Renal System
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication?
Decrease in the blood flow through the kidneys
ADH effects
Effects: Reabsorption of water (and only water) in distal convoluted tubules and collecting ducts
An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:
Encourage high fluid intake.
Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to:
Encourage high fluid intake.
A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patient's care, the nurse should be aware of the consequent risk of what complication?
An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the bladder, which increases the potential of a urinary tract infection. Older male patients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure, and urinary tract infections.
Aldosterone Stimuli
Angiotensin 2
Which instruction should a nurse give to a client who has a history of urinary tract infection to prevent recurrence?
Wipe from front to back. Encourage fluids throughout the day. Finish all antibiotic prescribed.
When the bladder contains 400 to 500 mL of urine, this is referred to as
functional capacity.
A kidney biopsy has been scheduled for a client with a history of acute kidney injury. The client asks the nurse why this test has been scheduled. What is the nurse's best response?
"A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."
The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother?
"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."
A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate?
"Keep your showers brief, patting your skin dry after showering."
A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult?
"Remember to drink frequently, even if you don't feel thirsty."
When fluid intake is normal, the specific gravity of urine should be:
1.010 to 1.025
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of:
1500 mL A 1-kg weight gain is equal to 1,000 mL of retained fluid.
A child needs to collect urine for 24 hours. The nurse explains to the parents and child that this test assesses glomerular filtration rate and how the kidneys are functioning. What results would be expected in this type of test?
A 24-hour urine collection is performed to obtain information about the creatinine clearance.
The nurse is completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom?
A dull sound when percussing over the bladder indicates a full bladder.
The nurse is admitting a client who is to undergo an open renal biopsy. About which of the following comments by the client should the nurse be most concerned?
A renal biopsy is an invasive procedure, whereby a small incision is made. Coumadin (warfarin) is an anticoagulant, and taking it places the client at increased risk for bleeding complications.
Urinary tract infections are usually successfully treated by what means?
Administering antibiotics
A patient is having a problem with retention of urine in the bladder. Which of the following diagnostic tests measures the amount of residual urine in the bladder?
Bladder ultrasonography
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL
Which of the following urine characteristics would the nurse anticipate when caring for a client whose lab work reveals a high urine specific gravity related to dehydration?
Concentrated urine (one with a high specific gravity) is a dark amber color due to the solutes in the urine. Clear or yellow urine indicates a flushing of the urinary system. Red urine indicates hematuria. A turbid urine may indicate bacteriuria.
A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure?
Encouraging fluid intake after dinner
The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group?
Enuresis
A client is being treated for AKI and the client daily weights have been ordered. The nurse notes a weight gain of 3 pounds (1.4 kg) over the past 48 hours. What nursing diagnosis is suggested by this assessment finding?
Excess Fluid Volume If the client with AKI gains or does not lose weight, fluid retention should be suspected. Short-term weight gain is not associated with excessive caloric intake or a sedentary lifestyle. Failure to thrive is not associated with weight gain.
A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include?
Excess fluid volume related to generalized edema
A client is being discharged with a diagnosis of toxic shock syndrome. What would be the priorityfor the nurse to teach the client?
Finishing all prescribed antibiotic therapy is the priority teaching intervention when discharging a client with toxic shock sydrome. Recurrence is possible, so it is vital that all medications be completed withing the prescribed time frame.
When describing the functions of the kidney to a client, which of the following would the nurse include?
Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.
An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect?
Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days).
A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching?
Immunosuppression is common after a kidney transplant.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?
Increased serum creatinine level
The nurse is caring for a client who describes changes in his voiding patterns. The client states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesn't seem to be much urine flow." What would the nurse expect this client's physical assessment to reveal?
Increased urinary urgency and frequency coupled with decreasing urine volumes strongly suggest urine retention.
The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. The nurse tells the caregiver that the most important reason the child needs increased fluids is to:
Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder.
A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect?
Infection
A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action?
Inform the health care provider and assess the client for signs of infection.
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test?
Monitor the client for an allergy to iodine contrast material.
The nurse is taking a history from an adolescent girl with suspected pelvic inflammatory disease (PID). What data will be most helpful in determining this girl's risk factors for PID?
Number of sexual partners Multiple sexual partners are a risk factor for PID. Race, age, and age at first menses are not considered risk factors for PID.
A client, aged 75, is diagnosed with a renal disease and administered nephrotoxic drugs in normal doses. The nurse is aware that it is important to observe the client closely for any changes in renal status. Which of the following measures may help a nurse determine a change in renal status?
Observing the client's urinary output.
The nurse is caring for a 9-month-old with cryptorchidism noted on the medical record. In which manner will the nurse assess this condition?
Palpate the scrotum for the testes
A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event?
Postinfectious causes of postinfectious glomerular disease are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks.
The nurse is caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur?
Postprocedural management is directed at relieving any discomfort resulting from the examination. Some burning upon voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected.
