care of the patient with a urinary disorder, renal failure

ARF

-multisystemic manifestations are present, requiring multiple laboratory tests. -interventions include: -medications -nutritional promotion -bed rest -infection control -skin care

nephrotic syndrome

-a cluster of clinical findings that can occur with almost any intrinsic renal disease or systemic disease that affects the glomerulus -diabetic nephropathy is the most common cause and results in proteinuria -treated with medication and dietary modification

catheterization

-a patient should be catheterized only if necessary, because instrumentation can lead to UTI -when an indwelling catheter cannot be avoided, a closed drainage system is essential -suprapubic catheterization allows bladder drainage by inserting a catheter or tube into the bladder through a suprapubic incision or puncture

chronic renal failure and end-stage renal disease

-a progressive and irreversible deterioration in renal function taking place over months to years -the end products of protein metabolism, normally excreted in urine, accumulate in the blood -major risk factors include diabetes, hypertension, proteinuria, family history, and increasing age -virtually every body system is affected by chronic renal failure

acute renal failure

-a typically reversible clinical syndrome in which there is an abrupt loss of kidney function and GFR over a period of hours to days -types: -prerenal ARF: caused by reduced blood flow to the kidney -intrarenal ARF: the result of parenchymal damage to the glomeruli or kidney tubules -postrenal ARF: the result of an obstruction -four clinical phases of ARF: initiation of onset, oliguric, diuretic, and recovery

dysfunctional voiding patterns: urinary incontinence

-affects people of all ages but is particularly common among the elderly -usually accompanied by overactive bladder

nursing care: the patient with an indwelling catheter

-assessment of the patient and the system -prevention of infection -minimizing trauma -retraining the bladder -assisting with intermittent self-catheterization

nursing process: the patient with urinary calculi

-assessment often reveals pain, nausea, vomiting, diarrhea, and abdominal distention -goals and interventions address relief of pain, prevention of recurrence, and absence of complications

chronic glomerulonephritis

-characterized by proteinuria, usually caused by repeated episodes of glomerular injury that results in renal destruction and broad manifestations -major complication is chronic renal failure or end-stage renal disease -assessment priorities include fluid and electrolyte status, cardiac status, and neurologic status

infections of the lower urinary tract

-cystitis: inflammation of the bladder -bacterial prostatitis: inflammation of the prostate -bacterial urethritis: inflammation of the urethra -bacteria enter the urinary tract: -by the transurethral route -through the bloodstream -by means of a fistula

neurogenic bladder

-dysfunction that results from a lesion of the nervous system and leads to urinary incontinence -two types: spastic bladder and flaccid bladder -interventions include continuous or intermittent self-catheterization, use of an external condom-type catheter, a diet low in calcium to prevent calculi, and encouragement of mobility and ambulation

acute glomerulonephritis

-inflammation of the glomerular capillaries -manifestations include hematuria, edema, azotemia, and proteinuria -treatment involves protein and sodium restriction and antibiotic administration -complications include hypertensive encephalopathy, heart failure, and pulmonary edema

b) diaphoresis is associated with renal calculi.

a nurse is assisting with the admission assessment of a client who has renal calculi. which of the following findings should the nurse expect? a) bradycardia b) diaphoresis c) nocturia d) bradypnea

management of incontinence

-management depends on the type of urinary incontinence and its causes -behavioral therapies are the first choice -pharmacologic therapy works best when used as an adjunct to behavioral interventions -surgery may be indicated when behavioral and pharmacologic therapy has been ineffective -nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable

CRF and ESRD

-medications include phosphate-binding agents, calcium supplements, antihypertensive and cardiac medications, antiseizure medications, and erythropoietin. -patients require nutritional support and dialysis

2) 3) 4) 5) if outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. the drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. the connecting tubing on the peritoneal dialysis system is also checked for kinks or twisting, and the clamps on the system are checked to ensure that they are open. there is no reason to contact the nephrologist. increasing the flow rate is an inappropriate action and is unassociated with the amount of outflow solution.

the nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. the nurse would take which actions? select all that apply. 1) contact the nephrologist. 2) check the level of the drainage bag. 3) reposition the client to his or her side. 4) place the client in good body alignment. 5) check the peritoneal dialysis system for kinks. 6) increase the flow rate of the peritoneal dialysis solution.

