urinary kidney, ureter, bladder, urethra , nephron

Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure? 1 Diarrhea 2 Anuria 3 Vomiting 4 Oliguria

4 Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders.

Bladder cancer 3 diagnosis cystoscopy, CT scan, BIOPSY; ultrasonography

4 Management 1 depend on grade, degree of invasion, age, physical, mental status 2 cystectomy with urinary diversion # wear special external applicance

TURP A client undergoes TURP for BPH. The client has a 28 Fr, 30-mL balloon, 3-way Foley catheter with continuous bladder irrigation. Which finding by the nurse best indicates that the bladder irrigation is running at an adequate rate? 1 BP 120/80mmHg; pulse 80/min # normal, hemodynamic stability 2 Intake 3200mL. output 3000mL 3 Lack of bladder spasms 4 Output urine is light pink in color

4 Output urine is light pink in color # indicates an adequate rate irrigation

The nurse reinforces teaching about self-management strategies for a client with urge incontinence. Which of the following statements indicate that teaching has been effective? SATA 1 join a walking program to lose excess weight 2 may have dry mouth as a SE of oxybutynin 3 need caffeine in the morning 4 perform Kegel exercise several times daily 5 will void Q2H until having fewer accident

1245 ex Management of urge incontinence includes loss of excess weight, anticholinergic medications (eg, oxybutynin), avoidance of bladder irritants, pelvic floor exercises, and bladder training. Dry mouth is a common adverse effect of anticholinergic medications.

You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining? 1 Ask the patient to cough. 2 Check for kinks in the outflow tubing. 3 Place the patient in a reverse Trendelenburg position. 4 Raise the drainage bag above the level of the abdomen.

2 Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions moving side to side or sitting up, applying gentle pressure over the abdomen, or having a bowel movement

The most indicative test for prostate cancer is: 1. Magnetic resonance imaging (MRI) 2. Prostate-specific antigen 3. Excretory urography 4. A thorough digital rectal examination

2 An elevated prostate-specific antigen level indicates prostate cancer, but it can be falsely elevated if done after the prostate gland is manipulated. A digital rectal examination should be done as part of the yearly screening, and then the antigen test is done if the digital exam suggests cancer. MRI is used in staging the cancer.

Which sign indicated the second phase of acute renal failure? 1. Urine output less than 100 ml/day 2. Daily doubling of urine output (4 to 5 L/day) 3. Urine output less than 400 ml/day 4. Stabilization of renal function

2 Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.

Immediately post-op after a prostatectomy, which complications requires priority assessment of your patient? 1. Deep vein thrombosis 2. Hemorrhage 3. Urine retention 4. Pneumonia

2 Hemorrhage is a potential complication. Urine retention isn't a problem soon after surgery because a catheter is in place. Pneumonia may occur if the patient doesn't cough and deep breathe. Thrombosis may occur later if the patient doesn't ambulate

Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient? 1. The patient shouldn't feel pain during initiation of dialysis 2. Taking a blood pressure reading on the affected arm can cause clotting of the fistula 3. The patient feels best immediately after the dialysis treatment 4. Using a stethoscope for auscultating the fistula is contraindicated

2 Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm.

You're planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include? 1. "Take this drug between meals and at bedtime." 2. "Your urine might turn bright orange." 3. "You need to take this antibiotic for 7 days." 4. "Don't take this drug if you're allergic to penicillin."

2 The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.

Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? 1 Administer a 5% dextrose solution 2 Infuse normal saline solution 3 Increase the rate of dialysis 4 Encourage active ROM exercises

2 ex because muscle cramps can occur when the sodium and water are removed to quickly during dialysis, so treatment includes: 1 administering normal saline or hypertonic normal saline solution 2 Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.

You suspect kidney transplant rejection when the patient shows which symptoms? 1 Pain in the incision, general malaise, and depression 2 Fever, weight gain, and diminished urine output 3Pain in the incision, general m alaise, and hypotension 4 Diminished urine output and hypotension

2 Symptoms of rejection include fever, rapid weight gain, hypertension, pain over the graft site, peripheral edema, and diminished urine output.

Which patient is at greatest risk for developing a urinary tract infection (UTI)? 1 A 20 y.o. woman with asthma 2 A 50 y.o. postmenopausal woman 3 A 28 y.o. with angina 4 A 35 y.o. woman with a fractured wrist

2 Women are more prone to UTI's after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Angina, asthma and fractures don't increase the risk of UTI.

