Nursing GU

The nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse should be alert for which of the following? 1) Trousseau's sign 2) Cardiac arrhythmias 3) Constipation 4) Decreased clotting time 5) Drowsiness and lethargy 6) Fractures

Hypocalcemia is a calcium deficit that causes nerve fiber irritability and repetive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign, cardiac arrhythmias, diarrhea, increased clotting time, anxiety and irritability. The calcium-phosphorus imbalance leads to brittle bones and pathologic fractures

Which laboratory test is the most accurate indicator of a client's renal function?

Creatinine clearance is the most accurate indicator of a client's renal function because it closely correlates with the kidney's glomerular filtration rate (125 ml/min) and tubular excretion ability

Which laboratory value supports a diagnosis of pyelonephritis? 1) Myoglobinuria 2) Ketonuria 3) Pyuria 4) Low WBC

Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria (presence of pus in the urine) and bacteriuria. The client exhibits fever, chills and flank pain. Because there is often a septic picture, the WBC count is more likely to be high rather than low.

Normal Specific Gravity

1.002 to 1.035

Metabolic Acidosis

HC03 <22 mEq/L

Normal pH of urine

4.5 to 8

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? 1) Encouraging coughing and deep breathing 2) Promoting carbohydrate intake 3) Limiting fluid intake 4) Providing pain-relief measures

During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema.

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: 1) confusion, headache, and seizures 2) acute bone pain and confusion 3) weakness, tingling, and cardiac arrhythmias 4) hypotension, tachycardia and tachypnea.

Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result form a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiological functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia and tachypnea signal hemorrhage, another dialysis complication.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: 1) chronic, excessive acetaminophen use 2) recent streptococcal infection 3) childhood asthma 4) family history of pernicious anemia

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

A client requires hemodialysis. Which type of drug should be withheld before this procedure? 1) Phosphate binders 2) Insulin 3) Antibiotics 4) Cardiac glycosides

Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Phosphate binders and insulin can be administered because they arent's removed from the blood by dialysis.

A client who has been treated for chronci renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? 1) Be sure to eat meat at every meal 2) Eat plenty of bananas 3) Increase your carb intake 4) Drink plenty of fluids, and use a salt substitute

Extra carbohydrates are needed to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium, meat, which is high in protein, bananas, which are high in potassium, and fluid, because the failing kidneys can't secrete adequate urine. Salt substitues are high in potassium and should be avoided.

A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include: 1) generalized edema, especially of the face and periorbital area 2) green tinged urine 3) moderte to severe hypotension 4) polyuria

Generalized edema, especially of the face and periorbital area, is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria, proteinuria, fever, chills, weakness, pallor, anorexia, nausea and vomitting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.

The nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: 1) hypernatremia 2) hypokalemia 3) Hyperkalemia 4) Hyperkalcemia

Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium in the the cells and temporarily reducing serum potassium levels.

A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? 1) Poor perfusion to the kidneys 2) Damage to cells in the adrenal cortex 3) Obstruction of the urinary collecting system 4) Nephrotoxic injury secondary to use of contrast media

Intrinsic renal failure results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may results in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortx. Obstruction of the urinary collecting system may cause postrenal failure

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.

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

A client with chronic renal failure (CRF) has developed a faulty red blood cell production. The nurse should monitor this client for: 1) nausea and vomiting 2) dyspnea and cyanosis 3) fatigue and weakness 4) thrush and circumoral pallor

RBCs carry oxygen throught the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. THrush signals fungal infection and circumoral pallor reflects decreased oxygention not signs of CRF.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is most appropriate for this client? 1) Impaired urinary elimination 2) Toileting self-care deficit 3) Risk for infection 4) Activity Intolerance

The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. Therefore, the client is at risk for infection. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products.

Which clinical finding wuold the nurse look for in a client with CRF? 1) Hypotension 2) Uremia 3) Metabolic alkalosis 4) Polycythemia

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

Normal ABGS pH PaO2 HC03 PaCO2

pH: 7.35 to 7.45 PaO2: 80 to 100 mm Hg HC03: 22 to 26 mEq/liter PaC02: 35-45 mm Hg

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding signals a significant problem during this procedure? 1) Blood glucose level of 200 mg/dl 2) WBC count of 20,000/mm3 3) Potassium level of 3.5 mEq/L 4) Hematocrit (HCT) of 35%

An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes, therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding scale insulin. A potassium level of 3.5 can be treating by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin