EAQ Renal
The health care provider prescribes 1 L of intravenous (IV) fluid to infuse over 4 hours for a client admitted for a urinary tract infection and hyponatremia. The tubing drop factor is 10 drops/mL. At what rate should the nurse infuse the medications?
42 drops/min
During an eight-hour shift a client has a 6-ounce cup of tea and 360 mL of water; the client vomits 100 mL, and the intravenous (IV) fluids instilled equaled the urinary output. What is this client's fluid balance at the end of this eight-hour period that the nurse must document on the client's intake and output record?
440mL
A client has a permanent colostomy. During the first 24 hours there is no drainage from the colostomy. The nurse concludes that this is a result of the:
Absence of intestinal peristalsis
After a transurethral vaporization of the prostate, the client returns to the unit with an indwelling urinary catheter and a continuous bladder irrigation. The client puts the call light on to report the need to urinate. What should the nurse do first?
Assess that the tubing attached to the collection bag is patent
A nurse is caring for a client who had a kidney transplant. What sign indicates that the client may be rejecting the transplanted kidney?
Fever
A client will be taking nitrofurantoin (Macrobid) 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client?
Increase the intake of fluids
A nurse is notified that the latest potassium level for a client in acute renal failure is 6.2 mEq. What action should the nurse take?
Take vital signs and notify the primary health care provider
A client is to have hemodialysis. What must the nurse do before this treatment?
Weight the client to establish a baseline for later comparison
A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information?
Low calcium
A client is at high risk for developing ascites because of cirrhosis of the liver. How should the nurse assess for the presence of ascites?
Percuss the client's abdomen and listen for dull sounds
A client with chronic kidney disease has been on hemodialysis for two years. The client relates to a nurse in the dialysis unit in an angry, critical manner and frequently does not follow the prescribed diet or take prescribed medications. What does the nurse identify as the most likely underlying cause of this behavior?
A defense against underlying depression and fear
After a transurethral resection of the prostate, a client has a three-way indwelling catheter inserted with a continuous bladder irrigation. The client complains of a need to void. What should the nurse do first?
Check the tubing connected to the client's collection bag to see if it is draining
A client with a history of chronic kidney disease is hospitalized. The nurse assesses the client for signs of related kidney insufficiency, which include:
Edema and pruritus
A nurse is evaluating a client's understanding of peritoneal dialysis. Which information in the client's response indicates an understanding of the purpose of the procedure?
Remove toxins in addition to other metabolic wastes
The nurse reviews the medical records of four male clients and concludes that the client that is at highest risk of developing prostate cancer is the:
Black 55-year-old
A nurse is assessing the urine of a client with a urinary tract infection. What appearance should the nurse expect this client's urine to have?
Cloudy
After a successful kidney transplant for a client with end-stage kidney disease, the nurse anticipates that laboratory studies will demonstrate:
Decreasing serum creatinine
A client is receiving furosemide (Lasix) to relieve edema. The nurse should monitor the client for which response to the medication?
Excessive loss of potassium ions
Before a client with syphilis can be treated, what should be determined?
Existence of allergies
A nurse is caring for a client with a diagnosis of cancer of the prostate. The nurse should teach the client that which serum level will be monitored throughout the course of the disease?
Prostate-specific antigen (PSA)
A client who is diagnosed with sexual dysfunction makes a comment to the nurse, "Well, I guess my sex life is over." What is the most appropriate response by the nurse?
"You are concerned about your sex life?"
A client is waiting for a kidney transplant. What explanation should the nurse include when teaching the client about the transplant?
"You will require immunosuppressive drugs daily for the rest of your life."
The nurse is caring for a client admitted for a severe kidney infection and hyponatremia. The health care provider prescribes ceftriaxone (Rocephin) 1 gram to be administered intravenously over 30 minutes. The intravenous (IV) piggyback contains 50 mL. The IV tubing drop factor is 15 drops/mL. At what rate should the nurse infuse the medication?
