NCLEX Urinary/Renal System

True or False? Water is the primary substance reabsorbed in the collecting duct?

True

How are renal calculi diagnosed?

UA, cystoscopy, IVP, renal stone analysis, KUB, or serum tests (calcium, oxalate, uric acid).

Three weeks after being treated for strep throat, a patient comes into the clinic with signs of acute glomerulonephritis. Which of the following symptoms will the nurse most likely find upon assessment of this patient? 1. periorbital edema 2. hunger 3. polyuria 4. polyphagia

Correct Answer: 1 Rationale: Acute proliferative glomerulonephritis is characterized by an abrupt onset of hematuria, proteinuria, salt and water retention, and evidence of azotemia that occurs 10 to 14 days after the initial infection. The urine often appears brown or cola-colored. Salt and water retention increase extracellular fluid volume, which leads to hypertension and edema. The edema is primarily noted in the face, particularly around the eyes or periorbital edema. Dependent edema, which affects the hands and upper extremities, may also be noted. Other manifestations may include fatigue, anorexia, nausea, and vomiting, and headache. Hunger (polyphagia) and polyuria are symptomatic of diabetes mellitus.

A male patient with a urinary stoma says, "I looked at it while you were out of the room. It's not so bad." The nurse realizes that this patient is demonstrating which of the following? 1. coping 2. denial 3. grief 4. anger

Correct Answer: 1 Rationale: Adaptive coping mechanisms include learning as much as possible about the surgery and its effects, practicing procedures, setting realistic goals and rehearsing various alternative outcomes. Accepting the stoma as part of the self is vital to adapting to the changed body image and is indicated by a willingness to provide self-care. The patient may initially use defensive mechanisms such as denial, minimization, and dissociation from the immediate situation to reduce anxiety and maintain psychological integrity. Grief and anger may also be expressed by the patient with a new stoma, but the patient's statement demonstrates a coping behavior.

A patient with an allergy to iodine is scheduled to have the following diagnostic tests. Which requires immediate nursing intervention? 1. renal angiogram 2. renal scan 3. voiding cystogram 4. portable ultrasonic bladder scan

Correct Answer: 1 Rationale: An angiogram includes the use of contrast dye, which often contains iodine. The nurse should contact the primary healthcare provider to report the iodine allergy. The other tests do not use contrast media.

A nurse on the postoperative unit should assign which of these staff members to perform a follow-up assessment for a patient who has returned home after having an intravenous pyelogram 24 hours ago? 1. RN floating from the immunology unit 2. LPN floating from the nephrology unit 3. LPN floating from the pulmonology unit 4. RN floating from the orthopedic unit

Correct Answer: 1 Rationale: Delayed reactions to contrast dyes containing iodine can occur. The most appropriate staff member to follow up with the patient is the RN from the immunology unit. This RN will have extensive experience with hypersentitivity reactions and is best prepared to meet the needs of the patient. Prior to discharge the nurse should instruct the patient to contact the healthcare provider for any delayed reactions to the dye (breathing difficulty, rash, itching, rapid heartbeat).

A patient with struvite-type kidney stones may be managed by what two interventions? 1. surgical intervention; antibiotic therapy 2. limiting foods high in calcium; taking thiazide diuretics 3. a sodium restricted diet; taking penicillamine 4. a low-purine diet; taking potassium citrate

Correct Answer: 1 Rationale: Management of the patient with struvite kidney stones includes surgical intervention or lithotripsy to remove the stone and antibiotic therapy for urinary tract infection (UTI). Limiting foods high in calcium and prescribing thiazide diuretics is common management for the patient with calcium phosphate and/or oxalate type kidney stones; restricting sodium in the diet and penicillamine is used for cystine type stones; and, a low-purine diet and potassium citrate is commonly prescribed for uric acid stones.

The nurse, completing discharge teaching for a patient diagnosed with pyelonephritis, is asked "What is pyelonephritis?" The nurse's best response would be which of the following? 1. "Pyelonephritis is an infection of the kidney." 2. "It is an inflammation of the bladder." 3. "Pyelonephritis is an infection of the lower urinary tract." 4. "It is a blockage in the tube from your kidney to your bladder."

Correct Answer: 1 Rationale: Pyelonephritis is an infection of the renal pelvis and parenchyma, the functional unit of the kidney. Pyelonephritis is not an inflammation of the bladder; it does not occur in the lower urinary tract or ureter.

A patient is diagnosed with 45% of normal glomerular filtration. The nurse realizes that this patient is experiencing which of the following? 1. renal insufficiency 2. acute renal failure 3. chronic renal failure 4. end-stage renal disease

Correct Answer: 1 Rationale: Renal insufficiency is where the glomerular filtration rate is 20% to 50% of normal. Acute renal failure, chronic renal failure, and end-stage renal disease are not defined by this criterion alone.

A patient who is diagnosed with renal cancer states, "I only lost a few pounds! I had no other symptoms!" The nurse realizes that the only consistent symptom of renal cancer is which of the following? 1. hematuria 2. flank pain 3. nausea 4. vomiting

Correct Answer: 1 Rationale: Renal tumors are often silent and have few manifestations. The classic triad of symptoms, which is gross hematuria, flank pain, and palpable abdominal mass, is seen in only about 10% of people with renal cell carcinoma. Hematuria, often microscopic, is the most consistent symptom. Systemic manifestations include fever without infection, fatigue, and weight loss. Nausea and vomiting are not frequent symptoms.

A married female patient has a history of repeated urinary tract infections (UTIs). Which of the following should the nurse include while assessing this patient? 1. preferred method of birth control 2. employment status 3. height and weight 4. activity status

Correct Answer: 1 Rationale: Risk factors for urinary tract infections (UTIs) include sexual intercourse and the use of diaphragm and spermicidal compounds for birth control and pregnancy. Employment status, height and weight, and activity status do not have a direct relationship to repeat UTI.

A nurse is advising a nursing student who is preparing a teaching presentation for fellow students regarding urinalysis. Which of these teaching points, if made by the student, requires intervention by the nurse? 1. Males patients should retract the foreskin and cleanse the glans with three cotton sponges saturated with cleansing solution, using a circular motion. 2. Female patients should separate the labia with one hand and clean the labia with the other, using sterile cotton swabs saturated with a cleansing solution, wiping back to front. 3. After cleansing, patients should start voiding and then begin to collect the specimen. 4. Patients should start taking prescribed antibiotics only after the specimen is collected.

Correct Answer: 1 Rationale: The female patient should cleanse the perineum with a front-to-back motion to avoid contaminating the urethral meatus with fecal bacteria. The other options are correct.

The nurse assesses a patient admitted to the medical-surgical unit who has a diagnosis of type I diabetes mellitus. The nurse notes that the patient's urine is cloudy and foul-smelling. Which of the following diagnostic tests does the nurse anticipate will be ordered based on this finding? 1. urine culture and sensitivity (C&S) 2. blood urea nitrogen (BUN) 3. creatinine clearance 4. residual urine

Correct Answer: 1 Rationale: Urine culture and sensitivity (C&S) is correct because cloudy and foul-smelling urine indicates a urinary tract infection. The diagnostic test to identify the organism responsible is a urine C&S. Blood urea nitrogen (BUN) measures the amount of urea (end product of protein metabolism) in the blood plasma. It does not identify infection. Creatinine clearance is a 24-hour urine test used to identify renal function; it will not identify an infection. Residual urine measures the amount of urine left in the bladder after voiding, and does not identify an infection.

A nurse is teaching a patient about a voiding cystogram procedure. Which of these statements, if made by the patient, would indicate that the patient has the correct understanding of the instruction? Select all that apply. 1. "A urinary catheter will be placed in my bladder." 2. "My bladder will be filled with fluid" 3. "I will describe when my bladder feels full." 4. "A peripheral IV will be inserted in my arm." 5. "I will be sedated for the procedure."

Correct Answer: 1,2,3 Rationale: During this procedure a urinary catheter will be placed in the bladder, then the bladder will be filled and during filling the patient will be asked to describe the first urge to void, and the sensation of being unable to delay urination any longer. A peripheral IV is not needed for this procedure and the patient is not sedated as the patient must report when the sensation of bladder filling is occurring.

When assessing a patient who is scheduled for a cystogram and at risk for complications directly related to the procedure, a nurse should alert the primary healthcare provider if the patient has which of these clinical manifestations? Select all that apply. 1. cystitis 2. prostatitis 3. neuroleptic malignant syndrome 4. right-sided hemiplegia 5. chronic pain

Correct Answer: 1,2,3 Rationale: When caring for a patient undergoing a cystogram, the nurse will assess history of cystitis or prostatitis (these disorders could result in sepsis after the procedure), hypersensitivity to anesthetics, and urinary patterns (amount, color, odor). Right-sided hemiplegia and chronic pain are not issues for this patient.

Which patients would not be able to do CAPD (Continuous Ambulatory Peritoneal Dialysis)?

-disc disease (fluid causes too much pressure on the back) -colostomy (high risk for infection)

What to do if you suspect kidney stone?

-get a urine specimen ASAP and have it checked for WBCs and RBCs -They will get pain meds immediately

Other Treatments for Kidney Stones

-increase fluids for life -maybe surgery -strain urine -Extracorporeal shock wave lithotripsy (to crush the stone)

Signs and Symptoms of Kidney Stones

-pain -n/v -WBCs in urine -HEMATURIA!

Dietary Needs of Peritoneal Dialysis patient

-Increase Fiber in diet (because they have decreased peristalsis due to abdominal fluid) -Increase protein in diet because they have big holes in the peritoneum and they lose protein with each exchange

Glomerulonephritis Patho

-Inflammatory reaction in the filtering part of the kidney (glomerulus) -antibodies lodge in the glomerulus; get scarring and decreased filtering -Main cause is strep (99%) -Acute can lead to chronic

Treatment for Kidney Stones (meds)

-Ketorolac (Toradol) for pain and inflammation -Ondansetron (Zofran) -Hydromorphone (Dilaudid)

Complications of Peritoneal Dialysis

-Major complication is infection (peritonitis) -Constant sweet taste (dialysate has sugar) -May get a hernia -Altered body image/sexuality -Anorexia -Low back pain

CAPD (Continuous Ambulatory Peritoneal Dialysis)

-Must have a client that has energy and the desire to be active in their treatment and also has the ability to learn and follow directions -Done 4 times a day, 7 days a week

Signs and Symptoms of Nephrotic Syndrome

-PROTEINURIA!! -hypoalbuminemia -edema (anasarca) -hyperlipidemia (increased triglycerides)

Renal Failure stems from 3 sources

-Pre-Renal Failure -Intra-Renal Failure -Post-Renal Failure

"A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to "a. avoid alcohol for the first 3 weeks. B. use a condom during sexual intercourse. c. have family members get an injection of immunoglobulin. d. follow a low-protein, moderate-carbohydrate, moderate-fat diet."

"3. Correct answer: b Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B."

The nurse is performing an assessment on a client bein evaluated for viral hepatitis. Which symptom will the nurse most likely assess on this client? 1. Arthralgia 2. Excitability 3. Headache 4. Polyphagia

"ANSWER: 1 Rationale: arthralgia is common in clients with viral hepatitis. Other symptoms of viral hepatits include lethargy, flulike symptoms, anorexia, N/V, abdominal pain, diarrhea, constipation, and fever. The others are not symptoms of viral hepatitis."

"A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal... a. hepatitis B surface antigen (HBsAg). b. anti-hepatitis B core immunoglobulin M (anti-HBc IgM). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)."

"ANSWER: D Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV IgG would indicate past infection and lifelong immunity."

A college student is required to be inoculated for hepatitis before entering college. The nurse reognizes that this client will be inoculated to prevent the development of...? "1. Hepatits D 2. Hepatits B 3, Hepatitis C 4.Hepatits E"

"Answer: 2 - Hepatits B Ratioinale: Sexually transmitted and is seen in all age groups. There is a vaccine for this type of Hepatitis

normal serum creatinine

0.6 - 1.5 mg/dL

How far above the coccyx will the bladder scanner be positioned?

1 to 1.5 inches above the symphysis pubis

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply.

1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 3. Place the client in good body alignment. 4. Check the peritoneal dialysis system for kinks.

Epididymitis from UTI patient teaching

1. Drink increased amounts of fluids. 2. Limit the force of the stream during voiding. 3. Use condoms to eliminate risk from chlamydia and gonorrhea.

What are the 2 types of Peritoneal Dialysis?

1. CAPD (Continuous Ambulatory Peritoneal Dialysis) 2. CCPD (Continuous Cycle Peritoneal Dialysis)

What are the 2 phases of Acute Renal Failure?

1. Oliguric Phase 2. Diuretic Phase

Steps to inserting an indwelling catheter

1. Open sterile catheterization tray using sterile technique 2. don sterile gloves 3. open all sterile supplies 4. clean each labile fold/ meatus 5. slowly insert lubricated catheter 6. advance catheter until urine flow

Steps for assessing a patients postvoid residual using a bladder scan?

1. press appropriate gender button 2. position scanner with directional arrow pointing toward head 3. press scanner head 1 to 1.5 inches above pubic symphysis 4. Aim scanner toward coccyx and activate scan 5. verify crossbars fall within bladder image 6. observe and record the volume measurement on the screen

normal creatinine production

15-25 mg/kg in 24 hours

A postvoid residual urine volume greater than what number increases the risk for the development of a urinary tract infection?

150 mL

Minimum amount in bladder to stimulate urgency to void

150-200 mL of Urine

(What is the ) recommended daily fluid intake

2,000 - 2,400 mL in fluids (is the)

The volume of urine in the bladder that usually causes the urge to urinate is ____ mL.

200-250 mL

Normal hourly urine output

30-50 mL/hr

The school nurse is discussing ways to prevent an outbreak of hepatitis A with a groupof high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? "1.Do not allow students to eat or drink after each other.2.Drink bottled water as much as possible.3.Encourage protected sexual activity.4.Thoroughly wash hands."

4. Thoroughly wash hands.

Normal Postvoid Residual

50 mL or less of urine

normal urine osmolarity

500 - 800 mOsm/kg

What sized catheters are used for infants and young children?

5F to 8F

What is the normal urine output for an adult?

60-75 cc/hr or 1440-1800/24 hrs.

Total bladder capacity ranges from _________ mL to _________ mL.

600-1000mL

You are preparing to insert a urinary catheter into a 3-year old child. Which sized urinary catheter should be used?

6F (sizes 5F-8F is for infants/ small children)

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? a) 4 months b) 7 months c) Over 1 year d) 1 month

7 months Explanation: Six to 12 months of therapy with UDCA is recommended in patients to dissolve the stones.

normal BUN level

8-25 mg/dL

What about for older children?

8F to 12F

Recommanded guideline for catherization

> 150 mL of urine

What should you suspect if a newly married women comes in with urinary frequency and urgency?

A UTI=more sex bc newly married so teach to urinate after intercourse.

How is BPH diagnosed?

A digital rectal exam confirms enlargement and prostate specific antigen helps confirm diagnosis and can indicate extent of hyperplasia.

What is a vascular access for hemodialysis?

A site where they have access to a large blood vessel because very rapid blood flow is essential for hemodialysis

Which of the following solutions is hypotonic? a) 0.45% NaCl b) 5% NaCl c) 0.9% NaCl d) Lactated Ringer's solution

A) 0.45% NaCl Half-strength saline is hypotonic. Lactated Ringer's solution is isotonic. Normal saline (0.9% NaCl) is isotonic. A solution that is 5% NaCl is hypertonic.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a) Dehydration b) Crackles c) Hypertension d) Hyperkalemia

A) Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of: a) Disturbed body image b) Situational low self esteem c) Anticipatory grieving d) Deficient knowledge: stoma care

A) Disturbed body image The client is exhibiting defining characteristics of disturbed body image.

To assess circulating oxygen levels, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which of the following diagnostic tests? a) Hemoglobin b) Hematocrit c) Arterial blood gases d) Serum iron levels

A) Hemoglobin Explanation: Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines, recommend that anemia be quantified using hemoglobin rather than hematocrit measurements. Hemoglobin is recommended as it is more accurate in the assessment of circulating oxygen than hematocrit. Serum iron levels measure iron storage in the body. Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output? a) It's an abnormal finding that requires further assessment. b) It's a normal finding caused by blood loss during surgery. c) It's an abnormal finding that will correct itself when the client ambulates. d) It's a normal finding associated with the client's nothing-by-mouth status.

A) It's an abornmal finding that requires further assessment. The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-by-mouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation promotes urination; however, the client should produce at least 30 ml of urine/hour.

A priority nursing intervention for a client with hypervolemia involves which of the following? a) Monitoring respiratory status for signs and symptoms of pulmonary complications. b) Establishing I.V. access with a large-bore catheter. c) Encouraging the client to consume sodium-free fluids. d) Drawing a blood sample for typing and crossmatching.

A) Monitoring respiratory status for signs ans symptoms of pulmonary complications Hypervolemia, or fluid volume excess (FVE), refers to an isotonic expansion of the extracellular fluid. Nursing interventions for FVE include measuring intake and output, monitoring weight, assessing breath sounds, monitoring edema, and promoting rest. The most important intervention in the list involves monitoring the respiratory status for any signs of pulmonary congestion. Breath sounds are assessed at regular intervals.

Russell Thompkins, a 77-year-old retired male, visits your general practice office twice monthly to maintain control of his congestive heart failure. He measures his weight daily and phones it to your office for his medical record. In a 24-hour period, how much fluid is Russell retaining if his weight increases by two pounds? a) One liter b) 1250 ml c) 1500 ml d) 500 ml

A) One liter A 2-lb weight gain in 24 hours indicates that the client is retaining 1L of fluid.

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? a) PaCO 36 b) HCO 21 mEq/L c) O saturation 95% d) pH 7.48

A) PaCO 36 Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma bicarbonate concentration. The HCO value is below normal. The PaCO value and the oxygen saturation level are within a normal range

Which of the following terms is used to refer to inflammation of the renal pelvis? a) Pyelonephritis b) Interstitial nephritis c) Urethritis d) Cystitis

A) Pyleonephritis Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.

A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse? a) Renal circulation b) Urine production c) Kidney function d) Kidney structure

A) Renal circulation A renal angiogram (renal arteriogram) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.

Itching Frost

AKA uremic frost -urea is in the blood and not in the urine, so it starts leaking out through the skin and itches. -must provide good skin care

When should dialysis at home occur?

AM, lunch, dinner, and before bed. Complications=peritonitis (check S&S infection). If diabetic adjust insulin with dialysate. 2000 dialysate goes in so should get more than 2000 out if not=may come out later with repositioning.

What should you make sure to ask an older gentleman before exams?

About urine stream so know if BPH and don't perforate anything.

What causes glomerulonephritis?

An antigen-antibody complex from a recent strep infection in glomeruli causes inflammation and decreased GFR.

Which priority teaching information should the nurse discuss with the client to help prevent contracting hep. B? 1.Explain the importance of good hand washing. 2.Tell the client to take the hepatitis B vaccine in three (3) doses. 3.Tell the client not to ingest unsanitary food or water. 4.Discuss how to implement standard precautions.

Answer 1 would be appropriate for prevention of hepatitis A.

"The female nurse sticks herself with a dirty needle. Which action should the nurse implement first? 1.Notify the infection control nurse. 2.Cleanse the area with soap and water. 3.Request post-exposure prophylaxis. 4.Check the hepatitis status of the client.

Answer 2. The nurse should first clean the needle stick with soap and water to help remove any virus that is on the skin

4. When reviewing the laboratory values for a patient admitted with a severe crushing injury after an industrial accident, the nurse will be most concerned about levels of a. creatinine. b. potassium. c. white blood cells (WBCs). d. BUN.

Answer: B Rationale: The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse will also review the other laboratory values, but abnormalities in these are not immediately life threatening. Cognitive Level: Application Text Reference: p. 1200 Nursing Process: Assessment NCLEX: Physiological Integrity

"To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when "A. Disposing of food trays B. Emptying bed pan C. Taking an oral temperature D. Changing IV tubing"

Answer: B Rationale: HAV is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A.

What is the treatment for UTIs?

Antimicrobials, increased fluid intake, and prevention teaching.

Transient Incontinence

Appears suddenly and lasts for 6m or less

Arterial steal syndrome

Arterial steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula, which is caused by tissue ischemia.

"To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when A. Disposing of food trays B. Emptying bed pans C. Taking an oral temperature D. Changing IV

B is the correct answer. HAV is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A.

Nursing management of the client with a urinary tract infection should include: a) Teaching the client to douche daily b) Discouraging caffeine intake c) Administering morphine sulfate d) Instructing the client to limit fluid intake

B) Discouraging caffeine intake Strategies for preventing urinary tract infection include proper perineal hygiene, increased fluid intake, avoiding urinary tract irritants (including caffeine), and establishing a frequent voiding regimen.

A urinalysis of a urine specimen that is not processed within 1 hour may result in erroneous measurement of a) glucose b) bacteria c) specific gravity d) white blood cells

B) bacteria bacteria in warm urine specimens multiply rapidly, and false or unreliable bacterial counts may occur with old urine. Glucose, specific gravity, and WBCs do not change in urine specimens, but pH becomes more alkaline, RBCs are hemolyzed, and casts may disintegrate.

To prevent the spread of hepatitis A infections the nurse is especially careful when: A) Disposing of food trays B) Disposing of bed pan C) taking an oral temp D) Changing IV tubing

B. Rationale: HAV is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A."

What are treatments/drugs that can help with urge incontinence?

Behavioral techniques (limiting fluids to 1-1/2 liters, don't drink anything within 2 hours of bedtime), Detrol and Ditropan can help reduce unwanted bladder contractions.

What are treatments/drugs that can help with stress incontinence?

Behavioral techniques (toileting schedule every 2-3 hrs), KAGEL EXERCISES, advise to decrease WT bc increases muscle control, Tofranil and Premarin (reduce the urge to urinate).

What should be used for a patient with HIV who is doing intermittent caths at home?

Benadine to clean and reuse!

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: a) 1 hour. b) 24 hours. c) 1 minute. d) 30 minutes.

C) 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.

Susan Young, a 57-year-old financial officer, has been exhibiting signs and symptoms which lead her urologist to suspect the adequacy of her urinary function. Beginning with the least invasive tests, which of the following would you expect the physician to prescribe to assess kidney function? Choose all correct options. a) Blood urea nitrogen (BUN) level b) Creatinine clearance c) Angiography d) All options are correct

C) Angiography Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.

A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? a) Hyperglycemia b) Hypercalcemia c) Hyperkalemia d) Hypernatremia

C) Hyperkalemia Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia.

The calcium level of the blood is regulated by which mechanism? a) Androgens b) Adrenal gland c) Parathyroid hormone (PTH) d) Thyroid hormone (TH)

C) PTH The serum calcium level is controlled by PTH and calcitonin. The thyroid hormone, adrenal gland, or androgens do not regulate the calcium level in the blood.

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? a) Metabolic alkalosis b) Metabolic acidosis c) Respiratory alkalosis d) Respiratory acidosis

C) Respiratory Alkalosis A client with pneumonia may hyperventilate in an effort to increase oxygen intake. Hyperventilation leads to excess carbon dioxide (CO2) loss, which causes alkalosis — indicated by this client's elevated pH value. With respiratory alkalosis, the kidneys' bicarbonate (HCO3-) response is delayed, so the client's HCO3- level remains normal. The below-normal value for the partial pressure of arterial carbon dioxide (PaCO2) indicates CO2 loss and signals a respiratory component. Because the HCO3- level is normal, this imbalance has no metabolic component. Therefore, the client is experiencing respiratory alkalosis.

Which set of arterial blood gas (ABG) results requires further investigation? a) pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L b) pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L c) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L d) pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L

C)pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/LThe ABG results pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L indicate respiratory alkalosis. The pH level is increased, and the HCO3- and PaCO2 levels are decreased. Normal values are pH 7.35 to 7.45; PaCO2 35 to 45 mm Hg; HCO3- 22 to 26 mEq/L.

"When planning care for a patient with cirrhosis, the nurse will give highest priority to which of the following nursing diagnoses? A: Imbalanced nutrition: less than body requirements B: Impaired skin integrity related to edema, ascites, and pruritis C: Ecess fluid volume related to portal hypertension and hyperaldosteronism D: Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

CORRECT: D Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, AIRWAY and BREATHING are always the highest priorities.

What can be used as a pressure dressing post op after TURP if excessive bleeding occurs?

Catheter balloon

What is functional incontinence?

Caused by problems that prevent you from getting to the bathroom in time to avoid an accident (trouble walking from arthritis).

In what type of patient should you expect <30 cc/hr of urine?

Chronic renal failure (don't call doc bc expected).

Which of the following is clinical manifestation of cholelithiasis? a) Nonpalpable abdominal mass b) Epigastric distress prior to a meal c) Upper left quadrant abdominal pain d) Clay-colored stools

Clay-colored stools Explanation: The patient with gallstones has clay-colored stools, and excruciating upper right quadrant pain that radiates to the back or right shoulder. The patient develops a fever and may have a palpable abdominal mass.

What is the correct way to insert an indwelling catheter into a male patient?

Clean gloves, wash penis with soap and water, rinse/dry, open sterile kit, sterile gloves, waterproof drape, iodine over swabs, verify balloon integrity, lubricate 6-7 inches of catheter tip, non dominant hand grasp shaft (contaminated), if uncircumcised same hand to retract foreskin, use dominant hand for cotton swabs (outward from meatus in circular motion-3x), pick up catheter 3 inches from tip, lift penis perpendicular to body, gently press both sides to open, insert & advance 7 to 9 inches or until urine is draining, then advance another inch. If resistance rotate or withdraw, return foreskin, advance balloon, gently tug until resistance, secure catheter to thigh or lower abdomen and secure drainage bag below bladder level.

why is peritoneal dialysate warmed?

Cold promotes vasoconstriction and limits blood flow. We want it warm to promote vasodilation and more blood flow.

A nurse is monitoring an older client suspected of having a urinary tract infection (UTI) for signs of the infection. The nurse would be alert to the presence of:

Confusion

"The physician has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D"

Correct 1 Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers.

Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person? "1. Hepatitis A. 2. Hepatitis B. 3. Hepatitis C. 4. Hepatitis D."

Correct 1 "1.The hepatitis A virus is in the stool of infected people up to two (2) weeks before symptoms develop. 2. Hepatitis B virus is spread through contact with infected blood and body fluids. 3.Hepatitis C virus is transmitted through infected blood and body fluids. 4.Hepatitis D virus only causes infection in people who are also infected with hepatitis B or C.

The physician has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1. Hep A, 2. Hep B, 3. Hep C, 4. Hep D

Correct 1: Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, D are transmitted more commonly via infected blood or bloody fluids.

"What type of precautions should the nurse implement to protect from being exposed to any of the hepatitis viruses? "1. Airborne precautions 2. Standard precautions 3. Droplet precautions 4. Exposure precautions"

Correct 2 2. Standard precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood

The nurse instructs a client diagnosed with hepatitis A about untoward signs and symptoms related to hepatitis that may develop. The one that should be reported to the practitioner is: 1)Fatigue 2)Anorexia 3)Yellow urine 4)Clay-covered stools

Correct 4 1)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 2)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 3) This is the expected color of urine. 4) Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines.

"The school nurse is discussing ways to prevent an outbreak of hepatitis A with a groupof high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? "1.Do not allow students to eat or drink after each other. 2.Drink bottled water as much as possible. 3.Encourage protected sexual activity. 4.Thoroughly wash hands.

Correct 4: "Hepatitis A is transmitted via the fecal-oralroute. Good hand washing helps to prevent its spread. HINT - good hand washing is the most impor-tant action in preventing transmission of any of the hepatitis viruses. Often, the test taker will not select the answer option that seemstoo easy—but remember, do not overlook the"

Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D"

Correct A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

A client is admitted with ongoing symptoms of the flu. There are no other obvious signs of illness. This client should be tested for hepatitis because: "a) She could have anicteric hepatitis, which means no jaundice. b) She has a blood pressure of 90/50. c) She was living with a roommate who had similar symptoms. d) She has an allergy to shellfish."

Correct A: (Correct Answer=A) Only about 25 percent of people with acute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised liver function that is overlooked due to lack of jaundice.

A college student is required to be inoculated for hepatitis before beginning college. The nurse realizes this client will be inoculated to prevent the development of: "A) Hep B B) Hep D C) Hep C D) Hep E"

Correct A: Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis

"A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which of the following? "1. Malaise 2. Dark stools 3. Weight gain 4. Left upper quadrant discomfort"

Correct Answer 1: Rationale: Hepatitis causes GI symptoms such as anorexia, nausea, right upper quadrant discomfort and weight loss. Fatigue and malaise are common. Stools will be light or clay colored if conjugated bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts.

A college student is required to be inculated for hepatitis before starting college. The nurse recognizes that he will be inoculated for: 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

Correct Answer 2 Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.

"Question: A 40-year-old woman has been diagnosed with hepatitis A and asks the nurse if other members of her family are at risk for ""catching"" the disease. The nurse's response should be based on the understanding that hepatitis A is transmitted primarily1. During sexual intercourse; 2. By contact with infected body secretions; 3. Through fecal contamination of food or water 4. Through kissing that involves contact with mucous membranes.

Correct Answer 3 Anwer: (3). Rationale: Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important to prevent the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important to decrease transmission. Sexual intercourse (1), contact with infected body secretions (2), and contact through mucous membranes (4) all present higher risk for hepatitis B and C.

The client is in the preicteric phase of hepatitis. Which signs/symptoms would thenurse expect the client to exhibit during this phase? 1.Clay-colored stools and jaundice.2.Normal appetite and pruritus.3.Being afebrile and left upper quadrant pain.4.Complaints of fatigue and diarrhea.

Correct Answer 4 "Flu-like" symptoms are the first com-plaints of the client in the preicteric phase of hepatitis, which is the initial phase and may begin abruptly or insidiously

A client is suspected of having hepatitis. Which diagnoistic test result will assist in confirming this diagonis ? A.Elevate hemoglobin level B. Elevated serum bilirubin level C. Elevated blood urea nitrogen level D. Decreasd erythrocycte sedimentation rate

Correct Answer B Laboratory indicator of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels.Thinking about the organ that is involved in hepatitis should assist in directing to choose option B liver function test.

What type of precaution should the nurse implement to protect from being exposed to any of the hepatitis viruses? A. Airborne Precautions. B. Standard Precautions. C. Droplet Precautions. D. Exposure Precautions.

Correct Answer B: Standard precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood. Airborne Precautions are only for airborne droplet nuclei or dust particles, Droplet precaution involves large particle droplets in the mucus membranes, and Exposure precaution is not a designated isolation category.

"A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal" "a. hepatitis B surface antigen (HBsAg). b. anti-hepatitis B core immunoglobulin M (anti-HBc IgM). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)."

Correct Answer D "Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV IgG would indicate past infection and lifelong immunity."

A nurse is caring for a patient who has a diagnosis of peritonitis related to a ruptured appendix. The patient states, "I hope I don't get a kidney infection from this with my kidneys being so close to my appendix. I had a kidney infection before and I felt terrible." Which explanation would be most appropriate for the nurse to give the patient? 1. "Your kidneys are located outside the peritoneum, the sack that encloses the appendix." 2. "Good thinking. Infections in the abdomen can spread to other organs." 3. "You need to speak with your primary healthcare provider about your concern." 4. "We can check your urine daily to assure the infection is not spreading."

Correct Answer: 1

A patient asks the nurse for ways to prevent recurrent urinary tract infections. Which of the following is an appropriate nursing response? 1. "Avoid douching." 2. "Clean the perineal area from back to front." 3. "Use feminine hygiene sprays." 4. "Wear clean nylon underpants."

Correct Answer: 1 Rationale: An appropriate response to this patient is to avoid douching. Instruct women to cleanse the perineal area from front to back after voiding and defecating. Teach women to void before and after sexual intercourse to flush out bacteria introduced into the urethra and bladder. Teach measures to maintain integrity of perineal tissues such as avoiding bubble baths, feminine hygiene sprays and vaginal douches; wearing cotton briefs and avoiding synthetic materials such as nylon; if postmenopausal, using hormone replacement therapy or estrogen cream.

A public health nurse is performing teaching for a patient who will be obtaining a sample of urine for a urinalysis at home. Which of these patient comments will cause the nurse to provide clarifying information? 1. "I will get the specimen as soon as I get home this evening." 2. "I won't touch the inside of the cup or lid." 3. "I will refrigerate the specimen until I bring it to the laboratory tomorrow." 4. "I will give the laboratory a list of the medications I am taking."

Correct Answer: 1 Rationale: An early morning specimen is preferred. The patient is bringing the specimen to the laboratory tomorrow, so an early morning specimen is possible and the most accurate and useful specimen. The other options are correct information.

A patient with an indwelling urinary catheter is demonstrating signs of asymptomatic bacteriuria. Which of the following would be the best course of action for this patient? 1. Remove the catheter and begin antibiotic therapy. 2. Begin oral antibiotic therapy for three days. 3. Begin intravenous antibiotic therapy. 4. Remove the catheter and monitor for continued signs of bacteriuria.

Correct Answer: 1 Rationale: Antibiotics and urinary anti-infectives are not generally recommended to treat asymptomatic bacteriuria in catheterized patients. The preferred treatment for catheter-associated urinary tract infection (UTI) is to remove the indwelling catheter, then administer a 10 to 14 day course of oral antibiotic therapy to eliminate the infection. Removing the catheter without the initiation of antibiotic therapy would not solve the problem. The infection could worsen.

The patient with chronic renal failure who is scheduled for dialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication 1. on return from dialysis. 2. during dialysis. 3. just before dialysis. 4. the day after dialysis.

Correct Answer: 1 Rationale: Antihypertensive medications such as enalapril are given after dialysis to prevent a hypotensive episode and the medication being removed from the bloodstream during dialysis. Waiting to give the medication the following day would lead to ineffective control of blood pressure.

A patient is admitted with signs of chronic renal failure. Which of the following is indicative of metabolic acidosis? 1. Kussmaul's respirations 2. low urine output 3. muscle cramps 4. diarrhea

Correct Answer: 1 Rationale: As renal failure progresses, hydrogen-ion excretion and buffer production are impaired, leading to metabolic acidosis. Respiratory rate and depth increase, as with Kussmaul's respirations, to compensate for metabolic acidosis. Low urine output, muscle cramps, and diarrhea are often associated with chronic renal failure, but the clearest indication of metabolic acidosis is Kussmaul's respirations.

A male patient is admitted for removal of a bladder papilloma. Which of the following should the nurse assess in this patient? 1. history of cigarette smoking 2. daily fluid intake 3. pedal pulses 4. appetite level

Correct Answer: 1 Rationale: Carcinogenic breakdown products of certain chemicals and from cigarette smoke are excreted in the urine and stored in the bladder, which possibly causes a local influence on abnormal cell development. Cigarette smoking is the primary risk factor for bladder cancer. The risk in smokers is twice that of non-smokers. Daily fluid intake, pedal pulses, and appetite are all important assessments but these findings would not indicate an increased risk for bladder papilloma.

A patient is diagnosed with postrenal acute renal failure. The nurse realizes that this type of renal failure can be caused by which of the following? 1. an enlarged prostate 2. hypovolemia 3. sepsis 4. drug toxicity

Correct Answer: 1 Rationale: Causes for postrenal acute renal failure include calculi, cancer, external compression, prostatic enlargement, strictures, and blood clots. Hypovolemia, sepsis, and drug toxicity would be considered prerenal causes of acute renal failure.

A patient who received a kidney transplant seven years ago is seen for increasing blood pressure and proteinuria. The nurse realizes that this patient is demonstrating signs of which of the following? 1. chronic kidney rejection 2. acute kidney rejection 3. renal artery stenosis 4. pyelonephritis

Correct Answer: 1 Rationale: Chronic rejection may develop months to years following transplant. The presenting manifestations progressive azotemia, proteinuria and hypertension are those of progressive renal failure. Acute rejection most commonly occurs in the weeks that immediately follow transplant. Renal artery stenosis manifests with a bruit over the surgical anastomosis site. Pyelonephritis manifests with abdominal discomfort and low-grade fever.

The nurse is caring for a patient receiving peritoneal dialysis. After completing the exchange and draining the dialysate, the nurse observes the dialysate is cloudy. The nurse interprets this finding as which of the following? 1. a sign of infection 2. a sign of vascular access occlusion 3. the normal appearance of dialysate 4. a sign of possible bowel perforation

Correct Answer: 1 Rationale: Dialysate is typically clear; cloudy or malodorous dialysate may indicate infection; blood or feces in the dialysate may indicate organ or bowel perforation.

A patient with diabetes and heart disease is diagnosed with chronic renal failure. The nurse realizes that this patient should NOT be prescribed which of the following classifications of medications? 1. oral antihyperglycemic agents 2. beta-blockers 3. calcium channel blockers 4. analgesics

Correct Answer: 1 Rationale: Drugs such as meperidine (Demerol), metformin (Glucophage), and other oral antihyperglycemic agents eliminated by the kidney are to be avoided. Beta-blockers, calcium channel blockers, and analgesics may be used with dosage adjustment.

A patient is diagnosed with hypertension caused by polycystic kidney disease. Which of the following might be helpful to control this patient's blood pressure? 1. ACE inhibitors 2. kidney transplant 3. dialysis 4. peritoneal dialysis

Correct Answer: 1 Rationale: Hypertension associated with polycystic disease is generally controlled using angiotensin-converting enzyme (ACE) inhibitors or other antihypertensive agents. Renal transplant or dialysis is indicated when kidney function cannot control the wastes from metabolic processes.

Which of the following should be included when providing instructions to a patient who is recovering from a nephrectomy for kidney cancer? 1. early recognition of a urinary tract infection (UTI) 2. ways to limit fluids 3. promote high-impact sports and activities 4. organ donor information

Correct Answer: 1 Rationale: If renal cancer was detected at an early stage and cure is anticipated, teaching should focus on protecting the remaining kidney, including measures to prevent infection, renal calculi, hydronephrosis and trauma; maintain a fluid intake of 2000 to 3000 mL per day; and increase the amount during hot weather or strenuous exercise; urinate when the urge is perceived and before and after sexual intercourse; properly clean the perineal area; manifestations of urinary tract infection (UTI), and the importance of early and appropriate evaluation and intervention; manifestations of prostatic hypertrophy; avoid contact sports such as football or hockey; and measures to prevent motor vehicle accidents or falls, which could damage the kidney. A discussion of organ donor information is not relevant.

The nurse, administering epoetin alfa (Epogen) to a patient on dialysis, understands the therapeutic outcome of this medication is to do which of the following? 1. treat the anemia seen in chronic renal failure patients on dialysis 2. combat the effects of dialysis on bone marrow 3. promote elimination of nephrotoxic drugs from the body 4. enhance absorption of iron and folate in the intestinal tract

Correct Answer: 1 Rationale: In chronic renal failure, erythropoietin production in the kidney declines, which suppresses RBC production leading to anemia. Erythropoiesis-stimulating agents such as epoetin alfa increase RBC production. Iron and folate deficiencies are also seen in the patient on dialysis but these are related to inadequate nutrition. Epoetin alfa has no action on bone marrow, does not promote elimination of nephrotoxic drugs from the body, and does not affect absorption of iron or folate.

The nurse instructs a patient in acute renal failure that the expected result of taking sodium polystyrene sulfonate (Kayexalate) is which of the following? 1. removing excess potassium 2. replacing sodium 3. replacement of magnesium 4. exchanging calcium for sodium

Correct Answer: 1 Rationale: Kayexelate is given to remove excess potassium in the patient with acute renal failure by exchanging sodium for potassium in the large intestine. It is not used to replace sodium or electrolytes.

The nurse is reviewing teaching with a patient who has a prescription for an intravenous pyelogram. The nurse recognizes that further teaching is needed when the patient states, "I will 1. not drink any fluids for at least 12 hours before the procedure." 2. start the bowel prep with a suppository the night before the procedure" 3. take the prescribed laxative the morning of the procedure." 4. not eat solid food for at least 8 hours before the procedure."

Correct Answer: 1 Rationale: Tell the patient not to eat food for 8 to 12 hours prior to the test; clear liquids are allowed. Instruct the patient to complete ordered pretest bowel preparation, including prescribed laxative or cathartic the evening before the test, and an enema or suppository the morning of the test.

A sexually active 20-year-old client has developed viral hepatitis. Which of the following statements, if made by the client, would indicate a need for futher teaching? 1. "A condom should be used for sexual intercourse." 2. "I can never drink alcohol again." 3. "I won't go back to work right away." 4. "My close friends should get the vaccine."

Correct Answer: 2. "I can never drink alcohol again." Rationale: To prevent transmission of hepatitis, a condom is advised during sexual intercourse and vaccination of the partner. Alcohol should be avoided because it is detoxified in the liver and may interfere with recover. Rest is especially important until laboratory studies show that liver function has returned to normal. The client's activity is increased gradually

The school nurse is discussing ways to prevent an outbreak of hepatitis A with a groupof high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? 1. Do not allow students to eat or drink after each other. 2.Drink bottled water as much as possible. 3.Encourage protected sexual activity. 4.Thoroughly wash hands.

Correct Answer: 4. Throroughly was hands" "1.Eating after each other should be discouraged,but it is not the most important intervention. 2.Only bottled water should be consumed in Third World countries, but that precaution isnot necessary in American high schools. 3.Hepatitis B and C, not hepatitis A, are trans-mitted by sexual activity. 4.Hepatitis A is transmitted via the fecal-oralroute. Good hand washing helps to prevent its spread. TEST-TAKING HINTS: The test taker must realize that good hand washing is the most important action in preventing transmission of any of the hepatitis viruses. Often, the test taker will not select the answer option that seems"

"A client is admitted with ongoing sypmtoms of the flu. There are no other obvious signs of illness. This client should be tested for hepatitis because: "A. She has a blood pressure of 90/50 B. whe has an allergy to shellfish C. She could have anicteric hepatitis, which means no jaundice D. She was living with a roommate who had similar symptoms"

Correct C Rationale: Only about 25 percet of people with acute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised liver function that is overlooked due to lack of jaundice. A roommate with the same symptoms could mean a communicable disease such as the flu.

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate? "A:"The hepatitis vaccine will provide immunity from this exposure and future exposures." B:"I am afraid there is nothing you can do since the patient was infectious before admission." C:"You will need to be tested first to make sure you don't have the virus before we can treat you." D: "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure.""

Correct D: Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.

A colleges student is required to be inoculated for hepatits before beginning college. The nurse relaizes this client will be inocualted to prevent the development of: 1. Hepatitis C 2. Hepatitis E 3. hepatitis B 4. Hepatitis D

Correct answer Hepatitis B Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? a) Monitor pulse oximetry every hour. b) Use incentive spirometry every hour. c) Instruct the client to cough only when necessary. d) Withhold analgesics unless necessary.

Correct response: Use incentive spirometry every hour. Explanation: The nurse instructs the client in techniques of coughing and deep breathing and in the use of incentive spirometry to improve respiratory function. The nurse assists the client to perform these activities every hour. Repositioning the client every 2 hours minimizes the risk of atelectasis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring pulse oximetry helps show changes in respiratory status and promotes early intervention, but it would do little to minimize the risk of atelectasis. Withholding analgesics is not an appropriate intervention due to the severe pain associated with pancreatitis

The home care nurse is visiting a client with a diagnosis of hepatitis of unknown etiology. The nurse knows that teaching has been successful if the patient makes which on of the following statements? "1. ""I am so sad that I am not able to hold my baby."" 2."" I will eat after my family eats."" 3. ""I will make sure that my children don't eat or drink after me."" 4. ""I'm glad that I don't have to get help taking care of my children."""

Correct: 3 "1. not spread by casual contact 2. can eat together, but not share utensils 3. to prevent transmission - do not share eating utensils or drinking glasses, wash hands before eating and after using toilet 4. alternate rest/activity to promote hepatic healing, mother of young children will need help"

The home care nurse is visiting a client during an icteric phase of hepatitis of unknown etiology. The nurse would be MOST concerned if the client made which of the following comments? "1. ""I must not share eating utensils with my family."" 2. ""I must use my own bath towel."" 3. ""I'm glad that my husband and I can continue to have intimate relations."" 4. ""I must eat small, frequent feedings."""

Correct: 3 3. ""I'm glad my husband..."" - CORRECT: avoid sexual contact until serologic indicators return to normal

A client is hospitalized with hepatitis A. Which of the client's regular medications is contraindicated due to the current illness? http://www.rnpedia.com/home/exams/nclex-exam/nclex-rn-practice-questions-6 "1. Prilosec (omeprazole) 2. Synthroid (levothyroxine) 3. Premarin (conjugated estrogens) 4. Lipitor (atorvastatin)

Correct: 4 Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.

"A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that: "A. pruritus is a common problem with jaundice in this phase. B. the patient is most likley to transmit the disease during this phase. C. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. D. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase."

Correct: A The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level B.. Elevated serum bilirubin level c. Elevated blood urea nitrogen leveld. Decreased erythrocycle sedimentation rate

Correct: B Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis

"A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to: "A. Avoid alcohol for the first 3 weeks B.use condoms during sexual intercourse C. have family members get an injection of immunoglobulin D. follow low protein, moderate carb, moderate fat diet"

Correct: B B. is the correct answer as it is important to instruct the patient they this disease can be spread through sexual contact

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. D.cryoprecipitate and fresh frozen plasma.

Correct: D Answer D. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren't specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.

To evaluate a client for hypoxia, the physician is most likely to order which laboratory test? a) Red blood cell count b) Sputum culture c) Total hemoglobin d) Arterial blood gas (ABG) analysis

D) ABGs Red blood cell count, sputum culture, total hemoglobin, and ABG analysis all help evaluate a client with respiratory problems. However, ABG analysis is the only test that evaluates gas exchange in the lungs, providing information about the client's oxygenation status.

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? a) Restricting fluid intake to reduce the need to void b) Establishing a predetermined fluid intake pattern for the client c) Encouraging the client to increase the time between voidings d) Assessing present voiding patterns

D) Assessing present voiding patterns Explanation: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

Which of the following are the insensible mechanisms of fluid loss? a) Bowel elimination b) Urination c) Nausea d) Breathing

D) Breathing Loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is unnoticeable and immeasurable. Losses from urination and bowel elimination are measurable.

You are caring for a client with severe hypokalemia. The physician has ordered IV potassium to be administered at 10 mEq/hr. The client complains of burning along their vein. What should you do? a) Change the electrolyte. b) Switch to an oral formulation. c) Increase the speed of transfusion. d) Dilute the infusion.

D) Dilute the infusion Treatment of severe hypokalemia requires treatment with IV infusion of potassium. Clients may experience burning along the vein with IV infusion of potassium in proportion to the infusion's concentration. If the client can tolerate the fluid, consult with the physician about diluting the potassium in a larger volume of IV solution. Oral potassium may not be enough in severe cases hypokalemia. Hypokalemia requires treatment with potassium and not any other electrolyte.

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? a) "My urine will be eliminated with my feces." b) "A catheter will drain urine directly from my kidney." c) "I will not need to worry about being incontinent of urine." d) "My urine will be eliminated through a stoma."

D) My urine will be eliminated through a stoma An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.

Which of the following is a characteristic of a normal stoma? a) Painful b) No bleeding when cleansing stoma c) Dry in appearance d) Pink color

D) Pink color Explanation: Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? a) Prepare for gastric lavage. b) Monitor the client's heart rhythm. c) Obtain a urine specimen for drug screening. d) Prepare to assist with ventilation.

D) Prepare to assist with ventilation Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore, the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening.

When collecting an admission history, the nurse identifies that the client prefers fish and crustaceans over other sources of protein. When planning discharge teaching for this client the nurse should include the fact that the cooked food most likely to remain contaminated by the virus that causes Hep A is A) canned tuna B) broiled shrimp C) baked haddock D) steamed lobster

D) Steamed lobster. The temperature during steaming is never high enough or sustained long enough to kill organisms

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Serum sodium level of 135 mEq/L b) Serum potassium level of 4.9 mEq/L c) Temperature of 99.2° F (37.3° C) d) Urine output of 20 ml/hour

D) 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 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? a) Perform deep-breathing exercises vigorously. b) Avoid carrying heavy items. c) Auscultate the lungs frequently. d) Wear a mask when performing exchanges.

D) Wear a mask when performing exchanges The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.

Intra-Renal Failure

Damage has occurred inside the kidney -Glomerulonephritis -Nephrotic Syndrome -Dye used in tests such as heart cath and CT scan because the dye is excreted by the kidney -Drugs (Aminoglycosides, Mycins) are nephrotoxic -malignant hypertension -also DM causes severe kidney vascular damage

A nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. To determine if the client is currently experiencing exacerbation of BPH, the nurse asks the client about the presence of which early symptom

Decreased force in the stream of urine

Aldosterone works in the _____ and acts to conserve _____ and induce excretion of potassium.

Distal convoluted tubule; sodium Aldosterone, the principal mineralocorticoid of the adrenal cortex, stimulates the reabsorption of sodium from the distal convoluted tubule. At the same time, aldosterone causes potassium to be excreted. It has no direct action on calcium regulation. Antidiuretic hormone reabsorbs water in the collecting ducts.

How can you provide the best care for an ESRD patient?

Early breakfast, give water soluble meds after dialysis otherwise they will dialyzed out of system=not effective, dont use dialysis access arm for administering IV meds, taking BP, or drawing blood, assess thrill and bruit of the fistula, if hypoglycemia give apple/orange juice, restrict your patients fluids to 1000 ml/day.

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by: a) Pleural effusion b) Sepsis c) Edema and inflammation d) Disseminated intravascular coagulopathy

Edema and inflammation Explanation: Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas.

A nurse is reviewing the client's record and notes that the health care provider has documented that the client has a renal disorder. On review of the laboratory results, the nurse would most likely expect to note which of the following?

Elevated blood urea nitrogen (BUN) level

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Increased serum calcium levels b) Elevated urine amylase levels c) Decreased liver enzyme levels d) Decreased white blood cell count

Elevated urine amylase levels Explanation: Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

A patient who needs a heart transplant has a very low cardiac output and severe peripheral edema. Which diuretic should the nurse administer to help achieve fluid balance in this patient?

Furosemide (Lasix) 40 mg IV push over 10 minutes When cardiac output is low, renal perfusion is low, and this signals the sympathetic nervous system to vasoconstrict and to conserve sodium and water. To overcome this problem, the nurse administers furosemide in an IV push, because loop diuretics function in low-cardiac output states. The infusion rate of the furosemide IV push should not exceed 4 mg/min, so the nurse infuses 40 mg over 10 minutes or more. Metolazone and bumetanide are poor choices because they are administered by mouth. It is unlikely that the patient is taking oral medications; however, and more important, oral medications take longer to act and may be less effective when administered by mouth as a result of hepatic metabolism. Mannitol is not indicated for peripheral edema.

A client newly diagnosed with chronic renal failure has recently begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse monitors the client during dialysis for:

Headache, deteriorating level of consciousness, and twitching

A nurse is caring for the client with epididymitis. The nurse understands that which treatment modality could increase swelling in the affected area?

Heating Pad

A nurse is collecting data on a newly admitted client with a diagnosis of bladder cancer. While collecting data on this client the nurse would most likely expect to note:

Hematuria

Which diuretic is a poor choice for a patient who has gout?

Hydrochlorothiazide (HydroDIURIL) Hydrochlorothiazide is a thiazide diuretic, which can cause an increased uric acid level, so it is a poor choice for a patient who has gout, because gout is a condition of impaired uric acid metabolism resulting in uric acid accumulation. Mannitol, acetazolamide, and spironolactone are better choices for this patient because they are less likely to increase the uric acid level.

What is dialysate (2 types)?

Hypertonic= added glucose to pull excess H20 out of body, Hypotonic= for electrolytes and waste elements to pull lytes and other elements out of body.

What kinds of drugs will kidney transplant patients be on?

Immunosuppressant drugs for life to help decrease chance of rejection and steroids to help decrease chance of rejection. = extremely immunocompromised

Transurethral Resection Syndrome

Increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

A nurse is inserting an indwelling urinary catheter into a male client. As the catheter is inserted into the urethra, urine begins to flow into the tubing. At this point, the nurse:

Inserts the catheter 2.5 to 5 cm and inflates the balloon Rationale: The catheter's balloon is behind the opening at the insertion tip. The catheter is inserted 2.5 to 5 cm after urine begins to flow to provide sufficient space to inflate the balloon.

What are treatments/drugs that can help with overflow incontinence?

Intermittent catheterization (seen in MS patients) and Duvoid (helps strengthen bladder contractions and helps the bladder empty).

What is important to know about a cystoscopy?

It is a scope that looks into the bladder via the urethra. Post care-pink tinged urine=normal, bright red clots w/increased HR and pulse=hemorrhage, and back or abd pain=perforation of bladder so notify MD.

What is important to know about KUB?

It is an xray of the 2 kidneys, 2 ureters, and bladder. No preparation needed and may be needed after a motor vehicle accident.

Nephrotic Syndrome: what is the main distinguishing factor?

LOSING TONS OF FLUID very edematous

Protein and Kidney problems Rule...

Limit protein with kidney problems EXCEPT with Nephrotic Syndrome and patients who are on peritoneal dialysis

Which of the following enzymes aids in the digestion of fats? a) Lipase b) Amylase c) Secretin d) Trypsin

Lipase Explanation: Lipase is a pancreatic enzyme that aids in the digestion of fats. Amylase aids in the digestion of carbohydrates. Secretin is responsible for stimulating secretion of pancreatic juice. Trypsin aids in the digestion of protein.

A patient who takes lisinopril (Zestril) for heart failure requires a diuretic to help prevent edema. Which is the best diuretic to administer to this patient?

