Renal

When preparing the client who is undergoing urography with contrast, the nurse plans to administer which medication before the procedure? c/o flank pain, dysuria, bilat knee pain with BUN/Cr: 54/2.4 a. Acetylcysteine b. Metformin c. Captopril d. Acetaminophen

A. Acetylcysteine (an antioxidant) may be used to prevent contrast-induced nephrotoxic effects; this client has kidney impairment demonstrated by increased creatinine.

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. Administers morphine sulfate 4 mg IV B. Begins an infusion of metoclopramide (Reglan) 10 mg IV C. Obtains a urine specimen for urinalysis D. Starts an infusion of 0.9% normal saline at 100 mL/hr

A. Morphine administered IV will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? "Should we filter air circulation?" "Can we use less radiographic contrast dye?" "Should we add low-dose dobutamine?" "Should we decrease IV rates?"

"Can we use less radiographic contrast dye?" Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.

Which instruction does the nurse give the client who needs a clean catch urine specimen? A. Save all urine for 24 hours. B. I will collect the first specimen of the morning. C. Do not touch the inside of the container. D. You will receive an isotope injection, then I will collect your urine.

C. A clean catch specimen is used to obtain urine for culture and sensitivity of organisms present; contamination by the client's hands will alter the specimen and results.

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

C. The scanner must be in the scan mode for male clients to ensure the scanner subtracts the volume of the uterus from the measurement.

The nurse is teaching the 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. 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.

To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? Construction worker Office secretary Schoolteacher Taxicab driver

Construction worker Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place the construction worker at risk for dehydration and pre-renal azotemia. The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

The nurse has the following assignment. Which client should be encouraged 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. A major feature of hyperparathyroidism is hypercalcemia, which predisposes to kidney stones; this client should remain hydrated.

Which laboratory test result for a client who is about to have a nephrostomy for hydronephrosis does the nurse report immediately to the physician? A. Serum sodium 137 mEq/L B. Serum potassium 4.8 mEq/L C. Blood urea nitrogen (BUN) 23 mg/dL D. International normalized ratio (INR) 4.6

D. Although the sodium and BUN levels are slightly higher than normal, they are within the ranges expected with hydronephrosis. The INR, however, is seriously elevated and indicates a dangerously long clotting time with a greatly increased risk for bleeding. It must be corrected before surgery.

Which of these staff members should be assigned to a client who has benign prostatic hyperplasia and hydronephrosis and needs an indwelling catheter inserted? A. An RN float nurse who has 10 years of experience with pediatric clients B. An LPN/LVN who has worked in the hospital's kidney dialysis unit until recently C. An RN without recent experience who has just completed an RN refresher course D. An LPN/LVN with 5 years of experience in an outpatient urology surgery center

D. Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center.

A 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. Phenazopyridine (Pyridium) will turn the client's urine red or orange. Care should be taken because it will stain undergarments. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed.

A nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? A. "For the best effect, perform all 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. When the client can start and stop the urine stream, the pelvic muscles are being used.

Which factor represents a sign or symptom of digoxin toxicity? Serum digoxin level of 1.2 ng/mL Polyphagia Visual changes Serum potassium of 5.0 mEq/L

Visual changes, anorexia, nausea, and vomiting are symptoms of digoxin toxicity. A digoxin level of 1.2 ng/mL is normal (0.5 to 2.0 ng/mL). Polyphagia is a symptom of diabetes. Although hypokalemia may predispose to digoxin toxicity, this represents a normal, not low, potassium value.

A nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences of them. Which client statement shows 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." C. "Trying to get to the bathroom to urinate every 6 hours is important for me." D. "Urinating 1000 mL on a daily basis is a good amount for me."

A. 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.

Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? Diltiazem (Cardizem) Lisinopril (Zestril) Clonidine (Catapres) Doxazosin (Cardura)

ACE Angiotensin-converting enzyme inhibitors such as lisinopril appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers such as diltiazem may indirectly prevent kidney disease by controlling hypertension, but are not specific to slowing progression of kidney disease. Vasodilators such as clonidine and doxazosin control blood pressure, but do not specifically protect from kidney disease.

A client in the intensive care unit with acute kidney injury (AKI) must maintain a mean arterial pressure (MAP) of 65 mm Hg to promote kidney perfusion. What is the client's MAP if the blood pressure is 98/50 mm Hg? (Record your answer using a whole number.) _____ mm Hg

ANS: 66 mm Hg MAP= 98+(2x50)/3=66

A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse? a. Place the client on a cardiac monitor immediately. b. Teach the client to limit high-potassium foods. c. Continue to monitor the client's intake and output. d. Ask to have the laboratory redraw the blood specimen.

ANS: A The priority action by the nurse should be to check the cardiac status with a monitor. High potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.

A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best? a. Check the client's digoxin (Lanoxin) level. b. Administer an anti-nausea medication. c. Ask if the client is able to eat crackers. d. Get a referral to a gastrointestinal provider.

ANS: A These signs and symptoms are indications of digoxin (Lanoxin) toxicity. The nurse should check the level of this medication. Administering antiemetics, asking if the client can eat, and obtaining a referral to a specialist all address the client's symptoms but do not lead to the cause of the symptoms.

