EXAM 2: NCLEX (Renal, GI, Neuro)

Characteristic of Hematuria:

cola-colored urine from blood

A pt that presents w/UTI s/s may be experiencing what:

frequency, urgency, suprapubic pain, dysuria, hematuria, fever, confusion in older adult

if UTI is suspected how many mls of fluid should the RN encourage daily?

3000 ml unless contraindicated ie CHF pt

Common test for renal caliculi?

CT scan

If Macrobid causes pulmonary side effects such as SOB, cough, etc when will they subside?

2-3 days after stopping

Physical Assessment of Renal System- AUSCULTATION:

AUSCULTATION: With a stethoscope the abdominal aorta and renal arteries are auscultated for a bruit (an abnormal murmur), which indicates impaired blood flow to the kidneys.

While taking Cipro or Levaquin if you experience dizziness, light sensitivity or light-headedness what might this indicate:

CNS toxicity

Macrobid may be used for tx of UTI, why?

it acts as a disinfectant in the urinary tract but is not effective outside of the UT

If pt is undergoing shockwave therapy as tx for stones what is an important teaching?

push fluids - stones will be broken up into sandlike particles

While taking Bactrim what side effect would be a concern:

sore throat

what symptom is different for older pts suffering from UTI?

they are more likely to present with confusion and not abd pain.

If pt is scheduled for an IVP what allergy should you assess for?

allergy to iodine or seafood

a pt who is being prescribed TMP-SMZ should be assessed for what allergy?

allergy to sulfas

T or F Macrobid should be given with milk?

True

Physical Assessment of Renal System- URODYNAMIC TESTS:

URODYNAMIC TESTS: study the storage of urine within the bladder and the flow of urine through the urinary tract to the outside of the body.

TMP-SMZ(Bactrim) may be prescribed for a pt with what?

UTI

Uric acid stone (excess purine) would require what kind of diet?

alkaline ash

Most important assessment if pyleonephritis is suspected?

check temperature

calcium rich foods include:

dairy products, lentils, fish w/ fine bones, dried fruits, nuts, chocolate, cocoa, Ovaltine

oxalate rich foods include:

dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans, chocolate, instant coffee, Ovaltine, tea, worcestershire sauce

S/s of pyleonephritis are the same as UTI except for ____

flank pain and/or pain at the costovertebral angle

Characteristic of Proteinuria:

foamy urine due to excess protein

What is glomerulonephritis?

-loss of kidney function -acute lasts 5-21 days -chronic after acute phase or slowly over time

Physical Assessment of Renal System- CREATININE CLEARANCE:

CREATININE CLEARANCE: Because almost all creatinine in the blood is normally excreted by the kidneys, creatinine clearance is the most accurate indicator of renal function. The result of a creatinine clearance test closely approximates that of the GFR.

A nurse is preparing to administer an I.M. injection in a client with a neuro/paralytic injury. Which muscle is best to use in this case? 1) Deltoid 2) Dorsal gluteal 3) Vastus lateralis 4) Ventral gluteal

RATIONALE: 1) IM injections should be give in the deltoid muscle in clients with neuropathic/ paralytic and spinal cord injuries. These clients exhibit reduced use of - and consequently reduced blood flow to - muscles in the buttocks (dorsal gluteal and ventral gluteal) and legs (vastus lateralis). Decreased blood flow results in decreased drug absorption.

A nurse is caring for a client with renal calculi. Which drug does the nurse expect the physician to order? 1) Opioids analgesics 2) Nonsteroidal anti-inflammatory drugs 3) Muscle relaxants 4) Salicylates

RATIONALE: 1) Opioid analgesics are usually needed to relieve the severe pain of renal calculi. NSAIDs and Salicylates are used for their anti-inflammatory and antipyretic properties and to treat less severe pain. Muscle relaxants are typically used to treat skeletal muscle spasms.

Bacterium most commonly causing UTI's?

