Renal, Reproductive and Infectious Diseases (EAQ's) - JG Orig

Sporozoa

A group of protozoans that do not have organelles for movement and are parasites.

are cup-like structures of the kidney present at the end of each papilla that collect urine.

Calices

According to Swanson's caring process, the nurse must know the client. Which factors enable the nurse to know the client better? Select all that apply.

Continuity of care by the nursing staff Collection of data about the client's clinical condition Engagement in a caring relationship without assumptions

The urinalysis report of a client reveals cloudy urine. What does a nurse infer from the client's report?

The client has a urinary infection. R: The urine becomes cloudy when an infection is present *due to the presence of leukocytes*. Therefore the nurse concludes that the client has a urinary infection.

The presence of ketones indicates

diabetic ketoacidosis.

Spirochetes are spiral-shaped bacteria; these microorganisms may cause

leprosy and syphilis.

Juxtaglomerular cells secrete

renin.

The presence of crystals in the urine indicates

that the specimen had been allowed to stand.

A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy?

"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion." Diffusion [1] [2] moves particles from an area of greater concentration to an area of lesser concentration; osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.

A nurse is caring for a client with end-stage renal disease. Which clinical indicators of end-stage renal disease should the nurse expect? Select all that apply.

*Azotemia* is an increase in nitrogenous waste, particularly urea, in the blood; this is common in end-stage renal disease. *Hypertension* occurs as a result of fluid and sodium overload and dysfunction of the rennin-angiotensin-aldosterone system. Excessive nephron damage in end-stage renal disease 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 end-stage renal disease. Anemia, not polycythemia, occurs because of decreased erythropoietin, decreased red blood cell (RBC) production, and decreased RBC survival time.

A nurse reviews the history of a client who is hospitalized with a diagnosis of urinary calculi and identifies that which factor may have contributed to the development of the calculi?

*Hyperparathyroidism* results in high serum calcium levels; as the blood is filtered through the nephron, precipitates of calcium may form calculi. Increased fluid intake will discourage stone formation by preventing stagnation of urine. A urine specific gravity of 1.017 is within the expected range of 1.010 to 1.030 and will not increase the risk of developing urinary calculi. A jogging schedule of 3 miles (4.8 km) daily reduces the risk of developing urinary calculi; activity improves glomerular filtration and inhibits calcium from leaving the bone.

Which organism causes malaria?

*Sporozoa* such as Plasmodium malariae cause malaria.

The nurse is caring for a client who got discharged from the hospital. The nurse finds that the client is having difficulty in determining which medications to take. What would be the best nursing intervention in this situation?

*The nurse should recommend the client's pharmacist to re-label the medications in large letters so that the client can easily read the name of the medicine and can take the medications properly*. The nurse should show the client examples of pill organizers that will help the client to sort the medications by the time of day for a period of seven days. The nurse does not need to fill the medication bottles or label because this action is already done by pharmacist when the client picks up the medicine from the pharmacy. Because the caregiver will not be with the client all day, the client should learn to take medication on his or her own.

What four organisms cause malaria?

1. Plasmodium vivax 2. Plasmodium ovale 3. Plasmodium falciparum 4. Plasmodium malariae

Presence of bilirubin in the urine indicates

1. anorexia nervosa 2. diabetic ketoacidosis 3. prolonged fasting

The nurse is caring for a client who has an implanted port and is receiving intravenous fluids. To decrease the risk of infection, the nurse should change the noncoring needle how often?

7 days Best practice guidelines indicate that noncoring needles be changed at least every 7 days to decrease risk of infection. Changing a noncoring needle every 3 to 5 days is too frequent and increases the risk for infection as well as client discomfort. Changing a noncoring needle every 9 days increases the risk of infection due to the prolonged length of time the needle is in place.

The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled into the peritoneal cavity. Which information will the nurse share with the client?

Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels R: Encouraging the removal of serum urea by preventing constriction of peritoneal blood vessels promotes vasodilation so that urea, a large-molecular substance, is shifted from the body into the dialyzing solution.

The client is scheduled for an abdominal hysterectomy with a bilateral oophorectomy. As the nurse prepares to have the client sign the informed consent, the client asks how long she should wait to become pregnant. Which action should the nurse take?

