q5 pt 2

23. Following ureteroscopy, for the removal of ureteral calculus, a stent is temporarily left in place. The client asks what purpose the stent provides. Which is the best response from the nurse? A) "The stent is coated with an antiinfective to promote healing." B) "The stent will catch any debris or blood clots left behind." C) "The stent will provide easier passing of future stones." D) "Inflammation from the stone can block the flow of urine."

Ans: D Feedback: Calculi can traumatize the lining of the ureters, resulting in inflammation and possible obstruction of urine flow. A stent is left behind to allow free-flowing urine until inflammatory process has resolved. Stent are not used for anti-infective properties or to catch debris or clots. Stents are not permanently placed for preventative measures.

19. The office nurse is providing information to a client who has experienced recurrent renal calculi. Which of the following jobs would place a client at greatest risk for calculi formation? A) Over-the-road truck driver B) Mining engineer C) Nursing instructor D) Rumba instructor

Ans: A Feedback: Calculi formation is often associated with immobility and/or stasis of urine. Working as an OTR truck driver requires prolonged sitting. Mining engineer, nursing instructors, and rumba dance instructors are less immobile.

5. A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? A) Hypertension B) Flank pain C) Fever D) Periorbital edema

Ans: A Feedback: Hypertension is present in approximately 75% of clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever

20. A client, who has suffered with recurrent renal calculi, has learned that the stones were composed of calcium oxalate. In providing dietary education to this client, which food contains the highest levels of oxalate and should be limited? A) Bananas B) Chocolate C) Herbal teas D) Beef

Ans: B Feedback: Because as many as 80% of all renal calculi are composed of calcium oxalate, some believe limiting the amount of oxalate taken in via diet can be helpful. Milk, chocolate, and cocoa are highest in oxalate. Black tea is also high in oxalate. Bananas, herbal tea, and beef are not indicated as high oxalate foods.

22. A nephrostomy tube is inserted in a client with a large ureteral calculus. Which is the most important consideration in providing nursing care for this client? A) Clamp the tube for no longer than 2 hours at a time. B) Maintain free, continuous urine drainage. C) Leave nephrostomy site open to the air. D) Use only sterile NSS to irrigate the tube.

Ans: B Feedback: Clamping or kinking of the tube will create backup of urine into the renal pelvis, resulting in hydronephrosis and can contribute to renal damage. Always make sure the urine is allowed to flow continuously and freely and do not irrigate. The nephrostomy tube is inserted through a stab wound and enters the kidney. A sterile dressing should be used to prevent pathogen entry.

21. A client with several calculi in the ureter is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which teaching statement by the nurse best describes the procedure? A) A scope is passed through the urethra to visualize and destroy the stones with a laser. B) After locating the calculi, a small incision is made to remove the stones. C) The stone is identified via fluoroscopy and then shock waves are used to shatter the stones. D) Once the calculi are located, a fine wire delivers shock waves to pulverize the stones.

Ans: C Feedback: ESWL is a procedure that uses 800 to 2400 shock waves aimed from outside the body toward soft tissues to dense stones. The repetition of the shock waves helps to shatter the stones into smaller particles that can be passed from the urinary tract. No incision is needed for ESWL therapy. Laser lithotripsy uses a fine wire placement to allow the laser beam to pulverize the stones.

18. A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? A) "I inherited this disorder from one of my parents." B) "The cysts can get quite large in size." C) "As long as I have one normal kidney, I should be fine." D) "If renal failure develops, I may need to consider dialysis."

Ans: C Feedback: Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.

6. A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect? A) Acute glomerulonephritis B) Ureteral stricture C) Urinary calculi D) Renal cell carcinoma

Ans: C Feedback: Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

24. Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? A) Urine output of 35 to 40 mL/hour B) Pain of 3 out of 10, 1 hour after analgesic administration C) SpO2 at 90% with fine crackles in the lung bases D) Blood tinged drainage in Jackson-Pratt drainage tube

Ans: C Feedback: The Risk for Ineffective Breathing Pattern is often a challenge in caring for clients post nephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.

7. A nurse identifies a nursing diagnosis of Risk for Ineffective Breathing Pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? A) Administer isotonic fluid therapy as ordered. B) Keep the drainage catheter below the level of insertion. C) Encourage use of incentive spirometer every 2 hours. D) Monitor temperature every 4 hours.

Ans: C Feedback: To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's

17. As the home health nurse reviews medications taken by the client with polycystic kidney disease, which medication should be addressed first? A) Lovastin (Mevacor) B) Methylprednisolone (Depo-Medrol) C) Furosemide (Lasix) D) Ibuprofen (Motrin)

Ans: D Feedback: Nephrotoxic drugs are not administered to clients with renal disease unless no other therapeutic agent is available. Ibuprofen (Motrin) is a nephrotoxic drug and nephrotoxic medications, such as nonsteroidal anti-inflammatory drugs and cephalosporin antibiotics, should be avoided in treating clients with polycystic kidney disease. Lovastin (Mevacor) (antihyperlidemic agent) and methylprednisolone (Depo-Medrol) (steroid) are drugs presently being reviewed for slowing the rate of disease progression in clients with polycystic kidney disease and are not considered nephrotoxic. Furosemide (Lasix) is a diuretic and has no significance in causing renal damage.

8. A client has undergone a renal transplant and returns to the healthcare agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? A) Hypotension B) Weight loss C) Polyuria D) Abdominal pain

Ans: D Feedback: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.