25 drops/min
A client with chronic renal failure has been on hemodialysis for two years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely:
A defense against underlying depression and fear
A client with lymphosarcoma is receiving allopurinol (Zyloprim) and methotrexate (Rheumatrex). The nurse can help the client prevent complications related to uric acid nephropathy by administering the:
Allopurinol and encouraging the intake of fluid
A client who is pregnant and expecting a boy asks the nurse when mature sperm cells form. The nurse bases her response on the knowledge that spermatogenesis occurs:
At the time of puberty
A nurse is assessing the urine of a client with a urinary tract infection. For which characteristic should the nurse assess each specimen of urine?
Clarity
A client who had a lithotripsy for a renal calculus is to be discharged from the hospital. What should the nurse include in the home care instructions?
Drink at least 3 L of fluid daily for four weeks
A client is scheduled to receive intravenous (IV) fluids to be delivered at 80 mL/hr. To adjust the drip rate when administering the IV via gravity, the nurse must determine the:
Drops per milliliter delivered by the infusion set
A nurse assesses a newly admitted client with renal colic to determine the signs and symptoms that are present. The nurse assesses the client for which primary subjective symptom?
Flank discomfort
A nurse teaches a client who is scheduled for a kidney transplant about the need for immunosuppressive medications. The nurse determines that the client understands the teaching when the client states, "I must take these medications:
For the rest of my life."
The nurse recalls that what scientific principle is basic to caring for a client with an indwelling urinary catheter?
Gravity
A client with acute glomerulonephritis complains of thirst. The most appropriate item that the nurse can offer to relieve the client's thirst is:
Hard candy
A client is admitted to the hospital with a diagnosis of cancer of the liver with ascites and is scheduled for a paracentesis. What nursing intervention is appropriate to include in the client's plan of care?
Having the client void before the procedure
A client with chronic kidney disease is scheduled to begin peritoneal dialysis. When discussing the procedure, the nurse explains that the purpose of the dialysis is to:
Help do some of the work usually done by the kidneys
A client is admitted to the hospital with a ureteral calculus. The nurse expects what urinary clinical findings?
Hematuria with sharp pain when voiding
A nurse reviews the history of a client who is hospitalized with a diagnosis of urinary calculi and identifies that which factor may have contributed to the development of the calculi?
History of hyperparathyroidism
A client who just had a kidney transplant is transferred from the postanesthesia care unit (PACU) to the intensive care unit (ICU). The nurse in the ICU should monitor the client's urinary output every:
Hour
Which is the most serious complication for which the nurse must monitor a client with kidney failure?
Hyperkalemia
A client with ascites is scheduled to have a paracentesis. What should the nurse include in the plan of care?
Instruct the client to urinate before the procedure
A client experiences difficulty in voiding after an indwelling urinary catheter is removed. The nurse determines that this difficulty most likely is related to:
Interruption in previous voiding habits
A nurse is administering gold salts to a client with the diagnosis of rheumatoid arthritis. For which adverse effect of this drug should the client be monitored?
Kidney damage
A client in a nursing home is diagnosed with urethritis. What should the nurse plan to do before initiating antibiotic therapy prescribed by the health care provider?
Obtain a urine specimen for culture and sensitivity
A nurse is caring for an older bedridden male client who is incontinent of urine. What nursing intervention is the most satisfactory initial approach to managing urinary incontinence?
Offering the urinal regularly
A nurse is monitoring a client with renal failure for signs of fluid excess. Which finding does the nurse identify as inconsistent with fluid excess?
Orthostatic hypotension
The nurse is caring for a client in the postanesthesia care unit. The client had a suprapubic prostatectomy for cancer of the prostate and has a continuous bladder irrigation in place. The purpose of this irrigation is to:
Prevent the development of clots in the bladder
A nurse is teaching the importance of annual physical examinations to an adult health and wellness class. The nurse reinforces that it is important for men who are middle-aged and older to have what laboratory test annually?
Prostate-specific antigen (PSA)
A nurse is counseling a woman who had recurrent urinary tract infections. What factor should the nurse explain is the reason why women are at a greater risk than men for contracting a urinary tract infection?
Proximity of the urethra to the anus
A client with ascites has a paracentesis, and 1500 mL of fluid is removed. For what immediate response is it most important for the nurse to monitor?