E.coli

Common interventions related to: UTI/ Cystitis

Empty bladder/bowel regularly & completely; Avoid stagnant urine in the bladder or urethra. Drink water prior to intercourse to promote urination & empty bladder after intercourse. Clean perineal area: front to back. Drink large amt fluids daily.

s/s of pyleonephritis:

HA, increased BP, facial/periorbital edema, lethargic, low grade temp, wt gain (edema), and protein-, hema-, olgi-, dys- uria

The nurse is assessing a client who reports painful urination during and after voiding. The nurse suspects the client may have a problem with which area of the client's urinary system? - 1. Bladder - 2. Kidneys - 3. Ureters - 4. Urethra

RATIONALE: 1) Pain during or after voiding indicates a bladder problems, usually infection. Kidney and ureter pain would be in the flank area, and problems or the urethra would cause pain at the external orifice that's commonly felt at the start of voiding.

If alkaline-ash diet is ordered to increase pH of urine what will it include:

Milk, veggies, beef, halibut, trout, salmon No prunes or plums

A client admitted for acute pyelonephritis is about to start antibiotic therapy. Which symptom would be expected in this client? 1) Hypertension 2) Flank pain on the affected side 3) Pain that radiates toward the unaffected side 4) No tenderness with deep palpation over the CVA

RATIONAL: 2) The client may complain of pain on the affected side because the kidney is enlarged and might have formed an abscess. Hypertension is associated with chronic pyelonephritis. Pain may radiate down the ureters or to the epigastrium. The client would have tenderness with deep palpation over the CVA.

A client with renal insufficiency is admitted with a diagnosis of pneumonia. He's being treated with IV antibiotics, which can be nephrotoxic. Which laboratory value(s) should be monitored closely? - 1. Blood Urea Nitrogen (BUN) and creatinine levels. - 2. Arterial Blood Gas (ABG) levels - 3. Platelet count - 4. Potassium level

RATIONALE: 1) BUN and creatinine levels should be monitored closely to detect elevations due to nephrotoxicity. ABG determinations are inappropriate for this situation. Platelets and potassium levels should be monitored according to routine.

A client with chronic renal failure is undergoing peritoneal dialysis. A nurse knows that the proper infusion time for the dialysate is: 1) 15 min 2) 30min 3) 1hr 4) 2hrs

RATIONALE: 1) Dialysate should be infused quickly. When performing dialysis, the dialysate should be infused over 15 minutes or less. The fluid then dwells in the peritoneum, whre the exchange of fluid and waste products takes place over a period ranging from 30min to several hours.

A client admitted with renal failure is in the oliguric phase. A nurse expects the client's 24-hr urine output to be less than what amount? 1) 200ml 2) 400ml 3) 800ml 4) 1,000ml

RATIONALE: Oliguria is defined as a diminished urine output of less than 400ml/24hrs

Physical Assessment of Renal System- INSPECTION: Skin, Mouth, Face & extremities, Abdomen, Weight, General State of Health

Renal System- INSPECTION: SKIN: pallor, yellow-gray cast, excoriations, changes in turgor, bruises, texture (e.g., rough, dry skin) MOUTH: stomatitis, ammonia breath odor FACE & EXTREMITIES: generalized edema, peripheral edema, bladder distention, masses, enlarged kidneys ABDOMEN: striae, abdominal contour for midline mass in lower abdomen (may indicate urinary retention) or unilateral mass (occasionally seen in adult, indicating enlargement of one or both kidneys from large tumor or polycystic kidney) WEIGHT: weight gain secondary to edema; weight loss and muscle wasting in renal failure GENERAL STATE OF HEALTH: fatigue, lethargy, and diminished alertness

Physical Assessment of Renal System- PALPATION:

Renal System- PALPATION: A landmark useful in locating the kidneys is the costovertebral angle formed by the rib cage and the vertebral column. The normal-size kidney is usually not palpable. If the kidney is palpable, its size, contour, and tenderness should be noted. Kidney enlargement is suggestive of neoplasm or other serious renal pathologic condition. The urinary bladder is normally not palpable unless it is distended with urine.

Glomerulonephritis is commonly related to what infection?

