Med/Surg Ch. 53, 54, 55
The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator?
Creatinine clearance level
A female patient visits her primary health care provider with a complaint of frequency of urination and incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis. The nurse knows that this is most likely due to which of the following?
Reflux of urine from the urethra into the bladder
If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection?
Perform meticulous perineal care daily with soap and water
The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, the absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following?
Peritonities
Which medication may be ordered to relieve discomfort associated with a UTI?
Phenazopyridine
A client has been diagnosed with acute glomerulonephritis. This condition causes:
Proteinuria
What is a hallmark of the diagnosis of nephrotic syndrome?
Proteinuria
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 patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms?
Pyridium
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
Recent history of streptococcal infection
A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal?
Relieve the pain.
During a routine assessment, the client states; "I wake up all night long to go the bathroom." The nurse documents this finding as which condition?
Nocturia
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
The term used to describe total urine output less than 0.5 mL/kg/hr is
Oliguria
Which of the following would a nurse classify as a prerenal cause of acute renal failure?
Septic shock
Which of the following nursing actions is most important in caring for the client following lithotripsy?
Strain the urine carefully for stone fragments.
When the bladder contains 400 to 500 mL of urine, this is referred to as
functional capacity.
The nurse is caring for a client who reports orange urine. The nurse suspects which factor as the cause of the urine discoloration?
phenazopyridine hydrochloride
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include
restricting sources of potassium usually found in fresh fruits and vegetables.
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?
A GFR of 30-59 mL/min/1.73 m2
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
Assessing present voiding patterns
Which value represents a normal BUN-to-creatinine ratio?
10:1
The nurse advises the patient with chronic pyelonephritis that he should:
Increase fluids to 3 to 4 L/24 hours to dilute the urine.
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of:
1,500 mL of fluid
A client is having a blood urea nitrogen (BUN) test. BUN level is:
increased in renal disease and urinary obstruction.
Which hormone causes the kidneys to reabsorb sodium?
Aldosterone
Which of the following is the most common site of a nosocomial infection?
Urinary tract
A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client?
"Do you take multiple vitamin preparations?"
While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question?
"Do you urinate while sleeping?"
The nurse is evaluating the effectiveness of discharge teaching for the client with an ileal conduit. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply.
"I cannot wait until I can have surgery to get rid of this ostomy." "I will need to change the appliance every day." "I will need to catheterize myself every 2 to 3 hours."
The nurse is giving discharge instructions to the client with uric acid renal calculi. Which statement by the client indicates the client understands the prescribed diet?
"I should limit my intake of meat and fish."
A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be:
1 to 2 L/day
When fluid intake is normal, the specific gravity of urine should be which of the following?
1.010 to 1.025.
A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?
150
The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal?
4000
Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?
6
Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as what?
Bladder retraining
The nurse is providing care to a client who has had a kidney biopsy. The nurse would need to be alert for signs and symptoms of which of the following?
Bleeding
A history of infection specifically caused by group A beta-hemolytic streptococcus is associated with which disorder?
Acute glomerulonephritis
A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?
Acute pain
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?
Administration of sodium polystyrene sulfonate [Kayexalate])
A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure?
After discarding the 8:00 am specimen
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
Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys?
Angiography
The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following?
Bleeding
A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. Which postoperative procedure should the nurse perform?
Maintain skin and stoma integrity
The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence?
Anticholinergic
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
An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care?
Application of an ostomy pouch
A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse?
Assess the patient's back and shoulder areas for signs of internal bleeding.
Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse?
Assess the patient's back and shoulder areas for signs of internal bleeding.
A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which action?
Maintain skin and stomal integrity.
What is the term for a concentration of urea and other nitrogenous wastes in the blood?
Azotemia
Which term is used to describe the concentration of urea and other nitrogenous wastes in the blood?
Azotemia
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 presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition?
Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?
Brief, hot daily showers
The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?
Calcium
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
Check for thrill or bruit over the access site.
Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted.
Citrus Fruits
Which nursing assessment finding indicates the client with renal dysfunction has not met expected outcomes?
Client reports increasing fatigue.
The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?
Cola-colored urine
The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program?
Medication usage
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test?
Monitor the client for an allergy to iodine contrast material.
The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find?
Costovertebral angle tenderness
A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection?
Creatinine
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?
Creatinine clearance
Which value does the nurse recognize as the best clinical measure of renal function?
