MedSurg: Saunders Renal and Urinary
A client with nephrolithiasis arrives at the clinic for a follow-up visit. Laboratory analysis of the stone that the client passed 1 week earlier indicates that the stone is composed of calcium oxalate. Based on these data, what food item does the nurse instruct the client to avoid? 1. Pasta 2. Lentils 3. Lettuce 4. Spinach
Answer: 4. Spinach Rationale: Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. Pasta, lentils, and lettuce are acceptable to consume.
The nurse is preparing to teach ostomy care to a client who has just had a urinary diversion; the client expresses concern about body appearance. Which client action indicates that the best initial positive adaptation is being made? 1. Agrees to look at the ostomy 2. Asks to defer ostomy care to the spouse 3. Asks to wait 1 more day before beginning to learn ostomy care 4.States that ostomy care is the nurse's job while the client is in the hospital
Answer: 1. Agrees to look at the ostomy Rationale: The best initial positive step in learning to care for an ostomy and to accept it as a part of the self is to be able to look at the ostomy. Once the client is able to look at the ostomy and touch it, the client can proceed more successfully to learn about ostomy care. The other options all indicate a deferral or refusal on the part of the client, which makes them less than optimal choices.
A client who has had a prostatectomy has been instructed in perineal exercises to gain control of the urinary sphincter. The nurse determines that the client demonstrates a need for further teaching when he states that he will perform which movement as part of these exercises? 1. Bearing down as if having a bowel movement 2. Tightening the muscles as if trying to prevent urination 3. Contracting the abdominal, gluteal, and perineal muscles 4. Tightening the rectal sphincter while relaxing abdominal muscles
Answer: 1. Bearing down as if having a bowel movement Rationale: The Valsalva maneuver (bearing down) is avoided after prostatectomy because it increases the risk of bleeding in the postoperative period. An acceptable exercise is to tighten the abdominal, gluteal, and perineal muscles as if trying to prevent urination. Another acceptable exercise is to tighten the rectal sphincter while relaxing the abdominal muscles; this prevents the Valsalva maneuver from occurring.
A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder? 1. Diabetes mellitus 2. Orthostatic hypotension 3. Coronary artery disease 4. Intravenous (IV) contrast medium
Answer: 1. Diabetes mellitus Rationale: Pyelonephritis is most commonly caused by entry of bacteria, obstruction, or reflux. Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, overuse of analgesics, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.
A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? 1. Fish 2. Plum juice 3. Fruit juice 4. Cranberries
Answer: 1. Fish Rationale: Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on health care provider prescription, the urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice.
A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 1. Notify the HCP before performing the catheterization. 2. Use a small-sized catheter and an anesthetic gel as a lubricant. 3. Administer parenteral pain medication before inserting the catheter. 4. Clean the meatus with soap and water before opening the catheterization kit.
Answer: 1. Notify the HCP before performing the catheterization. Rationale: 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. The other options include performing the catheterization procedure and therefore are incorrect.
The nurse is monitoring the urine output of a client with low serum protein level and urinary output less than 30 mL in the last hour. Based on these data, the nurse understands that low urinary output is caused by which force within the kidneys? 1. Oncotic pressure 2. Osmotic pressure 3. Filtration pressure 4. Hydrostatic pressure
Answer: 1. Oncotic pressure Rationale: The pulling pressure within the capillaries that is exerted by the plasma proteins is referred to as the oncotic pressure. Osmotic pressure is the movement of water along a pressure gradient. Filtration pressure is the pressure that is exerted with ultrafiltration, in which the pressure within the capillaries is greater than the pressure outside them; this results in fluids being pushed across the membrane into Bowman's capsule. Hydrostatic pressure in the capillaries allows fluid to be filtered out of the blood in the glomerulus.
The nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that education was effective if the client chooses which selections from a diet menu? 1. Spinach salad, milk, and a banana 2. Chicken, potatoes, and cranberries 3. Peanut butter sandwich, milk, and prunes 4.Linguini with shrimp, tossed salad, and a plum
Answer: 1. Spinach salad, milk, and a banana Rationale: In some client situations, the health care provider may prescribe a diet that consists of foods that yield either an alkaline or an acid residue in the urine. In an alkaline residue diet, all fruits are allowed except cranberries, blueberries, prunes, and plums. Options, 2, 3 and 4 represent an acid residue diet.
