MED SURG 2 CH. 42 EAQ
The nurse is caring for a patient who has been diagnosed with interstitial cystitis. In an effort to manage symptoms, which medication categories may be prescribed? Select all that apply. 1. Antispasmodics 2. Opioid analgesics 3. Bladder anesthetics 4. Monoclonal antibodies 5. Tricyclic antidepressants
1. Antispasmodics 3. Bladder anesthetics 5. Tricyclic antidepressants Antispasmodics are ordered to relieve the bladder spasms that occur with this disorder. Bladder anesthetics are useful as pain relievers. Tricyclic antidepressants are useful in the treatment of long-term discomfort. Opioid analgesics are typically not required. Monoclonal antibodies are not effective for this disorder.
The primary care provider orders a prescription for a fluoroquinolone agent, ciprofloxacin (Cipro) to for patient with a suspected urinary tract infection. Which information should be included in the patient teaching? Select all that apply. 1. Be sure to drink 1500 to 2000 ml of fluid each day to prevent crystal formation. 2. It is acceptable to take this medication at the same time as your daily iron tablets. 3. Take the antibiotic within 2 hours of an antacid agent to decrease stomach irritation. 4. We will notify you if another antibiotic is needed as a result of the urine culture and sensitivity. 5. The broad-spectrum antibiotic is effective against many gram-positive and gram-negative pathogens.
1. Be sure to drink 1500 to 2000 ml of fluid each day to prevent crystal formation. 4. We will notify you if another antibiotic is needed as a result of the urine culture and sensitivity. 5. The broad-spectrum antibiotic is effective against many gram-positive and gram-negative pathogens. The patient also must be instructed to drink 1500 to 2000 ml of fluid each day to prevent crystal formation in the kidney. A broad-spectrum antibiotic agent that is effective against many gram-positive and gram-negative pathogens is initially prescribed. The patient must be advised that there is a possibility that the bacteria may be resistant to the antibiotic and he or she will be notified if another antibiotic would be more effective upon receiving the results of the culture and sensitivity test. The antibiotic action is inhibited by calcium (antacid agents), iron, and zinc, so they should not be taken within 2 hours of taking the antibiotic.
The nurse is caring for a patient who has an external access device in the left arm for hemodialysis. The nurse is performing initial vital signs and assisting with data collection. What are the safety concerns for this patient? 1. Because the cannula is external, there is danger of hemorrhage, risk for skin breakdown, and restriction of activities. 2. Notify the primary health care provider immediately if a thrill or bruit is present over the site of the access device. 3. The hemodialysis staff (not the nurse) will manage everything related to dialysis assessments and ongoing safety concerns. 4. The patient has been on hemodialysis for years, and there are no relevant safety precautions pertaining to hemodialysis.
1. Because the cannula is external, there is danger of hemorrhage, risk for skin Because the cannula is external, there is danger of hemorrhage, risk for skin breakdown, and restriction of activities. It is expected that a thrill and a bruit are present over the site of the dialysis access device. The primary care nurse is responsible for the care of the assigned patient, which includes monitoring for complications and care of the fistula or graft. Safety concerns are present regardless of the length of time on hemodialysis.
The nurse is caring for a patient who is recovering from a nephrectomy. In an effort to reduce the risk for decreased urine volume, which nursing interventions should be performed? Select all that apply. 1. Monitor BUN and serum creatinine levels. 2. Weigh the patient every other day once stable. 3. Measure urinary output every 4 hours and record. 4. Check under the patient with each dressing drainage check. 5. Encourage a minimum of 1 liter of fluid in a 24-hour period.
1. Monitor BUN and serum creatinine levels. 4. Check under the patient with each dressing drainage check. Monitoring the BUN and serum creatinine and comparing to preoperative values will help assess kidney function. The nurse should check under the patient for blood that may flow to this dependent area, while the dressing remains dry and intact. The patient should be weighed every day as a better measure of fluid balance. Urinary output should be measured every 1 to 2 hours at first. Encourage a minimum of 3 liters of fluids daily.
A patient is admitted to the hospital with chronic kidney disease. Which frequent monitoring measures for changes in status must be implemented for this patient? Select all that apply. 1. Observe neuromuscular activity. 2. Monitor for orange-colored urine. 3. Assess water-soluble vitamins daily. 4. Accurately record intake and output. 5. Assess level of consciousness and orientation.
1. Observe neuromuscular activity. 4. Accurately record intake and output. 5. Assess level of consciousness and orientation. A patient with chronic kidney disease needs to have intake and output recorded accurately. It is necessary to observe neuromuscular activity and level of consciousness for early signs of fluid and electrolyte imbalances. Vitamin D intake is monitored, but it is a fat-soluble vitamin. Orange-colored urine is not associated with chronic kidney disease.
The LPN is caring for a patient who is being treated with hydralazine (Apresoline). The nurse should monitor for which important side effect of this medication? 1. Skin rash 2. Headache 3. Palpitations 4. Tachycardia
1. Skin rash Monitoring for skin rash would be the priority intervention because hydralazine is known to cause lupuslike symptoms. Headache, palpitations, and tachycardia are all known side effects of the medication.
The nurse is providing care for a patient who is in the diuretic stage of acute renal failure. Which signs or symptoms would the nurse expect this patient to exhibit? Select all that apply. 1. Urine output exceeding 400 ml per day 2. Retains calcium and bicarbonate 3. Urine osmolality decreases. 4. Few waste products are excreted. 5. Increasing BUN and serum creatinine.
1. Urine output exceeding 400 ml per day 2. Retains calcium and bicarbonate 4. Few waste products are excreted. In the diuretic stage, urine output exceeds 400 ml per day; calcium and bicarbonate are retained; and few waste products are excreted. In the initial stage, BUN and serum creatinine are increased. In the oliguric stage, urine osmolality decreases.