c)

the nurse recognized that a patient with chronic kidney disease will need which hormone replaced? a) anterior pituitary b) parathyroid c) erythropoietin d) corticotropin-releasing

cancer of the bladder

-painless gross hematuria is the most common symptom -treatments include medications, radiation, or surgery -creation of a urinary diversion is often necessary: -cutaneous urinary diversion: urine drains through an opening created in the abdominal wall and skin -continent urinary diversion: a portion of the intestine is used to create a new reservoir for urine -both require vigilant nursing care

upper UTIs

-pyelonephritis: a bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys -causes are the ascending spread of bacteria from the bladder or proliferation of bacteria from systemic sources -may be acute or chronic -both require treatment with antibiotics to prevent end-stage renal disease

types of incontinence

-stress incontinence: involuntary loss of urine as a result of sneezing, coughing, or changing position -urge incontinence: the involuntary loss of urine associated with a strong urge to void -reflex incontinence: the involuntary loss of urine due to hyperreflexia -overflow incontinence: the involuntary loss of urine associated with over distention of the bladder -functional incontinence: lower urinary tract function is affected by factors such as cognitive impairment -iatrogenic incontinence: loss of urine due to extrinsic medical factors, predominantly medications

lower urinary tract infections

-symptoms include dysuria, burning on urination frequency, urgency, nocturia, incontinence, and suprapubic or pelvic pain: -older adults often have an atypical presentation -diagnosed with urine cultures and sensitivities -management includes antibiotics and patient education

urinary retention

-the inability to empty the bladder completely during attempts to void -residual urine is urine that remains in the bladder after voiding -multiple causes, so thorough assessment is necessary -complications include renal calculi, pyelonephritis, and sepsis -in the case of acute urinary retention, decompression with a urinary catheter is commonly required -nursing care aims to encourage normal voiding patterns

renal trauma

-the most common renal injuries are contusions, lacerations, ruptures, and renal pedicle injuries or small internal lacerations -even a fairly small renal laceration can produce massive bleeding -goals of management are to control hemorrhage and pain, and prevent infection, as well as to preserve and restore renal function

kidney transplantation

-the treatment of choice for most patients with ESRD -preoperative management goals include bringing the patient's metabolic state to a level close to normal, making sure that the patient is free of infection, and initiating immunosuppressants -postoperative care priorities are: -administering medications -assessing for rejection -preventing infection -monitoring urinary function

genitourinary trauma

-urethral trauma -ureteral trauma -bladder trauma -the patient with genitourinary trauma should be assessed frequently -surgery is often required: -patients can be instructed about care of the incision and the importance of an adequate fluid intake

calculi

-urolithiasis: stones in the urinary tract -nephrolithiasis: stones in the kidneys -stones are formed when urinary concentrations of calcium oxalate, calcium phosphate, and uric acid increase -signs and symptoms depend on the presence of obstruction, infection, and edema, but pain is common -medical interventions include ureteroscopy, extracorporeal shock wave lithotripsy, or endourologic stone removal

hemodialysis

-vascular access is achieved by a temporary device, an arteriovenous fistula, or an arteriovenous graft -during dialysis, the patient, the dialyzer, and the dialysate bath require constant monitoring for complications -medications, fluid balance, and nutritional needs must be addressed -the patient is at risk of several complications

2) TUR syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. the client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

a client with benign prostatic hypertrophy undergoes a transurethral resection of the prostate and is receiving continuous bladder irrigations postoperatively. which are the signs/symptoms of transurethral resection syndrome? 1) tachycardia and diarrhea 2) bradycardia and confusion 3) increased urinary output and anemia 4) decreased urinary output and bladder spasms

b)

a 42-year-old male patient complains of nausea, vomiting, and right flank pain. what is the most likely cause of these symptoms? a) interstitial cystitis b) renal colic c) ureterocele d) nephritic syndrome

b)

a 55-year-old woman reports stress incontinence when sneezing and playing tennis. she asks what she can do to prevent this from happening. which of the following is the nurse's best response? a) start an anticholinergic medication. b) void immediately prior to playing tennis to try and decrease urine loss while playing. c) decrease overall fluid intake so this is unlikely to happen at any time. d) restrict intake of calcium-containing foods. e) choose more supportive undergarments.

3) the client who experiences epididymitis from UTI needs to increase intake of fluids to flush the urinary system. because organisms can be forced into the vas deferens and epididymis from strain or pressure during voiding, the client needs to limit the force of the stream. condom use can help to prevent urethritis and epididymitis from STIs. antibiotics are always taken until the full course of therapy is completed.

a client has epididymitis as a complication of a urinary tract infection. the nurse is giving the client instructions to prevent recurrence. the nurse determines that the client needs further teaching if the client states the intention to take which action? 1) drink an increased amount of fluids. 2) limit the force of the stream during voiding. 3) continue to take antibiotics until all symptoms are gone. 4) use condoms to eliminate risk associated with chlamydia and gonorrhea.