The nurse is caring for a client who has just returned from having a cystoscopy. The nurse should recognize which as an abnormal assessment finding for this client? 1. The nurse notes bright red urine output. 2. The nurse notes pink-tinged urine output. 3. The client reports having urinary frequency. 4.The client complains of burning when urinating.
Answer: 1. The nurse notes bright red urine output. Rationale: The main purpose of a cystoscopy is to inspect the interior of the bladder with a tubular lighted scope (cystoscope). Pink-tinged urine is a normal finding after this procedure, but bright red urine indicates hemorrhaging and is not a normal finding. The remaining options are normal findings following this procedure.
The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder? 1. Hypoglycemia 2. Diabetes mellitus 3. Coronary artery disease 4. Orthostatic hypotension
Answer: 2. Diabetes mellitus Rationale: Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in the remaining options are not associated risk factors.
The nurse is performing an assessment on a client after a cystoscopy. Which assessment finding indicates a need to notify the health care provider (HCP)? 1. A temperature of 99.4°F (37.4°C) 2. Grossly bloody urine with clots 3. A bluish or green tinge to the urine 4. A blood pressure of 120/82 mm Hg
Answer: 2. Grossly bloody urine with clots Rationale: Grossly bloody urine with clots following cystoscopy is always an abnormal finding and should be reported to the HCP immediately. The client may have clear or blood-tinged urine after cystoscopy. If a contrast agent such as methylene blue is used, the urine may have an unusual bluish or green tinge. A blood pressure of 120/82 mm Hg and a temperature of 99.4°F (37.4°C) are not abnormal findings at this time.
The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common sign or symptom of this type of cancer? 1. Dysuria 2. Hematuria 3. Urgency on urination 4. Frequency of urination
Answer: 2. Hematuria Rationale: The most common sign in clients with cancer of the bladder is hematuria {PAINLESS Hematuria [early]; hematuria with dysuria [Later]}. The client also may experience irritative voiding symptoms such as frequency, urgency, and dysuria, and these symptoms often are associated with carcinoma in situ. Dysuria, urgency, and frequency of urination are also symptoms of a bladder infection.
A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse should expect to note which abnormal finding documented on the client's medical record? 1. Bradycardia 2. Hypertension 3. Decreased cardiac output 4.Decreased central venous pressure
Answer: 2. Hypertension Rationale: AKI caused by glomerulonephritis is classified as an intrinsic or intrarenal cause of renal failure. It is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from a prerenal cause is characterized by decreased blood pressure, tachycardia, decreased cardiac output, and decreased central venous pressure. Bradycardia is not part of the clinical picture for any form of kidney failure.
The nurse is providing instructions to a client who is scheduled for cystoscopy and possible biopsy under general anesthesia. Which information should the nurse include? 1. The procedure will take about 4 hours. 2. Intravenous fluids may be started on the day of the procedure. 3. Preprocedure sedatives are never administered with general anesthesia. 4. Only a full liquid breakfast may be allowed on the day of the procedure.
Answer: 2. Intravenous fluids may be started on the day of the procedure. Rationale: Client preparation for cystoscopy and possible biopsy includes informing the client that intravenous fluids will be started the day of the procedure to ensure adequate hydration and flow of urine. The procedure will take approximately 30 minutes to 1 hour. An informed consent is obtained from the client, and preprocedure sedatives are administered as prescribed. If a general anesthetic is to be used, the client is told that fasting is necessary after midnight before the procedure.
The nurse provides instructions to a client about newly prescribed furosemide. Which information should the nurse use to provide instructions in this teaching session? 1. The medication acts on the distal tubule of the nephron. 2. The medication acts on the loop of Henle in the nephron. 3. The collecting duct of the nephron will be affected by this medication. 4. The site of action for furosemide is the proximal tubule of the nephron.
Answer: 2. The medication acts on the loop of Henle in the nephron. Rationale: Furosemide works by acting to excrete sodium, potassium, and chloride in the ascending limb of the loop of Henle; therefore, options 1, 3, and 4 are incorrect.
The nurse has performed a nutritional assessment on a client with cystitis. The nurse should tell the client to consume which beverage to minimize recurrence of cystitis? 1. Tea 2. Water 3. Coffee 4. White wine
Answer: 2. Water Rationale: Water helps flush bacteria out of the bladder, and an intake of 6 to 8 glasses per day is encouraged. Caffeine and alcohol can irritate the bladder. Therefore, alcohol- and caffeine-containing beverages such as coffee, tea, and wine are avoided to minimize risk.
A client who is to have a cystectomy with creation of an ileal conduit asks the nurse why the bowel needs to be cleansed before surgery if the bladder is being removed. Which response by the nurse is the most appropriate? 1. "All clients undergo bowel preparation with major surgery." 2. "This will decrease the chance of postoperative paralytic ileus." 3. "A portion of the bowel will be used to create the conduit for urinary diversion." 4. "This will reduce the chance that the surgeon will nick the bowel during surgery."
Answer: 3. "A portion of the bowel will be used to create the conduit for urinary diversion." Rationale: The client scheduled for surgical creation of either an ileal conduit or a reservoir undergoes bowel preparation the night before the procedure. Preparation can include intake of copious clear liquids, laxatives, enemas, and antibiotics, depending on health care provider preference. This is done primarily to prevent infection because a loop of bowel will be used to create the urinary diversion.
The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care? 1. "I change my pouch every week." 2. "I change the appliance in the morning." 3. "I empty the urinary collection bag when it is two-thirds full." 4. "When I'm in the shower I direct the flow of water away from my stoma."
Answer: 3. "I empty the urinary collection bag when it is two-thirds full." Rationale: The urinary collection bag should be changed when it is one-third full to prevent pulling of the appliance and leakage. The remaining options identify correct statements about the care of a urinary stoma.
The nurse measures the cardiac output of a client and finds it to be 6 L/min. Which amount of kidney perfusion should the nurse anticipate? 1. 100 to 300 mL/min 2. 500 to 1000 mL/min 3. 1200 to 1500 mL/min 4. 2000 to 2500 mL/min
Answer: 3. 1200 to 1500 mL/min Rationale: The kidneys normally receive about 20% to 25% of the cardiac output when the client is at rest. If the cardiac output is 6 L/min, the kidneys receive 1.2 to 1.5 L/min, which is equal to 1200 to 1500 mL/min.
A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of these data, which should the nurse specifically include in the dietary instructions? 1. Increase intake of dairy products. 2. Avoid citrus fruits and citrus juices. 3. Avoid green, leafy vegetables such as spinach. 4. Increase intake of meat, fish, plums, and cranberries
Answer: 3. Avoid green, leafy vegetables such as spinach. Rationale: Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The food items in options 1, 2, and 4 are acceptable to consume.
A home care nurse is making home visits to an older client with urinary incontinence who is very concerned about the incontinent episodes. Which finding by the nurse indicates that the client has an environmental barrier to normal voiding? 1. Presence of hand railings in the bathroom 2. Having 1 bathroom on each floor of the home 3. Bathroom located on the second floor, bedroom on the first floor 4. Night light present in the hall between the bedroom and bathroom
Answer: 3. Bathroom located on the second floor, bedroom on the first floor Rationale: Having the bathroom on the second floor and the bedroom on the first floor may pose a problem for the older client with incontinence. The need to negotiate the stairs and the distance both may interfere with reaching the bathroom in a timely fashion. It is more helpful to the incontinent client to have a bathroom on the same floor as the bedroom or to have a commode rented for use. Hand railings and night lights are helpful to the client in reaching the bathroom quickly and safely.
The nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food? 1. Breads 2. Poultry 3. Chocolate 4. Prune juice
Answer: 3. Chocolate Rationale: Clients with oxalate stones should avoid foods high in oxalate, such as tea, instant coffee, cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and peanut butter. Large doses of vitamin C may help increase oxalate excretion in the urine.