Creatinine clearance
The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition?
Decreased fluid intake
After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence?
Decreased pelvic muscle tone due to multiple pregnancies
Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply.
Deficient knowledge: management of urinary diversion Disturbed body image Risk for impaired skin integrity
A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following?
Diabetes mellitus
Which instruction would be included in a teaching plan for a client diagnosed with a UTI?
Drink liberal amount of fluids.
Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection?
Drink liberal amount of fluids.
A client has a full bladder. Which sound would the nurse expect to hear on percussion?
Dullness
An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:
Encourage high fluid intake.
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.
A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?
Encouraging intake of at least 2 L of fluid daily
Which of the following is a cause of a calcium renal stone?
Excessive intake of vitamin D
Although the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys?
Excreting protein
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
Fever
Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure?
Glomerulonephritis
Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply.
Hyperkalemia Anemia Hypocalcemia
The nurse is conducting a community education program on UTIs. The nurse determines that the participants understand the teaching when they identify which factor as contributing to UTIs in older adults?
Immunocompromise
The nurse is assisting in the development of a protocol for bladder retraining following removal of an indwelling catheter. Which item should the nurse include?
Implement a 2- to 3-hour voiding schedule
A client has an end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?
Increase carbohydrates and limit protein intake.
The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do?
Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation.
What is a characteristic of the intrarenal category of acute kidney injury (AKI)?
Increased BUN
What is a characteristic of the intrarenal category of acute renal failure?
Increased BUN
The nurse observes that the client's urine is orange. Which additional assessment would be important for this client?
Intake of medication such as phenytoin
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
A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?
Kidney
The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following?
Kidney stones
A patient has had surgery to create an ileal conduit for urinary diversion. What is a priority intervention by the nurse in the postoperative phase of care?
Monitor urine output hourly and report output less than 30 mL/hr.
Which is an effect of aging on upper and lower urinary tract function?
More prone to develop hypernatremia
A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation?
Need to urinate after engaging in sexual intercourse
Which of the following describes awakening at night to urinate?
Nocturia
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected?
On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?
Painless hematuria
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.
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
The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply.
Perform hand hygiene prior to patient care. Assist patients with frequent toileting. Provide careful perineal care.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
Tall, peaked T waves
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
Tea-colored urine
Which nursing assessment finding indicates the client has not met expected outcomes?
The client voids 75 cc four hours post cystoscopy.
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?
The costovertebral angle
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
Which of the following is the procedure of choice for men with recurrent or complicated urinary tract infections (UTIs)?
Transrectal ultrasonography
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse?
Turn the client from side to side.
A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:
check the client's pedal pulses frequently.
The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to
drink liberal amounts of fluids.
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.
Bladder retraining following removal of an indwelling catheter begins with
instructing the client to follow a 2- to 3-hour timed voiding schedule.
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 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.
Which characteristic is seen with a healthy stoma?
Pink color
Retention of which electrolyte is the most life-threatening effect of renal failure?
Potassium
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?
Renin
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
Risk for infection
What is used to decrease potassium level seen in acute renal failure?
Sodium polystyrene sulfonate
A child is brought into the clinic with symptoms of periorbital edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem?
Sore throat 2 weeks ago
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.
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
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
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 instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client?
Use an aseptic technique during the procedure.
The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include:
WBC 50
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?
Wear a mask when performing exchanges.
The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present?
When the urine output is less than 30 mL/h
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?
"Very few symptoms are associated with renal cancer."
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 preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse?
"I took my blood pressure medication with my morning coffee an hour ago."
The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective?
"I will feel a warm sensation as the dye is injected."
The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective?
"My urine will be eliminated through a stoma."
A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client?
"This medication will relieve your pain."
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective?
"Ultrafiltration methods take much longer than hemodialysis."
The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output?
Less than 400 mL
The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?
Location of discomfort
Examination of a client's bladder stones reveals that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?
Low purine
A patient who has been treated for uric acid stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient?
Low-purine diet
A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate I can't control it, and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence?
Urge
The nurse advises a patient with renal stones to avoid eating shellfish, asparagus, and organ meats. She emphasizes these foods because she knows that his renal stones are composed of which of the following substances?
Uric acid
A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?
Urinary caliculi
The most frequent reason for admission to skilled care facilities includes which of the following?
Urinary incontinence
The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document?
Urinary urgency