Chapter 62 & 63
A nurse is providing care to a group of patients on a urology unit. Which patient does the nurse identify as being at the greatest risk for developing urinary stones? 1) A 35-year-old female with quadriplegia from an auto accident 2) A 65-year-old male with a recent history of myocardial infarction 3) A 50-year-old male with type II diabetes mellitus 4) A 25-year-old female with several episodes of urinary infection
a
A patient admitted to the hospital with a diagnosis of gout has also been diagnosed with uric acid renal calculi. When planning meals for this patient, which diet will the nurse anticipate? 1) Low-purine diet 2) Low-sodium diet 3) A diet high in calcium 4) A diet low in calcium
a
A patient with acute kidney injury is complaining of a metallic taste in the mouth and has no appetite. Based on this data, which intervention by the nurse is the most appropriate? 1) Provide mouth care before meals 2) Administer an antiemetic as prescribed 3) Restrict fluids 4) Encourage the intake of protein, salt, and potassium
a
During a home visit, the nurse is concerned that an older adult patient is developing chronic kidney disease. The patient has no history of cardiovascular disease. Which data in the patient's assessment caused the nurse to have this concern? 1) Progressive edema 2) Complaints of hip joint pain 3) Recent increase in hunger and thirst 4) Warm moist skin
a
The nurse is assessing an adult patient in a urology clinic. The patient reports that she has been having "accidents" and expresses frustration about this normal part of aging. Which response by the nurse is the most appropriate? 1) "Tell me more about what you are experiencing." 2) "You may need to have surgery to manage this problem." 3) "I understand you are frustrated about this occurrence." 4) "Unfortunately, aging and incontinence go hand in hand."
a
The nurse is attempting to place a urinary catheter for an older adult female patient. The nurse is unable to visualize the patient's urinary meatus. Which alternate position for catheterization may be appropriate for this patient? 1) Side-lying, lifting up the buttock 2) Supine, with the HOB elevated at 30° 3) Supine, with the head of bed (HOB) elevated at 45° 4) Supine, with the bed flat, legs bent and apart in stirrups
a
The nurse is caring for a patient who is diagnosed with acute kidney injury. When reviewing the patient's laboratory data, which finding indicates that a patient has met the expected outcomes? 1) Decreasing serum creatinine 2) Decreasing neutrophil count 3) Decreasing lymphocyte count 4) Decreasing erythrocyte count
a
The nurse is planning care for the patient with acute kidney injury. The nurse plans the patient's care based on the nursing diagnosis of Excess Fluid Volume. Which assessment data supports this nursing diagnosis? 1) Pitting edema in the lower extremities 2) Bowel sounds positive in four quadrants 3) Wheezing in the lungs 4) Generalized weakness
a
The nurse is preparing to discharge a patient with chronic kidney disease. The nurse is teaching the patient and family about administering calcium acetate tablets by mouth with each meal at home. Which explanation about this medication is the most appropriate? 1) "The calcium acetate will lower your serum phosphate levels." 2) "The calcium acetate helps to neutralize your gastric acids." 3) "The calcium acetate will help to stimulate your appetite." 4) "The calcium acetate will decrease your serum creatinine levels."
