NU373 EAQ Evolve Elsevier: HESI Prep Renal, Urinary, Reproductive
A client with a suspected kidney disorder reports flank pain. Which nursing interventions would be conducted while performing flank assessment? Select all that apply. o Percussing the tender flank first o Forming both hands into a clenched fist o Asking the client to assume a sitting position o Placing one hand flat on the costovertebral angle (CVA) o Delivering a firm hand thump over the lower abdomen
o Asking the client to assume a sitting position o Placing one hand flat on the costovertebral angle (CVA) · While assessing the flank regions of a client with a suspected kidney disorder, the nurse should ask the client to assume a sitting position. The nurse should place one hand on the CVA during assessment. The nurse should first percuss the nontender flank; percussing the tender flank first may aggravate the client's pain. A clenched fist should be formed with one hand. The nurse should deliver a firm hand thump over the CVA.
A client with a history of excessive alcohol use develops hepatic portal hypertension and an elevated serum aldosterone level. For which complications would the nurse assess this client? o Chloride depletion and hypovolemia o Potassium retention and dysrhythmias o Sodium retention and fluid accumulation o Calcium depletion and pathological fractures
o Sodium retention and fluid accumulation · Aldosterone, a corticosteroid, causes sodium and water retention and potassium excretion by the kidneys. Hypovolemia will not occur with increased aldosterone levels because sodium and water are retained. Potassium is excreted in the presence of aldosterone and will not accumulate and cause dysrhythmias. Calcium is unaffected by aldosterone.
Which clinical indicators would the nurse expect for a client who has end-stage renal disease (ESRD)? Select all that apply. o Polyuria o Jaundice o Azotemia o Hypertension o Polycythemia
o Azotemia o Hypertension · Azotemia is an increase in nitrogenous waste, particularly urea, in the blood; this is common in ESRD. Hypertension occurs as a result of fluid and sodium overload and dysfunction of the renin-angiotensin-aldosterone system. Excessive nephron damage in ESRD causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency from an inability to concentrate urine. Jaundice is common with biliary obstruction, not ESRD. Anemia, not polycythemia, occurs because of decreased erythropoietin, decreased red blood cell (RBC) production, and decreased RBC survival time.
After receiving hemodialysis for several years, a client has a kidney transplant scheduled. Which statements would the nurse include in the client's preoperative teaching plan? Select all that apply. o "The kidney may not function immediately." o "Precautions are needed to prevent infection." o "A urinary catheter will be present postoperatively." o "Immunosuppressive medications will be given preoperatively." o "The arteriovenous fistula will be used for drawing blood specimens preoperatively."
o "The kidney may not function immediately." o "Precautions are needed to prevent infection." o "A urinary catheter will be present postoperatively." · Because infection is a major complication of a kidney transplant, prevention begins with the recognition of the earliest signs and symptoms. The transplanted kidney does not always function immediately; the client should know that dialysis may have to be continued. Just before surgery a urinary catheter is inserted and an antibiotic may be instilled into the bladder to decrease the risk of infection. Immunosuppressive therapy begins after the kidney transplant, not before surgery. The nurse should never use the vascular access for drawing blood or instilling intravenous medications.
Which option would the nurse offer a client with acute glomerulonephritis who reports thirst? o Ginger ale o Milkshake o Hard candy o Cup of broth
o Hard candy · Sucking on a hard candy will relieve thirst and increase carbohydrates but will not supply extra fluid. The client with acute glomerulonephritis needs to maintain a low protein diet, low sodium diet, and fluid restrictions. The goal is to minimize unnecessary fluid intake. Carbonated beverages contain sodium and provide additional fluid, which must be restricted. A milkshake contains both fluid and protein, which must be restricted. Broth contains sodium, which increases fluid retention.
Which response would the nurse use when a client scheduled for a transurethral incision of the prostate (TUIP) voices concern regarding impotence? o "It's understandable that you are worried; impotence is a very real possibility." o "I can understand your concern, but this procedure usually does not cause impotence." o "Most men worry about that ability; you should speak with your primary health care provider." o "You may be temporarily impotent, but normal functioning returns within a few months."
o "I can understand your concern, but this procedure usually does not cause impotence." · The response "I can understand your concern, but this procedure usually does not cause impotence" recognizes the concern and provides accurate information that may reduce anxiety. The response "It's understandable that you are worried; impotence is a very real possibility" is inaccurate information; impotence usually does not result. The reply "Most men worry about that ability; you should speak with your primary health care provider" closes off communication and transfers responsibility to the primary health care provider. The reply "You may be temporarily impotent, but normal functioning returns within a few months" does not recognize feelings and provides inaccurate information; impotence rarely, if ever, occurs with this procedure.
