Chapter 54 Renal and Urinary Problems

The nurse is assessing the potency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula 2. Presence of a radial pulse in the left wrist 3. Visualization of enlarged blood vessels at the fistula site 4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand

1 The nurse assesses the potency of the fistula bun palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate latency of the fistula. Enlarged visible blood vessels at the fistula site are a normal observation but are not indicative of fistula potency.

A client with a urinary tract infection is receiving ciprofloxacin by the intravenous (IV) route. The nurse appropriately administers the medication by the performing which action? 1. Infusing slowly over 60 minutes 2. Infusing in a light-protective bag 3. Infusing only through a central line 4. Infusing rapidly as a direct IV push medication

1 Ciprofloxacin is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin and skin structure. A single dose is administered slowly over 60 minutes to minimize discomfort and vein irritation. Ciprofloxacin is not light-sensitive, may be infused through a peripheral IV access, and is not give via IV push method.

A client with chronic kidney disease is receiving epoetin apfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 33% 2. Platelet count of 400,000mm3 3. White blood cell count of 6000 mm3 4. Blood urea nitrogen level of 15 mg/dL

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 42-52% in males and 37-47% in females. Therapeutic effect is seen when the hematocrit reaches between 30-33%. The normal platelet vaunt is 150,000-400,000mm3. The normal blood urea nitrogen level is 10-20. The normal WBC count is 5000-10,000. Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

The nurse is planning care for a child with hemolytic uremic syndrome who had been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? 1. Restrict fluids as prescribed 2. Care for the arteriovenous fistula 3. Encourage foods high in potassium 4. Administer analgesics as prescribed

1 Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms.

The nurse receives a call from a client concerned about eliminating borne-colored urine after taking nitrofurantoin for a urinary tract infection. The nurse should make which appropriate response? 1. "Continue taking the medication; the brown urine occurs and is not harmful" 2. "Take magnesium hydroxide with your medication to lighten the urine color" 3. "Discontinue taking the medication and make an appointment for a urine culture" 4. "Decrease your medication to hold the dose, because your urine is too concentrated"

1 Nitrofurantoin imparts a harmless brown color to the urine and the medication should not be discontinued until the prescribed dose is completed. Magnesium hydroxide will not affect urine color. In addition, antacids should be avoided because they interfere with medication effectiveness.

The nurse is reviewing a client's record and notes that the primary health care provider has documented that the client has chronic kidney disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Increased number of white blood cells in the urine

1 The creatinine level is the most specific laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost.

The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? 1.Fever, diarrhea, groin pain, and ecchymosis 2. Nausea, painful scrotal edema, and ecchymosis 3. Fever, nausea, vomiting, and painful scrotal edema 4. Diarrhea, groin pain, testicular torsion, and scrotal edema

3 Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection, although sometimes is can be caused by trauma.

A client is admitted to the emergency department following a fall from a horse, and the primary health care provider (PHCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action. 1.Notify the PHCP before performing the catheterization 2.Use a small-sized catheter and an anesthetic gel as a lubricant 3. Administer parenteral pain medication before inserting the catheter 4. Clean the meatus with soap and water before opening the catheterization kit

1 The preens of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the PHCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. Check the level of the drainage bag 2. Reposition the client to her or his side 3. Place the client in good body alignment 4. Check the peritoneal dialysis system for kinks 5. Contact the primary health care provider (PHCP) 6. Increase the flow rate of the peritoneal dialysis solution

1, 2, 3, 4 If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the side or making sure that the Clint is in good body alignment may assist with outflow drainage. The drainage bad needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing, and peritoneal dialysis system are 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 PHCP.

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? Select all that apply. 1. Pallor 2. Edema 3. Anorexia 4. Proteinuria 5. Weight loss 6. Decreased serum lipids

1, 2, 3, 4 Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mol/L). The nurse should plan which actions as a priority? Select all that apply. 1. Place the client on a cardiac monitor 2. Notify the primary health care provider (PHCP) 3. Put the client on NPO (nothing by mouth) status except for ice chips 4. Review the client's medications to determine whether any contain or retain potassium 5. Allow an extra 500mL of intravenous fluid intake to dilute the electrolyte concentration

1, 2, 4 Normal potassium is 3.5-5. A potassium level of 7 is elevated. The pt is at risk for developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the PHCP and also review medications to determine whether any contain potassium or are potassium retaining.