A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse should observe for which most common manifestation of this disorder? 1. Headache 2. Hypotension 3. Flank pain and hematuria 4. Complaints of low pelvic pain
Answer: 3. Flank pain and hematuria Rationale: The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is either colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia, and palpable kidney masses. Hypertension is another common finding and may be associated with cardiomegaly and heart failure. The client may complain of a headache, but this is not a specific assessment finding in polycystic kidney disease.
The nurse is caring for a client who was prescribed furosemide. The nurse should monitor the client for damage of which kidney structure? 1. Pelvis 2. Calyx 3. Nephron 4. Renal artery
Answer: 3. Nephron Rationale: The nephron is the functional unit of the kidney that is responsible for clearance of excess fluid and waste products of metabolism. {Many meds, including Furosemide, may cause nephrotoxicity}. The renal pelvis and calices collect urine to send to the ureter. The renal artery brings blood to the kidney for filtering by the nephron.
The nurse is admitting a client from the post-anesthesia care unit who has had percutaneous nephrolithotomy for calculi in the renal pelvis. The nurse anticipates that the client's care will most likely involve monitoring which device? 1. Ureteral stent 2. Suprapubic tube 3. Nephrostomy tube 4. Jackson-Pratt drain
Answer: 3. Nephrostomy tube Rationale: A nephrostomy tube is put in place after percutaneous nephrolithotomy for calculi in the renal pelvis. The client also may have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculous fragments. Options 1, 2, and 4 are incorrect.
A client is experiencing the syndrome of inappropriate antidiuretic hormone (ADH) secretion. When explaining this disorder to the client and family, the nurse recalls that ADH works to reabsorb water in which parts of the nephron? 1. The glomerulus and the calices 2. The loop of Henle and the distal tubule 3. The distal tubule and the collecting duct 4. The proximal tubule and the loop of Henle
Answer: 3. The distal tubule and the collecting duct Rationale: The distal tubule and the collecting duct of the nephron require the presence of ADH for water reabsorption. The hormone increases the permeability of the membranes to allow water to flow more easily along the concentration gradient. The glomerulus filters but does not reabsorb. The calices are responsible for collecting the urine. The proximal tubule and the loop of Henle reabsorb water without the assistance of ADH.
The nurse has administered a dose of meperidine hydrochloride to a client with renal colic as treatment for pain. The nurse carefully monitors this client for which side and adverse effect of this medication? 1. Bradycardia 2. Hypertension 3. Urinary retention 4. Increased respirations
Answer: 3. Urinary retention Rationale: Meperidine hydrochloride is an opioid analgesic. Side effects of meperidine hydrochloride include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.
The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching? 1. "I should try to maintain an acid ash diet." 2. "I should increase my fluid intake to 3 L per day." 3. "I should take my daily dose of vitamin C to acidify the urine." 4. "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."
Answer: 4. "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day." Rationale: Clients with acute pyelonephritis should be instructed to try to maintain an acid ash diet, which may be of some benefit. Also, they should increase fluid intake to 3 L per day; this helps relieve dysuria and flushes bacteria out of the bladder. However, for clients with chronic pyelonephritis and renal dysfunction, an increase in fluid intake may be contraindicated. Medications such as vitamin C help acidify the urine. Juices such as cranberry, plum, and prune juice will leave an acid ash in the urine. Caffeine, alcohol, chocolate, and highly spiced foods are avoided to prevent potential bladder irritation.
The ambulatory care nurse is providing instructions to a client after a cystoscopy. Which statement by the client indicates a need for further teaching? 1. "I should increase my fluid intake." 2. "I can apply heat to my lower abdomen." 3. "I may have some burning on urination for the next few days." 4. "If I notice any pink-tinged urine, I should contact the health care provider."
Answer: 4. "If I notice any pink-tinged urine, I should contact the health care provider." Rationale: The client is instructed that pink-tinged urine and burning on urination are expected for 1 to 2 days after the procedure. Increased fluid intake is encouraged. Application of heat to the lower abdomen, administration of mild analgesics, and the use of sitz baths may relieve discomfort. The client also is advised to avoid alcoholic beverages for 2 days after the test.