Lisinopril with hydrochlorothiazide (Zestoretic) Lisinopril with hydrochlorothiazide is the best choice for this patient because it provides two important therapies in a single once-a-day pill—the best choice for this patient because the patient is much more likely to adhere to the therapeutic regimen if it involves taking just one pill once a day. Furosemide is a suitable diuretic for this patient, but combinations of lisinopril and furosemide are not marketed. Spironolactone is contraindicated because it is likely to lead to an increased potassium level.

Disseminated intravascular coagulopathy (DIC) and severe diffuse edema develop in a 24-year-old female patient after a serious motor vehicle accident (MVA). Which of these diuretics can the nurse administer to avoid aggravating the coagulopathy? (Choose all that apply.)

Mannitol (Osmitrol) Among the listed medications, mannitol is the only diuretic that can be administered to this patient to avoid aggravation of a coagulopathy. Furosemide is contraindicated because it can cause thrombocytopenia and bone marrow suppression. Triamterene and spironolactone are contraindicated because they are potassium-sparing diuretics, and the patient is likely to be hyperkalemic as a result of hemolysis and injuries sustained in the crash. In addition, triamterene is a fairly weak diuretic that can cause megaloblastic anemia. Acetazolamide can cause hematuria and melena, which might confound evaluation of the patient's hematologic therapy; the medical team would not be able to determine whether the hematuria and melena were the result of the diuretic or the coagulopathy. Finally, hydrochlorothiazide is contraindicated because it can cause bone marrow suppression, which could lead to thrombocytopenia.

What should you teach your patient about urine control post foley removal after prostate removal?

May have urine incontinence after catheter removed but emphasize that normally temporary and he can do Kegal exercises by stopping his stream midway while peeing.

What should be done carefully when taking care of a renal transplant patient?

Must wash hands before and after touching pt with friction to avoid infection.

What are S&S of renal calculi?

N&V, pain radiates in flank area (costal vertebral angle), hematuria, sharp/sudden/severe pain (may be intermittent), pale, diaphoretic, frequent/painful urination.

Is someone with kidney stones a priority patient?

NO

What is the best treatment for pts with incontinence?

NO diapers, pads, or bed side commodes. TEACH KAGEL EXERCISES

What electrolytes does the kidney remove? Not working?

Na, K, and others. If not working then Values increase= muscle weakness and cardiac arrhythmias.

Which of the following would be included as a postoperative intervention for the patient undergoing a laparoscopic cholecystectomy? a) Semi-Fowler's position b) Low-carbohydrate, low-protein diet immediately after surgery c) NPO status postop for 2 days d) Observe color of sclera

Observe color of sclera Explanation: The nurse should be particularly observant of the color of the sclera. After recovery from anesthesia, the patient is placed in the low Fowler's position. Water and other fluids may be administered within hours after laparoscopic procedures. A soft diet is started after bowel sounds return.

What is urge incontinence?

Overactive bladder- the loss of urine as soon as you feel the urge to go to the bathroom.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse monitors this client for which manifestation of this disorder?

Pallor, diminished pulse, and pain in the left hand

What is someone with a suprapubic catheter at risk for? S&S?

Peritonitis (infection). Pus in tube=abnormal and tenderness=abnormal.

One difference between cholesterol stones (left) and the stones on the right are that the ones on the right account for only 10% to 25% of cases of stones in the United States. What is the name of the stones on the right? a) Pixelated b) Patterned c) Pearl d) Pigment

Pigment Explanation: There are two major types of gallstones: those composed predominantly of pigment and those composed primarily of cholesterol. Pigment stones probably form when unconjugated pigments in the bile precipitate to form stones; these stones account for 10% to 25% of cases in the United States. There are no gallstones with the names of pearl, patterned, or pixelated.

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a) Encouraging frequent visits from family and friends b) Positioning the client on the side with the knees flexed c) Administering an analgesic once per shift, as ordered, to prevent drug addiction d) Administering frequent oral feedings

Positioning the client on the side with the knees flexed Explanation: The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and ordered, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.

What foods should someone with uric acid stones avoid?

Purine foods: organ meats, venison, shell fish, gravies, legumes, and alcohol (urine is alkaline).

Early symptoms of exacerbation of BPH

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

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a) Maintaining adequate nutritional status b) Teaching about the disease and its treatment c) Preventing fluid volume overload d) Relieving abdominal pain

Relieving abdominal pain Explanation: The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain.

What is the preferred treatment for BPH?

Removal of prostate- transurethral resection is the preferred method because the risk of complications is lower.

What is a vasectomy? Interventions?

Removal or cut vas deferens (big scrotum). If pain: ice and elevate. Sperm lives 6 weeks after procedure. Sterile when have 2 negative sperm specimens a month apart.

What is an orchiectomy?

Remove one testes (unilateral)= can still father a child. Remove 2 testes (bilateral)=cannot father a child.

Risk factors for Pyelonephritis

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 indwelling or frequent urinary catheterization.

Sterile urine speicmen not required (for)

Routine Urinalysis (does not require what type of speicmen)

What is the correct way to apply a self-adhesive condom catheter?

Select the correct size appliance, clip pubic hair at base of shaft to prevent pulling from adhesive, apply protective coating, position at tip, hold 1-2 inches at top and unroll rest of way, connect drainage tip to collection device, and check to make sure corrected properly, position penis downward to facilitate drainage, inspect every 2 hours for circulatory impairment.

The potency of a diuretic depends on:

Site of mechanism of action Most diuretics share a basic mechanism of action: blockade of sodium and chloride reabsorption. The degree to which a diuretic can reabsorb sodium depends on where the diuretic acts in the nephron, because certain locations in the nephron reabsorb sodium better than do others; for example, the proximal convoluted tubules reabsorb 60% to 70% of the sodium from the glomerular filtrate. By blocking the reabsorption of these solutes, diuretics prevent the passive reabsorption of water. The dosage determines the strength of a specific diuretic's action at a specific site; however, depending on the medication, a high dosage of a low-potency medication can be less effective than a normal dosage of a high-potency diuretic. The only location in the nephron that reabsorbs water is the collecting ducts, and diuretics do not work in the collecting ducts. In the glomerulus, all solutes are filtered and the degree of sodium filtration depends on the health of the kidneys, the solute concentration in the blood, and renal artery pressure.

The mechanism of action for most diuretics involves impairment of:

Solute reabsorption Most diuretics act by impairing solute reabsorption. This may take place in the proximal or distal convoluted tubules or in the loop of Henle. Solute and water filtration takes place in the glomerulus. The primary sites for water reabsorption are the collecting ducts.

What is the treatment for renal calculi? Teaching/interventions?

Start IV, let patient walk bc can worsen when lying down, and if couldnt pass=Lithotripsy (sound waves pulverize stones). May cause bruising, may damage liver (hemorrhage), check vitals, no dressing so doesn't need changed. Strain urine for calculi (NA). NO morphine= more spasms.

What is the correct way to do a 24 hours urine collection?

Start and end with an empty bladder. Discard the 1st am urine to start then collect urine for the next 24 hours and include end void in the collection.

What is important to know about stent placement in kidneys for stones?

Stents placed in ureters, don't irrigate stents, don't touch stents, stents= sterile (Dr handles), should help drain urine (clear or yellow but need to make sure peeing).

How do kidneys release erythropoietin? Not working?decreased

Stimulates bone marrow. If not working then malfunctioning bone marrow d/t decreased erythropoietin (decreased WBC-infection, decreased Plts-bleeding, RBC-anemia). Epogen can help!!

What is the correct way to perform peritoneal dialysis?

Strict aseptic technique (mask), obtain dialysate, warm to body temp, attach primary tubing, open clamp, allow it to enter patients peritoneal cavity via gravity, close clamp once in, let it sit for prescribed time, when complete open clamp and let drain by gravity back into bag, observe and document outflow.

What should you teach a patient with UTI who is on a sulfa antibiotic?

Sun sensitive so use SPF 75 or higher.

What are nursing goals for UTI patients?

Symptomatic relief, teaching/prevention, showers are better than baths, perineal cleansing should be front to back, voiding after intercourse, antimicrobial therapy, white toilet paper, no perfumes etc. to area, wear cotton underwear.

What should you teach patients taking medication for erectile dysfunction?

Take 1 hour before sex, double vision and eye problems are side effects, don't take double the dose of meds bc can constrict blood flow and erection can last for 4 hours.

What is stress incontinence?

The loss or leaking of urine during exercise, sneezing, laughing, coughing, or when lifting something heavy.

What is important to know about an Intravenous pyelogram (IVP)?

The patient should be NPO for 8 hours. The test looks at the glomerulus. A laxative and dye will be given so check for iodine allergy, intestines need to be empty because the kidneys are behind the bowels. The outcome as a result of the laxative is visualization.

What should you do to obtain a clean catch urine specimen in a 9 year old boy?

They are modest so hold cup and turn head.

Anasarca

Total body edema

Prostatitis Treatment

Treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. The client is also taught to rest, increase fluid intake, and use sitz baths for comfort.

What will happen once patient is diagnosed with End Stage Renal Disease (ESRD)?

Undergo dialysis and begin diet and medication regimen. Options may include hemodialysis, peritoneal dialysis, or kidney transplant. Dialysis=outpatient 3x/week for 4 hours. Diet= 60 grams protein, 2 grams sodium, NO potassium, and 1000 ml water (restricted).

What is the proper steps for inserting an indwelling catheter in a female patient?

Verify order, explain procedure, wash hands, supine knees flexed, clean gloves, examine meatus, perineal care, sterile tray, sterile gloves, iodine on cotton swabs, attach syringe to catheter inflate and inspect, lubricate 1-2 inches, non-dominant seperate labia minora (contaminated), dominant hand cleanse with swabs (one downward stroke on each side of labium then meatus last), grasp catheter 2-3 inches from tip, insert, advance 2-3 inches or until urine flow advance another inch (resistance=rotate), inflate balloon, full gently, secure to patients thigh, and secure drainage bag below bladder.

What drugs are used to tx erectile dysfunction? Action?

Viagra, Levitra, and Cialis (increase blood flow to penis).

If residual prior to cath what should you do?

Void first then straight cath and document amount.

What is overflow incontinence?

When you often feel the need to urinate but you can't completely empty your bladder.

What rate does hemodialysis run?

With hemodialysis, blood is being removed, cleansed, and then returned at a rate of 300-800 ml/min

What are S&S of chronic renal failure?

Yellow discoloration, PRURITUS AND UREMIC FROST, CNS depression, increase BP, CHF, pericarditis, anorexia, N&V, GI bleeding, hyperglycemia, Gout, anemia, DEPRESSION, psychosis, infertility, and GFR <10%.

What color should a random urinalysis sample be?

Yellow/clear

A clinical situation in which the increased release of erythropoietin would be expected is: a) hypoexmia b) hypotension c) hyperkalemia d) fluid overload

a) Hypoexmia Erythropoietin is released when the oxygen tension of the renal blood supply is low and stimulates production of red blood cells in the bone marrow. Hypotension causes activation of the renin-angiotensin-aldosterone system, as well as release of ADH. Hyperkalemis stimulates release of aldosterone from the adrenal cortex, and fluid overload does not directly stimulate factors affecting the kidney.

urine that is red-orange is ___

acidic, or caused by medication

urine that is orange is ____

alkaline or concentrated

The digestion of carbohydrates is aided by a) trypsin. b) secretin. c) amylase. d) lipase.

amylase. Explanation: Amylase is secreted by the exocrine pancreas. Lipase aids in the digestion of fats. Trypsin aids in the digestion of proteins. Secretin is the major stimulus for increased bicarbonate secretion from the pancreas.

urine that is amber means ___

bile is present in urine

urine that is red is due to ____

blood or menses

During physical assessment of the urinary system, the nurse a) auscultates the lower abdominal quadrants for fluid sounds b) palpates an empty bladder at the level of the symphysis pubis c) percusses the kidney with a firm blow at the posterior costovertebral angle d) positions the patient prone to palpate the kidneys with a posterior approach

c) percusses the kidney with a firm blow at the posterior costovertebral angle To assess for kidney tenderness, the nurse strikes the fist of one hand over the dorsum of the other hand at the posterior costovertebral angle. The upper abdominal quadrants and costovertebral angles are auscultated for vascular bruits in the renal vessels and aorta, and an empty bladder is not palpable. The kidneys are palpated through the abdomen, with the patient supine.

While caring for a 77-year old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. The clinical manifestations the patient is most likely to experience include: a) cloudy urine and fever b) urethral burning and blood urine c) vague abdominal pain and disorientation d) suprapubic pain and slight decline in body temperature

c) vague abdominal pain and disorientation The usual classic symptoms of UTI are often absent in older adults, who tend to experience nonlocalized abdominal pain rather than dysuria and suprapubic pain. They may also experience cognitive impairment characterized by confusion or decreased level of consciousness.

Prerenal acute kidney failure

caused by cut-off of blood flow to the kidney - if recognized, highly treatable by restoring blood flow

Which medication can increase urination?

cholinergic agents

What should the waste drainage look like in peritoneal dialysis?

clear and straw colored (should be able to read a newspaper through it) Cloudy indicates infection

urine that is yellow is ___

concentrated (becoming dehydrated)

Total Incontience

continuous and unpredictable loss of urine due to anatomic abnormality.

acute renal transplant rejection: description, manifestations, and management

description: happens days to months after surgery, with the body mounting an immune defense against donor organ tissues manifestations: urine output drops, BUN and creatinine rise; fever; graft tenderness and swelling present management: increased dosage of medications will be administered, including steroids and monoclonal antibodies

hyperacute renal transplant rejection: description, manifestations, and management

description: happens w/in hours of surgery due to antibody rxn to donor antigens - rare due to histocompatibility assessments manifestations: no urine output management: client support, as kidney will be removed and hemodialysis resumed

chronic renal transplant rejection: description, manifestations, and management

description: months to years after surgery - may involve ann immune response to donor tissue manifestations: kidney function gradually declines, causing decreased urine output, increased BUN and creatinine; proteinuria may occur management: no specific treatment, but expect to return to hemodialysis

urine that is pink is due to ___

dilute blood (kidney issues possible)

Reflex Incontience

emptying bladder without the sensention of the need to void

Functional Incontinence

inability to reach the toliet to void

ADH

increases water reabsorption and urine concentration - keeps water in the body

glomerulonephritis

inflammation of the glomerulus due to an immune rxn to an antigen, typically after a group A hemolytic strep infection (after resp infection, skin infection, SLE)

urine that is burgundy is due to ____

laxatives

normal urine protein production

less than 150 mg/24 hours

Overflow Incontience

loss of urine associated with overdistention or overflow in the bladder

Urge Incontinence

loss of urine soon after feeling the urgue to void

urine that is dark gray is due to ____

medications or dyes

serum creatinine

nitrogenous waste in blood from muscle metabolism of creatine - reflect glomerular filtration rate - good measure of renal damage

urine that is pale yellow is ___

normal

What about a urinal is true?

nurses should encourage patient's to stand while using urinal

Postrenal acute kidney failure

obstruction in urine flow backs urine up into the kidney causing damage

Suprapubic catheters?

often preferred over an indwelling urethral catheter for long-term urinary drainage

Normal Urine pH

pH of 4.6 - 8 with 6 as avg.

erythropoietin

produced by kidneys when O2 levels in blood decrease to stimulate RBC production

Manifestations of chronic glomerulonephritis

progression of symptoms (proteinuria, hematuria, oliguria, increased BP, azotemia) from mild to moderate

Manifestations of acute glomerulonephritis

proteinuria hematuria with tea- or cola-colored urine facial and periorbital edema oliguria increased BP, possibly HTN azotemia (nitrogenous waste products in blood)

aldosterone

released by the adrenal cortex to promote Na absorption and K excretion - causes reabsorption of water b/c of the imbalance K levels go up, aldosterone secretion increased; increased aldosterone increases Na and H2O retention, depresses formation of renin

atrial natriuretic hormone (ANH)

released by the atria to promote sodium excretion from urine

renin

released by the kidneys to retain water and thus BP and fluid volume; Renin-angiotensin system turns angiotensinogen into Angiotensin I in the liver; angiotensin I forms angiotensin II in the lungs - angiotensin II is a vasoconstrictor that causes aldosterone production

nephrotic syndrome

renal disease characterized by massive edema and albuminuria; can be seen after any sort of renal condition that affects the glomerular capillary membrane; may lead to renal failure/ESRD

Why cholinergic agents?

stimulates the detrusor muscle, causing more frequent urination

creatinine clearance

test of how well creatinine is removal normal male: 95-135 mL/min normal female: 85-125 mL/min

Mixed Incontinence

urine loss with two or more types of incontinences

Choice Multiple question - Select all answer choices that apply. The nurse admits a woman reporting severe right upper quadrant pain after eating Christmas dinner. The nurse suspects gallbladder disease. Statistics show that incidence of gallbladder disease is greater for women who are a) Older than 40 years b) Obese c) Thin d) Multiparous

• Multiparous • Obese • Older than 40 years Explanation: Two to three times more women than men develop cholesterol stones and gallbladder disease; affected women are usually older than 40 years, multiparous, and obese.

"The school nurse is discussing ways to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important intervention that the school nurse must explain to the school teachers? "1.Do not allow students to eat or drink after each other. 2.Drink bottled water as much as possible. 3.Encourage protected sexual activity. 4.Thoroughly wash hands."

"Answer is 4. 1.Eating after each other should be discouraged,but it is not the most important intervention. 2.Only bottled water should be consumed in Third World countries, but that precaution is not necessary in American high schools. 3.Hepatitis B and C, not hepatitis A, are transmitted by sexual activity. 4.Hepatitis A is transmitted via the fecal-oral route. Good hand washing helps to prevent its spread."

"The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate? A. The hepatitis vaccine will provide immunity from this exposure and future exposures. B. I am afraid there is nothing you can do since the paitent was infectious before admission C. You will need to be tested first to make sure you don't have the virus before we treat you D. An injection of immunoglobin will need to be given to minimize or prevent the effects of this exposure"

"Answer: D. Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."

"Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person? "1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D"

"Correct answer: 1 Rationale: 1. The hepatitis A virus is in the stool of infected people for up to 2 weeks before symptoms develop 2. Hepatitis B is spread through contact with infected blood and body fluids 3. Hepatitis C is transmitted through contact with infected blood and body fluids 4. Hepatitis D infection only causes infection in people who are also infected with Hepatitis B or C"

A patient with hepatitis A is in the acute phase. The nurse plans care for the pateint based on the knowledge that: "a. pruritus is a common problem with jaundice in this phase. b. the pateint is most likely to transmit the disease during this phase. c. gastrointestinal symptoms are not severe in hepatitis A they are in hepatitis B. d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase."

"Correct answer: a Rationale: The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin."

What acid/base and Fluid/Electrolyte imbalances do people have with renal failure?

-Hyperkalemia (could cause lethal arrhythmias) -Metabolic Acidosis -Retain phosphorus (because serum calcium is going down and calcium is being pulled from the bones leading to osteoporosis)

How long after administering furosemide intravenously to a patient should the nurse anticipate the beginning of diuresis?

5 minutes The effects of IV furosemide begin within 5 minutes of administration and last 2 hours. IV therapy is used in critical situations (e.g., pulmonary edema) that demand immediate mobilization and elimination of fluid.

Which of the following electrolytes is a major cation in body fluid? a) Potassium b) Bicarbonate c) Chloride d) Phosphate

A) Potassium Potassium is a major cation that affects cardiac muscle functioning. Chloride is an anion. Bicarbonate is an anion. Phosphate is an anion.

Retention of which electrolyte is the most life-threatening effect of renal failure? a) Potassium b) Calcium c) Phosphorous d) Sodium

A) Potassium Retention of potassium is the most life-threatening effect of renal failure.

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute glomerulonephritis b) Acute renal failure c) Nephrotic syndrome d) Chronic renal failure

A) Acute glomerulonephritis Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this client, the nurse's priority should be to assess her: a) electrocardiogram (ECG) results. b) neuromuscular function. c) bowel sounds. d) respiratory rate.

A) ECG results Although changes in all these findings are seen in hyperkalemia, ECG results should take priority because changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia.

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? a) Urinary retention b) Painless hematuria c) Fever d) Frequency

A) Painless hematuria Explanation: The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.

A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction? a) Urinary retention b) Cystitis c) Bladder stones d) Urethral stricture

A) Urinary retention Urinary retention and urinary incontinence are voiding dysfunctions, temporary or permanent alterations in the ability to urinate normally. Cystitis is an infectious disorder. Bladder stones and urethral stricture are obstructive disorders.

A nurse is caring for a client diagnosed with cholelithiasis. Which of the following would be most appropriate for a client who is experiencing biliary colic? a) Ensure that the client rests. b) Administer analgesics to the client. c) Avoid administering antispasmodics. d) Ensure that the client has eaten a full meal.

Administer analgesics to the client. Explanation: The pain of acute cholecystitis may be so severe that the client requires analgesics. During an attack of biliary colic, the nurse should ensure that the client rests. The nurse should not give the client a full meal; instead, the nurse should monitor the client's ability to digest a bland liquid diet. The nurse should also administer antispasmodics or analgesics as prescribed to relieve pain and discomfort.

What diet should someone with oxalate stones be on? Foods to avoid?

Alkaline ash diet. Avoid high oxalate foods: TEAS, SPINACH, chocolate, and rhubarb (urine is alkaline)

A client with chronic renal failure has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now has mental cloudiness, dementia, and complaints of bone pain. The nurse interprets that these data are compatible with:

Aluminum intoxication

Aluminum intoxication

Aluminum intoxication may occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. This condition was formerly known as dialysis dementia. It may be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum

What drug is given to help a dialysis patient remove calcium from the GI tract?

Amphojel, a phosphate binder, helps bind calcium to phosphate to be removed in stool.

To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when: "A. Disposing of food trays B. Emptying the bed pan C. Taking an oral temperature D. Changing IV tubing"

Answer B, Rationale: HAV is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A.

The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention? A.Suggest that the client take warm showers. B.Add baby oil to the client's bath water. C.Apply powder to the client's skin. D.Suggest a hot-water rinse after bathing.

Answer B. Applying baby oil could help soothe the itchy skin. Answer A, C, and D would increase dryness and worsen the itching.

During evaluation of a patient at an outpatient clinic, the nurse determines that administration of hepatitis B vaccine has been effective when a specimen of the patient's blood reveals: a. HBsAg. b. anti-HBs c. anti-HBc IgM. d. anti-HBc IgG"

Answer B: The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV

11. A diabetic patient is admitted for evaluation of renal function because of recent fatigue, weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing history, the nurse identifies an early symptom of renal insufficiency when the patient states, a. "I get up several times every night to urinate." b. "I wake up in the night feeling short of breath." c. "My memory is not as good as it used to be." d. "My mouth and throat are always dry and sore."

Answer: A Rationale: Polyuria occurs early in chronic kidney disease (CKD) as a result of the inability of the kidneys to concentrate urine. The other symptoms would be expected later in the progression of CKD. Cognitive Level: Application Text Reference: p. 1206 Nursing Process: Assessment NCLEX: Physiological Integrity

23. A patient with chronic kidney disease (CKD) is started on hemodialysis, and after the first treatment, the patient complains of nausea and a headache. The nurse notes mild jerking and twitching of the patient's extremities. The nurse will anticipate the need to a. increase the time for the next dialysis to remove wastes more completely. b. switch to continuous renal replacement therapy (CRRT) to improve dialysis efficiency. c. administer medications to control these symptoms before the next dialysis. d. slow the rate for the next dialysis to decrease the speed of solute removal.

Answer: D Rationale: The patient has symptoms of disequilibrium syndrome, which can be prevented by slowing the rate of dialysis so that fewer solutes are removed during the dialysis. Increasing the time of the dialysis to remove wastes more completely will increase the risk for disequilibrium syndrome. CRRT is a less efficient means of removing wastes and, because it is continuous, would not be used for a patient with CKD. Administration of medications to control the symptoms is not an appropriate action; rather, the disequilibrium syndrome should be avoided. Cognitive Level: Application Text Reference: p. 1224 Nursing Process: Planning NCLEX: Physiological Integrity

3. A patient with severe heart failure develops elevated BUN and creatinine levels. The nurse plans care for the patient based on the knowledge that collaborative care of the patient will be directed toward the goal of a. preventing hypertension. b. replacing fluid volume. c. diluting nephrotoxic substances. d. maintaining cardiac output.

Answer: D Rationale: The primary goal of treatment for ARF is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing ARF, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct. Cognitive Level: Application Text Reference: pp. 1201-1202 Nursing Process: Planning NCLEX: Physiological Integrity

Which of the following is a correct route of administration for potassium? a) IV (intravenous) push b) Oral c) Intramuscular d) Subcutaneous

B) Oral Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. Potassium is not administered subcutaneously.

Which is the correct term for the ability of the kidneys to clear solutes from the plasma? a) Glomerular filtration rate (GFR) b) Renal clearance c) Specific gravity d) Tubular secretion

B) Renal Clearance Explanation: Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.

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? a) The kidneys are situated just above the adrenal glands. b) The left kidney usually is slightly higher than the right one. c) The kidneys lie between the 10th and 12th thoracic vertebrae. d) The average kidney is approximately 5 cm (2?) long and 2 to 3 cm (¾? to 1??) wide.

B) The left kidney usually is slightly higher than the right one The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.

The nurse observes the color of the client's urine which appears pale blue-green. The nurse obtains a drug history from the client based on the understanding that drugs used by the client may affect which of the following? a) Size of the urinary bladder b) Urinary tract tests c) Urine specific gravity d) Amount of urine produced

B) Urinary tract tests It is important to inquire about drugs because some drugs may affect the outcome of urinary tract tests as well as the color and odor of the urine. Dietary intake may affect urine characteristics as well as urinary tract disorders and their management. Drugs do not directly affect the size of the urinary bladder or the amount of urine produced.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level b. Elevated serum bilirubin level c. Elevated blood urea nitrogen level d. Decreased erythrocycle sedimentation rate"

B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.

Rationale for BUN testing with Kidney disorders

BUN testing is a frequently used laboratory test to determine renal function. The BUN level starts to rise when the glomerular filtration rate falls below 40% to 60%.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a) History of hyperparathyroidism b) History of osteoporosis c) Recent history of streptococcal infection d) Previous episode of acute pyelonephritis

C) Recent hx of streptococcal infection Explanation: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

A 57-year-old homeless female with a history of alcohol abuse has been admitted to your hospital unit. She was admitted with signs and symptoms of hypovolemia - minus the weight loss. She exhibits a localized enlargement of her abdomen. What condition could she be presenting? a) Hypovolemia b) Pitting edema c) Third-spacing d) Anasarca

C) Third spacing Third-spacing describes the translocation of fluid from the intravascular or intercellular space to tissue compartments, where it becomes trapped and useless. The client manifests signs and symptoms of hypovolemia with the exception of weight loss. There may be signs of localized enlargement of organ cavities (such as the abdomen) if they fill with fluid, a condition referred to as ascites.

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? a) "This medication will prevent re-infection." b) "This medication should be taken at bedtime." c) "This medication will relieve your pain." d) "This will kill the organism causing the infection."