The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.) a. Man with prostate cancer b. Woman with blood clots in the urinary tract c. Client with ureterolithiasis d. Firefighter with severe burns e. Young woman with lupus

ANS: A, B, C Urine flow obstruction, such as prostate cancer, blood clots in the urinary tract, and kidney stones (ureterolithiasis), causes post-renal AKI. Severe burns would be a pre-renal cause. Lupus would be an intrarenal cause for AKI.

. A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client's spouse about the kidney-specific formulation for the enteral solution compared to standard formulas. What components should be discussed in the teaching plan? (Select all that apply.) a. Lower sodium b. Higher calcium c. Lower potassium d. Higher phosphorus e. Higher calories

ANS: A, C, E Many clients with AKI are too ill to meet caloric goals and require tube feedings with kidney-specific formulas that are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formulas.

A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse? a. Warm the dialysate solution in a microwave before instillation. b. Take a sample of the effluent and send to the laboratory. c. Flush the tubing with normal saline to maintain patency of the catheter. d. Check the peritoneal catheter for kinking and curling.

ANS: B An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse. Checking the catheter for obstruction is a viable option but will not treat the peritonitis.

The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse? a. "My sodium level changes by movement from the blood into the dialysate." b. "Dialysis works by movement of wastes from lower to higher concentration." c. "Extra fluid can be pulled from the blood by osmosis." d. "The dialysate is similar to blood but without any toxins."

ANS: B Dialysis works using the passive transfer of toxins by diffusion. Diffusion is the movement of molecules from an area of higher concentration to an area of lower concentration. The other statements show a correct understanding about hemodialysis.

A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema? a. Maintaining oxygen saturation of 89% b. Minimal crackles and wheezes in lung sounds c. Maintaining a balanced intake and output d. Limited shortness of breath upon exertion

ANS: C With an optimal fluid balance, the client will be more able to eject blood from the left ventricle without increased pressure in the left ventricle and pulmonary vessels. Other ideal goals are oxygen saturations greater than 92%, no auscultated crackles or wheezes, and no demonstrated shortness of breath.

A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse's priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the client's pulse. d. Slow down the normal saline infusion.

ANS: D The nurse should assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter would evaluate the client's hemodynamic status, but this should not be the initial action by the nurse. Vital signs are also important after adjusting the intravenous infusion.

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? Abrupt decrease in urine output Blood-tinged urine Incisional pain Increase in urine output

An abrupt decrease in urine output may indicate complications such as rejection, acute kidney injury, thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output are expected findings after kidney transplantation

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? Increased blood urea nitrogen (BUN) Increased creatinine level Pale-colored urine Decreased sodium level

An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.

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

Answer: A Rationale: 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

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

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

Answer: B Rationale: 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 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."

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

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?"

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

The nurse in the urology clinic is providing teaching for a female client with cystitis. Which of these should be included 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 your urine remains cloudy, call the clinic. E. Expect some flank discomfort until the antibiotic has worked.

B,C,D: 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.

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

B. Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client may be oversedated and may not be aware of any discomfort caused by bladder distention.

When assessing the older adult, the nurse teaches the older adult that which age-related change causes nocturia? A. Decreased ability to concentrate urine B. Decreased production of antidiuretic hormone C. Increased production of erythropoietin D. Increased secretion of aldosterone

A. Nocturia may result from decreased kidney-concentrating ability associated with aging.

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? "Your diseased kidneys will be removed at the same time the transplant is performed." "The new kidney will be placed directly below one of your old kidneys." "It is essential for you to wash your hands and avoid people who are ill. "You will receive dialysis the day before surgery and for about a week after."

"It is essential for you to wash your hands and avoid people who are ill. Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential. Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery; after the surgery, the new kidney should begin to make urine.

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? "I can stop my medications when my kidney function returns to normal." "If my urine output is decreased, I should increase my fluids." "The anti-rejection medications will be taken for life." "I will drink 8 ounces of water with my medications."

"The anti-rejection medications will be taken for life." Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately if this occurs. It is not necessary to take anti-rejection medication with 8 ounces of water.

When assessing a client with pyelonephritis, the nurse recognizes that which of these conditions may predispose the client to the problem? A. Spinal cord injury B. Cardiomyopathy C. Hepatic failure D.Glomerulonephritis

A. Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones.

A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. What information does a nurse provide about taking her prescribed Bactrim? *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,B,C,E: Wearing sunscreen and protective clothing is important to do while on this drug. 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-as is stated here. The client should be advised to urinate every 3 to 4 hours or More often if he or she feels the urge

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

A,B,D: The client with a cystectomy and a Kock pouch, and a urinary incontinence would benefit from community resources and support groups. Others who have had their bladders removed are good sources for information and for help in establishing coping mechanisms.