The graduate nurse is caring for a client with decreased renal perfusion. The registered nurse determines that the graduate nurse demonstrates understanding of why this is occurring if which statement is made? 1. "It can be due to an increase in serotonin levels." 2. "It may be due to overhydration with intravenous fluids." 3. "It may be due to the client's hemoglobin of 13.2 g/dL (132 mmol/L)." 4. "It may be a consequence of decreased dopaminergic receptor stimulation."
Answer: 4. "It may be a consequence of decreased dopaminergic receptor stimulation." Rationale: Dopaminergic receptors are found in the renal blood vessels and in the nerves. When stimulated, they dilate renal arteries and help modulate release of the neurotransmitter dopamine. Renal artery dilation helps improve urine output by increasing blood flow through the kidneys. {If the pt is in shock and urine output decreases, first we give fluids and if the urine output is still low we start the patient on Dopamine drip at a low rate to dilate the renal blood vessels in order to increase urine output}. Serotonin is a local hormone that is released from platelets after an injury; it constricts arterioles but dilates capillaries. Dehydration, not overhydration, would decrease renal perfusion. A hemoglobin of 13.2 g/dL (132 mmol/L) is a normal value.
The home health nurse is planning to make a home visit to a client who has undergone surgical creation of an ileal conduit. The nurse should include which information on ostomy care in discussion with the client? 1. Plan to do appliance changes in the late evening hours. 2. Cut an opening that is slightly smaller than the stoma in the face plate of the appliance. 3. Appliance odor from urine breakdown to ammonia can be minimized by limiting fluids. 4. Cleanse the skin around the stoma, using gentle soap and water, and then rinse and dry well.
Answer: 4. Cleanse the skin around the stoma, using gentle soap and water, and then rinse and dry well. Rationale: The skin around the stoma is cleansed at each appliance change using a gentle, nonresidue soap and water. The skin is rinsed and then dried thoroughly. The appliance should be changed early in the morning because urine production is slowest from no fluid intake during sleep. The appliance is cut so that the opening is not more than 3 mm larger than the stoma. An opening smaller than the stoma will prevent application of the appliance. Generous fluid intake is encouraged to dilute the urine, decreasing the intensity of odor.
A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item? 1. Steak 2. Shrimp 3. Chicken liver 4. Cottage cheese
Answer: 4. Cottage cheese Rationale: With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet. Intake of foods with moderate levels of purines, such as red and white meats and some seafood, also is limited. Avoiding the consumption of milk and dairy products is a recommended dietary change for calculi composed of calcium stones but is acceptable for the client with a uric acid stone.
The nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which should the nurse expect to note in this client? 1. Decreased serum lipids 2. Signs of fluid volume deficit 3. Decreased protein in the urine 4. Decreased serum albumin levels
Answer: 4. Decreased serum albumin levels Rationale: Nephrotic syndrome describes a variety of signs and symptoms that accompany any condition that markedly impairs filtration by glomerular capillary membranes and results in increased permeability to protein. Hallmark signs and symptoms of this syndrome include increased serum lipids, edema, increased excretion of protein in the urine, and decreased serum albumin levels.
A client with a bladder injury has had surgical repair of the injured area with placement of a suprapubic catheter. Which is the most appropriate nursing action to prevent complications of this procedure? 1. Monitor urine output once per shift. 2. Measure specific gravity once per shift. 3. Encourage an excessive intake of oral fluids. 4. Ensure that the catheter tubing is not kinked.
Answer: 4. Ensure that the catheter tubing is not kinked. Rationale: A complication after surgical repair of the bladder is disruption of sutures, caused by tension on them from urine buildup. The nurse prevents this from happening by ensuring that the catheter is able to drain freely. This involves basic catheter care, including keeping the tubing free from kinks, maintaining the tubing at a level below the bladder, and monitoring the flow of urine frequently. Monitoring of urine output every shift is insufficient to detect decreased flow from catheter kinking. Measurement of urine specific gravity and an excessive intake of oral fluids do not prevent complications of bladder surgery.