The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? Select all that apply. 1. Hemodialysis 2. Peritoneal dialysis 3. Kidney transplant 4. Bilateral nephrectomy 5. Intense immunosuppression therapy

1, 3, 4 Polycystic kidney disease is a genetic familial disease in which the kidneys enlarge with cysts that rupture and scare the kidney, eventually resulting in end-stage real disease. Treatment options include hemodialysis or kidney transplant. Clients usually undergo bilateral nephrectomy to remove the large, painful, cyst-filled kidneys.

A client with chronic kidney disease being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardia, pale, and anxious, and the nurse suspects air embolism. What are the priority nursing actions? Select all that apply. 1. Administer oxygen to the client 2. Continue dialysis at a slower rate after checking the lines for air 3. Notify the primary health care provider (PHCP) and Rapid response team. 4. Stop dialysis and turn the client on the left side with head lower than feet 5. Bolus the client with 500mL of normal saline to break up the air embolus

1, 3, 4 The pt experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, position the client so the air embolus is in the right side of the heart, notify the PHCP and Rapid Response Team, and administer oxygen as needed.

Bethanechol chloride is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this mediation? 1. Gastric atony 2. Urinary strictures 3. Neurogenic atony 4. Gastroesophageal reflux

2 Bethanechol chloride can be hazardous 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. Evaluation of pressure within the urinary tract could damage or rupture the bladder in clients with these conditions.

The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole. Which instruction should be included in the list? 1. Advise that sunscreen is not needed 2. Drink 8-10 glasses of water per day 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 (PHCP) immediately

2 Each dose of trimethoprim-sulfamethoxazole should be administer with a full glass of water, and the client should maintain a high fluid intake to avoid crystalluria. The medication is more soluble in alkaline urine.

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis? 1. "His pediatrician said his kidneys are working well" 2. "I noticed his urine was the color of cola lately" 3. "I'm so glad they didn't find any protein in his urine" 4. "The nurse who admitted my child said his blood pressure was low"

2 Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised.

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention? 1. Cover the bladder with petroleum jelly gauze 2. Cover the bladder with a non adhering plastic wrap 3. Apply sterile distilled water dressings over the bladder mucosa 4. Keep the bladder tissue dry by covering it with dry sterile gauze

2 In bladder exstrophy, the bladder is exposed and external to the body. In the disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a non adhering plastic wrap. The use of petroleum jelly cause should be avoided, because this type of dressing can dry out, adhere to the mucous, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucous when removed.

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension 2. Generalized edema 3. Increased urinary output 4. Frank, bright red blood in the urine

2 Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the mediation is effective based on which observation? 1. Urine is clear amber 2. Urination is not painful 3. Urge incontinence is not present 4. A reddish-orange discoloration of the urine is present

2 Phenazpyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination. It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber. It does not treat urge incontinence. It will cause the client to have reddish-orange discoloration of the urine, but this is a side effect of the medication, not the desired effect.

The nurse is instructions a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client 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 syndrom

2 An extended dwell time increases the risk fo hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetes clients may require extra insulin when receiving peritoneal dialysis.

The nurse is providing dietary instructions to a client who has been prescribed cyclosporine. Which food item should the nurse instruct the client to exclude from the diet? 1. Red meat 2. Orange juice 3. Grapefruit juice 4. Green, leafy vegetables

3 A compound present in grapefruit juice inhibits metabolism of cyclosporine through the cytochrome P450 system. As a result, consumption of grapefruit juice can raise cyclosporine levels 50-100%, thereby greatly increasing the risk of toxicity. Red meats, orange juice, and green leafy vegetables do not interact with cytochrome P450 system.

The nurse is reviewing lab reports for a client receiving tacrolimus. Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Potassium level of 3.8 mEq/L 2. Platelet count of 300,000 mm3 3. Fasting blood glucose of 200mg/dL 4. White blood cell count of 6000mm3

3 A fasting blood glucose level of 200mg/dL is significantly elevated above the normal range of 70-99mg/dL and suggests an adverse effect. Recall that fasting blood glucose levels are sometimes based on primary heath care provider preference. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; gastrointestinal effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia.

