Renal Disorders

The nurse is evaluating the assessment of a client's arteriovenous fistula being used for hemodialysis. Which findings would prompt the nurse to notify the health care provider immediately? Select all that apply.

No thrill palpated at fistula site Absent pulse distal to the arteriovenous fistula No bruit auscultated at the fistula site

The client with chronic kidney disease who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). When should the nurse plan to administer this medication?

On return from dialysis 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

The nurse is caring for a 58-year-old client with renal failure who is on peritoneal dialysis. Which finding is considered most important by the nurse, requiring health care provider notification?

WBC 15,000 cells/mL. Peritonitis is the most common complication of peritoneal dialysis and is often caused by a contamination in the system. This infection can initially be determined by an increased WBC count. It can also include abdominal pain, cloudy peritoneal fluid, fever and chills, nausea and vomiting.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse monitors this client for which signs/symptoms of this disorder?

Pallor, diminished pulse, and pain in the left hand. Arterial steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula, which is caused by tissue ischemia.

The use of peritoneal dialysis for the treatment of chronic kidney disease would be contraindicated for which client?

The client with severe emphysema. Peritoneal dialysis requires the instillation of approximately 2 L of a dialysate solution into the peritoneal space. This is known as the "dwell time." While this fluid remains in the peritoneal space, it causes upward displacement of the diaphragm, resulting in decreased lung expansion.

The nurse is caring for a hospitalized client following cystoscopy and is monitoring for signs of complications associated with the procedure. Which result noted in the first few hours following the procedure indicates the need to notify the registered nurse?

Bloody urine with clots The client may have clear, yellow, or pink-tinged urine after cystoscopy. Bloody urine with clots is always an abnormal finding and should be reported immediately.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder noted on the client's record should the nurse identify as a risk factor for this disorder?

Diabetes mellitus 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 indwelling or frequent urinary catheterization.

The nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the nurse the reason for a renal biopsy, when other tests such as computed tomography (CT) and ultrasound are available. In formulating a response, the nurse incorporates the knowledge that a renal biopsy serves which purpose?

Gives specific cytological information about the lesion Renal biopsy is a definitive test that gives specific information about whether the lesion is benign or malignant. An ultrasound discriminates between a fluid-filled cyst and a solid mass.

The nurse is assigned to care for a client who has just returned to the nursing unit after having hemodialysis for the first time. The nurse monitors the client carefully for which signs and symptoms of disequilibrium syndrome?

Vomiting and headaches A complication that can occur during early dialysis is disequilibrium syndrome. This syndrome results from a high osmotic gradient in the brain following the rapid removal of fluid that can occur during hemodialysis.

The nurse is assisting in planning a diet for a client with acute kidney injury (AKI). The nurse plans to restrict which dietary component from this client's diet?

Potassium In the client with renal failure, potassium intake must be restricted as much as possible (30 to 50 mEq/day). The primary mechanism of potassium removal during acute kidney injury is dialysis.

A client with acute kidney injury (AKI) has been treated with sodium polystyrene sulfonate (Kayexalate) by mouth. The nurse evaluates this therapy as effective if which value is noted on follow-up laboratory testing?

Potassium, 4.9 mEq/L Of all the electrolyte imbalances that accompany renal failure, hyperkalemia is the most dangerous because it can lead to cardiac dysrhythmias and death. If the potassium level rises too high, sodium polystyrene sulfonate may be given to cause excretion of potassium through the gastrointestinal tract.

A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. Which are the signs/symptoms of transurethral resection (TUR) syndrome?

Bradycardia and confusion TURP 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 notes that a client's urinalysis report contains a notation of positive red blood cells (RBCs). The nurse interprets that this finding is unrelated to which item that is part of the client's medical record?

Diabetes mellitus Hematuria can be caused by trauma to the kidney, such as with blunt trauma to the lower posterior trunk or flank. Kidney stones can cause hematuria as they scrape the endothelial lining of the urinary system.

A client newly diagnosed with renal failure will be receiving peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is appropriate?