The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper fluid balance if which 24-hour intake and output totals are noted? 1. Intake 1500 mL, output 800 mL 2. Intake 3000 mL, output 2000 mL 3. Intake 2400 mL, output 2900 mL 4. Intake 1800 mL, output 1750 mL
Answer: 4. Intake 1800 mL, output 1750 mL Rationale: For the client on a normal diet, the normal fluid intake is approximately 1200 to 1800 mL of measurable fluids per day. The client's output in the same period should be about the same and does not include insensible losses, which are extra. Insensible losses are offset by the fluid in solid foods, which also is not measured.
A client has just had a Foley catheter removed and is to be started on a bladder retraining program. Which intervention will provide the most useful information about the client's ability to empty the bladder? 1. Calculating total fluid intake for the shift 2. Recording the amount of the client's voidings 3. Assisting the client to the bathroom every 2 hours 4. Measuring postvoid residual using a bladder scan
Answer: 4. Measuring postvoid residual using a bladder scan Rationale: Measuring postvoid residual gives specific information about the ability of the bladder to empty completely. Recording intake and output and assisting the client to the bathroom are general interventions but do not provide information about the client's ability to empty the bladder.
The nurse assessing the ureterostomy of a postoperative client interprets that the stoma has normal characteristics if which is observed? 1. Dry 2. Pale 3. Dark-colored 4. Red and moist
Answer: 4. Red and moist Rationale: Following ureterostomy, the stoma should be red and moist. A dry stoma may indicate fluid volume deficit. A pale stoma may indicate an inadequate vascular supply. Any darkness or duskiness of the stoma may mean loss of vascular supply and must be corrected immediately to prevent necrosis.
The nurse is caring for an older client. Which finding should the nurse expect to note in this client while evaluating renal function? 1. Tubular reabsorption increases 2. Urine-concentrating ability increases 3. Medications are metabolized in larger amounts 4. The glomerular filtration rate (GFR) diminishes
Answer: 4. The glomerular filtration rate (GFR) diminishes Rationale: As part of the normal aging process, the GFR decreases, along with each of the other functional abilities of the kidney. Tubular reabsorption and urine-concentrating ability also decrease. The kidneys have decreased ability to metabolize medications.
The nurse is caring for a client with a bladder infection. The nurse plans care understanding that the primary risk factor for spread of infection in this client is dysfunction of which structure? 1. Urethra 2. Nephron 3. Glomerulus 4. Ureterovesical junction
Answer: 4. Ureterovesical junction Rationale: The ureterovesical junction is the point at which the ureters enter the bladder. At this juncture, the ureter runs obliquely for 1.5 to 2 cm through the bladder wall before opening into the bladder. This anatomical pathway prevents reflux of urine back into the ureter and, in essence, acts as a valve to prevent urine from traveling back into the ureter and up to the kidney.
The nurse has conducted an educational session about risk factors for bladder cancer with clients in the ambulatory care center. Which statements by the clients indicate that teaching was effective? Select all that apply. 1. "Quitting smoking will help to reduce my risk." 2. "I have to consider natural alternatives to dye my hair." 3. "Infections of the bladder cannot cause bladder cancer." 4. "Chemicals have to enter the bladder directly in order to cause bladder cancer." 5. "I have to consult with my health care provider about long-term use of cyclophosphamide medications."
Answers: 1. "Quitting smoking will help to reduce my risk." 2. "I have to consider natural alternatives to dye my hair." 5. "I have to consult with my health care provider about long-term use of cyclophosphamide medications." Rationale: The greatest risk factor for bladder cancer is tobacco use. Exposure to toxins in hair dyes, rubber, paint, electric cable, and textile industries increases risk for bladder cancer. Chemicals may enter the body through contact with skin and mucous membranes in the respiratory tract. In addition, bladder infections and long-term use of cyclophosphamides may cause bladder cancer.