TURP BPH Transurethral resection Prostatectomy TURP 1 surgical remove prostate @ TURP with risk of Bleeding complication # REPORT MD if hematuria; hemoglobin, hematocrit 2 continuous Bladder Irrigation # initiated after the PURP to apply direct pressure on the bleeding & allow urine to drain # urine remains Light Pink without Clot @ indicates an irrigation adequate rate 3 anticholinergic Oxybutynin Ditropan # muscle relax to treat muscle spasm after TURP & catheter in place

2 HoLEP # laser enucleation of prostate advantage # little blood loss # safe if taking anticoagulants

Anticholinergic - Antispasmodics 1 medsm Darifenacin ▪ Dicyclomine ▪ Oxybutynin chloride ▪ Flavoxate ▪ Mirabegron ▪ Propantheline ▪ Solifenacin ▪ Tolterodine ▪ Trospium + treat overactive bladder # urge incontinence

2 SE anticholinergic syndrome e.g dry mouth, blurries vision, constipation, headache, dizziness, drowsiness, GI distress, tachycardia, urinary retention

Bladder cancer 1 risk factor SMOKE, carcinogen toxic exposure e.g certain dyes; recurrent bacterial UTI; high cholesterol & artificial sweetener intake; Pelvic radiation; family hx

2 SS painless hematuria; infection; dysuria; frequency urinary; PAIN in Pelvic & BACK with metaStasis # spread out cancer tissue

The nurse is reinforcing teaching on nutritional therapy for a client with CKD. Which statement indicates that further teaching is needed? 1 avoid canned soups & cold cut sandwiches 2 restrict Na+ & K+; but use salt substitute 3 avoid eating raw carrot & tomatoes on salad due to hemodialysis treatment 4 popsicles counted as liquid intake

2 restrict Na+ & K+; but use salt substitute # need further teaching Ex CKD management renal diet e.g restrict fluid/ Na+/K+/P+ # no salt substitute

The nurse is caring for a client with overflow urinary incontinence related to diabetic neuropathy. Which of the following interventions are appropriate? SATA 1 decrease fluid intake to 1 glass with each meal & HS 2 encourage to bear down while attempting to void 3 inspect perineal area for skin breakdown 4 measure postvoid residual volume as prescribed 5 wait 30 sec after voiding & then attempt to void again

2, 3, 4 ,5 ex option 1 # Fluid restriction can lead to dehydration with concentrated urine, which irritates the bladder and increases the risk for urinary tract infection. Dehydration also contributes to constipation, which worsens incontinence by compressing the bladder.

2 Hemodialysis 21 synthetic semipermeable membrane via vascular access e.g subclavian, jugular, femoral, arteriovenous AV via fistula or arteriovenous graft shunt ++ NO check BP or perform Venous stick # blood withdraw IV during VASCULAR ACCESS to prevent severe damage

22 complication infection, Hypotension, cramps, febrile reaction; N/; disequilibrium syndrome e.g cerebral edema # confuse & irritability => require slowing or discontinue dialysis+ Osmitrol mannitol use ++ NO rapid acting antiHPT prior to hemodialysis to prevent SHOCK => check with MD for alternative meds for scheduled hemodialysis

A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in this patient's diet? 1 Fats 2 Vitamin C 3 Protein 4 Carbohydrates

3 Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so this patient's protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patient's tissues.

Which intervention do you plan to include with a patient who has renal calculi? 1 Increase dietary purines 2 Restrict fluids 3 Strain all urine 4 Maintain bed rest

3 All urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Ambulation may help the movement of the stone down the urinary tract. Encourage fluid to help flush the stones out

Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? 1 Take frequent baths 2 Apply alcohol-based emollients to the skin 3 Keep fingernails short and clean 4 Rub the skin vigorously with a towel

3 Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the risk of infection.

Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? 1. Jaundice and flank pain 2. Polyuria and nocturia 3. Costovertebral angle tenderness and chills 4. Burning sensation on urination

3 Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection.

Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect? 1 Air embolus 2 Infection 3 Disequilibrium syndrome 4 Acute hemolysis

3 Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.

What is the best way to check for patency of the arteriovenous fistula for hemodialysis? 1 Pinch the fistula and note the speed of filling on release 2 Use a needle and syringe to aspirate blood from the fistula 3 Palpate the fistula throughout its length to assess for a thrill 4 Check for capillary refill of the nail beds on that extremity

3 The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent blood flow. Pinching the fistula could cause damage. Aspirating blood is a needless invasive procedure.

