Chapter 51: Renal and Urinary Problems

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

3 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. Test-Taking Strategy: Note the strategic word, priority, and use the steps of the nursing process as a guide. Options 1, 2, and 4 address implementation. Option 3 is the only option that addresses data collection.

After a renal biopsy, the client complains of pain at the biopsy site that radiates to the front of the abdomen. Which would this indicate? 1. Bleeding 2. Infection 3. Renal colic 4. Normal, expected pain

1 Rationale: If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding would be suspected. Hypotension, a decreasing hematocrit, and gross or microscopic hematuria would also indicate bleeding. Signs of infection would not appear immediately after a biopsy. Pain of this nature is not normal. There are no data to support the presence of renal colic. Test-Taking Strategy: Focusing on the subject, pain at the renal biopsy site, will assist you with eliminating options 3 and 4. Recalling that signs of infection may not appear immediately after biopsy will assist with directing you to option 1 from the remaining choices.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse monitors this client for which signs/symptoms of this disorder? 1. Edema and purpura of the left arm 2. Warmth, redness, and pain in the left hand 3. Aching pain, pallor, and edema of the left arm 4. Pallor, diminished pulse, and pain in the left hand

4 Rationale: Arterial steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula, which is caused by tissue ischemia. Warmth, redness, and pain would more likely characterize a problem with infection. Options 2 and 3 are not characteristics of steal syndrome. Test-Taking Strategy: Focus on the subject, arterial steal syndrome. Think about the name of the condition. Recalling that arterial steal syndrome results from vascular insufficiency will direct you to the correct option.

The nurse is caring for the client with epididymitis. Which treatment modalities would be implemented? Select all that apply. 1. Bed rest 2. Sitz bath 3. Antibiotics 4. Heating pad 5. Scrotal elevation

1, 2, 3, 5 Rationale: Common interventions used in the treatment of epididymitis include bed rest, elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics. A heating pad would not be used because direct application of heat could increase blood flow to the area and increase the swelling. Test-Taking Strategy: Focus on the subject, epididymitis. A sitz bath provides heat that is moist and soothing. However, knowing that direct heat may increase inflammation in tissue that is already at risk will guide you to eliminate option 4 as the item that could increase swelling.

The nurse is reviewing the client's record and notes that the primary health care provider (PHCP) has documented that the client has a renal disorder. Which laboratory results would indicate a decrease in renal function? Select all that apply. 1. Decreased hemoglobin level 2. Elevated serum creatinine level 3. Elevated thrombocyte cell count 4. Decreased red blood cell (RBC) count 5. Elevated blood urea nitrogen (BUN) level

1, 2, 4, 5 Rationale: BUN testing is a frequently used laboratory test to determine renal function. The BUN and serum creatinine levels start to rise when the glomerular filtration rate decreases to less than 40% to 60%. A decreased RBC count as well as a decreased hemoglobin level may be noted if erythropoietic function by the kidney is impaired. Thrombocyte cell counts do not indicate decreased renal function. Test-Taking Strategy: Focus on the subject, laboratory results indicating a decrease in renal function. Eliminate option 3 because an elevated count is not associated with the renal system. Think about the pathophysiology of renal disease and the organs affected. Also, remember that the BUN and creatinine levels are frequently used laboratory tests to determine renal function.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1. Peritonitis 2. Hyperglycemia 3. Hyperphosphatemia 4. Disequilibrium syndrome

2 Rationale: An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Peritonitis is a risk associated with breaks in aseptic technique. Hyperphosphatemia is an electrolyte imbalance that occurs with renal dysfunction. Disequilibrium syndrome is a complication associated with hemodialysis. Test-Taking Strategy: Focus on the subject, a complication associated with an extended dwell time. Noting the client's diagnosis and recalling that the dialysate solution contains glucose will direct you to the correct option.

The nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. To determine whether the client is currently experiencing exacerbation of BPH, the nurse would 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

4 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. Test-Taking Strategy: Note the strategic word, early. Option 2 identifies the most extreme symptom and therefore is eliminated first. From the remaining options, focusing on the strategic words and recalling the pathophysiology related to BPH will direct you to the correct option.

