Saunders: Renal

A client with end stage kidney disease (ESKD) begins peritoneal dialysis. The nurse observes for which signs/symptoms indicating peritonitis? Select all that apply. 1. Nausea and vomiting 2. Poor dialysate outflow 3. Abdominal tenderness 4. Cloudy peritoneal effluent 5. Oral temperature of 38° C 6. Clear fluid leakage at the catheter exit sit

Answer: 1. Nausea and vomiting 3. Abdominal tenderness 4. Cloudy peritoneal effluent 5. Oral temperature of 38° C Rationale: Peritoneal dialysis is a treatment used in clients with ESKD as an alternative to hemodialysis. The procedure involves the instillation of dialysate fluid into the peritoneal cavity where excess body wastes, fluid, and electrolytes are removed through diffusion and osmosis across the semipermeable peritoneal membrane and peritoneal capillaries. A peritoneal catheter is surgically placed into the abdominal cavity and is used to instill and drain the dialysate fluid, known as effluent. Peritonitis, or infection of the peritoneal cavity, is a possible complication of peritoneal dialysis. The effluent becomes cloudy instead of the normal clear straw color, and the client has symptoms of abdominal tenderness and pain, nausea, vomiting, and fever. Thirty-eight degrees Celsius is an elevated temperature indicating fever, a sign of infection. Poor dialysate outflow is usually caused by constipation. Leakage of clear fluid at the exit site of the peritoneal catheter is more likely to occur in obese or diabetic clients. It occurs as the client physiologically adjusts to the instillation of 2 L of dialysate fluid into the abdominal cavity.

A client who had a prostatectomy has learned perineal exercises to gain control of the urinary sphincter. The nurse determines that the client needs further teaching if the client states that he will perform which action as part of these exercises? 1. Perform the Valsalva maneuver. 2. Tighten the muscles as if trying to prevent urination. 3. Contract the abdominal, gluteal, and perineal muscles. 4. Tighten the rectal sphincter while relaxing abdominal muscles.

Answer: 1. Perform the Valsalva maneuver. Rationale: The Valsalva maneuver is avoided following prostatectomy because it increases the risk of bleeding in the postoperative period. An acceptable exercise is tightening the abdominal, gluteal, and perineal muscles, as if trying to prevent urination. Another acceptable exercise is tightening the rectal sphincter while relaxing the abdominal muscles; this prevents the Valsalva maneuver from occurring.

A client with acute kidney injury (AKI) has been treated with sodium polystyrene sulfonate (Kayexalate) by mouth. The nurse evaluates this therapy as effective if which value is noted on follow-up laboratory testing? 1. Potassium, 4.9 mEq/L 2. Sodium, 142 mEq/L 3. Calcium, 9.8 mg/dL 4. Phosphorus, 3.9 mg/dL

Answer: 1. Potassium, 4.9 mEq/L Rationale: Of all the electrolyte imbalances that accompany renal failure, hyperkalemia is the most dangerous because it can lead to cardiac dysrhythmias and death. If the potassium level rises too high, sodium polystyrene sulfonate may be given to cause excretion of potassium through the gastrointestinal tract. Each of the electrolyte levels noted in the question falls within the normal reference range for that electrolyte. The potassium level is measured following administration of this medication to note the extent of its effectiveness.

A client tells the nurse she completed an educational program to manage her stress incontinence but is now discouraged. Which information from the client indicates the need for further teaching? Select all that apply. 1. She performs the Kegel exercises every other day. 2. She quit drinking coffee with cream but drinks diet cola. 3. She has decreased her caloric and fat intake to lose weight. 4. She maintains her fluid intake to 3000mL of fluid daily. 5. She has begun an exercise program that includes lifting weights.

Answer: 1. She performs the Kegel exercises every other day. 2. She quit drinking coffee with cream but drinks diet cola. 5. She has begun an exercise program that includes lifting weights. Rationale: With stress incontinence, the client loses a small amount of urine involuntarily during activities that increase abdominal pressure, such as coughing, jogging, or lifting weights. This is due to weakened pelvic muscles and the inability to tighten the urethra enough to counteract bladder contraction. Kegel exercises, in which the woman contracts and relaxes the pelvic muscles to regain muscle tone should be done on a daily basis and may take up to 3 months before yielding positive results. Clients should avoid caffeine and alcohol that stimulate bladder contraction. Diet cola likely contains caffeine. The exercise program involving weight lifting also increases abdominal pressure, leading to incontinence. The client is correct to lose weight (source for increased abdominal pressure) and maintaining adequate fluid intake.