Explain that the pain will subside after the first few exchanges. Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, it disappears after a week or two.

A client has just undergone renal biopsy. In planning care for this client, the nurse should avoid which intervention?

Ambulate in the room and hall for short distances. After renal biopsy, bed rest is maintained for at least 24 hours. The client's vital signs and puncture site are assessed frequently during this time. Urine is tested periodically for occult blood to detect bleeding as a complication.

The nurse must ambulate a client who has a nephrostomy tube attached to a drainage bag. The nurse plans to do this most safely and effectively by performing which action?

Changing the drainage bag to a leg collection bag The safest approach to protect the integrity and safety of the nephrostomy tube with a mobile client is to attach the tube to a leg collection bag. This allows for greater freedom of movement while alleviating worry over accidental disconnection or dislodgement.

The nurse is reviewing the client's record and notes that the health care provider has documented that the client has a renal disorder. Which laboratory results would indicate a decrease in renal function? Select all that apply.

.Decreased red blood cell (RBC) count Elevated serum creatinine level Elevated blood urea nitrogen (BUN) level

A client with end stage kidney disease (ESKD) begins peritoneal dialysis. The nurse observes for which signs/symptoms indicating peritonitis? Select all that apply.

Abdominal tenderness Cloudy peritoneal effluent Oral temperature of 38° C Nausea and vomiting

A male client has a history of urinary tract infections due to urinary retention. Which intervention should the nurse implement to decrease the risk of infection?

Assist the client to stand for voiding. Most men are conditioned to urinate from a standing position, so a reasonable strategy is to assist the client to a standing position to increase the chance of emptying the bladder. This will decrease the risk of infection as the bladder empties more completely

A client has epididymitis as a complication of a urinary tract infection (UTI). The nurse is giving the client instructions to prevent a recurrence. The nurse determines that the client needs further teaching if the client states the intention to do which?

Continue to take antibiotics until all symptoms are gone. The client who experiences epididymitis from UTI should increase intake of fluids to flush the urinary system. Because organisms can be forced into the vas deferens and epididymis from strain or pressure during voiding, the client should limit the force of the stream.

The nurse is speaking with a client who underwent a minimally invasive procedure treatment for recurrent urolithiasis. Which instructions are appropriate to reinforce in the teaching plan? Select all that apply.

Drink at least 3000 mL of fluid each day. Complete the full course of prescribed antibiotics. Filter urine and collect any stones to take to the urological health care provider.

A client with new-onset renal failure is having a first hemodialysis treatment. The nurse is especially careful to monitor the client for which signs/symptoms after the dialysis treatment?

Headache, decreasing level of consciousness, and seizures Disequilibrium syndrome occurs most often in clients who are new to dialysis. It is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity.

The nurse is collecting data on a newly admitted client with a diagnosis of bladder cancer. Which sign/symptom should be noted first?

Hematuria Gross, painless hematuria is most frequently the first manifestation of bladder cancer. As the disease progresses, the client may experience dysuria, frequency, and urgency.

The client with diabetes mellitus receiving peritoneal dialysis asks the nurse why it is important to leave the dialysate infused only for a specific amount of time. The nurse responds that not adhering to the dwell time can increase the risk of the client experiencing which complication?

Hyperglycemia Dialysate contains glucose, which helps remove fluids through an osmotic gradient. An extended dwell time increases the risk of hyperglycemia in diabetic clients as a result of the absorption of glucose from the dialysate and electrolyte changes.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of risk for which complication?

Hyperglycemia. An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.

The nurse is inspecting the stoma of a client after creation of an ureterostomy. Which appearance should the nurse expect to note?

A red and moist stoma. After ureterostomy, the stoma should be red and moist. A pale stoma may indicate an inadequate amount of vascular supply, and a dry stoma may indicate a body fluid deficit. Any sign of darkness or duskiness in the stoma may mean a loss of vascular supply and must be corrected immediately, or necrosis can occur.

A female client has a prescription for a clean-catch urine culture. After providing a sterile specimen cup to the client, the nurse should give which instruction so that the specimen is collected properly?

Cleanse the labia using cleansing towels, begin to void into toilet, and then collect the specimen The client should cleanse the labia, begin to void, and then "catch" the sample midstream.

A client with acute glomerulonephritis had a urinalysis sent to the laboratory. The report reveals that there is hematuria and proteinuria in the urine. The nurse interprets that these results are which?

Consistent with glomerulonephritis Gross hematuria and proteinuria are the cardinal signs of glomerulonephritis. The urine may be small in volume, dark or smoky from the hematuria, and foamy from the proteinuria.

Which conditions places the client at risk for developing acute postrenal failure?

Hydronephrosis Postrenal failure is caused by an obstruction in the urinary tract, anywhere from the tubules to the urethral meatus. Some causes of obstruction include calculi, tumors, prostatic hypertrophy, or strictures, which impede the normal flow of urine.

A long-term care nurse notes that a female client has leakage of urine when sneezing, coughing, or laughing. The nurse reports that this client has which type of incontinence?

Stress incontinence Stress incontinence is caused by coughing, laughing, and other activities that increase intra-abdominal pressure.

The nurse is providing instructions to the client regarding the complications of peritoneal dialysis. The nurse instructs the client that which symptom is likely associated with the onset of peritonitis?

Fever. The signs of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output

An alkaline-ash diet is prescribed for a client with renal calculi. Which diet menu does the nurse advise the client to select?

A spinach salad, milk, and a banana In an alkaline-ash diet, all fruits are allowed except cranberries, prunes, and plums.

The nurse has a prescription to collect a 24-hour urine specimen from a client. The unlicensed assistive personnel (UAP) has been instructed on the collection technique. Which action by the UAP demonstrates the UAP needs further teaching?

Asks the client to void, save the specimen, and note the start time. Because the 24-hour urine test is a timed quantitative determination, the test must be started with an empty bladder.

The nurse is caring for the client with epididymitis. Which treatment modalities should be implemented? Select all that apply.

Bed rest Sitz bath Antibiotic Common interventions used in the treatment of epididymitis include bed rest, elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics

After a renal biopsy, the client complains of pain at the biopsy site, which radiates to the front of the abdomen. Which would this indicate?

Bleeding If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding should be suspected. Hypotension, a decreasing hematocrit, and gross or microscopic hematuria should also indicate bleeding.

The nurse is assisting a client with cystitis to select foods that are appropriate for an acid-ash diet. The nurse encourages the client to eat which food?

Cheese Foods that are allowed on an acid-ash diet include meat, fish, shellfish, cheese, eggs, poultry, grains, cranberries, prunes, plums, corn, lentils, and foods with high amounts of chlorine, phosphorus, and sulfur.

A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder?

Diabetes mellitus 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 indwelling or frequent urinary catheterization.

The nurse is caring for a client with epididymitis. The nurse anticipates noting which group of findings on data collection?

Fever, nausea and vomiting, and painful scrotal edema. Typical signs and symptoms of epididymitis include scrotal pain and edema, which are often accompanied by fever, nausea and vomiting, and chills.

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 which?

I will use an antibiotic prophylactically to prevent symptoms of Chlamydia. Antibiotics are not taken prophylactically to prevent acquisition of urethritis from Chlamydia. The risk of reinfection can be reduced by limiting the number of sexual partners and by the use of condoms.

The nurse is evaluating the data results of a client with sepsis and acute kidney injury with related azotemia and oliguria. Which are the primary features of azotemia and oliguria? Select all that apply.

Increase in serum creatinine Increase in blood urea nitrogen (BUN) Urine output less than 0.5 mL/kg/hour

The nurse is providing dietary instructions to a client with renal calculi, and the laboratory analysis has revealed that the calculus is composed of uric acid. The nurse tells the client that it would be helpful to make which dietary changes?

Increase intake of legumes in the diet. Dietary instructions to the client with a uric acid type kidney stone include increasing legumes, green vegetables, and fruits (except prunes, grapes, cranberries, and citrus fruits) to increase the alkalinity of the urine.