A patient was diagnosed as being in acute renal failure 10 days ago. The urine output for the past 24 hours is 380 mL, with increased serum creatinine, potassium, and phosphorous and decreased serum calcium and bicarbonate levels. Which phase best describes these symptoms? 1. Onset stage 2. Oliguric stage 3. Diuretic stage 4. Recovery stage
2. Oliguric stage During the oliguric stage, urine output decreases to 400 mL per day or less, and serum levels change as described. The onset stage lasts 1 to 3 days and may have normal to decreased urine output. The diuretic stage is characterized by urine output greater than 400 mL per day. During the recovery phase, serum electrolytes, BUN, and creatinine return to normal.
Which are parts of the nephron? Select all that apply. 1. Cortex 2. Tubule 3. Glomerulus 4. Renal pelvis 5. Bowman capsule
2. Tubule 3. Glomerulus 5. Bowman capsule The nephron is a vascular tubular system consisting of a tubule, glomerulus, and Bowman capsule. The kidney is divided into an outer layer called the cortex and an inner layer called the medulla. The renal pelvis is the area into which urine flows before it goes to the ureter.
A patient is being examined in the health care provider's office and has been diagnosed with calculi in the urinary tract. Which is most likely a factor that fostered the development of calculi in this patient? 1. Diluted urine 2. Active lifestyle 3. High dietary calcium 4. Familial history intake
4. Familial history intake Familial history is a factor that fosters the development of calculi. Concentrated urine, not diluted urine, is a factor that fosters the development of calculi. A sedentary lifestyle, not an active lifestyle, is a factor that fosters the development of calculi. Low dietary calcium intake, not high dietary calcium intake, is a factor that fosters the development of calculi.
The LPN is caring for a patient who is scheduled to undergo a cystoscopy. Which is the priority instruction needed for the patient related to postprocedural care? 1. Administer analgesics as needed for pain relief. 2. Restrict fluids to less than 1 liter of fluid per day. 3. Prepare sitz baths for the relief of urinary frequency. 4. Inform the patient that the urine should lighten from pink to normal within 48 hours.
4. Inform the patient that the urine should lighten from pink to normal within 48 hours. The urine will initially be pink to even wine-colored but should lighten to a normal color within 48 hours. The patient should notify the health care provider if the urine does not lighten appropriately. Administering analgesics for pain relief is important, but monitoring for blood in the urine is a higher priority. Fluids should be encouraged, not restricted. Sitz baths do provide comfort, but are not the priority of care.
A patient who has acute glomerulonephritis is experiencing activity intolerance. Which factors may cause activity intolerance? Select all that apply. 1. Infection 2. Anemia 3. Constipation 4. Pressure ulcer 5. Accumulated toxins
1. Infection 2. Anemia 5. Accumulated toxins Infection, anemia, and accumulated toxins may all contribute to activity intolerance in the patient who has acute glomerulonephritis. Constipation and pressure ulcer may be the result of prolonged activity intolerance and/or bed rest.
A patient is being discharged after lithotripsy has been performed. The patient asks the discharging nurse when returning to work is feasible. Which is the nurse's best response? 1. "Most patients are able to resume normal activities the next day after the procedure. Did you discuss this with your physician?" 2. "I don't see any reason why you can't return to work. I was able go right back to work the next day, and so was my brother-in-law." 3. "Because you have an incision and your urine has dark-red blood, you will not be able to return to work until your urine is clear of blood." 4. "You must not go to work for 2 weeks because you are still taking an antibiotic to prevent complications of a urinary tract infection (UTI)."
1. "Most patients are able to resume normal activities the next day after the procedure. Did you discuss this with your physician?" Most patients are able to resume normal activities the next day after a lithotripsy procedure. However, it is not appropriate to expect the patient to meet the same expectation just because the nurse has a personal experience regarding the procedure. An incision is not performed during the surgery, and the urine often contains dark-red blood. Antibiotic agents are generally given for about 2 weeks to prevent UTI and are not a reason to prevent returning to work.
A patient who has a urinary tract infection has been prescribed the antibiotic sulfisoxazole (Gantrisin) as treatment. Which information should be included in the teaching plan for this patient? Select all that apply. 1. Blood cell counts will be monitored while on this medication. 2. This medication may cause your urine to be colored green. 3. Take this medication with orange juice to increase its effectiveness. 4. Avoid excessive exposure to the sun while you are taking this medication. 5. Do not take this medication if you have ever had a reaction to sulfa drugs.
1. Blood cell counts will be monitored while on this medication. 4. Avoid excessive exposure to the sun while you are taking this medication. 5. Do not take this medication if you have ever had a reaction to sulfa drugs. This medication may cause agranulocytosis, and the patient should have blood cell counts monitored for this reason. Photosensitivity may occur; therefore, the patient should avoid the sun. Patients who have a sulfonamide allergy should not take this medication. This medication may cause the urine to be colored orange. The medication should be taken with a full glass of water to prevent crystals from occurring; orange juice has no effect on it.
The nurse is providing care to a patient who has a fluid imbalance resulting in an increased amount of urine output. Which factor affects the amount of urine produced? Select all that apply. 1. Fluid intake 2. Medications 3. Temperature 4. Uric acid production 5. Trigonal muscle relaxation
1. Fluid intake 2. Medications 3. Temperature The amount of urine produced is affected by fluid intake, temperature, diaphoresis, vomiting, diarrhea, and certain medications. Uric acid production and trigonal muscle relaxation do not affect urine production.