The client is scheduled for intravenous urography. During the assessment, the nurse notes a previous reaction of urticaria, itching, and sneezing to contrast dye. Which precautions does the nurse take? Select all that apply. A. Ensures that an antihistamine and a steroid are prescribed B. Documents the reaction on the chart C. Uses no contrast dye for the procedure D. Cancels the procedure E. Ensures that the health care provider is aware of the reaction

A,B,E: Suppression of immune and allergic responses should be undertaken. Allergies and suspected allergies must be documented in the medical record. The nurse must notify the provider of the previous response and obtain requests for antihistamine and corticosteroid. Contrast will give a more clear picture; if the provider believes it is necessary, suppression of the immune response is an acceptable intervention. The scope of practice for professional nursing does not include prescribing or canceling procedures.

Which client with an indwelling urinary catheter does a nurse re-assess 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 step-down unit C. Comatose client with careful monitoring I/Os D. Incontinent client with perineal skin breakdown E. Incontinent long-term care older adult

A,B,E: Three days after surgery, the client probably should be able to urinate on his or her own. If the surgery was a bladder or urethral repair, then discontinuing the catheter might not be a consideration so soon. However, 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 who is out of an intensive care situation is definitely one who should be considered for discontinuation of his or her catheter. He or she should be somewhat ambulatory and able to get to a bedside commode.The comatose client who is on strict I&O needs to have a urinary catheter in place to keep accurate account of his or her fluid balance.

A 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,C,D, E: Dysuria, Frequency, Nocturia and urgency are symptoms of a UTI. Enuresis-bed-wetting and polyuria-are not signs of a UTI.

The 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. By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control.

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

A. Increased blood urea nitrogen (BUN) can indicate dehydration.

A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. She is started on antibiotics and sent home. She returns to the clinic 3 days later-with the same symptoms. When asked about the previous UTI and medication regimen, she 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 the drug regimen can lead to recurrence of an infection and to bacterial drug resistance.

Which statement made by the client who is receiving intravesicular instillations of BCG for bladder cancer indicates to the nurse that more teaching is needed? A. "Holding my urine for at least 8 hours after the treatment keeps the drug in contact with my bladder." B. "Drinking plenty of fluids during the evening after the treatment helps get the drug out of my system." C. "Sitting to urinate for 24 hours after treatment prevents exposure of other people to the drug." D. "Avoiding intercourse for 24 hours after treatment reduces my wife's exposure to the drug."

A. Retaining urine for that long distends the bladder and increases the risk that the BCG will be absorbed systemically. In addition, the discomfort may cause the client to urinate rapidly, leading to more splashing and potentially exposing others to the BCG.

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

A. The drug can cause severe hypotension during and after the procedure. Warn him or her to avoid rapid position changes and of the risk for falling as a result of orthostatic (positional) hypotension.

Which assessments are most important for the nurse to perform when monitoring a client after a retrograde cystogram? A. Temperature and urine character B. Kidney tenderness and flank pain C. 24-hour urine volume, BUN and creatinine levels D. Angioedema and other indicators of systemic allergic response

A. The retrograde cystogram involves instilling a contrast dye directly into the bladder through the urethra. Infection is the primary concern from instruments entering the bladder. The dye does not enter the bloodstream, and systemic allergic responses do not occur. The kidneys are not involved in this imaging.

The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed? a. "I am thrilled that I can continue to eat fast food." b. "I will cut out bacon with my eggs every morning." c. "My cooking style will change by not adding salt." d. "I will probably lose weight by cutting out potato chips."

ANS: A Fast food restaurants usually serve food that is high in sodium. This statement indicates that more teaching needs to occur. The other statements show a correct understanding of the teaching.

12. A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best? a. Obtain daily weights of the client. b. Auscultate heart and breath sounds. c. Palpate the client's abdomen. d. Assess the client's diet history.

ANS: A Furosemide (Lasix) is a loop diuretic that helps reduce fluid overload and hypertension in clients with early stages of CKD. One kilogram of weight equals about 1 liter of fluid retained in the client, so daily weights are necessary to monitor the response of the client to the medication. Heart and breath sounds should be assessed if there is fluid retention, as in heart failure. Palpation of the client's abdomen is not necessary, but the nurse should check for edema. The diet history of the client would be helpful to assess electrolyte replacement since potassium is lost with this diuretic, but this does not assess the effect of the medication.

A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH). Which finding is the cause of immediate action by the nurse? a. Blood pressure of 76/58 mm Hg b. Sodium level of 138 mEq/L c. Potassium level of 5.5 mEq/L d. Pulse rate of 90 beats/min

ANS: A Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to maintain blood pressure. The specially trained nurse needs to monitor for ongoing fluid and electrolyte replacement. The sodium level is normal and the potassium level is slightly elevated, which could be normal findings for someone with acute kidney injury. A pulse rate of 90 beats/min is normal.

A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern? a. Albumin level of 2.5 g/dL b. Phosphorus level of 5 mg/dL c. Sodium level of 135 mmol/L d. Potassium level of 5.5 mmol/L

ANS: A Protein restriction is necessary with chronic renal failure due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the client's metabolic needs. The electrolyte values are not related to the protein-restricted diet.

. A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse? a. Discuss what the treatment regimen means to him. b. Refer the client to a mental health nurse practitioner. c. Reschedule the appointments to another date and time. d. Discuss the option of peritoneal dialysis.