Which statements indicate an understanding of the necessary dietary modifications of a client diagnosed with chronic kidney disease? Select all that apply. 1. "I should avoid coffee, and tea is preferable." 2. "I should avoid eggs, and a bagel is preferable." 3. "I should avoid salt, and soy sauce is preferable." 4. "I should avoid salt, and salt substitutes are preferable." 5. "I should consume approximately 40 g of protein daily." 6. "I should avoid carbonated sodas, and milk is preferable."

Answer: 2. "I should avoid eggs, and a bagel is preferable." 5. "I should consume approximately 40 g of protein daily." Rationale: Protein restriction is necessary in clients with chronic kidney disease because urea nitrogen and creatinine are the end products of protein metabolism, and clients with renal failure cannot excrete these waste products. Generally, clients with chronic kidney disease are placed on 40 g of daily protein restriction. Therefore, a bagel would be preferable to eggs in a protein-restricted diet. The client should avoid salt; however, a salt substitute is not an appropriate alternative because salt substitutes contain large amounts of potassium, and clients with chronic kidney disease commonly are on sodium and potassium restrictions. Tea and coffee both contain caffeine; therefore, one is not a good substitute for the other. Milk contains protein, and its consumption should be curtailed in a protein-restricted diet. The client should avoid salt, and soy sauce contains large amounts of salt.

The nurse is reinforcing dietary instructions to a client with renal calculi who must learn to eat an alkaline-ash diet. The nurse determines that the client has properly understood the information presented if the client chooses which selection from a diet menu? 1. Chicken, potatoes, and cranberries 2. A spinach salad, milk, and a banana 3. Peanut butter sandwich, milk, and prunes 4. Linguini with shrimp, tossed salad, and a plu

Answer: 2. A spinach salad, milk, and a banana Rationale: In an alkaline-ash diet, all fruits are allowed except cranberries, prunes, and plums. Options 1, 3, and 4 represent an acid-ash diet.

The nurse is caring for a client who had a renal biopsy. Which interventions should the nurse include in the plan of care for the client after this procedure? Select all that apply. 1. Restricting fluids during the first 24 hours 2. Administering pain medication as prescribed 3. Monitoring vital signs and the puncture site frequently 4. Testing serial urine samples with dipsticks for occult blood 5. Ambulating the client in the room and hall for short distances

Answer: 2. Administering pain medication as prescribed 3. Monitoring vital signs and the puncture site frequently 4. Testing serial urine samples with dipsticks for occult blood Rationale: After renal biopsy, the nurse ensures that the client remains in bed for at least 24 hours. Vital signs and puncture site assessments are done frequently during this time. Encouraging fluids is done to reduce possible clot formation in the kidney and urinary tract. A Hematest is done on serial urine samples with urine dipsticks to evaluate bleeding. Analgesics are often needed to manage the renal colic pain that some clients feel after this procedure.

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. Contact the health care provider (HCP). 2. Check the level of the drainage bag. 3. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. 6. Increase the flow rate of the peritoneal dialysis solution.

Answer: 2. Check the level of the drainage bag. 3. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. Rationale: If 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 on 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. There is no reason to contact the HCP. Increasing the flow rate is an inappropriate action and is unassociated with the amount of outflow solution.

A client, who had experienced significant blood loss in an automobile crash, was admitted to the hospital 2 days earlier. The nurse observes the client for which signs/symptoms that indicate acute kidney injury (AKI)? Select all that apply. 1. Hematuria 2. Elevated urine specific gravity 3. Severe spasmodic pain radiating to the groin area 4. Rising serum blood urea nitrogen (BUN) and creatinine levels 5. Urine output averaging 25 mL per hour while receiving an intravenous infusion at 150 mL/hour

Answer: 2. Elevated urine specific gravity 4. Rising serum blood urea nitrogen (BUN) and creatinine levels 5. Urine output averaging 25 mL per hour while receiving an intravenous infusion at 150 mL/hour Rationale: Any condition that interrupts blood flow to the kidneys may cause AKI due to a prerenal etiology. Correcting fluid and blood deficits improves blood flow to the kidneys and prevents or treats AKI. Signs associated with AKI include low urinary output of concentrated urine (elevated specific gravity). The BUN and creatinine rise to levels above normal because the kidneys are not effective in clearing the waste products from the body. Hematuria and spasmodic pain are associated with urolithiasis. Hematuria occurs with multiple renal conditions including cancerous tumors in the urinary system and renal trauma.