A 48-year-old patient is diagnosed with polycystic kidney disease (PKD). Which information is most appropriate for the nurse to include in the discharge teaching? 1. Importance of genetic counseling 2. Complications of renal transplantation 3. Intraperitoneal treatment of chronic pain 4. Differences between hemodialysis and peritoneal dialysis
1. Importance of genetic counseling The nurse should include the importance of genetic counseling in the discharge teaching because each of the patient's children has a 50% chance of having the condition. Preservation of kidney function, not renal transplantation, is the initial strategy. The patient is being discharged at this time, so pain control measures are appropriate to discuss. I However, intraperitoneal treatment of chronic pain is not performed in the outpatient environment. It is not appropriate to discuss the differences between hemodialysis and peritoneal dialysis at this point in time.
A patient is being treated for acute glomerulonephritis and is on a fluid restriction in the hospital setting. Which is the best method to assist the patient in coping with the intervention? 1. It helps to present fluids in small containers rather than serving an ounce or two in a large glass. 2. Place an 8-ounce glass of fluid on the table with lines marked to indicate amount of fluid intake permitted per hour. 3. Provide the patient with calming, soft sounds of the ocean, rain, or a waterfall to assist with the anxiety created by the restrictions. 4. Place 6 to 8 ounces of permitted fluid in the standard hospital water pitcher with a large amount of ice to make the volume appear larger.
1. It helps to present fluids in small containers rather than serving an ounce or two in a large glass. If fluids are restricted, the nurse must explain the need for the restriction and help the patient plan the timing and amounts of allowed fluids. Fluid restriction can be very distressing. It helps to present fluids in small containers rather than serving an ounce or two in a large glass. Therefore, the nurse would not place an 8-ounce glass of fluid at the bedside with marked lines because the process tempts the patient to take more fluid than is allotted for the designated timeframe. The same principle applies to the 6 to 8 ounces of fluid in a standard hospital water pitcher. The ice will melt, creating more volume. Calming, soft sounds will assist with the anxiety, but the sounds should not include those of water.
The LPN is caring for a patient who is undergoing a computed tomography (CT) scan. During the test, the patient tells the nurse that he is experiencing a salty taste in his mouth. Which is the most appropriate nursing action? 1. No action is needed; this response to the contrast media is expected. 2. Inform the health care provider; the patient is experiencing an anaphylactic reaction. 3. Inform the technician; the test must be stopped because of an anaphylactic reaction. 4. Closely monitor the patient's vital signs; an anaphylactic response may be imminent.
1. No action is needed; this response to the contrast media is expected. The contrast media may cause the patient to experience a salty taste in the mouth; no action is needed. The patient is not experiencing an allergic reaction; therefore no action is needed.
Which are expected age-related changes in the urinary system? Select all that apply. 1. Often have nocturia 2. Bladder muscles lose tone 3. Creatinine clearance increases 4. Thinning of membranes in nephrons 5. Urine production peaks during the waking hours
1. Often have nocturia 2. Bladder muscles lose tone Older people often have nocturia, meaning that they awaken from sleep to void. Bladder muscles weaken and muscle tone is lost with aging. Creatinine clearance decreases with age, and the pattern of peak urine production during the waking hours is lost.
Blood pressure is regulated by fluid volume maintenance and release of a hormone from the kidneys. The hormone is also released in response to inadequate renal blood flow. What hormone is being described? 1. Renin 2. Angiotensin 3. Parathormone 4. Erythropoietin
1. Renin Blood pressure is regulated by fluid volume maintenance and release of renin from the kidneys. The kidneys also release renin in response to inadequate blood flow. Angiotensin is produced in the liver. Parathormone is secreted by the parathyroid glands to maintain serum calcium. Erythropoietin is secreted in the kidneys and functions to stimulate bone marrow to produce red blood cells.
The nurse is providing education for a patient who was recently diagnosed with hypertension. The patient asks the nurse how the body maintains blood pressure. The nurse responds that the kidneys release which hormone, which works in conjunction with fluid volume maintenance to regulate blood pressure. 1. Renin 2. Erythropoietin 3. Parathormone 4. Angiotensinogen
1. Renin Blood pressure is regulated through the maintenance of the fluid volume and the release of renin from the kidneys. Erythropoietin is secreted in the kidneys and stimulates the bone marrow to produce red blood cells. Parathormone is secreted by the parathyroid glands to maintain serum calcium levels. Renin acts on angiotensinogen, a hormone produced by the liver, and converts it to angiotensin I. A lung enzyme converts angiotensin I to angiotensin II. Angiotensin II is a powerful peripheral vasoconstrictor.
The nurse is providing discharge education instructions in nutrition for a patient who has renal failure. Which nutrition considerations should be included? Select all that apply. 1. Restrict fluid intake to 1500 milliliters per day. 2. Dietary protein is increased and should include beans and legumes. 3. The patient receiving dialysis should restrict potassium and sodium intake. 4. People with low serum calcium are at a decreased risk for renal calculi. 5. Cranberry juice is recommended because of its ability to make the urine less acidic.
1. Restrict fluid intake to 1500 milliliters per day. 3. The patient receiving dialysis should restrict potassium and sodium intake. The patient receiving dialysis should restrict sodium and potassium intake to maintain electrolyte balance. Fluid intake may be restricted to 1000 to 1500 milliliters per day. Dietary protein is restricted, not increased, and should include complete proteins such as eggs, meat, and poultry. People with low serum calcium are at increased risk for formation of calculi. Cranberry juice is recommended for patients who have frequent urinary tract infections because it makes the urine more, not less, acidic.
