GU Exam - Chapter 67

2. p. 1399, Physiological Integrity When providing care to a client who has undergone a nephrostomy for hydronephrosis, which observation alerts the nurse to a possible complication? A. Urine output of 15 mL/hr B. Tenderness at the surgical site C. Blood urea nitrogen (BUN) of 23 mg/dL D. Pink-tinged urine draining from the nephrostomy

A Rationale: Urine output after a nephrostomy should be at least 25 to 40 mL/hr. Tenderness is expected at a new incisional site; the slight elevation of BUN alone is not alarming or indicative of a complication specific to nephrostomy. Pink-tinged urine indicating hematuria is common after instrumentation, but frank blood or increased bleeding over time is not expected.

1. p. 1397, Health Promotion and Maintenance Which statement made by the client newly diagnosed with polycystic kidney disease (PKD) indicates to the nurse that additional teaching for self-management is needed? A. "I will need to increase my daily water intake." B. "I will restrict my sodium to less than 2 mg daily." C. "Now I will need to take a blood pressure drug daily." D. "If I become sexually active or plan to have a family, I will seek genetic counseling."

B Rationale: Patients with PKD waste sodium rather than retaining it. They need an increased sodium and water intake. Aggressive control of hypertension is needed to preserve kidney function. Genetic counseling is advised before having children because PKD is inherited.

3. p. 1406, Health Promotion and Maintenance When assessing a client with diabetic nephropathy, which question about self-management should the nurse ask to determine whether the client is currently following best practices to slow progression of this condition? A. "Have you increased your protein intake to promote healing of the damaged nephrons?" B. "Do you avoid contact sports to reduce the risk for causing trauma to your kidneys?" C. "How do you manage your diet to keep your blood glucose levels in the target range?" D. "Have you increased your fluid intake based on urine output?"

C Rationale: All strategies to avoid prolonged or frequent hyperglycemia can slow progression of diabetic complications, and the open-ended question is nonjudgmental. Protein intake is likely to be advised to be decreased in response to kidney damage regardless of cause. Avoiding renal trauma is a good idea but not linked to best practices in diabetic nephropathy care. Although increasing fluid intake based on urine output may be a good idea during periods of strenuous activity or other dehydrating conditions, it is not linked to best practices for this condition.

p. 1407, Safety; Patient-Centered Care The 56-year-old African American woman is admitting for treatment of newly diagnosed renal cell carcinoma. You find her daughter in the hallway crying. She has heard that her mother has undergone genetic testing related to her cancer diagnosis and wonders if she (the daughter) is at increased risk for the same condition. She was with her mother during the renal scan before admission and is also worried that this exposure to a radioactive isotope will cause cancer in her. 1. Is renal cell carcinoma commonly inherited, and why is genetic testing done? 2. Do renal scan radioisotopes require radiation precautions? Why or why not? 3. What risk factors are associated with renal cell carcinoma? 4. How can you evaluate whether your information was understood by the daughter and if follow-up is needed?

Suggested responses: 1. Is renal cell carcinoma commonly inherited, and why is genetic testing done? Fewer than 3% of renal cell cancers are inherited. Genetic testing is likely to be done on the tumor cells (not the patient) to determine the susceptibility of the cancer to treatment options, including targeted therapy. 2. Do renal scan radioisotopes require radiation precautions? Why or why not? Renal scan isotopes do not require radiation precautions. The trace amount used in this procedure is not harmful. Of course, the nurse would wear gloves to maintain body secretion precautions. 3. What risk factors are associated with renal cell carcinoma? Smoking, obesity, and exposure to certain chemicals have been linked to renal cell carcinoma. These chemicals include cadmium and other heavy metals, asbestos, benzene, and trichloroethylene (an organic solvent used in some manufacturing processes and to degrease metal). 4. How can you evaluate whether your information was understood by the daughter and if follow-up is needed? Ask! Use the talk-back approach to determine whether the information about genetics and radioisotopes was understood. Ask if the information was helpful or has decreased her obvious distress about the events surrounding her mother's admission today.