3) an iodine-based dye may be used during the IVP and can cause allergic reactions such as itching, hives, rash, tight feeling in the throat, shortness of breath, and bronchospasm. checking for allergies is the priority. options 1, 2, and 4 are unnecessary.

a client is scheduled for intravenous pyelography. which priority nursing action would the nurse take? 1) restrict fluids. 2) administer a sedative. 3) determine if there is a history of allergies. 4) administer an oral preparation of radiopaque dye.

4) aluminum intoxication may occur when there is an accumulation of aluminum, an ingredient in many phosphate-binding antacids. it results in mental cloudiness, dementia, and bone pain from infiltration of bone with aluminum. this condition was formerly known as dialysis dementia. it may be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. it can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum.

a client with chronic kidney disease has been on dialysis for 3 years. the client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. the client now has mental cloudiness, dementia, and complains of bone pain. which do these data indicate? 1) advancing uremia 2) phosphate overdose 3) folic acid deficiency 4) aluminum intoxication

1) epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. it is used to treat anemia associated with chronic kidney disease. the normal hematocrit level is male: 42% to 52%; female: 37% to 47%. therapeutic effect is seen when the hematocrit reaches between 30% and 33%. the normal platelet count is 150,000 to 400,000 mm3. the normal blood urea nitrogen level is 10 to 20 mg/dL. the normal white blood cell count is 5000 to 10,000 mm3. platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

a client with chronic kidney disease is receiving epoetin alfa. which laboratory result would indicate a therapeutic effect of the medication? 1) hematocrit of 33% 2) platelet count of 400,000 mm3 3) white blood cell count of 6000 mm3 4) blood urea nitrogen level of 15 mg/dL

3) treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. the client is also taught to rest, increase fluid intake, and use sitz baths for comfort. antimicrobial therapy is always continued until the prescription is completely finished.

a client with prostatitis resulting from kidney infection has received instructions on management of the condition at home and prevention of recurrence. which statement indicates that the client understood the instructions? 1) stop antibiotic therapy when pain subsides. 2) exercise as much as possible to stimulate circulation. 3) use warm sitz baths and analgesics to increase comfort. 4) keep fluid intake to a minimum to decrease the need to void.

4) arterial steal syndrome results from vascular insufficiency after creation of a fistula. the client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula, which is caused by tissue ischemia. warmth, redness, and pain would more likely characterize a problem with infection. options 2 and 3 are not characteristics of steal syndrome.

a hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. the nurse monitors this client for which signs/symptoms of this disorder? 1) edema and purpura of the left arm 2) warmth, redness, and pain in the left hand 3) aching pain, pallor, and edema of the left arm 4) pallor, diminished pulse, and pain in the left hand

4) urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays. hematuria is not associated with urethritis. proteinuria is associated with kidney dysfunction.

a male client has a tentative diagnosis of urethritis. the nurse would assess the client for which manifestations of the disorder? 1) hematuria and pyuria 2) dysuria and proteinuria 3) hematuria and urgency 4) dysuria and penile discharge

a) b) c) d)

a male patient is concerned about changes to his urinary stream. which of the following are associated with lower urinary tract symptoms? select all that apply. a) urgency b) incontinence c) frequency d) dribbling e) costovertebral angle tenderness

a) the nurse should auscultate the client's lungs for pulmonary edema, which can indicate fluid overload and heart failure. b) the nurse should provide frequent mouth rinses due to uremic halitosis caused by urea waste in the blood. c) the nurse should restrict fluids based on urinary output to prevent fluid volume overload. e) the nurse should monitor for weight gain trends that can indicate fluid volume overload.

a nurse is assisting in planning of care for a client who has chronic kidney disease. which of the following actions should the nurse include in the plan of care? (select all that apply.) a) auscultate lungs for pulmonary edema. b) provide frequent mouth rinses. c) restrict fluids based on urinary output. d) provide a high-sodium diet. e) monitor for weight gain trends.

c) a nurse should check the client's level of consciousness. a rapid change in urea levels following hemodialysis can cause increased intracranial pressure and decrease the client's level of consciousness.

a nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. which of the following actions should the nurse take? a) administer an opioid medication. b) monitor for hypertension. c) check level of consciousness. d) recommend an increase in the dialysis exchange rate.

a) by reviewing the medications the client currently takes, the nurse can determine which medications to withhold until after dialysis. b) checking the AV fistula for a bruit determines the patency of the fistula for dialysis. d) measuring the client's weight before dialysis is essential for comparing it with the client's weight after dialysis. e) checking the serum electrolytes determines the need for dialysis and can help with evaluating effectiveness of the dialysis.