Which factors predispose a patient to developing renal calculi? Select all that apply. 1. Sedentary lifestyle 2. High alcohol intake 3. Hypoparathyroidism 4. Low dietary calcium intake 5. Frequent urinary tract infections 6. Excessive use of calcium-based antacids
1. Sedentary lifestyle 4. Low dietary calcium intake 5. Frequent urinary tract infections 6. Excessive use of calcium-based antacids A sedentary lifestyle and immobility contribute to urinary stasis, which increases the risk for developing calculi. A low dietary calcium intake is associated with calculi formation. Frequent urinary tract infections can cause urine to become alkaline or too acidic depending on the causative organism, causing substances to precipitate and resulting in calculus formation. High alcohol intake, while unhealthy, is not a risk factor. Hyperparathyroidism rather than hypoparathyroidism is a risk factor.
The health care provider has ordered a diagnostic blood test to determine the kidneys' ability to excrete wastes. Which blood test will be used? 1. Serum creatinine 2. Creatinine clearance 3. Blood urea nitrogen (BUN) 4. Urine culture and sensitivity
1. Serum creatinine Creatinine is a waste product of skeletal muscle breakdown. The level of creatinine in the blood is an indication of the kidneys' ability to excrete wastes. Creatinine clearance, the rate at which the kidney removes creatinine from the blood, is the best test of overall kidney function. This test requires the collection of all urine for 12 to 24 hours, as ordered. Creatinine clearance is not a blood test. The BUN test is a general indicator of the kidneys' ability to excrete urea, an end-product of protein metabolism. A urine culture permits the identification of microorganisms in the urine. Sensitivity testing determines which antibiotics will be effective against specific organisms.
The blood urea nitrogen (BUN) and the serum creatinine are elevated in a patient's laboratory results. Which test is the best for determining renal function? 1. The serum creatinine value is the best indicator of renal function. 2. The blood urea nitrogen (BUN) is best because it is not influenced by diet or liver function. 3. Serum creatinine is reflective of skeletal muscle breakdown, not renal function. 4. Neither BUN nor serum creatinine are correct because both are influenced by hydration.
1. The serum creatinine value is the best indicator of renal function. The serum creatinine value is the best indicator of renal function. Serum creatinine is elevated only in renal disorders and is a better measurement of kidney function. Unlike BUN, creatinine is not influenced by diet, hydration, nutritional status, or liver function. Skeletal muscle breakdown waste products consist of creatinine, which is cleared by the kidneys. The value increases when the kidneys are not functioning.
A patient at an extended-care facility is confused and is not oriented to place and time. Vital signs are within normal limits, except the temperature is 100.8° F. The patient's urine smells foul, and it is cloudy and dark in color. Which initial tests would the nurse anticipate the primary care provider will order for this patient? Select all that apply. 1. Urinalysis 2. Strain all urine 3. Urine culture and sensitivity 4. Abdominal and renal ultrasound 5. Flat plate of kidneys, ureters, and bladder (KUB)
1. Urinalysis 3. Urine culture and sensitivity Changes in level of consciousness and/or orientation are potential early signs of a urinary tract infection, particularly in older adults. A urinalysis and a urine culture and sensitivity test will indicate if this is the diagnosis. If kidney stones are suspected, it is appropriate to strain all urine. However, none of the patient's symptoms correlate with kidney stones. Abdominal and renal ultrasounds are used to detect cysts, tumors, urinary calculi, and urinary tract malformations or obstructions. A flat plate of kidneys, ureters, and bladder (KUB) provides a radiographic views of the kidneys, ureters, and bladder, but it is not indicated at this time.
. A patient who is experiencing chronic urethritis asks the nurse how she may reduce her risk factors in the future. Which nursing interventions are appropriate for this patient? Select all that apply. 1. Use a sitz bath for comfort. 2. Wipe from front to back after voiding. 3. Take a bubble bath at least daily to assure cleanliness. 4. Void before and after sexual intercourse as a means of prevention. 5. Increase the amount of fluids taken throughout the day to flush the urethra.
1. Use a sitz bath for comfort. 2. Wipe from front to back after voiding. 4. Void before and after sexual intercourse as a means of prevention. 5. Increase the amount of fluids taken throughout the day to flush the urethra. Using a sitz bath for comfort, wiping from front to back after voiding, voiding before and after sexual intercourse as a means of prevention, and increasing the amount of fluids taken throughout the day to flush the urethra will decrease the recurrence of urethritis. Bubble baths may actually reduce the normal flora in the urethra and act as an irritant that may increase the risk for urethritis.
The nurse is providing instructions for a patient who is receiving ciprofloxacin (Cipro) for a urinary tract infection. Which statement by the patient indicates the need for further teaching? 1. "I should notify my health care provider if I develop a rash or wheezing." 2. "I can take this medication along with my regular medicines, including my iron tablet." 3. "I will need to come to the hospital to have my blood drawn to check my liver function." 4. "I should be drinking plenty of water while I am taking this medication so that my urine is clear."
2. "I can take this medication along with my regular medicines, including my iron tablet." Ciprofloxacin (Cipro) should not be taken within 2 hours of antacids, iron, or zinc as they may decrease the effectiveness. Anaphylaxis and allergic reactions to this medication may occur. If the patient develops a rash or wheezing, he or she should notify the provider immediately. Liver function tests should be monitored as this medication may cause hepatotoxicity. Increasing fluid intake to 1500 to 2000 ml will help prevent crystal formation.
A patient had surgery to remove a cancerous kidney 2 days ago. Which patient statements and nursing observation best indicate that the patient has met the expected outcomes? 1. "My pain is an 8. May I have something for pain?" The nurse notes the last pain medication was given 45 minutes ago. 2. "I sure am hungry. When may I have something to eat?" The nurse hears audible bowel sounds, and the abdomen is soft. 3. "I was able to pull 500 milliliters on the incentive spirometer." The nurse does not hear any wheezes, and temperature is 99° F. 4. "I usually enjoy crochet projects, but I guess it doesn't matter anymore." The nurse notes that the patient makes minimal eye contact.