The nurse is assisting a client who is new to a low-potassium diet to select food items from the menu. Which food item is lowest in potassium and should be recommended to the client on this dietary restriction?

Lima beans Cantaloupe, spinach, and strawberries are high-potassium foods. Lima beans contain potassium but in lower amounts

A client hospitalized with urolithiasis has a sudden significant decrease in urine output. The nurse should perform which action?

Notify the registered nurse. A sudden significant decrease in urine output, to either oliguria or anuria, represents obstruction of the urinary tract, usually at the bladder neck or urethra. This represents a medical emergency, requiring prompt treatment to preserve kidney function.

A client with acute glomerulonephritis is admitted to the nursing unit. The nurse should plan to do which action immediately on admission?

Remove the water pitcher from the bedside. The client with acute glomerulonephritis commonly experiences fluid volume excess and fatigue. Interventions include fluid restriction and ongoing monitoring of weight, intake, and output.

A male client is diagnosed with urethritis caused by chlamydial infection. The unlicensed assistive personnel (UAP) assigned to the client asks the nurse what measures are necessary to prevent a contraction of the infection during care. Which instruction should the nurse give the UAP?

Standard precautions are sufficient because the infection is transmitted sexually.

Chlamydia is a sexually transmitted infection and is frequently called "non-gonococcal urethritis" in the male client. It requires no special precautions

Standard precautions are sufficient because the infection is transmitted sexually. Chlamydia is a sexually transmitted infection and is frequently called "non-gonococcal urethritis" in the male client.

A client complains of leaking urine whenever she sneezes, coughs, or laughs. The nurse recognizes that this report is consistent with which type of incontinence?

Stress Stress incontinence is caused by coughing, laughing, and other activities that increase intra-abdominal pressure. Reflex incontinence, sometimes called "overflow incontinence," is a loss of urine that is uncontrollable and occurs at predictable intervals.

A client with acute pyelonephritis is scheduled for a voiding cystourethrogram. Which information about this procedure should the nurse give to the client?

The client must void while the micturition process is filmed. Having to void in the presence of others can be very embarrassing for clients and actually may interfere with the client's ability to void. The nurse teaches the client about the procedure to try to minimize stress from lack of preparation and gives the client encouragement and emotional support.

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how this could happen. The nurse plans to base a response in part on the fact that which statement is true?

The kidneys generally require and receive about 20% to 25% of the resting cardiac output. The kidneys normally receive about 20% to 25% of the cardiac output and require adequate perfusion to function properly. With significant or prolonged decrease in blood supply, the kidneys can fail.

The nurse is assisting in planning a teaching session with a client diagnosed with urethritis caused by infection with Chlamydia. The nurse should plan to include which point in the teaching session?

The most serious complication of this infection is sterility. The most serious complication of chlamydial infection is sterility. The infection can be prevented by the use of latex condoms.. All sexual partners during the 30 days before diagnosis should be notified, examined, and treated as necessary.

A client with a history of prostatic hypertrophy has purchased the over-the-counter medication, diphenhydramine (Benadryl), to treat symptoms of a runny nose. The nurse explains to the client that this medication combined with prostatic hypertrophy could cause exacerbation of which symptom?

Urinary retention Diphenhydramine (Benadryl) is used to treat allergy symptoms. It should be used cautiously with prostatic hypertrophy because the anticholinergic effects of the medication could cause exacerbation of symptoms, including urinary retention or hesitancy.

The nurse is assessing a client with suspected acute kidney injury. Which finding would support a diagnosis of acute intrarenal failure?

Urine analysis positive for casts and cellular debris Acute tubular necrosis is responsible for 90% of acute intrarenal failure cases, and in these cases, the tubular epithelium is destroyed. The debris from the destruction of the epithelial cells can be detected in the urinalysis of a client with acute intrarenal failure.

A client with prostatitis resulting from kidney infection has received instructions on management of the condition at home and prevention of recurrence. Which statement indicates that the client understood the instructions?