Rapid, thready pulse
A client has a heminephrectomy and returns from the postanesthesia care unit with a nephrostomy tube and an indwelling urinary catheter. The client's urinary output is 50 mL/hr. What is the nurse's next action?
Record the findings
A client is transferred to the postanesthesia care unit after undergoing a pyelolithotomy. The client's urinary output is 50 mL/hr. The nurse should:
Record the output as an expected finding
A client is diagnosed as having invasive cancer of the bladder and radiation therapy is scheduled. What should the nurse expect the client to demonstrate that indicates success of radiation therapy?
Shrinkage of the tumor on scanning
A client with a history of excessive alcohol use develops hepatic portal hypertension and an elevated serum aldosterone level. For which complications should the nurse assess this client?
Sodium retention and fluid accumulation
In teaching a class about sexually transmitted diseases, the nurse discusses signs and symptoms associated with each and effects of delaying treatment. During the discussion, gummas, which are tumors that break and ulcerate, and mental and physical disability were described. Which disease is associated with this process?
Syphilis
A nurse is providing client teaching to a woman who has recurrent urinary tract infections. Which information should the nurse include concerning the reason why women are more susceptible to urinary tract infections than men?
The length of the urethra
A client who has repeated episodes of cystitis is scheduled for a cystoscopy to determine the possibility of urinary tract abnormalities. The client asks the nurse to describe the procedure. The nurse's most appropriate response is, "This procedure is:
The visualization of the inside of the bladder with an instrument connected to a source of light."
When assessing a client during peritoneal dialysis, a nurse observes that drainage of the dialysate from the peritoneal cavity has ceased before the required volume has returned. What should the nurse instruct the client to do?
Turn from side to side
The nurse provides discharge instructions to a male client who had a ureterolithotomy. The client has a history of recurrent urinary tract infections (UTIs). The teaching should include that indicators of a UTI are:
Urgency or frequency of urination
The laboratory values of a client with renal calculi reveal a serum calcium within expected limits and an elevated serum purine. The nurse concludes that the stone probably is composed of:
Uric acid
A client who is recovering from deep partial-thickness burns develops chills, fever, flank pain, and malaise. The health care provider makes a tentative diagnosis of urinary tract infection. Which diagnostic tests should the nurse expect the health care provider to prescribe to confirm this diagnosis?
Urinalysis and urine culture and sensitivity
The nurse is caring for a client that weighs 90 kilograms. The nurse is determining the client's response to fluid replacement therapy. The clinical finding that indicates adequate tissue perfusion to vital organs is:
Urinary output of 60mL/hr
To help prevent a cycle of recurring urinary tract infections, the nurse should plan to instruct a female client to:
Urinate as soon as possible after intercourse
A nurse is caring for a client with an indwelling urinary catheter. What is the most important action for the nurse to implement when irrigating the bladder?
Use sterile equipment
A client is scheduled for a transurethral resection of the prostate. What should the nurse tell the client to expect after surgery?
"An indwelling urinary catheter is required for at least a day."
A nurse is caring for a client who is scheduled to have a paracentesis. Immediately before the procedure, the nurse asks the client to void because a full bladder:
Increases the danger of puncture during the procedure
The nurse is providing education to a client who is scheduled for a transurethral microwave thermotherapy (TUMT) of the prostate. What would be appropriate to include in the postoperative teaching plan?
Initially, an indwelling urinary catheter will be in place.
A client is admitted to the hospital with a diagnosis of cirrhosis of the liver with ascites. What should the nurse do when preparing this client for a paracentesis?
Instruct the client to empty the bladder
A client has been admitted with a urinary tract infection. The nurse receives a urine culture and sensitivity report that reveals the client has vancomycin resistant entercoccus (VRE). After notifying the health care provider, which action should the nurse take to decrease the risk of transmission to others?
Move the client to a private room
A client with chronic kidney disease is on a restricted protein diet. The nurse provides teaching about high biologic-value (HBV) protein foods. An understanding of the rationale for this diet is demonstrated when the client states that HBV protein foods are:
Necessary to prevent muscle wasting
When a client returns from the postanesthesia care unit after a kidney transplant, the nurse should plan to measure the client's urinary output every:
One hour
What is the most basic method the nurse can use when encouraging hospitalized clients to void?