2. "I sure am hungry. When may I have something to eat?" The nurse hears audible bowel sounds, and the abdomen is soft. It is an expected outcome for peristalsis to return after surgery. Hunger, a soft abdomen, and audible bowel sounds are evidence that this expected outcome has been met. It is an expected outcome that postoperative pain is relieved. Pain rated 8 of 10 forty-five minutes after medication is administered indicates that this expected outcome has not been met. A low-grade fever and poor inspiration indicate an infection is taking place. A lack of interest in formerly enjoyable activities and little eye contact indicate difficulty coping.
A patient with renal calculi is hospitalized with gross hematuria and severe colicky left flank pain. Which nursing action will be the priority at this time? 1. Ambulate the patient every hour. 2. Administer prescribed analgesics. 3. Give antiemetics as needed for nausea. 4. Encourage an increased intake of oral fluids.
2. Administer prescribed analgesics. The chief complaint is usually pain. Opioid analgesics or parenteral NSAIDS and antispasmodic agents must be administered to relieve the intense, colicky pain associated with renal calculi. Ambulation may facilitate the passage of many calculi but is not a priority at this time. Pain does cause nausea and vomiting, but the relief of the pain will also relieve the nausea created by the pain. Either way, an antiemetic is not the highest priority as the question does not indicate that the patient is experiencing nausea. Oral fluids are not the priority.
The primary health care provider has diagnosed a patient with cystitis. Which methods to reduce the risk for infection should be included in the patient teaching? Select all that apply. 1. Wear nylon undergarments to provide warmth and moisture close to the perineum. 2. Drink a glass of water after swimming and before and after intercourse to "flush" the urethra. 3. Consider drinking cranberry juice to make the urine more acidic and discourage bacteria growth. 4. Take tub baths instead of showers, and avoid coffee, tea, and carbonated beverages with caffeine. 5. We will not need to see you again unless your symptoms return, but be sure to call if this does occur.
2. Drink a glass of water after swimming and before and after intercourse to "flush" the urethra. 3. Consider drinking cranberry juice to make the urine more acidic and discourage bacteria growth. Patient teaching to reduce the risk for future infections (cystitis) includes many elements. It is appropriate to advise the patient to consider drinking cranberry juice to make the urine more acidic and discourage bacteria growth. Cranberry juice is sometimes recommended to make urine more acidic and discourage bacterial growth. It is also appropriate to advise the patient to drink a glass of water after swimming and before and after intercourse to "flush" the urethra of potential bacteria. To keep the perineum drier, the patient is encouraged to wear cotton undergarments instead of synthetic materials such as nylon. The patient is encouraged to take showers instead of tub baths to avoid exposure to bacteria in a tub bath. The patient may need to be seen again.
The nurse is preparing to collect a urine creatinine clearance specimen on a patient. Please place the steps in the correct order for collecting this urine specimen. 1. Document the first void. 2. Explain the procedure to the patient. 3. Provide a specimen container. 4. Keep the specimen refrigerated during the collection process. 5. Save all urine for the specified number of hours.
2. Explain the procedure to the patient. 3. Provide a specimen container. 1. Document the first void. 5. Save all urine for the specified number of hours. 4. Keep the specimen refrigerated during the collection process. First explain the procedure, and then provide a specimen container. Then document the first void, and save all urine for the specified number of hours. Keep the specimen refrigerated during the collection process. Following these steps will assure that the specimen is collected correctly.
The nurse is caring for a patient at a long-term care facility who is taking phenazopyridine (Pyridium) to decrease discomfort and bladder spasms from an acute urinary tract infection. Which explanation is essential for the nurse to provide to the certified nursing assistant (CNA) regarding this patient? 1. The patient's urine will likely remain cloudy for about 1 week. 2. It is normal for the patient's urine to be orange red while taking this medication. 3. Provide perineal hygiene for this patient by wiping her perineum from back to front. 4. Remind the patient to restrict fluids so she does not have to make as many bathroom trips.
2. It is normal for the patient's urine to be orange red while taking this medication. The patient taking phenazopyridine (Pyridium), a drug that relieves burning on urination, causes the urine to be orange red, which may stain clothing. The patient's urine should not be cloudy once the infection clears. Perineal hygiene should be performed by wiping the perineum from front to back. The patient should have a high fluid intake.
The nurse is performing a bladder scan on a patient to check the amount of residual urine in the bladder after the patient has voided. What is the normal amount of residual urine? 1. Less than 25 mL 2. Less than 50 mL 3. Greater than 75 mL 4. Greater than 100 mL
2. Less than 50 mL A bladder scan may be performed to check the amount of urine in the bladder after a patient has voided (residual). Less than 50 mL is considered normal.
What normal renal changes occur during the aging process? Select all that apply. 1. Incontinence 2. Loss of nephrons 3. Weakening of bladder muscles 4. Decrease in creatinine clearance 5. Increased plasma renin and aldosterone levels 6. Kidney tubules more responsive to antidiuretic hormone (ADH)
2. Loss of nephrons 3. Weakening of bladder muscles 4. Decrease in creatinine clearance Loss of nephrons is a normal part of the aging process. Bladder muscles weaken and connective tissue increases causing decreased capacity. Creatinine clearance decreases with age. Incontinence is common, however it is not a normal part of the aging process. Plasma renin and aldosterone levels decrease, making tubules less responsive to ADH.
The nurse is providing care for a patient who has just undergone a closed renal biopsy. Which postprocedure nursing interventions will the nurse provide for this patient? 1. Check the white blood cell count 4 hours after the procedure. 2. Monitor vital signs, being alert for the possibility of hemorrhage. 3. Position the patient in the semi-Fowler position with the foot of the bed raised slightly. 4. Maintain the patient on NPO status for at least 12 hours postprocedure to prevent nausea.