Use warm sitz baths and analgesics to increase comfort. Treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. The client is also taught to rest, increase fluid intake, and use sitz baths for comfort. Antimicrobial therapy is always continued until the prescription is completely finished.

The nurse provides home care instructions to a client undergoing hemodialysis with regard to care of an arteriovenous (AV) fistula. Which statement by the client indicates an understanding of the instructions?

"I should check the fistula every day by feeling it for a vibration." The client is instructed to monitor fistula patency daily by palpating for a vibration, known as a thrill. 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.

A client has received instructions on self-management of peritoneal dialysis. The nurse determines that the client needs further teaching if the client makes which statement?

"I will use a strong adhesive tape to anchor the catheter dressing." The client is at risk for impairment of skin integrity resulting from the presence of the catheter, exposure to moisture, and irritation from tape and cleansing solutions

The nurse is caring for a client who had a renal biopsy. Which interventions should the nurse include in the plan of care for the client after this procedure? Select all that apply.

Administering pain medication as prescribed. Monitoring vital signs and the puncture site frequently Testing serial urine samples with dipsticks for occult blood

A client with chronic kidney disease 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 has mental cloudiness, dementia, and complaints of bone pain. Which does this data indicate?

Aluminum intoxication Occur when there is 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. This condition was formerly known as dialysis dementia.

The nurse is preparing a client scheduled for an intravenous pyelogram (IVP). The nurse should take which important action before the test?

Ask about allergies to iodine or shellfish. Some IVP dye is iodine based. It can cause allergic reactions manifested by itching, hives, rash, a tight feeling in the throat, shortness of breath, and bronchospasm.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply.

Check the level of the drainage bag. Reposition the client to his or her side. Place the client in good body alignment. Check the peritoneal dialysis system for kinks.

The nurse is monitoring an older client suspected of having a urinary tract infection (UTI) for signs of the infection. Which sign/symptom should occur first?

Confusion. In an older client, the only symptom of a UTI may be something as vague as increasing mental confusion or frequent unexplained falls. Frequency and urgency may commonly occur in an older client, and fever can be associated with a variety of conditions.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia (BPH), the nurse questions the client about use of which medication?

Decongestants In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about use of these medications if presenting with urinary retention

The nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. To determine if the client is currently experiencing exacerbation of BPH, the nurse should ask the client about the presence of which early symptom?

Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling.

A male client has a tentative diagnosis of urethritis. The nurse collects data from the client knowing that which are signs/symptoms of this disorder?

Dysuria and penile discharge Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge

The nurse suspects the client has a urinary tract infection (UTI). Which signs/symptoms suggest a UTI? Select all that apply.

Dysuria, Hematuria, Frequency, Flank pain, Cloudy urine.

A client has an arteriovenous (AV) shunt in place for hemodialysis. The nurse should take which priority precaution, knowing that bleeding is a potential complication?

Ensure that small clamps are attached to the AV shunt dressing. An AV shunt is a cannula with two ends that are tunneled subcutaneously into an artery and a vein.

The nurse is collecting data from a client with epididymitis. The nurse should expect to note which signs and symptoms of this problem?

Fever, nausea and vomiting, and painful scrotal edema Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. It most often is caused by infection, although sometimes it can be caused by trauma.

The nurse is assigned to care for a client who has returned to the nursing unit following a left nephrectomy. The nurse places the highest priority on monitoring which data?

Hourly urine output Following a nephrectomy, it is imperative to measure the urine output hourly. This is done to monitor the function of the remaining kidney and to detect renal failure early if it occurs.

client has undergone a transurethral resection of the prostate (TURP) a few hours ago to treat symptoms of benign prostatic hypertrophy. The nurse notes bright red blood and clots in the urinary catheter drainage bag. Which response should be the nurse's initial action?

Increase the flow rate of the continuous bladder irrigation. Increasing the flow rate of the continuous bladder irrigation usually controls bleeding and clot formation, and this should be the nurse's first action. If this is ineffective, then notification of the surgeon is appropriate.

The nurse is caring for a hemodialysis client who has been receiving treatment for several years and is not a candidate for kidney transplant. The nurse knows that the majority of deaths of hemodialysis clients are related to which causes? Select all that apply.