Strep. Intervention- prevent and treat strep quickly! Also: Immune dz such as Lupus. Vasculitis, Scarring from: HTN, Diabetic kidney dz. Intervention- control blood sugars and hypertension.

who are the most susceptible pts for UTI?

pregnant and/or sexually active women

if pt is on acid-ash diet to decrease pH of urine what will it include:

bread, cereal, whole grains, cranberries, legumes, tomatoes,oysters, fish, poultry, pastries

types of urinary tract caliculi

calcium oxalate (30-45%) calcium phosphate (8-10%) struvite (10-15%) cystine (1-2%)

interventions for UTI may include

heating pad for discomfort and Pyridium for spasms

Pts taking Pyridium should be taught what?

that a reddish orange discoloration of urine may occur.

If pt has renal insufficiency what would you assess for?

this is end-stage kidney disease, kidneys aren't functioning; assess for psychosocial changes - depression, anxiety, ability to cope, suicide, withdraw from loved ones

A nurse is caring for a client with end stage renal disease. Which nursing diagnosis has priority? 1) Activity intolerance 2) Excess fluid volume 3) Deficient knowledge 4) Chronic pain

RATIONALE: 2) Excess Fluid Volume is a top priority nursing diagnosis for a client with end stage renal disease because the kidney can no longer remove fluid and wastes. The other diagnoses may also apply, but they don't take priority.

A nurse is caring for a client in the immediate postoperative period after a prostatectomy. What complication requires priority assessment? 1) Pneumonia 2) Hemorrhage 3) Urine retention 4) Deep vein thrombosis

RATIONALE: 2) Immediately after a prostatectomy, , hemorrhage is a potential complication. Pneumonia may occur if the client doesn't turn, cough, and breathe deeply after surgery. Urine retention isn't a problem immediately after surgery because a catheter is in place. Thrombosis may occur later if the client doesn't ambulate.

Discharge instructions for a client treated for acute pyelonephritis should include which statement? - 1. Avoid taking any dairy products. - 2. Return for follow-up urine cultures. - 3. Stop taking the prescribed antibiotics when the symptoms subside. - 4. Recurrence is unlikely because you've been treated with antibiotics.

RATIONALE: 2) The client needs to return for follow-up urine cultures because bacteriuria may be present but asymptomatic. Intake of dairy products won't contribute to pyelonephritis. Antibiotics need to be taken for the full course of therapy regardless of the symptoms. Pyelonephritis typically recurs as a relapse or new infection and frequently recurs within 2 weeks of completing therapy.

A client is hospitalized and diagnosed with acute hydronephrosis. Which complaint does the nurse expect from this client? 1) Sudden onset of acute, colicky pain 2) Sharp left flank pain 3) Sharp, throbbing pain 4) Felling of pressure and distention

RATIONALE: 1) Sudden, acute colicky pain is a clinical sign of acute hydronephrosis. Hydronephrosis occurs when urine collects in the renal pelvis and calyces due to obstruction or atrophy of the urinary tract. Flank pain most commonly indicates a kidney infection, although it may occur hydronephrosis. Distention and pressure are commonly felt in the pelvis and bladder with lower urinary tract obstructions.

When performing a physical assessment, the nurse discovers a client's urinary drainage bag lying next to him. Based on this finding, the nurse identifies which priority nursing diagnosis? - 1. Risk for infection - 2. Reflex urinary incontinence - 3. Impaired comfort - 4. Risk for compromised human dignity

RATIONALE: 1) The drainage bag shouldn't be placed alongside the client or on the floor because of the increased risk of infection caused by microorganisms. It should hang on the bed in a dependent position. The other nursing diagnoses are not appropriate for this assessment finding.