2. Monitor vital signs, being alert for the possibility of hemorrhage. Vital signs should be monitored closely for hemorrhage as well as watching for restlessness and flank pain, which may also indicate bleeding. There is no need to check the white blood cell count; however the hemoglobin and hematocrit should be checked 6 hours after the biopsy. The patient should be in the supine position with a blanket roll under the flank area to provide pressure. There is no need to maintain NPO status after the procedure.
Aluminum hydroxide gel (Amphojel) is ordered for a patient to take on a daily basis. What is the purpose of taking this medication for a patient who has renal failure? 1. To supplement the dietary intake of calcium to combat hyperphosphatemia resulting from renal failure. 2. To bind with phosphates in the intestines to prevent absorption because renal failure causes hyperphosphatemia. 3. To prophylactically treats chronic urinary tract infections and is especially effective against recurrent urinary tract infections (UTIs) in men who are in renal failure. 4. To bind with calcium in the intestines to prevent absorption because renal failure results in the calcium resulting from to prevent absorption because the parathyroid is reacting to the levels of calcium as a res parathyroid elevating the calcium levels.
2. To bind with phosphates in the intestines to prevent absorption because renal failure causes hyperphosphatemia. In patients with renal failure, the kidneys are not able to clear the body of dietary phosphates. Aluminum hydroxide gel (Amphojel) binds with phosphates in the intestines to prevent absorption. When phosphates increase, calcium levels decrease. Aluminum hydroxide gel binds to the phosphates and decreases the binding to serum calcium. Antibiotics are used to treat acute and chronic urinary tract infections. The parathyroid gland does react to lowered calcium levels by obtaining additional calcium from the bones.
The nurse is teaching a patient regarding the treatment of cystitis. The nurse knows the patient needs further instructions if the patient makes which statements? Select all that apply. 1. "I will be increasing fluid intake." 2. "I will be using warm Sitz baths for comfort." 3. "I will be taking tea, coffee, and apple juice more often." 4. "I can discontinue the use of antibiotics as soon as symptoms cease." 5. "I should take a shower, instead of a bubble bath."
3. "I will be taking tea, coffee, and apple juice more often." 4. "I can discontinue the use of antibiotics as soon as symptoms cease." Patient teaching for the treatment and prevention of cystitis includes increasing fluid intake and using warm Sitz baths. Taking tea, coffee, and apple juice tends to irritate the bladder and should be discouraged. The patient with cystitis should be instructed to complete the entire course of prescribed antibiotics, even if symptoms have ceased. Showers are preferred because bubble baths are associated with causing symptoms of cystitis.
The nurse is providing care for a patient who had a lithotripsy procedure for the treatment of urinary calculi. Which effect would the nurse expect to see with this patient following lithotripsy? 1. Expect the urine to be colored a dark-red or smoky shade. 2. The patient will be able to resume normal activities within 8 hours. 3. A stent may be in place to help with the passage of the stone fragments. 4. The pulverized calculi will be excreted in the urine over the next few days.
3. A stent may be in place to help with the passage of the stone fragments. A stent may be placed in the ureter before treatment to assist with passage of stone fragments. Immediately postprocedure the urine is often bright red and will gradually turn to a dark-red or smoky color. The patient will be able to resume normal activities the day after the procedure. The pulverized calculi may take 1 to 4 weeks to be excreted in the urine.
What does the posterior pituitary gland release that affects the amount of water reabsorbed in the distal tubules and collecting ducts when the blood volume decreases or concentration increases? 1. Erythropoietin 2. GH (growth hormone) 3. ADH (antidiuretic hormone) 4. ACTH (adrenocorticotropic hormone)
3. ADH (antidiuretic hormone) ADH is stored in the posterior pituitary gland and is released when blood volume decreases or the concentration increases in cases such as dehydration. The result is urine becomes more concentrated and circulating blood increases. ACTH controls the growth, development, and function of the cortex of the adrenal glands. GH stimulates the growth and development of bones, muscles, and organs. Erythropoietin is secreted by the kidneys, not the posterior pituitary gland.
While caring for a patient with renal failure, the nurse reports that the patient has anuria. This term indicates which condition? 1. Low urine output 2. High urine output 3. Absence of urine output 4. Presence of blood in the urine
3. Absence of urine output Anuria is defined as the absence of urine output. Oliguria is defined as low urine output. Polyuria refers to high urine output. Hematuria is the presence of blood in the urine.
A patient is being treated for acute pain related to urinary calculi. Which risk factors may be present that would cause the development of a calculus? Select all that apply. 1. Diluted urine 2. Active lifestyle 3. Altered urinary pH 4. Excessive intake of oxalates 5. High dietary intake of calcium
3. Altered urinary pH 4. Excessive intake of oxalates The urine is normally acidic, with a pH ranging from 4.5 to 8; therefore an alteration in the pH may result in calculi. Excessive amounts of oxalate-containing foods such as beets, spinach, and sweet potatoes may predispose to calculi. Concentrated urine and a sedentary lifestyle may predispose to the development of urinary calculi. Low dietary calcium intake is attributed to calculi formation.
The nurse is providing care for a patient who has a diagnosis of postrenal failure. Which is the most likely cause of postrenal failure? 1. Diabetes mellitus 2. Nephrotoxic agents 3. Benign prostatic hypertrophy 4. Decreased blood flow to the glomeruli
3. Benign prostatic hypertrophy Benign prostatic hypertrophy, ureteral calculi, and obstructions beyond the kidneys that cause urine to back up are causes of postrenal failure. Diabetes mellitus, nephrotoxic agents, hypertension, and direct trauma to the kidneys may result in intrarenal failure. Decreased blood flow to the glomeruli may cause prerenal failure.