a
The nurse is providing care to a patient diagnosed with polycystic kidney disease. Which assessment finding would indicate to the nurse that the patient is experiencing an infection? 1) Increased temperature 2) Increased blood pressure 3) Decreased white blood cell count 4) Decreased urine output
a
The nurse is providing care to a patient who is diagnosed with renal trauma. The patient is experiencing hematuria and contusions but has normal imaging studies. Which grade of renal trauma should the nurse document? 1) Grade 1 2) Grade 2 3) Grade 3 4) Grade 4
a
The nurse is providing care to a patient who may have polycystic kidney disease. Which is the first symptom the nurse should assess this patient for? 1) Hypertension 2) Hematuria 3) Urinary frequency 4) Urinary calculi
a
The nurse is providing care to a patient with urge incontinence. Which drug classification should the nurse include in the patient's plan of care? 1) Anticholinergic 2) Topical estrogen 3) Alpha-adrenergic agonist 4) Calcium channel blocker
a
The nurse providing care to a patient whose medication therapy for the treatment of renal calculi has failed. Based on this data, which treatment option does the nurse anticipate for this patient? 1) Lithotripsy 2) Surgical removal 3) Dietary control 4) Initiation of IV fluids
a
Which intervention should the nurse include in the patient's plan of care to decrease the risk for developing a catheter-associated urinary tract infection? 1) Implementing intermittent catheterization 2) Administering the prescribed prophylactic antibiotic 3) Retaining the indwelling catheter throughout hospitalization 4) Encouraging the consumption of cranberry juice twice per day
a
The nurse is concerned that an older adult patient is at risk for developing acute kidney injury. Which information in the patient's history supports the nurse's concern? Select all that apply. 1) Diagnosed with hypotension 2) Recent aortic valve replacement surgery 3) Prescribed high doses of intravenous antibiotics 4) Total hip replacement surgery five years ago 5) Taking medication for type 2 diabetes mellitus
a b c
The nurse is providing training for the clinical staff of a skilled care facility and wants to include information on functional incontinence. Which risk factors for functional incontinence will the nurse include in the training? Select all that apply. 1) Limited mobility 2) Impaired vision 3) Lack of access to facilities 4) Dementia 5) Depression
a b c d
A patient with frequent urinary tract infections is seen in the urology clinic and is at risk for acute kidney injury. The nurse reviews the patient's medical history. Which item supports the patient's being at risk for acute kidney injury? Select all that apply. 1) Dehydration 2) Renal calculi 3) Ineffective wound healing 4) Low serum albumin 5) Hypertension
a b e
The nurse is preparing to administer hemodialysis treatment for a patient with chronic kidney disease. Which laboratory values does the nurse anticipate prior to the patient's treatment? Select all that apply. 1) Increased blood urea nitrogen (BUN) 2) Decreased potassium 3) Decreased phosphorus 4) Increased urine osmolality 5) Increased creatinine
a e
The nurse educator is speaking with a group of students about renal disorders. Which statement is appropriate for the educator to include regarding renal stones? 1) "Older adult patients are particularly at risk for urolithiasis." 2) "Young- or middle-age adult men are at an increased risk for stones." 3) "Women have a greater risk overall than men." 4) "Frequency is greater in the northern United States."
b
The nurse is caring for a patient admitted with a diagnosis of acute kidney injury. The patient asks the nurse, "Are my kidneys failing? Will I need a kidney transplant?" Which response by the nurse is the most appropriate? 1) "No, don't think that. You're going to be fine." 2) "Your condition can be reversed with prompt treatment and usually will not destroy the kidney." 3) "Kidney transplantation is likely, and it would be a good idea to start talking to family members." 4) "When the doctor comes to see you, we can talk about whether you will need a transplant."
b
The nurse is caring for a patient who will be discharged with an indwelling catheter. The nurse has provided education to the patient and family about catheter care once the patient is discharged. Which patient or family action indicates a correct understanding of the information presented? 1) Hanging the drainage bag on the towel rod 2) Taking a shower each day instead of taking a tub bath 3) Restricting the amounts of fluids per day 4) Emptying the drainage bag twice a day
b
The nurse is providing care to a patient who is experiencing urine leakage when coughing or laughing. Which type of incontinence should the nurse include in this patient's plan of care? 1) Urge 2) Stress 3) Overflow 4) Functional
b
The nurse is providing care to a patient with stress incontinence. Which drug classification should the nurse include in the patient's plan of care? 1) Anticholinergic 2) Topical estrogen 3) Alpha-adrenergic agonist 4) Calcium channel blocker
b
The nurse is triaging a patient who presents to the urgent care clinic with symptoms of severe flank pain with spasms, nausea, vomiting, and oliguria. The patient states that the pain was initially intermittent and radiated from the lower back to the lower quadrants of the abdomen. Which action by the nurse is the most appropriate? 1) Complete the physical assessment 2) Refer the patient to a urologist 3) Instruct the patient to increase fluids 4) Obtain a urine specimen for culture
b
The nurse on the medical unit is admitting an older adult patient whose primary symptoms include fatigue, pruritus, and pain in the right flank area. When conducting this patient's assessment, which technique is the most appropriate? 1) Palpation over the costovertebral angles and flanks 2) Blunt percussion over the costovertebral angles and flanks 3) Palpation of the lower pole of both kidneys 4) Capturing of both kidneys
b
While caring for a patient with chronic kidney disease, the nurse tracks the patient's serum albumin level. For which nursing diagnosis is the action most indicated? 1) Excess Fluid Volume 2) Imbalanced Nutrition: Less Than Body Requirements 3) Risk for Ineffective Perfusion 4) Risk for Infection
b
The nurse is providing care to a patient who is diagnosed with stress incontinence. Which assessment data would the nurse expect to collect while performing the patient's health history and physical? Select all that apply. 1) Urine leakage while talking 2) Urine leakage while coughing 3) Urine leakage while laughing 4) Skin breakdown on the buttock 5) A urinary catheter
b c d
A patient is admitted to the emergency department and diagnosed with urinary calculi after experiencing symptoms for one week. When planning care for this patient, which nursing diagnosis is the most appropriate? 1) Risk for Constipation 2) Risk for Disuse Syndrome 3) Imbalanced Nutrition 4) Activity Intolerance
c
A patient with a history of hypertension is diagnosed with chronic kidney disease. When the patient asks the nurse how this occurred, which response by the nurse is the most appropriate? 1) "Thickening of the kidney structures and gradual death of nephrons has caused this diagnosis." 2) "Cysts compress renal tissue that destroys the kidneys, causing this diagnosis." 3) "High blood pressure reduces renal blood flow and harms the kidney tissue, causing this diagnosis." 4) "Immune complexes form in the kidney tissue that causes inflammation, causing this diagnosis."
