Urinary Elimination PrepU
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?
Glomerulonephritis
Sympathomimetics have which of the following effects on the body?
Relaxation of bladder wall
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:
"As the disease progresses, you will most likely require renal replacement therapy."
The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective?
"My urine will be eliminated through a stoma."
The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL?
1,000 mL
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:
1,500 mL of fluid
Diagnostic indicators of chronic glomerular nephritis are a urine specific gravity of __________, variable proteinuria, and urinary casts.
1.010
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?
Administration of sodium polystyrene sulfonate [Kayexalate])
What is the term for the concentration of urea and other nitrogenous wastes in the blood?
Azotemia
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has?
Calcium
Urinary tract infections increase with age and disability. The nurse is aware that the elderly often fail to exhibit the typical symptoms of a UTI. Therefore, a urine culture and sensitivity should be obtained. What bacteria would the nurse expect to find to help confirm the diagnosis of a UTI?
Escherichia coli
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
In the diuresis period of AKI, the nurse should observe the patient closely for what complication?
Dehydration
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
Dehydration
An elderly client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?
Detects calculi, cysts, or tumors
Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply.
Disturbed body image Risk for impaired skin integrity Deficient knowledge: management of urinary diversion
Ms. Linden is in end-stage chronic renal failure and is being added to the transplant list. You are explaining to her how donors are found for clients needing kidneys. You would be accurate in telling her which of the following?
Donors are selected from compatible living donors.
A major goal when caring for a catheterized patient is to prevent infection. Select all the nursing actions that apply.
Empty the collection bag at least every 8 hours to reduce bacterial growth. Wash the perineal area with soap and water at least twice daily. Suspend the drainage bag off the floor.
A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?
Encouraging intake of at least 2 L of fluid daily
A chronic renal failure client complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
Hyperphosphatemia
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?
Hypovolemic shock caused by hemorrhage
Which of the following is a characteristic of the intrarenal category of acute renal failure?
Increased BUN
A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?
Kidney
The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output?
Less than 400 mL
Mr. Jarvis's renal failure has become chronic. You are seeing him in clinic and he discusses the various signs and symptoms he is experiencing. Select all of the following which you know to be associated with chronic renal failure.
Lethargy Muscle cramps Bleeding of the oral mucous membranes
The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?
Location of discomfort
A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex incontinence. The nurse understands that this is most likely due to:
Loss of motor control of the detrusor muscle.
Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?
Low purine
A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation?
Need to urinate after engaging in sexual intercourse
Treatment of metabolic acidosis in chronic renal failure includes:
No treatment
When assessing the impact of medications on the etiology of ARF, the nurse recognizes which of the following as the drug that is not nephrotoxic?
Penicillin
The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following?
Peritonitis
Which of the following medications may be ordered to relieve discomfort associated with a UTI?
Phenazopyridine (Pyridium)
Which of the following medications maybe ordered to relieve discomfort associated with a urinary tract infection?
Phenazopyridine (Pyridium)
Which of the following is the hallmark of the diagnosis of nephrotic syndrome?
Proteinuria
Which of the following terms is used to refer to inflammation of the renal pelvis?
Pyelonephritis
A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms?
Pyridium
Which of the following nursing actions is most important in caring for the client following lithotripsy?
Strain the urine carefully for stone fragments.
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 assessing the client's ileal conduit stoma in the clinic. Which assessment finding would be of greatest concern to the nurse?
The stoma is dusky red.
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
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
Urine output of 20 ml/hour
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
Urine output of 250 ml/24 hours
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?
Wear a mask when performing exchanges.
The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication?
With food
A dialysis client is prescribed erythropoietin (Epogen) to treat anemia associated with end-stage renal disease. The client weighs 147 lbs. The order is for Epogen 50 units/kg subcutaneously 3 times per week. The pharmacy supplied Epogen 3000 units/ml. How many milliliters will the nurse administer to the client? Round to the nearest tenth.
1.1
The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find?
Pyuria
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 ml. Urine output that's less than 50 ml in 24 hours is known as:
anuria
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:
fatigue and weakness.
Rejection of a transplanted kidney within 24 hours after transplant is termed
hyperacute rejection.
The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium?
Citrus fruits
A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered?
Cloudy urine
Which laboratory value supports a diagnosis of pyelonephritis?
Pyuria
Bladder retraining following removal of an indwelling catheter begins with
instructing the patient to follow a 2 to 3 hour timed voiding schedule.
The nurse is participating in a bladder retraining program for a patient who had an indwelling catheter for 2 weeks. The nurse knows that, during this process, straight catheterization, after catheter-free intervals, can be discontinued when residual urine is:
less than 100 ml
If an indwelling catheter is necessary, the nursing interventions that should be implemented to prevent infection include
performing meticulous perineal care daily with soap and water.
Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as:
Bladder retaining
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?
A GFR of 30-59 mL/min/1.73 m2
A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?
Acute Pain
A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following?
Kayexalate
The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern?
New diagnosis of urosepsis
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?
Oliguria
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?
Painless hematuria
Ms. Simpson, age 72 years, is being seen in the clinic with a suspected bladder tumor. These tumors occur more frequently in men than women and usually affect clients 50 years of age and older. Use of tobacco products is the leading cause of bladder cancer. You are asking Ms. Simpson about symptoms that she has had that brought her to the clinic. What is the most common first symptom of a malignant tumor of the bladder?
Painless hematuria
A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. Which of the following signs/symptoms is diagnostic for bladder cancer?
Painless, gross hematuria
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
Recent history of streptococcal infection
A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal?
Relieve the pain.
One of the roles of the nurse in caring for the clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include teaching which of the following?
Restricting sources of potassium usually found in fresh fruits and vegetables
Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis?
Risk for infection
Which of the following is a reversible cause of urinary incontinence in the older adult?
Constipation
An investment banker, with chronic renal failure, informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse?
"This type of dialysis will provide more independence."
A client presents at the clinic with complaints of urinary retention. What question should the nurse ask to obtain additional information about the client's complaint?
"When did you last urinate?"
The nurse is employed in an urologist office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence?
Anticholinergic
A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?
Application of an ostomy pouch
Which of the following terms is used to describe the concentration of urea and other nitrogenous wastes in the blood?
Azotemia
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
Check for thrill or bruit over the access site.
A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective?
Cipro
The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client?
Coffee
A client is prescribed amitriptyline, an antidepressant for incontinence. The nurse understands that this drug is an effective treatment because it:
Increases bladder neck resistance.
A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?
Increasing fluid intake to 3 L/day
A female client who suffers from urethral strictures undergoes a dilation procedure. Following the procedure, she experiences a burning sensation while voiding. Which of the following instructions would be most helpful?
Instruct her to take warm sitz baths.
A 44-year-old client is in the hospital unit where you practice nursing. From the results of a series of diagnostic tests, she has been diagnosed with acute glomerulonephritis. What would you expect to find as a result of this condition?
Proteinuria
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client?
SpO2 at 90% with fine crackles in the lung bases
The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections?
Urethra
A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate I can't control it, and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence?
Urge
A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?
Urinary calculi
Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis?
Blurred vision
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?
Brief, hot daily showers
The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include?
Change in cognitive functioning
The nurse working with a patient after an ileal conduit notices that the pouching system is leaking small amounts of urine. The appropriate nursing intervention is which of the following?
Change wafer and pouch.
