MEDSURG II: Saunders Renal and Urinary

The nurse provides instructions to a client about newly prescribed furosemide. Which information should the nurse use to provide instructions in this teaching session? 1. The medication acts on the distal tubule of the nephron. 2. The medication acts on the loop of Henle in the nephron. 3. The collecting duct of the nephron will be affected by this medication. 4. The site of action for furosemide is the proximal tubule of the nephron.

2. The medication acts on the loop of Henle in the nephron. Rationale: Furosemide works by acting to excrete sodium, potassium, and chloride in the ascending limb of the loop of Henle; therefore, options 1, 3, and 4 are incorrect.

A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 1. Notify the HCP before performing the catheterization. 2. Use a small-sized catheter and an anesthetic gel as a lubricant. 3. Administer parenteral pain medication before inserting the catheter. 4. Clean the meatus with soap and water before opening the catheterization kit.

Answer: 1. Notify the HCP before performing the catheterization. Rationale: The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing. The other options include performing the catheterization procedure and therefore are incorrect.

The nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food? 1. Breads 2. Poultry 3. Chocolate 4. Prune juice

Answer: 3. Chocolate Rationale: Clients with oxalate stones should avoid foods high in oxalate, such as tea, instant coffee, cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and peanut butter. Large doses of vitamin C may help increase oxalate excretion in the urine.

A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item? 1. Steak 2. Shrimp 3. Chicken liver 4. Cottage cheese

Answer: 4. Cottage cheese Rationale: With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet. Intake of foods with moderate levels of purines, such as red and white meats and some seafood, also is limited. Avoiding the consumption of milk and dairy products is a recommended dietary change for calculi composed of calcium stones but is acceptable for the client with a uric acid stone.

A client with chlamydial infection has received instructions on self-care and prevention of further infection. The nurse determines that the client needs further teaching if the client states that he or she will take which action? 1. Use latex condoms to prevent disease transmission. 2. Return to the clinic as requested for follow-up culture in 1 week. 3. Reduce the chance of reinfection by limiting the number of sexual partners. 4. Take an antibiotic so as to prophylactically prevent symptoms of Chlamydia.

Answer: 4. Take an antibiotic so as to prophylactically prevent symptoms of Chlamydia. Rationale: Antibiotics are not taken prophylactically to prevent acquisition of chlamydial infection. The risk of reinfection can be reduced by limiting the number of sexual partners and by the use of condoms. In some cases, follow-up culture is requested in 4 to 7 days to confirm a cure. The remaining options are correct measures.

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? 1. Fish 2. Plum juice 3. Fruit juice 4. Cranberries

1. Fish Rationale: Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on health care provider prescription, the urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice.

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The clinic nurse should ask which question first? 1. "Have you had any diarrhea?" 2. "Have you been constipated recently?" 3. "Have you had any abdominal discomfort?" 4. "Have you had an increased amount of flatulence?"

Answer: 2. "Have you been constipated recently?" Rationale: Reduced outflow from the dialysis catheter may be caused by the catheter position, infection, or constipation. Constipation may contribute to a reduced outflow because peristalsis seems to aid in drainage. Options 1, 3, and 4 are unrelated to the causes of reduced outflow from the dialysis catheter.

A client with benign prostatic hyperplasia undergoes a transurethral resection of the prostate. Postoperatively the client is receiving continuous bladder irrigations. The nurse assesses the client for manifestations of transurethral resection syndrome. Which assessment data would indicate the onset of this syndrome? 1. Tachycardia and diarrhea 2. Bradycardia and confusion 3. Increased urinary output and anemia 4. Decreased urinary output and bladder spasms

Answer: 2. Bradycardia and confusion Rationale: Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

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

Answer: 2. Diabetes mellitus Rationale: Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in the remaining options are not associated risk factors.

The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common sign or symptom of this type of cancer? 1. Dysuria 2. Hematuria 3. Urgency on urination 4. Frequency of urination

Answer: 2. Hematuria Rationale: The most common sign in clients with cancer of the bladder is hematuria {PAINLESS Hematuria [early]; hematuria with dysuria [Later]}. The client also may experience irritative voiding symptoms such as frequency, urgency, and dysuria, and these symptoms often are associated with carcinoma in situ. Dysuria, urgency, and frequency of urination are also symptoms of a bladder infection.

The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? 1. Fever, diarrhea, groin pain, and ecchymosis 2. Nausea, painful scrotal edema, and ecchymosis 3. Fever, nausea, vomiting, and painful scrotal edema 4. Diarrhea, groin pain, testicular torsion, and scrotal edema

Answer: 3. Fever, nausea, vomiting, and painful scrotal edema Rationale: Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection, although sometimes it can be caused by trauma. The remaining options do not present all of the accurate manifestations.

The nurse is creating a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care? 1. Increase the amount of protein in the diet. 2. Increase the amount of potassium in the daily diet. 3. Maintain a diet high in calories with frequent snacks. 4. Encourage the client to eat a large breakfast and smaller meals later in the day.

Answer: 3. Maintain a diet high in calories with frequent snacks. Rationale: Uremia usually is accompanied by nausea, anorexia, and an unpleasant taste in the mouth. Most clients experience more nausea and vomiting in the morning. Therefore, to maintain optimal nutrition, it is best for these clients to eat a diet that is high in calories with frequent snacks and a light breakfast in the morning and larger meals later in the day. Dietary management usually is aimed at restricting protein, sodium, and potassium.

A client is being discharged to home while recovering from acute kidney injury (AKI). Reduced dietary intake of which substance indicates to the nurse that the client understands the dietary teaching? 1. Fats 2. Vitamins 3. Potassium 4. Carbohydrates

Answer: 3. Potassium Rationale: The excretion of potassium and maintenance of potassium balance are normal functions of the kidneys. In the client with AKI or chronic kidney disease, potassium intake must be restricted as much as possible (to 60 to 70 mEq/day). The primary mechanism of potassium removal during AKI is dialysis. Vitamins, carbohydrates, and fats are not normally restricted in the client with AKI unless a secondary health problem warrants the need to do so. The amount of fluid permitted is generally calculated to be equal to the urine volume plus the insensible loss volume of 500 mL.

A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day. The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based on the client's statement? 1. The client has an accurate understanding of the procedure and aftercare. 2. The client does not realize how painful removal of the dialysis catheter will be. 3. The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. 4. The client is not aware that the alternative access site is left in place prophylactically for 2 months.

Answer: 3.The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. Rationale: An AV fistula is the internal creation of an arterial-to-venous anastomosis. This causes engorgement of the vein, allowing both the artery and the vein to be easily cannulated for hemodialysis. Fistulas take 1 to 2 weeks to mature (engorgement) or develop before they can be used for dialysis, so the current method of access must remain in place to be used during that period. Options 1, 2, and 4 are incorrect interpretations of the client's statement.

A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment. The nurse assesses for this occurrence by periodically checking the results of which laboratory test? 1. Bleeding time 2. Thrombin time 3. Prothrombin time (PT) 4. Partial thromboplastin time (PTT)

Answer: 4. Partial thromboplastin time (PTT) Rationale: Heparin is the anticoagulant used most often during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by checking the PTT, which is the appropriate measure of heparin effect. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities. The PT is a test used to monitor the effect of warfarin therapy.

A client has chronic kidney disease (CKD) that does yet not require dialysis. Which client statement indicates the need for further teaching? 1. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." 2. "The amount of fluid I can have every day depends on the amount of urine I put out." 3. "I will weigh myself on my bathroom scale every morning right after I have urinated." 4. "I should report a gain in weight, trouble with my breathing, or increased leg swelling."

1. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." Rationale: CKD is a condition in which the kidneys have progressive problems in their ability to clear nitrogenous waste products and control fluid and electrolyte balance within the body. Conservative treatment of CKD slows progression of the disease and includes reducing the protein, sodium, potassium, and phosphorus in the diet and controlling the blood pressure. It is important to reduce the sodium in the diet. Salt substitutes usually are potassium-based and should not be used by a client with CKD because of the risk of hyperkalemia. The client should alter the fluid intake in relation to urine output. Obtaining a daily weight is an important measurement that indicates fluid volume. The client should also monitor for signs and symptoms of fluid overload, which could include an increase in weight, edema, and fluid collection in the lungs.

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the health care provider (HCP)? 1. Red, bloody urine 2. Pain rated as 2 on a 0-10 pain scale 3. Urinary output of 200 mL higher than intake 4. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute

4. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute Rationale: Frank bleeding (arterial or venous) may occur during the first day after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 mL more than intake is adequate. A client pain rating of 2 on a 0-10 scale indicates adequate pain control. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The HCP should be notified.

The nurse is caring for a client with acute kidney injury (AKI) experiencing metabolic acidosis. When performing an assessment, the nurse should expect to note which breathing pattern? 1. Apnea 2. Kussmaul respirations 3. Decreased respirations 4. Cheyne-Stokes respirations

Answer: 2. Kussmaul respirations Rationale: Clinical manifestations associated with AKI occur as a result of metabolic acidosis. The nurse would expect to note Kussmaul respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. The breathing patterns noted in options 1, 3, and 4 are not characteristic of AKI.

A client with renal cancer is being treated preoperatively with radiation therapy. What statement by the client demonstrates understanding of proper care of the skin over the treatment field? 1. "I need to avoid skin exposure to direct sunlight and chlorinated water." 2. "I need to use lanolin-based cream on the affected skin on a daily basis." 3. "I need to use the hottest water possible to wash the treatment site twice daily." 4. "I need to remove the lines or ink marks using a gentle soap after each treatment."