Infectious complications. Stroke. Myocardial infarction (MI).

A client with end stage kidney disease (ESKD) undergoes a surgical procedure to create an arteriovenous fistula for hemodialysis in the upper extremity. The nurse should take which actions when the client returns from surgery? Select all that apply.

Monitor pain and administer analgesics. Monitor bleeding and swelling at the site. Check for audible bruit and palpable thrill at the fistula site.

Which observations by the nurse caring for clients on a hospital medical-surgical unit should be immediately reported to the health care provider? Select all that apply.

New confused mental state and pulse rate of 106 beats per minute in a 72-year-old client. A volume of 105 mL of urine over 4 hours in the collection bag of a 1-day postoperative client

A client is admitted to the emergency department following a fall from a horse. The health care provider (HCP) prescribes the insertion of an indwelling urinary catheter. The nurse notes blood at the urinary meatus while preparing for the procedure. Which action should the nurse take?

Notify the health care provider. 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 nurse is urging a client to cough and deep breathe after a 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 likely a result of which contributing factor?

Pain that is intensified because the location of the incision is near the diaphragm After nephrectomy, the client may be in considerable pain. This is due to the size of the incision and its location near the diaphragm, which makes coughing and deep breathing so uncomfortable.

The nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that the drainage from the outflow catheter is cloudy. The nurse notifies the registered nurse and plans to take which action?

Obtain a culture and sensitivity of the drainage. When the drainage becomes cloudy, peritonitis is suspected. A culture and sensitivity is obtained, and broad-spectrum antibiotics are added to the dialysis solution as prescribed pending culture and sensitivity results.

The nurse is admitting a client to the nursing unit who has returned from the postanesthesia care unit following prostatectomy. The client has a three-way Foley catheter with continuous bladder irrigation. The nurse should maintain the flow rate of the continuous bladder infusion to maintain which urine output characteristic?

Pale yellow or slightly pink. Bladder irrigant is not infused at a preset rate, but rather it is increased or decreased to maintain urine that is clear or pale yellow or that has just a slight pink tinge. The infusion rate should be increased if the drainage is red or if clots are seen.

The nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic kidney disease. Which finding indicates that the fistula is patent?

Palpation of a thrill over the fistula The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicates patency of the fistula.

A client, who had experienced significant blood loss in an automobile crash, was admitted to the hospital 2 days earlier. The nurse observes the client for which signs/symptoms that indicate acute kidney injury (AKI)? Select all that apply.

Rising serum blood urea nitrogen (BUN) and creatinine levels Urine output averaging 25 mL per hour while receiving an intravenous infusion at 150 mL/hour. Elevated urine specific gravity

A client, on the waiting list for a renal transplant, receives a hemodialysis treatment. Which findings indicate to the nurse that the treatment has been effective? Select all that apply.

Serum potassium level is within the normal range. The client's weight is 2 kilograms less than predialysis weight. Serum blood urea nitrogen (BUN) and creatinine levels are lower than predialysis.

A client tells the nurse she completed an educational program to manage her stress incontinence but is now discouraged. Which information from the client indicates the need for further teaching? Select all that apply.

She performs the Kegel exercises every other day. She quit drinking coffee with cream but drinks diet cola. She has begun an exercise program that includes lifting weights.

A client is diagnosed with polycystic kidney disease, and the nurse provides information to the client about the treatment plan. The nurse determines that the client needs further teaching if the client states that which component is part of the treatment plan?

Sodium restriction Individuals with polycystic kidney disease seem to waste rather than retain sodium. Thus, they need increased sodium and water intake. Aggressive control of hypertension is essential. Genetic counseling is advisable because of the hereditary nature of the disease.

The use of peritoneal dialysis for the treatment of chronic kidney disease would be contraindicated for which clients?

The client with chronic obstructive pulmonary disease (COPD) Peritoneal dialysis requires instillation of approximately 2 L of a dialysate solution into the peritoneal space. A client with COPD would be at high risk for developing respiratory distress if the respiratory system were to be further compromised by the instillation of the dialysate solution and the resulting upward displacement of the diaphragm.