A client is receiving peritoneal dialysis. What should the nurse do when the return fluid is slow to drain? 1) Check for kinks in the outflow tubing 2) Raise the drainage bag above the level of the abdomen 3) Place the client in a reverse Trendelenburg position 4) Ask the client to cough

RATIONALE: 1) Tubing problems are common cause of outflow difficulties. When the return fluid is slow to drain, check the tubing for kinks and ensure all clamps are open. Other measures that may improve drainage include having the client change positions (moving side to side or sitting up in bed), applying gentle pressure over the abdomen, or having a bowel movement. Placing the drainage bag lower (not higher) than the abdomen may also improve drainage. Placing the client in reverse Trendelenburg position wouldn't help drainage and could impair respirations. Coughing doesn't affect drainage time.

A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which intervention is important? - 1. Strain all urine - 2. Limit fluid intake - 3. Enforce strict bed rest. - 4. Encourage a high-calcium diet

RATIONALE: 1) Urine should be strained for calculi and sent to the laboratory for analysis. Fluid intake of 3 to 4 qt. 3 to 4 L/day is encouraged to flush the urinary tract and prevent further calculi formation. Ambulation is encouraged to help pass the calculi through gravity. A low-calcium formation of calcium calculi.

A nurse is teaching a male client how to collect a clean-catch midstream urine specimen. What cleaning technique should the nurse include in her teaching? 1) Clean in a circular motion, starting at the urethral meatus and moving several inches down the shaft of the penis. 2) Clean in circular patterns, starting several inches down the penis and moving up toward the tip of the penis. 3) Scrub back and forth across the urethral meatus and down the shaft of the penis. 4) Wipe in rows starting at the urethral meatus and moving down the shaft of the penis.

RATIONALE: 1) before collecting a clean-catch urine specimen, a male client should clean around the urethral meatus in a circular motion and move several inches down the shaft of the penis. When the penis is cleaned from down the shaft to up toward the urethral meatus, organisms from the skin of the penis are dragged toward the meatus. Scrubbing back and forth repeatedly moves organisms across the urethral meatus, not away from it. Some areas of the skin around the tip of the penis may be missed when cleaning is done in rows.

A nurse is instructing a client how to obtain an accurate clean-catch urine specimen for a urine culture. She should include what instruction? 1) Clean the perineal area well. 2) Wash the inside of the container. 3) Void to fill the container. 4) Leave the container open to the air.

RATIONALE: 1) when obtaining a clean-catch urine specimen, the perineal area should be thoroughly cleaned. The inside of the container is already sterile, so washing it would only contaminate it. Only a small specimen of urine is needed, so it isn't necessary to completely fill the container. The container should be closed as soon as the urine is collected to prevent contamination

A nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse should be alert for which of the following? SELECT ALL THAT APPLY. 1) Trousseau's sign 2) Cardiac arrhythmia 3) Constipation 4) Decreased clotting time 5) Drowsiness and lethargy 6) Fractures

RATIONALE: 1, 2, 6. Hypocalcemia is a calcium deficit that causes irritability and repetitive muscle spasms. S/S of hypocalcemia include Trousseau's sign, cardiac arrhythmias, diarrhea, increased clotting times, anxiety, and irritability. The calcium-phosphorus imbalance leads to brittle bones and pathologic fractures.

A nurse is caring for a client after a renal biopsy. The nurse observes the client for: 1) Increased activity 2) Bleeding 3) Changes in mental status 4) Increased blood pressure

RATIONALE: 2) A renal biopsy is obtained through needle insertion into the lower lobe of the kidney, which can need to hemorrhage, so the nurse needs to watch for signs and symptoms of bleeding. After the procedure, the client should remain still for 4 to 12 hours. Changes in mental status (unless the client is bleeding heavily) or blood pressure aren't related to renal biopsy.

A nurse is assessing a client diagnosed with acute pyelonephritis. Which of the following symptoms does the nurse expect to see? 1) Jaundice and flank pain 2) Costovertebral angle tenderness and chills 3) Burning sensation on urination 4) Polyuria and nocturia

RATIONALE: 2) Costovertebral angle tenderness and chills are symptoms of acute pyelonephritis (inflammation of the kidney and renal pelvis). Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection (UTI). Nocturia is associated with a lower UTI or benign prostatic hyperplasia. Polyuria is seen with diabetes mellitus, diabetes insipidus, or the use of diuretics.