Answer: 1. "I need to avoid skin exposure to direct sunlight and chlorinated water." Rationale: The client undergoing radiation therapy should avoid washing the site until instructed to do so. The client should then wash, using mild soap and warm or cool water, and pat the area dry. No lotions, creams, alcohol, or deodorants should be placed on the skin over the treatment site. Lines or ink marks that are placed on the skin to guide the radiation therapy should be left in place. The affected skin should be protected from temperature extremes, direct sunlight, and chlorinated water (as from swimming pools).

The nurse provides home care instructions to a client undergoing hemodialysis with regard to care of a newly created arteriovenous (AV) fistula. Which client statement indicates that teaching was effective? 1. "I should check the fistula every day by feeling it for a vibration." 2. "I am glad that the laboratory will be able to draw my blood from the fistula." 3. "I should wear a shirt with tight arms to provide some compression on the fistula." 4. "I should check my blood pressure in the arm where I have my fistula every week."

Answer: 1. "I should check the fistula every day by feeling it for a vibration. Rationale: An AV fistula provides access to the client's bloodstream for the dialysis procedure. The client is instructed to monitor fistula patency daily by palpating for a thrill (vibration feeling). The client is instructed to avoid compressing the fistula with tight clothing or when sleeping and that blood pressure measurements and blood draws should not be performed on the arm with the fistula. The client also is instructed to assess the fistula for signs and symptoms of infection, including pain, redness, swelling, and excessive warmth.

The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option? 1. A client with severe heart failure 2. A client with a history of ruptured diverticula 3. A client with a history of herniated lumbar disk 4. A client with a history of 3 previous abdominal surgeries

Answer: 1. A client with severe heart failure Rationale: Peritoneal dialysis may be the treatment option of choice for clients with severe cardiovascular disease. Severe cardiac disease can be worsened by the rapid shifts in fluid, electrolytes, urea, and glucose that occur with hemodialysis. For the same reason, peritoneal dialysis may be indicated for the client with diabetes mellitus. Contraindications to peritoneal dialysis include diseases of the abdomen such as ruptured diverticula or malignancies; extensive abdominal surgeries; history of peritonitis; obesity; and a history of back problems, which could be aggravated by the fluid weight of the dialysate. Severe disease of the vascular system also may be a relative contraindication.

The nurse is preparing to teach ostomy care to a client who has just had a urinary diversion; the client expresses concern about body appearance. Which client action indicates that the best initial positive adaptation is being made? 1. Agrees to look at the ostomy 2. Asks to defer ostomy care to the spouse 3. Asks to wait 1 more day before beginning to learn ostomy care 4. States that ostomy care is the nurse's job while the client is in the hospital

Answer: 1. Agrees to look at the ostomy Rationale: The best initial positive step in learning to care for an ostomy and to accept it as a part of the self is to be able to look at the ostomy. Once the client is able to look at the ostomy and touch it, the client can proceed more successfully to learn about ostomy care. The other options all indicate a deferral or refusal on the part of the client, which makes them less than optimal choices.

The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting which problem? 1. Anger 2. Projection 3. Depression 4. Withdrawal

Answer: 1. Anger Rationale: Psychosocial reactions to CKD and hemodialysis are varied and may include anger. Other reactions include personality changes, emotional lability, withdrawal, and depression. The individual client's response may vary depending on the client's personality and support systems. The client in this question is exhibiting anger. The client's behavior is not indicative of projection; in addition, the client's statement does not reflect withdrawal or depression.

A client who has had a prostatectomy has been instructed in perineal exercises to gain control of the urinary sphincter. The nurse determines that the client demonstrates a need for further teaching when he states that he will perform which movement as part of these exercises? 1. Bearing down as if having a bowel movement 2. Tightening the muscles as if trying to prevent urination 3. Contracting the abdominal, gluteal, and perineal muscles 4. Tightening the rectal sphincter while relaxing abdominal muscles

Answer: 1. Bearing down as if having a bowel movement Rationale: The Valsalva maneuver (bearing down) is avoided after prostatectomy because it increases the risk of bleeding in the postoperative period. An acceptable exercise is to tighten the abdominal, gluteal, and perineal muscles as if trying to prevent urination. Another acceptable exercise is to tighten the rectal sphincter while relaxing the abdominal muscles; this prevents the Valsalva maneuver from occurring.

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status? 1. Blood pressure 2. Apical heart rate 3. Jugular vein distention 4. Level of consciousness

Answer: 1. Blood pressure Rationale: The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. For kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The heart rate affects the cardiac output but can be altered by factors unrelated to kidney function. Jugular vein distention and level of consciousness are unrelated items.

The client with chronic kidney disease has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. Which action should the nurse immediately take? 1. Change the dressing. 2. Reinforce the dressing. 3. Flush the peritoneal dialysis catheter. 4. Scrub the catheter with povidone-iodine.

Answer: 1. Change the dressing. Rationale: Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis.

Which finding noted in the client on continuous ambulatory peritoneal dialysis (CAPD) should be reported to the health care provider (HCP)? 1. Cloudy yellow dialysate output 2. Client refusal to take the stool softener 3. Previous evening's dwell time of 8 hours 4. Peritoneal catheter site is not red, and the skin has grown around the cuff

Answer: 1. Cloudy yellow dialysate output Rationale: CAPD is a form of peritoneal dialysis in which exchanges are completed 4 or 5 times daily. Peritonitis is a major complication of this type of dialysis. Peritonitis can be recognized by cloudy dialysate outflow, fever, abdominal guarding (board-like abdomen), abdominal pain, pain on inflow, malaise, nausea, and vomiting. The client has the right to refuse medications, but it also is important for the nurse to explain the importance of medications to the client. Typically the dwell time during the night is for the entire time that the client sleeps, which could be around 7 to 9 hours. The peritoneal site should have intact skin. The skin grows around the peritoneal catheter cuff, and this prevents tunnel (around catheter) infections.

A client with chronic kidney disease (CKD) has been taking aluminum hydroxide gel. On the basis of this information, the nurse determines that the client is most at risk for which problem? 1. Constipation 2. Dehydration 3. Inability to tolerate activity 4. Impaired physical mobility

Answer: 1. Constipation Rationale: The client with CKD is almost certain to have a problem with constipation as a result of factors such as fluid restriction, fatigue that limits exercise, and dietary restrictions. In addition, phosphate-binding antacids such as aluminum hydroxide gel cause constipation as a side effect. The other problems listed are unrelated to the information in the question.

A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder? 1. Diabetes mellitus 2. Orthostatic hypotension 3. Coronary artery disease 4.Intravenous (IV) contrast medium

Answer: 1. Diabetes mellitus Rationale: Pyelonephritis is most commonly caused by entry of bacteria, obstruction, or reflux. Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, overuse of analgesics, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has chronic renal disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Increased number of white blood cells in the urine

Answer: 1. Elevated creatinine level Rationale: The creatinine level is the most specific laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and red blood cell count are associated with anemia or blood loss and not specifically with decreased renal function. Increased white blood cells in the urine are noted with urinary tract infection.

The nurse is providing instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of peritonitis, a serious complication, is most likely to be associated with which clinical manifestation? 1. Fever 2. Fatigue 3. Clear dialysate output 4. Leaking around the catheter site

Answer: 1. Fever Rationale: The signs of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output. Fatigue may be associated with peritonitis, but fever is the most likely sign. Leaking around the catheter site is not an indication of peritonitis.

The nurse is preparing to care for a client receiving peritoneal dialysis. Which should be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? 1. Maintain strict aseptic technique. 2. Add heparin to the dialysate solution. 3. Change the catheter site dressing daily. 4. Monitor the client's level of consciousness.

Answer: 1. Maintain strict aseptic technique. Rationale: The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although changing the catheter site dressing daily may assist in preventing infection, this option relates to an external site. Adding heparin to the dialysate solution and monitoring the client's level of consciousness are unrelated to the major complication of peritoneal dialysis.

The nurse is monitoring the urine output of a client with low serum protein level and urinary output less than 30 mL in the last hour. Based on these data, the nurse understands that low urinary output is caused by which force within the kidneys? 1. Oncotic pressure 2. Osmotic pressure 3. Filtration pressure 4. Hydrostatic pressure

Answer: 1. Oncotic pressure Rationale: The pulling pressure within the capillaries that is exerted by the plasma proteins is referred to as the oncotic pressure. Osmotic pressure is the movement of water along a pressure gradient. Filtration pressure is the pressure that is exerted with ultrafiltration, in which the pressure within the capillaries is greater than the pressure outside them; this results in fluids being pushed across the membrane into Bowman's capsule. Hydrostatic pressure in the capillaries allows fluid to be filtered out of the blood in the glomerulus.

The nurse is assessing a client who has returned from the postanesthesia care unit after transurethral resection of the prostate (TURP). The nurse should assess for which color in the urinary drainage tubing that indicates proper irrigation and adequate functioning of the device? 1. Pale pink 2. Dark pink 3. Bright red 4. Red with clots

Answer: 1. Pale pink Rationale: If the bladder irrigation solution is infusing at a sufficient rate, the urinary drainage will be pale pink. A dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation should be increased. Bright red bleeding and red urine with clots should be reported to the surgeon because either finding could indicate complications.

The nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP). The client has a 3-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and should expect which urine color during the immediate postoperative period? 1. Pale pink urine 2. Dark pink urine 3. Tea-colored urine 4. Bright red blood with small clots in the urine

Answer: 1. Pale pink urine Rationale: If the bladder irrigation is infusing at a sufficient rate, the urinary drainage through the Foley tubing should be pale pink. Dark pink urine indicates that the rate of the irrigation solution should be increased. Tea-colored urine is not seen after TURP but may be noted in a client with other renal disorders such as renal failure. Bright red bleeding and clots could indicate a complication, and if this is noted, it should be reported to the health care provider.