The student nurse is researching the urologic system and learns that which structure is a muscular sac that readily stretches to store urine? 1. Ureter 2. Kidney 3. Bladder 4. Urethra
3. Bladder The bladder is a muscular sac that readily stretches to store urine. The ureter carries urine from the renal pelvis to the bladder. The kidneys are bean-shaped organs located just under and below the twelfth rib near the waist in an area of the body called the flank. Each renal vein returns filtered blood directly to the inferior vena cava. The kidneys filter waste and concentrate, as well as collect and drain urine to the ureter. The urethra is a muscular tube lined with mucous membranes that carries urine from the bladder out of the body.
A patient has a respiratory tract infection caused by group A negative hemolytic streptococcus. The nurse stresses instructions to take all prescribed antibiotics to prevent which inflammatory condition of the urinary tract? 1. Urolithiasis 2. Pyelonephritis 3. Glomerulonephritis 4. Polycystic kidney disease
3. Glomerulonephritis Glomerulonephritis is an immunologic disease characterized by the inflammation of the capillary loops in the glomeruli. Urolithiasis is the formation of calculi (stones) in the urinary tract. Pyelonephritis is the inflammation of the renal pelvis. Polycystic kidney disease is a hereditary disorder characterized by grapelike cysts in place of normal kidney tissue.
Which is the most likely cause of tingling sensations, muscle twitches, irritability, and tetany in a patient who has chronic kidney disease? 1. Hypovolemia 2. Hyperkalemia 3. Hypocalcemia 4. Hypernatremia
3. Hypocalcemia Tingling sensations, muscle twitches, irritability, and tetany would be present in the patient who is experiencing hypocalcemia. Hypovolemia may cause hypotension and rapid, weak pulse. Hyperkalemia may cause dysrhythmias, nausea, and abdominal cramps. Hypernatremia may cause vomiting, diarrhea, and sweating.
The licensed practical nurse (LPN) is caring for a patient who is scheduled to begin treatment with a monoclonal antibody drug. Which priority nursing action should occur as the patient takes the first dose of this medication? 1. Detect early evidence of fluid overload. 2. Monitor the infusion site for extravasation. 3. Observe closely for evidence of anaphylaxis. 4. Determine the patient's use of coping mechanisms.
3. Observe closely for evidence of anaphylaxis. Although all of the interventions are important and should be implemented, monitoring the patient for evidence of anaphylaxis is the most important intervention, because anaphylaxis would most likely occur with the first dose and would be a life-threatening response. Secondarily, the nurse would monitor the patient for evidence of fluid overload, the infusion site for extravasation, and the patient for use of coping mechanisms.
A patient presents to the clinic with complaints of dysuria, bladder spasms, low-grade temperature, and abdominal discomfort for 3 days. A urinalysis and a culture and sensitivity test have been done. The diagnosis is cystitis. Which medication will be used to decrease discomfort and bladder spasms? 1. Gentamicin (Garamycin) 2. Sulfisoxazole (Gantrisin) 3. Phenazopyridine (Pyridium) 4. Hydrochlorothiazide (HydroDIURIL)
3. Phenazopyridine (Pyridium) Phenazopyridine (Pyridium) is often used for 2 or 3 days to decrease discomfort and bladder spasms. Gentamicin (Garamycin) is an antibiotic used to treat Gram-negative bacilli. Sulfisoxazole (Gantrisin) is an antibiotic used to treat urinary tract infections. Hydrochlorothiazide (HydroDIURIL) is a diuretic.
Which findings are most likely noted with data collection for a patient with acute renal failure, oliguric stage? 1. Urine output decreases to ≤100 mL/day and the BUN and creatinine begin to increase for a short period of time. 2. Urine output increases to 400 mL/day and may increase to above 4 L/day, and BUN and creatinine levels decrease. 3. Urine output decreases to ≤400 mL/day, the urine specific gravity is 1.010, and the patient becomes hypervolemic. 4. Urine output, BUN, and creatinine levels return to normal, and recovery has begun, but it may last as long as 1 to 12 months.
3. Urine output decreases to ≤400 mL/day, the urine specific gravity is 1.010, and the patient becomes hypervolemic. The four stages of acute renal failure are onset, oliguria, diuresis, and recovery. During the oliguric stage of acute renal failure, urine output decreases ≤400 mL/day, the urine specific gravity is 1.010, and the patient becomes hypervolemic. In the onset stage, BUN and serum creatinine increase for a short period. In the diuretic stage, urine output exceeds 400 mL/day and may increase to above 4 L/day, and BUN and creatinine levels decrease. In the recovery stage, urine output, BUN, and creatinine levels return to normal, and recovery begins but may last as long as 1 to 12 months. A decrease in urine output to ≤100 mL/day indicates anuria.
An older adult patient has a chemistry panel and other blood work performed for an annual checkup. Which test is the best indicator of kidney function for this patient? 1. Serum creatinine 2. Blood urea nitrogen (BUN) 3. Electrolytes (sodium and potassium) 4. 24-hour urine for creatinine clearance
4. 24-hour urine for creatinine clearance Creatinine clearance decreases with age. This means that the rate at which the kidneys are able to remove creatinine from the blood is diminished. Creatinine clearance is a better indicator of kidney function than serum creatinine. Blood urea nitrogen and electrolytes can be altered by other factors besides kidney function.
Which is the best indicator of the kidneys' ability to excrete an end product of protein metabolism? 1. Urine output 2. Serum creatinine 3. Creatinine clearance 4. Blood urea nitrogen (BUN)
4. Blood urea nitrogen (BUN) Blood urea nitrogen (BUN) is the best indicator of the kidneys' ability to excrete urea, an end product of protein metabolism. BUN is an estimate of the glomerular filtration rate (GFR) and is affected by the breakdown of protein. Creatinine clearance (a urine test) is the best indicator of renal function. Urine output is not reliable in that fluid intake and medications can affect output. Serum creatinine is a waste product of muscle breakdown and is a more reliable measurement of kidney function than BUN.
