exam 3

The nurse is caring for a patient who is scheduled for a cystoscopy (C&P) with basket extraction of a stone. What is the most important postoperative care for the nurse to provide?

Measuring urine output

The nurse notes that the urine from a patient with an ileal conduit has mucus strands. What action should the nurse take?

Nothing, as the nurse understands that this is a normal finding.

A patient has a glomerular filtration rate of 55%. What should this value indicate to the nurse?

The patients other tests will be in the normal range.

The nurse is participating in care planning for a patient with urge incontinence. What should the nurse recommend be included in this patients plan of care? (Select all that apply.)

-Void every 2 hours -. Practice relaxation breathing. -Use urge inhibition techniques. -Gradually increase length of time between voidings.

The nurse is contributing to the plan of care for a patient who is having an intravenous pyelogram (IVP) done to diagnose possible bladder cancer. Which intervention should the nurse recommend be included for the patient after the procedure?

Monitor creatinine level.

The nurse is reviewing the anatomy of the kidney with a patient scheduled for renal surgery. What should the nurse explain as being the structural and functional unit of the kidney?

Nephron

The nurse is to obtain orthostatic blood pressure measurements for a patient on dialysis for end-stage renal disease. What should the nurse do when measuring this patients blood pressure?

Obtain blood pressure while the patient is lying, sitting, and standing.

The nurse needs to obtain a urine specimen from a female patient. What action should the nurse take when obtaining this specimen?

Obtain the first voided urine of the day.

A patient recovering from radiological studies of the renal system has a nursing diagnosis of Impaired Urinary Elimination. Which outcome indicates that the nursing interventions have been effective?

Patient voids 35 mL/hour of clear urine.

The nurse is making a visit to the home of a patient with functional incontinence. Which observation indicates that teaching about the disorder has been effective?

Patient wearing sweat pants

the nurse is reinforcing teaching about the most serious side effect of peritoneal dialysis with a patient scheduled for the first treatment. Which side effect should the patient state that indicates correct understanding?

Peritonitis.

The nurse is reinforcing teaching provided to a patient about risk factors for prerenal injury. Which risk factor should the patient state that indicates understanding of this teaching?

Use of nonsteroidal anti-inflammatory drugs.

A patient who has diabetic nephropathy asks the nurse, Why am I using smaller doses of insulin than I used to? What would be the best explanation by the nurse?

Your kidneys are no longer breaking down the insulin as much as before.

The nurse reviews the process to obtain a midstream urine specimen for culture and sensitivity with a female patient. Which patient statements indicate understanding of this process? (Select all that apply.)

-The labia should be kept separated while voiding. - The genitalia should be thoroughly cleaned with the towelettes provided.

The nurse contributes to the plan of care for a patient with edema. Which action should the nurse take as the best indicator of this patients fluid volume status?

daily weight

The nurse is caring for a patient with chronic kidney disease. Which data collection technique is the best one for the nurse to use to determine this patients fluid volume status?

daily weight

The nurse is collecting data from a patient with suspected cancer of the bladder. What finding should the nurse recognize as the most common symptom of cancer of the bladder?

hematuria

A patient with glomerulonephritis develops acute kidney injury. Which form of kidney injury should the nurse realize has occurred with this patient?

intrarenal

The nurse is helping to prepare a patient for a renal biopsy. In which position should the nurse help the patient assume?

prone

A patient has a glomerular filtration rate of 20 mL/min. For which stage of renal failure should the nurse plan care for this patient?

severe

The nurse is reinforcing teaching provided to a patient about risk factors for the development of bladder cancer. What risk factor should the patient state that indicates understanding of this teaching?

smoking

The nurse is caring for a patient who has renal calculi. Which action is essential for the nurse to take?

strain all urine

A female patient is embarrassed because of not being able to walk to the bathroom in time before become incontinent of urine. Which type of incontinence should the nurse plan care for this patient?

urge

The nurse is collecting data from a patient who has returned from a dialysis session. After dialysis, the nurse should anticipate which patient finding?

weight loss

The nurse is reinforcing teaching provided to a patient about caring for a new fistula in the left arm for dialysis. Which patient statements indicates correct understanding? (Select all that apply.)