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula 2. Presence of a radial pulse in the left wrist 3. Visualization of enlarged blood vessels at the fistula site 4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand

Answer: 1. Palpation of a thrill over the fistula Rationale: The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit {Thrill you feel; Bruit you hear}. The presence of a thrill and bruit indicate patency of the fistula. Enlarged visible blood vessels at the fistula site are a normal observation but are not indicative of fistula patency. Although the presence of a radial pulse in the left wrist and capillary refill less than 3 seconds in the nail beds of the fingers on the left hand indicate adequate circulation to the hand, they do not assess fistula patency.

Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory studies? 1. Serum potassium, serum calcium 2. Urinalysis, hematocrit, hemoglobin 3. Culture and sensitivity testing, serum sodium 4. Urine specific gravity, intravenous pyelogram

Answer: 1. Serum potassium, serum calcium Rationale: Because of the potentially life-threatening outcomes associated with hyperkalemia and hypocalcemia, they are the most relevant to nursing management of the client with CKD. The diagnostic tests in the remaining options may be helpful in diagnosing CKD or in monitoring treatment but are not the most relevant. Additionally, decreased hematocrit and hemoglobin occur in CKD because of the decreased level of erythropoietin. However, a decrease in hematocrit and hemoglobin may be reflective of various health alterations.

The nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that education was effective if the client chooses which selections from a diet menu? 1. Spinach salad, milk, and a banana 2. Chicken, potatoes, and cranberries 3. Peanut butter sandwich, milk, and prunes 4. Linguini with shrimp, tossed salad, and a plum

Answer: 1. Spinach salad, milk, and a banana Rationale: In some client situations, the health care provider may prescribe a diet that consists of foods that yield either an alkaline or an acid residue in the urine. In an alkaline residue diet, all fruits are allowed except cranberries, blueberries, prunes, and plums. Options, 2, 3 and 4 represent an acid residue diet.

The nurse is caring for a client who has just returned from having a cystoscopy. The nurse should recognize which as an abnormal assessment finding for this client? 1. The nurse notes bright red urine output. 2. The nurse notes pink-tinged urine output. 3. The client reports having urinary frequency. 4. The client complains of burning when urinating.

Answer: 1. The nurse notes bright red urine output. Rationale: The main purpose of a cystoscopy is to inspect the interior of the bladder with a tubular lighted scope (cystoscope). Pink-tinged urine is a normal finding after this procedure, but bright red urine indicates hemorrhaging and is not a normal finding. The remaining options are normal findings following this procedure.

A client with chronic kidney disease has completed a hemodialysis treatment. The nurse should use which standard indicators to evaluate the client's status after dialysis? 1. Vital signs and weight 2. Potassium level and weight 3. Vital signs and blood urea nitrogen level 4. Blood urea nitrogen and creatinine levels

Answer: 1. Vital signs and weight Rationale: Following dialysis the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.

The nurse is performing an assessment on a client after a cystoscopy. Which assessment finding indicates a need to notify the health care provider (HCP)? 1. A temperature of 99.4°F (37.4°C) 2. Grossly bloody urine with clots 3. A bluish or green tinge to the urine 4. A blood pressure of 120/82 mm Hg

Answer: 2. Grossly bloody urine with clots Rationale: Grossly bloody urine with clots following cystoscopy is always an abnormal finding and should be reported to the HCP immediately. The client may have clear or blood-tinged urine after cystoscopy. If a contrast agent such as methylene blue is used, the urine may have an unusual bluish or green tinge. A blood pressure of 120/82 mm Hg and a temperature of 99.4°F (37.4°C) are not abnormal findings at this time.

The nurse is preparing to perform a discharge teaching with a client who is started on hemodialysis. Which information should the nurse provide regarding the hemodialysis schedule? 1. 5 hours of treatment 2 days per week 2. 2 hours of treatment 6 days per week 3. 3 to 4 hours of treatment 3 days per week 4. 2 to 3 hours of treatment 5 days per week

Answer: 3. 3 to 4 hours of treatment 3 days per week Rationale: The typical schedule for hemodialysis is 3 to 4 hours of treatment 3 days per week. Individual adjustments are made according to variables such as the size of the client, type of dialyzer, rate of blood flow, personal client preferences, and other factors.

The client diagnosed with benign prostatic hyperplasia (BPH) is scheduled for a transrectal ultrasound examination and a test to measure the level of prostate-specific antigen (PSA). The client says to the nurse, "I can't remember . . . can you tell me again why I need these tests to be done?" The nurse responds, knowing that these tests are done for which purpose? 1. Specifically to predict the course of BPH 2. Help to rule out the possibility of cancer 3. Pinpoint the likelihood of developing urinary obstruction 4. Give an indication of whether intermittent self-catheterization is needed

Answer: 2. Help to rule out the possibility of cancer Rationale: A transrectal ultrasound examination and PSA level determination help to rule out the possibility of prostate cancer. They do not specifically predict the course of BPH or the development of complications such as urinary obstruction. These tests have nothing to do with determining need for self-catheterization.

The nursing student is caring for a client with benign prostatic hyperplasia (BPH). The nursing instructor asks the student to identify the clinical manifestations associated with this condition. The student needs further teaching if the student states that which finding is an early symptom of BPH? 1. Nocturia 2. Hematuria 3. Decreased force of urine stream 4. Difficulty initiating urine stream

Answer: 2. Hematuria Rationale: Hematuria is not an early sign of BPH. Nocturia, decreased force of urine stream, and difficulty initiating urine stream are all early signs of BPH.

A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse should expect to note which abnormal finding documented on the client's medical record? 1. Bradycardia 2. Hypertension 3. Decreased cardiac output 4. Decreased central venous pressure

Answer: 2. Hypertension Rationale: AKI caused by glomerulonephritis is classified as an intrinsic or intrarenal cause of renal failure. It is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from a prerenal cause is characterized by decreased blood pressure, tachycardia, decreased cardiac output, and decreased central venous pressure. Bradycardia is not part of the clinical picture for any form of kidney failure.

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client? 1. Bradycardia 2. Hypertension 3. Decreased cardiac output 4. Decreased central venous pressure

Answer: 2. Hypertension Rationale: AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.

The nurse provides discharge instructions to a client after prostatectomy. What is the priority discharge instruction for this client? 1. Avoid driving a car for at least 1 week. 2. Increase fluid intake to at least 2.5 L/day. 3. Avoid lifting any objects greater than 30 pounds (13.6 kg). 4. Contact the health care provider (HCP) if small clots are noticed in the urine.

Answer: 2. Increase fluid intake to at least 2.5 L/day. Rationale: A daily intake of 2.5 L of fluid should be maintained to limit clot formation and prevent infection. Driving a car and sitting for long periods are restricted for at least 3 weeks. The client should be instructed to avoid lifting objects heavier than 20 pounds (9 kg) for at least 6 weeks. Passing small pieces of tissue or blood clots in the urine for up to 2 weeks after surgery is expected and does not necessitate contacting the HCP.

The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg because the client is at risk for developing which type of acute kidney injury? 1. Prerenal 2. Intrarenal 3. Postrenal 4. Extrarenal

Answer: 2. Intrarenal Rationale: Serum myoglobin levels increase in crush injuries when large amounts of myoglobin and hemoglobin are released from damaged muscle and blood cells. The accumulation may cause acute tubular necrosis, an intrarenal cause of renal failure. Prerenal causes are conditions that interfere with the perfusion of blood to the kidney. Postrenal causes include conditions that cause urinary obstruction distal to the kidney. The cause and the type of renal failure may determine the interventions used in treatment.

The nurse is providing instructions to a client who is scheduled for cystoscopy and possible biopsy under general anesthesia. Which information should the nurse include? 1. The procedure will take about 4 hours. 2. Intravenous fluids may be started on the day of the procedure. 3. Preprocedure sedatives are never administered with general anesthesia. 4. Only a full liquid breakfast may be allowed on the day of the procedure.

Answer: 2. Intravenous fluids may be started on the day of the procedure. Rationale: Client preparation for cystoscopy and possible biopsy includes informing the client that intravenous fluids will be started the day of the procedure to ensure adequate hydration and flow of urine. The procedure will take approximately 30 minutes to 1 hour. An informed consent is obtained from the client, and preprocedure sedatives are administered as prescribed. If a general anesthetic is to be used, the client is told that fasting is necessary after midnight before the procedure.

128. Reproductive Question: The nurse is planning teaching for a female client diagnosed with urethritis caused by chlamydial infection. Which information should the nurse plan to include in the teaching session? 1. Alter the perineal pH by using a spermicide with a condom. 2. Keep follow-up appointments for repeat cultures in 4 to 7 days. 3. Discontinue antibiotics after 3 weeks of uninterrupted administration. 4. Identify sexual partners for the past 12 months so they can be treated.

Answer: 2. Keep follow-up appointments for repeat cultures in 4 to 7 days. Rationale: Follow-up cultures are typically done in 4 to 7 days to evaluate the effectiveness of the medication. Using a spermicide does not change the perineal pH. The infection can be prevented by the use of latex condoms. Chlamydial infection is treated with antibiotics, which are not discontinued until the prescribed course is completed. All sexual partners during the 30 days before diagnosis should be notified, examined, and treated as necessary.

The nurse is caring for a client whose urine output was 25 mL per hour for 2 consecutive hours. The nurse reviews the health care provider's prescriptions and plans care, knowing that which client-related factor would increase the amount of blood flow to the kidneys? 1. Physiological stress 2. Release of norepinephrine 3. Release of low levels of dopamine 4. Sympathetic nervous system stimulation

Answer: 3. Release of low levels of dopamine Rationale: The release of low levels of dopamine exerts a vasodilating effect on the renal arteries, increasing urinary output. The other options cause renal vasoconstriction.

The nurse caring for a client immediately after transurethral resection of the prostate (TURP) notices that the client has suddenly become confused and disoriented. Which is the priority nursing action for this client? 1. Reorient the client. 2. Notify the health care provider (HCP). 3. Ensure that a clock and calendar are in the room. 4. Increase the flow rate of the intravenous infusion.

