Exam 3 renal
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia
A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for:
cardiac arrest.
The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching?
"I will take it with meals and bedtime snacks."
During a clinic visit, the mother of an infant with hydrocele states that the infant's scrotum is smaller now than when he was born. After teaching the mother about the infant's condition, which statement by the mother indicates that the teaching has been effective?
"It seems like the fluid is being reabsorbed."
When providing client teaching about continuous bladder irrigation following prostate surgery, the nurse should tell the client:
"The purpose of the irrigation is to keep bladder drainage clear and to prevent the formation of blood clots in the bladder."
An unlicensed assistive personnel (UAP) tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that is not possible because he has a catheter in place that is draining well." The nurse should tell the UAP:
"The urge to void is usually created by the large catheter, and he may be having some bladder
A client scheduled for a vasectomy asks the nurse how soon after the procedure he can have sexual intercourse without using an alternative birth control method. How should the nurse respond?
"You can safely have unprotected intercourse when your sperm count indicates sterilization."
Sulfamethoxazole has been prescribed to treat a client's urinary tract infection. The initial dosage is 2 g orally. The nurse has 500-mg tablets available. How many tablets should the nurse give? Record your answer using a whole number.
4
A nurse receives the assignment of the following clients for the shift. Following the report, which client should the nurse see first?
A client 3 days after kidney transplant with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L after dialysis
Which client is at highest risk for developing a hospital-acquired infection?
A client with an indwelling urinary catheter
A client has nephropathy. The health care provider (HCP) prescribes a 24-hour urine collection for creatinine clearance. Which action is necessary to ensure proper collection of the specimen?
Collect the urine in a preservative-free container and keep it on ice.
The nurse is providing preoperative instructions to a client who is having a transurethral resection of the prostate. The nurse should tell the client:
Expect blood in your urine in the first couple of days following the procedure."
A nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?
Fluid intake should be about equal to the urine output.
Which should be included in the client's plan of care during dialysis therapy?
Monitor the client's blood pressure.
A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which client statement indicates effective teaching?
My fallopian tubes will be tied off through a small abdominal incision."
Which is the correct order, from first to last, for proper placement of a urinary catheter? All options must be used
Prepare a sterile field. Lubricate the catheter adequately with a water-soluble lubricant. Insert the catheter far enough into the bladder to prevent trauma to the urethral tissue. Ensure free flow of urine.
Assessment of a 36-year-old woman who has malaise and dysuria reveals a temperature of 100° F (37.4° C) and painful blisters on the outside of her vagina. The client tells the nurse she had intercourse with a new partner 5 days ago. What should the nurse do?
Refer the client to a health care provider (HCP).
A client is prescribed alfuzosin for benign prostatic hyperplasia (BPH). What should the nurse teach the client?
Rise slowly from a supine position.
Which nursing diagnosis is appropriate for a client with renal calculi?
Risk for infection
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
Urine output of 250 ml/24 hours
The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which snack is most appropriate?
a gelatin dessert
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it:
allows the client to be more independent.
Eight hours after an abdominal hysterectomy, the client has not voided and says to the nurse, "I do not think I can urinate." The nurse should first:
assess the client's bladder.
The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink:
at least 3,000 mL of fluids daily.
Which abnormal blood value would not be improved by dialysis treatment?
decreased hemoglobin concentration
The most significant sign of acute renal failure is:
decreased urine output.
The nurse should specifically assess a client with prostatic hypertrophy for:
difficulty starting the flow of urine.
The nurse is assessing a client who has benign prostatic hypertrophy (BPH). The nurse should ask the client if he has:
difficulty starting the urinary stream.
A client has cystitis. The nurse should further assess the client for:
foul-smelling urine.
To reduce urethral irritation, where should the nurse tape the female client's Foley catheter?
inner thigh
The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate?
low-protein, low-sodium, low-potassium
A client who is 70 years of age and lives alone has stress incontinence. To prevent incontinence, the nurse advises the client to:
perform perineal muscle exercises (i.e., Kegel exercises).
The nurse teaches the client how to recognize an infection in the shunt by telling the client to assess the shunt each day for:
swelling at the shunt site.
A client has stress incontinence. Which data from the client's history contributes to the client's incontinence?
the client's history of three full-term pregnancies
Whichis an initial clinical manifestation of gonorrhea in men?
urethral discharge
A client was treated for a streptococcal throat infection 2 weeks ago. The client now has been diagnosed with acute poststreptococcal glomerulonephritis. The client asks the nurse how he could have prevented this condition. What should the nurse tell the client?
See your health care provider (HCP) for an early diagnosis and treatment of a sore throat."
The nurse is collecting data on a client with a urinary tract infection (UTI). Which statements should the nurse expect the client to make? Select all that apply.
"I need to urinate frequently." "It burns when I urinate." "I need to urinate urgently."
A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?
"I'm allergic to shellfish."
The client with benign prostatic hypertrophy is being transferred from the emergency department to a surgery unit. Which information should be included in the report from the nurse in the emergency department to the nurse responsible for admitting the client?