Call the primary healthcare provider immediately and hold preoperative medications. R: The primary healthcare provider should be notified immediately that the informed consent is not going to be signed because the client does not appear to understand the procedure. Bilateral oophorectomy is removal of the ovaries, and pregnancy is not possible. The primary healthcare provider should also be informed that preoperative medication is being held until the situation is worked out. An informed consent involves the primary healthcare provider telling the client in understandable terms about the diagnosis, treatment, likely outcome, alternative treatments, and possible complications. If there are questions before signing the consent, the primary healthcare provider must be contacted to provide further explanation. The nurse should ensure that the client signing the consent understands its meaning and is signing voluntarily. Clients are unable to provide consent if they have received analgesia. Having the client sign the informed consent without understanding it is an unethical action. It is not within the nurse's role to explain the surgical procedure, and it is obvious by the question asked that the client does not have all the necessary information. Telling the client that she will be unable to become pregnant after the surgery is not the nurse's responsibility

Which process does the IgD immunoglobulin support?

Differentiation of the B-lymphocytes R: IgD is present on the lymphocyte surface; this immunoglobulin differentiates B-lymphocytes. IgE causes symptoms of allergic reactions by adhering to mast cells and basophils. IgE also helps to defend the body against parasitic infections. IgA lines the mucous membranes and protects the body surfaces. IgM provides the primary immune response.

Radium inserted in the vagina of a client now is being removed. Which safety precaution should the nurse employ when assisting with the radium removal?

Ensure that long forceps are available for removing the radium R: Radium must be handled with long forceps because *distance helps limit exposure*. A nurse does not clean radium implants. Foil-lined rubber gloves do not provide adequate shielding from the gamma rays emitted by radium. The amount and duration of exposure are important in assessing the effect on the client; however, documentation will not affect safety during removal.

A child is diagnosed with hepatitis A. The client's parent expresses concern that the other members of the family may get hepatitis because they all share the same bathroom. What is the nurse's best reply?

Hepatitis A is spread via the fecal-oral route; transmission is prevented by *proper hand washing*. Buying a commode exclusively for the child's use is unnecessary; cleansing the toilet and washing the hands should control the transmission of microorganisms. It is not feasible to clean "from top to bottom" each time the bathroom is used. The use of disposable toilet covers is inadequate to prevent the spread of microorganisms if the bathroom used by the child also is used by others. Hand washing by all family members must be part of the plan to prevent the spread of hepatitis to other family members.

A nurse is caring for a client who is human immunodeficiency virus (HIV) positive. Which complication associated with this diagnosis is most important for the nurse to teach prevention strategies?

Infection R: The client has a weakened immune response. Instructions regarding rest, nutrition, and avoidance of unnecessary exposure to people with infections help reduce the risk for infection. Clients can be taught cognitive strategies to cope with depression, but the strategies will not prevent depression. The client may experience social isolation as a result of society's fears and misconceptions; these are beyond the client's control. Although Kaposi sarcoma is related to HIV infection, there are no specific measures to prevent its occurrence.

The registered nurse discusses normal renal function with the client. Which statements made by the client are correct regarding regulatory functions of the kidney? Select all that apply.

Maintaining the *acid-base balance* of the body by selectively reabsorbing and secreting certain substances from the blood is a regulatory function of the kidneys. The kidneys also perform the regulatory function of *electrolyte balanc*e by regulating the reabsorption of certain electrolytes while eliminating others depending on their levels in the serum. The kidneys perform hormonal function by secreting a hormone called erythropoietin that aids in synthesis of red blood cells (erythropoiesis). Activation of vitamin D is a hormonal function of the kidneys. The kidneys perform hormonal function by secreting the hormone renin that assists in blood pressure control.

Which urinalysis finding indicates a urinary tract infection?

Presence of leukoestrases *Leukoesterases* are released by white blood cells as a response to an infection or inflammation. Therefore, the presence of this chemical in urine indicates a urinary tract infection.

A client spends several minutes making negative comments to the nurse about numerous aspects of the hospital stay. What is the nurse's best initial response?

Refocusing the conversation on the client's fears, frustrations, and anger about the condition provides an opportunity for the client to verbalize the feelings underlying the behavior. Describing the purpose of different hospital therapies will have no effect on decreasing the client's anxiety or on allowing ventilation of feelings. Explaining that becoming so upset dangerously blocks the need for rest will not decrease anxiety so that the client can rest. Although allowing release of feelings is therapeutic, leaving denies the client the opportunity for verbalization and discussion.

A nurse is providing colostomy care to a client with a nosocomial infection caused by methicillin-resistant Staphylococcus aureus (MRSA). Which personal protective equipment (PPE) should the nurse use? Select all that apply.

Standard PPE, which should be used for performing colostomy care in a client positive for MRSA, includes gloves, gown, and goggles. A combination mask/eye shield may be used when caring for this client; however, a mask is not necessary. A mask would be necessary if the client had MRSA of the nares. Shoe covers and hair bonnet are not required for the client care situation described.