- do not sleep on my arm -Wear loose clothing on my left arm. -Avoid carrying heavy things with my left arm. -Do not allow blood pressures to be taken on my left arm.

The nurse is reinforcing teaching provided to a patient with polycystic kidney disease. Which patient statements indicate a correct understanding of the teaching? (Select all that apply.)

- it is a heredity disease -Genetic counseling is appropriate for individuals with this diagnose - There is no effective treatment to stop the progression of the disease. - It is characterized by the formation of multiple grapelike cysts in the kidney.

While collecting data, the nurse suspects that a patient is experiencing renal calculi. What did the nurse assess to come to this conclusion? (Select all that apply.)

- nausea -flank pain -Costovertebral tenderness -Pain radiating to the genitalia

. The nurse is reviewing normal kidney function with a patient experiencing an acute kidney injury. Which hormones should the nurse include that affect kidney function? (Select all that apply.)

-Aldosterone -Parathyroid hormone -Antidiuretic hormone (ADH) -Atrial natriuretic hormone (ANH)

The nurse is contributing to the plan of care for a patient who has chronic kidney disease. What possible effects of this condition should the nurse consider? (Select all that apply.)

-Anemia -Cardiac dysrhythmias -Peripheral neuropathy -anorexia, nausea, vomiting

The nurse is collecting data from a patient with a vascular access graft in the right arm for dialysis. What should the nurse do when assessing this patient? (Select all that apply.)

-Auscultate for a bruit over the site. -Palpate for a thrill in the right arm.

A patient is recovering from a renal arteriogram. What actions should the nurse take when caring for this patient? (Select all that apply.)

-Check distal pulses in leg every 30 to 60 minutes - A pressure dressing and sandbag used to apply pressure. - Implement bedrest for 12 hours, and instruct the patient not to bend leg.

While participating in the creation of a teaching plan, the nurse suggests that a patient ingest cranberry juice every day to reduce the risk of developing a UTI. What information did the nurse use to make this suggestion? (Select all that apply.)

-Compounds in cranberries inhibit the adherence of E. coli to the urogenital mucosa. -Cranberries reduce the incidence of UTIs in patients after renal transplants. -Cranberries contain a substance that prevents bacteria from sticking on the walls of the bladder.

The nursing home administrator for a skilled nursing facility is concerned because a large number of older residents are developing UTIs. What should the staff nurse explain about the development of UTIs in this population? (Select all that apply.)

-Diminished immune function -Enlarged prostate in older men - Presence of neurogenic bladder -Decline in estrogen in older women

A patient with a UTI is concerned about the expectation to void every three hours. What should the nurse explain to the patient about voiding this frequently? (Select all that apply.)

-Empties the bladder -. Reduces urine stasis - Prevents reinfection - lower bacterial counts

The nurse is caring for a patient with an indwelling catheter. What should the nurse include in this patients routine care? (Select all that apply.)

-Encourage fluid intake. -Maintain a closed system. - Secure the catheter to the patients leg. - Remove the catheter as soon as possible.

The nurse is contributing to the plan of care for a patient with chronic kidney disease. The nurse has recognized a growing body of evidence related to restricting protein intake. Which evidence should the nurse use to develop the plan of care? (Select all that apply.)

-Increased protein is recommended for patients on hemodialysis. -Protein calorie malnutrition should be avoided for patients on hemodialysis - Optimum nutritional status should be maintained for all patients with kidney disease. -Protein energy malnutrition is a predictor of mortality and morbidity for patients on dialysis.

The nurse is caring for a patient with an elevated uric acid level. Which health problems should the nurse consider as potentially causing this patients elevation? (Select all that apply.)

-Leukemia - Malnutrition - Kidney disease. - Use of thiazide diuretics

The nurse is collecting data for a patient who has suspected kidney disease. What health problems should the nurse consider as being associated with a high urine specific gravity? (Select all that apply.)

-Nephrosis - Dehydration - Heart failure -Diabetes mellitus

A 32-year-old female patient is diagnosed with uncomplicated cystitis. Which medications should the nurse expect to be prescribed for this patient? (Select all that apply.)