A client is diagnosed with cystitis. Client teaching aimed at preventing a recurrence should include which instruction? - 1. Bathe in a tub. - 2. Wear cotton underwear. - 3. Use a feminine hygiene spray. - 4. Limit your intake of cranberry juice.

RATIONALE: 2) Cotton underwear prevents infection because it allows for air to flow to the perineum. Women should shower instead of taking a tub bath to prevent infection. Feminine hygiene spray can act as an irritant. Cranberry juice helps prevent cystitis because it increases urine acidity; alkaline urine supports bacterial growth, so cranberry juice intake should be increased, not limited.

While undergoing hemodialysis, a client becomes restless and tells a nurse that he has a headache and feels nauseous. Which complication does the nurse suspect? 1) Infection 2) Disequilibrium syndrome 3) Air embolus 4) Acute hemolysis

RATIONALE: 2) Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This may lead to cerebral edema and increased intracranial pressure (IICP). S/S of ICCP include HA, nausea, and restlessness as well as vomiting, confusion, twitching, and seizures. Fever and elevated WBC may indicate infection. Popping or ringing in the ears, chest pain, dizziness, or coughing suggests an air embolus. Chest pain, dyspnea, burning at the access site and cramping suggests acute hemolysis.

A nurse is assessing a client who might have a UTI. What statement by the client suggests that a UTI is likely? 1) I urinate large amounts. 2) It burns when I urinate. 3) I go for hours without the urge to urinate. 4) My urine has a sweet smell.

RATIONALE: 2) Dysuria (painful urination) is a common symptom of a UTI. Voiding large amounts of urine isn't associated with UTI's; clients with UTI's commonly report frequent voiding of small amounts of urine. A client with a UTI is unlikely to be able to go for hours without urinating because UTI's increase feelings of urgency to void. Urine with a sweet acetone odor is associated with diabetic ketoacidosis. Foul-smelling urine may be a sign of infection.

A nurse is teaching a female client how to prevent the recurrence of urinary tract infection. The nurse should teach her to do which action? 1) Wipe from back to front after urination or a bowel movement. 2) Urinate every 2 to 3 hours. 3) Drink at least 8 oz (236.6ml) of fluid each day. 4) Take daily bubble baths.

RATIONALE: 2) The nurse should instruct the client to void every 2 to 3 hours to flush bacteria from the urethra and prevent urinary stasis in the bladder. Wiping from front to back (Not back to front) after a bowel movement or urination moves bacteria away from the urethral meatus. Drink 2 to 3 quarts (2 to 3L) of fluid per day helps flush bacteria out of the urinary tract. The nurse should tell the client to avoid bubble baths because they can irritate the urethra, increasing the risk of inflammation and infection.

A nurse is instructing a client with renal calculi about recommended daily fluid consumption. The nurse would be most helpful by telling the client to drink approximately: 1) 4 cups per day 2) 8 cups per day 3) 12 cups per day 4) 16 cups per day

RATIONALE: 3) A client with renal calculi should drink 3L (12 cups) of fluid per day.

While undergoing hemodialysis, a client complains of muscle cramps. What intervention is effective in relieving muscle cramps? 1) Encourage active ROM exercises. 2) Administer a 5% dextrose solution. 3) Infuse normal saline solution. 4) Increase the rate of dialysis.

RATIONALE: 3) Because muscle cramps can occur when sodium and water are removed too quickly during dialysis, treatment includes administering normal saline or hypertonic normal saline solution. ROM exercises and an infusion of 5% dextrose solution wouldn't reduce muscle cramps. Reducing, not increasing, the rate of dialysis may also alleviate muscle cramps.

A client is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. What finding is the nurse most likely to find in the client's history? 1) Renal calculi 2) Renal trauma 3) Recent sore throat 4) Family history of acute glomerulonephritis

RATIONALE: 3) Recent sore throat. Typically, acute glomerulonephritis occurs 2 to 3 weeks after a strep throat infection. The Most Common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body. Renal calculi and renal trauma aren't known to cause acute glomerulonephritis. A family history isn't associated with the development of acute glomerulonephritis.