ANS: A The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options, assessment of the client's acceptance of the treatment should come first.

3. A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this client's history? a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?" b. "Do you have anyone in your family with renal failure?" c. "Have you had a diet that is low in protein recently?" d. "Has a relative had a kidney transplant lately?"

ANS: A There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the client since both the serum creatinine and BUN are elevated, indicating some renal problems. A family history of renal failure and kidney transplantation would not be part of the questioning and could cause anxiety in the client. A diet high in protein could be a factor in an increased BUN.

A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority? a. Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c. Teach the client to drink 2 to 3 liters of water daily. d. Perform an electrocardiogram.

ANS: A This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the client to drink 2 to 3 liters of water each day. An intravenous line may be ordered later, after the client's degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

A client is undergoing hemodialysis. The client's blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (Select all that apply.) a. Adjust the rate of extracorporeal blood flow. b. Place the client in the Trendelenburg position. c. Stop the hemodialysis treatment. d. Administer a 250-mL bolus of normal saline. e. Contact the health care provider for orders.

ANS: A, B, D Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Modest decreases in blood pressure, as is the case with this client, can be maintained with rate adjustment, Trendelenburg positioning, and a fluid bolus. If the blood pressure drops considerably after two boluses and cooling dialysate, the hemodialysis can be stopped and the health care provider contacted.

A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are accurate regarding PD? (Select all that apply.) a. "You will not need vascular access to perform PD." b. "There is less restriction of protein and fluids." c. "You will have no risk for infection with PD." d. "You have flexible scheduling for the exchanges." e. "It takes less time than hemodialysis treatments."

ANS: A, B, D PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is no need for vascular access. Protein is lost in the exchange, which allows for more protein and fluid in the diet. There is flexibility in the time for exchanges, but the treatment takes a longer period of time compared to hemodialysis. There still is risk for infection with PD, especially peritonitis.

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.) a. Urine output of 100 mL in 4 hours b. Urine output of 500 mL in 12 hours c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg

ANS: A, C, E The low urine output, sediment, and blood pressure should be reported to the provider. Postoperatively, the nurse should measure intake and output, check the characteristics of the urine, and report sediment, hematuria, and urine output of less than 0.5 mL/kg/hour for 3 to 4 hours. A urine output of 100 mL is low, but a urine output of 500 mL in 12 hours should be within normal limits. Perfusion to the kidneys is compromised with low blood pressure. The amber odorless urine is normal.

A client is recovering from a kidney transplant. The client's urine output was 1500 mL over the last 12-hour period since transplantation. What is the priority assessment by the nurse? a. Checking skin turgor b. Taking blood pressure c. Assessing lung sounds d. Weighing the client

ANS: B By taking blood pressure, the nurse is assessing for hypotension that could compromise perfusion to the new kidney. The nurse then should notify the provider immediately. Skin turgor, lung sounds, and weight could give information about the fluid status of the client, but they are not the priority assessment.

The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding? a. Woman with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c. Man with skin itching from head to toe d. Client with halitosis and stomatitis

ANS: B Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs. Hypertension is common in most clients with CKD, and skin itching increases with calcium-phosphate imbalances, another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis

The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the client's recent history? a. Pyelonephritis b. Myocardial infarction c. Bladder cancer d. Kidney stones

ANS: B Pre-renal causes of AKI are related to a decrease in perfusion, such as with a myocardial infarction. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are post-renal causes of AKI related to urine flow obstruction.

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this client's care? a. Edema and pain b. Electrolyte and fluid imbalance c. Cardiac and respiratory status d. Mental health status

ANS: B This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance is essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client's cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.) a. "I can continue to take antacids to relieve heartburn." b. "I need to ask for an antibiotic when scheduling a dental appointment." c. "I'll need to check my blood sugar often to prevent hypoglycemia." d. "The dose of my pain medication may have to be adjusted." e. "I should watch for bleeding when taking my anticoagulants."

ANS: B, C, D, E In discharge teaching, the nurse must emphasize that the client needs to have an antibiotic prophylactically before dental procedures to prevent infection. There may be a need for dose reduction in medications if the kidney is not excreting them properly (antacids with magnesium, antibiotics, antidiabetic drugs, insulin, opioids, and anticoagulants).

The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (Select all that apply.) a. "I need to decrease sodium, cholesterol, and protein in my diet." b. "My weight should be maintained at a body mass index of 30." c. "Smoking should be stopped as soon as I possibly can." d. "I can continue to take an aspirin every 4 to 8 hours for my pain." e. "I really only need to drink a couple of glasses of water each day."

ANS: B, D, E Weight should be maintained at a body mass index (BMI) of 22 to 25. A BMI of 30 indicates obesity. The use of nonsteroidal anti-inflammatory drugs such as aspirin should be limited to the lowest time at the lowest dose due to interference with kidney blood flow. The client should drink at least 2 liters of water daily. Diet adjustments should be made by restricting sodium, cholesterol, and protein. Smoking causes constriction of blood vessels and decreases kidney perfusion, so the client should stop smoking.