-Nitrofurantoin (Macrodantin - Sulfamethoxazole and trimethoprim (Bactrim, Septra

The nurse is contributes to the plan of care for an older patient. What should the nurse recognize as normal signs of aging within the renal system? (Select all that apply.)

-Number of nephrons decreases -Detrusor muscle tone decreases

the nurse is monitoring a patient with chronic kidney disease. Which findings should the nurse realize indicates fluid overload? (Select all that apply.)

-Periorbital edema -Crackles in the lungs - increased bp

A patient with chronic kidney disease has a serum potassium level of 6 mEq/L. Which action should the nurse take? (Select all that apply.)

-Place the patient on a cardiac monitor. -inform RN to notify physician

The nurse is caring for a patient with an indwelling urinary catheter. Which instructions should the nurse provide to help prevent development of a urinary tract infection? (Select all that apply.)

-Position the tubing to allow free flow of the urine. -Use aseptic technique when emptying the drainage bag - Keep the catheter securely taped to prevent catheter movement.

The nurse is reviewing data for a patient with acute kidney injury. Which diagnostic test results should the nurse recognize that indicate kidney injury? (Select all that apply.)

-Serum creatinine 4.2 mg/dL -Urine output of 100 mL in 24 hours -Fixed urine specific gravity of 1.010

The nurse is reinforcing teaching provided to a patient with chronic kidney disease who is receiving hemodialysis three times a week at a hemodialysis center. Which statements should be included? (Select all that apply.)

-You may feel weak and fatigued after the treatment. -You may not be able to eat before the treatment session -You will need to be weighed before and after the session. -Report any numbness, swelling, redness, or drainage from the dialysis access site. - You may experience some bleeding from the puncture site or a nosebleed. Report it if it doesnt stop within a few minutes.

The nurse is collecting data for a patient with kidney disease. Which information should the nurse identify as being normal urinalysis findings? (Select all that apply.)

-amber color -Specific gravity of 1.010 -Small quantities of enzymes

The nurse is reinforcing teaching provided to a patient with a history of calcium oxalate kidney stones. The nurse recognizes that teaching has been effective if the patient avoids which foods? (Select all that apply.)

-cocoa -spinach -Instant coffee

The nurse notes it is time to administer prescribed gentamicin (Garamycin) for a patient with acute kidney injury and suspected streptococcal pneumonia. Which action should the nurse take at this time? (Select all that apply.)

-hold med -Consult physician about medication order.

The nurse is contributing to a staff education program about the risks of smoking and conditions related to smoking. Which statements by a staff member indicate correct understanding of the teaching? (Select all that apply.)

-kidney cancer -bladder cancer -Diabetic nephropathy

The nurse is reviewing the results of a patients urinalysis. Which components should the nurse identify as being abnormal in urine? (Select all that apply.)

-protein -RBC

The nurse is caring for a patient with kidney disease. How should the nurse end a 24-hour urine test at the end of the 24 hours?

. The patient voids at the end of 24 hours, adding it to the collection container

The nurse is collecting data for a patient with kidney disease. When reviewing a urinalysis report, which range should the nurse recognize as normal specific gravity of urine?

1.002 to 1.035

The nurse determines that a patients urine output is normal. How many mL of urine did the patient void within the last 24 hours?

1000 to 2000

A patient is being evaluated for renal dialysis. What creatinine clearance value should the nurse realize this patient must have to live without needing dialysis treatments?

10ml

A patient hourly urine output is recorded. Which output rates should be brought to the attention of the registered nurse (RN) immediately?

15ml/hr

the nurse is instructing a patient on the use of Kegel exercises. How many times a day should the nurse recommend that these exercises be performed?

30-80

The nurse is reinforcing 24-hour fluid intake teaching for a patient to prevent further UTIs. Which amount should the patient state that indicates that teaching has been effective?

3000ml

The nurse is catheterizing a patient after voiding to determine the amount of residual urine in the bladder. What should the nurse consider as being the normal amount of urine within the bladder after urination?

50ml

. The nurse is reviewing a urinalysis report. What should the nurse recognize as the normal average pH of urine?