The nurse is providing dietary instructions to a client with renal calculi, and the laboratory analysis has revealed that the calculus is composed of uric acid. The nurse tells the client that it would be helpful to make which dietary changes? 1. Increase intake of seafood in the diet. 2. Increase intake of legumes in the diet. 3. Include organ meat type foods in the diet. 4. Increase intake of cranberries and citrus fruits.

Answer: 2. Increase intake of legumes in the diet. Rationale: Dietary instructions to the client with a uric acid type kidney stone include increasing legumes, green vegetables, and fruits (except prunes, grapes, cranberries, and citrus fruits) to increase the alkalinity of the urine. The client should also be instructed to decrease purine sources such as organ meats, gravies, red wines, goose, venison, and seafood.

The nurse is caring for a client who received a recent kidney transplant. Besides actual rejection of the transplant, which are some of the most important complications this client is at risk for? Select all that apply. 1. Colitis 2. Malignancies 3. Respiratory disease 4. Cardiovascular disease 5. Susceptibility to infection 6. Corticosteroid-related complications

Answer: 2. Malignancies 4. Cardiovascular disease 5. Susceptibility to infection 6. Corticosteriod-related complications Rationale: Rejection is one of the major problems of kidney transplant recipients. Besides recurrence of renal disease, kidney transplant clients are also at risk for malignancies, cardiovascular disease caused by atherosclerotic vascular disease, infection, and corticosteroid-related complications. Incidences of infection usually occur within the first month of transplant.

A client has epididymitis as a complication of a urinary tract infection (UTI). The nurse is giving the client instructions to prevent a recurrence. The nurse determines that the client needs further teaching if the client states the intention to do which? 1. Drink increased amounts of fluids. 2. Limit the force of the stream during voiding. 3. Continue to take antibiotics until all symptoms are gone. 4. Use condoms to eliminate risk from chlamydia and gonorrhea.

Answer: 3. Continue to take antibiotics until all symptoms are gone. Rationale: The client who experiences epididymitis from UTI should 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. Antibiotics are always taken until the full course of therapy is completed.

A client is scheduled for intravenous pyelography (IVP). Which priority nursing action should the nurse take? 1. Restrict fluids. 2. Administer a sedative. 3. Determine a history of allergies. 4. Administer an oral preparation of radiopaque dye.

Answer: 3. Determine a history of allergies Rationale: An iodine-based dye may be used during the IVP and can cause allergic reactions such as itching, hives, rash, tight feeling in the throat, shortness of breath, and bronchospasm. Checking for allergies is the priority. Options 1, 2, and 4 are unnecessary.

The client with diabetes mellitus receiving peritoneal dialysis asks the nurse why it is important to leave the dialysate infused only for a specific amount of time. The nurse responds that not adhering to the dwell time can increase the risk of the client experiencing which complication? 1. Infection 2. Fluid overload 3. Hyperglycemia 4. Disequilibrium syndrome

Answer: 3. Hyperglycemia Rationale: Dialysate contains glucose, which helps remove fluids through an osmotic gradient. An extended dwell time increases the risk of hyperglycemia in diabetic clients as a result of the absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin during peritoneal dialysis. Options 1, 2, and 4 are not associated specifically with dwell time.

A client with chlamydial infection has received instructions on self-care and prevention of further infection. The nurse determines that the client needs further teaching if the client states which? 1. I will use latex condoms to prevent disease transmission. 2. I will return to the clinic as requested for follow-up culture in 1 week. 3. I will use an antibiotic prophylactically to prevent symptoms of Chlamydia. 4. I will reduce the chance of reinfection by limiting the number of sexual partners.

Answer: 3. I will use an antibiotic prophylactically to prevent symptoms of Chlamydia. Rationale: Antibiotics are not taken prophylactically to prevent acquisition of urethritis from Chlamydia. The risk of reinfection can be reduced by limiting the number of sexual partners and by the use of condoms. In some instances, follow-up culture is requested in 4 to 7 days to confirm a cure.