The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8° F (37.6° C). What is the most appropriate action by the nurse? a. Administer fluid to increase blood pressure. b. Check the white blood cell count. c. Monitor the client's temperature. d. Connect the client to an electrocardiographic (ECG) monitor.

ANS: C During hemodialysis, the dialysate is warmed to increase diffusion and prevent hypothermia. The client's temperature could reflect the temperature of the dialysate. There is no indication to check the white blood cell count or connect the client to an ECG monitor. The other vital signs are within normal limits.

The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching? a. "I should leave the drainage bag above the level of my abdomen." b. "I could flush the tubing with normal saline if the flow stops." c. "I should take a stool softener every morning to avoid constipation." d. "My diet should have low fiber in it to prevent any irritation."

ANS: C Inflow and outflow problems of the dialysate are best controlled by preventing constipation. A daily stool softener is the best option for the client. The drainage bag should be below the level of the abdomen. Flushing the tubing will not help with the flow. A diet high in fiber will also help with a constipation problem.

A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time? a. Decreased calcium levels b. Increased phosphorus levels c. No adventitious sounds in the lungs d. Increased edema in the legs

ANS: C The absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the client's body. Decreased calcium levels and increased phosphorus levels are common findings with CKD. Edema would indicate a fluid imbalance.

The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub? a. Registered nurse who just floated from the surgical unit b. Registered nurse who just floated from the dialysis unit c. Registered nurse who was assigned the same client yesterday d. Licensed practical nurse with 5 years' experience on this floor

ANS: C The client is exhibiting symptoms of pericarditis, which can occur with chronic kidney disease. Continuity of care is important to assess subtle differences in clients. Therefore, the registered nurse (RN) who was assigned to this client previously should again give care to this client. The float nurses would not be as knowledgeable about the unit and its clients. The licensed practical nurse may not have the education level of the RN to assess for pericarditis.

A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L Potassium 5 mEq/L Blood urea nitrogen (BUN) 44 mg/dL Serum creatinine 2.5 mg/dL What initial intervention would the nurse anticipate? a. Start hemodialysis immediately. b. Discuss the need for peritoneal dialysis. c. Increase the dose of immunosuppression. d. Return the client to surgery for exploration.

ANS: C The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute rejection of the transplanted kidney. The client does not need hemodialysis, peritoneal dialysis, or further surgery at this point.

The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? a. Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c. Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left arm

ANS: C The nurse should not use the arm with the AV fistula for intravenous infusion, blood pressure readings, or venipuncture. Compression and infection can result in the loss of the AV fistula. The AV fistula should be monitored by auscultating or palpating the access site. Checking the distal pulse would be an appropriate assessment.

A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)? a. Antibiotic b. Histamine blocker c. Bronchodilator d. Angiotensin-converting enzyme (ACE) inhibitor

ANS: D ACE inhibitors stop the conversion of angiotensin I to the vasoconstrictor angiotensin II. This category of medication also blocks bradykinin and prostaglandin, increases renin, and decreases aldosterone, which promotes vasodilation and perfusion to the kidney. Antibiotics fight infection, histamine blockers decrease inflammation, and bronchodilators increase the size of the bronchi; none of these medications helps slow the progression of CKD in clients with hypertension.

23. A nurse is caring for a client who is scheduled for a dose of cefazolin and vitamins at this time. Hemodialysis for this client is also scheduled in 60 minutes. Which action by the nurse is best? a. Administer cefazolin since the level of the antibiotic must be maintained. b. Hold the vitamins but administer the cefazolin. c. Hold the cefazolin but administer the vitamins. d. Hold all medications since both cefazolin and vitamins are dialyzable.

ANS: D Both the cefazolin and the vitamins should be held until after the hemodialysis is completed because they would otherwise be removed by the dialysis process.

A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the client's nose and around the intravenous catheter. What action by the nurse is the priority? a. Hold pressure over the client's nose for 10 minutes. b. Take the client's pulse, blood pressure, and temperature. c. Assess for a bruit or thrill over the arteriovenous fistula. d. Prepare protamine sulfate for administration.

ANS: D Heparin is used with hemodialysis treatments. The bleeding alerts the nurse that too much anticoagulant is in the client's system and protamine sulfate should be administered. Pressure, taking vital signs, and assessing for a bruit or thrill are not as important as medication administration.

A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse? a. Use the catheter for the next laboratory blood draw. b. Monitor the central venous pressure through this line. c. Access the line for the next intravenous medication. d. Place a heparin or heparin/saline dwell after hemodialysis.

ANS: D The central line should have a heparin or heparin/saline dwell after hemodialysis treatment. The central line catheter used for dialysis should not be used for blood sampling, monitoring central venous pressures, or giving drugs or fluids.

A client with chronic kidney disease states, "I feel chained to the hemodialysis machine." What is the nurse's best response to the client's statement? a. "That feeling will gradually go away as you get used to the treatment." b. "You probably need to see a psychiatrist to see if you are depressed." c. "Do you need help from social services to discuss financial aid?" d. "Tell me more about your feelings regarding hemodialysis treatment."

