Med Surg Question Collection 1

After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first?

Assess peripheral pulses in the left leg.

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.

Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis?

Blurred vision Explanation: Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis. Severe hypertension needs prompt treatment to prevent convulsions. Presence of albumin (protein) and RBCs in the urine, along with periorbital and peripheral edema, are common symptoms associated with glomerulonephritis.

A client requires hemodialysis. Which type of drug should be withheld before this procedure?

Cardiac glycosides

The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium?

Citrus fruits

The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable?

Clients have chronic renal failure.

A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient?

Compatible blood and tissue types

The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?

Diminished erythropoietin production

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection?

Drink liberal amount of fluids.

What is true about extracorporeal shock wave lithotripsy (ESWL)? Select all that apply.

-Stones are shattered into smaller particles that are passed from the urinary tract. -ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation.

The nurse is reviewing the client's lab results. Which lab result requires follow up by the nurse? Select all that apply.

-Urine: RBC 20 -BUN 28 mg/dL

Which value represents a normal BUN-to-creatinine ratio?

10:1

A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is:

anaphylaxis Explanation: Anaphylaxis is a cause of prerenal acute renal failure. Myoglobinuria secondary to burns is a cause of intrarenal acute renal failure. Polycystic disease is a cause of intrarenal acute renal failure. Ureteral stricture is a cause of postrenal acute renal failure.

A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as:

anuria

A client develops acute renal failure (ARF) after receiving IV therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 mL, the nurse suspects that the client is at risk for:

cardiac arrhythmia.

The nurse is assessing a client's new stoma and observes that the stoma color is now dark purple. The appropriate nursing intervention is to

contact the physician.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

White blood cell (WBC) count of 20,000/mm3

A nurse receives her client care assignment. Following the report, she should give priority assessment to the client:

who, following a kidney transplant, has returned from hemodialysis with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L.

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 nurse recognizes which condition as an integumentary manifestation of chronic renal failure?

Gray-bronze skin color

Resection of a client's bladder tumor has been incomplete and the client is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the client, the nurse should emphasize the need to do which of the following?

Hold the solution in the bladder for 2 hours before voiding.

The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program?

Hypotension

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?

Increased serum creatinine level

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:

continuous inflow and outflow of irrigation solution.

A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:

notify the physician about cloudy or foul-smelling urine.

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

fatigue and weakness.

A physician orders cystoscopy and random biopsies of the bladder for a client who reports painless hematuria. Test results reveal carcinoma in situ in several bladder regions. To treat bladder cancer, the client will have a series of intravesical instillations of bacillus Calmette-Guérin (BCG), administered 1 week apart. When teaching the client about BCG, the nurse should mention that this drug commonly causes:

hematuria

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.

A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

weight loss.

The most accurate indicator of fluid loss or gain in an acutely ill client is

weight.

A 45-year-old man with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis?

"Hemodialysis is a treatment option that is usually required three times a week."

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."

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

"Increase your carbohydrate intake."

A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate?

"Keep your showers brief, patting your skin dry after showering."

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BPH)?

Voiding pattern

A client is prescribed flavoxate (Urispas) following cystoscopy. Which of the following instructions would the nurse give the client?

"This medication will relieve your pain."

A patient has a suprapubic catheter inserted postoperatively. What would be the advantages of the suprapubic catheter versus a urethral catheter? Select all that apply.

-The patient can void sooner than with a urethral catheter. -The suprapubic catheter allows for more mobility. -The suprapubic catheter permits measurement of residual urine without urethral instrumentation.

A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in:

1 minute. Explanation: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

A nurse is teaching a client about peritoneal dialysis. The nurse should tell the client the dwell time is:

20 minutes

A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what topic?

Current medication use

The nurse is caring for a patient with dementia in the long-term care facility when the patient has a change in cognitive function. What should the nurse suspect this patient may be experiencing?

A UTI

The nurse is caring for a client scheduled for renal angiography following a motor vehicle accident. What client preparation should the nurse most likely provide before this test?