c
A patient with renal failure is receiving peritoneal dialysis. The nurse is explaining the process to the patient. Which statement would the nurse include in a discussion with the patient? 1) "The peritoneum is more permeable because of the presence of excess metabolites." 2) "The metabolites will diffuse from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration." 3) "The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." 4) "The solutes in the dialysate will enter the bloodstream through the peritoneum."
c
A patient with urinary calculi is admitted to the hospital. When planning care for this patient, which goal is most appropriate? 1) The patient will lose 25 pounds in three months. 2) The patient will ambulate three times a day. 3) The patient will request pain medication at the onset of pain. 4) The patient will shower independently.
c
The nurse is administering peritoneal dialysis to a patient with acute kidney injury. The nurse notes the presence of a cloudy dialysate return. After notifying the health-care provider, which action by the nurse is the most appropriate? 1) Measure abdominal girth 2) Document the cloudy dialysate 3) Culture the dialysate return 4) Increase dialysate instillation
c
The nurse is caring for a patient with a history of chronic urinary tract infections. The nurse is planning care for this patient based on the priority nursing diagnosis of urinary retention related to scarring. Based on this data, which prescription does the nurse anticipate from the health-care provider? 1) Antibiotic therapy 2) An anticholinergic medication 3) Intermittent straight catheterization 4) Removal of bladder stones
c
The nurse is caring for a patient with a urinary catheter. Which nursing diagnosis is a priority for this patient? 1) Chronic Pain related to an obstruction 2) Risk for Impaired Skin Integrity related to incontinence 3) Risk for Infection related to catheter placement 4) Self-Care Deficit related to presence of urinary catheter
c
The nurse is caring for a patient with chronic kidney disease who is pale and experiencing fatigue. The nurse attributes these symptoms to anemia secondary to chronic kidney disease. The patient's spouse asks why the patient is anemic. Which response by the nurse is the most appropriate? 1) "Your spouse has a genetic tendency for the development of anemia." 2) "The increased metabolic waste products in the body depress the bone marrow and cause anemia." 3) "There is a decreased production by the kidneys of the hormone erythropoietin, which is the cause of anemia." 4) "The patient is not eating enough iron-rich foods, which is causing anemia."
c
The nurse is planning care for a patient with chronic kidney disease and osteoporosis. After reviewing the patient's medical record, which is the priority nursing diagnosis for this patient? 1) Anxiety 2) Disturbed Body Image 3) Risk for Injury 4) Risk for Bleeding
c
The nurse is providing care to a patient who is diagnosed with renal trauma. The patient has a renal laceration that is greater than 1 cm in depth, but the laceration does not involve the collecting system. Which grade of renal trauma should the nurse document? 1) Grade 1 2) Grade 2 3) Grade 3 4) Grade 4
c
The nurse is providing care to a patient with a spinal cord injury. Which type of incontinence should the nurse include in this patient's plan of care? 1) Urge 2) Stress 3) Overflow 4) Functional
c
The nurse provides education for a patient who is experiencing urinary incontinence. Which statement by the patient indicates the need for further education? 1) "Relaxation of pelvic muscles may be a factor in incontinence." 2) "Reduced urethral resistance can be a cause of incontinence." 3) "Incontinence is normal with aging." 4) "A disturbance of my bladder is a factor in the development of incontinence."