The nurse is reinforcing dietary instructions to a client with renal calculi who must learn to eat an alkaline-ash diet. The nurse determines that the client has properly understood the information presented if the client chooses which selection from a diet menu?

A spinach salad, milk, and a banana In an alkaline-ash diet, all fruits are allowed except cranberries, prunes, and plums.

A client who suffered a crush injury to the leg has a highly positive urine myoglobin level. The nurse plans to monitor this particular client carefully for signs of which complication?

Acute tubular necrosis 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, the renal tubules may become clogged with myoglobin, which causes acute tubular necrosis.

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 reaction?

Anger 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 nurse is caring for a client who received a recent kidney transplant. Besides actual rejection of the transplant, which are some of the most important complications this client is at risk for? Select all that apply.

Cardiovascular disease Susceptibility to infection Corticosteroid-related complications Malignancies

A client newly diagnosed with chronic kidney disease has recently begun hemodialysis. Which are signs/symptoms of disequilibrium syndrome?

Headache, deteriorating level of consciousness, and twitching. Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea and vomiting, twitching, and possible seizure activity. It is caused by rapid removal of solutes from the body during hemodialysis.

A client who had a prostatectomy has learned perineal exercises to gain control of the urinary sphincter. The nurse determines that the client needs further teaching if the client states that he will perform which action as part of these exercises?

Perform the Valsalva maneuver. The Valsalva maneuver is avoided following prostatectomy because it increases the risk of bleeding in the postoperative period. An acceptable exercise is tightening the abdominal, gluteal, and perineal muscles, as if trying to prevent urination.

A client contacts the health care provider's office to report she is not feeling well, has burning with urination, and suspects she may have a urinary tract infection. The nurse instructs the client to collect a urine specimen for testing. Which urinalysis findings indicate the presence of a urinary tract infection? Select all that apply.

White blood cells, 10 Leukoesterase, present Nitrites, present

Which statements indicate an understanding of the necessary dietary modifications of a client diagnosed with chronic kidney disease? Select all that apply.

"I should avoid eggs, and a bagel is preferable." "I should consume approximately 40 g of protein daily." Protein restriction is necessary in clients with chronic kidney disease because urea nitrogen and creatinine are the end products of protein metabolism, and clients with renal failure cannot excrete these waste products.

The nurse has reinforced instructions to the client with a cystocele about Kegel exercises. The nurse determines that the client has not fully understood the directions if the client makes which statement?

"Begin voiding and then stop the stream, holding residual urine for an hour." Kegel exercises strengthen the perineal floor and are useful to prevent and manage cystocele, rectocele, and enterocele. There are several acceptable ways to perform Kegel exercises. These involve starting and stopping the flow of urine either once for up to 5 minutes, or several times during a single voiding for about 5 seconds.

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 nurse appropriately asks which question first?

"Have you experienced any constipation recently?" Reduced outflow from the dialysis catheter may be due to the catheter position, infection, or constipation. Constipation may contribute to a reduced outflow because peristalsis seems to aid in drainage.

Aluminum hydroxide is prescribed for the client with chronic kidney disease (CKD). When should the nurse instruct the client to take this medication?

With meals The client with chronic kidney disease who is receiving aluminum hydroxide should take the medication with meals. The phosphate-binding effect is best when it is taken with food. If tablets are used, they should be chewed well before swallowing.

The nurse documents that the urine collected from a client diagnosed with early stage polycystic kidney disease is dilute with a low-specific gravity. Based on this documentation, which specific gravity result was likely present

1.000 Specific gravity is a measure of the concentration of particles in the urine. A normal range of urine specific gravity is approximately 1.005 to 1.030. Early in polycystic kidney disease, the ability of the kidneys to concentrate urine decreases.

A client diagnosed with chronic kidney disease is being treated at home with continuous ambulatory peritoneal dialysis. The client notes that there is a decrease in the catheter outflow following the prescribed 6-hour dwell time and calls the nurse to report this occurrence. The nurse should reinforce instructing the client to take which action?

