Renal Ignatavicius Chapters 65, 66, 67, 68

A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns? A "Arise slowly and call for assistance when ambulating." B "I must measure your intake and output." C "We must save your urine because it is radioactive." D "I must attach you to this cardiac monitor."

A "Arise slowly and call for assistance when ambulating." Captopril can cause severe hypotension during and after the procedure, so the client should be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension. Intake and output measurement is not necessary after this procedure, unless it had been requested previously. A small amount of radionuclide is used in a renal scan; the urine is not radioactive, although the nurse should practice Standard Precautions, as always, and wear gloves. Cardiac monitoring is not needed, although the nurse should monitor for hypotension secondary to captopril.

A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? (Select all that apply.) A "Be certain to wear sunscreen and protective clothing." B "Drink at least 3 liters of fluids every day." C "Take this drug with 8 ounces of water." D "Try to urinate frequently to keep your bladder empty." E "You will need to take all of this drug to get the benefits."

A "Be certain to wear sunscreen and protective clothing." B "Drink at least 3 liters of fluids every day." C "Take this drug with 8 ounces of water." E "You will need to take all of this drug to get the benefits." Wearing sunscreen and protective clothing is important while taking trimethoprim/sulfamethoxazole. Increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules; fluid intake prevents this complication. Clients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. Emptying the bladder is important, but not keeping it empty. The client should be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.

A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? A "Because the kidneys cannot get rid of fluid, blood pressure goes up." B "The damaged kidneys no longer release a hormone that prevents high blood pressure." C "The waste products in the blood interfere with other mechanisms that control blood pressure." D "This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."

A "Because the kidneys cannot get rid of fluid, blood pressure goes up." In chronic kidney disease, fluid levels increase in the circulatory system. The statements asserting that damaged kidneys no longer release a hormone to prevent high blood pressure, waste products in the blood interfere with other mechanisms controlling blood pressure, and high blood pressure is a compensatory mechanism that increases blood flow through the kidneys in attempt excrete waste products are not accurate regarding the relationship between chronic kidney disease and high blood pressure.

A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease? A "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." B "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." C "If my children have the ADPKD gene, they will have cysts by the age of 30." D "My children have a 50% chance of inheriting the ADPKD gene that causes the disease."

A "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." There is no way to prevent ADPKD, although early detection and management of hypertension may slow the progression of kidney damage. Limiting salt intake can help control blood pressure. Presentation of ADPKD can vary by age of onset, manifestations, and illness severity, even in one family. Almost 100% of those who inherit a polycystic kidney disease (PKD) gene will develop kidney cysts by age 30. Children of parents who have the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease.

An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? A "Have you tried using the toilet at least every couple of hours?" B "How does that make you feel?" C "We can fix that." D "That happens when we get older."

A "Have you tried using the toilet at least every couple of hours?" By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control. The client has already stated how she feels; asking her again how she feels does not address her concern nor does it allow for nursing education. The nurse cannot assert that the problem can be fixed because this may be untrue. Suggesting that the problem occurs as we get older does not address the client's concern and does not provide for nursing education.

The school nurse is counseling a teenage student about how to prevent kidney trauma. Which statement by the student indicates a need for further teaching? A "I can't play any type of contact sports because my brother had kidney cancer." B "I avoid riding motorcycles." C "I always wear pads when playing football." D "I always wear a seat belt in the car."

A "I can't play any type of contact sports because my brother had kidney cancer." Contact sports and high-risk activities should be avoided if a person has only one kidney. A family history of kidney cancer does not prohibit this type of activity. To prevent kidney and genitourinary trauma, caution should be taken when riding bicycles and motorcycles. People should wear appropriate protective clothing when participating in contact sports. Anyone riding in a car should wear a seat belt.

The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught? A "I should be drinking at least 1.5 to 2.5 liters of fluids every day." B "It is a good idea for me to reduce germs by taking a tub bath daily." D "Trying to get to the bathroom to urinate every 6 hours is important for me." E "Urinating 1000 mL on a daily basis is a good amount for me."

A "I should be drinking at least 1.5 to 2.5 liters of fluids every day." To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day. Showers, rather than tub baths, are recommended for women who have recurrent UTIs. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. Urinary output should be at least 1.5 liters daily. Ensuring this amount "out" is a good indicator that the client is drinking an adequate amount of fluid.

The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction? A "I take my medication only when I have symptoms." B "I always wipe front to back." C "I don't use bubble baths and other scented bath products." D "I try to drink 3 liters of fluid a day."

A "I take my medication only when I have symptoms." Clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent. Wiping front to back helps prevent UTIs because it prevents infection-causing microorganisms in the stool from getting near the urethra. Limiting bubble baths and drinking 3 liters of fluid a day help prevent UTIs.

A client who was previously diagnosed with a urinary tract infection (UTI) and started on antibiotics returns to the clinic 3 days later with the same symptoms. When asked about the previous UTI and medication regimen, the client states, "I only took the first dose because after that, I felt better." How does the nurse respond? A "Not completing your medication can lead to return of your infection." B "That means your treatment will be prolonged with this new infection." C "This means you will now have to take two drugs instead of one." D "What you did was okay; however, let's get you started on something else."

A "Not completing your medication can lead to return of your infection." Not completing the drug regimen can lead to recurrence of an infection and bacterial drug resistance. Needing to be re-treated does not mean that the client will have a prolonged treatment regimen. Some treatment modalities are given over a 3-day period. Given this client's history, larger doses for a shorter time span may be a wise plan. The client does not need to take two drugs, and this response is punitive rather than instructive. Saying that the client's actions were okay does not inform the client with respect to nonadherence. The client needed to take all the prescribed medication to make certain that the infection was properly treated.

What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? (Select all that apply.) A "Your urine will be strained after the procedure." B "Be sure to finish all of your antibiotics." C "Immediately call the health care provider if you notice bruising." D "Remember to drink at least 3 liters of fluid a day to promote urine flow." E "You will need to change the incisional dressing once a day."

A "Your urine will be strained after the procedure." B "Be sure to finish all of your antibiotics." D "Remember to drink at least 3 liters of fluid a day to promote urine flow." After lithotripsy, urine is strained to monitor the passage of stone fragments. Clients must finish the entire antibiotic prescription to decrease the risk of developing a urinary tract infection. Drinking at least 3 L of fluid a day dilutes potential stone-forming crystals, prevents dehydration, and promotes urine flow. Bruising on the flank of the affected side is expected after lithotripsy as a result of the shock waves that break the stone into small fragments. The client must notify the health care provider if he or she develops pain, fever, chills, or difficulty with urination because these signs and symptoms may signal the beginning of an infection or the formation of another stone. There is no incision with extracorporeal shock wave lithotripsy. There may be a small incision when intracorporeal lithotripsy is performed.