Answer: 2. Notify the health care provider (HCP). Rationale: The client who suddenly becomes disoriented and confused after TURP could be experiencing early signs of hyponatremia. This may occur because the flushing solution used during the operative procedure is hypotonic. If the solution is absorbed through the prostate veins during surgery, the client experiences increased circulating volume and dilutional hyponatremia. The nurse should notify the HCP of these symptoms. Reorienting the client and ensuring that a clock and calendar are visible may be helpful but do not correct the problem. The nurse does not increase the flow rate of an intravenous infusion without a prescription from the HCP. In addition, speeding up the flow rate could potentially worsen the problem, depending on the solution that is infusing.

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5°C (101.2°F). Which nursing action is most appropriate? 1. Encourage fluid intake. 2. Notify the health care provider. 3. Continue to monitor vital signs. 4. Monitor the site of the shunt for infection.

Answer: 2. Notify the health care provider. Rationale: A temperature of 101.2°F (38.5°C) is significantly elevated and may indicate infection. The nurse should notify the health care provider (HCP). Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should be monitored, but the HCP should be notified first.

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client? 1. Prevent fluid overload. 2. Prevent loss of electrolytes. 3. Promote the excretion of wastes. 4. Reduce the urine specific gravity.

Answer: 2. Prevent loss of electrolytes. Rationale: In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in this phase of AKI.

The nurse has performed a nutritional assessment on a client with cystitis. The nurse should tell the client to consume which beverage to minimize recurrence of cystitis? 1. Tea 2. Water 3. Coffee 4. White wine

Answer: 2. Water Rationale: Water helps flush bacteria out of the bladder, and an intake of 6 to 8 glasses per day is encouraged. Caffeine and alcohol can irritate the bladder. Therefore, alcohol- and caffeine-containing beverages such as coffee, tea, and wine are avoided to minimize risk.

A client who is to have a cystectomy with creation of an ileal conduit asks the nurse why the bowel needs to be cleansed before surgery if the bladder is being removed. Which response by the nurse is the most appropriate? 1. "All clients undergo bowel preparation with major surgery." 2. "This will decrease the chance of postoperative paralytic ileus." 3. "A portion of the bowel will be used to create the conduit for urinary diversion." 4. "This will reduce the chance that the surgeon will nick the bowel during surgery."

Answer: 3. "A portion of the bowel will be used to create the conduit for urinary diversion." Rationale: The client scheduled for surgical creation of either an ileal conduit or a reservoir undergoes bowel preparation the night before the procedure. Preparation can include intake of copious clear liquids, laxatives, enemas, and antibiotics, depending on health care provider preference. This is done primarily to prevent infection because a loop of bowel will be used to create the urinary diversion.

The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care? 1. "I change my pouch every week." 2. "I change the appliance in the morning." 3. "I empty the urinary collection bag when it is two-thirds full." 4. "When I'm in the shower I direct the flow of water away from my stoma."

Answer: 3. "I empty the urinary collection bag when it is two-thirds full." Rationale: The urinary collection bag should be changed when it is one-third full to prevent pulling of the appliance and leakage. The remaining options identify correct statements about the care of a urinary stoma.

A client with prostatitis following kidney infection has received instructions on management of the condition at home and prevention of recurrence. The nurse determines that education was effective if the client makes which statement? 1. "I will stop antibiotic therapy when pain subsides." 2. "I will exercise as much as possible to stimulate circulation." 3. "I should use warm tub baths and analgesics to increase comfort." 4. "I will keep fluid intake to a minimum to decrease the need to void."

Answer: 3. "I should use warm tub baths and analgesics to increase comfort." Rationale: Treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. The nurse also teaches the client to rest, increase fluid intake, and use sitz baths or warm tub baths for comfort. Antimicrobial therapy is always continued until the prescription is finished.

The nurse measures the cardiac output of a client and finds it to be 6 L/min. Which amount of kidney perfusion should the nurse anticipate? 1. 100 to 300 mL/min 2. 500 to 1000 mL/min 3. 1200 to 1500 mL/min 4. 2000 to 2500 mL/min

Answer: 3. 1200 to 1500 mL/min Rationale: The kidneys normally receive about 20% to 25% of the cardiac output when the client is at rest. If the cardiac output is 6 L/min, the kidneys receive 1.2 to 1.5 L/min, which is equal to 1200 to 1500 mL/min.

The nurse is planning a teaching session with a client who has chronic kidney disease (CKD) about managing the condition between dialysis treatments. The nurse should plan to include the instruction that weight gain between dialysis treatments should be ideally what value? 1. 11 to 13 lbs (5 to 6 kg) 2. 4.5 to 9 lbs (2 to 4 kg) 3. 2 to 3 lbs (1 to 1.5 kg) 4. 1 to 2 lbs (0.5 to 1.0 kg)

Answer: 3. 2 to 3 lbs (1 to 1.5 kg) Rationale: Limiting weight gain to 2 to 3 lbs (1 to 1.5 kg) between dialysis treatments helps prevent the hypotension that occurs with the removal of large volumes of fluid during dialysis. The nurse instructs the client in how to manage daily fluid allotment to assist the client in staying within a low fluid intake range to prevent excess weight gain. Options 1, 2, and 4 are incorrect.

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of these data, which should the nurse specifically include in the dietary instructions? 1. Increase intake of dairy products. 2. Avoid citrus fruits and citrus juices. 3. Avoid green, leafy vegetables such as spinach. 4. Increase intake of meat, fish, plums, and cranberries

Answer: 3. Avoid green, leafy vegetables such as spinach. Rationale: Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The food items in options 1, 2, and 4 are acceptable to consume.

A client is being evaluated as a potential kidney donor for a family member. The client asks the nurse why separate teams are evaluating donor and recipient. What is the most appropriate response by the nurse? 1. Helps reduce the cost of the preoperative workup 2. Saves the client and the recipient valuable preoperative time 3. Avoids a conflict of interest between the team evaluating the recipient and the team evaluating the donor 4. Provides for a sufficient number of persons reviewing the case so that no information is overlooked

Answer: 3. Avoids a conflict of interest between the team evaluating the recipient and the team evaluating the donor Rationale: Both the kidney donor and the kidney recipient need thorough medical and psychological evaluation before transplant surgery. Separate teams evaluate the donor and the recipient to avoid a conflict of interest in providing care for the 2 clients. Options 1, 2, and 4 are not related to the purpose of this approach.

A home care nurse is making home visits to an older client with urinary incontinence who is very concerned about the incontinent episodes. Which finding by the nurse indicates that the client has an environmental barrier to normal voiding? 1. Presence of hand railings in the bathroom 2. Having 1 bathroom on each floor of the home 3. Bathroom located on the second floor, bedroom on the first floor 4. Night light present in the hall between the bedroom and bathroom

Answer: 3. Bathroom located on the second floor, bedroom on the first floor Rationale: Having the bathroom on the second floor and the bedroom on the first floor may pose a problem for the older client with incontinence. The need to negotiate the stairs and the distance both may interfere with reaching the bathroom in a timely fashion. It is more helpful to the incontinent client to have a bathroom on the same floor as the bedroom or to have a commode rented for use. Hand railings and night lights are helpful to the client in reaching the bathroom quickly and safely.

A client who is undergoing peritoneal dialysis calls the nurse at the renal unit and reports the presence of severe abdominal pain and diarrhea. The client also informs the nurse that the peritoneal dialysis returns are brown-tinged in color. Which would the nurse suspect? 1. Infection 2. An intact catheter 3. Bowel perforation 4. Bladder perforation

Answer: 3. Bowel perforation Rationale: Complications of a peritoneal catheter include infection, perforation of the bowel or bladder, and bleeding. Brown-tinged returns suggest bowel perforation, which usually is accompanied by severe abdominal pain and diarrhea. Cloudy or opaque returns suggest possible infection. Urine-colored returns suggest possible bladder perforation. An intact catheter is unrelated to the information provided in the question.

In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should the nurse anticipate? 1. Glycosuria 2. Polyphagia 3. Crackles auscultated in the lungs 4. Blood pressure of 98/58 mm Hg

Answer: 3. Crackles auscultated in the lungs Rationale: CKD is a condition in which the kidneys have progressive problems in clearing nitrogenous waste products and controlling fluid and electrolyte balance within the body. Cardiovascular symptoms of heart failure and hypertension are caused by the fluid volume overload resulting from the kidneys' inability to excrete water. Signs and symptoms of heart failure include jugular venous distention, S3 heart sound, pedal edema, increased weight, shortness of breath, and crackles auscultated in the lungs. The typical signs and symptoms of CKD include proteinuria or hematuria, not glycosuria. The nurse would observe anorexia and nausea in this client, not polyphagia.

A client undergoing hemodialysis begins to experience muscle cramping. What is the best action by the hemodialysis nurse in this situation? 1. Administer hypotonic saline. 2. Increase the ultrafiltration rate. 3. Decrease the ultrafiltration rate. 4. Administer magnesium sulfate.

Answer: 3. Decrease the ultrafiltration rate. Rationale: Muscle cramps during hemodialysis result from either too rapid removal of water and sodium or neuromuscular hypersensitivity. The nurse corrects this situation by either slowing down the ultrafiltration rate on the hemodialyzer or administering hypertonic or isotonic normal saline. Magnesium sulfate is not prescribed to correct this occurrence.

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse should observe for which most common manifestation of this disorder? 1. Headache 2. Hypotension 3. Flank pain and hematuria 4. Complaints of low pelvic pain

Answer: 3. Flank pain and hematuria Rationale: The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is either colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia, and palpable kidney masses. Hypertension is another common finding and may be associated with cardiomegaly and heart failure. The client may complain of a headache, but this is not a specific assessment finding in polycystic kidney disease.

The nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse should base the response on knowing that which is the action of the glucose in the solution? 1. Decreases the risk of peritonitis 2. Prevents disequilibrium syndrome 3. Increases osmotic pressure to produce ultrafiltration 4. Prevents excess glucose from being removed from the client

Answer: 3. Increases osmotic pressure to produce ultrafiltration Rationale: Increasing the glucose concentration makes the solution more hypertonic. The more hypertonic the solution, the higher the osmotic pressure for ultrafiltration and thus the greater the amount of fluid removed from the client during an exchange. The remaining options do not identify the purpose of the glucose.

The nurse assessing the ureterostomy of a postoperative client interprets that the stoma has normal characteristics if which is observed? 1. Dry 2. Pale 3. Dark-colored 4.Red and moist

Answer: 4. Red and moist Rationale: Following ureterostomy, the stoma should be red and moist. A dry stoma may indicate fluid volume deficit. A pale stoma may indicate an inadequate vascular supply. Any darkness or duskiness of the stoma may mean loss of vascular supply and must be corrected immediately to prevent necrosis.

The nurse has completed teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse should determine that education was effective if the client states to record which parameters daily? 1. Pulse and respiratory rate 2. Amount of activity and sleep 3. Intake and output (I&O) and weight 4. Blood urea nitrogen (BUN) and creatinine levels

Answer: 3. Intake and output (I&O) and weight Rationale: The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording I&O and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight per day. It is not necessary to record the pulse and respiratory rate or the amount of activity and sleep; these parameters are not specifically related to hemodialysis. BUN and creatinine levels are not measured on a daily basis.

The nurse is caring for a client who was prescribed furosemide. The nurse should monitor the client for damage of which kidney structure? 1. Pelvis 2. Calyx 3. Nephron 4. Renal artery

Answer: 3. Nephron Rationale: The nephron is the functional unit of the kidney that is responsible for clearance of excess fluid and waste products of metabolism. {Many meds, including Furosemide, may cause nephrotoxicity}. The renal pelvis and calices collect urine to send to the ureter. The renal artery brings blood to the kidney for filtering by the nephron.

The nurse is admitting a client from the postanesthesia care unit who has had percutaneous nephrolithotomy for calculi in the renal pelvis. The nurse anticipates that the client's care will most likely involve monitoring which device? 1. Ureteral stent 2. Suprapubic tube 3. Nephrostomy tube 4. Jackson-Pratt drain

Answer: 3. Nephrostomy tube Rationale: A nephrostomy tube is put in place after percutaneous nephrolithotomy for calculi in the renal pelvis. The client also may have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculous fragments. Options 1, 2, and 4 are incorrect.

A client with renal cell carcinoma of the left kidney is scheduled for nephrectomy. The right kidney appears normal at this time. The client is anxious about whether dialysis will ultimately be needed. The nurse should plan to use which information in discussions with the client to alleviate anxiety? 1. There is a strong likelihood that the client will need dialysis within 5 to 10 years. 2. There is absolutely no chance of needing dialysis because of the nature of the surgery. 3. One kidney is adequate to meet the needs of the body as long as it has normal function. 4. Dialysis could become likely, but it depends on how well the client complies with fluid restriction after surgery.

Answer: 3. One kidney is adequate to meet the needs of the body as long as it has normal function. Rationale: Fears about having only 1 functioning kidney are common in clients who must undergo nephrectomy for renal cancer. These clients need emotional support and reassurance that the remaining kidney should be able to fully meet the body's metabolic needs, as long as it has normal function. Therefore, the remaining options are incorrect.

The nurse is urging a client to cough and deep breathe after nephrectomy. The client tells the nurse, "That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is most likely to be a result of which factor? 1. A stress response to the ordeal of surgery 2. A latent fear of needing dialysis if the surgery is unsuccessful 3. Pain that is intensified because of the location of the incision near the diaphragm 4. Effects of circulating metabolites that have not been excreted by the remaining kidney

Answer: 3. Pain that is intensified because of the location of the incision near the diaphragm Rationale: After nephrectomy, the client may be in considerable pain. This is because of the size of the incision and its location near the diaphragm, which make coughing and deep breathing very uncomfortable. For this reason, opioids are used liberally and may be most effective when provided as patient-controlled analgesia or through epidural analgesia. The items in the other options are not likely factors for the client's statement.

The nurse is planning discharge teaching for a client newly diagnosed with chronic kidney disease (CKD). Which factor will enhance the educational process? 1. Anxiety 2. Memory deficits 3. Presence of family 4. Short attention span

Answer: 3. Presence of family Rationale: The client with CKD may have several barriers to learning. The presence of family members is helpful because they need to understand the disease and treatment and may help reinforce information with the client after the formal teaching session is over. Anxiety about the disease and its ramifications frequently interferes with learning. Physiological effects of the disease process also impair the client's mental functioning. Specifically, the client may exhibit a short attention span and have memory deficits. Mental functioning usually improves once hemodialysis has begun.

The health care provider writes prescriptions for a client with chronic kidney disease (CKD). Which prescription should the nurse question? 1. Insert a saline lock. 2. Obtain a daily weight. 3. Provide a high-protein diet. 4. Administer a calcium supplement with each meal.

Answer: 3. Provide a high-protein diet. Rationale: When a client experiences CKD, the blood urea nitrogen (BUN) and serum creatinine levels rise. The client also experiences increased potassium, increased phosphates, and decreased calcium. BUN and creatinine are the byproducts of protein metabolism, so monitoring protein intake is important, with care taken to include proteins of high biological value. Clients with CKD will have protein restricted early in the disease to preserve kidney function. In end-stage disease, protein is restricted according to the client's weight, the type of dialysis, and protein loss. With CKD, the nurse is concerned about fluid volume overload and accumulation of waste products. Because of the kidneys' inability to excrete fluid, it is important for the nurse to prevent as well as assess for early signs of fluid volume excess. Infusing an intravenous (IV) solution into a client with CKD significantly increases the risk for overload. If an IV access is needed, it usually involves only a saline lock. Obtaining the client's daily weight is one of the most important assessment tools for evaluating changes in fluid volume. The kidneys also are responsible for removing waste products. The client also receives phosphate binders, calcium supplements, and vitamin D to prevent bone demineralization (osteodystrophy) from chronically elevated phosphate levels.

A client is experiencing the syndrome of inappropriate antidiuretic hormone (ADH) secretion. When explaining this disorder to the client and family, the nurse recalls that ADH works to reabsorb water in which parts of the nephron? 1. The glomerulus and the calices 2. The loop of Henle and the distal tubule 3. The distal tubule and the collecting duct 4. The proximal tubule and the loop of Henle

Answer: 3. The distal tubule and the collecting duct Rationale: The distal tubule and the collecting duct of the nephron require the presence of ADH for water reabsorption. The hormone increases the permeability of the membranes to allow water to flow more easily along the concentration gradient. The glomerulus filters but does not reabsorb. The calices are responsible for collecting the urine. The proximal tubule and the loop of Henle reabsorb water without the assistance of ADH.

The nurse has administered a dose of meperidine hydrochloride to a client with renal colic as treatment for pain. The nurse carefully monitors this client for which side and adverse effect of this medication? 1. Bradycardia 2. Hypertension 3. Urinary retention 4. Increased respirations

Answer: 3. Urinary retention Rationale: Meperidine hydrochloride is an opioid analgesic. Side effects of meperidine hydrochloride include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

The nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further teaching about the diuretic phase of acute kidney injury? 1. "The increase in urine output indicates the return of some renal function." 2. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." 3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." 4. "The blood urea nitrogen and creatinine levels will continue to rise during the first few days of diuresis."

Answer: 3."The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." Rationale: The diuretic phase of acute kidney injury is characterized by an increase in urine output of more than 1000 mL in a 24-hour period. This increase in urine output indicates the return of some renal function; however, blood urea nitrogen and creatinine levels continue to rise during the first few days of diuresis. The diuretic phase develops about 14 days after the initial insult and lasts about 10 days.

The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching? 1. "I should try to maintain an acid ash diet." 2. "I should increase my fluid intake to 3 L per day." 3. "I should take my daily dose of vitamin C to acidify the urine." 4. "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."

Answer: 4. "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day." Rationale: Clients with acute pyelonephritis should be instructed to try to maintain an acid ash diet, which may be of some benefit. Also, they should increase fluid intake to 3 L per day; this helps relieve dysuria and flushes bacteria out of the bladder. However, for clients with chronic pyelonephritis and renal dysfunction, an increase in fluid intake may be contraindicated. Medications such as vitamin C help acidify the urine. Juices such as cranberry, plum, and prune juice will leave an acid ash in the urine. Caffeine, alcohol, chocolate, and highly spiced foods are avoided to prevent potential bladder irritation.

The ambulatory care nurse is providing instructions to a client after a cystoscopy. Which statement by the client indicates a need for further teaching? 1. "I should increase my fluid intake." 2. "I can apply heat to my lower abdomen." 3. "I may have some burning on urination for the next few days." 4. "If I notice any pink-tinged urine, I should contact the health care provider."

Answer: 4. "If I notice any pink-tinged urine, I should contact the health care provider." Rationale: The client is instructed that pink-tinged urine and burning on urination are expected for 1 to 2 days after the procedure. Increased fluid intake is encouraged. Application of heat to the lower abdomen, administration of mild analgesics, and the use of sitz baths may relieve discomfort. The client also is advised to avoid alcoholic beverages for 2 days after the test.

The graduate nurse is caring for a client with decreased renal perfusion. The registered nurse determines that the graduate nurse demonstrates understanding of why this is occurring if which statement is made? 1. "It can be due to an increase in serotonin levels." 2. "It may be due to overhydration with intravenous fluids." 3. "It may be due to the client's hemoglobin of 13.2 g/dL (132 mmol/L)." 4. "It may be a consequence of decreased dopaminergic receptor stimulation."