C) This medication will relieve your pain Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

What if important to know about needle biopsy of the kidney?

Complication=bleeding so check clotting times, NO NSAIDS, ASA, OR COUMADIN, Can hold breath on command, Aftercare: watch for hemorrhage, bedrest 24 hrs, normal activities in 2 weeks and increase fluids to keep urine clear.

A client has epididymitis as a complication of urinary tract infection (UTI). The nurse is giving the client instructions to prevent a recurrence. The nurse determines that the client needs further instruction if the client states the intention to:

Continue to take antibiotics until all symptoms are gone. *Antibiotics are always taken until the full course of therapy is completed.

What is important to know about after a TURP?

Continuous bladder irrigation, blood clots are normal for first 8 hours, 8-24 hours should change to brown clots, 72 hrs should be shreds and no more clots, bladder spasms may occur, increase fluids to prevent UTI, pink tinged urine, avoid straining with BM (high fiber diet and laxative) best rest first 24. NO LPN or NA. Distended abd, bulging, increased symphysis pubis=bleeding/blocked catheter=call MD bc can't touch dressing.

Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person? 1.Hepatitis A.2.Hepatitis B.3.Hepatitis C.4.Hepatitis D.

Correct Answer 1: The hepatitis A virus is in the stool of infected people up to two (2) weeks beforesymptoms develop.

Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person? 1.Hepatitis A. 2.Hepatitis B.3.Hepatitis C.4.Hepatitis D

Correct 1 "1.The hepatitis A virus is in the stool of infected people up to two (2) weeks beforesymptoms develop. 2.Hepatitis B virus is spread through contact with infected blood and body fluids.3.Hepatitis C virus is transmitted throughinfected blood and body fluids.4.Hepatitis D virus only causes infection inpeople who are also infected with hepatitis Bor C"

The physician has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1. Hep-A 2. Hep-B. 3. Hep-C. 4 Hep-D

Correct Answer 1: Hep-A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hep-B, -C or -D are most commonly transmitted via infected blood or body fluids.

A patient who is scheduled to have a renal ultrasound tells a nurse, "I am afraid I will not be able to stand the pain of this test." Which of these outcomes would be most appropriate for the nurse to establish with this patient? The patient will 1. explain the typical experience of a patient having a renal ultrasound. 2. discuss feelings associated with painful experiences. 3. explain pain medications available during this procedure. 4. discuss the typical experience of a patient using conscious sedation.

Correct Answer: 1 Rationale: A renal ultrasound is a noninvasive test conducted to detect renal or perirenal masses, identify obstructions, and diagnose renal cysts and solid masses. It is done by applying a conductive gel to the skin and placing a small external ultrasound probe on the patient's skin. Sound waves are recorded on a computer as they are reflected off tissues. There is no discomfort associated with the test and pain medications are not needed. When the patient understands the typical experience for a patient having this test, fears of a painful experience will be addressed and resolved.

A nurse is assessing a 68-year-old female patient who states, "I am having episodes of urinary incontinence." The nurse should recognize this statement as indicating which of the following? 1. an abnormal finding requiring further testing 2. an indication of the presence of a urinary infection 3. a normal outcome of the aging process 4. the result of having several children

Correct Answer: 1 Rationale: An abnormal finding requiring further testing is correct because incontinence is not a normal part of the aging process, and therefore will require further investigation to identify the cause. An indication of the presence of a urinary infection is incorrect because although frequency and urgency can be symptoms of a urinary tract infection, a culture and sensitivity test is necessary in order to determine infection. A normal outcome of the aging process and a result of having several children are incorrect because incontinence is not normal, and is it not necessarily the result of having had several children.

The nurse working on a nephrology unit is providing telephone triage to a patient who states, "I am worried that my child may be genetically at risk for kidney problems in adulthood." The nurse should recognize that which of these comments by the patient best indicates that the patient's child may be at future risk for manifesting a genetic kidney disorder? 1. "My mother had lots of cysts on her kidneys." 2. "I have a bladder infection at least once a year." 3. "The child's father has Parkinson's disease." 4. "My father had kidney cancer."

Correct Answer: 1 Rationale: When conducting a health assessment interview and physical assessment, it is important for the nurse to consider genetic influences on health. During the health assessment interview, ask about family members with health problems affecting kidney function, or of family members diagnosed with polycystic disease. A grandmother with polycystic kidney disease increases the grandchild's risk for having the disorder. A yearly bladder infection in a mother is not the most important indicator of a genetic kidney disorder. Parkinson's disease is not associated with kidney disease. Kidney cancer is not highly associated with heredity.

The nurse is reviewing the serum creatinine laboratory results for a group of patients. The nurse identifies which of the following patients as being at risk for having falsely elevated serum creatinine levels: A patient with a diagnosis of which of the following? (Select all that apply.) 1. rhinovirus taking 10,000 mg of vitamin C daily 2. Parkinson's disease and a prescription for methyldopa 3. bipolar disorder and a prescription for lithium carbonate 4. acne vulgaris and a prescription for tetracycline 5. insomnia taking over-the-counter melatonin

Correct Answer: 1,2,3

A patient is participating in bladder retraining activities. Of the following, select the toileting activities that can reduce episodes of incontinence. Select all that apply. 1. scheduled toileting 2. habit training 3. intermittent straight catheterization 4. external catheter placement at bedtime 5. use of adult incontinence protection devices

Correct Answer: 1,2 Rationale: Behavioral techniques such as scheduled toileting, habit training, and bladder retraining are used to reduce the frequency of incontinence. Scheduled toileting is toileting at regular intervals (e.g. every two to four hours). Habit retraining is toileting the patient on a schedule that corresponds with the normal pattern. Intermittent straight catheterization is not a toileting activity. Use of adult incontinence devices does not reduce periods of incontinence.

Home care teaching for the patient after a radical nephrectomy should include which of the following? Select all that apply. 1. Avoid contact sports and falls. 2. Older males should schedule routine screening exams for prostatic hypertrophy. 3. Monitor weight. 4. Monitor for signs of rejection. 5. Maintain prescribed fluid restrictions.

Correct Answer: 1,2 Rationale: Home care teaching focuses on protecting the remaining kidney including measures to prevent infection, calculi, hydronephrosis, and trauma. Patients should avoid contact sports and use measures to prevent motor vehicle accidents and falls that could damage the kidney. Older male patients should know manifestations of prostatic hypertrophy and schedule routine screening exams. Perineal hygiene, maintaining fluid intake of 2000-2500 mL per day, urinating frequently, and watching for manifestations of urinary tract infections are included in teaching. Monitoring weight, noting any signs of rejection, and maintaining prescribed fluid restrictions are concerns for the patient after a kidney transplant.

A patient is discharged after transurethral resection of a superficial bladder tumor. Which of the following would be included in the discharge instructions? Select all that apply. 1. avoid constipation, continue stool softener 2. increase fluid intake 3. bedrest 4. calling physician if painless hematuria occurs 5. making a follow-up appointment in one year

Correct Answer: 1,2,4 Rationale: Instructions relevant to the patient post-resection include avoiding constipation, use of a stool softener and increasing fluid intake. Painless hematuria is the typical sign in 75% of urinary tract tumors. After tumor resection, patients should be followed at three-months for tumor recurrence. Activity to tolerance is recommended, not bedrest.

"A client is admitted with ongoing symptoms of the flu. There are no other obvious signs of illness. This client should be tested for hepatitis because: "a) She has an allergy to shellfish. b) She could have anicteric hepatitis, which means no jaundice. c) She was living with a roommate who had similar symptoms. d)She has a blood pressure of 90/50.

Correct answer: B" Only about 25 percent of people with acute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised liver function that is overlooked due to lack of jaundice.

A patient is told that a horseshoe kidney was a coincidental finding on a recent x-ray. He asks if this will create problems in the future. What is the nurse's best response? 1. "This does not necessarily affect kidney function but increases the risk of kidney infection." 2. "You can ignore this information." 3. "No, it's just something to be aware of and won't cause you any problems." 4. "I'll give you specific instructions on how to prevent kidney stone formation."

Correct Answer: 4 Rationale: Horseshoe kidney is one of the most common renal malformations but typically does not affect renal function. There are increased risks of UTI, hydronephrosis, and stone formation. Patients with this malformation should be educated on measures to promote optional kidney function such as adequate daily fluid intake, hygiene practices to help prevent UTI, and knowing signs and symptoms of early manifestations of UTI. Option 1 is inappropriate because it does not respond to the patient's question and gives false reassurance.

A patient is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level, b. Elevated serum bilirubin level, c. Elevated blood urea nitrogen level, d. Decreased erythrocyte sedimentation rate

Correct B Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin leveles, elevated erythrocyte sedimentatation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.

"A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission? "A. Sexual contact with an infected partner. B. Contaminated food. C. Blood transfusion. D. Illegal drug use.

Correct answer: B" Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Hepatitis B, C, and D are transmitted through infected bodily fluids.

sx of glomerulonephritis

early: pharyngitis, fever, malaise, weakness, fatigue urine alterations positive ASO titer elevated ESR, BUN, and creatinine, decreased creatinine clearance

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the student have understood the material when they identify which of the following as a cause of stress incontinence? a) Obstruction due to fecal impaction or enlarged prostate b) Bladder irritation related to urinary tract infections c) Increased urine production due to metabolic conditions d) Decreased pelvic muscle tone due to multiple pregnancies

D) Decreased pelvic muscle tone due to multiple pregnancies Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.

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? a) Pregnancy b) Diabetes mellitus c) Neuromuscular disorders d) Hypotension

D) Hypotension Hypertension, not hypotension, is a risk factor for kidney disease.

Which of the following would be a potential cause of respiratory acidosis? a) Vomiting b) Hyperventilation c) Diarrhea d) Hypoventilation

D) Hypoventilation Respiratory acidosis is always due to inadequate excretion of CO, with inadequate ventilation, resulting in elevated plasma CO concentration, which causes increased levels of carbonic acid. In addition to an elevated PaCO, hypoventilation usually causes a decrease in PaO.

Which type of incontinency refers to the involuntary loss of urine due to medications? a) Overflow b) Urge c) Reflex d) Iatrogenic

D) Iatrogenic Explanation: Iatrogenic incontinence is the involuntary loss of urine due to medications. Reflex incontinence is the involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? a) Decreased blood urea nitrogen (BUN) b) Decreased potassium c) Increased serum albumin d) Increased serum creatinine

D) Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

An age related change in the kidney that leads to nocturia in an older adult is a) decreased renal mass b) decreased detrusor muscle tone c) decreased ability to conserve sodium d) decreased ability to concentrate urine

D) decreased ability to concentrate urine The decreased ability to concentrate urine results in an increased volume of dilute urine, which does not maintain the usual diurnal elimination pattern. A decrease in bladder capacity also contributes to nocturia, but decreased bladder muscle tone results in urinary retention. Decreased renal mass decreases renal reserve, but function is generally adequate under normal circumstances.

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes melitus. Which of the following explains the cause of this secondary diabetes? a) Inability for the liver to reabsorb serum glucose b) Ingestion of foods high in sugar c) Dysfunction of the pancreatic islet cells d) Renal failure

Dysfunction of the pancreatic islet cells Explanation: Diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The hazard of severe hypoglycemia with alcohol consumption is stressed to the client and family. When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. A standard treatment with pancreatitis is to make the client NPO. The dysfunction is related to the pancreas, not the liver.

What is a risk factor for renal calculi?

Dehydration (avoid diuretics)

A client is scheduled for intravenous pyelography (IVP). Before the test, the priority nursing action would be to:

Determine a history of allergies.

A nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, would the nurse identify as a risk factor for this disorder?

Diabetes Mellitus

What are risk factors for developing erectile dysfunction (impotence)?

Diabetes, heart disease, high blood pressure, prostate enlargement, spinal cord injury, stroke, smoke heavily, drink heavily, aren't physically active, or if overweight.

A patient with heart disease has taken furosemide (Lasix) for 3 months and complains of fatigue and palpitations to the healthcare provider. Once the provider has determined that the patient's condition is stable, which information should the nurse include in patient teaching to help this patient feel better?

Eat bananas and orange juice daily. The nurse instructs the patient to eat more bananas and to drink orange juice, because these foods are good sources of potassium. The nurse provides these instructions because the patient takes furosemide, a loop diuretic that excretes a significant amount of potassium with sodium. This occurs because the drug acts in the ascending loop of Henle. These instructions are also proper because the patient complains of fatigue and palpitations, both of which can be caused by hypokalemia. Increasing the consumption of meat and fish is proper if the patient is anemic. The nurse avoids instructing the patient to increase exercise without provider approval. Emergency treatment is not necessary for palpitations unless the patient has syncope or other clinical indicators of hypotension or low cardiac output.

What should you teach a fireman who has experienced an inguinal hernia?

He shouldn't go back to work bc he lifts too much weight at work and may experience more hernias in future as a result. A desk job is okay.

Nephrotic Syndrome Patho

Inflammatory response in the glomerulous, big holes form so protein starts leaking out into the urine (proteinuria), now the patient is hypoalbuminemic (low albumin in the blood), and without albumin you can't hold onto the fluid in the vascular space, so all the fluid in the vascular space then goes out into the tissues and the circulating blood volume goes down. The kidneys sense the decreased volume and they want to help replace it, so the renin-angiotensin system kicks in and aldosterone is produced. Aldosterone retains sodium and water, but there is not any protein to hold it in, so the fluid keeps going out to the tissues. This results in total body edema!

What if surgery in the flank area is done for a kidney stones?

Nephrostomy tube is placed in kidney to drain urine (comes out all around tube so frequent dressing changes).

What should an chronic renal failure patient no receive?

No salt substitutes (K+), no dilantin or IV dyes, no mycin drugs (blind or no pee), and anything with K+. (can give apple for snack).

T/F Urinary elimination from an ileal conduit can be voluntarily controlled after stoma heals?

No, this involves surgical resection of the small intestine, ureters are transplanted to an isolated segment of small bowel. Ostomies created from small intestine cannot be controlled

The nurse prepares to administer digoxin (Lanoxin) and furosemide (Lasix) to a male patient. For which findings should the nurse monitor to help prevent a serious complication of therapy?

Poor appetite, irritable reflexes, irregular heart beat This patient is at high risk for ventricular dysrhythmias because of the combination therapy. Digoxin is used to treat heart failure and atrial dysrhythmias; however, the risk of serious digoxin toxicity resulting in ventricular dysrhythmias increases greatly when the patient has hypokalemia. Unfortunately, this patient is at high risk for hypokalemia because he also takes furosemide, a loop diuretic, which promotes potassium loss. Hence the nurse needs to detect the signs of hypokalemia and ventricular irritability—including anorexia, irregular heart rate, and hyperreflexia—early. Digoxin toxicity and hypokalemia are unlikely to lead to convulsions, accumulation of pulmonary fluid, or increased blood pressure.

(What is the purpose of) pelvic floor muscle traing - Kegel Exercise

Strenghtening the perineal and abdominal muscles (is called)

If dialysis outflow drainage is inadequate

The nurse attempts to stimulate outflow by changing the client's position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and the peritoneal dialysis system is also checked for kinks or twisting, and the clamps on the system are checked to ensure that they are open.

True or False? GFR is primarily dependent on adequate blood flow and adequate hydrostatic pressure.

True

True or False? Increased permeability in the glomerulus causes loss of proteins into the urine.

True

True or False? Prostaglandin synthesis by the kidneys causes vasodilation and increased renal blood flow.

True

Who needs CRRT?

a fragile cardiovascular patient with acute renal failure

A client with urinary incontinence asks the nurse for suggestions about managing this condition. Which suggestion would be most appropriate? a) "Make sure to eat enough fiber to prevent constipation." b) "Try drinking coffee throughout the day." c) "Use scented powders to disguise any odor." d) "Limit the number of times you urinate during the day."

a) "Make sure to eat enough fiber to prevent constipation." Explanation: Suggestions to manage urinary incontinence include avoiding constipation such as eating adequate fiber and drinking adequate amounts of fluid. Scented powders, lotions, or sprays should be avoided because they can intensify the urine odor, irritate the skin, or cause a skin infection. Stimulants such as caffeine, alcohol, and aspartame should be avoided. The client should void regularly, approximately every 2 to 3 hours to ensure bladder emptying.

Which of the following urine specific gravity values would indicate to the nurse that the patient is receiving excessive IV fluid therapy? a) 1.002 b) 1.010 c) 1.025 d) 1.030

a) 1.002 A urine specific gravity of 1.002 is low, indicating dluite urine and the excretion of excess fluid. Fluid overload, diuretics, or lack of ADH can cause dilute urine. Normal urine specific gravity indicates concentrated urine that would be seen in dehydration.

Stress Incontinence

an involuntary loss of urine related to an increase in intra-abdominal pressure. (laughing, sneezing, etc.)

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Weight loss b) Fever c) Absence of pain d) Diuresis

b) Fever Fever is an indicator of infection or transplant rejection.

"A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? a. "You may have eaten contaminated restaurant food." b. "You could have gotten it by using I.V. drugs." c. "You must have received an infected blood transfusion." d. "You probably got it by engaging in unprotected sex.""

"Answer A. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex."

"A client with acute hepatitis is prescribed lactulose. The nurse knows this medication will: A. Prevent the absorption of ammonia from the bowel. B. Prevent hypoglycemia. C. Remove bilirubin from the blood. D. Mobilize iron stores from the liver"

"Correct Answer: A Rationale: Lactulose helps prevent the absorption of ammonia from the bowel because it will cause frequent bowel movements, which facilitates the removal of ammonia from the intestines."

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which of the following responses by the nurse is most appropriate? "A) The hepatitis vaccine will provide immunity from this exposure and future exposures."" B) I am afraid there is nothing you can do since the patient was infectious before admission."" C) You will need to be tested first to make sure you don't have the virus before we can treat you."" D) An injection of immunoglobulin will need to be given to prevent or minimize the effects of this exposure."""

"Correct Answer: D Rationale: Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks of exposure. It may not prevent an infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? a) "Maintain a high-fat, high-carbohydrate diet." b) "Maintain a high-sodium, high-calorie diet." c) "Maintain a high-fat diet and drink at least 3 L of fluid a day." d) "Maintain a high-carbohydrate, low-fat diet."

"Maintain a high-carbohydrate, low-fat diet." Explanation: A client with a history of pancreatitis should avoid foods and beverages that stimulate the pancreas, such as fatty foods, caffeine, and gas-forming foods; should avoid eating large meals; and should eat plenty of carbohydrates, which are easily metabolized. Therefore, the only correct instruction is to maintain a high-carbohydrate, low-fat diet. An increased sodium or fluid intake isn't necessary because chronic pancreatitis isn't associated with hyponatremia or fluid loss.

Treatment for Glomerulonephritis

-Get rid of strep -Balance activity with rest -I&O and daily weights (fluid problem) -monitor blood pressure -Dietary needs: low protein, low salt, increase carbs for energy -Dialysis -Diuresis begins 1-3 weeks after onset -blood and protein may stay in the urine for months -teach the signs and symptoms of renal failure

What is an advantage of using a condom catheter?

- collects urine into a drainage bag without risk of infection associated with indwelling urinary catheters

Which are age related changes that affect the patients' ability to maintain desired urinary function?

- decreased joint mobility - diminished ability of kidney's to concentrate urine -decreased bladder mucle tone -decreased bladder contractility (not necessarily decreased congnitive function)

AVF vs. AVG vascular access

-AVF (arteriovenous fistula) in the forearm with an anastomosis between the artery and a vein -AVG (ateriovenous graft) a synthetic graft to join the vessels Both require surgery, takes weeks to mature and to be ready for repeated venipunctures

How to assess the access site

-Assess for patency -Palpate for thrill (cat-purring sensation) -Ascultate for bruit (turbulent blood flow) -Feel a thrill and hear a bruit...good thing

Causes of Nephrotic Syndrome

-Bacterial or viral infections -NSAIDs -heroin -Cancer and genetic predisposition -systemic disease like lupus or diabetes -Strep

Fluid Challenge to test for fixed specific gravity

-Bolus with 250 mL or greater of NS and they fail if the specific gravity stays the same

CCPD (Continuous Cycle Peritoneal Dialysis)

-Connect their peritoneal dialysis catheter to a cycler at night and their exchange is done automatically while they sleep. Disconnected in the AM; has more freedom.

Signs and Symptoms of Renal Failure

-Creatinine and BUN increase -Specific Gravity changes (initially it is up (concentrated), may lose the ability to concentrate and dilute urine, may need to do a bolus challenge to test for a fixed specific gravity) -Anemia (not enough erythropoietin) -Htn, HF (retaining fluid) -Anorexia, N/V (retaining toxins) -Itching frost (uremic frost) -Acid/Base and fluid/electrolyte imbalances

Treatment of Nephrotic Syndrome

-Diuretics -ACE inhibitors to block aldosterone secretion -Prednisone to decrease inflammation (shrink holes so protein can't get out; immunosuppressed) -Lipid-lowering drugs for hyperlipidemia -decrease sodium -increase protein in diet (This is the one person that you can increase protein in) -Anticoagulation therapy for up to 6 months -dialysis

Care of Access site

-Do not used for IV access, drawing blood, administering meds -No BP, needle sticks, or constriction on that extremity

Vascular Access notes for hemodialysis

-During dialysis, 2 needles are inserted into the vascular access. -One needle will allow blood to be pulled from the circulation and sent to the hemodialysis machine -The other is used to return filtered blood to the client's circulation -The arterial end of the access will remove the blood and return is through the low pressure venous end

A nursing instructor is reviewing with the class the steps in urine formation. Place in the correct order from first to last the sequence the instructor would present. -Filtrate enters Bowman's capsule -Plasma filtered through glomerulus -Formed urine drains from the collecting tubules, into the renal pelvis, and down each ureter to the bladder -Filtrate moves through tubular system of the nephron and is either reabsorped or excreted

-Plasma filtered through glomerulus -Filtrate enters Bowman's capsule -Filtrate moves through tubular system of the nephron and is either reabsorped or excreted -Formed urine drains from the collecting tubules, into the renal pelvis, and down each ureter to the bladder

Diuretic Phase

-Sudden Onset -urine output goes up...pees a lot -the patient is in a fluid volume deficit (shock) -The potassium will decrease -Follow up with Acute renal patients, because the recovery could take a year

General Information about Hemodialysis

-The machine is acting like the glomerulus (filter) -Done 3-4 times per week -Client has to watch what they eat and drink in between treatments -Given an anticoagulant during dialysis to prevent clots (usually heparin) -depression is common, sometimes suicide -Electrolytes and BP are watched constantly -Not all patients can tolerate dialysis (unstable cardiovascular system can't)

Continuous Renal Replacement Therapy (CRRT)

-Typically done in an ICU setting and is continuous, so the patient doesn't have drastic fluid shifts -Never more than 80ml of blood out of the body at one time being filtered and therefore does not stress the cardiovascular system as much.

Oliguric Phase

-Urine output decreases -UO of 100-400 mL/24 hours -This client is in fluid volume excess -The potassium will be increased!

General notes about peritoneal dialysis

-Use a peritoneal membrane as a filter -Dialysate is warmed and infused into the peritoneal cavity by gravity via a Tenckhoff catheter -The fluid (2000-2500 ml) fills the peritoneal cavity (takes about 10 min) remains in peritoneal cavity for a prescribed amount of time. this is called the dwell time -Then the bag is lowered and the fluid along with the toxins, etc. are drained and this is called the exchange.

Problems associated with protein loss

-blood clots (thrombosis)...normally blood protein keeps us from clotting -cholesterol and triglycerides will be increased

Why use peritoneal dialysis instead of hemo?

-someone who can't tolerate hemo or someone who chooses peritoneal

Signs and Symptoms of Glomerulonephritis

-sore throat (strep) -malaise and headache (toxins building) -BUN and creatinine increases (can't excrete urea or creatinine) -Sediment, protein, blood in urine (smokey, rust/cola color) -flank pain (costovertebral angle tenderness) -Increased BP -facial edema -decreased urine output -increased urine specific gravity (concentrated) -client going into fluid volume overload

normal urine specific gravity

1.015 - 1.025

Normal range of specific gravity of urine

1.015-1.025 in concentration

The blader can fill up to how many mL of urine

3,000-4,000 mL of urine

(How much urine shoud be discarded into toliet before) obtaining a urine specimen

30 mL of urine should be discarded (when)

amount of water that SHOULD be produced by the kidneys in an adult per hour

30 mL/hour or 0.5 mg/kg/hour

What is the minimum urine output for an adult per hour?

30 ml/hr (<30 ml/h=abnormal)

Which of the following is the most common cause of symptomatic hypomagnesemia? a) Alcoholism b) IV drug use c) Sedentary lifestyle d) Burns

A) Alcoholism Alcoholism is currently the most common cause of symptomatic hypomagnesemia. IV drug use, sedentary lifestyle, and burns are not the most common causes of hypomagnesemia.

Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder? a) Anticholinergic agent b) Over-the-counter decongestant c) Tricyclic antidepressants d) Estrogen hormone

A) Anticholinergic agent Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions as well as increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.

When a client's ventilation is impaired, the body retains which substance? a) Carbon dioxide (CO2) b) Oxygen c) Sodium bicarbonate d) Nitrous oxide

A) Carbon dioxide (CO2) When ventilation is impaired, the body retains CO2 because the carbonic acid level increases in the blood. Sodium bicarbonate is used to treat acidosis. Nitrous oxide, which has analgesic and anesthetic properties, commonly is administered before minor surgical procedures. When ventilation is impaired, the body doesn't retain oxygen. Instead, the tissues use oxygen and CO2 results.

The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? a) Catheterize the client immediately after the client voids. b) Check for residual after the client reports the urge to void. c) Set up a routine schedule of every 4 hours to check for residual urine. d) Record the volume of urine obtained.

A) Catheterize the client immediately after the client voids Explanation: To obtain accurate residual volumes, it is important that clients void first and that catheterization occur immediately after the attempt. The nurse should record both the volume voided (even if it is zero) and the volume obtained by catheterization. Intermittent catheterizations are performed based on a schedule, usually 3 to 4 times per day. Residual urine refers to the amount remaining in the bladder after voiding. It is essential that the client voids.

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? a) Check for thrill or bruit over the access site. b) Warm the solution to body temperature. c) Inspect the catheter insertion site for infection. d) Add the prescribed drug to the dialysate.

A) Check for thrill or bruit over the access site. When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.

A patient with an obstruction of the renal artery causing renal ischemia exhibits HTN. One factor that may contribute to HTN: a) increase renin release b) increased ADH secretion c) decreased aldosterone secretion d) increased synthesis and release of prostaglandins

A) Increase Renin Release Renin is released in resonse to decreased B/P, renal ischemia, eosinophil chemotactic factor (ECF) depletion, and other factors affecting blood suppy to the kidney. It is they catalyst of the renin-angiotensin-aldosterone system, which raises B/P when stimulated. ADH is secreted by the posterior pituitary in response to serum hyperosmolality and low blood volume. Aldosterone is secreted within the renin-angiotensin II, and kidney prostaglandins lower B/P by causing vasodilation.