a nurse is caring for a client who had acute injury and is scheduled for hemodialysis. which of the following actions should the nurse take? (select all that apply.) a) review the medications the client currently takes. b) check the AV fistula for a bruit. c) calculate the client's hourly urine output. d) measure the client's weight. e) check serum electrolytes. f) use the access site area for venipuncture.

c) the greatest risk to the client is obstruction of urine flow by the renal calculus resulting in damage to the kidney. therefore, absence of urine output is the priority finding for the nurse to report to the provider.

a nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. which of the following findings is the priority for the nurse to report to the provider? a) flank pain that radiates to the lower abdomen b) client report of nausea c) absent urine output for 1 hr d) serum WBC count 15,000/mm3

d) the greatest risk to the client is injury to the renal system and sepsis from the UTI. the priority intervention is to administer antibiotics.

a nurse is caring for a client who has a urinary tract infection. which of the following is the priority intervention by the nurse? a) offer a warm sitz bath. b) recommend drinking cranberry juice. c) encourage increased fluids. d) administer an antibiotic.

a) clients who have an allergy to seafood are at higher risk for an allergic reaction to the contrast dye they will receive during the procedure. b) clients who take metformin are at risk for lactic acidosis from the contrast dye with iodine they will receive during the procedure. c) clients should receive an enema to remove fecal contents, fluid, and gas from the colon for a more clear visualization. e) clients who have asthma have a higher risk of an exacerbation as an allergic response to the contrast dye they will receive during the procedure.

a nurse is caring for a client who has type 2 diabetes mellitus and will have excretory urography. prior to the procedure, which of the following actions should the nurse take? (select all that apply.) a) identify an allergy to seafood. b) withhold metformin for 24 hr. c) administer an enema. d) obtain a serum coagulation profile. e) check for asthma.

a) the nurse should monitor serum glucose levels because the dialysate solution contains glucose. b) the nurse should monitor for a report cloudy dialysate return, which indicates infection. expected dialysate outflow is a clear, light-yellow solution. d) the nurse should monitor for shortness of breath, which can indicate inability inability to tolerate a large volume of dialysate. e) the nurse should check the access site dressing for wetness and look for kinking, pulling, clamping, or twisting of the tubing, which can increase the risk for exit-site infections.

a nurse is caring for a client who will undergo peritoneal dialysis. which of the following actions should the nurse plan to take? (select all that apply.) a) monitor serum glucose levels. b) report cloudy dialysate return. c) warm the dialysate in a microwave oven. d) monitor for shortness of breath. e) check the access site dressing for wetness. f) maintain medical asepsis when accessing the catheter insertion site.

a) a client who is at 32 weeks of gestation is at risk for developing pyelonephritis because increased pressure on the urinary system during pregnancy causes reflux or retention of urine. b) a client who has renal calculi is at risk for pyelonephritis because stones harbor bacteria. d) the client who has a neurogenic bladder can retain urine, promoting bacterial growth and causing pyelonephritis. e) the client who has diabetes mellitus is at risk for pyelonephritis because glucose in the urine promotes bacterial growth.

a nurse is caring for several clients. which of the following clients are at risk for developing pyelonephritis? (select all that apply.) a) a client who is at 32 weeks of gestation b) a client who has kidney calculi c) a client who has a urine pH of 4.2 d) a client who has a neurogenic bladder e) a client who has diabetes mellitus

d) the client in stage 3 chronic kidney disease can have a potassium level greater than 5.0 mEq/L.

a nurse is checking a client's laboratory findings. which of the following findings is expected for a client who has stage 3 chronic kidney disease? a) blood urea nitrogen 15 mg/dL b) hemoglobin 14.4 g/dL c) serum creatinine 1.1 mg/dL d) serum potassium 6.0 mEq/L

b) a positive leukocyte esterase indicates a urinary tract infection.

a nurse is checking urinalysis results for four clients. which of the following urinalysis results indicates a urinary tract infection? a) positive for hyaline casts b) positive for leukocyte esterase c) positive for ketones d) positive for crystals

d) a client who develops an allergic reaction to contrast media used during a CT of the renal pelvis can experience manifestations such as tachycardia, dyspnea, rash, and pruritus.

a nurse is collecting date from a client who has returned to the medical-surgical unit following a CT scan of the kidneys with IV contrast. which of the following findings should the nurse identify as an indication the client is experiencing an allergic reaction to the contrast material? a) bradycardia b) pink-tinged urine c) hyperpyrexia d) pruritus

a) the client requires adequate nutrition to promote healing. c) the nurse should gently palpate the costovertebral angle for flank tenderness, which can indicate inflammation and infection. d) the nurse should monitor urinary output to ensure that 1 to 3 L of urine is excreted daily. e) the nurse should administer antibiotics to treat the bacteriuria and decrease progressive damage to the kidney.