A male client has a tentative diagnosis of urethritis. The nurse would assess the client for which manifestations of the disorder? 1. Hematuria and pyuria 2. Dysuria and proteinuria 3. Hematuria and urgency 4. Dysuria and penile discharge

4 Rationale: Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays. Hematuria is not associated with urethritis. Proteinuria is associated with kidney dysfunction. Test-Taking Strategy: Focus on the subject, manifestations of urethritis. Recalling that urethritis generally is accompanied by dysuria in the male client will assist you in eliminating options 1 and 3. Knowing that the problem originates in the urethra, not the kidneys, will assist you in eliminating option 2, because proteinuria indicates a problem with kidney function.

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 do these data indicate? 1. Advancing uremia 2. Phosphate overdose 3. Folic acid deficiency 4. Aluminum intoxication

intoxication4 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. Test-Taking Strategy: Focus on the subject, aluminum hydroxide. Use knowledge about the manifestations that would occur in each condition presented in the options to answer correctly. Also, note the relation between the medication name in the question and option 4.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which health problem noted on the client's record would the nurse identify as a risk factor for this diagnosis? 1. Hypoglycemia 2. Diabetes mellitus 3. Coronary artery disease 4. Orthostatic hypotension

2 Rationale: Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization. Test-Taking Strategy: Focus on the subject, pyelonephritis. Eliminate options 1 and 4 first as least likely being associated as risk factors. From the remaining options, remember that diabetes mellitus can cause renal complications. This will direct you to the correct option.

A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. Which are the signs/symptoms of transurethral resection (TUR) syndrome? 1. Tachycardia and diarrhea 2. Bradycardia and confusion 3. Increased urinary output and anemia 4. Decreased urinary output and bladder spasms

2 Rationale: TUR syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting. Test-Taking Strategy: Knowledge regarding the subject, TUR syndrome, is required to answer this question. Recalling that increased intracranial pressure is the concern will direct you to option 2.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse would take which actions? Select all that apply. 1. Contact the nephrologist. 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.

2, 3, 4, 5 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 nephrologist. Increasing the flow rate is an inappropriate action and is unassociated with the amount of outflow solution. Test-Taking Strategy: Focus on the subject, peritoneal dialysis outflow and inflow. Use the principles related to gravity flow and preventing obstruction to flow to answer this question. This will assist you with determining what the correct interventions are.

The nurse is monitoring an older client suspected of having a urinary tract infection (UTI) for signs of infection. Which sign/symptom is likely to present first? 1. Fever 2. Urgency 3. Confusion 4. Frequency

3 Rationale: In an older client, the only symptom of a UTI may be something as vague as increasing mental confusion or frequent unexplained falls. Frequency and urgency may commonly occur in an older client, and fever can be associated with a variety of conditions. Test-Taking Strategy: Note the strategic word, first. Although all may be signs/symptoms of urinary tract infection, note the client in the question is an older client to determine which one occurs first. Eliminate options 2 and 4 because they may commonly occur in an older client. Eliminate option 1 next because fever can be associated with a variety of conditions.

A client has epididymitis as a complication of a urinary tract infection (UTI). The nurse is giving the client instructions to prevent recurrence. The nurse determines that the client needs further teaching if the client states the intention to take which action? 1. Drink an increased amount 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 associated with chlamydia and gonorrhea.

3 Rationale: The client who experiences epididymitis from UTI needs to 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 needs to limit the force of the stream. Condom use can help to prevent urethritis and epididymitis from STIs. Antibiotics are always taken until the full course of therapy is completed. Test-Taking Strategy: Note the strategic words, needs further teaching. These words indicate a negative event query and the need to select the incorrect client statement. Because option 1 is consistent with good practices in the prevention of UTI, this option can be eliminated first. From the remaining options, it is necessary to know that the force of stream needs to be limited to prevent backflow into the epididymis and that condoms are helpful in preventing this disorder from occurring as a complication of a sexually transmitted infection. Remember that antibiotics are not stopped when symptoms subside and need to be taken until the full course of therapy is completed.

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.

3 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. Test-Taking Strategy: Focus on the subject, prostatitis. Eliminate option 1 first because stopping medication therapy before the end of the course is contraindicated. Option 4 is also eliminated because fluid intake would be increased. From the remaining options, it is necessary to understand that sitz baths provide comfort and that rest is helpful in the healing process. Knowledge of either of these concepts will direct you to option 3.