Comp. NCLEX Review Ch. 59 - Renal or Genitourinary Disorders

Which discharge instructions would the nurse give to a client who will receive an aminoglycoside antibiotic at home to address the risk of nephrotoxicity? Select all that apply: 1. increase fluid intake to 2000-2500 mL fluid daily 2. report sudden weight gain or puffy eyes 3. don't be concerned w/edema as a normal side effect 4. elevated blood pressure is an expected drug effect 5. eat a low protein diet while taking this antibiotic

1, 2. The client should maintain a fluid intake of 2000 to 2500 mL per day to reduce the risk of nephrotoxicity. To detect nephrotoxicity early, the client should report signs of edema. Edema is not a normal side effect of the medication. To reduce the risk of nephrotoxicity, the client should report hypertension. It is unnecessary to eat a low protein diet while taking an aminoglycoside antibiotic

Which statements by a female client indicate that instruction in ways to prevent UTI was understood? Select all that apply: 1. "I should avoid tub baths and take showers instead." 2. "I should drink 8 to 10 glasses of fluid per day." 3. "I should only wear nylon underpants." 4. "I should void every 6 hours while I am awake." 5. "I should use powder or talc to aid in keeping the perineal skin dry."

1, 2. Tub baths can promote migration of bacteria in the lower urinary tract; the client should shower instead. Maintaining an intake of 8 to 10 glasses of fluid daily will help prevent UTI. Cotton underpants are best, and nylon should be avoided because synthetic fibers retain body moisture and irritate the perineal area, which can promote the growth of bacteria. Emptying the bladder every 2 to 4 hours while awake is recommended to prevent urinary stasis. Powder or talc can be irritating to perineal skin and should be avoided

A child has been admitted with acute glomerulonephritis (AGN). All of the following tests are positive for AGN. The nurse concludes that which laboratory test is most indicative of this disease? 1. elevated antistreptinolysin O (ASO) titers 2. elevated erythrocyte sedimentation rate (ESR) 3. presence of hematuria according to urinalysis 4. elevated creatinine concentrations

1. An elevated ASO titer indicates a recent streptococcal infection, which is a precursor to AGN. An elevated ESR indicates inflammation in the body and is associated with many diseases. Hematuria is simply blood in the urine, which has many possible causes. Creatinine concentrations reflect the functioning of the kidney

The mother of a child at the renal clinic asks why a radiological evaluation is performed on all children who have had one documented UTI. What information would the nurse include as the best explanation for use of X-ray? 1. it rules out structural abnormalities 2. it confirms the absence of bacterial colonies after antimicrobial therapy 3. it determines which kidney was infected 4. it determines the probability of the infection recurring

1. Radiological evaluations done after a documented UTI in children reveal structural abnormalities in 1-2% of girls and 10% of boys. Radiological tests cannot confirm bacterial colonies, determine the site of an old infection, or help predict whether infection will reoccur

Which statements by a client who has received a renal transplant indicates that the desired outcome of discharge teaching has been met? Select all that apply: 1. "I will double my prednisone dose if my urine output is less than 300 mL/day." 2. "I will need to avoid crowds and prevent infection." 3. "Now I can eat whatever I want as long as I watch how much salt I use." 4. "Since I have not yet rejected the transplant, I never have to worry about rejection anymore." 5. "I should check my temperature and report increases to the physician."

2, 5. Clients with renal transplant need to be on long-term immunosuppressive drugs that predispose them to infection. The client must verbalize factors that potentially expose him to infection. Self-monitoring of temperature helps the client detect signs of rejection early that can be reported to the physician. The client must adhere to medication doses prescribed by the physician. Dietary restrictions for sodium must be discussed with the physician and the dietician. The success of transplantation is not guaranteed and the client could experience signs of rejection after discharge.