a nurse is contributing to the plan of care for a client who has chronic pyelonephritis. which of the following actions should the nurse recommend? (select all that apply.) a) assist with a referral for nutrition counseling. b) encourage daily fluid intake of 1 L. c) palpate the costovertebral angle. d) monitor urinary output. e) administer antibiotics.

a) the nurse should provide a high-protein diet to replace the high rate of protein breakdown and loss that occurs with acute kidney injury. b) the nurse should check the urine for blood, stones, and particles indicating and obstruction of the renal system. c) the nurse should check for intermittent anuria due to obstruction or damage to kidneys or urinary structures.

a nurse is contributing to the plan of care for a client who has postrenal AKI due to metastatic cancer. the client has a serum creatinine of 5 mg/dL. which of the following interventions should the nurse recommend? (select all that apply.) a) provide a high-protein diet. b) check the urine for blood. c) monitor for intermittent anuria. d) weigh the client once per week. e) provide NSAIDs for pain.

c) the nurse should ask the charge nurse to administer a fluid challenge for hypovolemia. hypovolemia can reduce blood flow to the kidneys causing low urinary output and blood pressure.

a nurse is contributing to the plan of care for a client who has prerenal acute kidney injury following abdominal aortic aneurysm repair. urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mm Hg. the nurse should anticipate which of the following interventions? a) prepare the client for a CT scan with contrast dye. b) administer ketorolac for pain. c) administer a fluid challenge. d) position the client in reverse trendelenburg.

4) decreased force in the stream of urine is an early sign of BPH. the stream later becomes weak and dribbling. the client may then develop hematuria, frequency, urgency, urge incontinence, and nocturia. if untreated, complete obstruction and urinary retention can occur.

the nurse is collecting data from a client who has had benign prostatic hyperplasia in the past. to determine whether the client is currently experiencing exacerbation of BPH, the nurse would ask the client about the presence of which early symptom? 1) nocturia 2) urinary retention 3) urge incontinence 4) decreased force in the stream of urine

a) the nurse should check the BUN and serum creatinine to determine the presence and degree of uremia or waste products that remain following dialysis. b) prior to dialysis, the nurse should withhold medications the treatment can partially dialyze. after the treatment, the nurse should administer the previously held medications. c) a client who is postdialysis is at risk for hypovolemia due to a rapid decrease in fluid volume. d) the nurse should monitor the access site for bleeding because the client receives heparin during the procedure to prevent clotting of blood.

a nurse is contributing to the plan of care for a client who received hemodialysis. which of the following interventions should the nurse recommend? (select all that apply.) a) check BUN and serum creatinine. b) administer medications the nurse withheld prior to dialysis. c) observe for manifestations of hypovolemia. d) monitor the access site for bleeding. e) measure blood pressure on the extremity with AV access.

b) the greatest risk to the client following a kidney biopsy is hemorrhage due to a lack of clotting at the puncture site. the nurse should report this finding to the provider immediately.

a nurse is monitoring a client who had a kidney biopsy for postoperative complications. which of the following complications should the nurse identify as causing the greatest risk to the client? a) infection b) hemorrhage c) hematuria d) pain

b) the nurse should begin the testing period after discarding the first voiding.

a nurse is preparing to begin a 24-hr urine collection for a client. which of the following actions should the nurse take? a) store collected urine in a designated container at room temperature. b) discard the first voiding when beginning the test. c) post a notice on the client's door regarding the testing. d) document any urine collection that was missed during the 24 hr of the testing.

a) the client should limit the intake of food high in animal protein, which contains calcium phosphate. b) the client should limit intake of sodium, which affects the precipitation of calcium phosphate in the urine. d) the client should report burning with urination to the provider because this can indicate a urinary tract infection. e) the client should increase fluid intake to 2 to 3 L/day. a decrease in fluid intake can cause dehydration, which increases the risk of calculi formation.

a nurse is reinforcing discharge instructions with a client who had spontaneous passage of a calcium phosphate renal calculus. which of the following instructions should the nurse include in the teaching? (select all that apply.) a) limit intake of food high in animal protein. b) reduce sodium intake. c) strain urine for 48 hr. d) report burning with urination to the provider. e) increase fluid intake to 3 L/day.

b) the client who has renal calculi composed of calcium oxalate should avoid intake of black tea because it is a source of oxalate. d) the client who has renal calculi composed of calcium oxalate should avoid intake of peanuts because it is a source of oxalate. e) the client who has renal calculi composed of calcium oxalate should avoid intake of spinach because it is a source of oxalate.