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? a) Need to urinate after engaging in sexual intercourse b) Need to wear underwear made from synthetic material c) Importance of urinating every 4 to 6 hours while awake d) Suggestion to take tub baths instead of showers

A) Need to urinate after engaging in sexual intercourse Measures to prevent cystitis include voiding after sexual intercourse, wearing cotton underwear, urinating every 2 to 3 hours while awake, and taking showers instead of tub baths.

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? a) Potassium b) Sodium c) Chloride d) CO2

A) Potassium The nurse should identify potassium: 2.2 mEq/L as critical because a normal potassium level is 3.8 to 5.5 mEq/L. Severe hypokalemia can cause cardiac and respiratory arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dl) and the chloride level is a bit low (normal is 100 to 110 mEq/L). Although these levels should be reported, neither is life-threatening. The BUN (normal is 8 to 26 mg/dl) and creatinine (normal is 0.8 to 1.4 mg/dl) are within normal range.

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? a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. b) Administer furosemide (Lasix) 20 mg I.V. c) Encourage oral fluids. d) Start hemodialysis after a temporary access is obtained.

A) Start IV fluids with 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.

Which conditions lead to chronic respiratory acidosis in older adults? a) Thoracic skeletal change b) Overuse of sodium bicarbonate c) Decreased renal function d) Erratic meal patterns

A) Thoracic skeletal change Poor respiratory exchange as the result of chronic lung disease, inactivity, or thoracic skeletal changes may lead to chronic respiratory acidosis. Decreased renal function in older adults can cause an inability to concentrate urine and is usually associated with fluid and electrolyte imbalance. A poor appetite, erratic meal patterns, inability to prepare nutritious meals, or financial circumstances may influence nutritional status, resulting in imbalances of electrolytes. Overuse of sodium bicarbonate may lead to metabolic alkalosis.

A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess: a) Trousseau's sign. b) Hegar's sign. c) Homans' sign. d) Goodell's sign.

A) Trossaeu's sign This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Urine output of 250 ml/24 hours b) Temperature of 100.2° F (37.8° C) c) Serum creatinine level of 1.2 mg/dl d) Blood urea nitrogen (BUN) level of 22 mg/dl

A) Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply. a) Vitamin D synthesis b) Secretion of prostaglandins c) Vitamin B production d) Secretion of insulin e) Regulation of blood pressure

A) Vitamin D synthesis B) Secretion of prostaglandins E) Regulation of blood pressure Explanation: Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.

The sites where urinary stones are most likely to obstruct the urinary system are at the __________ and the ____________.

Ureteropelvic junction and Ureterovesical junction

What prevents the elimination of very dilute urine?

ADH Antidiuretic hormone (ADH), known as the water-conserving hormone, acts on the collecting duct to regulate conservation of water by increasing the water permeability of the collecting ducts; this decreases the amount of water eliminated in urine. Aldosterone acts to conserve sodium. Hypernatremia works to pull fluid from the interstitial spaces into the intravascular space; however, without ADH and adequate renal function, the sodium level may be irrelevant. Glomerular filtration works to remove solutes and water from the arterial blood, so glomerular filtrate is not dilute.

What diet should someone with calcium stones be on? Foods to avoid?

Acid ash diet. Limit dairy foods (acid urine pH).

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a) Anxiety related to unknown outcome of hospitalization b) Acute pain related to biliary spasms c) Deficient knowledge related to prevention of disease recurrence d) Imbalanced nutrition: Less than body requirements related to biliary inflammation

Acute pain related to biliary spasms Explanation: The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

What is important to know about nephrotic syndrome? Tx?

Acute, complication=skin breakdown, massive protein loss in urine, hypoalbuminemia, edema (anasarca), increased cholesterol. Tx: diuretics, steroids, increased protein, increased calorie, decreased Na.

What are signs of kidney transplant rejection?

Acute: (1 wk-2yrs post op), oliguria, anuria, increased temp (>37.8C), increased BP, flank tenderness, lethargy, decreased specific gravity, fluid retention. Chronic: (over months to yrs), gradual increase in BUN/creatinine, imbalances in electrolytes, fatigue.

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a) Placing the client in a semi-Fowler's position b) Administering morphine I.V. as ordered c) Providing mouth care d) Maintaining nothing-by-mouth (NPO) status

Administering morphine I.V. as ordered Explanation: The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

What is an inguinal hernia?

An abnormal bulge or protrusion of intestine through the muscle of abd that can be seen and felt in the groin area. Tx=surgery to fix.

The physican has determine the client with Hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

Answer 1: Hepatitis A is the correct answer because it is transmitted by the oral-fecal route, via contaminated food or food handlers. B, C, and D are transmitted most commonly via infected body fluids

"Several children at a daycare center have been infected with hepatitis A virus. Which instruction by the nurse would reduce the risk of hepatitis A to the other children and staff members? "1. Hand washing after diaper changes 2. Isolation of the sick children 3. Use of masks during contact with the children 4. Sterilization of all eating utensils"

Answer 1: Rationale: children in day care centers are at risk for hepatits A infection which is transmitted via fecal-oral route due to poor hand hygeine practices and poor sanitation. Isolation of sick children, use of mask during contact, and sterilization of all eating utensils would not be useful in breaking the chain of infection.

The RN is providing discharge information to a client with hep B. The RN instructs the client to prevent transmission via: a. airborne pathogens 2. blood and body secretions 3. skin contact 4. fecal and oral routes

Answer 2: Hep b is transmitted via blood and body secretions. The RN instructs the client to prevent transmission through correct use of latex condoms, and by not sharing personal care items that may have blood on them. Diseases such as pneumonia are spread by airborne pathogens, hep A is spread by fecal and oral routes. Hep B is not transmitted by skin contact.

"Which statement by the client diagnosed with hepatitis warrants immediate intervention by the clinic nurse? "1) ""I will not drink any type of beer or mixed drink."" 2)""I will get adequate rest so I don't get exhausted."" 3) ""I had a big hearty breakfast this morning."" 4) ""I took some cough syrup for this nasty head cold.""

Answer 4: "Rationale: 1) The client should avoid all alcohol to prevent further liver damage and promote healing. 2) Rest is needed for healing of the liver and to promote optimum immune function. 3) Clients with hepatitis need increased caloric intake so this is a good statement. 4)The client needs to understand some types of cough syrup have alcohol and all alcohol must be avoided to prevent further injury to the liver; therefore, this statement requires intervention"

"A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? "a. "You may have eaten contaminated restaurant food." b. "You could have gotten it by using I.V. drugs." c. "You must have received an infected blood transfusion." d. "You probably got it by engaging in unprotected sex.""

Answer A Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex."

Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A ,b. hep b, C Hep C, D. Hep D

Answer A. Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? "A. "You may have eaten contaminated restaurant food." b. "You could have gotten it by using I.V. drugs." c. "You must have received an infected blood transfusion." d. "You probably got it by engaging in unprotected sex.""

Answer A. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.

"Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? "a. Hep A. b. Hep. B. c. Hep. C. d. Hep D

Answer A: Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

"A patient with hepatitis B is being discharged in 2 days. In the discharge teching plan the nurse should include instructions to: a. Avoid alcohol for the first 3 weeks b. Use a condom during sexual intercourse c. Have family members get an injection of immunoglobin d. Follow a low-protein, moderate-carbohydrate, moderate-fat diet

Answer B Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

A client is admitted to the hospital with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? "a. Select foods high in fat b. Increase intake of fluids, including juices. c. Eat a good supper when anorexia is not as severe. d. Eat less often, preferably only three large meals daily."

Answer B : Although no special diet is required to treat viral hepatitis, it is generally recommended that clients consume a low-fat diet because fat may be tolerated poorly because of decreased bile production. Small frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morining, so it is easier to eat a good breakfast. An adequated fluid intake of 2500 to 3000 mL/day that includes nutritional juices is also important.

27. In the immediate postoperative period, the nurse caring for a patient who is a recipient of a kidney transplant would expect that fluid therapy would involve administration of IV fluids a. to be determined hourly, based on every milliliter of urine output. b. at a minimum rate of 100 ml/hr to perfuse the kidney. c. titrated to keep blood pressure within a normal range. d. at a rate to keep urine clear and without blood clots.

Answer: A Rationale: Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. Fluid infusion rate is titrated rather than being at a set rate. Blood pressure and urine appearance are not the major parameters considered when titrating fluid infusion. Cognitive Level: Comprehension Text Reference: p. 1228 Nursing Process: Implementation NCLEX: Physiological Integrity

18. Before administration of calcitriol (Rocaltrol) to a patient with CKD, the nurse should check the laboratory value for a. serum phosphate. b. total cholesterol. c. creatinine. d. potassium.

Answer: A Rationale: If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcitriol should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not impact whether calcitriol should be administered. Cognitive Level: Application Text Reference: p. 1210 Nursing Process: Implementation NCLEX: Physiological Integrity

31. A patient with CKD brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required? a. Milk of magnesia 30 ml administered orally b. Oral acetaminophen (Tylenol) 650 mg c. Multivitamin with iron d. Calcium phosphate (PhosLo)

Answer: A Rationale: Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD. Cognitive Level: Application Text Reference: p. 1207 Nursing Process: Assessment NCLEX: Physiological Integrity

24. A patient with diabetes who has chronic kidney disease (CKD) is considering using continuous ambulatory peritoneal dialysis (CAPD). In discussing this treatment option with the patient, the nurse informs the patient that a. patients with diabetes who use CAPD have fewer dialysis-related complications than those on hemodialysis. b. home CAPD requires more extensive equipment than does home hemodialysis. c. CAPD is contraindicated for patients who might eventually want a kidney transplant. d. dietary restrictions are stricter for patients using CAPD than for those having hemodialysis.

Answer: A Rationale: Patients with diabetes have better control of blood pressure, less hemodynamic instability, and fewer problems with retinal hemorrhages when using peritoneal dialysis than when using hemodialysis. CAPD is less expensive and has fewer dietary restrictions than hemodialysis. CAPD is not a contraindication for a kidney transplant. Cognitive Level: Application Text Reference: p. 1220 Nursing Process: Implementation NCLEX: Physiological Integrity

17. The nurse has instructed a patient who is receiving hemodialysis about dietary management. Which diet choices by the patient indicate that the teaching has been successful? a. Scrambled eggs, English muffin, and apple juice b. Cheese sandwich, tomato soup, and cranberry juice c. Split-pea soup, whole-wheat toast, and nonfat milk d. Oatmeal with cream, half a banana, and herbal tea

Answer: A Rationale: Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate. Cognitive Level: Application Text Reference: pp. 1211-1212 Nursing Process: Evaluation NCLEX: Physiological Integrity

10. A patient with renal insufficiency is scheduled for an intravenous pyelogram (IVP). Which of the following orders for the patient will the nurse question? a. Ibuprofen (Advil) 400 mg PO PRN for pain b. Dulcolax suppository 4 hours before IVP procedure c. Normal saline 500 ml IV before procedure d. NPO for 6 hours before IVP procedure

Answer: A Rationale: The contrast dye used in IVPs is nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided. The suppository and NPO status are necessary to ensure that adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure. Cognitive Level: Application Text Reference: p. 1203 Nursing Process: Implementation NCLEX: Physiological Integrity

12. A patient is diagnosed with stage 3 CKD. The patient is treated with conservative management, including erythropoietin injections. After teaching the patient about management of CKD, the nurse determines teaching has been effective when the patient states, a. "I will measure my urinary output each day to help calculate the amount I can drink." b. "I need to take the erythropoietin to boost my immune system and help prevent infection." c. "I need to try to get more protein from dairy products." d. "I will try to increase my intake of fruits and vegetables."

Answer: A Rationale: The patient with CKD who is not receiving dialysis is generally taught to restrict fluids. The patient would need to measure urine output and then add 600 ml for insensible losses to calculate an appropriate oral intake. Erythropoietin is given to increase red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD. Cognitive Level: Application Text Reference: p. 1212 Nursing Process: Evaluation NCLEX: Health Promotion and Maintenance

21. In preparation for hemodialysis, a patient has an AV native fistula created in the left forearm. When caring for the fistula postoperatively, the nurse should a. check the fistula site for a bruit and thrill. b. assess the rate and quality of the left radial pulse. c. compare blood pressures in the left and right arms. d. irrigate the fistula site daily with low-dose heparin.

Answer: A Rationale: The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula. Cognitive Level: Comprehension Text Reference: p. 1221 Nursing Process: Implementation NCLEX: Physiological Integrity

"A patient with hepatitis A is in the acute phase. The nurse plans to care for the patient based on the knowledge that "A. pruritus is a common problem with jaundice in this phase. B. the patient is most likely to transmit the disease in this phase. C. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. D. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase.

Answer: A" The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

"During an admission assessment, the nurse notes a client with hepatitis exhibits all of the following signs or symptoms. Which one is not related to hepatitis? "A. Anorexia B. Bloody stools C. Dark urine D. Yellow sclera"

Answer: B "RATIONALE (A) Anorexia is an expected assessment finding with hepatitis. (B) Rectal bleeding is not related to hepatitis. Further assessment 358 Clinical Specialties: Content Reviews and Testsis needed to identify the cause. (C) Dark urine is an expected assessment finding with hepatitis and is a result of increased serum bilirubin being excreted by the kidneys. (D) Yellow sclera is a sign of jaundice and is an expected assessment finding with hepatitis. Jaundice is caused by increased serum bilirubin"

25. A patient who has been on continuous ambulatory peritoneal dialysis (CAPD) is hospitalized and is receiving CAPD with four exchanges a day. During the dialysate inflow, the patient complains of having abdominal pain and pain in the right shoulder. The nurse should a. massage the patient's abdomen and back. b. decrease the rate of dialysate infusion. c. stop the infusion and notify the health care provider. d. administer the PRN acetaminophen (Tylenol).

Answer: B Rationale: Abdominal pain and referred shoulder pain can be caused by a rapid infusion of dialysate; the nurse should slow the rate of the infusion. Massage and administration of acetaminophen (Tylenol) would not address the reason for the pain. There is no need to notify the health care provider. Cognitive Level: Application Text Reference: p. 1219 Nursing Process: Implementation NCLEX: Physiological Integrity

26. The nurse is assessing a patient who is receiving peritoneal dialysis with 2-L inflows. Which information should be reported immediately to the health care provider? a. The patient complains of feeling bloated after the inflow. b. The patient's peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient has an outflow volume of 1600 ml.

Answer: B Rationale: Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient. Cognitive Level: Application Text Reference: p. 1219 Nursing Process: Assessment NCLEX: Physiological Integrity

19. To determine glomerular filtration rate (GFR) for a patient with chronic kidney disease, the nurse will plan to a. schedule frequent blood urea nitrogen (BUN) tests. b. initiate a 24-hour collection of the patient's urine. c. check the specific gravity on serial urine specimens. d. use a bladder scanner to check for residual urine.

Answer: B Rationale: Creatinine clearance testing, the most accurate way to assess GFR, requires a 24-hour urine collection. BUN levels may increase for other reasons, such as dehydration, and are not as accurate in determining glomerular filtration. Urine-specific gravity testing and monitoring residual urine would not be useful in determining the GFR. Cognitive Level: Application Text Reference: p. 1206 Nursing Process: Planning NCLEX: Physiological Integrity

36. A patient complains of leg cramps during hemodialysis. The nurse should a. give acetaminophen (Tylenol). b. infuse a bolus of normal saline. c. massage the patient's legs. d. reposition the patient.

Answer: B Rationale: Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps. Cognitive Level: Application Text Reference: p. 1223 Nursing Process: Implementation NCLEX: Physiological Integrity

34. A patient receiving peritoneal dialysis using 2 L of dialysate per exchange has an outflow of 1200 ml. Which action should the nurse take first? a. Infuse 1200 ml of dialysate during the inflow. b. Assist the patient in changing position. c. Administer a laxative to the patient. d. Notify the health care provider about the outflow problem.

Answer: B Rationale: Outflow problems may occur because the peritoneal catheter is collapsed by a portion of the intestine, and repositioning the patient will move the catheter and allow outflow to occur. If less than the ordered 2 L of dialysate is infused, the dialysis will be less effective. Administration of a laxative may also help if the patient's colon is full, but this should be tried after repositioning the patient. If the problem with outflow persists after the patient is repositioned, the health care provider should be notified. Cognitive Level: Application Text Reference: p. 1219 Nursing Process: Implementation NCLEX: Physiological Integrity

2. A patient with acute renal failure (ARF) has an arterial blood pH of 7.30. The nurse will assess the patient for a. tachycardia. b. rapid respirations. c. poor skin turgor. d. vasodilation.

Answer: B Rationale: Patients with metabolic acidosis caused by ARF may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Tachycardia and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in ARF. Cognitive Level: Application Text Reference: pp. 1200-1201 Nursing Process: Assessment NCLEX: Physiological Integrity

9. After noting increasing QRS intervals in a patient with ARF, which action should the nurse take first? a. Notify the patient's health care provider. b. Check the chart for the most recent blood potassium level. c. Look at the patient's current BUN and creatinine levels. d. Document the QRS interval.

Answer: B Rationale: The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with ARF, but these would not directly affect the ECG. Documentation of the QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia. Cognitive Level: Application Text Reference: p. 1200 Nursing Process: Implementation NCLEX: Physiological Integrity

30. Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse? a. The blood glucose is 144 mg/dl. b. The patient has a round, moonlike face. c. There is a nontender lump in the axilla. d. The patient's blood pressure is 150/92.

Answer: C Rationale: A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The elevated glucose, moon face, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy. Cognitive Level: Application Text Reference: p. 1230 Nursing Process: Assessment NCLEX: Physiological Integrity

20. A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it a. can accommodate larger needles. b. increases patient mobility. c. is much less likely to clot. d. can be used sooner after surgery.

Answer: C Rationale: AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not impact on needle size or patient mobility. Cognitive Level: Application Text Reference: p. 1221 Nursing Process: Implementation NCLEX: Physiological Integrity

28. To monitor for corticosteroid-related complications after a kidney transplant, the nurse teaches the patient to report a. pain at the donor kidney site. b. dizziness with position change. c. pain in the hips, knees, and other joints. d. changes in the character of the urine.

Answer: C Rationale: Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Pain at the site, orthostatic dizziness, and changes in the urine appearance are not associated with corticosteroid use. Cognitive Level: Comprehension Text Reference: p. 1230 Nursing Process: Implementation NCLEX: Physiological Integrity

7. The health care provider orders IV glucose and insulin to be given to a patient in ARF whose serum potassium level is 6.3 mEq/L. To best evaluate the effectiveness of the medications, the nurse will a. monitor the patient's electrocardiograph (ECG). b. check the blood glucose level. c. obtain serum potassium levels. d. assess BUN and creatinine levels.

Answer: C Rationale: Changes in potassium will impact on the ECG and muscle strength, but the nurse should expect to recheck the serum potassium level during the infusion of glucose and insulin to determine the effectiveness of the therapy. The blood glucose level should be monitored during the infusion to assess for hypoglycemia or hyperglycemia. The BUN and creatinine levels will not change with administration of glucose and insulin. Cognitive Level: Application Text Reference: pp. 1201-1202 Nursing Process: Evaluation NCLEX: Physiological Integrity

8. A patient in ARF has a gradual increase in urinary output to 3400 ml a day with a BUN of 92 mg/dl (33 mmol/L) and a serum creatinine of 4.2 mg (371 μmol/L). The nurse should plan to a. use a urine dipstick to monitor for proteinuria. b. auscultate the lungs to assess for pulmonary edema. c. take the blood pressure to check for hypotension. d. draw blood to monitor for hyperkalemia.

Answer: C Rationale: During the diuretic phase of ARF, fluid and electrolyte losses may cause hypovolemia, hypotension, hyponatremia, and hypokalemia. Proteinuria, pulmonary edema, and hyperkalemia occur during the oliguric phase. Cognitive Level: Application Text Reference: p. 1201 Nursing Process: Planning NCLEX: Physiological Integrity

22. A patient begins hemodialysis after having had conservative management of chronic kidney disease. The nurse explains that one dietary regulation that will be changed when hemodialysis is started is that a. unlimited fluids are allowed since retained fluid is removed during dialysis. b. increased calories are needed because glucose is lost during hemodialysis. c. more protein will be allowed because of the removal of urea and creatinine by dialysis. d. dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.

Answer: C Rationale: Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is allowed. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes. Cognitive Level: Application Text Reference: p. 1211 Nursing Process: Implementation NCLEX: Physiological Integrity

16. Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess a. the BUN and creatinine. b. the blood glucose level. c. the patient's bowel sounds. d. the level of consciousness (LOC).

Answer: C Rationale: Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not impact on the nurse's decision to give the medication. Cognitive Level: Application Text Reference: pp. 1202, 1210 Nursing Process: Assessment NCLEX: Physiological Integrity

29. Two hours after a kidney transplant, the nurse obtains all these data when assessing the patient. Which information is most important to communicate to the health care provider? a. The BUN and creatinine levels are elevated. b. The urine output is 900 to 1100 ml/hr. c. The patient's central venous pressure (CVP) is decreased. d. The patient has level 8 (on a 10-point scale) incision pain when coughing.

Answer: C Rationale: The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant. Cognitive Level: Application Text Reference: p. 1228 Nursing Process: Assessment NCLEX: Physiological Integrity

35. A patient with acute renal failure (ARF) requires hemodialysis and temporary vascular access is obtained by placing a catheter in the left femoral vein. The nurse will plan to a. restrict the patient's oral protein intake. b. discontinue the retention catheter. c. place the patient on bed rest. d. start continuous pulse oximetry.

Answer: C Rationale: The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry. Cognitive Level: Application Text Reference: p. 1221 Nursing Process: Planning NCLEX: Physiological Integrity

1. A patient admitted with severe dehydration has a urine output of 380 ml over the next 24 hours and elevated blood urea nitrogen (BUN) and creatinine levels. A finding that the nurse would expect when reviewing the patient's urinalysis is a. proteinuria. b. bacteriuria. c. high specific gravity. d. tubular casts.

Answer: C Rationale: The patient's renal failure has been caused by the prerenal problem of hypovolemia. Prerenal oliguria is characterized by the ability of the kidneys to concentrate urine, resulting in a high urine specific gravity. The urinalysis in intrarenal failure would show proteins and tubular casts. Bacteriuria would be typical of a urinary tract infection (UTI), not renal failure. Cognitive Level: Application Text Reference: pp. 1198-1199 Nursing Process: Assessment NCLEX: Physiological Integrity

14. As the nurse reviews a diet plan with a patient with diabetes and renal insufficiency, the patient states that with diabetes and kidney failure there is nothing that is good to eat. The patient says, "I am going to eat what I want; I'm going to die anyway!" The best nursing diagnosis for this patient is a. imbalanced nutrition: more than required related to knowledge deficit about appropriate diet. b. risk for noncompliance related to feelings of anger. c. grieving related to actual and perceived losses. d. risk for ineffective health maintenance related to complexity of therapeutic regimen.

Answer: C Rationale: The patient's statements that there is nothing that is good to eat and that death is unavoidable indicate grieving about the losses being experienced as a result of the diabetes and chronic kidney disease (CKD). The patient data do not indicate knowledge deficit, anger, or the complexity of the therapeutic program as being issues for this patient. Cognitive Level: Application Text Reference: p. 1215 Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

13. A patient with CKD has a nursing diagnosis of disturbed sensory perception related to central nervous system changes induced by uremic toxins. An appropriate nursing intervention for this problem is to a. convey a caring attitude and foster the nurse-patient relationship. b. keep the patient on bed rest to avoid possible falls or other injuries. c. ensure restricted protein intake to prevent nitrogenous product accumulation. d. provide an opportunity for the patient to discuss concerns about the condition.

Answer: C Rationale: Uremia is caused by the products of protein breakdown, and protein restriction is used to decrease uremia. Because the primary cause of the patient's disturbed sensory perception is the uremia, conveying a caring attitude and providing opportunities for the patient to discuss concerns will not be as helpful as protein restriction. Although safety is a concern for the patient, bed rest is likely to promote weakness. The patient should be supervised when out of bed. Cognitive Level: Application Text Reference: p. 1211 Nursing Process: Implementation NCLEX: Physiological Integrity

6. A patient in the oliguric phase of acute renal failure has a 24-hour fluid output of 150 ml emesis and 250 ml urine. The nurse plans a fluid replacement for the following day of ___ ml. a. 400 b. 800 c. 1000 d. 1400

Answer: C Rationale: Usually fluid replacement should be based on the patient's measured output plus 600 ml/day for insensible losses. Cognitive Level: Application Text Reference: pp. 1201-1202 Nursing Process: Implementation NCLEX: Physiological Integrity

33. A new order for IV gentamicin (Garamycin) 60 mg BID is received for a patient with diabetes who has pneumonia. When evaluating for adverse effects of the medication, the nurse will plan to monitor the patient's a. blood glucose. b. serum potassium. c. BUN and creatinine. d. urine osmolality.

Answer: C Rationale: When a patient at risk for CKD receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in determining the effect of the gentamicin. Cognitive Level: Application Text Reference: p. 1213 Nursing Process: Evaluation NCLEX: Physiological Integrity

32. A patient with hypertension and stage 2 chronic kidney disease is receiving captopril (Capoten). Before administration of the medication, the nurse will check the patient's a. creatinine. b. glucose. c. phosphate. d. potassium.

Answer: D Rationale: Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention; therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not impact whether the captopril was given or not. Cognitive Level: Application Text Reference: p. 1210 Nursing Process: Assessment NCLEX: Physiological Integrity

15. The RN observes an LPN/LVN carrying out all these actions while caring for a patient with renal insufficiency. Which action requires the RN to intervene? a. The LPN/LVN carries a tray containing low-protein foods into the patient's room. b. The LPN/LVN assists the patient to ambulate in the hallway. c. The LPN/LVN administers erythropoietin subcutaneously. d. The LPN/LVN gives the iron supplement and phosphate binder with lunch.

Answer: D Rationale: Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency. Cognitive Level: Application Text Reference: p. 1211 Nursing Process: Implementation NCLEX: Psychosocial Integrity

5. A patient admitted with sepsis has had several episodes of severe hypotension. Laboratory results indicate a BUN 50 mg/dl (10.7 mmol/L), serum creatinine 2.0 mg/dl (177 µmol/L), urine sodium 70 mEq/L (70 mmol/L), urine specific gravity 1.010, and cellular casts and debris in the urine. The nurse knows these findings are consistent with a. chronic renal insufficiency. b. prerenal failure. c. postrenal failure. d. acute tubular necrosis.

Answer: D Rationale: The specific gravity and presence of casts and debris in the urinalysis suggest intrarenal failure and acute tubular necrosis. The sudden onset indicates that the renal failure is acute, not chronic. In prerenal failure, there would not be casts or debris in the urine. The patient does not have risk factors for postrenal failure. Cognitive Level: Application Text Reference: pp. 1198-1199 Nursing Process: Assessment NCLEX: Physiological Integrity

"The school nurse is discussing ways to prevent an outbreak of hepatitis A with a groupof high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? 1. Do not allow students to eat or drink after each other 2. Drink bottled water as much as possible. 3. Encourage protected sexual activity. 4. Throughly wash hands.