Which clients with long-term urinary problems does the nurse refer to community resources and support groups? (Select all that apply.) A A 32-year-old with a cystectomy B A 44-year-old with a Kock pouch C A 48-year-old with urinary calculi D A 78-year-old with urinary incontinence E An 80-year-old with dementia

A A 32-year-old with a cystectomy B A 44-year-old with a Kock pouch D A 78-year-old with urinary incontinence Clients with a cystectomy, Kock pouch, or urinary incontinence would benefit from community resources and support groups. Others who have had their bladders removed are good sources of information and for help in establishing coping mechanisms. They can provide ideas for living with the problem or methods of curing (or minimizing) it. Urinary calculi typically are not a long-term problem that requires community resources and support groups. The older adult client with dementia would not benefit from community resources and support groups because of the client's cognitive difficulties.

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? A Administer morphine sulfate 4 mg IV. B Begin an infusion of metoclopramide (Reglan) 10 mg IV. C Obtain a urine specimen for urinalysis. D Start an infusion of 0.9% normal saline at 100 mL/hr.

A Administer morphine sulfate 4 mg IV. Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension. An infusion of metoclopramide (Reglan) 10 mg IV should be begun after the client's pain is controlled. A urine specimen for urinalysis should be obtained and an infusion of 0.9% normal saline at 100 mL/hr should be started after the client's pain is controlled.B

When caring for a client with nephrotic syndrome, which intervention should be included in the plan of care? A Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss B Administering heparin to prevent deep vein thrombosis (DVT) C Providing antibiotics to decrease infection D Providing transfusion of clotting factors

A Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss ACE inhibitors can decrease protein loss in the urine. Heparin is administered for DVT, but in nephrotic syndrome it may reduce urine protein and kidney insufficiency. Glomerulonephritis may occur secondary to an infection, but it is an inflammatory process; antibiotics are not indicated for nephrotic syndrome. Clotting factors are not indicated unless bleeding and coagulopathy are present.

The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse? A Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min. B Urine output over the past hour was 80 mL. C Pain is at a level 4 (on a 0-to-10 scale). D Dressing has a 1-cm area of bleeding.

A Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min. Bleeding is a complication of radical nephrectomy; tachycardia and hypotension may indicate impending hypovolemic or hemorrhagic shock. The surgeon should be notified immediately and fluids should be administered, complete blood count should be checked, and blood administered, if necessary. A urine output of 80 mL can be considered normal. The nurse can administer pain medication, but must address hemodynamic instability and possible hemorrhage first. Administering pain medication to a client who has developed shock will exacerbate hypotension. A dressing with a 1-cm area of bleeding is expected postoperatively.

When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next? A Check vital signs. B Notify the surgeon. C Continue to monitor. D Insert a nasogastric (NG) tube.

A Check vital signs. The client's abdomen may be distended from bleeding; hemorrhage or adrenal insufficiency causes hypotension, so vital signs should be taken to see if a change in blood pressure has occurred. The surgeon should be notified after vital signs are assessed. An NG tube is not indicated for this client.

For which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider? (Select all that apply.) A Client with an allergy to shrimp B Client with a history of asthma C Client who requests morphine sulfate every 3 hours D Client with a blood urea nitrogen of 62 mg/dL and a creatinine of 2.0 mg/dL E Client who took metformin (Glucophage) 4 hours ago

A Client with an allergy to shrimp B Client with a history of asthma D Client with a blood urea nitrogen of 62 mg/dL and a creatinine of 2.0 mg/dL E Client who took metformin (Glucophage) 4 hours ago The client who will be undergoing a CT scan with contrast should be asked about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. Contrast reactions have been reported to be as high as 15% in these clients. Clients with asthma have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. The risk for contrast-induced nephropathy is increased in clients who have pre-existing renal insufficiency (e.g., serum creatinine levels greater than 1.5 mg/dL or estimated glomerular filtration rate less than 45 mL/min). Metformin must be discontinued at least 24 hours before and for at least 48 hours after any study using contrast media because the life-threatening complication of lactic acidosis, although rare, could occur. There are no contraindications to undergo CT with contrast while taking morphine sulfate. CT with contrast may help to identify the underlying cause of pain.

Which age-related change can cause nocturia? A Decreased ability to concentrate urine B Decreased production of antidiuretic hormone C Increased production of erythropoietin D Increased secretion of aldosterone

A Decreased ability to concentrate urine Nocturia may result from decreased kidney-concentrating ability associated with aging. Increased production of antidiuretic hormone, decreased production of erythropoietin, and decreased secretion of aldosterone are age-related changes.

An older adult client diagnosed with stress incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect? (Select all that apply.) A Dry mouth B Increased blood pressure C Increased intraocular pressure D Constipation E Reddish-orange urine color

A Dry mouth C Increased intraocular pressure D Constipation Oxybutynin is an anticholinergic/antispasmodic. Side effects include dry mouth, urinary retention, constipation, and risk for increased intraocular pressure with the potential to make glaucoma worse. Alpha-adrenergic agonists and beta blockers, which may be prescribed for urinary incontinence, may cause an increase in blood pressure. Phenazopyridine, a bladder analgesic used to decrease urinary pain, causes the urine to be a reddish-orange color.

The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? (Select all that apply.) A Dysuria B Enuresis C Frequency D Nocturia E Urgency F Polyuria

A Dysuria C Frequency D Nocturia E Urgency Dysuria (painful urination), frequency, nocturia (frequent urinating at night), and urgency (having the urge to urinate quickly) are symptoms of UTI. Enuresis (bed-wetting) and polyuria (increased amounts of urine production) are not signs of a UTI.

Which urinary assessment information for a client indicates the potential need for increased fluids? A Increased blood urea nitrogen B Increased creatinine C Pale-colored urine D Decreased sodium

A Increased blood urea nitrogen Increased blood urea nitrogen can indicate dehydration. Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.

When caring for a client with polycystic kidney disease, which goal is most important? A Preventing progression of the disease B Performing genetic testing C Assessing for related causes D Consulting with the dialysis unit

A Preventing progression of the disease Preventing complications and progression of the disease is the goal. Genetic testing should be done, but this is not a priority. Assessment for related causes is an intervention, not a goal. Not all clients with polycystic kidney disease require dialysis.

When taking the health history of a client with acute glomerulonephritis (GN), the nurse questions the client about which related cause of the problem? A Recent respiratory infection B Hypertension C Unexplained weight loss D Neoplastic disease

A Recent respiratory infection An infection often occurs before the kidney manifestations of acute GN. The onset of symptoms is about 10 days from the time of infection. Hypertension is a result of glomerulonephritis, not a cause. Weight gain, not weight loss, is symptomatic of fluid retention in GN. Cancers are not part of the cause of GN.

Which condition may predispose a client to chronic pyelonephritis? A Spinal cord injury B Cardiomyopathy C Hepatic failure D Glomerulonephritis

A Spinal cord injury Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones. Weakness of the heart muscle may cause kidney impairment, not an infection. Pyelonephritis may damage the kidney, not the liver. Glomerulonephritis may result from infection, but may not cause infection of the kidney.