ANS: D The nurse needs to explore the client's feelings in order to help the client cope and enter a phase of acceptance or resignation. It is common for clients to be discouraged because of the dependency of the treatment, especially during the first year. Referrals to a mental health provider or social services are possibilities, but only after exploring the client's feelings first. Telling the client his or her feelings will go away is dismissive of the client's concerns.

A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? "I'll talk to the health care provider and have your name removed from the waiting list." "You sound frustrated with the situation." "You're right, the wait is endless for some people." "I'm sure you'll get a phone call soon that a kidney is available."

Acknowledging the client's frustration reflects the feelings the client is having and offers assistance and support. Talking to the health care provider and removing the client from the waiting list does not allow the nurse to hear more and perhaps offer therapeutic listening or a solution to the problem. Telling the client that the wait is endless for some people cuts the client off from sharing his or her concerns and accentuates the negative aspects of the situation. The waiting time for kidney matches is increasing due to a shortage of organs; the nurse should not offer false hope by suggesting that the client will get a phone call soon.

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.

Answer: A Rationale: 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 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.

Answer: B Rationale: 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 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."

Answer: C Rationale: 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.

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.

Answer: C Rationale: 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.

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

Answer: C Rationale: 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.

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

Answer: C Rationale: 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.

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

Answer: D Rationale: 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.

Answer: D Rationale: 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.

A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? "All of this is new. What can't you do?" "Are you afraid of dying?" "How are you doing this morning?" "What concerns do you have about your kidney disease?"

Asking the client about any concerns is open-ended and specific to the client's concerns. Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) Check brachial pulses daily. Auscultate for a bruit every 8 hours. Teach the client to palpate for a thrill over the site. Elevate the arm above heart level. Ensure that no blood pressures are taken in that arm.

Auscultate for a bruit every 8 hours. Correct Teach the client to palpate for a thrill over the site. Correct Ensure that no blood pressures are taken in that arm. Correct A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? Auscultate for pericardial friction rub. Assess for crackles. Monitor for decreased peripheral pulses. Determine if the client is able to ambulate.

Auscultate for pericardial friction rub. The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? Consuming a low-calcium diet Avoiding peas, nuts, and legumes Drinking cola beverages only once daily Increasing dairy products enriched with vitamin D

Avoiding peas, nuts, and legumes Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Calcium should not be restricted; hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

When assessing the client with pyelonephritis, which finding does the nurse anticipate will be present? Select all that apply. A. Suprapubic pain B. Vomiting C. Chills D. Dysuria E. Oliguria

B,C,D: Burning (dysuria), urgency, and frequency, Chills along with fever, Nausea and vomiting are symptoms of pyelonephritis. Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

Pt is diagnosed with stress incontinence and 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. Administer the drug at bedtime. B. Encourage increased fluids. C. Increase fiber. D. Limit the intake of dairy products. E. Offer hard candy for "dry" mouth.

B,C,E. Anticholinergics cause dry mouth and constipation. Increasing fluids and fiber will help.

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,C,F: Certain chemicals are known to be carcinogenic in evaluating the risk for bladder cancer. Bathing after exposure and Protective gear is advisable.Tobacco use is one of the highest if not the highest risk factor in the development of bladder cancer.

The health care provider prescribes the drug, estrogen (Premarin). Which risks does the nurse tell the client to expect? Select all that apply. A. Dry mouth B. Endometrial cancer C. Increased intraocular pressure D. Thrombophlebitis E. Vaginitis

B,D: Estrogen use can increase the risk for endometrial cancer and the risk for thrombophlebitis. Women who smoke-especially-should not use this drug.

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

B. A decreased presence of white blood cells indicates the eradication of infection.

A 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. Catheters are cleaned and re-used. Proper handwashing and cleaning of the catheter have shown no increase in bacterial complications. Catheters are replaced when they show signs of deteriorating.

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. Causes of hydronephrosis or hydroureter include tumors, stones, trauma, structural defects, and fibrosis.

What should the nurse teach the client who is undergoing a study using contrast media? A. "You will need to have anesthesia or sedation." B. "A feeling of heat or warmth occurs when the contrast is injected." C. "Expect your urine to have a pink or red tinge after the procedure." D. "You will not be able to eat or drink for 4 to 6 hours after the procedure."

B. Contrast medium causes a sensation of flushing, heat, or warmth as it circulates through the bloodstream.

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

B. Kidney ultrasounds are noninvasive procedures without complications; the LPN/LVN can provide this care.

The RN is caring for a client who has just had a kidney biopsy. Which of these actions should the nurse perform first? A. Obtain BUN and creatinine. B. Position the client supine. C. Administer pain medications. D. Check urine for hematuria.

B. The client is positioned supine for several hours after a kidney biopsy to decrease the risk for hemorrhage.

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instructions 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. The toilet should not be shared for 24 hours following the procedure because others using the toilet could be infected with the live virus that was instilled into the client. If the toilet must be shared, then specific cleaning precautions need to be taken each time the client uses the toilet. The best scenario is for the client not to share the toilet.