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 101.2 F. Which nursing action is most appropriate? 1. Encourage fluid intake 2. Continue to monitor vital signs 3. Notify the primary health care provider 4. Monitor the site of the shunt for infection

3 A temperature of 101.2 F is significantly elevated and may indicate infection. The nurse should notify the primary health care provider (PHCP). Dialysis clients can not have fluid intake encouraged. Vital sign sand the stung site should be monitored, but the PHCP should be notified first.

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assess the client to determine a history of which condition? 1. Pyelonephritis 2. Glomerulonephritis 3. Trauma to the bladder or abdomen 4. Renal cancer in the client's family

3 Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are this not applicable to the client described in this question.

The nurse, who is administering bethanechol chloride, is monitoring for cholinergic overdose associated with the medication. The nurse should check the client for which sign of overdose? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration

3 Cholinergic overdose of bethanechol chloride produced manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Remember that the sympathetic nervous system speeds the heart rate and the cholinergic nervous system speeds the heart rate. Treatment includes supportive measures and the administration of atropine sulfate (Anticholinergic) subcutaneously or intravenously.

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 m/dL 3. Blood urea nitrogen level of 25 mg/dL 4. Fasting blood glucose level of 99 mg/dL

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 10-20 mg/dL. The normal creatinine level for a male is 0.6-1.2 mg/dL and for a female is 0.5-1.1 mg/dL. Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is 14-18 g/dL for a male and 12-16 g/dL for a female. A normal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The normal fasting glucose is 70-99mg/dL.

The nurse collects a urine specimen preoperatively from a child with episadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which should the nurse most likely expect to note? 1. Hematuria 2. Proteinuria 3. Bacteriuria 4. Glucosuria

3 Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorm of the penis. This anatomical characteristic facilitates entry of bacteria into the urine.

A week after kidney transplantation, a client develops a temperature of 101 F, the blood pressure is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The z-ray indicated that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment? 1. Antibiotic therapy 2. Peritoneal dialysis 3. Removal of the transplanted kidney 4. Increased immunosuppression therapy

4 Acute rejection most often occurs within 1 week after transplantation but can occur any time post-transplantation. Clinical mainfestations include fever, malaise, elevated white blood cell count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Treatment consists of increasing immunosuprresive therapy.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptoms if it develops during the course of this medications therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4 Clients taking trimethoprim-sulfamethoxazole should be informed about early signs and symptoms of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the Clint should be instructed to notify the primary health care provider (PHCP) if these occur.

The nurse provided discharge instructions to the parents of a 2-year-old child who had an orchiopexy to correct cryptorchidism. Which statement by the parents indicated the need for further instruction? 1. "I'll check his temperature" 2. "I'll give him medication so he'll be comfortable" 3. "I'll check his voiding to be sure there's no problem" 4. "I'll let him decide when to return to his play activities"

4 Cyrptorchidism is a condition in which 1 or both testes fail to descend through the intgional canal into the scrotal sac. surgical correction may be necessary. All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury. This prevents dislodging of the suture, which is internal. parent should be taught to monitor the temperature, provide analgesics as needed, and monitor the urine output.

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptoms of benign prostatic hyperplasia? 1. Nocturia 2. Scrotal edema 3. Occasional constipation 4. Decreased force in the stream of urine

4 Decreased force in the stream of urine is an early symptoms of benign prostatic hyperplasia. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and noctuid. If untreated, complete obstruction and urinary retention can occur.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating level of consciousness, and twitching

4 Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes form the blood during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

The nurse is performing an assessment on a client has returned from the dialysis unit following hemodialysis. The client is complaining of heachace and nausea and is extremely restless. Which is the priority nursing action? 1. Monitor the client 2. Elevate the head of the bed 3. Assess the fistula site and dressing 4. Notify the primary health care provider (PHCP)

4 Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome, and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation.

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bad. Which assessment finding indicates the need to notify the primary health care provider (PHCP)? 1. Red, bloody urine 2. Pain rated as 2 on a 0 to 10 pain scale 3. Urinary output of 200mL higher than intake 4. Blood pressure, 100/50mm Hg, pulse 130 beats per minute

4 Frank bleeding (arterial or venous) may occur during the first day after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200mL more than intake is adequate. A client pain rating of 2 on a scale of 0-10 indicated adequate pain control. A rapid pulse with a low blood pressure is a potential sign excessive blood loss. The PHCP should be notified.

