Lewis Medical Surgical- Renal (46)

Which client is at highest risk for developing a hospital-acquired infection? a. A client with an indwelling urinary catheter b. A client with a laceration to the left hand c. A client who's taking prednisone d. A client with Crohn's disease

a. A client with an indwelling urinary catheter The invasive nature of an indwelling urinary catheter increases the client's risk of a hospital-acquired infection. The nurse must perform careful, frequent catheter care to minimize the client's risk. Although the client with a laceration, the client who's taking prednisone, and the client with Crohn's disease have a risk of infection, the one with an indwelling catheter is at the greatest risk.

Which nursing diagnosis is a priority in the care of a patient with renal calculi? a. Acute pain b. Risk for constipation c. Deficient fluid volume d. Risk for powerlessness

a. Acute pain Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.

A client comes into the emergency department with severe back pain radiating to the left lower groin region. Morphine sulfate 10 mg IV is administered as ordered. One hour later the client states that the pain is still at 8 of 10. Which actions would the nurse take? a. Contact the physician and explain that the pain is still at 8 of 10 one hour after the morphine has been administered and request a higher dosage. b. Check to ensure the correct dosage was given and ask the client if he/she has routinely taken painkillers or street drugs. c. Tell the client that the order is for every 3-4 hours and explain that an additional dose cannot be given for 2 more hours. d. Explain that a high dose of the pain medication has been administered and that it takes longer than 1 hour to exert its therapeutic effect.

a. Contact the physician and explain that the pain is still at 8 of 10 one hour after the morphine has been administered and request a higher dosage. Renal colic can be one of the most severe pain experiences. The ordered dosage of analgesic has not provided relief, so additional intervention is appropriate. Because of the severity of the pain, it is not appropriate for the client to wait until the next dose is due. Although the client is receiving a therapeutic dose, it is not effective. The interval between doses of the analgesic is too great. There may be a tolerance to the analgesic if the client has routinely taken painkillers; however, relief is still needed now.

Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which measure should the nurse first recommend in an attempt to resolve the woman's incontinence? a. Kegel exercises b. Use of adult incontinence pads c. Intermittent self-catheterization d. Dietary changes including fluid restriction

a. Kegel exercises Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem, and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.

A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a Foley catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? a. Notify the HCP. b. Use a small-sized catheter. c. Administer pain medication before inserting the catheter. d. Use extra povidone-iodine solution in cleansing the meatus.

a. Notify the HCP. The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing. Therefore options b,c, and d are incorrect.

The urinalysis of a male patient reveals a high microorganism count. What data should the nurse use to determine the area of the urinary tract that is infected (select all that apply)? a. Pain location b. Fever and chills c. Mental confusion d. Urinary hesitancy e. Urethral discharge f. Post-void dribbling

a. Pain location e. Urethral discharge Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis, but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.

A client with acute kidney injury has a serum potassium level of 6.0 mEq/L. The nurse should plan which action as a priority? a. Check the sodium level. b. Place the client on a cardiac monitor. c. Encourage increased vegetables in the diet. d. Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration.

b. Place the client on a cardiac monitor. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse also may assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action of the nurse.

A client undergoes cystoscopy with bladder biopsy. After the procedure, which assessment is most appropriate for the nurse to make? a. Percuss the bladder for distention. b. Assess the patency of the Foley catheter. c. Assess urine for excessive bleeding. d. Obtain a urine specimen for culture.

c. Assess urine for excessive bleeding. After cystoscopy with biopsy, the nurse would assess for excessive hematuria, which might indicate hemorrhage caused by the biopsy. Catheters are not routinely inserted after cystoscopy. The nurse would not assess for bladder distention unless the client was having difficulty voiding. Urine cultures are not routinely ordered after cystoscopy.

Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor? a. Tighten both buttocks together. b. Squeeze thighs together tightly. c. Contract muscles around rectum. d. Lie on back and lift legs together.

c. Contract muscles around the rectum. To teach pelvic floor exercises, or Kegel exercise, the nurse should instruct the patient (without contracting the legs, buttocks, or abdomen) to contract the muscles around the rectum (pelvic floor muscles) as if stopping a stool, which should result in a pelvic lifting sensation.

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the health care provider (HCP)? a. Red bloody urine b. Pain related to bladder spasms c. Urinary output of 200 mL higher than intake d. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute

d. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute Frank bleeding (arterial or venous) may occur during the first day after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 mL more than intake is adequate. Bladder spasms are expected to occur following surgery. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The HCP should be notified.