A child has been admitted to the unit with nephrotic syndrome. In talking with the mother, she reports that a cousin had acute glomerulonephritis (AGN) last year. The mother asks how these two disease compare, as they both affect the kidneys. The nurse's response would include which piece of information? 1. both disorders produce smoky colored urine 2. both disorders cause greatly reduced urine output 3. both disorders have a genetic basis 4. both disorders require treatment with antibiotic therapy

2. Both AGN and nephrotic syndrome are characterized by a reduction in urine output. AGN presents with smoky urine while the urine in nephrotic syndrome is clear and frothy. AGN is a postinfectious disease with no genetic basis. Antibiotics are not used in nephrotic syndrome

Which laboratory data is the most accurate indicator that a client with acute renal failure has met the expected outcomes? 1. decreasing blood urea nitrogen (BUN) levels 2. decreasing serum creatinine 3. decreasing neutrophil count 4. decreasing lymphocyte count

2. Creatinine is the metabolic end product of creatine phosphate and is excreted via the kidneys in relatively constant amounts. BUN, a measurement of the nitrogen portion of urea, is also excreted in urine and is a good indicator of renal function. However, conditions that increase protein catabolism also cause a rise in BUN levels. Therefore, the serum creatinine levels are more appropriate to evaluate in determining the return of renal function. Neutrophils and lymphocytes are not used to monitor the return of renal function

In a child with acute renal failure, the nurse would help to prevent hyperkalemia by limiting which foods in the child's diet? 1. grains, cheese, & citrus fruits 2. potatoes, tomatoes, & oranges 3. cereals, processed sugars, & wheat 4. rice, leafy green vegetables, & carbonated beverages

2. Potatoes, tomatoes, and oranges have a high level of potassium content. The others have less potassium in them

A client w/urinary tract infection (UTI) is precribed phenazopyridine (Pyridium). Which instruction would the nurse give the client? 1. "This drug will take care of the infection causing your symptoms." 2. "Your urine may turn reddish orange and may cause staining of your clothes." 3. "Take the drug before meals to minimize GI symptoms." 4. "Always keep this drug and use it at the first symptom of UTI."

2. The drug makes the urine reddish orange in color, and the client should be advised that this might stain the underwear and other clothing. The client should also be reassured that it should not be confused with blood in the urine. Phenazopyridine does not target the cause of the infection. Taking the drug after meals minimizes GI symptoms associated with the use of this drug. Indiscriminate use of a urinary analgesic can mask symptoms and delay initiation of treatment.

A client w/a urinary diversion device has the nursing diagnosis Risk for Impaired Skin Integrity. Which interventions will the nurse use with this client? Select all that apply: 1. change urine collection device every other day 2. teach self-catheterization technique 3. empty the bag reservoir every 2 hours 4. monitor for foul-smelling urine 5. ensure appliance wafer is not more than 1/8 inch larger than stoma

3, 5. Emptying the reservoir bag every 2 hours prevents overfilling and possible leakage of urine into the skin surface. Ensuring that opening is not more than 1/8 inch larger than stoma reduces the risk of skin irritation and breakdown from urine on the skin. The urine collection device should be changed as needed to maintain integrity of the system. Self- catheterization is not appropriate for this nursing diagnosis. Monitoring for foul-smelling urine and monitoring for signs of infection are more appropriate interventions for the diagnosis risk for infection

Which statement made by a client w/polycystic kidney disease indicates that the desired outcome has been met? 1. "I know these drugs will make the cysts disappear." 2. "the development of renal failure with this disease is very rare." 3. "I will have my family seek genetic counseling and screening." 4. "I sure am glad that hemodialysis will shrink the cysts."

3. Adult polycystic kidney disease is an autosomal-dominant disorder, and the client should be advised to have family members screened for the disease. The cysts will not disappear. Eventually, clients with this disease require dialysis or transplantation because of renal failure. The management of clients with polycystic kidney disease is mainly supportive and not curative

A client with chronic renal failure asks the nurse why he is anemic. What response by the nurse is best? 1. "The increased metabolic waste products in your body depress the bone marrow." 2. "We will need to review your dietary intake of iron-rich foods." 3. "There is a decreased production by the kidneys of the hormone erythropoietin." 4. "It is most likely that you have hereditary traits for the development of anemia."

3. Anemia is common in clients with renal failure because of decreased production of erythropoietin by the kidneys and shortened RBC life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs. Metabolic wastes do not depress the bone marrow. Anemia is common in clients with renal failure but is not caused by iron deficiency. Heredity does not play a role in anemia associated with renal failure.

A client w/renal calculi is advised to restrict calcium in the diet. The nurse determines that the client understands the restriction when the client states to avoid which types of food? 1. chicken, beef, & salmon 2. green vegetables, fruit, & legumes 3. chocolate, smoked fish, & low-fat milk 4. eggs, meat, & poultry

3. Chocolate, smoked fish, milk products, beans, lentils, and dried fruits are high in calcium. In calcium phosphate and calcium oxalate calculi, dietary management includes an acid-ash diet and limiting foods high in calcium and oxalate. The other foods listed may be consumed as desired.