Which question should the nurse ask the parents of a cild suspected of having glomerulonephritis? 1. "Did your child fall off a bike onto the handlebars?" 2. "Has the child had persistent nausea and vomiting?" 3. "Has the child been itching or had a rash anytime in the last week?" 4. "Has the child had a sore throat or a throat infection in the last few weeks?"

4 Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A B-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a child becomes ill. with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1-2 weeks.

The nurse is reviewing a treatment plan with the parents of a newborn wit hypospadias. Which statement by the parents indicates their understanding of the plan? 1. "Caution should be used when straddling my infant on a hip" 2. "Vital signs should be taken daily to check for bladder infection" 3. "Catheterization will be necessary when my infant does not void" 4. "Circumcision has been delayed to save tissue for surgical repair"

4 Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant should not be circumcised, because the dorsal foreskin tissue will be used for surgical repair of the hypospadias.

A 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 should be questioned about the use of which medication? 1. Diuretics 2. Antibiotics 3. Antilipemics 4. Decongetants

4 In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These mediations lessen the voluntary ability to contract the bladder.

A 7-year-old child is seen in a clinic, and the pediatrician documents a diagnosis of nighttime (notional) enuresis. The nurse should provide which information to the parents? 1. Nighttime (nocturnal) enuresis does not respond to treatment 2. Nighttime (nocturnal) enuresis is caused by psychiatric problem 3. Nighttime (nocturnal) enuresis requires surgical intervention to improve the problem 4. Nighttime (nocturnal) enuresis is usually outgrown without therapeutic intervention

4 Nighttime (nocturnal) enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrow bedwetting without therapeutic intervention. The child id unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.

Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints? 1. The client may have contacted the flu 2. The client is experiencing anaphylaxis 3. The client is experiencing expected effects of the medications 4. The client is experiencing a pulmonary reaction requiring cessation of the medication

4 Nitrofurantoin can induce two kinds of pulmonary reactions: acute and subacute. Acute reactions, which are most common, manifest with dyspnea, chest pain, chills, fever, cough, and alveolar infiltrates. These symptoms resolves 2-4 days after discontinuing the medication.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complications? 1. Warmth, redness, and pain in the left hand 2. Ecchymosis and audible bruit over the fistula 3. Edema and reddish discoloration of the left arm 4. Pallor, diminished pulse, and pain the left hand

4 Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia/ Warmth and redness probably would characterize a problem with infection. Ecchymosis and a bruit are normal finding for a fistula.

Tacrolimus is prescribed for a client who underwent a kidney transplant. Which instruction should the nurse include when teaching the client about this medication? 1. Eat at frequent intervals to avoid hypoglycemia 2. Take the medication with a full glass of grapefruit juice 3. Change positions carefully due to risk of orthostatic hypotension 4. Take the oral medication every 12 hours at the same time every day

4 Tacrolimus is a potent immunosuppressant used to prevent organ rejection in transplant client. It is important that medication be taken at 12-hour intervals to maintain a stable blood level to prevent organ rejection. Adverse effects include hyperglycemia and hypertension, so the client does not eat frequently to avoid hypoglycemia or use precautions to avoid orthostatic hypotension. Tacrolimus is metabolized through the cytochrome P450 system, so grapefruit juice is not allowed.

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder? 1. Soft and swollen prostate gland 2. Swollen and boggy prostate gland 3. Tender and edematous prostate gland 4. Tender, indurated prostate gland that is warm to the touch

4 The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder.

Oxybutynin chloride is prescribed for a client with urge incontinence. Which sign would indicate a possible toxic effect related to this medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness

4 Toxicity (overdosage) of oxybutynin 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 overdosage.

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? 1. Hematuria and pyuria 2. Dysuria and proteinuria 3. Hematuria and urgency 4. Dysuria and penile discharge

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.

A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis. The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply. 1. Peritoneal dialysis 2. Analysis of the urinary stone 3. Intravenous opioid analgesics 4. Insertion of a nephrostomy tube 5. Placement of a ureteral stent with ureteroscopy

4, 5 Urolithiasis is the condition that occurs when a stone forms in the urinary system. Hydronephrosis develops when the stone has blocked the ureter and urine backs up and dilates and damages the kidney. Priority treatment is to allow the urine to drain and relive the obstruction in the ureter. This is accomplished by placement of a percutaneous nephrostomy time to drain urine from the kidney and planet of a urinary stent to keep the ureter open.