"The client was catheterized, and 1,100 mL of urine was obtained. The urine appeared cloudy, and a specimen was sent to the laboratory."
A client with chronic renal failure is experiencing central nervous system (CNS) changes caused by uremic toxins. Which nursing approach would be most appropriate for addressing the changes?
Assess the client's mental status regularly.
The nurse is completing an intake and output record for a client who is receiving continuous bladder irrigation after transurethral resection of the prostate. How many milliliters of urine should the nurse record as output for her shift if the client received 1,800 ml of normal saline irrigating solution and the output in the urine drainage bag is 2,400 ml? Record your answer using a whole number.
600
A client with chronic kidney disease (CKD) has a blood urea nitrogen (BUN), 100 mg/dL, serum creatinine 6.5 mg/dL, potassium 6.1 mEq/L, and lethargy. Which of the following is the priority nursing assessment?
Cardiac rhythm
A client undergoes extracorporeal shock wave lithotripsy (ESWL) to break up and remove renal calculi. Which nursing measure is appropriate for the postoperative care of this client?
Instruct the client to anticipate hematuria for about 24 hours after the procedure. Explanation:
A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?
Use of corticosteroids
A client with stress incontinence asks the nurse what kind of diet she should follow at home. The nurse should recommend that the client:
avoid alcohol and caffeine.
A client is scheduled for an intravenous pyelogram (IVP). The evening before the procedure, the nurse learns that the client is allergic to shellfish. The nurse should:
cancel the IVP and notify the health care provider (HCP).
The nurse finds a container with the client's urine specimen sitting on a counter in the bathroom. The client states that the specimen has been sitting in the bathroom for at least 2 hours. The nurse should:
discard the urine and obtain a new specimen.
The primary reason for lubricating the urinary catheter generously before inserting it into a male client is that this technique helps reduce:
friction along the urethra when the catheter is being inserted.
The client with first-time bacterial cystitis is being treated with an antibiotic to be taken for 7 days. The nurse should instruct the client to:
take the entire prescription as ordered.
A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan?
"Another method of contraception is needed until the sperm count is 0."
An 18-year-old female is to have a pelvic exam. Which response by the nurse would be best when the client says that she is nervous about the upcoming pelvic examination?
"Can you tell me more about how you are feeling?"
Which statements by a female client would indicate that she is at high risk for a recurrence of cystitis?
"I can usually go 8 to 10 hours without needing to empty my bladder."
A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which of the following statements, if made by a group member, would indicate understanding of the teaching?
"I should notify the physician if urinary urgency, burning, frequency, or difficulty urinating occurs."
A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs?
"I should take at least 1,000 mg of vitamin C each day."
The nurse is instructing the unlicensed assistive personnel (UAP) about the correct technique for obtaining a clean-catch urine culture from a female client. Which statement indicates
"I will ask the client to clean her labia, void into the toilet, and then into the specimen cup."
The nurse is instructing an unlicensed assistive personnel (UAP) to collect a urine specimen from an indwelling catheter. Which statement indicates that the UAP understands the instructions?
"I will get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container."
The client with a urinary tract infection is given a prescription for trimethoprim. Which statement indicates that the client understands how to take the medication?
"I will take all the pills and then return to my doctor."
The client with pyelonephritis asks the nurse, "How will I know whether the antibiotics are effectively treating my infection?" What should the nurse tell the client?
"Your health care provider will take a urine culture."
A client with marked oliguria is ordered a test dose of 0.2 g/kg of 15% mannitol solution intravenously over 5 minutes. The client weighs 132 lb. How many grams would the nurse administer? Record your answer as a whole number.
12
A registered nurse and a nursing assistant are caring for a group of clients. Which client's care may safely be delegated to the nursing assistant?
A client diagnosed with renal calculi who must ambulate four times daily and drink plenty of fluids
Which of the following is a priority nursing diagnosis for the client presenting with pelvic inflammatory disease?
Acute pain.
A nurse is admitting an older female client to the gynecology surgical unit. When the nurse asks the client what medication she is taking at home, the client responds that she is taking a little red pill in the morning and a white capsule at night for her blood pressure. What action by the nurse is focused on safe, effective care of this client?
Ask a family member to bring the medications from home in the original vials for proper identification and administration times.
The unlicensed assistive personnel (UAP) reports to the nurse that the client with an abdominal hysterectomy who returned from the recovery room 1 hour earlier has saturated the blue pad with bright red blood. What should the nurse do?
Ask the UAP to obtain vital signs while the nurse calls the surgeon.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
Assess the AV fistula for a bruit and thrill.
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl
The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which action would be most important for the nurse to include in pretest preparation?
Check the client's history for allergy to iodine.
A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows: pH 7.30 PaO2 97 PaCO2 37 HCO3 18 The nurse would expect what sets of assessment findings?
Clammy skin, blood pressure 86/46 mm Hg, headache
A client is scheduled for an intravenous pyelogram (IVP). In preparation for the procedure, what should the nurse ask the client?