A client with end-stage renal disease (ESRD) is to be admitted to the hospital because of shortness of breath. The serum potassium level is 7.0 mEq/L. What appropriate hospital unit should this client be admitted to? 1. A semiprivate room in a medical surgical unit. 2. A private room in a medical surgical unit 3. A nursing unit with continuous cardiac monitoring 4. A nursing unit for ventilator-assisted clients

3. Clients with potassium levels of 6.5 and greater are predisposed to develop cardiac arrhythmias, muscle cramps, and gastrointestinal symptoms. The client should be admitted to a nursing unit with telemetry or cardiac monitoring capabilities because of the risk of developing life-threatening cardiac dysrhythmias. Typical ECG abnormalities associated with hyperkalemia are prolonged PR interval; wide QRS; tall, tented T-wave; and ST segment depression. Major cardiac dysrhythmias common in clients with highly elevated potassium levels include heart block, ventricular standstill, and ventricular fibrillation. A semi-private room may not necessarily have cardiac monitoring. A private room is not necessary. The client does not need to be admitted to a unit with ventilated clients

A client with chronic renal failure has fluid volume excess. The laboratory report indicates the sodium level to be 120 mEq/L. The nurse interprets this as which of the following? 1. an elevated sodium level that must be reported immediately to the physician 2. an error in the laboratory analysis 3. a possible hemodilution effect secondary to excessive water retention 4. an expected reduced number of sodium ions in clients with chronic renal failure

3. Clients with renal failure retain sodium, and any decrease in the serum level (normal 135-145 mEq/L) will most likely be caused by hemodilution from the excessive fluid retention. A sodium level of 120 mEq/L is significantly lower than normal. There is no reason to conclude there is a laboratory error. Clients with renal failure retain sodium, and the number of sodium ions would be expected to increase if there was not a corresponding increase in fluid retention

A client in the intensive care unit develops prerenal failure following surgery. Which of the following causes should the nurse suspect? 1. vascular disease 2. urethral obstruction 3. hypovolemia 4. glomerulonephritis

3. Prerenal failure is caused by factors such as hypovolemia and decreased cardiac output that reduce renal blood flow and perfusion. Vascular disease may be a factor in the development of intrarenal failure. Urethral obstruction can cause postrenal failure. Glomerulonephritis may be a factor in the development of intrarenal failure

The nurse is explaining the process of peritoneal dialysis to a client who recently developed renal failure. Which statement would the nurse include in a discussion with the client? 1. "the solutes in the dialysate will enter the bloodstream through the peritoneum." 2. "the peritoneum is more permeable because of the presence of excess metabolites." 3. "the peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." 4. "The metabolites will move from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration."

3. The peritoneum acts as a semipermeable membrane, allowing substances to move from an area of high concentration (the blood) to an area of lower concentration (the dialysate). Metabolic waste products and excess water can be eliminated through osmosis and diffusion utilizing the peritoneum as the semipermeable membrane

A male client who presents to the emergency department w/coffee-colored urine and edema states he has a sore throat a few weeks ago. His blood pressure is elevated, and urinalysis shows blood and protein in the urine. The nurse interprets that this clinical picture is consistent w/which developing health problem? 1. urinary tract infection 2. urinary calculi 3. acute glomerulonephritis 4. acute prostatitis

3. The symptoms are typical of acute glomerulonephritis. Hematuria and proteinuria are caused by a damaged glomerular capillary membrane, which allows blood cells and proteins to escape into the renal filtrate. A urinary tract infection usually manifests with signs of infection including fever, malodorous urine, frequency, and urgency. Clients with urinary calculi usually present with renal colic. Prostatitis, or inflammation of the prostate gland, has presenting symptoms similar to a urinary tract infection

The nurse is caring for an adult client with poor urine output. The nurse would report to the health care provider if the client had a urine output less than how many milliliters per hour for 2 consecutive hours? Provide a numerical answer

30 mL The minimal urine output by the kidneys per hour is 30 mL. It is prudent for the nurse to report a drop below this amount if it persists for 2 hours or longer so that corrective treatment can be undertaken