While assessing a client with overactive bladder, the nurse discovers the client also has the following health problems. Which health problem could be made worse by the drug tolterodine (Detrol)? A. Asthma B. Glaucoma C. Hypotension D. Diabetes mellitus

B. Tolterodine is an anticholinergic drug that can raise intraocular pressure and make some types of glaucoma worse. It is absolutely contraindicated for clients with uncontrolled narrow- or closed-angle glaucoma. It can be used with caution for clients who are being treated for open-angle glaucoma if the disease is well controlled.

A 67-year-old client who had an abdominal x-ray as part of pre-admission testing for a gastrointestinal problem has just been told that he has a horseshoe-shaped kidney. He is very upset, telling the nurse that he has never had any health problems until the past month and now feels that he is "falling apart." What is the nurse's best response? A. Remind him that it was lucky that he was being x-rayed anyway and that the problem was found at an early stage. B. Reassure him that it is unlikely that the kidney shape is important since he has not had other kidney problems. C. Ask him whether anyone else in his family has ever been diagnosed with a horseshoe-shaped kidney. D. Reassure him that his health care provider will request a consultation with a kidney specialist.

B. Variations in the number and shape of the kidneys are relatively common. Most variations are not harmful and do not require further assessment. The fact that this client is 67 years old and has had few health problems is a good indication that this is just an incidental finding on x-ray and has no meaning for his kidney health.

Which percussion technique does the nurse use to assess the client with reports of flank pain? A. Places fingers outstretched over the flank area and percusses with fingertips B. Places one hand with palm down flat over the flank area and uses the other fisted hand to thump the hand on the flank C. Places one hand with the palm up over the flank area and cups the other hand to percuss the hand on the flank D. Quickly taps the flank area with cupped hands

B. While the client assumes a sitting, side-lying, or supine position, form one of the hands into a clenched fist. Place the other hand flat over the costovertebral (CVA) angle of the client. Then, quickly deliver a firm thump to the hand over the CVA area.

Which statement made by a client who has acute pyelonephritis indicates to the nurse correct understanding of the antibiotic therapy? A. "If my temperature is normal for 3 days in a row, the infection is gone and I can stop taking the drug." B. "If my temperature goes above 100° for 2 days, I should take double the dose of the drug." C. "Even if I feel completely well, I should take the drug exactly as prescribed until it is gone." D. "I should notify my prescriber to change the medication if I develop diarrhea while taking this drug."

C. Antibiotic therapy is most effective when taken for the entire course and not just when symptoms are present. Most antibiotic therapy results in some degree of diarrhea. Although additional drugs may be needed to control this side effect, it is usually unnecessary to stop the drug.

When reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomography (CT) angiography with contrast, it is essential for the nurse to perform which intervention? A. Obtain a thyroid-stimulating hormone (TSH) level. B. Report the blood urea nitrogen (BUN) and creatinine. C. Hold the metformin 24 hours before and on the day of the procedure. D. Notify provider regarding blood glucose and hemoglobin A1c values.

C. Before studies with contrast media are performed, the nurse must withhold metformin, which may cause lactic acidosis.

A 53-year-old postmenopausal woman is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her? 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. Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance.

The client prescribed cephalexin (Keflex) for cystitis reports that she has had a severe allergic reaction to penicillin in the past. What is the nurse's best action? A. Reassure the client that Keflex is not penicillin. B. Place an allergy alert band on the client's wrist. C. Notify the prescriber before administering the first Keflex dose. D. Highlight this important information in the client's medical record.

C. Cephalexin is a cephalosporin and has a chemical structure very similar to the structure of penicillin. Often a person who is allergic to penicillin is also allergic to cephalosporins. Even if the prescriber wishes to proceed with cephalosporin therapy, he or she may first prescribe premedication to reduce the risk for an allergic response

A 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. Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis.

Which of the following would alarm the nurse immediately after return of the client from the operating room for cystoscopy performed under conscious sedation? A. Pink-tinged urine B. Urinary frequency C. Temperature of 100.8 D. Client lethargic

C. Fever, chills, or an elevated white blood cell (WBC) count suggests infection after an invasive procedure; notify the provider.

When a diabetic client returns to the medical unit after IV urography, all of these interventions are prescribed. Which action will the nurse take first? A. Give lisper (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 (Capote).

C. Fluids are needed because the dye has an osmotic effect, causing dehydration and potential kidney failure.

A 32-year-old female with a urinary tract infection 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 nurse expect the health care provider to prescribe? A. Nitrofurantoin after intercourse B. Premarin C. Trimethoprim/sulfamethoxazole D. Trimethoprim with intercourse

C. Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole or fosfomycin is effective in treating uncomplicated, community-acquired UTI in women.

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

C. 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.

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. Keep urine collection bags 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.

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

C. Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue.

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

C. Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence

The client is in the emergency department (ED) 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. Provide privacy, assistance, and voiding stimulants, such as warm water over the perineum, as needed, for the client with urinary problems.

The certified wound, ostomy, continence nurse (CWOCN) or enterostomal therapist (ET) 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. The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms.

A client's urinalysis shows all of the following results. Which result does the nurse report to the health care provider? A. pH 5.8 B. Osmolarity 450 C. Nitrites present D. Sodium 5 mEq/L

C. The osmolarity, pH, and sodium concentration are within normal ranges. Nitrites are not usually present in urine. Many types of bacteria, when present in the urine, convert nitrates (normally found in urine) into nitrites. A positive finding indicates a urinary tract infection.

