/dL B) Serum albumin of 3.7 g/dL C) Serum potassium of 4.5 mEq/L D) Serum sodium of 153 mEq/L
Answer: B Rationale: Urinary retention occurs frequently after surgery due to administration of opioids and anesthesia, and in older men, who often have an enlarged prostate gland or BPH. Body position can also contribute to urinary retention. Most men are used to urinating when standing up; therefore, the nurse or UAP should help the client out of bed rather than offer a urinal for use in bed. The nurse should first try noninvasive methods to help the client urinate in a normal position and provide privacy to help the client relax. (Option A): The second intervention should be a bladder scan. If the client is unable to urinate, an ultrasound scan can be used to noninvasively assess the volume of urine in the bladder. It can also be used to determine the residual bladder volume after the client has urinated to assess the amount of retention. (Option C): An indwelling catheter is not currently indicated for this client. Catheter-associated urinary tract infection (CAUTI) is a significant hospital-acquired infection. The risk of CAUTI can be reduced by using an indwelling catheter only when other interventions have failed to produce desired outcomes. (Option D): Intermittent catheterization would be the third interventino if the client has been unable to urinate or has significant urinary retention (>300-400mL) 36% answered correctly
The nurse is caring for a 68 year old male client following a laparoscopic cholecystectomy 8 hours ago. The client has not urinated since surgery. Which would be the most appropriate initial intervention? A) Conduct a bladder scan B) Help the client out of bed C) Insert an indwelling catheter using sterile technique D) Obtain a prescription for intermittent catheterization
Answer: D Rationale: Blood and urine cultures should be obtained prior to initiation of antibiotic therapy whenever possible to identify the causative microorganisms and determine the most effective antibiotics. Given this client's age and underlying diabetes, sepsis can occur quickly. Therefore, antibiotics should be given immediately after cultures are obtained (option A). (Option B): The nurse should check the client's baseline renal function and complete blood count tests to compare subsequent findings. This is not a priority nursing intervention. (Option C): The client has a history of renal calculi. Straining all urine is not the priority nursing intervention. 55% answered correctly
The nurse is caring for a 72 year old client with a history of renal calculi and diabetes mellitus who was admitted for acute pyelonephritis. The nurse assesses shaking chills, temperature of 101.2F and flank pain. Which of the following is the priority nursing intervention? A) Administer intravenous antibiotics B) Check baseline serum creatinine level C) Have the client strain all urine D) Obtain blood and urine cultures
Answer: A and D Rationale: Insufficient outflow most often results from constipation when distended intestines block the catheter's holes. If outflow becomes sluggish, the nurse should assess the client's bowel patterns and administer appropriate prescribed medications (Option A). The nurse should also check the tubing for kinks and reposition the client to a side-lying position or assist with ambulation (Option D). (Option B): The nurse must identify the problem before instilling additional fluids (Option C): Routine assistive measures should be performed before contacting the health care provider (Option E): The client should be placed in a side-lying position or assisted with ambulation to improve fluid flow 9% answered correctly. (YES, ONLY 9%!!)