Answer= 4 1. Eating after each other should be discouraged but it is not the most important intervention. 2. only bottle water should be consumed in Third World countries, but that precaution is not necessary in American high schools. 3. Hepatitis B and C, not hepatitis A, are transmitted by sexual acvitity. 4. Hepatitis A is transmitted via the fecal-oral route. Good hand washing helps to prevent its spread.

Which of the following is considered an isotonic solution? a) 3% NaCl b) 0.9% normal saline c) Dextran in NS d) 0.45% normal saline

B) 0.9% Normal Saline An isotonic solution is 0.9% normal saline (NaCl). Dextran in NS is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.

Below which serum sodium level may convulsions or coma can occur? a) 140 mEq/L b) 135 mEq/L c) 142 mEq/L d) 145 mEq/L

B) 135 mEq/L Normal serum concentration level ranges from 135 to 145 mEq/L. When the level dips below 135 mEq/L, there is hyponatremia. Manifestations of hyponatremia include mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and personality changes. Convulsions or coma can occur if the deficit is severe. Values of 140, 142, and 145 mEq/L are within the normal range.

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? a) Alkaline b) Acidic c) Basic d) Neutral

B) Acidic Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.

A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond? a) Renin-angiotensin-aldosterone system b) Bicarbonate-carbonic acid buffer system c) Sodium-potassium pump d) ADH-ANP buffer system

B) Bicarbonate-carbonic acid buffer system The major chemical regulator of plasma pH is the bicarbonate-carbonic acid buffer system. Therefore options A and C are incorrect. Option D does not exist, it is only a distractor for this question.

The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include? a) Hematuria b) Change in cognitive functioning c) Back pain d) Incontinence

B) Change in cognitive functioning The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? a) Hypovolemia b) Dehydration c) Hypervolemia d) Fluid volume excess

B) Dehydration The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances. Therefore, options A, C, and D are incorrect.

A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have lead to the low specific gravity of urine? a) Repeated diarrhea b) Excess fluid intake c) Frequent vomiting d) Urine retention

B) Excessive fluid intake Excess fluid intake results in low specific gravity of urine. Excessive fluid intake will result in formation of dilute urine. When the urine is diluted, it results in low specific gravity of urine. Frequent vomiting, repeated diarrhea, and urine retention will result in high specific gravity of urine.

The nurse is caring for a client who is exhibiting symptoms of tachypnea and circumoral paresthesias. What should be the nurse's first course of action? a) Stop mechanical ventilation. b) Find and correct the cause of tachypnea. c) Administer cardiopulmonary resuscitation (CPR). d) Give a dose of aspirin.

B) Find and correct the cause of tachypnea Tachypnea or rapid breathing may result from various reasons including acute anxiety, high fever, thyrotoxicosis, early salicylate poisoning, hypoxemia, or mechanical ventilation. The rapid breathing expels more CO2 than necessary. This causes a deficit in carbonic acid, leading to respiratory alkalosis. Circumoral paresthesia is one of the symptoms. The first course of action is to detect and treat the cause of tachypnea. The nurse has to maintain mechanical ventilation if the client is dependent on it. CPR administration is required only if the client's condition needs it. Aspirin is not advised as early aspirin poisoning may be a cause of the tachypnea.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? a) "Be aware that your urine will be cherry-red for 5 to 7 days." b) "Increase your fluid intake to 2 to 3 L per day." c) "Apply an antibacterial dressing to the incision daily." d) "Take your temperature every 4 hours."

B) Increase your fluid intake to 2 to 3 L per day The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? a) Give medications that promote fluid retention. b) Limit sodium and water intake. c) Teach client behaviors that decrease urination. d) Assess for dehydration.

B) Limit sodium and water intake Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? a) Metabolic alkalosis b) Metabolic acidosis c) Respiratory acidosis d) Respiratory alkalosis

B) Metabolic acidosis This client's pH value is below normal, indicating acidosis. The HCO3- value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis.

A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client? a) No, start with the sodium chloride IV. b) No, sodium intake should be restricted. c) Yes, this will correct the sodium deficit. d) Yes, along with the hypotonic IV.

B) No, sodium intake should be restricted The symptoms and the high level of serum sodium suggest hypernatremia, (excess of sodium). It is necessary to restrict sodium intake. Salt tablets and sodium chloride IV can only worsen this condition but may be required in hyponatremia (sodium deficit). Hypotonic solution IV may be a part of the treatment but not along with the salt tablets.

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? a) Metabolic acidosis b) Respiratory alkalosis c) Metabolic alkalosis d) Respiratory acidosis

B) Respiratory Alkalosis Respiratory alkalosis results from alveolar hyperventilation. It's marked by a decrease in PaCO2 to less than 35 mm Hg and an increase in blood pH over 7.45. Metabolic acidosis is marked by a decrease in HCO3? to less than 22 mEq/L, and a decrease in blood pH to less than 7.35. In respiratory acidosis, the pH is less than 7.35 and the PaCO2 is greater than 45 mm Hg. In metabolic alkalosis, the HCO3? is greater than 26 mEq/L and the pH is greater than 7.45.

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? a) Bradycardia b) Tachycardia c) Increased urine output d) Vasodilation

B) Tachycardia Fluid volume deficit, or hypovolemia, occurs when the loss of extracellular fluid exceeds the intake of fluid. Clinical signs include oliguia, rapid heart rate, vasoconstriction, cool and clammy skin, and muscle weakness. The nurse monitors for rapid, weak pulse and orthostatic hypotension.

The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with: a) Urethritis b) Ureteral colic c) Interstitial cystitis d) Acute prostatitis

B) Ureteral colic

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: a) delayed ejaculation. b) hematuria. c) impotence. d) renal calculi.

B) hematuria Intravesical instillation of BCG commonly causes hematuria. Other common adverse effects of BCG include urinary frequency and dysuria. Less commonly, BCG causes cystitis, urinary urgency, urinary incontinence, urinary tract infection, abdominal cramps or pain, decreased bladder capacity, tissue in urine, local infection, renal toxicity, and genital pain. BCG isn't associated with renal calculi, delayed ejaculation, or impotence.

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? a) pH, 7.25; PaCO2 50 mm Hg b) pH, 7.35; PaCO2 40 mm Hg c) pH, 7.40; PaCO2 35 mm Hg d) pH, 7.5; PaCO2 30 mm Hg

B) oh, 7.25; PaCO2 50 mm Hg In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 7.5 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. A ph value of 7.40 with a PaCO2 value of 35 mm Hg and a pH value of 7.35 with a PaCO2 value of 40 mm Hg represent normal ABG values, reflecting normal gas exchange in the lungs.

A patient with Hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to : A.) avoid alcohol for the first 3 weeks B.) use a condom during sexual intercourse C.) have family members get an injection of immunoglobulin D.) follow a low-protein, moderate carbohydrate, moderate fat diet.

B.) use a condom during sexual intercourse Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

After a renal biopsy, the client complains of pain at the biopsy site, which radiates to the front of the abdomen. Based on this complaint, the nurse further monitors the client for:

Bleeding

Pre-Renal Failure Causes

Blood can't get to the kidney; poor renal perfusion -hypotension -decreased heart rate -hypovolemic -any form of shock

A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. The nurse monitors the client for signs of transurethral resection (TUR) syndrome, including:

Bradycardia and confusion

The nurse instructs a patient who takes an angiotensin-converting enzyme (ACE) inhibitor to avoid foods that are good sources of potassium, but the patient continues to exhibit a high serum potassium level with normal renal function. Which diuretic should the nurse administer to help prevent adverse effects of hyperkalemia for this patient?

Bumetanide (Bumex) The nurse wants to administer a diuretic that aids the excretion of potassium, because this will help diminish the patient's tendency to retain potassium. Therefore the nurse wants to administer a loop diuretic, such as bumetanide, because these agents induce excretion of potassium along with sodium and water. Aldosterone, a hormone secreted from the adrenal cortex, induces sodium retention and potassium excretion. Spironolactone blocks the action of aldosterone, leading to sodium loss and potassium retention. Mannitol is an osmotic diuretic that has a minor effect on serum electrolytes; it will not help reduce the patient's serum potassium level. Amiloride and spironolactone are contraindicated because although they induct the excretion of sodium effectively, they also induce the retention of potassium.

The normal serum value for potassium is a) 96 to 106 mEq/L. b) 135 to 145 mEq/L. c) 3.5 to 5.5 mEq/L. d) 8.5 to 10.5 mg/dL.

C) 3.5-5.5 mEq/L Serum potassium must be within normal limits to prevent cardiac dysrhythmia. Normal serum sodium is 135 to 145 mEq/L. Normal serum chloride is 96 to 106 mEq/L. Normal total serum calcium is 8.5 to 10

A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client? a) "Have you any artificial joints?" b) "Do you have a pacemaker?" c) "Do you have any allergies?" d) "Who has come with you today?"

C) Do you have any allergies? Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.

An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? a) Hypophosphatemia b) Hypernatremia c) Hypokalemia d) Hyperkalemia

C) Hypokalemia Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a defict in total potassium stores. Potassium-losing diuretics, such as loop diuretics, can induce hypokalemia.

Which of the following is a factor contributing to UTI in older adults? a) Low incidence of chronic illness b) Sporadic use of antimicrobial agents c) Immunocompromise d) Active lifestyle

C) Immunocompromise Factors that contribute to urinary tract infection in older adults include immunocompromise, high incidence of chronic illness, immobility, and frequent use of antimicrobial agents.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? a) Nausea or vomiting b) Hallucinations or tinnitus c) Light-headedness or paresthesia d) Abdominal pain or diarrhea

C) Light-headedness or paresthesia The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic alkalosis d) Metabolic acidosis

C) Metabolic Alkalosis A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: a) diaphoresis. b) tremors. c) muscle weakness. d) constipation.

C) Muscle weakness Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client? a) Clean intermittent catheterization b) Suprapubic cystostomy tube c) Permanent drainage with a urethral catheter d) Credé voiding procedure

C) Permanent drainage with a urethral catheter Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones, renal diseases, bladder infections, and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream. Clean intermittent catheterization has the fewest complications and is the preferred treatment for urinary retention. The Credé voiding procedure is used in the case of clients who have lost control over their nervous systems, secondary to injury or disease.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Impaired urinary elimination b) Toileting self-care deficit c) Risk for infection d) Activity intolerance

C) Risk for infection Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a) a decreased serum phosphate level secondary to kidney failure. b) an increased serum calcium level secondary to kidney failure. c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. d) metabolic alkalosis secondary to retention of hydrogen ions.

C) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

"The client is admitted to the hospital with viral hepatitis, complaining of ""no appetite"" and ""losing my taste for food."" What instruction should the nurse give the client to provide adequate nutrition? "1. Select foods high in fat 2. Increase intake of fluids, including juices 3. Eat a good supper when anorexia is not as severe 4. Eat less often, preferbly only three large meals daily"

Correct 2: Rationale: Although no specific diet is required to treat viral hepatitis, it is recommended tht clients consume a low-fat diet because fat may be poorly tolerated because of decreased bile production. Small frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 mL/day that includes nutritional juices is also important.

A 40-year-old woman has been diagnosed with hepatitis A and asks the nurse if other members of her family are at risk for ""catching"" the disease. The nurse's response should be based on the understanding that hepatitis A is transmitted primarily:" "1. during sexual intercourse 2. by contact with infected body secretions. 3. through fecal contamination of food or water. 4. through kissing that involves contact with mucous membranes."

Correct 3: "Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important to prevent the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important to decrease transmission.

A client is admitted with ongoing symptoms of the flu. There are not other obvious signs of illness. This client should be tested for hepatitis because... "A. She could have anicteric hepatitis, which means no jaundice B. She has an allergy to shellfish C. She has a blood pressure of 90/50 D. She was living with a roommate who had similar symptoms"

Correct A Rationale: A. Only about 25% percent of people with aute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised her liver function that is overlooked due to lack of jaundice.

Which of the following should be assessed in an elderly patient with age-related renal dysfunction? 1. evidence of medication or drug toxicity 2. recreational activities 3. activity status 4. daily meal pattern

Correct Answer: 1 Rationale: With age-related changes in kidney function, there is a decrease in glomerular filtration rate (GFR). This can lead to a decrease in the clearance of drugs, primarily through the kidneys. The nurse should assess this patient for drug toxicity. Recreational activities, activity status, and meal patterns may or may not be affected.

"A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that "a. pruritus is a common problem with jaundice in this phase. b. the patient is most likely to transmit the disease during this phase. c. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase.

Correct A Rationale: The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

"A college student is required to be inoculated for hepatitis before beginning college. The nurse realizes that this client will be inoculated to prevent the development of... A: Hepatitis B B: Hepatitis C C: Hepatitis E D: Hepatitis D"

Correct A: Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.

"The nurse is caring for a pt. in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the pt. complains of pain in the right lower quadrant. The nurse will document this as which of the following signs of appendicitis? A. Rovsing sign B. Referred pain C. Chvostek's sign D. Rebound tenderness"

Correct Answer A In patients with suspected appendicitis, Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.

The nurse is providing preoperative teaching for a patient scheduled for a cystogram. The nurse knows follow-up is needed when the patient states, "After the procedure, I need to contact my primary healthcare provider if I experience 1. bloody urine." 2. low urine output." 3. abdominal pain." 4. chills or fever."

Correct Answer: 1 Rationale: Some blood is expected in the urine following the procedure. The nurse should provide more information regarding the monitoring of blood in the urine. The nurse should instruct the patient to immediately notify the physician if the urine remains bloody for more than three voidings after the procedure, or if bright bleeding develops. Low urine output, abdominal or flank pain, chills, or fever do not identify blood in the urine although these complications can occur.

A nurse is developing a postoperative plan of care for a patient who is scheduled to have a cystogram. Which of these outcomes should receive priority in the plan? The patient will be free from signs and symptoms of which of the following? 1. hemorrhage 2. bladder perforation 3. urinary retention 4. postprocedure pain

Correct Answer: 1 Rationale 1: Using the ABCs to prioritize patients' needs, hemorrhage relates to circulation and is a priority concern over bladder perforation, urinary retention, and postoperative pain, though all are important.

A nurse is advising a nursing student who is preparing a teaching presentation for fellow students regarding urinalysis. Which of these teaching points, if made by the student, requires intervention by the nurse? 1. Urine culture 150,000 organisms/mL. Female patients should separate the labia with one hand and clean the labia with the other, using sterile cotton swabs saturated with a cleansing solution, wiping back to front. 2. serum creatinine 1.20 mg/dL. 3. urine osmolality 400 mOsm/kg H2O. 4. blood urea nitrogen (BUN) 30 mg/dL.

Correct Answer: 1 Rationale 2: The other test results are within normal range. Rationale 3: The other test results are within normal range. Rationale 4: The other test results are within normal range.

The nurse is caring for a patient who states, "My urine has a red-tinged appearance." Which of these questions would be the most important for the nurse to ask this patient? 1. "What medications do you take?" 2. "Are you allergic to any food or drugs?" 3. "Do you wake up at night to void?" 4. "How many times a day do you usually void?" 5. "What medications do you take?"

Correct Answer: 1 Rationale: "What medications do you take?" is correct because several common medications can cause the urine to become red-tinged. Red-tinged urine that occurs in the absence of medications can indicate hematuria, and will need further investigation. Red-tinged urine is not related to allergies. "Do you wake up at night to void?" and "How many times a day do you usually void?" are both incorrect because these questions will elicit data regarding frequency of urination, not red-tinged urine.

Which of these outcomes would be most appropriate for a nurse to establish with a patient who has just voided and who is scheduled to have a portable ultrasonic bladder scan immediatly? The scan will indicate which of the following? 1. less than 100 mL of urine in the bladder 2. between 100 and 150 mL of urine in the bladder 3. between 150 and 200 mL of urine in the bladder 4. more than 200 mL of urine in the bladder

Correct Answer: 1 Rationale: A normal ultrasonic bladder scan finding is less than 100 mL for a residual voiding.

A nurse is teaching a nursing student about the effects of a sustained drop in systemic blood pressure on the juxtaglomerular cells of the distal tubules in the kidneys. The nurse knows teaching has been effective when the student states, "This juxtaglomerular cell response to low blood pressure is utilized with the medication 1. captopril (Capoten)." 2. digoxin (Lanoxin)." 3. furosemide (Lasix)." 4. adenosine (Adenocard)."

Correct Answer: 1 Rationale: A sustained drop in systemic blood pressure triggers the juxtaglomerular cells to release renin. Renin acts on a plasma globulin, angiotensinogen, to release angiotensin I, which is in turn converted to angiotensin II. As a vasoconstrictor, angiotensin II activates vascular smooth muscle throughout the body, causing systemic blood pressure to rise. Captopril (Capoten) is an ACE inhibitor, which blocks the conversion of angiotensin I to the vasodilator angiotensin II. The other drugs are not ACE inhibitors.

A male patient has a history of calcium calculi. Which of the following medications can be prescribed to help this patient? 1. furosemide (Lasix) 2. penicillin (Pentids) 3. allopurinol (Alloprim) 4. NSAIDs

Correct Answer: 1 Rationale: A thiazide diuretic, which is frequently prescribed for calcium calculi, acts to reduce urinary calcium excretion and is very effective in preventing further stones. Furosemide (Lasix) is a thiazide diuretic. Penicillin (Pentids) is an antimicrobial. Allopurinol (Alloprim) is used to reduce serum levels of uric acid. NSAIDs (nonsteroidal anti-inflammatory drugs) are used to reduce pain and fever. Neither penicillin, allopurinol, nor NSAIDs would influence the formation of calcium stones.

A nurse is reviewing laboratory data for a patient who had a voiding cystogram that revealed an urge to void at 100 mL. Which of these nursing diagnoses should receive priority for this patient? 1. Risk for Urge Urinary Incontinence 2. Risk for Impaired Skin Integrity 3. Self-Care Deficit 4. Risk for Urinary Retention

Correct Answer: 1 Rationale: A voiding cystogram is conducted to evaluate bladder capacity and neuromuscular functions of the bladder, urethral pressures, and causes of bladder dysfunction. A measured quantity of fluid is instilled into the bladder, and the filling capacity and voiding pressures are measured. Normal values: urine stream strong and uninterrupted, normal filling pattern, and sensation of fullness; bladder capacity: 300-600 mL; urge to void: >150 mL; fullness felt: 300 mL. A patient who has a sensation of an urge to void at 100 mL is at greatest Risk for Urge Urinary Incontinence. Risk for Impaired Skin Integrity, Self-Care Deficit, and Risk for Urinary Retention would not be appropriate diagnoses for the patient with these test results.

A male patient needs to increase the acidity of his urine. Which foods should this patient increase in his diet? 1. cranberries, grapes, and tomatoes 2. sardines and herring 3. green vegetables and oranges 4. beans, chocolate, and dairy products

Correct Answer: 1 Rationale: Acidifying foods include cheese, cranberries, eggs, grapes, meat and poultry, plums and prunes, tomatoes, and whole grains. Sardines, herrings, oranges, green vegetables, beans, chocolate, and dairy products tend to have an alkaline influence on the urine.

The nurse recognizes that the risk for dehydration in the elderly increases significantly due to which age-related change in renal function? 1. the decreased ability of the kidney to concentrate urine 2. hypoplasia 3. the presence of renal cysts 4. the reduced clearance of drugs excreted by the kidney

Correct Answer: 1 Rationale: Age-related changes in the kidney include the decreased ability to concentrate urine and compensate for increased or decreased salt intake. When this is combined with diminished effectiveness of antidiuretic hormone (ADH) and a reduced thirst response, both age-related, the elderly patient's risk for dehydration increases. Hypoplasia is a congenital renal disorder; renal cysts are hereditary. Decreased glomerular filtration rate (GFR) which is an age-related change in renal function results in reduced clearance of drugs excreted through the kidneys.

When assessing a patient who is scheduled to have a CT scan of the kidneys, which of these findings would prompt the nurse to notify the primary healthcare provider? 1. allergy to iodine and seafood 2. . urinary output of 1,200 mL in 24 hours 3. last bowel movement one day ago 4. height 5'8" and weight 160 pounds

Correct Answer: 1 Rationale: Allergy to iodine and seafood is correct because a CT scan of the kidneys requires the injection of a radiopaque dye that contains iodine. A patient who is allergic to iodine or seafood will be unable to have this test. Urinary output of 1,200 mL in 24 hours, last bowel movement one day ago, and height 5'8" and weight 160 pounds are all incorrect because these are all normal findings, and therefore do not require that the physician be notified.

An 80-year-old female patient says to the nurse, "I can't hold my water very well so I don't leave the house much." Which of the following is an appropriate nursing response? 1. "This is not something you have to live with. Talk with your doctor about this problem." 2. "I understand." 3. "I guess it's hard getting older." 4. "Do you get enjoyment out of watching television?"

Correct Answer: 1 Rationale: Although urinary incontinence rarely causes serious physical effects, it frequently has significant psychosocial effects, and can lead to lowered self-esteem, social isolation, and even institutionalization. Inform all patients that urinary incontinence is not a normal consequence of aging and that treatments are available. The nurse must give a response that addresses the problem while being empathetic. Asking the patient about his or her television viewing has no relevance.

A patient with an indwelling urinary catheter is demonstrating signs of asymptomatic bacteriuria. Which of the following would be the best course of action for this patient? 1. Remove the catheter and begin antibiotic therapy. 2. Begin intravenous antibiotic therapy. 3. Begin oral antibiotic therapy for three days. 4. Remove the catheter and monitor for continued signs of bacteriuria.

Correct Answer: 1 Rationale: Antibiotics and urinary anti-infectives are not generally recommended to treat asymptomatic bacteriuria in catheterized patients. The preferred treatment for catheter-associated urinary tract infections (UTIs) is to remove the indwelling catheter, than administer a 10 to 14 day course of oral antibiotic therapy to eliminate the infection. Removing the catheter without the initiation of antibiotic therapy would not solve the problem. The infection could worsen.

The nurse observes no change in urine output and a distended bladder in a patient with an indwelling urinary catheter and drainage system. The immediate nursing intervention is to do which of the following? 1. Assess the catheter tubing for kinks and position so drainage is maintained by gravity. 2. Notify the physician. 3. Flush the catheter with sterile saline using a large syringe. 4. Change the catheter.

Correct Answer: 1 Rationale: Assess and maintain patency and integrity of all catheter systems. A kinked catheter may damage the urinary system. Notifying the physician is not an immediate intervention. Flushing and changing a catheter increases the risk of infection.

A nursing student is assessing a patient who is reporting constant dull pain over the lower abdomen. The student inspects, palpates, and auscultates the patient's abdomen. After leaving the patient's room the nurse tells the student, "Your assessment findings may not be accurate because you 1. palpated prior to auscultating." 2. inspected prior to palpating." 3. inspected prior to auscultating." 4. auscultated after inspecting."

Correct Answer: 1 Rationale: Auscultate immediately after inspection because percussion or palpation may increase bowel motility and interfere with sound transmission during auscultation.

A patient with polycystic kidney disease is planning to be married and asks the nurse if his children could inherit this disorder. What is the nurse's best response? 1. "Yes, this condition can be inherited." 2. "Yes, but this condition is so rare that you shouldn't worry about it." 3. "No, polycystic kidney disease occurs because of spontaneous mutations." 4. "You should ask your fiancée to come with you to your next office visit so we can discuss this."

Correct Answer: 1 Rationale: Autosomal dominant polycystic kidney disease is relatively common, affecting 1 in every 300 to 1000 people and accounts for 4% of ESRD in the U. S. Approximately 90% of cases are inherited as an autosomal dominant trait and the remaining 10% are due to spontaneous mutations. Option 2 gives false reassurance and Option 4 is inappropriate because the nurse does not respond to the patient's question.

A patient who is recovering from acute renal failure is being discharged. Which of the following should the nurse include in this patient's instructions? 1. Avoid alcohol consumption. 2. Use over-the-counter medications as needed. 3. Instruct to weigh self at least once a week. 4. Resume a normal diet.

Correct Answer: 1 Rationale: Because alcohol can increase the nephrotoxicity of some drugs, discourage alcohol ingestion. Additional teaching includes avoiding exposure to nephrotoxins, particularly those found in over-the-counter products, preventing infection and other major stressors that can slow healing, monitoring weight, blood pressure and pulse, manifestations of relapse, continuing dietary restrictions and knowing when to contact the physician.

A middle-aged male patient comes into the clinic for "frequency" and voiding "small amounts of urine at a time." The nurse realizes that this patient might be experiencing symptoms of which of the following? 1. benign prostatic hypertrophy (BPH) 2. cystitis 3. renal calculi 4. bladder cancer

Correct Answer: 1 Rationale: Benign prostatic hypertrophy (BPH) is a common cause of urinary retention; difficulty initiating and maintaining urine flow is often the presenting complaint in men with BPH. Cystitis symptoms may include frequency but would be coupled with burning, pain during urination, and hematuria. Renal calculi would likely cause flank pain. Bladder cancer symptoms would include hematuria.

During the health history interview of a patient diagnosed with postoperative urinary retention, the nurse asks if the patient is taking what medication to stimulate micturition? 1. bethanechol (Urecholine) 2. tolterodine (Detrol) 3. propantheline bromide (Pro-Banthine) 4. nitrofurantoin (Macrobid)

Correct Answer: 1 Rationale: Bethanechol (Urecholine) increases detrusor muscle tone producing a contraction strong enough to initiate micturition. It is primarily used to treat postoperative and postpartum urinary retention. Tolterodine and propantheline are used to treat spastic bladder; nitrofurantoin is a urinary anti-infective medication.

When preparing a patient for an intravenous pyelogram (IVP), the nurse reviews diagnostic data, noting all of the following. Which of these findings requires notification of the physician before proceeding with the test? 1. blood urea nitrogen (BUN) 55 mg/dLdl 2. serum creatinine 1.3 mg/dL 3. urine culture <10,000 organisms/mL 4. residual urine of 80 mL

Correct Answer: 1 Rationale: Blood urea nitrogen (BUN) 55 mg/dL is correct because this level is elevated, indicating that there might be a problem of renal function. The physician will need to be notified because an IVP involves the injection of dye that must eventually cleared by the kidney, and if there is already compromised renal function, the test may not be administered. Serum creatinine 1.3 mg/dL, urine culture <10,000 organisms/mL, and residual urine of 80 mL are all incorrect because these values are all within the normal range, and therefore will not require physician notification

A patient is diagnosed with chronic pyelonephritis. The nurse realizes that this patient is prone to developing which of the following? 1. chronic renal failure 2. cystitis 3. acute renal failure 4. renal calculi

Correct Answer: 1 Rationale: Chronic pyelonephritis involves chronic inflammation and scarring of the tubules and interstitial tissues of the kidney. It is a common cause of chronic renal failure. Cystitis may cause acute pyelonephritis and acute renal failure. Renal calculi are generally caused by dietary intake and not by chronic pyelonephritis.