Which clients with an indwelling urinary catheter does the nurse reassess to determine whether the catheterization needs to be continued or can be discontinued? (Select all that apply.) A Three-day postoperative client B Client in the stepdown unit C Comatose client with careful monitoring of intake and output (I&O) B Incontinent client with perineal skin breakdown E Incontinent older adult in long-term care

A Three-day postoperative client B Client in the stepdown unit E Incontinent older adult in long-term care Three days after surgery, the postoperative client probably should be able to urinate on his or her own. This may be influenced by the type of surgery, but most clients do not need long-term catheterization after they have surgery. The incidence of complications (colonization of bacteria) begins to increase after 48 hours postinsertion. The client in the stepdown unit is definitely one who should be considered for catheter discontinuation; he or she should be somewhat ambulatory and able to get to a bedside commode. Incontinence in older adults does not necessarily mean that they have to be catheterized. The introduction of a catheter invites the possibility of infection. These clients can often be managed with adult incontinence pads with less risk for developing a urinary tract infection. These infections in the older adult population are serious and should be avoided. The comatose client who is on strict I&O must have a urinary catheter in place to keep an accurate account of fluid balance. A client who is incontinent with no breakdown areas would be considered, but perineal skin problems in this situation make a catheter necessary for this client's skin to have a clean, dry environment for healing.

An 84-year-old male client is being admitted after surgery to remove a section of his bowel (colectomy) following a diagnosis of colon cancer. His urine output from an indwelling urinary catheter after 3 hours in the postanesthesia care unit plus the amount in the bag on admission to the medical-surgical unit totals 100 mL. The urine is cloudy and dark yellow. He also has a history of hypertension. After evaluating the patency of the collection device, what is the most appropriate action for the nurse to perform? A. Notify the health care provider of the low urine output. B. Increase the rate of intravenous fluids until urine output is 0.5 mL/kg/hr. C. Continue to assess the client and re-evaluate urine output in 4 hours. D. Ask about his typical voiding patterns and about any previous episodes of urinary problems.

A. Notify the health care provider of the low urine output. The lowest acceptable urine output to avoid acute kidney injury (AKI) is 0.5 mL/kg/hr, which, in this 70-kg man, is about 35 mL/hr or a total of at least 105 mL. Surgery places clients at risk for both hypo- and hypervolemia. Waiting an additional 4 hours to obtain 6-hour trend data delays the prompt assessment and intervention necessary to avoid AKI. It is not appropriate to increase fluid rate, and it is unlikely the client is ready to take oral fluid this soon after surgery on the gastrointestinal tract. Voiding is not an issue with a urinary collection device.

A 65-year old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? A. Smoking B. Urine with a high specific gravity C. Recurrent urinary tract infections D. History of cancer in another organ or tissue

A. Smoking Many compounds in tobacco enter the bloodstream and affect other organs, such as the bladder. Concentrated urine is associated with kidney stones and UTIs. The urinary bladder is not a common site for metastases.

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

A. Urine output of 15 mL/hr Urine output after a nephrostomy should be at least 25 to 40 mL/hr. Tenderness is expected at a new incisional site; the slight elevation of BUN alone is not alarming or indicative of a complication specific to nephrostomy. Pink-tinged urine indicating hematuria is common after instrumentation, but frank blood or increased bleeding over time is not expected.

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for postprocedure home care? A "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." B "Do not share your toilet with family members for the next 24 hours." C "Please be sure to stand when you are urinating." D "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."

B "Do not share your toilet with family members for the next 24 hours." The toilet should not be shared for 24 hours following this procedure because others using the toilet could be infected with the live virus that was instilled into the client. If only one toilet is available in the household, teach the client to flush the toilet after use and to follow this by adding 1 cup of undiluted bleach to the bowl water. The bowl is then flushed after 15 minutes, and the seat and flat surfaces of the toilet are wiped with a cloth containing a solution of 10% liquid bleach. The client must sit when he is urinating for at least 24 hours postprocedure to prevent splashing of the contaminated urine out of the commode, where it could be toxic for anyone who comes in contact with it. Underwear or other clothing that has come into contact with urine during the 24 hours after instillation should be washed separately from other clothing in a solution of 10% liquid bleach; it does not need to be discarded.

Which statement by a client with diabetic nephropathy indicates a need for further education about the disease? A "Diabetes is the leading cause of kidney failure." B "I need less insulin, so I am getting better." C "My blood sugar may drop really low at times." D "I must call my provider if the urine dipstick shows protein."

B "I need less insulin, so I am getting better." When kidney function is reduced, insulin is available for a longer time and thus less of it is needed. Unfortunately, many clients believe this means that their diabetes is improving. It is true that diabetes mellitus is the leading cause of end-stage kidney disease among Caucasians in the United States. Clients with worsening kidney function may begin to have frequent hypoglycemic episodes. Proteinuria, which may be mild, moderate, or severe, indicates a need for follow-up.

The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? A "A small-lumen catheter will help prevent injury to my urethra." B "I will use a new, sterile catheter each time I do the procedure." C "My family members can be taught to help me if I need it." D "Proper handwashing before I start the procedure is very important."

B "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating. The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization and is a principle that should be stressed.

A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? A "Don't worry, no one else will know." B "Take your time. What is bothering you the most?" C "Why are you hesitant?" D "You need to tell me so we can determine what is wrong."

B "Take your time. What is bothering you the most?" Asking the client what is bothering him or her expresses patience and understanding when trying to identify the client's problem. Telling the client that others will not know is untrue because the client's symptoms will be in the medical record for other health care personnel to see. Asking why the client is hesitant can seem accusatory and threatening to the client. Admonishing the client to disclose his or her symptoms is too demanding; the nurse must be more understanding of the client's embarrassment.

The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) B A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours C A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy D A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

B A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention. The 26-year-old admitted with urosepsis and slight fever, the 32-year-old scheduled for cystoscopy, and the 40-year-old with noninfectious urethritis are not at immediate risk for complications or deterioration.

The nurse anticipates that a client who develops hypotension and oliguria post nephrectomy may need the addition of which element to the regimen? A Increase in analgesics B Addition of a corticosteroid C Administration of a diuretic D Course of antibiotic therapy

B Addition of a corticosteroid Loss of water and sodium occurs in clients with adrenal insufficiency, which is followed by hypotension and oliguria; corticosteroids may be needed. The nurse should use caution when administering analgesics to a hypotensive client; no indication suggests that pain is present in this client. A diuretic would further contribute to fluid loss and hypotension, potentially worsening kidney function. A few doses of antibiotics are used prophylactically preoperatively and postoperatively; additional therapy is used when evidence of infection exists.

The RN is working with unlicensed assistive personnel (UAP) in caring for a group of clients. Which action is best for the RN to delegate to UAP? A Assessing the vital signs of a client who was just admitted with blunt flank trauma and hematuria B Assisting a client who had a radical nephrectomy 2 days ago to turn in bed C Helping the provider with a kidney biopsy for a client admitted with acute glomerulonephritis D Palpating for bladder distention on a client recently admitted with a ureteral stricture

B Assisting a client who had a radical nephrectomy 2 days ago to turn in bed UAP would be working within legal guidelines when assisting a client to turn in bed. Although assessment of vital signs is within the scope of practice for UAP, the trauma victim should be assessed by the RN because interpretation of the vital signs is needed. Assisting with procedures such as kidney biopsy and assessment for bladder distention are responsibilities of the professional nurse that should not be delegated to staff members with a limited scope of education.