Which observations by the nurse caring for clients on a hospital medical-surgical unit should be immediately reported to the health care provider? Select all that apply. 1. Pink-colored urine voided by a client admitted for urolithiasis 2. Mucous shreds noted in the urine of a client who has an ileal conduit 3. New confused mental state and pulse rate of 106 beats per minute in a 72-year-old client 4. No urinary output for 24 hours in a client who has hemodialysis 3 times weekly 5. A volume of 105 mL of urine over 4 hours in the collection bag of a 1-day postoperative client

Answer: 3. New confused mental state and pulse rate of 106 beats per minute in a 72-year-old client 5. A volume of 105 mL of urine over 4 hours in the collection bag of a 1-day postoperative client Rationale: The nurse should report the new confusion and slightly tachycardic condition of the older client because these data suggest symptoms of a urinary tract infection requiring antibiotic therapy. The nurse should report the low urinary output in the postoperative client, so interventions can be prescribed to diagnose and/or avoid acute kidney injury (AKI). Slight hematuria is an expected finding in a client with urolithiasis (renal stones). Urine with mucous shreds is an expected finding in a client with an ileal conduit because the portion of ileum that functions as the "bladder" is bowel mucosa. Some clients who receive routine hemodialysis produce small amounts of urine but others do not urinate because the kidney function is now done through hemodialysis.

The nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that the drainage from the outflow catheter is cloudy. The nurse notifies the registered nurse and plans to take which action? 1. Stop the peritoneal dialysis. 2. Institute hemodialysis temporarily. 3. Obtain a culture and sensitivity of the drainage. 4. Add antibiotics to the next several dialysis bags.

Answer: 3. Obtain a culture and sensitivity of the drainage. Rationale: When the drainage becomes cloudy, peritonitis is suspected. A culture and sensitivity is obtained, and broad-spectrum antibiotics are added to the dialysis solution as prescribed pending culture and sensitivity results. The dialysis solution may also be heparinized to prevent catheter occlusion. Some clients must switch to hemodialysis if peritonitis is severe or recurring, but the nurse does not make this decision. The peritoneal dialysis is not stopped.

The nurse is assisting in planning a diet for a client with acute kidney injury (AKI). The nurse plans to restrict which dietary component from this client's diet? 1. Fats 2. Vitamins 3. Potassium 4. Carbohydrates

Answer: 3. Potassium Rationale: In the client with renal failure, potassium intake must be restricted as much as possible (30 to 50 mEq/day). The primary mechanism of potassium removal during acute kidney injury is dialysis. Options 1, 2, and 4 normally are not restricted in the client with acute kidney injury

A client with prostatitis resulting from kidney infection has received instructions on management of the condition at home and prevention of recurrence. Which statement indicates that the client understood the instructions? 1. Stop antibiotic therapy when pain subsides. 2. Exercise as much as possible to stimulate circulation. 3. Use warm sitz baths and analgesics to increase comfort. 4. Keep fluid intake to a minimum to decrease the need to void.

Answer: 3. Use warm sitz baths and analgesics to increase comfort Rationale: 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. Antimicrobial therapy is always continued until the prescription is completely finished.

The nurse is caring for a 58-year-old client with renal failure who is on peritoneal dialysis. Which finding is considered most important by the nurse, requiring health care provider notification? Refer to chart. 1. BUN: 40mg/dL 2. Heart rate: 96 beats per minute 3. WBC 15,000 cells/mL 4. ECG: First-degree heart block

Answer: 3. WBC 15,000 cells/mL Rationale: Peritonitis is the most common complication of peritoneal dialysis and is often caused by a contamination in the system. This infection can initially be determined by an increased WBC count. It can also include abdominal pain, cloudy peritoneal fluid, fever and chills, nausea and vomiting.

A client has received instructions on self-management of peritoneal dialysis. The nurse determines that the client needs further teaching if the client makes which statement? 1. "I will monitor my weight daily." 2. "I will take my vital signs daily." 3. "I will use meticulous aseptic technique for dialysate bag changes." 4. "I will use a strong adhesive tape to anchor the catheter dressing."

Answer: 4. "I will use a strong adhesive tape to anchor the catheter dressing." Rationale: The client is at risk for impairment of skin integrity resulting from the presence of the catheter, exposure to moisture, and irritation from tape and cleansing solutions. The client should be instructed to use paper or nonallergenic tape to prevent skin irritation and breakdown. It is proper procedure for the client to use aseptic technique and to self-monitor vital signs and weight on a daily basis.