An elderly patient is scheduled for a CT scan with and without contrast dye. Which of the following should be done prior to this CT scan? 1. Monitor renal function. 2. Assess for level of responsiveness. 3. Assess vital signs. 4. Keep the patient n.p.o.

Correct Answer: 1 Rationale: Common nephrotoxins associated with acute tubular necrosis include the aminoglycoside antibiotics and radiologic contrast media. Many other drugs, heavy metals such as mercury and gold, and some common chemicals such as ethylene glycol (antifreeze) are also potentially toxic. The risk for acute tubular necrosis is higher when nephrotoxic drugs are given to older patients or patients with preexisting renal insufficiency, and when used in combination with other nephrotoxins. Dehydration increases the risk by increasing the toxin concentration in nephrons. Monitoring responsiveness and vital signs are important, but do not address the specific risks of this examination. The specific location of the body for the CT scan is not indicated, therefore, it is not known if the patient would need to be kept n.p.o prior to the test.

All of the following diagnostic tests are ordered for a patient with renal disease. The nurse understands that which one of the following will be used in the evaluation of the patient's glomerular filtration rate (GFR)? 1. creatinine clearance 2. blood urea nitrogen (BUN) 3. intravenous pyelogram (IVP) 4. renal ultrasound

Correct Answer: 1 Rationale: Creatinine clearance is correct because this study (a 24-hour urine) measures the ability of the kidney to clear a given amount of creatinine out of the plasma within a given time period. Creatinine is a substance produced from the breakdown of muscle and is cleared by the kidney at a constant rate. This test is used to determine the glomerular filtration rate or the ability of the kidney to clear substances out of the plasma. Blood urea nitrogen (BUN) measures the amount of urea in the plasma and, although it is reflective of kidney function, it can be affected by both protein intake and fluid balance. Intravenous pyelogram (IVP) identifies the structures of the urinary system, not the function. Renal ultrasound identifies renal or perirenal masses or obstructions.

An elderly patient is admitted to the hospital with cardiac complications associated with diabetes. What should be of concern to the nurse regarding this patient's medications? 1. the type and amount of medications in relation to the patient's renal function 2. if the patient taking the prescribed dosages 3. what vitamins and supplements this patient is taking 4. the costs of the patient's medications

Correct Answer: 1 Rationale: Decreased glomerular filtration rate (GFR) in the older adult also reduces the clearance of drugs excreted through the kidneys. This reduced clearance prolongs the half-life of drugs and may necessitate lower drug doses and longer dosing intervals. Common medications affected by decreased GFR include cardiac medications and anti-diabetic agents. Assessing the patient's compliance with the prescribed dose is important in any circumstance but is not specific to this scenario. Use of vitamin supplements should be assessed, but is not specific to the situation described. The nurse might suspect noncompliance if the cost of medications is an issue.

A patient is scheduled for a lithotripsy for renal calculi. The purpose of a bowel preparation prior to this procedure is to do which of the following? 1. Ensure maximum visualization of the kidney and the stones. 2. Ensure that there is no evidence of constipation prior to the procedure. 3. Increase comfort. 4. Reduce postoperative pain.

Correct Answer: 1 Rationale: Fecal material in the bowel may impede fluoroscopic visualization of the kidney and stone. Constipation prior to the procedure has no bearing on the procedure if bowel preparation is completed. Bowel preparation would not contribute to patient comfort or reducing postoperative pain.

A patient is discharged after photocoagulation for a bladder papilloma. Instructions for this patient including making an appointment for follow-up 1. in three months. 2. in one year. 3. in three years. 4. if symptoms return.

Correct Answer: 1 Rationale: Following cystoscopic tumor resection, patients are followed at three-month intervals for tumor recurrence. A follow-up appointment would be needed to evaluate and for concerns or issues. Follow-up needs to be timely and one or three years would be too long. The patient would be encouraged to make a follow-up appointment at any time if the symptoms occur, no matter what the timeframe. Recurrences may develop anywhere in the urinary tract, including the renal pelvis, ureter, or urethra.

A patient who is recovering from spinal surgery had "an accident" while attempting to reach the bathroom to void. The type of incontinence this patient most likely experienced is which of the following? 1. functional 2. urge 3. stress 4. total

Correct Answer: 1 Rationale: Functional incontinence results from physical, environmental, or psychosocial causes. Impaired mobility is one such cause. Urge incontinence occurs when the patient must void immediately when the urge is perceived. Stress incontinence is the result of coughing or laughing. Total incontinence is loss of all voluntary control over urination and urine loss occurs without stimulus and in all positions.

A patient states, "I have a family history of both type 1 and type 2 diabetes mellitus. Before I decide to have children, I am going to speak with a healthcare professional who specializes in working with people with health problems that are passed from parent to child." Which of these statements would be the most appropriate for the nurse to record in the patient's medical record? "The patient has a future plan to discuss concerns about familial tendency for diabetes with 1. a genetic counselor." 2. a home health nurse." 3. an obstetrician." 4. a physical therapist."

Correct Answer: 1 Rationale: Genetic counselors specialize in working with families who have diseases associated with heredity. The other options are incorrect.

The nurse, teaching a patient about the concept of hemodialysis, would include that dialysis is a process that 1. moves blood through a semipermeable membrane into a dialyzer that is used to remove waste products as well as correct fluid and electrolyte imbalances. 2. allows a choice of either diffusion osmosis or ultrafiltration to remove excess water from the body. 3. increases potassium and calcium to the blood when passing through the dialyzer and works on the principle of diffusion. 4. will add electrolytes and water to the blood when passing through a semipermeable membrane to correct electrolyte imbalances.

Correct Answer: 1 Rationale: Hemodialysis uses the principles of diffusion and ultrafiltration to remove electrolytes, waste products, and excess water from the body. Blood is taken from the patient and pumped into the dialyzer where a semipermeable membrane allows small molecules to pass through. The direction of movement across the membrane is determined by the concentration of that product in the blood and the dialysate. Calcium can be added to dialysate to replace depleted body stores.

A patient with acute renal failure (ARF) is prescribed furosemide (Lasix). The nurse realizes that this medication will be helpful to the patient because it will do which of the following? 1. reduce edema 2. keep sodium in the body 3. preserve protein 4. be the gentlest diuretic to use

Correct Answer: 1 Rationale: If restoration of renal blood flow does not improve urinary output, a potent loop diuretic such as furosemide or an osmotic diuretic such as mannitol (Osmitrol) may be given with intravenous fluids. If nephrotoxins are present, the combination of fluids and diuretic may, in effect, "wash out" the nephrons and reduce toxin concentration. Second, establishing urine output may prevent oliguria, and reduce the degree of azotemia and fluid and electrolyte imbalances. Furosemide may also be used to manage salt and water retention associated with ARF as it helps to eliminate sodium. It does not preserve protein. Medications are not typically prescribed by their "gentleness." Each patient's response to a medication can be unique.

A nurse is caring for a patient who asks the nurse why females are more likely than males to contract bladder infections. The nurse knows teaching has been effective when the patient identifies which of the following as a female risk factor for bladder infections? 1. The urinary meatus is closer to the bladder than in most males. 2. The urinary meatus is farther from the anus than most males. 3. The pH of the female urethra is more conducive to infection. 4. Females urinate more frequently than males, increasing risk.

Correct Answer: 1 Rationale: In females, the urethra is approximately 1.5 inches (3 to 5 cm) long, and the urinary meatus is anterior to the vaginal orifice. In males, the urethra is approximately 8 inches (20 cm) long. The shorter distance of the female urethra creates a mechanism by which more females than males contract bladder infections. The female urinary meatus is closer, not farther from the anus than in most males, also increasing risk for bladder infections. The pH of the female urethra is not more conducive to infection. Frequent urination decreases the risk of bladder infection making this choice incorrect.

Which of the following statements by a female patient indicates that teaching was effective about ways to prevent urinary tract infection (UTI)? 1. "I should drink 8 to 10 glasses of fluids per day." 2. "I should limit intake of water so I won't need to urinate so often." 3. "I should only wear nylon underpants." 4. "I should void every six hours while I am awake."

Correct Answer: 1 Rationale: Intake of 8-10 glasses of fluids per day will help to prevent UTIs. Cotton underpants are best, and nylon should be avoided because synthetic fibers dry and irritate the perineal area which can promote bacteria growth. The patient should not delay emptying the bladder when the urge is felt. Emptying the bladder every 2-4 hours is recommended to prevent urinary stasis.

Which of the following methods of bladder emptying would be preferred for an elderly patient who is prone to developing urinary tract infections (UTIs)? 1. intermittent catheterization 2. indwelling urinary catheterizations 3. Credé maneuver 4. timed intervals for taking patient to bathroom to void

Correct Answer: 1 Rationale: Intermittent catheterization carries a lower risk of infection than an indwelling catheter, and is preferred for patients who are unable to empty their bladder by voiding. The Credé maneuver is a technique used to assist patients with spinal cord injury to empty the bladder. Timed intervals to take patients to void would not be effective if they are not able to empty their bladder by voluntary voiding. The urine would remain in the bladder and be a site for infection to develop.

Which of the following interventions would be appropriate for a patient in renal failure with the diagnosis of Imbalanced Nutrition: Less than Body Requirements? 1. Provide mouth care before meals. 2. Schedule meals for three times each day. 3. Provide antiemetics after meals. 4. Weigh once per week.

Correct Answer: 1 Rationale: Interventions for this nursing diagnosis should include monitoring food and nutrient intake as well as episodes of vomiting; weighing daily before breakfast; administering antiemetics 30 to 60 minutes before meals; assisting with mouth care prior to meals and at bedtime; coordinating small meals and between meal snacks; arranging a dietary consultation; tracking weight to monitor nutritional status, laboratory values such as serum albumin and BUN and anthropometric measurements; and administering parenteral nutrition as prescribed.

Which of the following contributes to the increased incidence of urinary tract infections (UTIs) among older adult females? 1. loss of tissue elasticity 2. enhanced immune response 3. decreased risk of urinary stasis 4. decreased and less protective prostatic secretions

Correct Answer: 1 Rationale: Loss of tissue elasticity results in changes in bladder position and incomplete emptying, which contributes to the development of UTIs. Decreased immune response and increased risk of urinary stasis contribute to the increased incidence of UTIs in older females. Prostatic secretions are found in males.

Because of normal changes due to aging, the nurse anticipates that a 75-year-old patient's serum creatinine level might be which of the following? 1. 0.3 mg/dL 2. 2.4 mg/dL 3. 4.8 mg/dL 4. 6.4 mg/dL

Correct Answer: 1 Rationale: Lower than normal is correct because serum creatinine level reflects the by-product of muscle breakdown, and an older adult with less muscle mass can be expected to have a lower-than-normal level. 0.5-1.5 mg/dL is the normal creatinine range for adults. Higher than normal, variable with fluid status, and within normal range are all incorrect because the question is asking for the expected change due to the aging process, and that is less muscle mass, and therefore less serum creatinine.

The nurse is planning the care of a patient with chronic glomerulonephritis. The goal of treatment for this patient should include which of the following? 1. maintaining renal function 2. achieving maximum independence 3. returning to work as soon as possible 4. lifestyle changes

Correct Answer: 1 Rationale: Management of all types of glomerulonephritis acute and chronic, primary and secondary focuses on identifying the underlying disease process and preserving kidney function. In most glomerular disorders, there is no specific treatment to achieve a cure. Treatment goals are to maintain renal function, prevent complications and support the healing process. Although maintenance of independence, returning to work and lifestyle adaptation may be included in the plan of care, they are not priorities.

A patient with chronic kidney disease is diagnosed with hypertension. The nurse realizes that this patient's blood pressure needs to be controlled because of which of the following? 1. It can slow the decline of kidney function. 2. It is the easiest diagnosis to treat. 3. There are medications available to treat this disorder. 4. Everyone should have low-normal blood pressure.

Correct Answer: 1 Rationale: Management of hypertension to maintain blood pressure within normal limits prevents kidney damage. When hypertension is secondary to kidney disease, adequate blood pressure control can slow the decline of renal function. Hypertension is not always easily diagnosed. The goal of having this patient's blood pressure under control is directly related to his chronic kidney disease. Just because medications are available to treat the disorder is not a rationale for why blood pressure should be controlled. The idea of everyone having low-normal blood pressure does not apply to this patient because of the new diagnosis and history of chronic kidney disease.

The nurse is caring for a patient who states, "I need to micturate." The nurse's best response is which of the following? 1. "There is a restroom at the end of the hallway." 2. "Have you been taking your medication on a daily basis?" 3. "Do you have a supply of sterile catheters?" 4. "Do you have someone who can drive you home?"

Correct Answer: 1 Rationale: Micturation is the acting of urinating or voiding. The best response is to direct the patient to a restroom.

A patient had a renal stent removed. Which of the following should be included in the care of this patient? 1. Monitor urine output. 2. Encourage ambulation. 3. Ensure an adequate protein intake. 4. Monitor blood pressure.

Correct Answer: 1 Rationale: Monitor urine output closely for the first 24 hours after stents or ureteral catheters are removed. Edema or stricture of ureters may impede output and lead to hydronephrosis and kidney damage. Ambulation, adequate protein intake and blood pressure monitoring are all important in the care of this patient; however, ensuring that urine output is adequate following stent removal is the highest priority.

In formulating the teaching plan for a patient who is taking metformin (Glucophage), the nurse should include which of these priority instructions? Notify your healthcare provider if 1. you need a diagnostic test that uses iodinated contrast. 2. your urine becomes orange or red-tinted. 3. your urine becomes more concentrated. 4. you need an intermittent or indwelling urinary catheterization.

Correct Answer: 1 Rationale: Oral hypoglycemic agents are contraindicated for use with iodinated contrast, as the combination of the two can precipitate renal failure. Patients should be taught to inform all healthcare providers if they have a prescription for an oral hypoglycemic agent. Orange or red-tinted urine, concentrated urine, or needing urinary catheterizations have no interaction with metformin.

A patient with a urinary diversion device has the nursing diagnosis of Risk for Impaired Skin Integrity. Which of the following interventions will the nurse use with this patient? 1. Empty the bag reservoir every two hours. 2. Change urine collection device every other day. 3. Teach self-catheterization technique. 4. Monitor for foul-smelling urine.

Correct Answer: 1 Rationale: Overfilling of the collection bag can damage the seal, allowing leakage and contact of urine with the skin. The urine collection device is changed as needed. Teaching self-catheterization technique is not an appropriate intervention for this diagnosis. Monitoring for foul smelling urine is an intervention for the diagnosis of Risk for Infection.

A patient diagnosed with a symptomatic urinary tract infection (UTI), is prescribed phenazopyridine (Pyridium). The patient should be instructed that urine will 1. become orange or red. 2. have a green tint. 3. turn brown in color. 4. become clearer and pale yellow.

Correct Answer: 1 Rationale: Phenazopyridine (Pyridium) turns urine orange or red in color. This medication does not turn the color of urine to green, brown or clear pale yellow.

Which of these findings, if identified in an adult patient who is scheduled for an intravenous pyelogram, should a nurse report to the primary healthcare provider immediately? 1. serum osmolality of 1500 mOsm/kg/H2O 2. serum creatinine of 1.30 mg/dL 3. blood urea nitrogen of 20 mg/dL 4. hourly urine output of 45 mL/hour

Correct Answer: 1 Rationale: Prior to the IVP the nurse should assess renal and fluid status, including serum osmolality, creatinine, and blood urea nitrogen (BUN) levels. Notify the physician of any abnormal values. This patient's serum osmolality is elevated. Normal findings are 50-1200 mOsm/kg/H2O. Elevated serum osmolality may indicate a high-protein diet, SIADH, Addison's disease, dehydration, or hyperglycemia. The creatinine, BUN, and hourly urine output findings are within normal limits for this patient.

A nurse is teaching a nursing student about kidney function. The nurse states, "In healthy kidneys, almost all organic nutrients such as glucose and amino acids are reabsorbed." The nurse knows the student understands teaching when the student states, "Your comment means that 1. the nutrients move from blood to filtrate to blood, then back to the blood." 2. the nutrients move from filtrate to blood, then back to the filtrate." 3. the nutrients remain in the kidneys at all times." 4. the nutrients are large molecules and remain in the blood at all times."

Correct Answer: 1 Rationale: Reabsorption may be active or passive. Substances move from the blood into the filtrate, then are reclaimed into the blood.

A male patient comes into the emergency department with symptoms of renal colic. The nurse realizes that this patient most likely has a calculi that is obstructing which of the following? 1. ureter 2. bladder 3. renal pelvis 4. urethra

Correct Answer: 1 Rationale: Renal colic is acute, severe flank pain on the affected side. It develops when a stone obstructs the ureter and causes ureteral spasm. Calculi in the bladder, renal pelvis or urethra would not cause flank pain or colic.

A patient who has prescriptions for both an intravenous pyelogram and a barium enema tells the nurse, "I will schedule the intravenous pyelogram to be done before the barium enema." Which of these responses by the nurse is most appropriate? 1. "Please make your appointments, as you have indicated." 2. "Please clarify with your primary healthcare provider which should be completed first." 3. "Please reverse the order of your planned appointments." 4. "The order of the tests is irrelevant. You may change the order to meet your needs."

Correct Answer: 1 Rationale: Schedule an IVP prior to any ordered barium test or gallbladder studies using contrast material, as residual contrast material from the barium enema or gallbladder studies may interfere with the IVP results.

The nurse is to collect a urine culture specimen from a catheterized patient. Which of the following statements describes the correct technique? 1. With a sterile syringe, the nurse aspirates several mL of urine from the sampling port after swabbing it with alcohol. A small volume of urine is emptied from the urine collection bag into a sterile specimen cup. 2. The nurse disconnects the catheter from the drainage tubing and allows 1-3 mL of urine to drain into a sterile specimen container. 3. With a sterile syringe and needle, the nurse aspirates 50 mL of urine from the catheter above where it is connected to the drainage tubing. 4. A small volume of urine is emptied from the urine collection bag into a sterile specimen cup.

Correct Answer: 1 Rationale: Several mL of urine can be aspirated with a sterile syringe from the sampling port after swabbing it with alcohol. Options 2 and 3 are incorrect because the urinary catheter and drainage system should remain a closed system to prevent infection. Option 4 is incorrect because urine in the drainage bag has collected over several hours and is not fresh urine needed for a culture specimen.

While being catheterized for urinary retention, the patient becomes diaphoretic and pale. Which of the following can be done to help this patient? 1. Clamp the catheter after draining 500 mL of urine. 2. No action is needed, as this situation is transient. 3. Remove the urinary catheter. 4. Provide the patient with fluids.

Correct Answer: 1 Rationale: Some patients may experience a vasovagal response and become pale, sweaty and hypotensive if the bladder is rapidly drained. The vasovagal response is not to be an expected response in each patient during catheterization. The nurse should be aware that it is a possible response in some patients and be able to recognize and respond to it. Draining 500 mL increments and clamping the catheter for 5 to 10 minutes between increments may prevent this response. Removing the urinary catheter or replacing fluids will not address the symptoms.

An elderly patient with diabetes is diagnosed with a flaccid bladder. Which of the following should be included in the care of this patient? 1. Instruct the patient about the Credé method of bladder emptying. 2. Maintain alkaline urine. 3. Instruct the patient about the use of anticholinergic medications. 4. Remind the patient to restrict fluids.

Correct Answer: 1 Rationale: The Credé method (applying pressure to the suprapubic region with the fingers of one or both hands), manual pressure on the abdomen, and the Valsalva maneuver (bearing down while holding one's breath) promote bladder emptying for the patient with a spastic or flaccid bladder. Altering the pH of the urine, use of anticholinergics or restricting fluids would not assist the patient to adapt to the neurogenic issue that is causing flaccid bladder.

The nurse is caring for patient who has been diagnosed with an altered mycogenic mechanism of the renal blood vessels. The patient asks, "Why is it so important that I treat my hypertension and keep my blood pressure within normal limits?" The nurse's best response is which of the following? 1. "Your kidneys may have difficulty protecting themselves from high blood pressure." 2. "Your blood pressure medication is toxic to your kidneys in high doses." 3. "If not controlled, the condition will require an indwelling urinary catheter." 4. "High blood pressure increases your risk for kidney stones."

Correct Answer: 1 Rationale: The myogenic mechanism, which responds to pressure changes in the renal blood vessels, controls the diameter of the afferent arterioles to achieve autoregulation. An increase in systemic blood pressure causes the renal vessels to constrict, whereas a decrease in blood pressure causes the afferent arterioles to dilate. These changes adjust the glomerular hydrostatic pressure and, indirectly, maintain the GFR. An alteration in this system exposes the kidneys to pressures that are too high for proper long term kidney function. Option 2 does not address the patient's question. Option 3 and 4 are incorrect.

A 12-year-old patient who is scheduled to have a renal angiogram asks why the nurse has touched the patient's feet and marked an "X" on the top of both feet. Which of these responses would be most appropriate for the nurse to make? 1. "I feel your pulses there. I can check that the blood is flowing properly to your legs and feet." 2. "Are you afraid? Why do you ask?" 3. "It is a nursing thing. What is that game you are playing?" 4. "A needle is inserted in your femoral artery so the circulation to your extremity could be compromised during this test."

Correct Answer: 1 Rationale: The patient is 12 years old. Most 12-year-old patients have reached the formal operations stage of thinking and can think abstractly and reason logically. The correct option addresses the patient's question directly. Asking the patient a closed question about fear and then asking why the patient asks closes down communication and may make the patient defensive. Telling the patient "it is a nursing thing" and then changing the subject from the patient's question minimizes the patient's concern. Using medical terms with which the patient is likely not familiar also blocks communication. This option may alarm the patient unnecessarily.

A nurse is assessing a patient. Which of the following patient statements best alerts the nurse to the likelihood of the patient having a distended bladder? 1. "I am in pain and it is worse when I press on my abdomen." 2. "My back is killing me." 3. "It feels like someone is stabbing me in the abdomen with a knife." 4. "It hurt constantly with spasms once in a while."

Correct Answer: 1 Rationale: The patient with a distended bladder experiences constant pain increased by any pressure over the bladder. Kidney pain is experienced in the back and the costovertebral angle (the angle between the lower ribs and adjacent vertebrae) and may spread toward the umbilicus. Renal colic (pain in response to renal calculi moving through the ureter) is severe, sharp, stabbing, and excruciating; often it is felt in the flank, bladder, urethra, testes, or ovaries. Bladder and urethral pain is usually dull and continuous but may be experienced as spasms.

Which of the following indicates that a patient with chronic renal failure understands the dietary regimen? 1. The patient had an apple and oatmeal for breakfast, peanut butter sandwich for lunch, and pasta with fish for dinner. 2. Breakfast included bacon and eggs; lunch was a hot dog with sauerkraut; dinner consisted of baked canned ham with green peas. 3. The patient reported eating two bananas for breakfast, rice and beans for lunch, and fruit salad, green beans and an 8-ounce steak for dinner. 4. The patient related eating half a cantaloupe and three eggs for breakfast, a baked potato with processed cheese spread and broccoli for lunch, and chicken, pinto beans, squash, and pecan pie for dinner.

Correct Answer: 1 Rationale: The patient with chronic renal failure needs to adhere to a low-protein, sodium- and potassium-restricted diet. Processed foods (canned ham, sauerkraut, cheese spread) contain high levels of sodium. Option 3 includes excessive amounts of potassium (bananas) and protein.

Which of the following statements by a patient with uric acid stones indicates that teaching was effective about prevention of lithiasis? 1. "I should avoid organ meats and sardines in my diet." 2. "I will increase purine-rich foods in my diet." 3. "I know to avoid eating vitamin D-enriched foods." 4. "I will have to make my urine more acidic by eating cheese, cranberries, grapes, and tomatoes."

Correct Answer: 1 Rationale: The patient with uric acid stones requires a diet low in purines, which are found in organ meats and sardines. Patients with calcium stones should limit vitamin D. Alkalinizing the urine will reduce the formation of uric acid stones.

A nursing student asks all of the following questions when assessing a patient who is scheduled to have an MRI of the kidneys. Which of these questions would require the nurse to intervene? 1. "When did you last have anything to eat or drink?" 2. "Have you ever been treated for chest pain?" 3. "Do you have any tattoos?" 4. "Is there any possibility you could be pregnant?"

Correct Answer: 1 Rationale: There are no restrictions regarding food or fluids for this test. Patients with a history of chest pain should be asked if they have a prescription for transdermal nitroglycerin patches, which must be removed prior to the test. The nurse should assess for any metallic implants (such as pacemakers, clips on brain aneurysms, body piercings, tattoos, and shrapnel). If present, the nurse should notify the imaging physician. Ask if patient is pregnant; if so the test is not performed.

A patient has been given instruction about adult polycystic kidney disease (APKD). Which of these statements, if made by the patient, would indicate that the patient needs further instruction? Select all that apply. 1. "This disorder can be cured if I take my medication carefully." 2. "APKD is inherited from parent to child." 3. "The problem that causes this disease is in the cell chromosomes." 4. "Many fluid-filled sacks are found in the kidneys." 5. "This disorder can cause my kidneys to work poorly."

Correct Answer: 1 Rationale: There is no medication that can cure this disorder. Adult polycystic kidney disease (APKD) is linked to a familial chromosome 16 disorder. The disease is characterized by large cysts in one or both kidneys and a gradual loss of kidney tissue with resultant chronic renal failure.

The nurse is caring for a patient who sustained a fall with a fractured femur and was unable to summon help or receive healthcare treatment for 48 hours. On arrival at the emergency department, the patient's blood urea nitrogen level is 50 mg/dL. The serum creatinine level is 1.0 mg/dL. These findings would help substantiate a nursing diagnosis of which of the following? 1. Deficient Fluid Volume 2. Anxiety related to crisis 3. Acute Pain 4. Impaired Nutrition

Correct Answer: 1 Rationale: To assess if the patient's elevated blood urea nitrogen is caused by dehydration or renal failure, the nurse assesses the serum creatinine value. The patient's serum creatinine is normal, which does not indicate kidney failure. A nursing diagnosis of Deficient Fluid Volume is appropriate for this patient.

A nurse working in a postoperative unit is caring for a patient who states, "I voided a small amount of urine, but I feel as if I need to void more and am unable to do so." The patient receives a prescription for a post-voiding residual urine test. The nurse correctly prepares to perform the procedure by gathering supplies that include which of the following? 1. a urine collecting device and a straight urinary catheter 2. a urine collecting device and a voiding diary 3. an indwelling urinary catheter and an insertion kit 4. a peripheral IV insertion kit and a urine collecting device

Correct Answer: 1 Rationale: To evaluate the amount of urine in bladder post-voiding is correct. This diagnostic test is ordered to determine urinary retention or incomplete bladder emptying, which could be a consequence of the operative experience. To correctly perform the procedure, the nurse gathers a urinary collecting device and asks the patient to void. A straight urinary catheter is inserted and removed and the amount of urine obtained from the bladder is measured. Voiding diaries, indwelling urinary catheters, and peripheral IVs are not required for this procedure.