The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? A Client who has just returned from having a kidney artery angioplasty B Client with polycystic kidney disease who is having a kidney ultrasound C Client who is going for a cystoscopy and cystourethroscopy D Client with glomerulonephritis who is having a kidney biopsy

B Client with polycystic kidney disease who is having a kidney ultrasound Kidney ultrasounds are noninvasive procedures without complications; the LPN/LVN can provide this care. A kidney artery angioplasty is an invasive procedure that requires postprocedure monitoring for complications, especially hemorrhage; a registered nurse is needed. Cystoscopy and cystourethroscopy are procedures that are associated with potentially serious complications such as bleeding and infection. These clients should be assigned to RN staff members. Kidney biopsy is associated with potentially serious complications such as bleeding, and this client should be assigned to RN staff members.

When assessing a client with acute glomerulonephritis, which finding causes the nurse to notify the provider? A Purulent wound on the leg B Crackles throughout the lung fields C History of diabetes D Cola-colored urine

B Crackles throughout the lung fields Crackles indicate fluid overload resulting from kidney damage; shortness of breath and dyspnea are typically associated. The provider should be notified of this finding. Glomerulonephritis may result from infection (e.g., purulent wound); it is not an emergency about which to notify the provider. The history of diabetes would have been obtained on admission. Dark urine is expected in glomerulonephritis.

Which laboratory test is the best indicator of kidney function? A Blood urea nitrogen (BUN) B Creatinine C Aspartate aminotransferase (AST) D Alkaline phosphatase

B Creatinine Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best indicator of renal function. BUN may be affected by protein or fluid intake. AST and alkaline phosphatase are measures of hepatic function.

Which clinical manifestation in a client with pyelonephritis indicates that treatment has been effective? A Decreased urine output B Decreased white blood cells in urine C Increased red blood cell count D Increased urine specific gravity

B Decreased white blood cells in urine A decreased presence of white blood cells in the urine indicates the eradication of infection. A decreased urine output, an increased red blood cell count, and increased urine specific gravity are not symptoms of pyelonephritis.

A client diagnosed with stress incontinence is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? (Select all that apply.) A Take the drug at bedtime. B Encourage increased fluids. C Increase fiber intake. D Limit the intake of dairy products. E Use hard candy for dry mouth.

B Encourage increased fluids. C Increase fiber intake. E Use hard candy for dry mouth. Anticholinergics cause constipation; increasing fluids and fiber intake will help with this problem. Anticholinergics also cause extreme dry mouth, which can be alleviated with using hard candy to moisten the mouth. Taking the drug at night and limiting dairy products will not have an effect on the complications encountered with propantheline.

Which factor is an indicator for a diagnosis of hydronephrosis? A History of nocturia B History of urinary stones C Recent weight loss D Urinary incontinence

B History of urinary stones Causes of hydronephrosis or hydroureter include tumors, stones, trauma, structural defects, and fibrosis. Nocturia is a key feature of polycystic kidney disease and pyelonephritis, but it is not associated with hydronephrosis. Recent weight loss and urinary incontinence may be factors in renal cell carcinoma, but are not associated with hydronephrosis.

The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first? A Obtain blood urea nitrogen (BUN) and creatinine. B Position the client supine. C Administer pain medications. D Check urine for hematuria.

B Position the client supine. The client is positioned supine for several hours after a kidney biopsy to decrease the risk for hemorrhage. BUN and creatinine would be obtained before the procedure is performed. Only local discomfort should be noted around the procedure site; severe pain would indicate hematoma. Although pink urine may develop, the nurse should position the client to prevent bleeding first; the other actions are appropriate after this procedure, but do not need to be done immediately after the biopsy.

Which interventions are helpful in preventing bladder cancer? (Select all that apply.) A Drinking 2½ liters of fluid a day B Showering after working with or around chemicals C Stopping the use of tobacco D Using pelvic floor muscle exercises E Wearing a lead apron when working with chemicals F Wearing gloves and a mask when working around chemicals and fumes

B Showering after working with or around chemicals C Stopping the use of tobacco F Wearing gloves and a mask when working around chemicals and fumes Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. Bathing after exposure to them is advisable. Tobacco use is one of the highest, if not the highest, risk factor in the development of bladder cancer. Increasing fluid intake is helpful for some urinary problems such as urinary tract infection, but no correlation has been noted between fluid intake and bladder cancer risk. Using pelvic floor muscle strengthening (Kegel) exercises is helpful with certain types of incontinence, but no data show that these exercises prevent bladder cancer. Precautions should be taken when working with chemicals; however, lead aprons are used to protect from radiation.

Which sign or symptom, when assessed in a client with chronic glomerulonephritis (GN), warrants a call to the health care provider? A Mild proteinuria B Third heart sound (S3) C Serum potassium of 5.0 mEq/L D Itchy skin

B Third heart sound (S3) S3 indicates fluid overload secondary to failing kidneys; the provider should be notified and instructions obtained. Mild proteinuria is an expected finding in GN. A serum potassium of 5.0 mEq/L reflects a normal value; intervention would be needed for hyperkalemia. Although itchy skin may be present as kidney function declines, it is not a priority over fluid excess.

The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? (Select all that apply.) A Cleanse the perineum from back to front after using the bathroom. B Try to take in 64 ounces of fluid each day. C Be sure to complete the full course of antibiotics. D If urine remains cloudy, call the clinic. E Expect some flank discomfort until the antibiotic has worked.

B Try to take in 64 ounces of fluid each day. C Be sure to complete the full course of antibiotics. D If urine remains cloudy, call the clinic. Between 64 and 100 ounces (2 to 3 liters) of fluid should be taken daily to dilute bacteria and prevent infection. Not completing the course of antibiotics could suppress the bacteria, but would not destroy all bacteria, causing the infection to resurface. For persistent symptoms of infection, the client should contact the provider. The perineal area should be cleansed from front to back or "clean to dirty" to prevent infection. Cystitis produces suprapubic symptoms; flank pain occurs with infection or inflammation of the kidney.

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

B. "I will restrict my sodium to less than 2 mg daily." Patients with PKD waste sodium rather than retaining it. They need an increased sodium and water intake. Aggressive control of hypertension is needed to preserve kidney function. Genetic counseling is advised before having children because PKD is inherited.

A 60-year-old African-American client is newly diagnosed with mild chronic kidney disease (stage 2 CKD). She has a history of diabetes, and her current A1C is 8.0%. She asks the nurse whether any of the following factors could have caused this problem. Which factor should the nurse indicate may have influenced the development of CKD? A. She heavily salted her food as a child and teenager but added no extra salt to her food as an adult. B. Her chronic hyperglycemia caused blood vessel changes in the kidney that can damage kidney tissue. C. Her paternal grandparents had type 2 diabetes and hypertension. D. She drinks 2 cups of coffee water daily.

B. Her chronic hyperglycemia caused blood vessel changes in the kidney that can damage kidney tissue. Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) needing dialysis. Managing hyperglycemia delays the onset and progression of CKD. This level of caffeine intake would not lead to either kidney damage or hypertension. The fact that she has reduced her salt intake during adulthood would only help prevent hypertensive kidney disease. The family history of type 2 diabetes and hypertension is a potential risk factor, but her own diabetes and lack of glycemic control manifested by the elevated A1C have a more direct and great adverse effect on kidney function.