Do you have any allergies?"
A client is diagnosed with pyelonephritis. Which nursing action is a priority for care now?
Ensure sufficient hydration.
A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged I.V. pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow?
Evaluating patency of the drainage lumen
A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan?
Increase daily fluid intake to at least 2 to 3 L.
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
Increase your fluid intake to 2 to 3 L per day.
After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?
It's an abnormal finding that requires further assessment.
What are important nursing care measures for a client with diabetes who is admitted with end-stage renal failure?
Restrict sodium and potassium and restrict fluids as ordered.
The nurse collects a urine specimen from a client for a culture and sensitivity analysis. What should the nurse do next?
Send the specimen to the laboratory immediately.
The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which approach would be best?
Spend time with the client addressing her concerns and then stay with her while she talks with her husband.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?
The client keeps the drainage bag below the bladder at all times.
After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?
The client reports bladder spasms and the urge to void.
A nurse preceptor is observing a new graduate during care of a client in contact isolation. Which action by the new graduate indicates a need for further teaching about handling infectious materials?
The nurse uses alcohol gel to clean her hands after changing linen soiled with urine and feces.
A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?
Transurethral resection of the prostate (TURP)
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?
Use sterile technique when irrigating the catheter.
The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client?
Use the unaffected arm for blood pressure measurements.
Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate?
Validate the client's understanding of the material frequently.
Which client is at highest risk for developing a urinary tract infection?
a man with an indwelling urinary catheter
A charge nurse is completing day-shift client care assignments on the genitourinary floor. A new graduate is present for her first day on the unit. An agency nurse and an experienced nurse are also present on the unit. The charge nurse should assign the new graduate to the care of:
an elderly client with bladder cancer awaiting surgery, an elderly client who had a prostatectomy and bladder irrigation 2 days ago, and an elderly client with renal insufficiency.
A male client reports having impotence. The nurse examines the client's medication regimen and determines that a contributing factor to impotence could be:
antihypertensives.
A client who had transurethral resection of the prostate has dribbling urine after his Foley catheter is removed on the second postoperative day. The nurse notes that the client had 200 mL of urine output in the last 8 hours with a 1,000 mL intake. The nurse should first:
assess for bladder distention.
A nurse is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to:
breathe deeply.
When teaching a client with chronic renal failure who is taking antibiotics about signs and symptoms of potential nephrotoxicity to report, the nurse should encourage the client to promptly report which changes in the color of the urine? Select all that apply.
cloudy smoky pink
The client with acute renal failure is recovering and asks the nurse, "Will my kidneys ever function normally again?" The nurse's response is based on knowledge that the client's renal status will most likely:
continue to improve over a period of weeks.
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should assess the client for which alteration in fluid and electrolyte balance?
decreased serum sodium level
Urinary tract infection (UTI) is a potential problem after spinal cord injury. To prevent an UTI, the nurse should encourage the client to:
drink at least 2,000 mL of fluid daily.
A female client who has a urinary diversion tells the nurse, "This urinary pouch is embarrassing. Everyone will know that I am not normal. I do not see how I can go out in public anymore." The most appropriate nursing goal for this client is to:
express fears about the urinary diversion.
The client is on a fluid restriction of 500 mL/day plus replacement for urine output. Because the client's 24-hour urine output yesterday was 150 mL, the total fluid allotment for the next 24 hours is 650 mL. How should the nurses distribute this fluid over the next 24 hours?
given in small amounts throughout each shift
A client is admitted to the recovery room after cystoscopy with biopsy. Before the nurse can discharge the client, the nurse should be sure the client:
has voided.
An elderly client with a diagnosis of chronic renal failure is being discharged to home with his wife. The home health nurse visits the hospital before discharge to discuss home safety with the client, who reports decreased mobility and a need for greater assistance with activities of daily living. The nurse focuses her home-safety teaching on:
having adequate lighting, removing cluttered paths, and using nonskid bathroom surface
Which factor would put the client at increased risk for pyelonephritis?
history of diabetes mellitus
A physician enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8-hour shift if she covers the set with a paper, sterile drape. This action by the nurse is:
inappropriate because irrigation requires strict sterile technique.
The client has a continuous bladder irrigation after a transurethral resection. A major goal related to the irrigation is to:
maintain catheter patency.
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 ml. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:
microorganism transfer.
A client is to receive belladonna and opium suppositories, as needed, postoperatively after transurethral resection of the prostate (TURP). The nurse should give the client these drugs when he demonstrates signs of:
pain from bladder spasms.
A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding, or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:
stress incontinence.
An elderly male client has been taking doxazosin 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first:
take his blood pressure lying, standing, and sitting.
The nurse should tell a client who is to obtain a midstream urine specimen to:
void directly into the sterile specimen container after voiding a small amount into the toilet.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
The client will have an abdominal hysterectomy tomorrow. Which information will be most important for the nurse to give to the client prior to admission to the hospital?
what she can eat and drink before admission