A client with bladder cancer has undergone surgical removal of the bladder with creation of an ileal conduit. Which assessment findings indicate that the client is developing complications? Select all that apply. 1. Dusky appearance of the stoma 2. Stoma protrusion from the skin 3. Sharp abdominal pain with rigidity 4. Urine output greater than 30 mL/hour 5. Mucus shreds in the urine collection bag
Answers: 1. Dusky appearance of the stoma 2. Stoma protrusion from the skin 3. Sharp abdominal pain with rigidity Rationale: To create an ileal conduit, the surgeon takes a short segment of the small intestine and reconnects the remaining intestine so that it functions normally. One end of the removed segment of intestine is placed at the skin surface to create the stoma. The stoma should be red and moist. A pale, dusky stoma indicates poor vascular supply that could result in necrosis. The stoma should be flush to the skin. The client should not have sharp abdominal pain with rigidity, an indication of peritonitis. Any of these findings should be reported to the health care provider. Options 4 and 5 are normal findings.
The nurse has a prescription to obtain a urinalysis specimen from a client with an indwelling urinary catheter. Which actions should the nurse include in performing this procedure? Select all that apply. 1. Explaining the procedure to the client 2. Clamping the tubing of the drainage bag 3. Aspirating a sample from the port on the drainage tubing 4. Obtaining the specimen from the urinary drainage bag 5. Wiping the port with an alcohol swab before inserting the syringe
Answers: 1. Explaining the procedure to the client 2. Clamping the tubing of the drainage bag 3. Aspirating a sample from the port on the drainage tubing 5. Wiping the port with an alcohol swab before inserting the syringe Rationale: A urine specimen is not taken from the urinary drainage bag. Urine undergoes chemical changes while sitting in the bag, so its properties do not necessarily reflect current client status. In addition, it may become contaminated with bacteria from opening the system. The remaining options are correct interventions for obtaining the specimen.
The nurse is creating a plan of care for a client with a diagnosis of nephrotic syndrome whose glomerular filtration rate (GFR) is normal. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Monitor daily weight. 2. Maintain sodium restrictions. 3. Maintain a diet low in protein. 4. Monitor intake and output (I&O). 5. Maintain bed rest when edema is severe.
Answers: 1. Monitor daily weight. 2. Maintain sodium restrictions. 4. Monitor intake and output (I&O). 5. Maintain bed rest when edema is severe. Rationale: Controlling edema is a critical aspect of therapeutic management of nephrotic syndrome. If the GFR is normal, dietary intake of proteins is needed to restore normal plasma oncotic pressure and thereby decrease edema. Daily measurement of weight and abdominal girth, and careful monitoring of I&O will determine whether weight loss is caused by diuresis or protein loss. Dietary modifications may include salt restriction and fluid restriction and are based on the client's symptoms. Bed rest is prescribed to promote diuresis when edema is severe.
A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 3. Put the client on NPO (nothing by mouth) status except for ice chips. 4. Review the client's medications to determine if any contain or retain potassium. 5.Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.
Answers: 1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 4. Review the client's medications to determine if any contain or retain potassium. Rationale: The normal potassium level is 3.5-5.0 mEq/L (3.5-5.0 mmol/L). A potassium level of 7.0 is elevated. 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. The nurse should notify the HCP and also review medications to determine if any contain potassium or are potassium retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly.
The nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings should the nurse expect to note? Select all that apply. 1. Proteinuria 2. Hematuria 3. Positive ketones 4. A low specific gravity 5. A dark and smoky appearance of the urine
Answers: 1. Proteinuria 2. Hematuria 5. A dark and smoky appearance of the urine Rationale: In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross proteinuria and hematuria. The specific gravity is elevated, and the urine may appear dark and smoky. Positive ketones are not associated with this condition but may indicate a secondary problem.
The nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan that will aid in acidifying the urine? Select all that apply. 1. Milk 2. Prune juice 3. Apricot juice 4. Cranberry juice 5. Carbonated drinks
Answers: 2. Prune juice 3. Apricot juice 4. Cranberry juice Rationale: Acidification of the urine inhibits multiplication of bacteria. Fluids that acidify the urine include prune, apricot, cranberry, and plum juice. Carbonated drinks should be avoided because they increase urine alkalinity. Two glasses of milk a day can make the urine more alkaline, which could aid in the development of kidney stones.