The client arrives to the primary care clinic with a problem of new abdominal pain and blood in her urine. She is afebrile. Which information is most important for the nurse to obtain from this client's history? A. Kidney cancer in the client's family B. Injury or trauma to the abdomen or pelvis C. Treatment for a urinary tract infection in the past 12 months D. Recent exposure to heavy metals, drugs, or other nephrotoxins

B. Injury or trauma to the abdomen or pelvis Bladder trauma or injury should be considered in the patient with abdominal pain. Lack of fever reduces suspicion for infection; pain is not usually associated with kidney cancer or acute and chronic kidney injury from nephrotoxins

Which instruction does the nurse give a client who needs a clean-catch urine specimen? A "Save all urine for 24 hours." B "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." C "Do not touch the inside of the container." D "You will receive an isotope injection, then I will collect your urine."

C "Do not touch the inside of the container." A clean-catch specimen is used to obtain urine for culture and sensitivity of organisms present; contamination by the client's hands will render the specimen invalid and alter results. Saving urine for 24 hours is not necessary for a midstream clean-catch urine specimen. After cleaning, the client should initiate voiding into the commode, then stop and resume voiding into the container. Only 1 ounce (30 mL) is needed; the remainder of the urine may be discarded into the commode. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. A clean-catch specimen for culture does not require an injection of isotope, simply cleansing of the perineum.

A. The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? A "I must avoid drinking carbonated beverages." B "I need to douche vaginally once a week." C "I should drink 2½ liters of fluid every day." D "I will not drink fluids after 8 PM each evening."

C "I should drink 2½ liters of fluid every day." Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis. Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8:00 p.m. would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late-night fluid intake to 120 mL.

The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? A "I must clean with the wipes and then urinate directly into the cup." B "I will have to drink 2 liters of fluid before providing the sample." C "I'll start to urinate in the toilet, stop, and then urinate into the cup." D "It is best to provide the sample while I am bathing."

C "I'll start to urinate in the toilet, stop, and then urinate into the cup." To provide a clean-catch urine sample, the client should initiate voiding, then stop, then resume voiding into the container. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. Although cleaning with wipes before providing a clean-catch urine sample is proper procedure, a step is missing. It is not necessary to drink 2 liters of fluid before providing a clean-catch urine sample. Providing a clean-catch urine sample does not involve bathing.

A. A 53-year-old postmenopausal woman reports "leaking urine" when she laughs, and is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? A "They can relieve your anxiety associated with incontinence." B "They help your bladder to empty." C "They may be used to improve urethral resistance." D "They decrease your bladder's tone."

C "They may be used to improve urethral resistance." Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance. Relieving anxiety has not been shown to improve stress incontinence. No drugs have been shown to promote bladder emptying, and this is not usually the problem with stress incontinence. Emptying the bladder is accomplished by the individual or, if that is not possible, by using a catheter. Decreasing bladder tone would not be a desired outcome for a woman with incontinence.

The nurse is educating a female client about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do? A "Douche—but only once a month." B "Use only white toilet paper." C "Wipe from front to back." D "Wipe with the softest toilet paper available."

C "Wipe from front to back." Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection. Douching is an unhealthy behavior because it removes beneficial organisms as well as the harmful ones. White toilet paper helps prevent allergies, not infections. Using soft toilet paper does not prevent infection.

The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? A Hemoglobin and hematocrit (H&H) B White blood cell (WBC) count C Blood urea nitrogen (BUN) and creatinine D Lipid levels

C Blood urea nitrogen (BUN) and creatinine BUN and creatinine are kidney function tests. With back-pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction; H&H monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.

After receiving change-of-shift report on the urology unit, which client does the nurse assess first? A Client post radical nephrectomy whose temperature is 99.8° F (37.6° C) B Client with glomerulonephritis who has cola-colored urine C Client who was involved in a motor vehicle crash and has hematuria D Client with nephrotic syndrome who has gained 2 kg since yesterday

C Client who was involved in a motor vehicle crash and has hematuria The nurse should be aware of the risk for kidney trauma after a motor vehicle crash; this client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria because hemorrhage can be life-threatening. Although slightly elevated, the low-grade fever of the client who is post radical nephrectomy is not life-threatening in the same way as a trauma victim with bleeding. Cola-colored urine is an expected finding in glomerulonephritis. Because of loss of albumin, fluid shifts and weight gain can be anticipated in a client with nephrotic syndrome.

A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? A Bladder training B Credé method C Habit training D Kegel exercises

C Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis. Bladder training, the Credé method, and learning Kegel exercises require that the client be alert, cooperative, and able to assist with his or her own training.

When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? A Abdominal girth B Presence of urinary infection C History of hysterectomy D Hematuria

C History of hysterectomy The scanner must be in the scan mode for female clients to ensure the scanner subtracts the volume of the uterus from the measurement, or in the scan mode for male clients for women who have undergone a hysterectomy. The nurse performs this procedure in response to distention or pressure in the bladder; girth is not a factor. This procedure detects urine retained in the bladder, not infection. The presence of retained urine in the bladder is assessed, regardless of hematuria.

When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first? A Give lispro (Humalog) insulin, 12 units subcutaneously. B Request a breakfast tray for the client. C Infuse 0.45% normal saline at 125 mL/hr. D Administer captopril (Capoten).

C Infuse 0.45% normal saline at 125 mL/hr.

Which information suggests that a client with diabetes may be in the early stages of kidney damage? A Elevation in blood urea nitrogen (BUN) B Oliguria C Microalbuminuria D Painless hematuria

C Microalbuminuria In the early stages of diabetic nephropathy, micro-levels of albumin are first detected in the urine. Progressive kidney damage occurs before dipstick procedures can detect protein in the urine. BUN may change in response to protein and fluid intake. Oliguria is a later finding in kidney disease and may also be present in dehydration. Painless hematuria often occurs with kidney cancer.

When caring for a client with uremia, the nurse assesses for which symptom? A Tenderness at the costovertebral angle (CVA) B Cyanosis of the skin C Nausea and vomiting D Insomnia

C Nausea and vomiting Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue. CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.

The nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first? A Administer heparin intravenously. B Remove the urinary catheter. C Notify the health care provider. D Irrigate the catheter with sterile saline.

C Notify the health care provider. Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. The nurse should monitor urine output and notify the health care provider of obvious blood clots or a decreased or absent urine output. Heparin will not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and should not be removed at this time. The Foley catheter may be irrigated with sterile saline, as ordered.

Which percussion technique does the nurse use to assess a client who reports flank pain? A Place outstretched fingers over the flank area and percuss with the fingertips. B Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. C Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. D Quickly tap the flank area with cupped hands.

C Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. While the client assumes a sitting, side-lying, or supine position, the nurse forms one of the hands into a clenched fist. The other hand is placed flat over the costovertebral (CVA) angle of the client. Then, a firm thump is quickly delivered to the hand over the CVA area. Percussion is not appropriate for flank pain. Placing one hand palm up is not the correct technique. Percussion therapy, not assessment, involves tapping the flank area.