6

A patient is diagnosed with end-stage kidney disease. The nurse realizes that what percentage of functioning nephrons have been lost in this patient?

90%

The nurse learns that a patient has a urine pH of 7.9. What question should the nurse ask the patient after learning of this laboratory value?

Are you a vegetarian?

The nurse is reinforcing teaching provided to a patient with chronic kidney disease. Which patient statement indicates the need for further teaching?

As long as I dont eat protein, Ill be okay.

A patient hospitalized for orthopedic surgery had a urinary catheter inserted. The patient later develops a urinary tract infection (UTI) and asks the nurse what caused it. What is the appropriate response by the nurse?

Bacteria probably ascended the catheter, causing the infection.

The nurse is caring for a patient who has an acute kidney injury. Which diagnostic test result should the nurse identify as most supporting this diagnosis?

Blood urea nitrogen 20 mg/100 mL (normal 8 to 25 mg/100 mL)

The nurse is caring for a patient with an acidbase imbalance from kidney disease. How should the nurse explain the role of the kidneys to maintain acidbase balance in the body to the patient?

Conserving or excreting bicarbonate ions

The nurse is caring for an unstable patient with acute kidney injury. What therapy should the nurse expect to be ordered?

Continuous renal replacement therapy (CRRT)

A patient is scheduled for an intravenous pyelogram (IVP). What care should the nurse provide before the patient has this procedure?

Enema evening before the test

The nurse is caring for a male patient with functional incontinence. What action should the nurse take to help prevent incontinence?

Ensure that the patient has ready access to the urinal.

The nurse is caring for a patient who has a nephrostomy tube. What action should the nurse take to maintain the integrity of this device?

Ensure tube is not kinked or clamped.

The nurse is caring for a patient with a kidney infection. When providing prescribed medications, the nurse should recall that which structure is the capillary network in each nephron?

Glomerulus

A patient with glomerulonephritis asks, How could I have gotten this? How should the nurse respond?

Have you had a sore throat or skin infection recently?

A 19-year-old patient reports flank pain and scanty urination. The nurse notices periorbital edema, and the urinalysis reveals white blood cells, red blood cells, albumin, and casts. What question would be most important for the nurse to include in data collection?

Have you had a strep infection of the throat or skin recently?

The nurse is reinforcing teaching provided to a patient about antibiotics prescribed for a UTI. Which patient statement indicates teaching has been effective?

I will take the antibiotics until they are gone regardless of symptoms.

The nurse is reviewing the history and physical of a patient who has an infection. What term should the nurse realize describes an infection of the kidneys?

Pyelonephritis

A patient with chronic kidney disease is very weak due to low hemoglobin. What should the nurse understand as the best explanation for the anemia?

Secretion of erythropoietin by the diseased kidney is reduced.

A patient with pneumonia has a blood urea nitrogen (BUN) of 32 mg/dL and creatinine of 0.8 mg/dL. What should the nurse realize is the most probable explanation for this finding?

The patient is dehydrated.

The nurse is collecting data from a patient with stress incontinence. Which finding should the nurse document?

The patient loses small amounts of urine when he or she coughs or sneezes.

A patient who is on hemodialysis for chronic kidney disease is prescribed sevelamer hydrochloride (Renagel) with meals. What explanation should be provided to the patient as the primary reason the medication is being given?

To prevent damage to bones from high phosphorus levels

The nurse is reviewing a patients history and physical report. What term should the nurse recognize is being used to describe waste products building up in the blood

Uremia

During an assessment, the nurse notes that a patient has crystals deposited on the skin. What should this finding indicate to the nurse?

Uremic frost

A patients urinalysis results are: white blood cells (WBC) 100+/hpf; red blood cells (RBC) 4/hpf; bacteria, moderate amount; nitrite, positive; specific gravity, 1.025; urine, cloudy. What should the nurse recognize these findings indicate?

Urinary tract infection

The nurse is caring for a patient recovering from a renal biopsy. For which complication should the nurse monitor the patient during the 24 hours after the procedure?

bleeding

The nurse is collecting data from a patient with kidney disease. Which adventitious lung sound should the nurse recognize as being caused by fluid overload?

crackles