Retention of which electrolyte is the most life-threatening effect of renal failure?
Potassium
Effects of ANP/BNP
Reduces sodium (puts sodium into the urine) and fluid reabsorption + suppresses renin/aldosterone/ADH; these are KING!
Antidiuretic hormone (ADH) - what secretes it?
Secreted by the posterior pituitary
The nurse is caring for a 10-year-old boy with end-stage renal disease (ESRD) with metabolic acidosis. What would the nurse expect to administer if ordered?
Sodium bicarbonate tablets
What is used to decrease potassium level seen in acute renal failure?
Sodium polystyrene sulfonate
aldosterone effects
Sodium reabsorption in exchange for potassium or hydrogen ion in the collecting ducts; AND absorption of water
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
A 16-year-old adolescent tells the nurse about having severe dysmenorrhea. Which action would be the best health teaching measure?
Take over-the-counter ibuprofen for its prostaglandin action.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
Tall, peaked T waves
The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis?
Tea-colored urine
To prevent further urinary tract infections in a preschooler, what measures would you teach her mother?
Teach her to wipe her perineum front to back after voiding.
A nursing student asks the nurse why older adults are at risk for renal disease. The best response by the nurse is:
The GFR decreases 1 ml/min per year beginning between the ages of 35 and 40 years.
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:
The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what topic?
The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or stress.
The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to do what?
The nurse ensures that the client is protected from exposure to infection by hospital staff, visitors, and other clients with active infections. Careful handwashing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the client is receiving high doses of immunosuppressants. Visitors may be limited, but are not normally barred outright. Ensuring kidney function is vital, but does not prevent infection.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning.
The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician?
The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill.
A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing?
The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.
The nurse is reviewing the causative organisms noted on laboratory reports. Which organism is transmitted solely by sexual contact?
The organism transmitted solely by sexual contact is Trichomonas. The other organisms are causes of various infections and acquired in various ways.
A client has just completed a renal biopsy. Which manifestation should be given priority attention?
The presence of voiding is a priority after a renal biopsy to prevent blood clotting and blocked urine flow.
An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, what would lead the nurse to suspect that the adolescent has candidiasis?
Thick, white cheese-like discharge
The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document?
Urinary urgency
spec gravity values and meanings
Urine specific gravity is a measurement of the kidney's ability to concentrate urine; levels between 1.010-1.025 are considered normal. The specific gravity of water is 1.000. A urine specific gravity less than 1.010 may indicate overhydration. A urine specific gravity greater than 1.025 may indicate dehydration.
The nurse is working with a child with altered genitourinary status. Which intervention would be included in the plan of care for the client with excess fluid volume?
Weigh the child daily on the same scale.
what secretes aldosterone
adrenal cortex
As women age, many experience an increased sense of urgency to void, as well as an increased risk of incontinence. This is usually the result of age-related changes in which part of the renal system?
bladder
Which term describes painful or difficult urination?
dysuria
The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse recalls that several substances are filtered from the blood by the glomerulus and these substances are then excreted in the urine. The nurse identifies the presence of which substances in the urine as abnormal findings?
glucose/protein
Antidiuretic hormone (ADH) Stimuli for secretion
high plasma osmolarity
Natriuretic hormones/peptides (ANP, BNP) Stimuli forsecretion
if the heart chambers are getting stretched d/t increased venous volume return
A client is having a blood urea nitrogen (BUN) test. BUN level is:
increased in renal disease and urinary obstruction.
The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess?
leukocyte count
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:
microorganism transfer.
The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is:
obtaining a clean catch voided urine.
A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:
renal calculi.
An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to:
take the child to a private room and interview her regarding her sexual history and partners.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula?
"A vein and an artery in your arm will be attached surgically."
A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client?
"Do you have any allergies?"
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse?
"Even a perfect match does not guarantee organ success."
A 45-year-old man with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis?
"Hemodialysis is a treatment option that is usually required three times a week."
The nurse is caring for a client who underwent a kidney transplant. The client appears anxious and tearful and states, "My body is going to reject the new kidney; I know I'm going to die." What is the best response by the nurse?
"I understand your concerns, let's talk about them."
A female adolescent comes to the clinic for an evaluation. Assessment reveals a possible urinary tract infection. What would the nurse expect to be done to confirm this suspicion?
A urinary tract infection is diagnosed by a urine culture. A kidney, ureter, and bladder x-ray would provide information about the size and contour of the kidneys. An ultrasound can detect differing sizes of kidneys or ureters and help to differentiate between solid or cystic kidney masses. An intravenous pyelogram provides information about the collecting systems of the kidney and ureters.
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?
Azotemia
intrarenal causes of AKI?
Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated?
The specific gravity will be high.
The nurse is providing preprocedure teaching about an ultrasound. The nurse informs the client that in preparation for an ultrasound of the lower urinary tract the client will require what?
Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedure.