A. Which nursing activity illustrates proper aseptic technique during catheter care? A Applying Betadine ointment to the perineal area after catheterization B Irrigating the catheter daily C Positioning the collection bag below the height of the bladder D Sending a urine specimen to the laboratory for testing

C Positioning the collection bag below the height of the bladder Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract. Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized clients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation should be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.

A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? A Increased oral fluids B IV fluids C Privacy D Health history forms

C Privacy The nurse should provide privacy, assistance, and voiding stimulants, such as warm water over the perineum, as needed, for the client with urinary problems. Increased oral fluids and IV fluids would exacerbate the client's problem. Obtaining a health history is not the priority for this client's care.

A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration should be cared for by which staff member? A RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma B RN who is caring for a client who just returned after having renal artery balloon angioplasty C RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy D RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

C RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy The client scheduled for nephrectomy is the most stable client; the RN caring for this client will have time to perform the frequent monitoring and interventions that are needed for the newly admitted client. The client receiving chemotherapy will require frequent monitoring by the RN. The client after angioplasty will require frequent vital sign assessment and observation for hemorrhage and arterial occlusion. The client with acute hypertension will need frequent monitoring and medication administration.

The certified Wound, Ostomy, and Continence Nurse or enterostomal therapist teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? A Nutritional and dietary care B Respiratory care C Stoma and pouch care D Wiping from front to back (asepsis)

C Stoma and pouch care The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms. The registered dietitian teaches the cystectomy client about nutritional care. The respiratory therapist teaches the cystectomy client about respiratory care. The client with a cystectomy does not require instruction about front-to-back wiping.

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? A Functional B Overflow C Stress D Urge

C Stress Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence. Functional incontinence is not caused by a weakened pelvic floor; rather, it is due to structural problems often resulting from injury or trauma. Overflow incontinence is caused by too much urine being stored in the bladder. Urge incontinence is caused by a problem (i.e., neurologic) with the client's urge to urinate.

Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation? A Pink-tinged urine B Urinary frequency C Temperature of 100.8° F D Lethargy

C Temperature of 100.8° F Fever, chills, or an elevated white blood cell count after cystoscopy suggest infection after an invasive procedure; the provider must be notified immediately. Pink-tinged urine is expected after a cystoscopy; gross hematuria would require notification of the surgeon. Frequency may be noted as a result of irritation of the bladder. If sedation or anesthesia was used, lethargy is an expected effect.

A 32-year-old female with a urinary tract infection (UTI) reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the health care provider prescribe? 1. Nitrofurantoin (Macrodantin) after intercourse 2. Estrogen (Premarin) 3. Trimethoprim/sulfamethoxazole (Bactrim) 4. Phenazopyridine (Pyridium) with intercourse

C Trimethoprim/sulfamethoxazole (Bactrim) Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole is effective in treating uncomplicated, community-acquired UTI in women. Drugs from the same class as nitrofurantoin reduce bacteria in the urinary tract by inhibiting bacterial reproduction (bacteriostatic action). This client needs a drug that will kill bacteria. Estrogen cream may help prevent recurrent UTIs in postmenopausal women, which this client is not (at age 32). Use of Premarin is related to problems with incontinence. Phenazopyridine (Pyridium) is not used to treat infection, but symptoms of a UTI.

When caring for a client who had a nephrostomy tube inserted 4 hours ago, which is essential for the nurse to report to the health care provider? A Dark pink-colored urine B Small amount of urine leaking around the catheter C Tube that has stopped draining D Creatinine of 1.8 mg/dL

C Tube that has stopped draining The provider must be notified when a nephrostomy tube does not drain; it could be obstructed or dislodged. Pink or red drainage is expected for 12 to 24 hours after insertion and should gradually clear. The nurse may reinforce the dressing around the catheter to address leaking urine; however, the provider should be notified if there is a large quantity of leaking drainage, which may indicate tube obstruction. A creatinine level of 1.8 mg/dL is expected in a client early after nephrostomy tube placement (due to the minor kidney damage that required the nephrostomy tube).

The client passes a urinary stone that laboratory analysis indicates is composed of calcium oxalate. Based on this analysis, which instruction does the nurse specifically include for dietary prevention of the problem? A. "Increase your intake of meat, fish, and cranberry juice." B. "Avoid citrus fruits and citrus juices such as oranges." C. "Avoid dark green leafy vegetables such as spinach." D. "Decrease your intake of dairy products, especially milk."

C. "Avoid dark green leafy vegetables such as spinach." Calcium oxalate stones form more easily in the presence of oxalate. Sources of oxalate include spinach, black tea, and rhubarb. Avoiding these sources of oxalate may reduce the number of stones formed. Citrus intake is not restricted in this type of stone and is often suggested to be increased. Dietary intake of calcium does not appear to affect calcium-based stone formation, although the client should avoid calcium mineral supplements. Moderation of meat reduces stone formation in general.

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

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

For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter? A. 36-year-old woman who is blind receiving diuretics B. 46-year-old man who has paraplegia and is admitted for asthma management C. 56-year-old woman who is admitted with a vaginal-rectal fistula and diabetes D. 66-year-old man who has severe osteoarthritis and high risk for falling

C. 56-year-old woman who is admitted with a vaginal-rectal fistula and diabetes This client has a wound that can be irritated by urine and whose urinary tract could become infected by the draining fistula (her diabetes increases her overall risk for infection). All of these other clients could be managed with frequent toileting. The men could also be managed with external urine collection devices.

The nurse is completing documentation for a client with acute kidney injury who is being discharged today. The nurse notices that the client has a serum potassium level of 5.8 mEq/L. Which is the priority nursing action? A. Asking the client to drink an extra 500 mL of water to dilute the electrolyte concentration and then re-checking the serum potassium level B. Encouraging the client to eat potassium-binding foods and to contact his or her primary care provider within 24 hours. C. Checking the remaining values on the electrolyte panel and informing the provider of all results before the client is discharged. D. Applying a cardiac monitor and evaluating the client's muscle strength and muscle irritability.

C. Checking the remaining values on the electrolyte panel and informing the provider of all results before the client is discharged. Repeating the laboratory test is a reasonable option, but the provider must make this decision after being informed about the context, including the results of the entire electrolyte panel, which will also have information about renal function (creatinine and blood urea nitrogen). Although the potassium level is slightly elevated, it is not a value commonly associated with cardiac dysrhythmias or skeletal muscle changes. Although additional fluid intake may dilute some electrolytes, potassium is not generally altered by plasma volume. There are no foods that specifically bind potassium and, depending on the rapidity of the rise in serum potassium, waiting a day may result in harm to the patient.