What change indicates recovery in a patient with nephritic syndrome? 1. Gain in body weight 2. Decrease in blood pressure to normal 3. Disappearance of protein from the urine 4. Increase in serum lipid levels

3 With nephrotic syndrome, the glomerular basement membrane of the kidney becomes more porous, leading to loss of protein in the urine. As the patient recovers, less protein is found in the urine.

Your patient has complaints of severe right-sided flank pain, nausea, vomiting and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi? 1 History of mild flu symptoms last week 2 Pain radiating to the right upper quadrant 3 Dark, scant urine output 4 Dark-colored coffee-ground emesis

3 Patients with renal calculi commonly have blood in the urine caused by the stone's passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant.

AVF major complication are Infection especially ESKD & diabetes; stenosis; thrombosis; hemorrhage intervention 1 report extremities numbness, tingling to prevent neuromuscular damage 2 DO NOT allow anyone other than dialysis personnel to draw blood or take BP to prevent thrombosis

3 Avoid wear restrictive clothing or jewelry 4 do not carry object >5lbs; however, exercise squeezing soft ball or a sponge several times a day 5 check vascular fx several time a day by feeling for vibration to assess for patency, stenosis, clotting

Urinary calculi Management 1 Use of IV fluids 2 Pain management 6 Dietary alterations for those with recurring calcium, uric acid, or oxalatestones

3 ECSWL Extracorporeal shock wave lithotripsy 4 Straining the urine to detect passage of the stone 5 Surgical management e.g stenting, ureteroscopy, percutaneous ureterolithotomy, percutaneous nephrolithotomy

TLS Tumor Lysis Syndrome 1 occurs due to rapid lysis of cells and the resulting release of intracellular potassium and phosphorus into serum. 2 Phosphorus binds to calcium, leading to hypocalcemia. The breakdown of cellular nucleic acids causes severe hyperuricemia. .

3 IV hydration and hypouricemic medications eg, allopurinol are prescribed to promote purine excretion and prevent acute kidney injury

UTI 1 cause by E.coli, contamination during catheterization or instrumentation 2 SSS pain & burning on urination; urinary frequent & urgency; flank pain; N/V

3 MEDs antibiotics, urinary antispasmodics, and increased fluids . e.g Levofloxacin, a fluoroquinolone antibiotic prescribed to treat urinary tract infections, has no known cross-sensitivity to penicillin.

A nurse is caring for a client 2 days after surgical creation of an AVF in the forearm. Which finding should the nurse report immediately to the health care provider? 1 pitting edema 2+ of extremity with AVF 2 loud swooshing sound auscultated over the AVF 3 Pale skin of the hand of the arm with AVF 4 pain at surgical site 3/10 during exercise

3 Pale skin of the hand of the arm with AVF # SS ischemia need report immediately to MD ex. without prompt intervention, ischemia may lead to limp necrosis

BPH Benign Prostatic Hyperplasia 1 men over age 50 2 BPH obstructive vesical neck or prostatic urethra due to larger prostate

3 SS 31 hesitancy, frequency, urgency # incomplete empty bladder & urinary retention; Bladder fullness 32 NOCTuria 33 risk of UTI # burning urination sensation & cloudy, foul smell urine

What information would be most important for the nurse to obtain from a client with suspected bladder cancer who reports blood in the urine but no associated pain? 1 family hx 2 industrial chemical exposure 3 Tobacco use 4 Usual diet

3 TOBACCO use is the primary risk factor of Bladder cancer

Urinary calculi 1 result from immobility, cancer, increase D intake, overactive parathyroid 2 labs hi.Ca2+, hi.Mg2+; low Phostphorus, oxalate

3 diagnostic Xray, CBC, ultrsound, 24h urine test, CT 4 SS severe FLANK pain; Fever; N/V, oliguria or anuria; hematuria

Prostatitis 1 cause by viral illness or infection with sexually transmitter disease 2 can be acute or chronic with SS chill & fever; dysuria; Urethral discharge; erectile dysfx; perineal pain radiates to sacral area

3 diagnostic urine culture; in.WBC, negative culture @ NO bacteria inf.