a nurse is reinforcing discharge teaching with a client who has spontaneously passed a calcium oxalate calculus. to decrease the chance of recurrence, the client should avoid which of the following foods? (select all that apply.) a) red meat b) black tea c) cheese d) peanuts e) spinach

d) the nurse should explain to the client that hemodialysis restores electrolyte balance by removing excess sodium, potassium, fluids, and waste products, and also restores acid-base balance.

a nurse is reinforcing teaching with a client who has chronic kidney disease and is to begin hemodialysis. which of the following information should the nurse include? a) hemodialysis restores kidney function. b) hemodialysis replaces hormonal function of the renal system. c) hemodialysis allows an unrestricted diet. d) hemodialysis returns a balance to serum electrolytes.

d) the nurse should tell the client to strain urine following the lithotripsy procedure to collect the stone fragments for laboratory analysis.

a nurse is reinforcing teaching with a client who is scheduled for extracorporeal shock wave lithotripsy. which of the following statements by the client indicates understanding of the teaching? a) "i will be fully awake during the procedure." b) "lithotripsy will reduce my chances of having stones in the future." c) "i will report any bruising that occurs to my doctor." d) "straining my urine following the procedure is important."

d) the nurse should explain to the client that a KUB can identify renal calculi, strictures, calcium deposits, and obstructions of the urinary system.

a nurse is reinforcing teaching with and client who will have an x-ray of the kidneys, ureters, and bladder. which of the following statements should the nurse include? a) "you will receive contrast dye during the procedure." b) "an enema is necessary before the procedure." c) "you will need to lie in a prone position during the procedure." d) "the procedure determines whether you have a kidney stone."

a) the client should avoid sitting in a wet bathing suit, which can increase the risk for a UTI by colonization of bacteria in a moist, warm environment. c) the client should empty the bladder when there is an urge to void. retaining urine for an extended period of time increases the risk for a UTI. e) the client should take a shower daily to promote good body hygiene and decrease colonization of bacteria in the perineal area that can cause a UTI.

a nurse is reviewing information with a female client who has frequent urinary tract infections. which of the following information should the nurse include? (select all that apply.) a) avoid sitting in a wet bathing suit. b) wipe the perineal area back to front following elimination. c) empty the bladder when there is an urge to void. d) wear synthetic fabric underwear. e) take a shower daily.

c) the nurse should identify nephrotoxic agents, such as cocaine, as a causative factor of intrarenal AKI.

a nurse is reviewing the medical record of a client who has intrarenal acute kidney injury. which of the following factors should the nurse identify as the cause of this form of AKI? a) shock b) prostate hyperplasia c) cocaine use disorder d) liver failure

b)

a patient who has been diagnosed with a small kidney stone has been told to increase fluid intake. the patient wants to know why this is necessary. what is the nurse's best response? a) "this will decrease your pain." b) "this will increase urine production and help move the stone from your system." c) "this will help pain medications work more quickly." d) "this will help prevent any nausea you are having."

c)

a sexually active, 23-year-old woman presents with a history of three UTIs in the past 12 months. what is the first step in her evaluation? a) a urine culture b) an intravenous pyelogram to look for an anatomic abnormality c) a history and physical examination d) a 3-day course of antibiotics e) a pregnancy test

2) sulfonamides can potentiate the effects of warfarin sodium, phenytoin, and orally administered hypoglycemics such as tolbutamide. when an oral anticoagulant is combined with a sulfonamide, a decrease in the anticoagulant dosage may be needed.

a sulfonamide is prescribed for a client with a urinary tract infection. during review of the client's record, the nurse notes that the client is taking warfarin sodium daily. which prescription would the nurse anticipate for this client? 1) discontinuation of warfarin sodium 2) a decrease in the warfarin sodium dose 3) an increase in the warfarin sodium dosage 4) a decrease in the usual dose of of the sulfonamide

1) if pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding would be suspected. hypotension, a decreasing hematocrit, and gross or microscopic hematuria would also indicate bleeding. signs of infection would not appear immediately after a biopsy. pain of this nature is not normal. there are no data to support the presence of renal colic.

after a renal biopsy, the client complains of pain at the biopsy site that radiates to the front of the abdomen. which would this indicate? 1) bleeding 2) infection 3) renal colic 4) normal, expected pain

2) bethanechol chloride can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. the medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

bethanechol chloride is prescribed for a client with urinary retention. which health problem would be a contraindication to the administration of this medication? 1) gastric atony 2) urinary strictures 3) neurogenic atony 4) gastroesophageal reflux

3) cyclosporine is an immunosuppressant. nephrotoxicity can occur from the use of cyclosporine. nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. the normal blood urea nitrogen level is 10 to 20 mg/dL. the normal creatinine level for a male is 0.6 to 1.2 mg/dL and for a female 0.5 to 1.1 mg/dL. cyclosporine can lower complete blood cell count levels. a normal hemoglobin is male: 14 to 18 g/dL; female: 12 to 16 g/dL. a normal hemoglobin is not an adverse effect. cyclosporine does not affect the glucose level. the normal fasting glucose is 70 to 99 mg/dL.