c
A patient agrees to receive long-term hemodialysis to treat chronic kidney disease. For which surgical procedure should the nurse instruct this patient? 1) Insertion of a double-lumen catheter into the subclavian artery 2) Placement of a peritoneal catheter 3) Insertion of a subarachnoid-peritoneal shunt 4) Placement of an arteriovenous fistula
d
A patient with chronic kidney disease is experiencing manifestations of anemia. Based on this data, which treatment does the nurse anticipate for this patient? 1) Begin fluid restriction. 2) Administer intravenous glucose and insulin. 3) Begin a low-sodium diet. 4) Epoetin injections
d
A young school-age patient is in the hospital with acute kidney injury following a streptococcus infection. The parents are Spanish-speaking and speak little English. The parents, through an interpreter, ask the nurse what mistake they made that caused the child to be so sick. Which response by the nurse is the most appropriate? 1) "Your child does not have enough dietary protein." 2) "Your child has a congenital defect that led to renal failure." 3) "Your child's renal failure has been caused by a low calcium level." 4) "Your child's recent infection may have caused the renal failure."
d
The nurse instructs a patient with chronic kidney disease on the prescribed medication furosemide (Lasix). Which patient statement indicates that teaching has been effective? 1) "I will take this medication to keep my calcium balance normal." 2) "This medication will make sure I have enough red blood cells in my body." 3) "I will take this pill to keep the protein level in my body stable." 4) "This pill will reduce the swelling in my body and get rid of the extra potassium."
d
The nurse is caring for a patient from another country who was admitted with hypertension and chronic kidney disease. The patient is receiving hemodialysis three times a week. The nurse is assessing the client's diet, and the patient reports the use of salt substitutes. When teaching the patient to avoid salt substitute, which rationale supports this teaching point? 1) They will increase the risk of AV fistula infection. 2) They will cause the patient to retain fluid. 3) They will interact with the client's antihypertensive medications. 4) They can potentiate hyperkalemia.
d
The nurse is caring for a patient with a history of kidney stones. The stones have been analyzed and are all composed of calcium phosphate. Based on this data, which foods should the nurse teach the patient to avoid? 1) Chicken, beef, and ham products 2) Organ meats, sardines, and seafood 3) Tomatoes, fruits, and nuts 4) Flour, milk, and ice cream
d
The nurse is caring for an older adult patient diagnosed with chronic kidney disease. The patient reports no bowel movement in the past two days. Based on this data, which condition is the patient at an increased risk for developing? 1) Metabolic acidosis 2) Hypocalcemia 3) Increased serum creatinine levels 4) Hyperkalemia
d
The nurse is providing care to a patient with benign prostatic hyperplasia (BPH). Which drug classification should the nurse include in the patient's plan of care? 1) Diuretic 2) Anticholinergic 3) Topical estrogen 4) Alpha-adrenergic agonist
d
The nurse is reviewing discharge instructions for a patient diagnosed with urinary incontinence resulting from a urinary tract infection. Which statement made by the patient indicates the need for further education? 1) "I should drink plenty of water to prevent damage to my kidneys while I am on the antibiotics for the infection." 2) "Drinking cranberry juice will decrease the risk for developing urinary tract infections." 3) "I will contact the health-care provider prior to taking over-the-counter medications while on my antibiotic." 4) "I will continue to hold my urine while in public so that I do not get another infection."
d
The nurse is working in a urology clinic and is providing care for a patient with urinary stress incontinence. The nurse has chosen the diagnosis of Stress Urinary Incontinence related to sphincter incompetence. Which is the desired outcome for a patient with this diagnosis? 1) The patient will stop the flow of urine when voiding. 2) The patient will improve her incontinence within one month. 3) The patient will empty her bladder every time she voids. 4) The patient will perform four to five squeezes (Kegel exercises) for 10-15 seconds.
d
he nurse is preparing to discharge a patient who underwent lithotripsy in the treatment of a kidney stone. What should the nurse teach the patient to prevent further complications of urinary calculi after discharge? 1) "You will need to increase your oral fluid intake to 1 L/day." 2) "It will be important that you not drive while taking pain medications." 3) "It will be important to maintain a diet high in purines." 4) "You will need to monitor for the signs and symptoms of a urinary tract infection (UTI)."
d