Why is a Neisseria gonorrhoeae infection particularly troublesome for a female client?

Symptoms are often overlooked R: Many female clients who contract gonorrhea are asymptomatic or have minor symptoms that are often overlooked, making it possible for them to remain a source of infection. The infection can be treated with one intramuscular injection of *ceftriaxone*.

Difference b/t protozans and sporozoans

The fifth Phylum of the Protist Kingdom, known as Apicomplexa, gathers several species of obligate intracellular protozoan parasites classified as Sporozoa or Sporozoans, because they form reproductive cells known as spores. Many sporozoans are parasitic and pathogenic species, such as Plasmodium (P. falciparum, P. malariae, P. vivax), Toxoplasma gondii, Pneumocysts carinii, Coccidian, Babesia, Cryptosporidum (C. parvum, C. muris), and Gregarian. The Sporozoa reproduction cycle has both asexual and sexual phases. The asexual phase is termed schizogony (from the Greek, meaning generation through division), in which merozoites (daughter cells) are produced through multiple nuclear fissions. The sexual phase is known as sporogony (i.e., generation of spores) and is followed by gametogony or the production of sexually reproductive cells termed gamonts. Each pair of gamonts form a gamontocyst where the division of both gamonts, preceded by repeated nuclear divisions, originates numerous gametes. Gametes fuse in pairs, forming zygotes that undergo meiosis (cell division), thus forming new sporozoites. When sporozoites invade new host cells, the life cycle starts again. This general description of Sporozoan life cycle has some variation among different species and groups. Sporozoans have no flagellated extensions for locomotion, with most species presenting only gliding motility, except for male gametes in the sexual phase, which have a flagellated stage of motility. All Sporozoa have a cellular structure known as apical complex, which gave origin to the name of the Phylum, i.e., Apicomplexa. Sporozoa cellular organization consists of the apical complex, micropore, longitudinal microtubular cytoskeleton, and cortical alveoli. The apical complex consists of cytoskeletal and secretory structures forming a conoid (a small open cone), polar wings that fix the cytoskeletal microtubules, two apical rings, and secretory vesicles known as micronemes and rhoptries. The apical complex enables Sporozoans to invade the host cells.

Arrange the events of communication throughout the nursing process in chronological order.

The first step of communication throughout the nursing process is assessment, which involves assessing medical records and diagnostic tests. The second step is nursing diagnosis, which involves the intrapersonal analysis of assessment findings. The third step is planning, which involves the documentation of expected outcomes. The fourth step is implementation, which involves performing verbal, visual, auditory, and tactile health teaching activities. The final step is evaluation, which involves identifying the factors affecting the outcomes.

is the initial part of the nephron, which filters blood to make urine.

The glomerulus

curved-rod-shaped bacteria; these microorganisms causes cholera.

Vibrio

When assessing a client's blood pressure, the nurse notes that the blood pressure reading in the right arm is 10 mm Hg higher than the blood pressure reading in the left arm. The nurse understands what about this finding?

When auscultating blood pressures, readings between the arms can vary as much as 10 mm Hg and are often higher in the right arm. Readings that differ by 15 mm Hg or more suggest atherosclerosis or disease of the aorta. Lymphedema is swelling in one or more extremities that is the result from impaired flow of the lymphatic system.

The nurse reviews the medical record of a client who is eligible to receive end-of-life care. What are the criteria for a client to receive this type of care? Select all that apply.

When the expected death of the client is within 6 months When the client seeks no aggressive disease management When the client has been issued a "do not resuscitate" order R: Clients who do not seek aggressive disease management and are expected to die in a span of 6 months are eligible for end-of-life care. The client may require end-of-life care when he or she has signed a "do not resuscitate" order. A client who is nearing death may not receive end-of-life care; instead, the client receives comfort care. An informed consent form signed by a family member is not necessary for the client to receive end-of-life care.

an abnormal absence of menstruation.

amenorrhea

A nurse educates the client about the relationship between the kidneys and blood pressure. Which term should the nurse use to describe the part of the kidney that senses changes in blood pressure?

macula densa R: The macula densa, a part of the distal convoluted tubule, consists of cells that sense changes in the volume and pressure of blood.

Ringworm such as tinea corporis may cause

mycotic infections.

dysmenorrhea

painful menstruation

What is plasmodium?

protozoan that causes malaria and destroys red blood cells

Renin is produced when

sensing cells in the macula densa sense changes in blood volume and pressure.