I&O 1 perfect if equal 2 or approximal <500 mL

3 if >=500mL # risk of retention

A client with chronic kidney disease has a subcutaneous AVF placed in the nondominant left wrist for hemodialysis. Which of the following statements indicate the client understands how to care for the fistula properly? SATA 1 don't need to call MD if having numbness or tingling in the left arm 2 take BP in the nondominant left arm 3 squeeze a small sponge with the left hand several times a day 4 touch the site & feel for a vibration several times a day 5 try not to sleep on the left arm

3, 4, 5

You're developing a care plan with the nursing diagnosis risk for infection for your patient that received a kidney transplant. A goal for this patient is to: 1. Remain afebrile and have negative cultures 2. Resume the patient's normal job within 2 to 3 weeks 3. Try to discontinue cyclosporine (Neoral) as quickly as possible 4. Resume normal fluid intake within 2 to 3 days .

1 The immunosuppressive activity of cyclosporine places the patient at risk for infection, and steroids can mask the signs of infection. The patient may not be able to resume normal fluid intake or return to work for an extended period of time and the patient may need cyclosporine therapy for life

Which action is most important during bladder training in a patient with a neurogenic bladder? 1. Set up specific times to empty the bladder 2. Force fluids 3. Encourage Kegel exercises 4. Encourage the use of an indwelling urinary catheter

1 Instruct the patient with neurogenic bladder to write down his voiding pattern and empty the bladder at the same times each day.

A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments? 1 Low-protein diet with a prescribed amount of water 2 Low-protein diet with unlimited amounts of water 3 No protein in the diet and use of a salt substitute 4 No restrictions

1 The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Salt substitutes shouldn't be used without a doctor's order because it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed.

Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is: 1 Check the patient's latest potassium level 2 Give the patient IV lidocaine (Xylocaine) 3 Call the doctor immediately 4 Prepare to defibrillate the patient

1 The patient with ESRD may develop arrhythmias caused by hypokalemi. Call the doctor after checking the patient's potassium values. Lidocaine may be ordered if the PVCs are frequent and the patient is symptomatic.

After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated? 1 Disequilibrium syndrome 2 Hypervolemia 3 Peritonitis 4 Respiratory distress

1 Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can diffuse from the body's cells into the vascular system.

Which statement correctly distinguishes renal failure from prerenal failure? 1. With prerenal failure, an IV isotonic saline infusion increases urine output 2. With prerenal failure, there is less response to such diuretics as furosemide (Lasix) 3. With prerenal failure, hemodialysis reduces the BUN level 4. With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure

1 Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion; giving isotonic fluids improves urine output. Vasoactive substances can increase blood pressure in both conditions.

UI Interventions 1 Loss of excess weight to reduce pressure on the pelvic floor 2 Pelvic floor exercises (eg, Kegel) to strengthen the muscles and help prevent urinary leakage (Option 4). 3 Bladder training eg, voiding every 2 hours while awake and gradually lengthening intervals between voiding

1 Anticholinergic medications eg, oxybutynin, tolterodine to decrease bladder spasms. SE Dry mouth # xerostomia 2 Avoidance of bladder irritants eg, artificial sweeteners, caffeine, citrus juices, alcohol, carbonated drinks, nicotine

A client with CKD has blood laboratory results Na+ 150; K+ 6.0; Cl- 100; Ca2+ 9.0; Mg2+ 2.0; Phosphorus 5.8. What is the best afternoon snack to provide to this client? 1 Apple slices with caramel dip 2 chips Na & avocado K dip 3 Nonfat yogurt K & P with orange slices K 4 vanilla pudding K&P with strawberries K

1 Apple slices with caramel dip Ex CKD management renal diet e.g restrict fluid/ Na+/K+/P+ # no salt substitute

The nurse is preparing to administer morning medications to a client with type 2 DM and ESKD who is scheduled for dialysis today. Which medication should the nurse hold for clarification prior to administration? 1 Atenolol # antiHPT 2 Calcium acetate # block absorption phosphate 3 Insulin lispro # fast acting insullin 15-30 bf meal 4 Vit E # fat soluble vit to prevent leg cramps during sitting dialysis

1 Atenolol # antiHPT @ severe hypotension during dialysis treatment ex Unless otherwise indicated by MD, antiHPT and other blood pressure-lowering medications eg, furosemide, antibiotics, digoxin, and water-soluble vitamins B, C, and folic acid should be held prior to dialysis.