following kidney transplantation, cyclosporine is prescribed for a client. which laboratory result would indicate an adverse effect from the use of this medication? 1) hemoglobin level of 14.0 g/dL 2) creatinine level of 0.6 mg/dL 3) blood urea nitrogen level of 25 mg/dL 4) fasting blood glucose level of 99 mg/dL

a)

mrs. anderson has an indwelling catheter after an open cholecystectomy. she develops cramping in the suprapubic area and urinary leakage. what is the nurse's first intervention? a) make certain the catheter is not kinked b) evaluate for incisional pain c) explain that her symptoms are due to peristalsis d) irrigate the urinary catheter to assess for blockage of flow e) provide an antispasmodic medication

4) toxicity of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. drowsiness is a frequent side effect of the medication but does not indicate overdose.

oxybutynin chloride is prescribed for a client with neurogenic bladder. which sign would indicate a possible toxic effect related to this medication? 1) pallor 2) drowsiness 3) bradycardia 4) restlessness

4) the nurse would instruct the client that a reddish-orange discoloration of the urine may occur. the nurse also would instruct the client that this discoloration can stain fabric. the medication needs to be taken after meals to reduce the possibility of gastrointestinal upset. a headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

phenazopyridine hydrochloride is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. which instruction would the nurse reinforce to the client? 1) take the medication at bedtime. 2) take the medication before meals. 3) discontinue the medication if a headache occurs. 4) a reddish-orange discoloration of the urine may occur.

4) episodes of urinary retention can be triggered by certain medications such as decongestants, anticholinergics, and antidepressants. diuretics, antibiotics, and antitussives generally do not trigger urinary retention. retention can also be precipitated by other factors such as alcoholic beverages, infection, bed rest, and becoming chilled.

the client who has a cold is seen in the emergency department with an inability to void. because the client has a history of benign prostatic hyperplasia, the nurse determines that the client needs to be questioned about the use of which class of medications? 1) diuretics 2) antibiotics 3) antitussives 4) decongestants

1) 2) 3) 5) common interventions used in the treatment of epididymitis include bed rest, elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics. a heating pad would not be used because direct application of heat could increase blood flow to the area and increase the swelling.

the nurse is caring for the client with epididymitis. which treatment modalities would be implemented? select all that apply. 1) bed rest 2) sitz bath 3) antibiotics 4) heating pad 5) scrotal elevation

2) an extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. diabetic clients may require extra insulin when receiving peritoneal dialysis. peritonitis is a risk associated with breaks in aseptic technique. hyperphosphatemia is an electrolyte imbalance that occurs with renal dysfunction. disequilibrium syndrome is a complication associated with hemodialysis.

the nurse is instructing a client with diabetes mellitus about peritoneal dialysis. the nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1) peritonitis 2) hyperglycemia 3) hyperphosphatemia 4) disequilibrium syndrome

3) in an older client, the only symptom of a UTI may be something as vague as increasing mental confusion or frequent unexplained falls. frequency and urgency may commonly occur in an older client, and fever can be associated with a variety of conditions.

the nurse is monitoring an older client suspected of having a urinary tract infection for signs of infection. which sign/symptom is likely to present first? 1) fever 2) urgency 3) confusion 4) frequency

c) crackles in the lungs is suggestive of heart failure or pulmonary edema, a life threatening complication of fluid overload from oliguria or anuria of kidney failure. this requires immediate evaluation. potassium of 5.0 mEq/L is a normal value. the client who refuses a fingerstick is not unstable in this situation and will not require immediate attention. uremic waste products on the skin causing itching is an expected finding in patients with kidney failure; this does not require immediate follow up.

the nurse is receiving report on a client with AKI. what should the nurse follow up on first? a) potassium value of 5.0 mEq/L b) patient refused fingerstick blood glucose c) crackles throughout lung fields d) patient reports itching skin

2) each dose of sulfadiazine needs to be administered with a full glass of water, and the client needs to maintain a high fluid intake. the medication is more soluble in alkaline urine. the client would not be instructed to taper or discontinue the dose. some forms of sulfadiazine cause urine to turn dark brown or red. this does not indicate the need to notify the PHCP.

the nurse is reinforcing discharge instructions with a client receiving sulfadiazine. which would be included in the list of instructions? 1) restrict fluid intake. 2) maintain a high fluid intake. 3) decrease the dosage when symptoms are improving to prevent an allergic response. 4) if the urine turns dark brown, call the primary health care provider immediately.