Which clinical manifestations would the nurse expect the client who has chronic kidney disease with hypocalcemia to exhibit? Select all that apply. o Acidosis o Lethargy o Fractures o Osteomalacia o Eye calcium deposits
o Fractures o Osteomalacia o Eye calcium deposits · Because of calcium loss from the bone, fractures, osteomalacia, and eye calcium deposits occur. Acidosis decreases calcium that binds to albumin, resulting in more ionized calcium (free calcium) in the blood. Lethargy and weakness are associated with hypercalcemia.
The nurse reviews the kidney function blood studies of four clients. Which client's results indicate kidney impairment? o Client 1 o Client 2 o Client 3 o Client 4
o Client 4 · Elevated creatinine level signifies impaired kidney function or kidney disease. As the kidneys become impaired for any reason, the creatinine level in the blood will rise due to poor clearance of creatinine by the kidneys. Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys. If the kidneys are not able to remove urea from the blood normally, the blood urea nitrogen (BUN) level rises. The normal range of serum creatinine lies between 0.6 and 1.2 mg/dL (53.04-106.08 mmol/L). The normal range of BUN lies between 10 and 20 mg/dL (3.57-7.14 mmol/L). Client 4's levels indicate kidney impairment. The serum creatinine and BUN are within normal limits for clients 1, 2, and 3.
Which action would the nurse include when developing a postprocedure plan of care for a client with continuous bladder irrigations after a transurethral vaporization of the prostate? o Measure the output hourly and monitor total output trends. o Monitor the specific gravity of the urine each shift. o Irrigate the triple-lumen catheter with normal saline three times daily. o Deduct the amount of instilled irrigant from the total output.
o Deduct the amount of instilled irrigant from the total output. · The amount of irrigant instilled into the bladder must be deducted from the total output to determine the amount of urine produced. The client will have an indwelling catheter, and hourly measurements are not possible because the irrigant is mixing with the urine. Abnormal specific gravity values are not associated with this procedure and would be inaccurate because the irrigant is mixing with the urine. Because the bladder is being irrigated continuously, no additional irrigations are needed.
Which complications would the nurse expect in the client with a renal disorder who has a blood urea nitrogen (BUN)/creatinine ratio of 28? Select all that apply. o Malnutrition o Hepatic damage o Kidney impairment o Fluid volume deficit o Obstructive uropathy
o Fluid volume deficit o Obstructive uropathy · The normal range of BUN/creatinine ratio is 6 to 25. The BUN/creatinine ratio of 28 is a higher value than the normal; the client may have complications like fluid volume deficit and obstructive uropathy. A decrease in BUN levels indicates malnutrition and severe hepatic damage. Increased serum creatinine levels indicate kidney impairment.
Which genitourinary factor contributes to urinary incontinence in older adult clients and needs to be considered by the nurse when planning the care for these clients? o Sensory deprivation o Urinary tract infection o Frequent use of diuretics o Inaccessibility of a bathroom
o Urinary tract infection · Urinary incontinence in older adults can be a sign of urinary tract infection. Urinary tract infections affect the genitourinary tract and interfere with voluntary control of micturition. Sensory deprivation is a neurological, not a genitourinary, factor. Frequent use of diuretics is an iatrogenic, not genitourinary, factor. Inaccessibility of a bathroom is an environmental, not genitourinary, factor.
An ambulatory client with benign prostatic hyperplasia reports to the morning nurse his inability to void all night long. Upon assessment, the nurse identifies distention of the client's bladder. Which action would the nurse implement? o Ask him to use a urinal. o Encourage increased fluids. o Assist him into a warm shower. o Exert pressure over the pubic area.
o Assist him into a warm shower. · Warm water often will relax the urinary sphincter, enabling a client to void. The client already indicated an inability to void, so asking him to use a urinal is inappropriate; plus, the client is ambulatory, able to stand, and go to the bathroom, which is a more natural method than the urinal. The distended bladder indicates adequate fluid intake, increasing fluid intake will increase pressure and may result in hydronephrosis. Pressure over a distended bladder induces pain, which causes muscular contraction of the urinary sphincter.