A nurse is caring for a child with acute glomerulonephritis. Frequent monitoring of which of the following is a priority? 1 BP 2 hematuria 3 I&O 4 peripheral edema

1 BP # need close monitor to identify risk of severe HTP # risk of pulmonary edema, hypertensive encephalopathy

Renal transplant 1 lifetime therapy with immunosuppressives NO grapefruit juice with meds

1 Neoral cyclosporine modified mixed orange juice or apple juice in a glass container or in the special container NO PLASTIC 2 Sandimmune cyclosporine non-modified mixed in orange juice, milk, or chocolate milk room temperature

Air Embolism in a Client Receiving Hemodialysis 1 emergency 2 SS dyspnea, tachypnea, chest pain, hypotension, reduced oxygen saturation, cyanosis, anxiety, and any change in sensorium

1 Stop the hemodialysis 2 turn pt on the LEFT side with HEAD Down 3 Notify RN, MD, nephrologist 4 O2 therapy 5 check VS & pulse Oximetry 6 Document event, action, pt response

kidneys common therapy 1 diuretic, antihypertension 2 Antibiotic 3 Steroids 4 antigout 5 antispasmodics 6 immunosuppressive 7 DHT inhibitor

1 bed rest 2 I&O 3 diet low Na; adequate or restrict fluid; low protein 4 K+ limited if oliguria 5 SS edema # weigh daily, circulatory overload 6 dialysis

Prostatitis management 1 bactrim, Cipro

1 bed rest 2 Sitz bath to relieve pain 3 adequate fluid 4 sex intercourse

nephrosis syndrome 1 cause by glomerulonephritis, acute allergy, systemic illness 2 SS severe proteinuria, edema, hypoAlbuminemia; hypercholesterolemia. hyperlipidemia, increased coagulate, decreased renal perfusion

1 bed rest . 2 Prevention of skin breakdown 3 Daily weights 4 Strict I&O 5 Moderate protein intake with sodium restrictions 6. MEDS steroids and immunosuppressives, ACE inhibitors, antilipidemics, heparin, and diuretics

The nurse is caring for pt receiving treatment for BPH. Which pt statement requires further investigation? 1 I have a burning sensation when urinate 2 dribbling after urination # SS 3 missed 3 day of finasteride during trip 4 nocturia 3 times last night # SS

1 burning urination sensation, or cloudy foul smell urine # risk of UTI required immediately further assess & treatment Exp. 3 finasteride # long term inhibit further grow of prostate

End stage renal disease ESRD 1 kidney NO LONGER maintain metabolic, fluid, e- @ risk build up toxic in blood e.g retain waste, urea & nitrogenous waste

1 dialysis e.g peritoneal VS hemodialysis 2 renal transplant

Arteriovenous Fistula AVF # AV shunt 1 a surgically created hole to connection of an artery and vein to provide circulatory access for hemodialysis in forearm or upper arm 2 Complication infection; Or distal extremity Ischemia # skin pallor; pain in distal, numbness, tingling, diminishes pulse, poor capillary refill @ without prompt treatment, ischemia can lead to limb necrosis

1 elevation extremity to reduce edema 2 frequent check AVF sound e.g loud swooshing # AVF working properly 3 hand grip exercise e.g ball squeezing, hand flexing 4 NO carry heavy object >5lbs 5 NO take BP/ draw the blood/ IV on AVF 6 report infection; distal pain/pallor/diminished pules # ischemia; severe or prolong edema >2week # severe HPT

kidney labs renal fx test

1 gravity 1.010 -1.030 2 BUN 7-22 3 creatine 0.8-1.2 hemoglobin 12-16 fe; 14-18 male 1.3 hematocrit = 3 times of hemoglobin

Percutaneous nephrolithotripsy 1 breaks and removes kidney stones, and can lead to severe pain.

1 opioids eg, morphine can cause constipation, symptoms can be managed with pharmacologic eg, docusate sodium, sennoside 2 nonpharmacologic interventions eg, increased activity, increased fiber and fluid intake

analgesics 1 med Pentosan polysulfate sodium ; Phenazopyridine 2 SE Nausea, headache, vertigo

1 phenazopyridine # red or orange urine 2 NO with renal or hepatic dis. 3 interferes with accurate urine test for glucose & ketones

You're preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority? 1 Heavily lubricate the catheter before insertion Irrigate and clean the meatus before catheterization Check the discharge for occult blood before catheterization Delay catheterization and notify the doctor

4 Bleeding at the urethral meatus is evidence that the urethra is injured. Because catheterization can cause further harm, consult with the doctor.