The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient outflow. What initial actions are appropriate for the nurse to take? Select all that apply. A) Ask the date of last bowel movement and administer prescribed stool softeners B) Clamp the catheter and instill an additional 100 mL of dialysate to prime the tubing C) Contact the client's health care provider D) Examine the catheter for kinks and obstructions E) Place the client in the supine position to relieve pressure on the abdomen
Answer: C Rationale: UTI's can occur in the kidneys (pyelonephritis), bladder (cystitis), and/or urethra (urethritis). Pyelonephritis (inflammation of the kidney parenchyma) causes flank pain that is experienced in the back at the costovertebral angle (the angle between the lower ribs and adjacent vertebrae) and may spread toward the umbilicus. Cystitis alone does not cause nausea/vomiting or chills. Presence of these, fever, and signs and symptoms of a lower UTI (dysuria, urgency, and frequency) indicate pyelonephritis. (Option A): The client with a distended bladder experiences constant pain increased by any pressure over the bladder. Bladder distention is found through palpation (firmness, pain, urgency) and percussion (dullness) over the suprapubic area. (Option B): Bladder and urethral pain is usually dull and continuous and may be experienced as spasms. The detrusor muscle of the bladder may spasm if cystitis is present. (Option D): Renal colic pain (in response to renal calculi) is excruciating, sharp, and stabbing; the client would be tossing in the bed unable to find a comfortable position. Pain radiates down to the groin area as the stone travels down the ureter. 40% answered correctly
The nurse is conducting a pain assessment on a client with dysuria. Which pain description is most likely associated with pyelonephritis? A) Constant; increased by pressure over the suprapubic area B) Dull and continuous; occasional spasms over the suprapubic area C) Dull flank pain; extending toward the umbilicus D) Excruciating; sharp flank pain radiating to the groin
Answer: B Rationale: Sodium and salt should not be considered equal because the sodium content in 1 gram of sodium chloride is equivalent to 400 mg of sodium. Salt substitutes can contain potassium chloride and cause hyperkalemia. Clients with chronic kidney disease are at risk of fluid overload and hyperkalemia. To avoid these complications and prevent progressive kidney damage, clients are advised to follow certain dietary restrictions. These include the following: -Sodium restriction involves avoiding high sodium foods such as cured meats, pickled foods, canned soups, frankfurters, cold cuts, soy sauce, and salad dressings (option A) -Fluid intake must be monitored accurately and often is restricted (option D) -Potassium restrictions will vary depending on kidney function. Raw carrots, tomatoes, and orange juice are high potassium foods that clients with advanced kidney disease or on hemodialysis should avoid (option C) -Low protein diet (0.6-0.8 g/kg/day) helps prevent kidney disease progression. If the client is already on dialysis, liberal protein intake is recommended to prevent malnutrition. 67% answered correctly
The nurse is performing discharge teaching on nutritional therapy for a client with chronic kidney disease. Which statement indicates that further teaching is needed? A) "Because I have chronic kidney disease, I should avoid canned soups and cold cut sandwiches." B) "I can use a salt substitute because I am required to restrict both sodium and potassium in my daily diet." C) "I must avoid eating raw carrots and tomatoes on my salads because I take hemodialysis treatments." D) "The ice cream I eat should be counted in my daily fluid intake because it becomes liquid at room temperature."
Answer: D Rationale: Infection (peritonitis) is a major complication of peritoneal dialysis. Using sterile technique when spiking and changing bags of dialysate is a priority to avoid contamination and reduce the risk of peritonitis. (Option A): The catheter drainage bag is placed below the level of the abdomen to aid gravity in fluid outflow (effluent). The placement is important but not the highest priority. (Option B): The client is typically placed in Fowler's or semi-Fowler's position to utilize gravity. If the outflow becomes sluggish, the client can be turned from side to side to increase flow. The positioning is important but not a priority. (Option C): Cloudy effluent indicates infection, blood effluent indicates possible perforation, and brown effluent indicates suspected bowel perforation. Therefore, documenting the effluent characteristics is important but not a priority over sterile technique. 62% answered correctly
The nurse prepares to instill dialysate for a client receiving peritoneal dialysis. Which nursing action is priority? A) Ensuring that the drainage collection bag is below the level of the abdomen B) Placing the client in semi-Fowler's position C) Recording the characteristics (eg, color) of output dialysate D) Using sterile technique when spiking and attaching the bag of dialysate
Answer: A Rationale: Catheter-associated urinary tract infections are prevalent in hospital settings. Only indwelling urinary catheters should be used when appropriate. Appropriate uses include the following: -Clients with urinary obstruction or retention, or a need for strict intake and output in critically ill clients -Perioperative use for surgical procedures such as urologic surgery or prolonged surgeries, or when large doses of fluid or diuretics are given during surgery -During prolonged immobilization when bedrest is essential -To improve end-of-life comfort -To facilitate healing of an open perineal or sacral wound in incontinent clients Inappropriate uses include the following: -Convenience or replacement for nursing care when the client is elderly, confused, incontinent, or voids frequently (Options B, C, & D) -For obtaining a urine culture when the client can follow instructions and void voluntarily -Postoperatively for prolonged periods when other appropriate indications are not present 66% answered correctly
The nurse reviews a prescription to insert an indwelling urinary catheter in a hospitalized client. Which rationale for indwelling urinary catheter insertion is most appropriate? A) The client has acute urinary retention B) The client is confused and incontinent C) The client is elderly and at risk for falls D) The client is receiving intravenous diuretics