A client arrives at the ambulatory care clinic with low abdominal pain. A routine urine specimen reveals hematuria. The client does not have a fever. The nurse should next ask the client about a history of which condition? 1. Pyelonephritis 2. Glomerulonephritis 3. Renal cancer in the client's family 4. Blow or trauma to the bladder or abdomen

Answer: 4. Blow or trauma to the bladder or abdomen Rationale: Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever because they are infections. Renal cancer would cause pain in the flank area, not the low abdomen.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia (BPH), the nurse questions the client about use of which medication? 1. Diuretics 2. Antibiotics 3. Antitussives 4. Decongestants

Answer: 4. Decongestants Rationale: In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about use of these medications if presenting with urinary retention. Retention also can be precipitated by other factors, such as alcoholic beverages, infection, bed rest, and becoming chilled.

A client newly diagnosed with renal failure will be receiving peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is appropriate? 1. Stop the dialysis. 2. Slow the infusion. 3. Decrease the amount to be infused. 4. Explain that the pain will subside after the first few exchanges

Answer: 4. Explain that the pain will subside after the first few exchanges Rationale: Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, it disappears after a week or two. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.

The nurse documents that the urine collected from a client diagnosed with early stage polycystic kidney disease is dilute with a low-specific gravity. Based on this documentation, which specific gravity result was likely present? 1. 1.000 2. 1.010 3. 1.020 4. 1.030

Answer: 1. 1.000 Rationale: Specific gravity is a measure of the concentration of particles in the urine. A normal range of urine specific gravity is approximately 1.005 to 1.030. Early in polycystic kidney disease, the ability of the kidneys to concentrate urine decreases. Options 2, 3, and 4 indicate a normal range for specific gravity.

The nurse is caring for a hospitalized client following cystoscopy and is monitoring for signs of complications associated with the procedure. Which result noted in the first few hours following the procedure indicates the need to notify the registered nurse? 1. Yellow urine 2. Pink-tinged urine 3. Pale yellow urine 4. Bloody urine with clots

Answer: 4. Bloody urine with clots Rationale: The client may have clear, yellow, or pink-tinged urine after cystoscopy. Bloody urine with clots is always an abnormal finding and should be reported immediately.

A client diagnosed with chronic kidney disease is being treated at home with continuous ambulatory peritoneal dialysis. The client notes that there is a decrease in the catheter outflow following the prescribed 6-hour dwell time and calls the nurse to report this occurrence. The nurse should reinforce instructing the client to take which action? 1. Ambulate in the home. 2. Immediately notify the health care provider. 3. Perform straight catheterization of the bladder. 4. Flush the peritoneal catheter with a thrombolytic medication.

Answer: 1. Ambulate in the home Rationale: The most common causes of decreased outflow of dialysate in peritoneal dialysis are displacement and obstruction of the catheter. Obstruction may be a result of malposition, adherence of the catheter tip to internal organs, constipation, or infection. The client with decreased catheter outflow should first attempt to displace the catheter tip from internal organs by changing positions or walking. This may be a simple solution to the problem. If the client has been constipated, treatment of the constipation would be necessary. The health care provider need not be notified immediately, unless the client is exhibiting signs of infection or if attempts to noninvasively clear the obstruction are not effective. Straight catheterization of the bladder will not alleviate this problem, and the client should never instill any type of medication into the catheter besides the medications contained in the dialysate solution.

The nurse must ambulate a client who has a nephrostomy tube attached to a drainage bag. The nurse plans to do this most safely and effectively by performing which action? 1. Changing the drainage bag to a leg collection bag 2. Hanging the drainage bag from a walker while ambulating 3. Tying the drainage bag to the client's waist while ambulating 4. Asking the client to hold the drainage bag lower than the level of the bladder

Answer: 1. Changing the drainage bag to a leg collection bag Rationale: The safest approach to protect the integrity and safety of the nephrostomy tube with a mobile client is to attach the tube to a leg collection bag. This allows for greater freedom of movement while alleviating worry over accidental disconnection or dislodgement. The other options do not present the most safe and effective methods to ensure the integrity of the tube.

The nurse is collecting data on a newly admitted client with a diagnosis of bladder cancer. Which sign/symptom should be noted first? 1. Dysuria 2. Urgency 3. Frequency 4. Hematuria

Answer: 4. Rationale: Gross, painless hematuria is most frequently the first manifestation of bladder cancer. As the disease progresses, the client may experience dysuria, frequency, and urgency.