Ambulate in the home. The most common causes of decreased outflow of dialysate in peritoneal dialysis are displacement and obstruction of the catheter. Obstruction may be a result of malposition, adherence of the catheter tip to internal organs, constipation, or infection.

A client is admitted to the surgical nursing unit following transurethral resection of the prostate (TURP) for benign prostatic hypertrophy. The client has a bladder irrigation infusing, and output is light cherry colored. The blood pressure is 134/82 mm Hg, the pulse is 84 beats per minute, and the client is afebrile with a respiratory rate of 18 breaths per minute. The licensed practical nurse (LPN) assisting in caring for the client collects assessment data 1 hour after admission to the nursing unit. The LPN notifies the registered nurse (RN) if which is noted on data collection?

Blood pressure of 102/50 mm Hg, pulse 110 beats per minute A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The LPN would notify the RN, who would then contact the health care provider. Bladder spasms are expected to occur following surgery and are treated with medication. Some hematuria is usual for several days after surgery and is managed initially by increasing the flow rate of the bladder irrigation

A client arrives at the ambulatory care clinic with low abdominal pain. A routine urine specimen reveals hematuria. The client does not have a fever. The nurse should next ask the client about a history of which condition?

Blow or trauma to the bladder or abdomen Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria.

A client is seen in the health care clinic and acute pyelonephritis is suspected. The nurse reviews the client's record and should expect to note which associated signs and symptoms documented? Select all that apply.

Chills General weakness Nausea and vomiting Typical signs and symptoms of acute pyelonephritis include high fever, chills, nausea, vomiting, flank pain on the affected side with costovertebral angle tenderness, general weakness, and headache.

A client's kidneys are retaining greater amounts of sodium. The nurse anticipates that the kidneys are also retaining greater amounts of which other substances?

Chloride and bicarbonate Sodium is a cation. When sodium retention is increased, the kidney also has increased reabsorption of chloride and bicarbonate, which are anions.

The nurse is reinforcing dietary instructions to a client diagnosed with acute glomerulonephritis. The nurse determines that the client understands the information presented if the client states the intention to do which action?

Limit protein intake. The diet for the client with acute glomerulonephritis is generally high in calories and low in protein. This diet inhibits protein catabolism and allows the kidneys to rest. In acute glomerulonephritis, it is important to protect the kidneys while they are recovering their function.

A client is scheduled for intravenous pyelography (IVP). Which priority nursing action should the nurse take?

Determine a history of allergies.. An iodine-based dye may be used during the IVP and can cause allergic reactions such as itching, hives, rash, tight feeling in the throat, shortness of breath, and bronchospasm. Checking for allergies is the priority.

A client who underwent a kidney transplant 6 months earlier is seen in the clinic for a routine monthly appointment. The nurse reviews how the client has been doing and observes for signs/symptoms of acute rejection. Which signs/symptoms suggest acute rejection of the transplanted kidney? Select all that apply.

Elevation of blood pressure over baseline Abdominal tenderness on the side of the kidney transplant. Elevation of serum blood urea nitrogen (BUN) and creatinine. Oliguria

The nurse is admitting a client with chronic kidney disease (CKD) to the nursing unit. The nurse monitors the client for which frequent cardiovascular sign that occurs in CKD?

Hypertension Hypertension is the most common cardiovascular finding in the client with CKD. It is a result of a number of mechanisms, including volume overload, renin-angiotensin system stimulation, vasoconstriction from sympathetic stimulation, and absence of prostaglandins.

The nurse is reinforcing instructions to a client about the types of fluids that assist in prevention and treatment of urinary tract infections (UTIs). The nurse instructs the client to consume which fluids? Select all that apply.

Prune juice Apple juice Cranberry juice he client at risk for UTIs should be instructed to consume adequate amounts (2000 to 2500 mL/day) of fluids. Certain fluids can be used to minimize the risk for development of UTI, such as prune juice, apple juice, cranberry juice, and water.