Which assessments are most important for the nurse to perform when monitoring a client who returns to the medical-surgical unit after a dye-enhanced CT scan? A. Body temperature and urine odor B. Kidney tenderness and flank pain C. Urine volume and color D. Specific gravity and pH

C. Urine volume and color To prevent dye-induced nephrotoxicity, the nurse should evaluate the urine and ensure a large, dilute output for several hours after the test. Generally, the amount of contrast does not cause dehydration; the concern is that the high osmolar content of some dyes has a direct nephrotoxic affect. Kidney tenderness and flank pain may indicate bleeding, a complication from a kidney biopsy. Body temperature and urine odor may indicate a UTI after manipulation of the urinary tract system and manipulation (e.g., placement of a urinary catheter or instilling of fluid into the bladder) does not occur with a CT scan.

A. A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? A "Blood in my urine has become less noticeable, so maybe I don't need this procedure." B "I have been taking cephalexin (Keflex) for an infection." C "I previously had several ESWL procedures performed." D "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

D "I take over-the-counter naproxen (Aleve) twice a day for joint pain." Because a high risk for bleeding during ESWL has been noted, clients should not take nonsteroidal anti-inflammatory drugs before this procedure; the ESWL will have to be rescheduled for this client. Blood in the client's urine should be reported to the health care provider, but will not require rescheduling of the procedure because blood is frequently present in the client's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. The client's taking cephalexin (Keflex) and the fact that the client has had several previous ESWL procedures should be reported, but will not require rescheduling of the procedure.

The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a correct understanding of these procedures? A "If I restrict my oral intake of fluids, the adjustment will be easier." B "I must go to the restroom more often because my urine will be excreted through my anus." C "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." D "I will have to drain my pouch with a catheter."

D "I will have to drain my pouch with a catheter." For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter. Fluids should not be restricted. A neobladder does not require the use of an ostomy bag.

The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? A "I am so relieved that I can continue eating my fried fish meals every week." B "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." C "My wife will be happy to know that I can keep enjoying her liver and onions recipe." D "I will no longer be able to have red wine with my dinner."

D "I will no longer be able to have red wine with my dinner." Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client should decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming. Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stones consist of calcium oxalate.

The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective? A "Because renal cell carcinoma usually affects both kidneys, I'll need to be watched closely." B "I'll eventually require some type of renal replacement therapy." C "I'll need to decrease my fluid intake to prevent stress to my remaining kidney." D "My remaining kidney will provide me with normal kidney function now."

D "My remaining kidney will provide me with normal kidney function now." After a nephrectomy, the second kidney is expected to eventually provide adequate kidney function, but this may take days or weeks. Renal cell carcinoma typically only affects one kidney. Renal replacement therapy is not the typical treatment for renal cell carcinoma. Fluids should be maintained to flush the remaining kidney.

An older adult woman confides to the nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? A "Don't worry about it. You need them." B "Shop at night, when stores are less crowded." C "Tell everyone that they are for your husband." D "That is tough. What do you think might help?"

D "That is tough. What do you think might help?" Stating that the situation is tough acknowledges the client's concerns, and asking the client to think about what might help assists the client to think of methods to solve her problem. Telling the client not to worry is dismissive of the client's concerns. Telling the client to shop at night does not empower the client, and it reaffirms the client's embarrassment. Suggesting to the client that she tell everyone they are for her husband also does not empower the client; rather, it suggests to the client that telling untruths is acceptable.

During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? A "Drink 2 liters of fluid and urinate at the same time every day." B "Eat breakfast and go to bed at the same time every day." C "Check your blood sugar and do a urine dipstick test." D "Weigh yourself and take your blood pressure."

D "Weigh yourself and take your blood pressure." Regular weight assessment monitors fluid restriction control, while blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction. Fluid intake and urination, and breakfast time and bedtime, do not need to be at the same time each day. Clients with diabetes, not kidney disease, should regularly check their blood sugar and perform a urine dipstick test.

The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? A "For the best effect, perform all of your exercises while you are seated on the toilet." B "Limit your exercises to 5 minutes twice a day, or you will injure yourself." C "Results should be visible to you within 72 hours." D "You know that you are exercising correct muscles if you can stop urine flow in midstream."

D "You know that you are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used. Pelvic muscle exercises can be performed anywhere and should be performed more often than 5 minutes twice daily. Noticeable results take several weeks.

A. The health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? A "It will act as an antibacterial drug." B "This drug will treat your infection, not the symptoms of it." C "You need to take the drug on an empty stomach." D "Your urine will turn red or orange while on the drug."

D "Your urine will turn red or orange while on the drug." Phenazopyridine will turn the client's urine red or orange. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed, and care should be taken because it will stain undergarments. Phenazopyridine reduces bladder pain and burning by exerting a local analgesic/anesthetic effect on the mucosa of the urinary tract. It does treat the symptoms of bladder infection; it has no antibacterial action. Phenazopyridine should be taken with a meal or immediately after eating.

Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN? A A 42-year-old with painless hematuria who needs an admission assessment B A 46-year-old scheduled for cystectomy who needs help in selecting a stoma site C A 48-year-old receiving intravesical chemotherapy for bladder cancer D A 55-year-old with incontinence who has intermittent catheterization prescribed

D A 55-year-old with incontinence who has intermittent catheterization prescribed Insertion of catheters is within the education and legal scope of practice for LPN/LVNs. Admission assessments and intravesical chemotherapy should be done by an RN. Preoperative preparation for cystectomy and stoma site selection should be done by an RN and either a Certified Wound, Ostomy, and Continence Nurse or an enterostomal therapy nurse.

Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter? A Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. B Remove the existing catheter and obtain a sample during the process of inserting a new Foley. C Use a sterile syringe to withdraw urine from the urine collection bag. D Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.

D Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine. Clamping the tubing, attaching a syringe to the specimen, and withdrawing at least 5 mL of urine is the correct technique for obtaining a sterile urine specimen from the client with a Foley catheter. Disconnecting the Foley catheter from the drainage tube and collecting urine directly from the Foley increases the risk for microbe exposure. A Foley catheter should not be removed to get a urine sample. Microbes may be in the urine collection bag from standing urine, so using a sterile syringe to withdraw urine from the urine collection bag is not the proper technique to obtain a urine sample.

The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day? A Client with chronic kidney disease B Client with heart failure C Client with complete bowel obstruction D Client with hyperparathyroidism

D Client with hyperparathyroidism A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones; this client should remain hydrated. A client with chronic kidney disease should not consume 2 to 3 liters of water because the kidneys are not functioning properly, and this could lead to fluid retention. People with heart failure typically have fluid volume excess. A client with complete bowel obstruction may experience vomiting and should be NPO.

When planning an assessment of the urethra, what does the nurse do first? A Examine the meatus. B Note any unusual discharge. C Record the presence of abnormalities. D Don gloves.

D Don gloves. Before examination begins, body fluid precautions (gloves) must be implemented first. Examining the meatus, noting unusual discharge, or recording the presence of abnormalities are things that the nurse should do after putting on gloves.

What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)? A Limit fluid intake. B Increase caffeine consumption. C Limit sugar intake. D Drink about 3 liters of fluid daily.

D Drink about 3 liters of fluid daily. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs. Fluids flush the system and should not be limited. Increased caffeine intake and limiting sugar intake will not prevent UTIs.

Which goal for a client with diabetes will best help to prevent diabetic nephropathy? A Heed the urge to void. B Avoid carbohydrates in the diet. C Take insulin at the same time every day. D Maintain glycosylated hemoglobin (HbA1c).