What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease? 1. Pain 2. Activity intolerance 3. Knowledge deficit 4. Fluid volume excess

4 Fluid volume excess because the kidneys aren't removing fluid and wastes. The other diagnoses may apply, but they don't take priority.

Which criterion is required before a patient can be considered for continuous peritoneal dialysis? 1 Hemodialysis must have failed 2 The patient must be in a home setting 3 The vascular access must have healed 4 The patient must be hemodynamically stable

4 Hemodynamic stability must be established before continuous peritoneal dialysis can be started.

Polystyrene sulfonate (Kayexalate) is used in renal failure to: 1. Correct acidosis 2. Prevent constipation from sorbitol use 3. Reduce serum phosphate levels 4. Exchange potassium for sodium

4 In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium.

Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium). 1. Once painful urination is relieved, discontinue prescribed antibiotics. 2. Take phenazopyridine just before urination to relieve pain. 3. If the urine turns orange-red, call the doctor. 4. After painful urination is relieved, stop taking phenazopyridine.

4 Pyridium is taken to relieve dysuria because is provides an analgesic and anesthetic effect on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved. The urine may temporarily turn red or orange due to the dye in the drug. The drug isn't taken before voiding, and is usually taken 3 times a day for 2 days.

dialysis 1 Peritoneal dialysis # flexible catheter into peritoneal cavity

# risk of peritonitis e.g fever, abdominal discomfort; return of cloudy dialysate

A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care? 1 Apply pressure to the needle site upon discontinuing hemodialysis 2 Place the left arm on an arm board for at least 30 minutes 3 Keep the left arm dry 4 Keep the head of the bed elevated 45 degrees

1 Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.

A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you do to prevent complications associated with this device? 1. Avoid taking blood pressures in the arm with the fistula. 2. Palpate pulses above the fistula. 3. Report a bruit or thrill over the fistula to the doctor. 4. Insert I.V. lines above the fistula.

1 Don't take blood pressure readings in the arm with the fistula because the compression could damage the fistula. IV lines shouldn't be inserted in the arm used for hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill should be reported to the doctor.

Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient? 1. Hypertension, oliguria, and fatigue 2. Dysuria, frequency, and urgency 3. Back pain, nausea, and vomiting 4. Fever, chills, and right upper quadrant pain radiating to the back

1 Mild to moderate HTN may result from sodium or water retention and inappropriate rennin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.

BPH management 1 alpha receptor blocker e.g Tamsulosin Flomax # Notify MD if CATARACT surgery to avoid FLOOPY IRIS syndrome complication 2 antiandrogen inhibit prostate further growing e.g finasteride Proscar # severe birth defect # wear glove when dispense; avoid hand crushed or broken 3 Saw palmetto herbal

1 void schedule 2 avoid caffeine & antihistamine 3 shrink or slow growth of prostate 4 surgical prostate resection PURP or HoLEP

Which cause of hypertension is the most common in acute renal failure? 1 Hypovolemia 2 Hypervolemia 3 Pulmonary edema 4 Anemia

2 Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of rennin. Therefore, hypervolemia causes hypertension.

A client diagnosed with acute glomerulonephritis has pitting edema in the lower extremities, a blood pressure of 170/80 mm Hg, and proteinuria. When the practical nurse is assisting in the development of a care plan for this client, which measurement is the most accurate indicator of fluid loss or gain and should therefore be included in the plan? 1 BP measurement # high BL can result from fluid retention OR vasoconstrict 2 DAILY Weight 3 Severity of pitting edema 4 strict I&O

2 DAILY Weight is the most accurate indicator of fluid gain or loss Ex gain >= 2lbs/24h or 5lbs/week @ severe fluid retention 2.2lbs = 1kg = 1000mL

Anticholinergic - Antispasmodics 1 cautiously with narrow angle glaucoma e,g tolterodine, propantheline 2 oxybutynin NO HPT, GI or genitourinary obstruction, glaucoma, sever colitis, myasthenia gravis

2 Dizziness, drowsiness # NO drive, machinary 3 SS toxicity BP, confusion, tachyHR, flushed red face, resp. Depression, nervous, restless, hallucination, irritability

Which of the following causes the majority of UTI's in hospitalized patients? 1 Inadequate perineal care 2 Lack of fluid intake 3 Immunosuppression 4 Invasive procedures

4 Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection.