An older adult patient who has benign prostatic hyperplasia is admitted to the hospital with chills, fever, and vomiting. Which finding by the nurse will be most helpful in determining whether the patient has an upper urinary tract infection (pyelonephritis)? 1. Suprapubic pain 2. Bladder distention 3. Foul-smelling urine 4. Costovertebral tenderness
4. Costovertebral tenderness Severe pain or a constant dull ache occurs in the flank area over the kidney (costovertebral area). Signs and symptoms of acute pyelonephritis include high fever, chills, nausea, vomiting, and dysuria. Suprapubic pain, bladder distention, and foul-smelling urine are not associated with an upper urinary tract infection such as pyelonephritis.
A patient who is diagnosed with acute glomerulonephritis following an infection of the respiratory tract has presented with 3+ ankle and leg edema and periorbital edema. Why is the edema present? 1. Heart failure is a result of the infection, causing fluid retention. 2. The edema and weight gain are the result of high salt (sodium) intake. 3. The excess fluid is related to low serum albumin levels and proteinuria. 4. Glomerular permeability decreases, allowing antigen-antibody deposits.
4. Glomerular permeability decreases, allowing antigen-antibody deposits. An antigen-antibody reaction results in inflammation of the glomeruli, and scar tissue forms. Glomerular permeability increases, allowing proteins to leak into the urine. The glomerular filtration rate decreases, and nitrogenous wastes accumulate in the blood. The heart is only affected by the increased volume in circulation resulting in hypertension. High salt (sodium) intake does result in increase in fluid retention, edema, and weight gain; however it is not the reason for the edema and periorbital edema with acute glomerulonephritis. Restriction of salt intake will help decrease fluid retention, but fluid will continue to leak into the subcutaneous tissues until serum albumin levels are corrected.
Upon return from the surgical unit, the nurse is providing postoperative care for a patient who had a urinary diversion procedure. The patient's heart rate is 100, respirations are 24, and blood pressure is 120/84. The temperature is within normal range. The patient has intravenous fluids running, and the urinary output has totaled 50 milliliters for the last 3 hours. What is the nurse's best action? 1. The patient is stable, and it is acceptable to report to the oncoming nurse so the nurse can take a scheduled break. 2. The nurse should continue to monitor the patient because the blood pressure is normal and urinary output is adequate. 3. The nurse should administer opioid medications for pain, which is causing the elevation in heart rate and the respirations. 4. The patient is displaying signs and symptoms of decreased intravascular volume, and the nurse must notify the primary health care provider immediately.
4. The patient is displaying signs and symptoms of decreased intravascular volume, and the nurse must notify the primary health care provider immediately. The patient is displaying signs and symptoms of decreased intravascular volume, and the primary health care provider must be notified immediately. The nurse must perform ongoing assessments of vital signs; intake and output; patency of tubes; bowel sounds; comfort; and appearance of the drainage, stoma, and wound. The patient is not stable and is in the onset stage of acute renal failure. The nurse should not give an unstable patient to an oncoming nurse in order to take a scheduled break. The patient is experiencing fluid deficit because compensatory mechanisms are working to increase intravascular volume by releasing the renin, angiotensin, aldosterone (RAA) system. Also, antidiuretic hormone has been released to retain fluid, resulting in decreased urinary output. The tachycardia and tachypnea support this assessment. If immediate action is not taken, the blood pressure will begin to fall. Urinary output is not normal for 3 hours. There should be approximately 30 ml of urine formed on average per hour, therefore 90 ml should be present. Administering an opioid medication at this time is not necessary because pain is not evident and opioids cause vasodilation, which will further increase the need for intravascular volume.
What is the role of the kidney in the regulation of the patient's blood pressure? 1. The kidney secrets renin in response to low blood pressure. The renin acts on angiotensin II, which triggers the release of antidiuretic hormone and aldosterone, resulting in fluid retention to increase the blood pressure. 2. Angiotensin I is triggered by antidiuretic hormone (ADH) and converted by a lung enzyme (angiotensin-converting enzyme or ACE) to release sodium and water into the urine. 3. The posterior pituitary gland releases aldosterone, which causes the nephron to reabsorb sodium and water. The lungs release angiotensin II to convert renin in the kidneys into angiotensin I. 4. The posterior pituitary gland releases antidiuretic hormone (ADH) to stimulate the release of renin and aldosterone from the adrenal gland, which in turn releases angiotensin II to cause vasoconstriction.
4. The posterior pituitary gland releases antidiuretic hormone (ADH) to stimulate the release of renin and aldosterone from the adrenal gland, which in turn releases angiotensin II to cause vasoconstriction. The second mechanism by which the kidneys affect blood pressure is the secretion of renin. Renin is released in response to inadequate renal blood flow or low arterial pressure. Renin acts on angiotensinogen, a hormone produced by the liver, and converts it to angiotensin I. A lung enzyme converts angiotensin I to angiotensin II. Angiotensin II is a powerful peripheral vasoconstrictor. In addition, angiotensin II triggers the release of aldosterone from the adrenal cortex. Aldosterone stimulates tubular reabsorption of sodium and water, and plasma volume is expanded, resulting in increased blood pressure. The nephron units do reabsorb sodium and water as a result of aldosterone release. The posterior pituitary gland does release antidiuretic hormone (ADH) but does not stimulate the release of renin or aldosterone. Aldosterone is released from the adrenal gland, not the posterior pituitary gland. ADH is triggered by angiotensin II.