A female patient is admitted with multiple medical problems and incontinence, regardless of the position or situation. The type of incontinence that this patient is more likely to be experiencing is which of the following? 1. total 2. urge 3. stress 4. overflow

Correct Answer: 1 Rationale: Total incontinence is loss of all voluntary control over urination, and urine loss occurs without stimulus and in all positions. Urge incontinence occurs when the patient must void immediately when the urge is perceived. Stress incontinence is the result of coughing or laughing. Overflow incontinence is when the bladder is filled beyond capacity.

A nurse is reviewing the diagnostic results of renal testing for an 80-year-old patient and notes that the patient's findings include a decreased size of the renal cortex, atherosclerosis of the renal arteries, and hypoosmolality of urine. Which of these explanations would be most appropriate for the nurse to give the patient? 1. These are typical changes associated with aging. 2. These are signs of chronic renal failure. 3. These are signs of acute renal failure. 4. These are signs of a genetic renal disorder.

Correct Answer: 1 Rationale: Typical age-related changes of the renal system include a decreased size of the renal cortex, atherosclerosis of the renal arteries, and hypoosmolality. Some of these manifestations may be associated with acute or chronic renal failure or a genetic renal disorder. This triad in an 80-year-old patient is an expected finding.

The nurse is completing the instructions to a patient who underwent a cadaver kidney transplant and is ready for discharge from the hospital. Which of the following statements by the patient would indicate that further teaching is needed? 1. "I'm glad I won't have to take immunosuppressants any longer." 2. "I know to check my weight on a regular basis." 3. "I'll call my doctor if I notice any decrease in my urine output." 4. "I'll tell my friends to stay away from if they have colds or the flu."

Correct Answer: 1 Rationale: Unless the donor and recipient are identical twins, immunosuppressants are taken to minimize the immune response to reject the transplanted organ. The patient will need to check weight on a regular basis. The patient should contact the physician with any decreases in urine output. The patient should also avoid individuals who have colds or the flu.

Which of these assessments of an 86-year-old patient requires immediate nursing intervention? 1. reports of urinary incontinence 2. reports of urinary frequency 3. reports of urinary urgency 4. reports of nocturia

Correct Answer: 1 Rationale: Urinary incontinence is not a normal part of aging and requires immediate nursing intervention. Reports of urinary frequency, urgency, and nocturia are more common in older adults than in younger people. These may represent normal changes expected with aging.

A female patient is admitted with an overdistended bladder. Which of the following diagnostic tests can be done to confirm the diagnosis of urine retention? 1. bladder scan 2. renal scan 3. intravenous pyelography (IVP) 4. MRI

Correct Answer: 1 Rationale: Urinary retention is confirmed using a bladder scan or by inserting a urinary catheter (if possible) and measuring the urine output. Renal scan, intravenous pyelography (IVP) and MRI will provide information about the structure of the kidney and vascular flow in the renal system, but are not the tests of choice in determining urine retention.

Which of the following interventions would be appropriate for a patient with Fluid Volume Excess related to chronic glomerulonephritis? 1. Weigh daily on the same scale. 2. Document energy level. 3. Schedule activities to conserve energy. 4. Assess for signs of infection.

Correct Answer: 1 Rationale: Weigh daily using a consistent technique (i.e., time of day, scale and clothing). Accurate daily weights are the best indicator of approximate fluid balance. Energy level and signs of infection do not address the issue of fluid volume excess.

Which of these explanations would be most appropriate for a nurse to give to a patient who is scheduled to have a portable ultrasonic bladder scan to measure residual urine? 1. "You will have more than one reading taken." 2. "You will have an intermittent urinary catheter inserted and removed." 3. "You will have to delay the urge to void as long as possible." 4. "You will have the scan one hour after voiding in the toilet."

Correct Answer: 1 Rationale: When performing a portable ultrasonic bladder scan the nurse obtains several readings and uses the largest (the most accurate). The nurse should print the information, place it on the patient's chart, and document the residual urine amount. The patient is not asked to delay voiding. No catheterization is performed as part of this test. The scan is performed immediately after the patient voids.

A patient is being instructed on how to perform Kegel exercises. Which of the following should be included in these instructions? Select all that apply. 1. While voiding, stop the flow of urine and hold for a few minutes. 2. Tighten the muscles around the anus to resist defecation. 3. Take a deep breath and hold while performing the exercise. 4. These should be performed at least once per day. 5. These should be performed for at least several months.

Correct Answer: 1,2 Rationale: Kegel exercises should begin by identifying the pelvic muscles with these techniques: stop the flow of urine during voiding and hold for a few seconds, tighten the muscles at the vaginal entrance around a gloved finger or tampon or tighten the muscles around the anus as though resisting defection. The patient should perform these exercises by tightening pelvic muscles, holding for 10 seconds and relaxing for 10 to 15 seconds. The patient should keep abdominal muscles and breathing relaxed while performing exercises. The exercises should be performed twice a day and work up to four times a day. Encourage exercising at a specific time each day or in conjunction with another daily activity. It is important to establish a routine because these exercises should be continued for life. Assistive devices, such as vaginal cones and biofeedback, may be useful for patients who have difficulty identifying appropriate muscle groups.

A patient is scheduled to have an arteriovenous (AV) fistula created for hemodialysis. Which of the following statements are appropriate for this patient?Select all that apply. 1. Always use the dominant hand and arm for blood pressure readings. 2. A functioning fistula has a palpable pulse and bruit. 3. Ensure the use of the dominant hand and arm for placement. 4. The fistula can be used immediately after its creation. 5. Venipunctures should be performed on the arm with the fistula.

Correct Answer: 1,2 Rationale: The nondominant arm is preferred for fistula placement. A functional arteriovenous (AV) fistula has a palpable pulse and a bruit on auscultation. The arm in which is fistula is placed should not be used for blood pressure or for venipuncture and that arm should be marked as not available for these purposes. It takes about a month for the fistula to mature.

A nurse observes a colleague including all of these measures when providing care to a patient who recently had a percutaneous renal biopsy. Which would require the nurse to intervene? Select all that apply. Standard Text: Select all that apply. 1. monitors vital signs every 15 minutes 2. applies pressure to site for 15 minutes after procedure 3. teaches patient to use aspirin for minor post procedure pain 4. teaches patient to increase oral fluid intake 5. teaches patient to report decreased urination

Correct Answer: 1,2 Rationale: The nurse holds pressure at the percutaneous site of a renal biopsy for 20 minutes after the procedure. The patient is at risk for bleeding and should not use aspirin as an over-the-counter pain reliever immediately after a renal biopsy, as it will promote bleeding. Options 3, 4, and 5 are all correct.

A nurse is performing discharge teaching with a patient who had a cystogram. The nurse should instruct the patient to use which of the following techniques to promote comfort? Select all that apply. 1. Take a sitz bath. 2. Increase oral fluid intake. 3. Take acetaminophen for minor pain. 4. Apply heat to the lower back. 5. Drink one ounce of brandy or rum with warm water.

Correct Answer: 1,2,3 Rationale: Appropriate techniques for relieving pain after a cystogram include taking a sitz bath, increasing oral fluid intake, and using over-the-counter analgesics that do not promote bleeding. Apply heat to the lower abdomen, not the lower back. Tell the patient to avoid alcoholic drinks for two days and that a slight burning sensation with voiding may occur for a day or two.

Nursing responsibilities when giving osmotic diuretics include which of the following? Select all that apply. 1. Check mannitol (Osmitrol) solution for crystallization prior to IV administration. 2. Evaluate urine output after test dose is given. 3. Assess for signs of worsening heart failure 4. Assess for orthostatic hypotension. 5. Monitor patient for signs of ototoxicity.

Correct Answer: 1,2,3 Rationale: Osmotic diuretics commonly used are mannitol and urea (Ureaphil), which pull extracellular water into the vascular system and increase the glomerular filtration rate (GFR). They are given intravenously and mannitol solution should be checked for crystallization prior to administration. A test dose may be given and urine output is evaluated for an adequate response. The patient should be assessed for signs of worsening heart failure because of the increased vascular volume that occurs with these medications. Orthostatic hypotension is not an issue due to the increase in intravascular volume but should be assessed when giving loop diuretics. Ototoxicity is a concern with high doses of loop diuretics.

A patient with chronic renal failure is trying to decide between hemodialysis and peritoneal dialysis. Which of the following are advantages of peritoneal dialysis for this patient? Select all that apply. 1. minimal vascular complications 2. liberal intake of fluids 3. better self-management 4. better metabolite elimination 5. lower risk of infection

Correct Answer: 1,2,3 Rationale: Peritoneal dialysis has several advantages over hemodialysis. Heparinization and vascular complications associated with an arteriovenous (AV) fistula are avoided. The clearance of metabolic wastes is slower but more continuous. More liberal intake of fluid and nutrients is often allowed for the patient on continuous ambulatory peritoneal dialysis (CAPD). The patient on peritoneal dialysis is better able to self-manage the treatment regimen, which reduces feelings of helplessness. The major disadvantages of peritoneal dialysis include less effective metabolite elimination and risk for infection (peritonitis), serum triglyceride levels may increase, and the presence of an indwelling catheter may cause a body image disturbance.

Risk factors for renal cancer include which of the following? Select all that apply. 1. obesity 2. over 55 years of age 3. genetic predisposition 4. female 5. bladder calculi

Correct Answer: 1,2,3 Rationale: Risk factors for the development of renal cancer include obesity, smoking, age greater than 55, and having a genetic predisposition to the disease. Males are affected more than females by a 2:1 ratio. A history of renal calculi, not bladder calculi, are also known risk factors.

The nurse is reviewing the laboratory results for a patient who has a prescription for an estimated glomerular filtration rate (EGFR). The nurse knows that which of the following factors may be utilized to determine the estimated glomerular filtration rate? Select all that apply. 1. serum creatinine 2. patient's age 3. patient's gender 4. patient's racial origin 5. serum blood urea nitrogen

Correct Answer: 1,2,3,4 Rationale: The EGFR is calculated based on the serum creatinine, age, gender, and (in some instances) racial origin. Serum blood urea nitrogen results is not utilized.

According to evidence-based practice for patients undergoing stem cell transplants, which NANDA nursing diagnoses would be appropriate? Select all that apply. 1. Ineffective Coping 2. Fatigue 3. Interrupted Family Processes 4. Risk for Infection 5. Excess Fluid Imbalance

Correct Answer: 1,2,3,4 Rationale: Due to the long-term commitment (6-8 weeks) in isolation and the uncertainty of treatment's outcomes, coping mechanisms often become ineffective due to the variety of physical, mental, and financial issues that are faced during this life-threatening process. Role strain, depression, pain, loss of independence, and severe fatigue all contribute to difficulties in coping. Fatigue occurs with stem cell transplants from the complete bone marrow suppression, which causes anemia and decreased RBC to carry the oxygen needed for cellular functioning. Emotional stressors also create a fatigue while dealing with the entire treatment process. Major depression is not uncommon post-transplant. Family commitment and role changes are needed while hospitalized, since strict isolation occurs during the transplant treatment process. Children might not be allowed to visit, causing further separation by family members. Job roles (family dynamics) might be changed during hospitalization and recovery. Prior to transplant with stem cells, the patient receives total body chemotherapy, causing bone marrow suppression. Therefore, the WBCs are depleted prior to the transplant, and the ability to fight off an infection is decreased significantly, creating the need for strict isolation for the patient. With chemotherapy, there often is a tendency for nausea and vomiting, leading to fluid loss and not fluid retention. Therefore, the patient is more likely to have a "deficit" rather than an "excess" when receiving stem cell transplants. Steroid treatment can cause a fluid shift, but usually not an "excess fluid balance."

Place the following steps in correct order when caring for a urinary stoma. Choice 1. Cleanse skin around stoma with soap and water, rinse, pat or air dry. Choice 2. Assess stoma, noting color and moisture. Choice 3. Remove old pouch; use warm water to loosen seal. Choice 4. Use stoma guide to determine size of bag opening and/or protective ring. Trim as needed. Choice 5. Apply bag with opening no more than 1-2 mm wider than outside of stoma. Choice 6. Apply skin barrier; allow skin to dry, then connect bag to urine-collection device.

Correct Answer: 3,2,1,4,5,6 Rationale: Care of a urinary stoma includes removing the old pouch by gently pulling away from skin. Warm water or adhesive solvent may be used to loosen the seal if necessary. Assess stoma, noting color and moist appearance. Urine flow may be prevented by placing rolled gauze or tampon over stoma opening. Cleanse skin around stoma with soap and water, rinse, and pat or air dry. Use the stoma guide to determine correct size of bag opening and/or protective ring. Trim bag or seal as needed. Apply skin barrier; allow skin to dry. Apply the bag with an opening no more than 1-2 mm wider than outside of stoma. Allow no wrinkles or creases where the bag contacts the sin. Connect bag to urine-collection device; dispose of old bag, used supplies and gloves. Chart procedure.

Which of these laboratory results would be most important for a nurse to monitor for a patient who has lower abdominal pain and urinary urgency? 1. serum creatinine 1.20 mg/dL 2. urine Osmolality 400 mOsm/kg H2O 3. BUN 30 mg/dL 4. urine culture 150,000 organisms/mL

Correct Answer: 4 Rationale 1: BUN and serum creatinine tests are use primarily to evlauate kidney function. Rationale 2: Urine osmolality is used to evaluate increaded and decreased urine output. Rationale 3: BUN and serum creatinine tests are use primarily to evlauate kidney function.

A patient withhepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to "a) Avoid alcohol for the first 3 weeks b) use a condom during sexual intercourse c) have family members get an injection of immunoglobulin d) follow a low-protein, moderate-carbohydrate, moderate fat diet"

Correct B "Correct Answer: B Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B."

"The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate?" "A. "The hepatitis vaccine will provide immunity from this exposure and future exposures." B. "I am afraid there is nothing you can do since the patient was infectious before admission." C. "You will need to be tested first to make sure you don't have the virus before we can treat you." D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure.""

Correct C "Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."

"A client with acute hepatitis is prescribed lactulose. The nurse knows this medication will: "a. Mobilize iron stores from the liver. b. Prevent hypoglycemia c. Remove bilirubin from the blood d. Prevent the absorption of ammonia from the bowel.

Correct D Lactulose helps prevent the absorption of ammonia from the bowel because it will cause frequent bowel movements, which facilitates the removal of ammonia from the intestines.

"1. A health care provider who has not been immunized for hepatitis B is exposed to the hepatitis B virus (HBV) through a needle stick from an infected patient. The infection control nurse informs the individual that treatment for the exposure should include: a. baseline hepatitis B antibody testing now and in 2 months. b. active immunization with hepatitis B vaccine. c. hepatitis B immune globulin (HBIG) injection. d. both the hepatitis B vaccine and HBIG injection.

Correct D The recommended treatment for exposure to hepatitis B in unvaccinated individuals is to receive both HBIG and the hepatitis B vaccine, which would provide temporary passive immunity and promote active immunity. Antibody testing may also be done, but this would not provide protection from the exposure.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a) Therapeutic index b) GI absorption rate c) Liver function studies d) Creatinine clearance

D) Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

"The client with hepatitis asks the nurse ""I went to an herbalist, who recommended I take milk thistle. What do you think about the herb?"" Which statement is the nurse's best response? "1. ""You are concerned about taking an herb"" 2. ""The herb has been used to treat liver disease"" 3. ""I would not take anything that is not prescribed"" 4. ""Why would you want to take any herbs?""

Correct: 2 "1. This is a therapeutic response and the nurse should provide factual information 2. Milk thistle has an active ingredient, silymarin, which has been used to treat liver disease for more than 2,000 yrs. It is a powerful oxidant and promotes liver cell growth. 3. The nurse should not discourage complementary therapies. 4. This is a judgmental statement, and the nurse should encourage the client to ask questions."

"A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to... a. avoid alcohol for the first 3 weeks b. use a condom during sexual intercourse c. have family members get an injection of imunoglobulin d. follow a low-protein, moderate-carbohydrate, moderate-fat diet."

Correct: B Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when: A) Disposing of food trays B) Emptying the bed pan C)Taking an oral temperature D) changing IV tubing

Correct: B.... Rationale: HAV is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A

What should kidney transplant pts avoid?

Crowds, oral polio vaccine, and varicella vaccine.

Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract infection? a) Drink coffee or tea to increase diuresis b) Use tub baths as opposed to showers c) Void every 4 to 6 hours d) Drink liberal amount of fluids

D) Drink liberal amounts of fluids Patients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The patient should shower instead of bathe in a tub because bacteria in the bath water may enter the urethra.

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance? a) Hypocalcemia b) Hyperkalemia c) Hypokalemia d) Hypercalcemia

D) Hypercalcemia The normal reference range for serum calcium is 9 to 11 mg/dl. A serum calcium level of 12 mg/dl clearly indicates hypercalcemia. The client's other laboratory findings are within their normal ranges, so the client doesn't have hypernatremia, hypochloremia, or hypokalemia.

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? a) Increased red blood cell count b) Decreased serum potassium level c) Increased serum calcium level d) Increased serum creatinine level

D) Increased serum creatinine level Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.

Patients diagnosed with hypervolemia should avoid sweet or dry food because: a) It obstructs water elimination. b) It can cause dehydration. c) It can lead to weight gain. d) It increases the client's desire to consume fluid.

D) It increases the client's desire to consume fluid The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is rationed, and the client is advised to take limited amount of fluid when thirsty. Sweet or dry food can increase the client's desire to consume fluid. Sweet or dry food does not obstruct water elimination nor does it cause dehydration. Weight regulation is not part of hypervolemia management except to the extent that it is achieved on account of fluid reduction.

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? a) "The effluent should be allowed to drain by gravity." b) "It is important to use strict aseptic technique." c) "The infusion clamp should be open during infusion." d) "It is appropriate to warm the dialysate in a microwave."

D) It is appropriate to warm the dialysate in a microwave Explanation: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

Disequilibrium syndrome

Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea and vomiting, twitching, and possible seizure activity. It is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. It most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

How frequently is an intermittent cath done?

Every 4 hours (4x75 ml=300 cc output per cath).

What is the major function of the kidneys? If not working?

Excretion of fluid. If not working then decreased output=increased edema= increased BP and headaches.

What are the four big functions of the kidneys?

Excretion of fluids, removal of byproducts, removal of electrolytes, and release of erythropoietin.

What are symptoms of a cystitis urinary tract infection?

FREQUENCY, URGENCY, suprapubic pain, burning upon urination, hematuria, fever, N&V, an urge to urinate with empty bladder, occasional pus in urine. (if not addressed can lead to fever, chills, blood in urine, backache/kidney involvement).

True or False? Atrial Natriuretic Factor (ANF) is secreted by the right atruim when atrial blood pressure is low, and it inhibits the action of aldosterone.

False Atrial Natriuretic Factor (ANF) is secreted by the right atruim when atrial blood pressure is low, and it inhibits the action of high antidiuretic hormone (ADH) or renin or angiotensin II

True or False? The primary function of the kidney is to excrete nitogeneous waste products.

False Primary function of kidney is to regulate the volume and composition of extracellular fluids

How can a patient protect a hemodialysis fistula?

Feel for thrill (bumble bees), listen for bruit (swooshing), assess the fistula (steal syndrome=call MD)- infection, numbness/tingling/etc., Dont sleep on side of fistula or carry purse on arm with fistula (LIFE LINE), no tight fitting clothing on that arm.

(Why shoud 1st urine of the day not be use when) collecting a urine speiceman

First urine of the day is not fresh (Should not be used when)

What are symptoms of pyelonephritis UTI?

Flank pain, dysuria, pain at costovertebral angle, and same as cystitis.

How is fluid replacement determined?

Fluid replacement=24 hour fluid loss + 500 cc (insensible water loss)

How are UTIs diagnosed?

Urinalysis with culture and sensitivity.

For which metabolic effects of therapy does the nurse monitor the patient after administering triamterene (Dyrenium)?

Glycosuria, hyeruricemia, hyperlipidemia Adverse effects of thiazide diuretics such as triamterene include glycosuria and hyperglycemia, hyperuricemia, and hyperlipidemia. Triamterene can cause hypovolemia but it is not a metabolic effect. In addition, triamterene can cause hypocalemia and hypochloremic alkalosis.

What two things kill the renal failure patient?

H20 and potassium

What are S&S of glomerulonephritis?

HA, increased BP, facial/periorbital edema, malaise, low grade fever, weight gain, proteinuria, hematuria, oliguria, decreased GFR, inflammation.

Epididymitis treatment rationale

Increase intake of fluids to flush the urinary system. Because organisms can be forced into the vas deferens and epididymis from strain or pressure during voiding, the client should limit the force of the stream. Condom use can help prevent urethritis and epididymitis from sexually transmitted infections.

Which diuretic is the drug of choice for the prevention of tissue damage after a closed head injury?

Mannitol (Osmitrol) Mannitol is the drug of choice to prevent increased intracranial pressure after a closed head injury; although it works along the entire length of the nephron, it reduces intracranial pressure and cerebral edema by reducing cellular edema. Metolazone and furosemide are loop diuretics and hydrochlorothiazide is a thiazide diuretic; they are of little benefit in reducing cerebral edema.

Who shouldn't take erectile dysfunction medications?

Men taking nitrates or alpha blockers (for cialis flomax is okay).

What are signs and symptoms of Benign prostatic hyperplasia?

Prostate enlarges and compresses the urethra so urine stream can be weak and diminish to dribble, a frequent need to void and straining during urination are common, unable to empty bladder, infection, bloody urine, painful retention with need for catheterization.

The nurse is caring for a patient with liver disease who has gained 5 lb in 3 days. The nurse wants to administer a diuretic that acts in which part of the nephron?

Proximal convoluted tubule The nurse needs to administer an especially effective diuretic to help prevent adverse effects of hypervolemia in the patient with liver disease. Drugs that act in the proximal convoluted tubules block solute reabsorption to the greatest degree, thereby producing the best diuresis. Because the amount of solute in the nephron becomes progressively smaller as filtrate flows from the proximal tubule to the collecting duct, drugs whose site of action is closest to the glomerulus block the greatest amount of solute reabsorption and thus produce the greatest diuresis. The glomerulus filters solute and water; reabsorption starts to occur in the proximal convoluted tubules. The collecting ducts reabsorb water, and the distal convoluted tubule is the farthest site of reabsorption from the glomerlus and therefore reabsorbs water less effectively.

Total parental nutrition (TPN) should be used cautiously in patients with pancreatitis due to which of the following? a) They can digest high-fat foods. b) They are at risk for hepatic encephalopathy. c) They are at risk for gallbladder contraction. d) They cannot tolerate high-glucose concentration.

They cannot tolerate high-glucose concentration. Explanation: Total parental nutrition (TPN) is used carefully in patients with pancreatitis because some patients cannot tolerate a high-glucose concentration, even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, while intake of high protein increases risk for hepatic encephalopathy in patients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

What is the treatment for glomerulonephritis? Rooming assignment?

Tx: bactrim (for decreased urine output) and diet (5 year old gomerulo=eat burger). Room assignment with anyone who isn't contagious bc glomerulo isn't and doesn't want anything.

How should someone with a peritoneal dialysis catheter maintain it?

Typically lie flat or in low semi fowlers and have pt put on face mask, remove old dressing, assess site, clean skin with hydrogen peroxide circles from the site out, apply iodine to catheter site and catheter (check for allergies), place gauze under catheter, gauze over and secure with tape, change dressing q 1-2 days/wet.

What byproducts of digestion do the kidneys remove? If not working?

Urea and creatinine. If not working than BUN and creatinine elevate. BUN reflects fluid and protein balance. Creatinine is the true measure of renal function (0.6-1.3=normal).

Post-Renal Failure

Urine can't get out of the kidney -Enlarged prostate -kidney stone -tumors -ureteral obstruction -edematous stomas (ileal conduit)

What is important to know about a renal angiogram?

Use a laxative before, catheter is inserted into the femoral artery and dye is injected. Post op: leg remains straight w/cold compresses on pressure site. Monitor for hematuria at the site and pulses. Back or flank pain= rupture of the artery and can cause death.

What is pyridium?

Used to decrease burning during urination only (if no burning then don't take).

What shouldn't be in urine?

WBCs, RBCs, Protein, and Sugar

Which nursing action is most appropriate for a client hospitalized with acute pancreatitis? a) Withholding all oral intake, as ordered, to decrease pancreatic secretions b) Limiting I.V. fluids, as ordered, to decrease cardiac workload c) Administering meperedine, as ordered, to relieve severe pain d) Keeping the client supine to increase comfort

Withholding all oral intake, as ordered, to decrease pancreatic secretions Explanation: The nurse should withhold all oral intake to suppress pancreatic secretions, which may worsen pancreatitis. Typically, this client requires a nasogastric tube to decompress the stomach and GI tract. Although pancreatitis may cause considerable pain, it's treated with I.M. meperidine (Demerol), not morphine, which may worsen pain by inducing spasms of the pancreatic and biliary ducts. No clinical evidence supports the use of meperidine for pain relief in pancreatitis, and, in fact, accumulation of its metabolites can cause CNS irritability and possibly seizures. Pancreatitis places the client at risk for fluid volume deficit from fluid loss caused by increased capillary permeability. Therefore, this client needs fluid resuscitation, not fluid restriction. A client with pancreatitis is most comfortable lying on the side with knees flexed.

A woman with no hx of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. The nurse anticipates that the patient will a) need to have a blood specimen drawn for a CBC and kidney function test b) not be treated with medications unless she develops a fever, chills, or flank pain c) be requested to obtain a clean-catch midstream urine specimen for culture and sensitivity d) be treated empirically with TMP-SMX Bactrim for 3 days.

d) be treated empirically with TMP-SMX Bactrium for 3 days Unless a patient has a hx of recurrent UTIs, TMP-SMX or nitrofurantoin is usually used to empirically treat an initial UTI without a culture and sensitivity test. Asymptomatic bacteriuria does not justify tc, but symptomatic UTIs should always be treated.

Intrarenal acute kidney failure

disease process, ischemia, or toxic conditions cause disease within the kidney

urine that is blue is due to ____

dyes or medications

Phases of renal failure: initiation/oliguric, maintenance/diuretic, and recovery

initiation: few manifestations maintenance: oliguria recovery: improved urinary output and renal function

Signs and Symptoms of renal failure

malaise, headache, anorexia, n/v, decreased output, weight gain, retaining toxins and fluid

BUN

measuress nitrogenous urea in blood - a sign of kidney health, dehydration, and dietary health - beast evaluated with serum creatinine levels

urine that is tea-colored is due to ____

melanin or hematuria

What do you do if all the fluid does not come out of the individual with peritoneal dialysis?

turn the patient from side to side.

Absorption or leakage of urine wastes out of the urinary system is prevented by the cellular characteristics of the _______.

urothelium

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) light amber urine. b) circumoral pallor. c) yellow sclerae. d) black, tarry stools.

yellow sclerae. Explanation: Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.