Administration of a laxative Explanation: Before the procedure, a laxative may be prescribed to evacuate the colon so that unobstructed x-rays can be obtained. A 24-hour urine test is not necessary prior to the procedure. Gastrografin and potassium chloride are not given prior to renal angiography.

Nephrotoxicity can occur as a result of the use of aminoglycosides such as gentamicin. Select all of the following statements which are true.

Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity.

The nurse is conducting discharge teaching for a client who was admitted with a kidney stone. The nurse includes which instruction as a measure to prevent additional kidney stones?

Avoid drinking tea. Explanation: The nurse should teach the client to avoid tea and other oxalate-containing foods, such as spinach, strawberries, rhubarb, peanuts, and wheat bran. The client should restrict protein intake to 60 g/day and should drink two glasses of water at bedtime. Low-calcium diets are generally not recommended.

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 Explanation: The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.

As the nurse comes from morning report, she is instructed to use a bladder scanner on a client following a client's attempt at urination. The client is able to void 300 mL. The client denies any pain on urination. The nurse scans 250 mL of remaining urine in the bladder. Which entry is most correct when documenting the intervention?

Client voided 300 mL with 250 mL residual volume

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?

Encourage use of incentive spirometer every 2 hours.

To obtain information about the chief report and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important?

It may indicate multiple medications taken by the client. Explanation: The nurse should obtain information about a client's medication history because older client, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older client is not used to obtain information about the client's general health, childhood and family illnesses, or drugs that are contraindicated for use by the client.

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include?

Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.

The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated?

Obtaining a blood pressure reading from the right arm

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic?

Penicillin

A female client is undergoing a bladder training program as treatment for urinary incontinence. Which of the following techniques would be the most appropriate suggestion?

Performing Kegel exercises.

A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action?

Place emergency medical equipment in the procedure room.

A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced?

Renal tubular cells will generate new bicarbonate.

Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator?

Serum glucose Explanation: The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.

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 IV fluids with a normal saline solution bolus followed by a maintenance dose. Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

The nurse planning care for a client with overflow and stress incontinence includes preparation for which intervention?

Transrectal resection Explanation: A transrectal resection is the procedure of choice for men with overflow and stress incontinence.

Which clinical finding should a nurse look for in a client with chronic renal failure?

Uremia Explanation: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

The term used to describe total urine output less than 0.5 mL/kg/hr is

oliguria Explanation: Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.

Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:

removal of the transplanted kidney.

The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply

-"I will never have another urinary stone again." -"I need to take allopurinol." -"Tylenol is best to control my pain." -"I'm so glad I don't have to make any changes in my diet." Explanation: Nonsteroidal anti-inflammatory drugs are used to treat renal stone pain. Oxalate-containing foods should be avoided. Fluid intake should total 2 to 3 liters, if not contraindicated. Allopurinol (Zyloprim) is prescribed for uric acid stones. Recurrence of stones occurs in about half of individuals.

Which of the following is classified as a upper urinary tract infection (UTI)? Select all that apply.

-Acute pyelonephritis -Renal abscess Explanation: Upper UTIs include acute pyelonephritis, renal abscess, perineal abscess, chronic pyelonephritis, and interstitial nephritis. Lower UTIs include cystitis, urethritis, and prostatitis.

Which of the following is a potential cause of transient incontinence? Select all that apply.

-Delirium -Restricted activity -Infection of urinary tract -Atrophic vaginitis -Stool impaction

A gerontologic nurse is assessing a client who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply.

-Fever -New onset of confusion Explanation: Early symptoms of UTI in older adults include burning, urgency, and fever. Some patients develop incontinence and delirium with the onset of a UTI. Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none are directly suggestive of a UTI.

Enlargement of the prostate causes which of the following to occur? Select all that apply.

-Frequency -Oliguria -Anuria -Obstruction of urine flow

A client is being cared for after a nephrectomy. Because of the incisional pain and restricted positioning, the client frequently suffers from breathing difficulty. Which measures should the nurse include in the care plan to relieve this distress? Select all that apply.

-Help the client to breathe deeply and cough every 2 hours. -Provide firm support for the incision when the client coughs. -Auscultate lung sounds once per shift.

The nurse is caring for a client's status after a motor vehicle accident. The client has developed AKI. What are the nurse's roles in caring for this client? Select all that apply.