A 22 y.o. patient with diabetic nephropathy says, "I have two kidneys and I'm still young. If I stick to my insulin schedule, I don't have to worry about kidney damage, right?" Which of the following statements is the best response? 1 "You would be correct if your diabetes could be managed with insulin." 2 "You should talk to your doctor because statistics show that you're being unrealistic." 3 "You have little to worry about as long as your kidneys keep making urine." 4 "Even with insulin, kidney damage is still a concern."

4 Kidney damage is still a concern. Microavascular changes occur in both of the patient's kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of end-stage renal disease. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management.

You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely? 1 "I go hours without the urge to pee." 2 "My pee smells sweet." 3 "I pee a lot." 4 "It burns when I pee."

4 A common symptom of a UTI is dysuria. A patient with a UTI often reports frequent voiding of small amounts and the urgency to void. Urine that smells sweet is often associated with diabetic ketoacidosis.

What is the most important nursing diagnosis for a patient in end-stage renal disease? 1. Altered nutrition: less than body requirements 2. Activity intolerance 3. Risk for injury 4. Fluid volume excess

4: Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD

glomerulonephritis diagnostic 1 in. specific gravity 2 hematuria; proteinuria 3 Blood study BUN, creatine, erythrocyte; C3 complement serum; immunoGlobulin C; antinuclear antibodies; circulating immune complexes 4 renal biopsy

5 ASO a positive AntiStreptolysin # indicate prior infection with Group A Steptococcus 6 urine collect 24h for creatine clearance # NO caffeinated e.g coffee, tea, soft drink prior to test

Prevention of Cystitis uti Use good perineal care, wiping front to back. Avoid bubble baths, tub baths, and vaginal deodorants or sprays. Void every 2 to 3 hours. Wear cotton pants and avoid wearing tight clothes or pantyhose with slacks.

Avoid sitting in a wet bathing suit for prolonged periods. If pregnant, void every 2 hours. If menopausal, use estrogen vaginal creams to restore pH. Use water-soluble lubricants for intercourse especially after menopause. Void and drink a glass of water after intercourse.

Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs over the past two years. She is fatigued from lack of sleep, has lost weight, and urinates frequently even in the night. Her labs show: sodium, 154 mEq/L; osmolarity 340 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which nursing diagnosis is priority? 1 Fluid volume deficit related to osmotic diuresis induced by hyponatremia 2 Fluid volume deficit related to inability to conserve water 3 Altered nutrition: Less than body requirements related to hypermetabolic state Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency

Fluid volume deficit related to inability to conserve water

Immunosuppression following Kidney transplantation is continued: 1 Until the kidney is not anymore rejected 2 A week after transplantation 3 For life 4 24 hours after transplantation

For life

prevent organ reject 1 Immunosuppressants # Cyclosporine, Sirolimus, Tacrolimus 2 Glucocorticoid # Prednisone 3 Cytotoxic # Azathioprine, Mercaptopurine, Mycophenolate mofetil 4 Antibodies# Antithymocyte g

Hematopoietic Growth Factors 1 Erythropoietic ▪ Epoetin alfa ▪ Darbepoetin alfa ▪ Peginesatide 2 Leukopoietic ▪ Filgrastim ▪ Pegfilgrastim ▪ Sargramostim

glomerulonephritis Acute 1 SS hematurine # Dark & smoke color urine; headache; N/V; oliguria; HPT # fluid retain, edema ++ closely monitor BP to indicate severe HPT @ pulmonary edema; encephalopathy

Management 1 antibiotic; diuretic; antiHPT; steroid 2 bed rest; Daily Weight; I&O; diet low Na+, low protein; limit K during oliguria; monitor edema & circulatory overload, BP

glomerulonephritis 1 group A Streptococcus 2 Systemic lupus erythematosus, Scleroderma, PolyArterisis nodosa 3 acute VS chronic

Nursing care is focused on monitoring vital signs particularly blood pressure; and fluid status, avoiding salt in the diet, and conserving energy

You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than: 800ml 400ml 200ml 1000ml

Oliguria is defined as urine output of less than 400ml/24hours.