An alkaline-ash diet is prescribed for a client with renal calculi. Which diet menu does the nurse advise the client to select? 1. Chicken, rice, and cranberries 2. A spinach salad, milk, and a banana 3. Peanut butter sandwich, milk, and prunes 4. Pasta with shrimp, tossed salad, and a plum

Answer: 2. A spinach salad, milk, and a banana Rationale: In an alkaline-ash diet, all fruits are allowed except cranberries, prunes, and plums. The fruits in options 1, 3, and 4 are eliminated in an acid-ash diet.

A male client has a history of urinary tract infections due to urinary retention. Which intervention should the nurse implement to decrease the risk of infection? 1. Assist the client to stand for voiding. 2. Withhold oral fluids after 6:00 ᴘᴍ daily. 3. Teach the client to wash his hands properly. 4. Ask the client to take his temperature daily.

Answer: 1. Assist the client to stand for voiding. Rationale: Most men are conditioned to urinate from a standing position, so a reasonable strategy is to assist the client to a standing position to increase the chance of emptying the bladder. This will decrease the risk of infection as the bladder empties more completely. Withholding fluids after 6:00 ᴘᴍ may improve client sleep but is harmful and is more likely to increase than decrease the risk of bladder infection. Thorough hand washing is always suitable for client teaching; however, bladder contamination from the client's hands is not the problem. Monitoring the temperature will not prevent infection but aids in the early detection of infection.

The nurse is speaking with a client who underwent a minimally invasive procedure treatment for recurrent urolithiasis. Which instructions are appropriate to reinforce in the teaching plan? Select all that apply. 1. Drink at least 3000 mL of fluid each day. 2. Expect some intermittent hematuria to occur. 3. Complete the full course of prescribed antibiotics. 4. Take acetaminophen (Tylenol) if chills and fever occur. 5. Filter urine and collect any stones to take to the urological health care provider.

Answer: 1. Drink at least 3000 mL of fluid each day. 3. Complete the full course of prescribed antibiotics. 5. Filter urine and collect any stones to take to the urological health care provider. Rationale: Kidney stones or urolithiasis is often treated with minimally invasive surgical procedures that may include placement of a stent. The stent allows passage of the stone without further irritation of the ureter. Clients should drink at least 3 L of fluid to promote passage of the stone and prevent future stone formation. Filtering the urine and retrieving the stone allows stone analysis. Further preventive treatment is prescribed based on the type of stone. It is important that clients complete the course of prescribed antibiotics to prevent infection after the procedure. Clients should contact the urologic health care provider if hematuria or fever occur and not self-treat.

The nurse suspects the client has a urinary tract infection (UTI). Which signs/symptoms suggest a UTI? Select all that apply. 1. Dysuria 2. Hematuria 3. Frequency 4. Flank pain 5. Polydipsia 6. Cloudy urine

Answer: 1. Dysuria 2. Hematuria 3. Frequency 4. Flank pain 6. Cloudy urine Rationale: Dysuria, which may be pain or burning on urination, is often the first symptom. Hematuria is caused by irritation to tissue irritation in the urinary system. Frequency is symptomatic of bladder irritation. Flank pain accompanies infection that has spread to the kidneys. Cloudy urine is caused by bacteria and white blood cells. Polydipsia is not associated with a UTI but rather with diabetes mellitus.

A client who suffered a crush injury to the leg has a highly positive urine myoglobin level. The nurse plans to monitor this particular client carefully for signs of which complication? 1. Respiratory failure 2. Brain attack (stroke) 3. Myocardial infarction 4. Acute tubular necrosis

Answer: 4. Acute tubular necrosis Rationale: The normal urine myoglobin level is negative. After extensive muscle destruction or damage, myoglobin is released into the bloodstream, where it is cleared from the body by the kidneys. When a large amount of myoglobin is being cleared from the body, the renal tubules may become clogged with myoglobin, which causes acute tubular necrosis. This is one form of acute kidney injury.

A client with chronic kidney disease 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. Which does this data indicate? 1. Advancing uremia 2. Phosphate overdose 3. Folic acid deficiency 4. Aluminum intoxication

Answer: 4. Aluminum intoxication Rationale: 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.

The 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 should ask the client about the presence of which early symptom? 1. Nocturia 2. Urinary retention 3. Urge incontinence 4. Decreased force in the stream of urine

Answer: 4: Decreased force in the stream of urine. 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.