D Maintain glycosylated hemoglobin (HbA1c). Maintaining long-term control of blood glucose will help prevent the progression of diabetic nephropathy. Voiding when the client has the urge prevents the backflow of urine and infection. The diabetic diet is composed of carbohydrates, proteins, and fats. Although taking insulin at the same time each day may indirectly help control blood glucose, it is not the best option.

When caring for a client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which element does the nurse anticipate will be used? A Fresh-frozen plasma B Platelet infusions C 5% dextrose in water D Normal saline solution (NSS)

D Normal saline solution (NSS) Isotonic solutions and crystalloid solutions are administered for volume expansion; 0.9% sodium chloride (NSS) and 5% dextrose in 0.45% sodium chloride may be used. Clotting factors, contained in fresh-frozen plasma, are given for bleeding, not for volume expansion. Platelet infusions are administered for deficiency of platelets. A solution hypotonic to the client's blood, 5% dextrose, is administered for nutrition or hypernatremia, not for volume expansion.

A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the provider visited the client the day before. What action does the nurse take? A Asks the client to sign the informed consent B Cancels the procedure C Asks the client's spouse to sign the form D Notifies the department and the provider

D Notifies the department and the provider The client may be asked to sign the consent form in the department; notifying both the provider and the department ensures communication across the continuum of care, with less likelihood of omission of information. The provider gives the client a complete description of and reasons for the procedure and explains complications; the nurse reinforces this information. The procedure should not be cancelled without an attempt to correct the situation. The client has not received sedation, so nothing suggests that the client is not competent to consent.

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? A Encouraging them to drink fluids B Irrigating all catheters daily with sterile saline C Recommending that catheters be placed in all clients D Periodically re-evaluating the need for indwelling catheters

D Periodically re-evaluating the need for indwelling catheters Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTIs in the hospital setting. Encouraging fluids, although it is a valuable practice for clients with catheters, will not necessarily prevent the occurrence of UTIs in the hospital setting. In some clients, their conditions do not permit an increase in fluids, such as those with congestive heart failure and kidney failure. Irrigating catheters daily is contraindicated; any time a closed system is opened, bacteria may be introduced. Placing catheters in all clients is unnecessary and unrealistic. This practice would place more clients at risk for the development of UTI.

A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? A Maintaining bedrest B Medicating for pain C Monitoring for hematuria D Promoting fluid intake

D Promoting fluid intake The nurse should ensure adequate hydration by urging the client to take oral fluid or by giving IV fluids. Hydration reduces the risk for kidney damage. Bedrest is not indicated for the client who has undergone a CT scan with contrast dye. CT with contrast dye is not a painful procedure, so pain medication is not indicated. The client who has undergone CT with contrast dye is not at risk for hematuria.

When preparing a client for nephrostomy tube insertion, it is essential for the nurse to monitor which factor before the procedure? A Blood urea nitrogen (BUN) and creatinine B Hemoglobin and hematocrit (H&H) C Intake and output (I&O) D Prothrombin time (PT) and international normalized ratio (INR)

D Prothrombin time (PT) and international normalized ratio (INR) The procedure will be cancelled or delayed if coagulopathy in the form of prolonged PT/INR exists because dangerous bleeding may result. Nephrostomy tubes are placed to prevent and treat kidney damage; monitoring BUN and creatinine is important, but is not essential before this procedure. H&H is monitored to detect anemia and blood loss; this would not occur before the procedure. This client should be on I&O during the entire hospitalization; it is not necessary only before the procedure, but throughout the admission.

A client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? A Decreases bacterial count B Destroys white blood cells C Enhances the action of antibiotics D Provides comfort

D Provides comfort Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis. Antibiotics, not antiseptics, are used to decrease bacterial count and treat pyelonephritis infection; the action of antibiotics is not enhanced with antiseptics. White blood cells, along with antibiotics, fight infection.

A. A client who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? A Discharges the client to her home for strict bedrest for the duration of the pregnancy B Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria C Recommends that the client refrain from having sexual intercourse until after she has delivered her baby D Refers the client to the clinic nurse practitioner for immediate follow-up

D Refers the client to the clinic nurse practitioner for immediate follow-up Pregnant women with UTIs require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor with adverse effects for the fetus. It is unsafe for the client to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Having sexual intercourse (or not having it) is not related to the client's problem. The client's symptoms need follow-up with a health care provider.

A. The nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by the health care provider for a client with a urinary tract infection (UTI), does the nurse question? A Bactrim B Cipro C Noroxin D Tegretol

D Tegretol Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin (gatifloxacin) and Tegretol (carbamazepine). The former is used for UTI, and the latter is prescribed as an oral anticonvulsant. Bactrim (trimethoprim/sulfamethoxazole), Cipro (ciprofloxacin), and Noroxin (norfloxacin) are drugs used to treat UTI.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the home health aide (unlicensed assistive personnel [UAP])? A Assisting the client in developing a schedule for when to take prescribed antibiotics B Inserting a straight catheter as necessary if the client is unable to empty the bladder C Teaching the client how to use the Credé maneuver to empty the bladder more fully D Using a bladder scanner (with training) to check residual bladder volume after the client voids

D Using a bladder scanner (with training) to check residual bladder volume after the client voids Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill. Assisting the client in developing a schedule for when to take prescribed antibiotics, inserting a straight catheter, and teaching the client to use the Credé maneuver all require more education and are in the legal scope of practice of the LPN/LVN or RN.

One of the nurse's roles is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? A Children's terms that are easily understood B Slang words and terms that are heard "socially" C Technical and medical terminology D Words that the client uses.

D Words that the client uses. The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client. The use of children's terms is demeaning to adult clients. The use of slang terms is unprofessional. Technical terms should not be used because the client may not know what they mean.

The client's urinalysis shows all of the following abnormal results. Which result does the nurse report to the health care provider immediately? A. pH 7.8 B. Protein 31 mg C. Sodium 15 mEq/L D. Leukoesterase and nitrate positive

D. Leukoesterase and nitrate positive Although the alkaline pH is abnormal, it may be the results of diet or other benign factors; the slight increase in protein is concerning but not urgent and may be explained by diet, strenuous activity, or other benign causes, similar to the slightly elevated sodium, which could be from salty food ingestion. However, the most common cause of positive leukoesterase result is a UTI, and this test is further confirmed with a positive nitrate result.

A client in the community health clinic is prescribed trimethoprim/sulfamethoxazole for cystitis. She reports that she developed hives to "something called Septra." What is the nurse's best action? A. Reassure the client that Septra is not trimethoprim/sulfamethoxazole. B. Highlight this important information in the client's medical record. C. Place an allergy alert band on the client's wrist. D. Notify the prescriber immediately.

D. Notify the prescriber immediately. Septra is a brand name for TMP-SMX, a sulfa-based antibiotic with multiple brand names. It is inappropriate to band a wrist in a community health clinic. This information may need to be added to the client's medical record, but simply highlighting the information will not prevent an avoidable adverse drug event. The provider needs the allergy information in order to substitute another effective antibiotic.