Answer: 4. "It may be a consequence of decreased dopaminergic receptor stimulation." Rationale: Dopaminergic receptors are found in the renal blood vessels and in the nerves. When stimulated, they dilate renal arteries and help modulate release of the neurotransmitter dopamine. Renal artery dilation helps improve urine output by increasing blood flow through the kidneys. {If the pt is in shock and urine output decreases, first we give fluids and if the urine output is still low we start the patient on Dopamine drip at a low rate to dilate the renal blood vessels in order to increase urine output}. Serotonin is a local hormone that is released from platelets after an injury; it constricts arterioles but dilates capillaries. Dehydration, not overhydration, would decrease renal perfusion. A hemoglobin of 13.2 g/dL (132 mmol/L) is a normal value.

The client with a crush injury to the leg has a highly positive urine myoglobin level. The nurse should assess this client carefully for signs and symptoms of which problem? 1. Brain attack 2. Respiratory failure 3. Myocardial infarction 4. Acute tubular necrosis

Answer: 4. Acute tubular necrosis Rationale: The normal urine myoglobin level is negative. After extensive muscle destruction or damage, myoglobin is released into the bloodstream, where it is cleared from the body by the kidneys. When a large amount of myoglobin is being cleared from the body, there is a risk of the renal tubules being clogged with myoglobin, causing acute tubular necrosis. This is one form of acute kidney injury. The remaining options are unrelated to a positive myoglobin level.

A client with chronic kidney disease who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril. When should the nurse plan to administer this medication? 1. During dialysis 2. Just before dialysis 3. The day after dialysis 4. On return from dialysis

Answer: 4. On return from dialysis Rationale: Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure.

A client with epididymitis is upset about the extent of scrotal edema. Attempts to reassure the client that this condition is temporary have not been effective. The nurse should plan to address which client problem? 1. Pain related to fluid accumulation in the scrotum 2. Uneasiness related to inability to reduce scrotal swelling 3. Guilt related to the possibility of sterility secondary to scrotal swelling 4. Altered body appearance related to change in the appearance of the scrotum

Answer: 4. Altered body appearance related to change in the appearance of the scrotum Rationale: Altered body appearance is a problem when the client has either a verbal or a nonverbal response to a change in the structure or the function of a body part. Pain may apply but does not correlate with the information in the question. There are no data in the question that uneasiness, inability to reduce scrotal swelling, or sterility is a client concern.

A client with chronic kidney disease (CKD) has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now presents with mental cloudiness, dementia, and complaints of bone pain. The nurse determines that these assessment data are compatible with which condition? 1. Advancing uremia 2. Phosphate overdose 3. Folic acid deficiency 4. Aluminum intoxication

Answer: 4. Aluminum intoxication Rationale: Aluminum hydroxide may be prescribed as a phosphate-binding agent. Aluminum intoxication can occur when there is an accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. It can be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum. The data in the question are not specifically associated with the other conditions noted in the options.

A client is having difficulty coughing and deep-breathing because of pain after a nephrectomy. Which action by the nurse is helpful in promoting optimal respiratory function? 1. Administering pain medication just before ambulation 2. Administering pain medication when the client asks for it 3. Encouraging the use of the incentive spirometer every 8 hours 4. Assisting the client to splint the incision during respiratory exercise

Answer: 4. Assisting the client to splint the incision during respiratory exercise Rationale: The client who has had a nephrectomy may have pain with coughing and deep breathing and other respiratory exercises because the location of the incision is so close to the diaphragm. The nurse assists the client by offering opioid analgesics when due, encouraging incentive spirometer use hourly, and assisting the client to splint the incision during coughing. If the client takes pain medication only before ambulation, control of pain may be insufficient, which will not promote optimal respiratory function (pain medication should be offered 30 to 45 minutes before the client ambulates). Laparoscopic nephrectomy can also be performed. Compared to conventional nephrectomy, the laparoscopic approach is less painful and requires no sutures or staples, involves a shorter hospital stay, and has a much faster recovery.

The home health nurse is planning to make a home visit to a client who has undergone surgical creation of an ileal conduit. The nurse should include which information on ostomy care in discussion with the client? 1. Plan to do appliance changes in the late evening hours. 2. Cut an opening that is slightly smaller than the stoma in the face plate of the appliance. 3. Appliance odor from urine breakdown to ammonia can be minimized by limiting fluids. 4. Cleanse the skin around the stoma, using gentle soap and water, and then rinse and dry well.

Answer: 4. Cleanse the skin around the stoma, using gentle soap and water, and then rinse and dry well. Rationale: The skin around the stoma is cleansed at each appliance change using a gentle, nonresidue soap and water. The skin is rinsed and then dried thoroughly. The appliance should be changed early in the morning because urine production is slowest from no fluid intake during sleep. The appliance is cut so that the opening is not more than 3 mm larger than the stoma. An opening smaller than the stoma will prevent application of the appliance. Generous fluid intake is encouraged to dilute the urine, decreasing the intensity of odor.

The nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which should the nurse expect to note in this client? 1. Decreased serum lipids 2. Signs of fluid volume deficit 3. Decreased protein in the urine 4. Decreased serum albumin levels

Answer: 4. Decreased serum albumin levels Rationale: Nephrotic syndrome describes a variety of signs and symptoms that accompany any condition that markedly impairs filtration by glomerular capillary membranes and results in increased permeability to protein. Hallmark signs and symptoms of this syndrome include increased serum lipids, edema, increased excretion of protein in the urine, and decreased serum albumin levels.

A client with a bladder injury has had surgical repair of the injured area with placement of a suprapubic catheter. Which is the most appropriate nursing action to prevent complications of this procedure? 1. Monitor urine output once per shift. 2. Measure specific gravity once per shift. 3. Encourage an excessive intake of oral fluids. 4. Ensure that the catheter tubing is not kinked.

Answer: 4. Ensure that the catheter tubing is not kinked. Rationale: A complication after surgical repair of the bladder is disruption of sutures, caused by tension on them from urine buildup. The nurse prevents this from happening by ensuring that the catheter is able to drain freely. This involves basic catheter care, including keeping the tubing free from kinks, maintaining the tubing at a level below the bladder, and monitoring the flow of urine frequently. Monitoring of urine output every shift is insufficient to detect decreased flow from catheter kinking. Measurement of urine specific gravity and an excessive intake of oral fluids do not prevent complications of bladder surgery.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? 1. Warmth, redness, and pain in the left hand 2. Ecchymosis and audible bruit over the fistula 3. Edema and reddish discoloration of the left arm 4. Pallor, diminished pulse, and pain in the left hand

Answer: 4. Pallor, diminished pulse, and pain in the left hand Rationale: Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth and redness probably would characterize a problem with infection. Ecchymosis and a bruit are normal findings for a fistula.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating level of consciousness, and twitching

Answer: 4. Headache, deteriorating level of consciousness, and twitching Rationale: Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates. Tachycardia and fever are associated with infection. Generalized weakness is associated with low blood pressure and anemia. Restlessness and irritability are not associated with disequilibrium syndrome.

A week after kidney transplantation, a client develops a temperature of 101°F (38.3°C), the blood pressure is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment? 1. Antibiotic therapy 2. Peritoneal dialysis 3. Removal of the transplanted kidney 4. Increased immunosuppression therapy

Answer: 4. Increased immunosuppression therapy Rationale: Acute rejection most often occurs within 1 week after transplantation but can occur any time posttransplantation. Clinical manifestations include fever, malaise, elevated white blood cell count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Treatment consists of increasing immunosuppressive therapy. Antibiotics are used to treat infection. Peritoneal dialysis cannot be used with a newly transplanted kidney due to the recent surgery. Removal of the transplanted kidney is indicated with hyperacute rejection, which occurs within 48 hours of the transplant surgery.

The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper fluid balance if which 24-hour intake and output totals are noted? 1. Intake 1500 mL, output 800 mL 2. Intake 3000 mL, output 2000 mL 3. Intake 2400 mL, output 2900 mL 4. Intake 1800 mL, output 1750 mL

Answer: 4. Intake 1800 mL, output 1750 mL Rationale: For the client on a normal diet, the normal fluid intake is approximately 1200 to 1800 mL of measurable fluids per day. The client's output in the same period should be about the same and does not include insensible losses, which are extra. Insensible losses are offset by the fluid in solid foods, which also is not measured.

A client with chronic kidney disease (CKD) is prescribed aluminum hydroxide. Which information should the nurse include while instructing the client regarding the action of this medication? 1. It prevents ulcers. 2. It prevents constipation. 3. It promotes the elimination of potassium from the body. 4. It combines with phosphorus and helps eliminate phosphates from the body.

Answer: 4. It combines with phosphorus and helps eliminate phosphates from the body. Rationale: Aluminum hydroxide {You MUST know Sevelemer = Aluminum hydroxide. Should be taken with food} may be prescribed for a client with CKD. It binds with phosphate in the intestines for excretion in the feces, thus lowering phosphorus levels. It can cause constipation, and it does not promote the elimination of potassium. It may be used in the treatment of hyperacidity associated with gastric ulcers, but this is not the purpose of its use in the client with renal failure.

A client has just had a Foley catheter removed and is to be started on a bladder retraining program. Which intervention will provide the most useful information about the client's ability to empty the bladder? 1. Calculating total fluid intake for the shift 2. Recording the amount of the client's voidings 3. Assisting the client to the bathroom every 2 hours 4. Measuring postvoid residual using a bladder scan

Answer: 4. Measuring postvoid residual using a bladder scan Rationale: Measuring postvoid residual gives specific information about the ability of the bladder to empty completely. Recording intake and output and assisting the client to the bathroom are general interventions but do not provide information about the client's ability to empty the bladder.