The nurse caring for a client undergoing a hemodialysis procedure places high priority on evaluating the client frequently for what common complication during the treatment? 1. hyperglycemia 2. infection & fever 3. dialysis dementia 4. hypotension

4. Hypotension is the most common complication during hemodialysis and is related to several factors, including changes in serum osmolality and rapid removal of fluid from the intravascular compartment. Hyperglycemia could occur in peritoneal dialysis because of the glucose composition of the dialysate. Infection and fever should be an ongoing assessment, not just when the client is undergoing hemodialysis. Dialysis dementia is a progressive, long-term complication

Which statement made by a client w/chronic renal failure and who is on hemodialysis indicates the need for further teaching? 1. "I will report any increase in my weight of 5 pounds in a 2-day period." 2. "I take my prescribed antihypertensive drugs daily." 3. "I am careful to take precautions in the arm with the AV fistula." 4. "I comply with salt restrictions in my diet by using salt substitutes."

4. Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases in weight do need to be reported to the health care provider as a possible indication of fluid volume excess. The control of hypertension is essential in the management of a client with renal failure. An AV fistula does need to be protected from injury that could be caused by constricting clothing, venipunctures, and other items.

A child is being treated for nephrotic syndrome. The nurse has told the mother that it is important to keep the child's skin clean and dry. When the mother asks why, what rationale would the nurse include in the response? 1. the skin is fragile secondary to electrolyte deficiency 2. frequent urination may leave moisture on the skin that predisposes to breakdown 3. dietary restrictions make fighting infection hard 4. the condition causes a reduction of gamma globulin in the body

4. Nephrotic syndrome involves the loss of protein in the urine. Gamma globulins, which help the body fight infections, are proteins. There is no electrolyte deficiency. The child is oliguric and therefore does not urinate frequently. The only restrictions on the child's intake are fluid and perhaps sodium

What type of renal failure would the nurse expect to see in a client who overdosed accidentally on tobramycin (Nebcin)? 1. prerenal failure 2. postrenal failure 3. extrarenal failure 4. intrarenal failure

4. Nephrotoxic drugs, such as aminoglycoside antibiotics (tobramycin), can damage the nephrons and cause intrarenal (within the kidneys) failure. Prerenal causes of renal failure include any condition that reduces the blood flow to the kidney, such as heart failure, shock, and other conditions. Postrenal failure can be caused by conditions that obstruct urine outflow in the lower urinary system. There is no condition called extrarenal failure

In conducting client teaching w/a client who will undergo peritoneal dialysis at home, the nurse includes discussion of what common & significant complication of peritoneal dialysis? 1. pulmonary embolism 2. hypotension 3. dyspnea 4. peritonitis

4. Peritonitis is a grave complication of peritoneal dialysis, caused by bacteria that may enter through the catheter or dialysate solution. Hypotension is a common complication of hemodialysis but not peritoneal dialysis. Pulmonary embolism and dyspnea are not common complications of peritoneal dialysis

A client is scheduled for a partial nephrectomy. In teaching the client about postoperative care, the nurse uses which rationale to explain why aggressive measures are needed to prevent atelectasis & pneumonia? 1. nephrectomy involves paralyzing the intercostal muscles 2. intraoperative surgical contamination of the pulmonary structures is unavoidable 3. the client must be maintained in a flat position for 24 hours 4. the surgery involve an upper abdominal or flank incision

4. The proximity of the incision to the muscles involved in breathing and coughing makes the client breathe shallowly and avoid coughing because of the fear of pain. This can lead to atelectasis and pneumonia. The intercostal muscles are not paralyzed by nephrectomy. Pulmonary structures are not contaminated during surgery. The client should be turned and repositioned to reduce the risk of atelectasis and pneumonia. There is no need to lie flat for 24 hours

The nurse is preparing to admit a client w/urge incontinence. In writing the nursing care plan, the nurse writes interventions that target which manifestation? 1. involuntary loss of urine w/out warning or stimulus 2. loss of urine when coughing or sneezing 3. inability to empty bladder 4. inability to inhibit urine flow long enough to reach the toilet

4.Urge incontinence is the unpredictable passage of urine soon after a strong urge to void is felt. Total incontinence is involuntary loss of urine without warning or stimulus. Stress incontinence is loss of urine when intra-abdominal pressure rises, such as with coughing or sneezing. Urinary retention is an inability to empty the bladder