-Providing emotional support for the family -Monitoring for complications -Participating in emergency treatment of fluid and electrolyte imbalances -Providing nursing care for primary disorder (trauma)

A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event?

Streptococcal infection

Which type of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure?

Stress

The nurse is preparing the procedure room for a client who will undergo an intravenous pyelogram. Which item(s) should the nurse include?

Suction equipment Explanation: The contrast agent injected into the client for an intravenous pyelogram is allergenic and nephrotoxic. Emergency supplies and equipment should be readily available in case the client experiences an anaphylactic reaction, including airway and suction equipment, oxygen, epinephrine, corticosteroids, and vasopressors.

The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this client?

Taking a BP reading on the affected arm can damage the fistula.

A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD?

The client has a history of diverticulitis.

A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact?

The left kidney usually is slightly higher than the right one.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV 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 nurse is instructing a health class of high school seniors on the function of the kidney. The nurse is correct to highlight which information? Select all that apply.

-Excretes waste products -Controls blood pressure -Regulate calcium and the synthesis of vitamin D -Activates growth hormone -Regulates red blood cell production Explanation: The nurse is correct to highlight all of the options except regulates estrogen and progesterone. The pituitary gland controls hormone secretion.

A client is diagnosed with polycystic kidney disease. Which symptom would the nurse most likely assess?

Hypertension

When caring for a patient with an uncomplicated, mild urinary tract infection (UTI), the nurse knows that recent studies have shown which of the following drugs to be a good choice for short-course (e.g., 3-day) therapy?

Levofloxacin (Levaquin) Levofloxacin, a fluoroquinolone, is a good choice for short-course therapy of uncomplicated, mild to moderate UTI. Clinical trial data show high patient compliance with the 3-day regimen (95.6%) and a high eradication rate for all pathogens (96.4%). Trimethoprim sulfamethoxazole is a commonly used medication for treatment of a complicated UTI, such as pyelonephritis. Nitrofurantoin is a commonly used medication for treatment of a complicated UTI, such as pyelonephritis. Ciprofloxacin is a good choice for treatment of a complicated UTI. Recent studies have found ciprofloxacin to be significantly more effective than TMP-SMX in community-based patients and in nursing home residents.

The client is admitted to the nursing unit for a biopsy of the urinary tract tissue. When planning nursing care for the postoperative period, which nursing intervention documents the prescribed activity level?

Maintain the client on bedrest Explanation: In the postoperative period, the client remains on bed rest as the nurse assess for signs of bleeding. If the client is to be discharged on the following day, the client is to maintain limited activity for several days to avoid spontaneous bleeding.

A client, aged 75, is diagnosed with a renal disease and administered nephrotoxic drugs in normal doses. The nurse is aware that it is important to observe the client closely for any changes in renal status. Which of the following measures may help a nurse determine a change in renal status?

Observing the client's urinary output.

Which statement should be included in the teaching plan for a client prescribed sildenafil?

Only one tablet of the prescribed dose should be taken each day.

Which finding is an early indicator of bladder cancer?

Painless hematuria

Which laboratory value supports a diagnosis of pyelonephritis?

Pyuria

The nurse is teaching a client with recurrent urinary tract infections (UTIs) ways to decrease risk for additional UTIs. The nurse includes which information?

Void immediately after sexual intercourse.

Which of the following is a strategy to promote urinary continence?

Void regularly, 5 to 8 times a day

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about:

recent streptococcal infection. Explanation: A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.

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:

renal calculi.

A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:

sodium polystyrene sulfonate (Kayexalate)

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. Before catheterization, the nurse would discuss with the physician information about

the type and size of the catheter to be used.

The nurse is caring for a client with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply.

-Assess for the presence of peripheral edema. -Assess the client's BP. Explanation: Most clients with acute glomerular inflammation have some degree of edema and hypertension. Dysrhythmias, RLQ pain, and changes in mental status are not among the most common manifestations of acute glomerular inflammation.

A client diagnosed with chronic renal failure is receives continuous peritoneal dialysis (PD). The nurse instructs the client about which diet plan?