A client being discharged home after renal transplantation has a risk for infection related to immunosuppressive medication therapy. The nurse determines that the client needs further teaching on measures to prevent and control infection if the client states that it is necessary to take which action? 1. Take an oral temperature daily. 2. Use good hand-washing technique. 3. Take all scheduled medications exactly as prescribed. 4. Monitor urine character and output at least 1 day each week.

Answer: 4. Monitor urine character and output at least 1 day each week. Rationale: The client receiving immunosuppressive medication therapy must learn and use infection control methods for use at home. The client self-monitors urine output and its characteristics on a daily basis. The client must learn proper hand-washing technique and should take the temperature daily to detect early infection. This is especially important because the client also takes corticosteroids, which mask signs and symptoms of infection. All medications should be taken exactly as prescribed.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1. Monitor the client. 2. Elevate the head of the bed. 3. Assess the fistula site and dressing. 4. Notify the health care provider (HCP).

Answer: 4. Notify the health care provider (HCP). Rationale: Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified. Monitoring the client, elevating the head of the bed, and assessing the fistula site are correct actions, but the priority action is to notify the HCP.

The nurse is analyzing the posthemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased? 1. Potassium 2. Creatinine 3. Phosphorus 4. Red blood cell (RBC) count

Answer: 4. Red blood cell (RBC) count Rationale: Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia because RBCs are lost during dialysis from blood sampling and anticoagulation and from residual blood left in the dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the anemia already caused by the disease process.

A client with nephrolithiasis arrives at the clinic for a follow-up visit. Laboratory analysis of the stone that the client passed 1 week earlier indicates that the stone is composed of calcium oxalate. Based on these data, what food item does the nurse instruct the client to avoid? 1. Pasta 2. Lentils 3. Lettuce 4. Spinach

Answer: 4. Spinach Rationale: Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. Pasta, lentils, and lettuce are acceptable to consume.

A client experiencing end-stage kidney disease has an arteriovenous (AV) fistula placed surgically for hemodialysis. Which action is most appropriate for the nurse to document in the plan for care of the AV fistula? 1. Palpate the bruit of the AV fistula weekly to assess for thrombosis. 2. Use the AV fistula site for blood draws to prevent increased pain of multiple blood draws. 3. Take the blood pressure readings in the extremity with the AV fistula to get a more accurate reading. 4. Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis.

Answer: 4. Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis. Rationale: An AV fistula is a vascular access system that is required for hemodialysis. It is a device established for clients who need long-term hemodialysis. It is created by connecting an artery to a vein inside the body to create a vessel that can handle the amount of blood flow necessary for effective dialysis. Bleeding, clotting, and infection are risks with all vascular devices. It also is very important to avoid any activity that would promote the status of blood or increase the risk for infection. Taking the blood pressure in the affected arm, carrying heavy objects in the arm, and lying on the arm at night could increase the risk for clotting in the fistula. To check circulation of the fistula, the nurse should palpate or feel for the thrill or auscultate (listen with a stethoscope) for the bruit. It is important to do this at least daily to ascertain the patency of the fistula. To avoid infection, that extremity is never used for peripheral intravenous access (placement of an intravenous line) or for blood draws. Strict aseptic technique is used in accessing the fistula for dialysis.

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder? 1. Soft and swollen prostate gland 2. Swollen, and boggy prostate gland 3. Tender and edematous prostate gland 4. Tender, indurated prostate gland that is warm to the touch

Answer: 4. Tender, indurated prostate gland that is warm to the touch Rationale: The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder.

A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? 1. The client washes hands at least once per day. 2. The client's temperature remains lower than 101°F (38.3°C). 3. The client avoids blood pressure (BP) measurement in the left arm. 4. The client's white blood cell (WBC) count remains within normal limits.

Answer: 4. The client's white blood cell (WBC) count remains within normal limits. Rationale: General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand-washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the problem of risk for injury.

The nurse is caring for an older client. Which finding should the nurse expect to note in this client while evaluating renal function? 1. Tubular reabsorption increases 2. Urine-concentrating ability increases 3. Medications are metabolized in larger amounts 4. The glomerular filtration rate (GFR) diminishes

Answer: 4. The glomerular filtration rate (GFR) diminishes Rationale: As part of the normal aging process, the GFR decreases, along with each of the other functional abilities of the kidney. Tubular reabsorption and urine-concentrating ability also decrease. The kidneys have decreased ability to metabolize medications.

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart problem can affect the kidneys. The nurse should formulate a response using what fact about the kidneys? 1. The kidneys get fatigued from having to filter too much fluid. 2. The kidneys can react adversely to moderate doses of furosemide. 3. The kidneys will shut down easily if serum levels of digoxin are high. 4. The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

Answer: 4. The kidneys generally require and receive about 20% to 25% of the resting cardiac output. Rationale: Heart failure is referred to as a prerenal cause of acute kidney injury because heart failure results in decreased blood flow to the kidneys. The kidneys normally receive about 20% to 25% of the cardiac output and require adequate perfusion to function properly. With a significant or prolonged decrease in blood supply, the kidneys can fail. Options 1 and 3 are incorrect. As for option 2, large doses of furosemide resulting in severe dehydration may lead to decreased kidney perfusion, but moderate doses of furosemide do not cause prerenal acute kidney injury, and furosemide may be used to treat acute kidney injury.

The nurse is caring for a client immediately after nephrectomy and renal transplantation. What is the most appropriate datum to use in planning administration of intravenous fluids to this client? 1. A strict hourly rate of 100 mL 2. A strict hourly rate of 150 mL 3. One half of the previous hour's urine output 4. The number of milliliters in the previous hour's urine output

Answer: 4. The number of milliliters in the previous hour's urine output Rationale: Intravenous fluids are managed very carefully after nephrectomy and renal transplantation. Fluids are usually given according to a formula that takes into account the previous hour's urine output. The desired urine output is generally high; therefore, options 1, 2, and 3 are incorrect.

The nurse is caring for a client with a bladder infection. The nurse plans care understanding that the primary risk factor for spread of infection in this client is dysfunction of which structure? 1. Urethra 2. Nephron 3. Glomerulus 4. Ureterovesical junction

Answer: 4. Ureterovesical junction Rationale: The ureterovesical junction is the point at which the ureters enter the bladder. At this juncture, the ureter runs obliquely for 1.5 to 2 cm through the bladder wall before opening into the bladder. This anatomical pathway prevents reflux of urine back into the ureter and, in essence, acts as a valve to prevent urine from traveling back into the ureter and up to the kidney.

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include? 1. "It is acceptable to eat whatever you want on the day before hemodialysis." 2. "It is acceptable to exceed the fluid restriction on the day before hemodialysis." 3. "Medications should be double-dosed on the morning of hemodialysis because of potential loss." 4. "Several types of medications should be withheld on the day of dialysis until after the procedure."

Answer: 4."Several types of medications should be withheld on the day of dialysis until after the procedure." Rationale: Many medications are dialyzable, which means that they are extracted from the bloodstream during dialysis. Therefore, many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be double-dosed because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.

The nurse is admitting a client who has an arteriovenous (AV) fistula in the right arm for hemodialysis. Which nursing intervention is the best way to prevent injury to the AV site? 1. Putting a large note about the access site on the front of the medical record 2. Applying an allergy bracelet to the right arm, indicating the presence of the fistula 3. Telling the client to inform all caregivers who enter the room about the presence of the access site 4. Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm"

Answer: 4.Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm" Rationale: No venipunctures or blood pressure measurements should be performed in a limb with a hemodialysis access device. This commonly is communicated to all caregivers by placing a sign at the client's bedside. Placing a note on the front of the medical record does not ensure that everyone caring for the client is aware of the access device. An allergy bracelet is placed on the client with an allergy. The client should not be assigned the responsibility for informing caregivers. Some agencies use special bracelets for clients with an AV fistula to alert health care providers. Agency guidelines should always be followed in the care of the client.

The nurse has conducted an educational session about risk factors for bladder cancer with clients in the ambulatory care center. Which statements by the clients indicate that teaching was effective? Select all that apply. 1. "Quitting smoking will help to reduce my risk." 2. "I have to consider natural alternatives to dye my hair." 3. "Infections of the bladder cannot cause bladder cancer." 4. "Chemicals have to enter the bladder directly in order to cause bladder cancer." 5. "I have to consult with my health care provider about long-term use of cyclophosphamide medications."

Answers: 1. "Quitting smoking will help to reduce my risk." 2. "I have to consider natural alternatives to dye my hair." 5. "I have to consult with my health care provider about long-term use of cyclophosphamide medications." Rationale: The greatest risk factor for bladder cancer is tobacco use. Exposure to toxins in hair dyes, rubber, paint, electric cable, and textile industries increases risk for bladder cancer. Chemicals may enter the body through contact with skin and mucous membranes in the respiratory tract. In addition, bladder infections and long-term use of cyclophosphamides may cause bladder cancer.

A client with end-stage renal disease (ESRD) has the problem of ineffective coping. Which nursing interventions are appropriate in working with this client? Select all that apply. 1. Acknowledge the client's feelings. 2. Assess the client and family's coping patterns. 3. Explore the meaning of the illness with the client. 4. Set limits on mood swings and expressions of hostility. 5. Give the client information when the client is ready to listen.

Answers: 1. Acknowledge the client's feelings. 2. Assess the client and family's coping patterns. 3. Explore the meaning of the illness with the client. 5. Give the client information when the client is ready to listen. Rationale: Clients with ESRD are likely to experience mood swings or express hostility, anger, and depression, among other responses. The nurse should acknowledge the client's feelings, allow the client to express those feelings, and be supportive. Options 1, 2, 3, and 5 are helpful and appropriate interventions for the client. Setting limits for this client is not client focused, does not allow the client to express concerns, and is nontherapeutic in this situation.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 3. Contact the health care provider (HCP). 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. 6. Increase the flow rate of the peritoneal dialysis solution.