A nurse is teaching a client how to collect a clean catch midstream urine specimen for culture and sensitivity testing. What instructions should a nurse include? 1) Collect the first 30ml of urine voided on rising in the morning 2) Discard the first void urine; collect for the next 24hrs 3) Collect a specimen after discarding the first 30ml of urine 4) Collect all urine voided until the bladder is empty

RATIONALE: 3) To collect a clean catch midstream urine specimen; tell the client to void 30ml, stop, and then begin collecting the urine in a sterile urine container. After the sterile container is removed, the client should then finish voiding rest of the urine in the bladder. Discarding the first 30ml of urine flushes away microorganisms that may be around the urinary meatus and distal portions of the urethra. Collecting the first 30ml of urine voided on rising in the morning results in a contaminated specimen. Urine isn't collected for 24hrs for a clean-catch specimen. The first and last voided urine are discarded in a clean catch specimen.

Which client is at greatest risk for developing a UTI? 1) A 35 year old woman with an arm fracture. 2) An 18 year old woman asthma. 3) A 50 year old postmenopausal woman. 4) A 28 year old woman with angina.

RATIONALE: 3) Women are more prone to UTI's after menopause. Urinary stasis may develop due to a loss of pelvic muscle tone and prolapse of the bladder or uterus. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. While chronic diseases, including diabetes mellitus and impaired immunity, increase the risk of UTI, angina, asthma, and fractures don't increase the risk of UTI.

A client is scheduled to undergo a transurethral prostatectomy (TURP) under spinal anesthesia. During the preoperative teaching, the nurse explains to the client that as a result of spinal anesthesia he'll: 1) Be unable to move his arms immediately after surgery 2) Require analgesics to relieve pain in his back 3) Be unable to move his legs immediately after surgery 4) Require a special machine to help him breathe after surgery

RATIONALE: 3) a client who had anesthesia can't move extremities below the level of the anesthesia. This client wouldn't be able to move his legs but could move his arms. Back pain isn't necessarily caused by spinal anesthesia. He wouldn't have difficulty breathing.

A nurse is caring for a client who has undergone surgery to create an ileal conduit. Which expected outcome statement is appropriate for this client? 1) The client uses sterile gloves when changing the appliance. 2) The client demonstrates the ability to irrigate the stoma correctly. 3) The client expresses understanding and acceptance of the fact that he can no longer engage in sexual relations. 4) The stoma remains pink and moist.

RATIONALE: 4) A healthy stoma is pink and moist. Sterile gloves aren't necessary when changing the appliance. The stoma isn't to be irrigated. There's no physiologic reason why the client can't engage in sexual relations.

Which method should be used to collect a specimen for urine culture? - 1. Have the client void in a clean container. - 2. Clean the foreskin of the penis of uncircumcised men before specimen collection. - 3. Have the client void into a urinal, and then pour the urine into the specimen container. - 4. Have the client begin the stream of urine in the toilet and catch the urine in a sterile container midstream.

RATIONALE: 4) Catching urine midstream reduces the amount of contamination by microorganisms at the meatus. Voiding in a clean container is done for a random specimen, not a clean-catch specimen for urine culture. When cleaning an uncircumcised male, the foreskin should be retracted and the glands penis should be cleaned to prevent specimen contamination. Voiding in a specimen because the urinal isn't sterile.

A nurse is writing the teaching plan for a client with cystitis who's receiving phenazopyridine (Pyridium). What instruction should the nurse include? 1) Call the physician if urine turns orange-red 2) Take phenazopyridine just before urination to relieve pain 3) Discontinue prescribed antibiotics after painful urination is relieved 4) Stop taking phenazopyridine after painful urination is relieved.

RATIONALE: 4) Phenazopyridine is taken to relieve dysuria because it provides an analgesic and anesthetic effect on the urinary tract mucosa. The client can stop taking it after the dysuria is relieved. Warn the client that the dye in the drug (azo dye) may temporarily turn the urine red or orange but that isn't cause for calling the physician. Phenazopyridine is usually taken three times per day for 2 days. It isn't taken just before voiding. Antibiotics must be taken for the full course of therapy, even if the burning on urination is relieved.