1) 2) 4) 5) BUN testing is a frequently used laboratory test to determine renal function. the BUN and serum creatinine levels start to rise when the glomerular filtration rate decreases to less than 40% to 60%. a decreased RBC count as well as a decreased hemoglobin level may be noted if erythropoietic function by the kidney is impaired. thrombocyte cell counts do not indicate decreased renal function.

the nurse is reviewing the client's record and notes that the primary health care provider has documented that the client has a renal disorder. which laboratory results would indicate a decrease in renal function? select all that apply. 1) decreased hemoglobin level 2) elevated serum creatinine level 3) elevated thrombocyte cell count 4) decreased red blood cell count 5) elevated blood urea nitrogen level

2) risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

the nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. which health problem noted on the client's record would the nurse identify as a risk factor for this diagnosis? 1) hypoglycemia 2) diabetes mellitus 3) coronary artery disease 4) orthostatic hypotension

d)

the nurse knows that a frequent cause of white blood cells in the patient's urine is which condition? a) prostate enlargement b) hypertension c) bladder cancer d) genitourinary infection

b) e) symptoms of transplant rejection include fever, edema, weight gain, leukocytosis, tenderness of the graft site, and returning symptoms of uremia. thrill and bruit over the fistula indicate a positive outcome for the fistula. palpitations and thirst may be symptoms of fluid volume deficit, which is not found in the renal failure patient. flank pain and pyuria are symptoms of pyelonephritis.

the nurse recognizes the patient comprehends the signs and symptoms of renal transplant rejection when the patient states he will monitor for which of these signs and symptoms? select all that apply. a) thrill and bruit over the fistula b) weight gain and fever c) palpitations and thirst d) flank pain and pyuria e) swelling of the ankles and around the eyes

3) toxicity produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

the nurse who is administering bethanechol chloride is monitoring for acute toxicity associated with the medication. the nurse should check the client for which sign of toxicity? 1) dry skin 2) dry mouth 3) bradycardia 4) signs of dehydration

c)

traci, a 29-year-old married woman, frequently experiences a UTI after sexual intercourse. in addition to instruction regarding voiding after intercourse, her initial management may include which of the following? a) a recommendation for abstinence b) testing for anatomic abnormalities c) a prescription for antibiotics to be used post-coitus d) boric acid suppositories e) wipe the vagina from back to front after voiding

4) clients taking trimethoprim-sulfamethoxazole need to be informed about early signs of blood disorders that can occur from this medication. these include sore throat, fever, and pallor, and the client needs to be instructed to notify the primary health care provider if these symptoms occur. the other options do not require PHCP notification.

trimethoprim-sulfamethoxazole is prescribed for a client. the nurse would instruct the client to report which symptom if it developed during the course of this medication therapy? 1) nausea 2) diarrhea 3) headache 4) sore throat

c)

when being instructed on methods for managing the mucus in their urinary diversion, patients should be reminded to do which of the following? a) increase fiber intake b) consume high levels of citrus fruits and juices c) increase consumption of cranberry juice d) avoid caffeine consumption e) increase intake of dairy products

a) patients should avoid potassium-containing foods such as greens, citrus, banana, tomato, and cantaloupe. apples and pears are permitted on a renal diet as are proteins of high biologic value and carbohydrates such as grains.

when caring for the patient with kidney failure, the nurse teaches the patient to manage his diet by avoiding which foods? a) green leafy vegetables and citrus b) apples and pears c) proteins of high biologic value d) oat, wheat, and rye-containing products

d) the patient with nephrotic syndrome has hyperlipidemia and risk for cardiovascular disease as part of the constellation of symptoms. minimizing saturated fats is a prudent means to prevent cardiovascular disease. dark urine and clay colored stools are symptoms of gallbladder or hepatic disease. voiding every 2 hours on a schedule is useful to prevent incontinence. there are no ocular complications of nephrotic syndrome that will prevent the client from driving at night.

when caring for the patient with nephrotic syndrome, what is appropriate to include in the teaching plan to prevent long-term? a) observe for dark urine and clay-colored stool. b) void every 2 hours on schedule. c) avoid driving at night. d) minimize the intake of saturated fat.

b) while hematuria may be present in renal trauma, tachycardia and hypotension are clear symptoms of hemorrhagic shock and must be addressed immediately. the professional nurse has the skills to assist a patient who is upset. a scar on the flank represents an old wound; this is not an immediate concern.

when planning care for the patient with kidney trauma, the nurse notifies the physician immediately for which of these findings? a) laboratory reports microscopic hematuria b) tachycardia and hypotension c) patient is upset and crying d) scar noted on patient's left flank