BPH 4 diagnosis urinalyris, renal fx test; digital rectal ex., CBC

PSA Prostate specific antigen level 1 age 45 2 cause if use Saw palmetto due to a FALSE Lowering PSA level

patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120ml. The drainage system has no obstructions. Which intervention has priority? 1 Place the patient in the shock position, and notify the surgeon 2 Flush the urinary catheter with sterile water or saline 3 Evaluate the patient's circulation and vital signs 4 Give a 500ml bolus of isotonic saline

Question 12 Explanation: A total UO of 120ml is too low. Assess the patient's circulation and hemodynamic stability for signs of hypovolemia. A fluid bolus may be required, but only after further nursing assessment and a doctor's order.

The most common early sign of kidney disease is: Inability to dilute or concentrate urine Sodium retention Development of metabolic acidosis Elevated BUN level

Question 31 Explanation: Increased BUN is usually an early indicator of decreased renal function.

You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi? 1 High fluid intake 2 Decreased calcium intake 3 Increased calcium loss from the bones 4 Decreased kidney function

Question 8 Explanation: Bones lose calcium when a patient can no longer bear weight. The calcium lost from bones form calculi, a concentration of mineral salts also known as a stone, in the renal system.

Cholinergic 1 med Bethanechol 2 increase bladder tone, treat non-obstructive urinary retention & neurogenic bladder

SE HypoBP, bronchoconstriction; heart block; increase saliva; N/V, diarrhea, abdominal cramp, urinary urgency, flushing & sweating; headache

A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects? Stress Overflow Reflex Urge

Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressure, such as with coughing or sneezing.

Urge incontinence UI# overactive bladder, occurs when the bladder contracts randomly, causing a strong, sudden urge to urinate that is followed by urine leakage. .

UI may occur without cause or may result from spinal cord injury and impairment of the bladder eg, interstitial cystitis OR neurological system eg, Parkinson disease, stroke

Cholinergic bethanechol 1 empty stomach 1h bf or 2h af 2 NEVER by Intramuscular or IV routes 3 I&O 4 monitor bladder tone & fx 5 NO with urinary stricture or obstruction

cholinergic toxic 1 excess saliva, sweat, involunary urination & defecation; bradyHR, severe hypoBP 2 antidote ATROPINE

kidneys skill 1 urinary catheterization 2 Administering medication 3 bladder irrigation 4 Assessing patency of AV shunt 5 Performing peritoneal dialysis 6 Performing stoma care 7 Collecting urine specimen # clean catch, sterile, 24 hour 8 Assisting with renal biopsy

diagnostic 1 CBC 2 Complete metabolic panel 3 urinalysis 4 intravenous pyelogram 5 CT scan

kidney fx

fluid volume, BP, e-; filter & eliminate urine; erythrocyte RBC, vit D

CKD chronic kidney disease 1 decrease glomerular filtration @ retention of fluid/K+/Phos # need restricted fluid, Na+, K+, Phos

food allow for CKD e.g apple, pear, grape, pineapple, black/can/blue berries, # plum

food high in K+ 1 dairy product e.g milk, yogurt, pudding 2 certain fruit e.g banana, orange, strawberries, carrots, coconut, watermelons, avocado

food high in 1 Phosphorus e.g dairy products, chicken, turkey 2 Na+ e.g bake potatoes, tomatoes; canned/fast food, dressing, pickled, soy sauce

Overflow urinary incontinence 1 due to compression of the urethra eg, uterine prolapse, prostate enlargement; OR impairment of the bladder muscle eg, spinal cord injury, diabetic neuropathy, anticholinergic medications. => Both types involve incomplete bladder emptying and urinary retention, which lead to overdistension and overfilling of the bladder and frequent involuntary dribbling of urine

intervention 1. fixed void schedule e.g Q2H 2 techniques assist with bladder empty e.g Valsalva maneuver # bear down; Crede maneuver # gently apply pressure to the lower abdomen; double void # wait 20-30sec after voiding & then attempt to void a second time 3 monitor for perineal skin breakdown 4 measure postvoid residual volume as prescribed

glomerulonephritis chronic 1 SS proteinUria & hi. creatinine, BUN, maybe normal or low specific gravity, e- imbalance 2 Pedal EDEMA & peripheral NEUROPATHY; Weigh loss; NOCTuria; GI, Anemia; GOUT; HPT

management 1 meds diuretic, antiHPT, antiAnemic 2 treat hyperK+ with Sodium Polystyrene sulfonate Kayexelate +/- sorbitol 3 strict morning fluid I & O 4 diet low Na+/ protein to prevent overload