During a health history, which statement by a client indicates a risk of renal calculi? - 1. "I've been drinking a lot of cola soft drinks lately." - 2. "I've been jogging more than usual." - 3. "I've had more stress since we adopted a child last year." - 4. "I'm a vegetarian and eat cheese two or three times each day."

RATIONALE: 4) Renal calculi are commonly composed of calcium. Diets high in calcium may predispose a person to renal calculi. Milk and milk products are high in calcium. Cola soft drinks don't contain ingredients that would increase the risk of renal calculi. Jogging and increased stress aren't considered risk factors for renal calculi formation.

A nurse is instructing a client with oxalate renal calculi. What foods should the nurse urge the client to eliminate from his diet? 1) Citrus fruits, molasses, and dried apricots 2) Milk, cheese, and ice cream 3) Sardines, liver and kidney 4) Spinach rhubarb and asparagus

RATIONALE: 4) To reduce the formation of oxalate calculi, urge the client to avoid foods high in oxalate, such as spinach, rhubarb, and asparagus. Other oxalate- rich foods to avoid include tomatoes, beets, chocolate, cocoa, celery, and parsley. Citrus fruits, molasses, dried apricots, milk, cheese, ice cream, sardines and organ meats do NOT produce oxalate and do NOT need to be omitted from the client's diet.

A client returns from the operating room after extensive abdominal surgery. He has 1,000ml of lactated Ringer's solution infusing via central line. The physician orders the I.V. fluid to be infused at 125ml/hr plus the total output of the previous hour. The drip factor of the tubing is 15gtt/min. The client's output for the previous hour was 75m. via Foley catheter, 50ml via NG tube, and 10ml via Jackson-Pratt tube. How many drops per minute should the nurse set the I.V. flow rate at to deliver the correct amount of fluid? Record as a whole number. ______ ggt/minute.

RATIONALE: 65ggt/min. First calculate the volume to be infused in milliliters: 75ml + 50ml + 10ml = 135ml total output for the previous hour; 135ml + 125ml ordered as a constant flow = 260ml to be infused over the next hour. Next, used the formula: Volume to be infused/ Total minutes to be infused x Drip Factor = Drops per min. In this case, 260ml divided by 60min x 15 ggt/min = 65 ggt/min

After a retropubic prostatectomy, a client needs continuous bladder irrigation. The client has an I.V. of D5W infusing at 40ml/hr and a triple lumen urinary catheter with normal saline solution infusing at 200,l/hr. A nurse empties the urinary catheter drainage bag 3 times during an 8 hr period, for a total of 2780ml. How many milliliters does the nurse calculate as urine? Round to the nearest whole number. ________ ml

RATIONALE: During 8 hrs, 1600ml of bladder irrigation has been infused (200ml x 8hrs = 1600ml/8hrs). The nurse then subtracts this amount of infused bladder irrigation from the total volume in the drainage bag (2780ml - 1600ml = 1180ml) to determine urine output.

A client in acute renal failure becomes severely anemic and the physician prescribes 2 units of packed red blood cells. A nurse should plan to administer each unit: 1) As quickly as the client can tolerate the infusion 2) Over 30minutes to an hour 3) Between 1 and 3 hours 4) Up to 6 hours, but no longer

RATIONALE: Infusing a unit of RBCs over 1 to 3 hours is standard practice.

Physical Assessment of Renal System- PERCUSSION:

Renal System- PERCUSSION: Tenderness in the flank area may be detected by fist percussion (kidney punch). Normally a firm blow in the flank area should not elicit pain. Normally a bladder is not percussible until it contains 150 ml of urine. If the bladder is full, dullness is heard above the symphysis pubis. A distended bladder may be percussed as high as the umbilicus.

T or F calcium stones are alkaline:

True - this pt would need acid ash diet

Post surgery for stone removal hematuria is expected T or F

True bright red blood would be cause for concern