Providing privacy
A nurse administers trimethoprim-sulfamethoxazole (Bactrim) to a client diagnosed with a urinary tract infection. What should the nurse monitor to determine the therapeutic effectiveness of the drug?
White blood cell (WBC) count
A client with tuberculosis is started on a chemotherapy protocol that includes rifampin (RIF). The nurse evaluates that the teaching about rifampin is effective when the client states:
"I can expect my urine to turn orange from this medication."
A client who is dehydrated is to receive an intravenous (IV) solution of normal saline to be infused at 175 mL/hr. The drop factor of the IV set is 15 gtts/mL. At what drop rate should the nurse adjust the flow to provide the prescribed solution? Record your answer using a whole number. ___gtts/min
44gtts/min
An older adult client is demonstrating mild confusion after surgical repair of a hernia. What should the nurse do to provide for this client's safety?
Activate the position-sensitive bed alarm.
A client develops kidney damage as a result of a transfusion reaction. What is the most significant clinical response that the nurse should assess when determining kidney damage?
Decreased urinary output
A nurse is caring for a client with acute kidney failure who is receiving a protein restricted diet. The client asks why this diet is necessary. What information should the nurse include in a response to the client's questions?
This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.
A 40-year-old client scheduled for a hemicolectomy because of ulcerative colitis asks if having a hemicolectomy means wearing a pouch and having bowel movements in an abnormal way. Which is the best response by the nurse?
"No, only part of the colon is removed and the rest reattached."
Before a transurethral resection of the prostate (TURP), a client asks about what to expect postoperatively. The most appropriate response by the nurse is:
"There will be an indwelling urinary catheter and a continuous bladder irrigation in place."
A client with renal colic is scheduled for extracorporeal shock-wave lithotripsy. The night before the procedure, the client puts the call light on frequently and has many demands. Which would be an appropriate statement for the nurse to make?
"You are facing a new experience tomorrow; tell me what concerns you have."
A client is taught how to change the dressing and how to care for a recently inserted nephrostomy tube. On the day of discharge the client states, "I hope I can handle all this at home; it's a lot to remember." The best response by the nurse is:
"You seem to be nervous about going home"
A female client has a history of frequent urinary tract infections (UTIs). To decrease the incidence of the infections, the nurse instructs the client to increase fluid intake and:
Empty the bladder every three hours
A nurse administers sodium polystyrene sulfonate (Kayexalate) to a client with chronic renal failure. Which finding provides evidence that the intervention is effective?
Potassium decreases to 4.2mEq/L
A client with a urinary retention catheter reports discomfort in the bladder and urethra. What should the nurse do first?
Check the patency of the catheter
The primary health care provider prescribes furosemide (Lasix) 80 mg by mouth daily. Before administering the furosemide, it is most important for the nurse to:
Check the potassium lab results
A nurse is reviewing the laboratory reports of a client with a diagnosis of end-stage renal disease. What test result should the nurse anticipate?
Potassium of 6.3 mEq/L
A client was treated with a radium implant for cancer of the cervix. What information is important for the nurse to teach the client when giving discharge instructions?
Return for follow-up care
The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. The nurse concludes that the presence of what substance in the urine needs to be reported to the health care provider?
Large proteins
At 10 AM the nurse hangs a 1000 mL bag of D5W with 20 mEq of potassium chloride to be administered at 80 mL/hr. At noon the health care provider prescribes a stat infusion of an intravenous (IV) antibiotic of 100 mL to be administered via piggyback over one hour. How much later than expected will it take the primary bag to empty if the nurse interrupts the primary infusion to use the circulatory access for the secondary infusion of the antibiotic?
One hour
A client seeks help for dealing with incontinence. A nursing intervention is to teach Kegel exercises. These exercises are often beneficial in treatment for this type of incontinence:
Stress incontinence
What should the nurse do to obtain an accurate urine output for a client with a continuous bladder irrigation (CBI)?
Subtract the volume of irrigant from the total drainage