Answers: 1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. Rationale: If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the HCP. Increasing the flow rate should not be done and also is not associated with the amount of outflow solution.

A client with bladder cancer has undergone surgical removal of the bladder with creation of an ileal conduit. Which assessment findings indicate that the client is developing complications? Select all that apply. 1. Dusky appearance of the stoma 2. Stoma protrusion from the skin 3. Sharp abdominal pain with rigidity 4. Urine output greater than 30 mL/hour 5. Mucus shreds in the urine collection bag

Answers: 1. Dusky appearance of the stoma 2. Stoma protrusion from the skin 3. Sharp abdominal pain with rigidity Rationale: To create an ileal conduit, the surgeon takes a short segment of the small intestine and reconnects the remaining intestine so that it functions normally. One end of the removed segment of intestine is placed at the skin surface to create the stoma. The stoma should be red and moist. A pale, dusky stoma indicates poor vascular supply that could result in necrosis. The stoma should be flush to the skin. The client should not have sharp abdominal pain with rigidity, an indication of peritonitis. Any of these findings should be reported to the health care provider. Options 4 and 5 are normal findings.

The nurse has a prescription to obtain a urinalysis specimen from a client with an indwelling urinary catheter. Which actions should the nurse include in performing this procedure? Select all that apply. 1. Explaining the procedure to the client 2. Clamping the tubing of the drainage bag 3. Aspirating a sample from the port on the drainage tubing 4. Obtaining the specimen from the urinary drainage bag 5. Wiping the port with an alcohol swab before inserting the syringe

Answers: 1. Explaining the procedure to the client 2. Clamping the tubing of the drainage bag 3. Aspirating a sample from the port on the drainage tubing 5. Wiping the port with an alcohol swab before inserting the syringe Rationale: A urine specimen is not taken from the urinary drainage bag. Urine undergoes chemical changes while sitting in the bag, so its properties do not necessarily reflect current client status. In addition, it may become contaminated with bacteria from opening the system. The remaining options are correct interventions for obtaining the specimen.

The nurse is creating a plan of care for a client with a diagnosis of nephrotic syndrome whose glomerular filtration rate (GFR) is normal. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Monitor daily weight. 2. Maintain sodium restrictions. 3. Maintain a diet low in protein. 4. Monitor intake and output (I&O). 5. Maintain bed rest when edema is severe.

Answers: 1. Monitor daily weight. 2. Maintain sodium restrictions. 4. Monitor intake and output (I&O). 5. Maintain bed rest when edema is severe. Rationale: Controlling edema is a critical aspect of therapeutic management of nephrotic syndrome. If the GFR is normal, dietary intake of proteins is needed to restore normal plasma oncotic pressure and thereby decrease edema. Daily measurement of weight and abdominal girth, and careful monitoring of I&O will determine whether weight loss is caused by diuresis or protein loss. Dietary modifications may include salt restriction and fluid restriction and are based on the client's symptoms. Bed rest is prescribed to promote diuresis when edema is severe.

The nurse is conducting an interview of an older client and is concerned about the possibility of benign prostatic hyperplasia (BPH). Which are characteristics of this disorder? Select all that apply. 1. Nocturia 2. Incontinence 3. Enlarged prostate 4. Nocturnal emissions 5. Decreased desire for sexual intercourse

Answers: 1. Nocturia 2. Incontinence 3. Enlarged prostate Rationale: Nocturia, incontinence, and an enlarged prostate are characteristics of BPH and need to be assessed for in all male clients over 50 years of age. Nocturnal emissions are commonly associated with prepubescent males. Low testosterone levels (not BPH) may be associated with a decreased desire for sexual intercourse.

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 3. Put the client on NPO (nothing by mouth) status except for ice chips. 4. Review the client's medications to determine if any contain or retain potassium. 5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

Answers: 1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 4. Review the client's medications to determine if any contain or retain potassium. Rationale: The normal potassium level is 3.5-5.0 mEq/L (3.5-5.0 mmol/L). A potassium level of 7.0 is elevated. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the HCP and also review medications to determine if any contain potassium or are potassium retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly.Answers: 1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 4. Review the client's medications to determine if any contain or retain potassium. Rationale: The normal potassium level is 3.5-5.0 mEq/L (3.5-5.0 mmol/L). A potassium level of 7.0 is elevated. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the HCP and also review medications to determine if any contain potassium or are potassium retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly.

The nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings should the nurse expect to note? Select all that apply. 1. Proteinuria 2. Hematuria 3. Positive ketones 4. A low specific gravity 5. A dark and smoky appearance of the urine

Answers: 1. Proteinuria 2. Hematuria 5. A dark and smoky appearance of the urine Rationale: In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross proteinuria and hematuria. The specific gravity is elevated, and the urine may appear dark and smoky. Positive ketones are not associated with this condition but may indicate a secondary problem.

A client with chronic kidney disease (CKD) is being managed by continuous ambulatory peritoneal dialysis (CAPD). During outflow, the nurse notes that only half of the 2-L dialysate has returned and the flow has stopped. Which interventions should the nurse take to enhance the outflow? Select all that apply. 1. Reposition the client. 2. Encourage a low-fiber diet. 3. Make sure the peritoneal catheter is not kinked. 4. Slide the peritoneal catheter farther into the abdomen. 5. Check that the drainage bag is lower than the client's abdomen. 6. Assess the stool history, and institute elimination measures if the client is constipated.

Answers: 1. Reposition the client. 3. Make sure the peritoneal catheter is not kinked. 5. Check that the drainage bag is lower than the client's abdomen. 6. Assess the stool history, and institute elimination measures if the client is constipated. Rationale: CAPD is a method of peritoneal dialysis in which the client infuses dialysate into the abdomen through a special peritoneal catheter and then lets it dwell {stays} for a period of hours. After a specified time, the client drains the dialysate out of the abdomen by gravity and then instills another 1.5 to 3 L of dialysate into the peritoneal cavity. During the dwell time, substances are exchanged across the peritoneal membrane through the process of diffusion. It is important for the nurse to make sure that all of the dialysate in each treatment is removed to ensure proper waste and fluid removal. The distal end of the peritoneal catheter hangs loosely within the abdomen cavity, so if the nurse encourages the client to change position, placement of the catheter also could be changed, potentially increasing outflow. Because the peritoneal catheter and the tubing to the drainage bag are long and flexible, either could get kinked. Correcting this is an easy solution to the outflow problem. The peritoneal catheter is surgically placed in the abdomen, and the skin grows around the cuff. With peritoneal dialysis, gravity is the process whereby dialysate is removed from the peritoneal cavity. Keeping the bag lower than the abdomen enhances gravity. Constipation is one of the primary causes of poor outflow. Assessing and intervening for constipation and encouraging a high-fiber diet are important actions to include in the care of a client on peritoneal dialysis. The catheter cannot be physically manipulated. In addition, this is not an action that would be within the focus of a nursing responsibility.

A client is diagnosed with epididymitis. The nurse checks the health care provider's prescriptions and expects that which measures will be prescribed? Select all that apply. 1. Sitz bath 2. Antibiotics 3. Scrotal elevation 4. Use of a heating pad 5. Bed rest with bathroom privileges

Answers: 1. Sitz bath 2. Antibiotics 3. Scrotal elevation 5. Bed rest with bathroom privileges Rationale: Common interventions used in the treatment of epididymitis include bed rest with bathroom privileges, elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics. A heating pad would not be used because direct application of heat would enhance blood flow to the area, thereby increasing the swelling.

A client is about to begin hemodialysis. Which measures should the nurse employ in the care of the client? Select all that apply. 1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron 5. Covering the connection site with a bath blanket to enhance extremity warmth

Answers: 1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron Rationale: Infection is a major concern with hemodialysis. For that reason, the use of sterile technique and the application of a face mask for both nurse and client are extremely important. It also is imperative that standard precautions be followed, which includes the use of goggles, mask, gloves, and apron. The connection site should not be covered; it should be visible so that the nurse can assess for bleeding, ischemia, and infection at the site during the hemodialysis procedure.

The nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan that will aid in acidifying the urine? Select all that apply. 1. Milk 2. Prune juice 3. Apricot juice 4. Cranberry juice 5. Carbonated drinks

Answers: 2. Prune juice 3. Apricot juice 4. Cranberry juice Rationale: Acidification of the urine inhibits multiplication of bacteria. Fluids that acidify the urine include prune, apricot, cranberry, and plum juice. Carbonated drinks should be avoided because they increase urine alkalinity. Two glasses of milk a day can make the urine more alkaline, which could aid in the development of kidney stones.

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement made by the new nursing graduate indicates an understanding of the procedure for hemodialysis? Select all that apply. 1. "Sterile dialysate must be used." 2. "Dialysate contains metabolic waste products." 3. "Heparin sodium is administered during dialysis." 4. "Dialysis cleanses the blood of accumulated waste products." 5. "Warming the dialysate increases the efficiency of diffusion."

Answers: 3. "Heparin sodium is administered during dialysis." 4. "Dialysis cleanses the blood of accumulated waste products." 5. "Warming the dialysate increases the efficiency of diffusion." Rationale: Heparin sodium is used during dialysis, and it inhibits the tendency of blood to clot when it comes in contact with foreign substances. Option 4 is the purpose of dialysis. The dialysate is warmed to approximately 100°F to increase the efficiency of diffusion and to prevent a decrease in the client's blood temperature. Dialysate is made from clear water and chemicals and is free from any metabolic waste products or medications. Bacteria and other microorganisms are too large to pass through the membrane; therefore, the dialysate does not need to be sterile.