The nurse is collecting data from a client who has a history of benign prostatic hyperplasia. To determine whether the client currenlty is experiencing this condition, the nurse should ask the client about the presence of which early symptom? a. Nocturia b. Urinary retention c. Urge incontinence d. Decreased force in the stream of urine

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

The nurse teaches a 21-year-old female patient who came to the clinic to discuss interventions to prevent a recurrence of urinary tract infections. Which statement, if made by the patient, indicates that teaching was effective? a. "I will urinate before and after having intercourse." b. "I will use vinegar as a vaginal douche every week." c. "I should drink three 8-ounce glasses of water daily." d. "I can stop the antibiotics when symptoms disappear."

a. "I will urinate before and after having intercourse." The woman should empty her bladder before and after sexual intercourse. She should avoid vaginal douches and maintain adequate oral fluid intake (15 mL per pound of body weight). All of the antibiotics should be taken as prescribed even if symptoms are no longer present.

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has a renal function disorder. On review of the laboratory results, the nurse most likely would expect to note which finding? a. Elevated creatinine level b. Decreased hemoglobin level c. Decreased red blood cell count d. Decreased white blood cell count

a. Elevated creatinine level Measuring the creatinine level is a frequently used laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and red blood cell count may be noted if bleeding from the urinary tract occurs of if erythropoietic function by the kidney is impaired. An increased white blood cell count is most likely to be noted in renal disease.

After an intravenous pyelogram (IVP), the nurse should include which measure in the client's plan of care? a. Encourage adequate fluid intake. b. Administer a laxative. c. Assess for hematuria. d. Maintain bed rest.

a. Encourage adequate fluid intake. After an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent. There is no need to place the client on bed rest or administer a laxative. An IVP would not cause hematuria.

The nurse collects a urine specimen from a client for a culture and sensitivity analysis. What should the nurse do next? a. Send the specimen to the laboratory immediately. b. Store the specimen in the refrigerator until it can be sent to the laboratory. c. Send the specimen with the next pickup. d. Send the specimen the next time an unlicensed assistive personnel (UAP) is available.

a. Send the specimen to the laboratory immediately. A specimen for culture and sensitivity should be sent to the laboratory promptly so that a smear can be taken before organisms start to grow in the specimen.

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? a. Blood pressure b. Cardiac rhythm c. Weight changes d. Arterial blood gases

b. Cardiac rhythm Manifestations of CKD result from loss of the renal regulatory functions of filtering metabolic waste products and maintaining fluid and electrolyte balance. These laboratory results indicate CKD, but the most significant result is the potassium level. The normal range of potassium is between 3.5 and 5.0 mEq/L. A potassium level greater than 7 mEq/L may produce fatal cardiac dysrhythmias. Normal BUN level ranges from 8 to 23 mg/dL; normal serum creatinine level ranges from 0.7 to 1.5 mg/dL.

The most significant sign of acute renal failure is: a. Elevated body temperature. b. Increased blood pressure. c. Decreased urine output. d. Increased urine specific gravity.

c. Decreased urine output. A sudden change in urine output is typical of acute renal failure. Most commonly, the initial change is greatly decreased urine output. Later in the course of acute renal failure, the client may have marked diuresis (nonoliguric failure). A high body temperature or sudden increase in blood pressure is not typically associated with acute renal failure. Urine specific gravity usually is within a low-normal range because the kidneys have difficulty concentrating urine.

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? a. Hematuria and polyuria b. Dysuria and proteinuria c. Hematuria and urgency d. Dysuria and penile discharge

d. Dysuria and penile discharge Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays.

The nurse is caring for a 73-year-old man patient with a history of benign prostatic hyperplasia and symptoms of a possible urinary tract infection. Which diagnostic finding would support this diagnosis? a. White blood cell count is 7500 cells/µL. b. Antistreptolysin-O (ASO) titer is 106 Todd units/mL. c. Glucose, protein, and ketones are present in the urine. d. Nitrites and leukocyte esterase are present in the urine.

d. Nitrites and leukocyte esterase are present in the urine. A diagnosis of urinary tract infection is suspected if there are nitrites (indicating bacteriuria), white blood cells (WBCs), and leukocyte esterase (an enzyme present in WBCs indicating pyuria). Presence of glucose and ketones indicate uncontrolled diabetes mellitus. An elevated WBC count (>11,000 cells/µL) indicates a bacterial infection. Antistreptolysin-O (ASO) titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria.

A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: a. Acute prostatitis. b. An overdistended bladder. c. Interstitial cystitis. d. Renal calculi.

d. Renal calculi. Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.