High-protein diet Explanation: Because of protein loss with continuous PD, the client is instructed to eat a high-protein, nutritious diet. The client is also encouraged to increase daily fiber intake to help prevent constipation, which can impede the flow of dialysate into or out of the peritoneal cavity. A low-protein diet is required to reduce the production of end products of protein metabolism that the kidneys are unable to excrete. Establishing a diet high in calories and low in protein, sodium, and potassium is essential for clients with acute renal failure.

The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client?

Keep the dialysis supplies in a clean area, away from children and pets

When caring for a client with an uncomplicated mild urinary tract infection (UTI), the nurse knows that recent studies have shown which drug to be a good choice for short-course (e.g., 3-day) therapy?

Levofloxacin Explanation: Levofloxacin, a fluoroquinolone, is a good choice for short-course therapy of uncomplicated mild to moderate UTI. Clinical trial data show high client compliance with the 3-day regimen (95.6%) and a high eradication rate for all pathogens (96.4%). Trimethoprim-sulfamethoxazole (TMP-SMZ) and nitrofurantoin are commonly used to treat complicated UTIs, such as pyelonephritis. Ciprofloxacin is also a good choice for treatment of a complicated UTI. Recent studies have found ciprofloxacin to be significantly more effective than TMP-SMZ in community-based clients and in nursing home residents.

Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure?

Palpate the abdominal wall for rebound tenderness. Explanation: Peritonitis is the most serious complication of peritoneal dialysis. To detect rebound tenderness, the nurse presses one hand firmly into the abdominal wall and quickly withdraws the hand. Rebound tenderness exists when pain occurs upon removal; this pain is associated with inflammation of the peritoneal cavity.

The nurse is teaching the client who will undergo surgery for the creation of a nephrostomy. Which of the images best depicts this type of cutaneous urinary diversion?

Picture with normal anatomy and drain from kidney. Explanation: A cutaneous diversion involves the creation of an opening through the abdominal wall and skin to allow urine to drain. A nephrosostomy (Option D) allows urine to drain directly from the kidney through a percutaneous catheter through an opening in the flank. An ileal conduit (Option A) is the most common cutaneous diversion, whereby both ureters empty into an isolated section of the ileum. One end of the isolated segment is brought through the abdominal wall and allows urine to drain through a stoma. With a cutaneous ureterostomy (Option B), the ureter is detached from the bladder and brought through the abdominal wall and attached to an opening in the skin. The bladder is sutured to the abdominal wall and a stoma is created through the abdominal and bladder walls for drainage of urine in a vesicostomy (Option C).

A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram?

Pruritus

A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude?

The pouch faceplate doesn't fit the stoma.

The nurse is assessing a patient upon admission to the hospital. What significant nursing assessment data is relevant to renal function? Select all that apply.

-Any voiding disorders -The patient's occupation -The presence of hypertension or diabetes Explanation: When obtaining the health history, the nurse should inquire about the following: dysuria (painful or difficult urination), as well as when during voiding (i.e., at initiation or at termination of voiding) this occurs; occupational, recreational, or environmental exposure to chemicals (plastics, pitch, tar, rubber); hypertension; or diabetes.

The nurse has been asked to provide health information to a female patient diagnosed with cystitis. Select all the teaching points that apply.

-Cleanse around the perineum and urethral meatus after each bowel movement. -Drink liberal amounts of fluid. -Void no more frequently than every 6 hours to allow urine to dilute the bacteria in the bladder. Explanation: With an infection, fluids should be increased up to 4 L/day, but caffeinated beverages should be avoided because they can irritate the urinary tract. Therefore, voiding more than seven times per day will help clear out bacteria from the bladder. See Box 28-3 in the text.

A nurse on the renal unit is caring for a client who will soon begin peritoneal dialysis. The family of the client asks for education about the peritoneal dialysis catheter that has been placed in the client's peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply.

-The cuffs are made of Dacron polyester. -The cuffs stabilize the catheter. -The cuffs prevent the dialysate from leaking. -The cuffs provide a barrier against microorganisms. Explanation: Most of these catheters have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not absorb dialysate.