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. An RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma B. An RN who is caring for a client who just returned after having renal artery balloon angioplasty C. An RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy D. An RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

C. This RN is caring for the most stable client and will have time to do the frequent monitoring and interventions that are needed for the newly admitted client.

A nurse is educating a female 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 your front to your back." D. "Wipe with the softest toilet paper available."

C. Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection.

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

C. With back pressure on the kidney, glomerular filtration is reduced or absent resulting in permanent kidney damage; BUN and creatinine are kidney function tests.

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? Client with chronic kidney failure who was just admitted with shortness of breath Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted Client with azotemia whose blood urea nitrogen and creatinine are increasing Client receiving peritoneal dialysis who needs help changing the dialysate bag

Client with chronic kidney failure who was just admitted with shortness of breath The dyspnea of the client with chronic kidney failure may indicate pulmonary edema and should be assessed immediately. The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions, but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? Avoiding venipuncture and blood pressure measurements in the affected arm Modifications to allow for complete rest of the affected arm How to assess for a bruit in the affected arm How to practice proper nutrition

Compression of vascular access causes decreased blood flow and may cause occlusion; if this occurs, dialysis will not be possible. The arm should be exercised to encourage venous dilation, not rested. The client can palpate for a thrill; a stethoscope is not needed to auscultate the bruit at home. The nurse should take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the graft or fistula by compression or occlusion must take priority because lifesaving dialysis cannot be performed.

A client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse? _________

Correct Responses 167 drops/min 20 gtt × 500 mL = 10,000/60 min = 167 drops/min

Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL Crackles in the lung fields Temperature of 98.8° F (37.1° C) Blood pressure of 164/98 mm Hg 3+ edema of the lower extremities

Crackles in the lung fields Correct Blood pressure of 164/98 mm Hg Correct 3+ edema of the lower extremities Correct Signs and symptoms of fluid retention (e.g., crackles in the lung fields and 3+ edema of the lower extremities) indicate transplant rejection. Increased blood pressure is also a symptom of transplant rejection. Increasing BUN and creatinine are symptoms of rejection; a BUN of 21 mg/dL and a creatinine of 0.9 mg/dL reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

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; 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. Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.

When planning an assessment of the urethra, what does the nurse do first? A. Examines the meatus B. Notes any unusual discharge C. Records the presence of abnormalities D. Dons gloves

D. Before examination begins, body fluid precautions (gloves) must be donned first.

What does the nurse teach the client to prevent 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. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs.

A nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by a 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. Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin and Tegretol. The former is used for UTI, and the latter is prescribed as an oral anticonvulsant.

The client had IV urography 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. Ensure adequate hydration by urging the client to take oral fluid or by giving IV fluids. Hydration reduces the risk for kidney damage.

A nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates 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. 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.

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

D. Insertion of catheters is within the education and legal scope of practice for LPNs/LVNs.

For which client living at home is intermittent self-catheterization an inappropriate method for incontinence management? A. 36-year-old woman who is blind B. 46-year-old man who has paraplegia C. 56-year-old woman who has diabetes D. 66-year-old man who has severe osteoarthritis

D. Intermittent self-catheterization requires significant manual dexterity to reach the area and perform the catheterization without contaminating the catheter. A person with severe osteoarthritis is not likely to be able to perform this technique safely. The technique does not require vision or the use of the lower extremities. A person with diabetes would be at increased risk for infection and would need to understand how to avoid contamination.

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 (CNP) for immediate follow-up

D. Pregnant women with UTI 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.

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 catheters should be placed in all clients D. Re-evaluating periodically the need for indwelling catheters

D. Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTI in the hospital setting.

The 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. 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.

A nurse 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. 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 client with diabetes who also has persistent proteinuria asks what he could do to prevent eventual kidney failure. What is the nurse's best response? A. "Wear pads and other protective gear around your lower back when engaging in contact sports." B. "Drink at least 3 L of water daily and avoid carbonated beverages." C. "Limit your intake of proteins to less than 100 g daily." D. "Keep your blood glucose levels in the target range."

D. The presence of persistent proteinuria indicates kidney damage has already occurred and is likely to eventually progress to kidney failure. Although kidney failure cannot be prevented, the decline in kidney function can be slowed with tight glycemic control. The severity of diabetic kidney disease is related to the degree of hyperglycemia the client generally experiences. With poor control of hyperglycemia, the complicating problems of atherosclerosis, hypertension, and neuropathy (which promote loss of bladder tone, urinary stasis, and urinary tract infection) are more severe and more likely to cause additional kidney damage sooner.

Which technique does the nurse use to obtain a sterile urine specimen from the client with a Foley catheter? A. Disconnects the Foley catheter from the drainage tube and collects urine directly from the Foley B. Removes the existing catheter and obtains a sample during the process of inserting a new Foley C. Uses a sterile syringe to withdraw urine from the urine collection bag D. Clamps the tubing, attaches a syringe to the specimen, and withdraws at least 5 mL of urine

D. This is the correct technique for obtaining a sterile urine specimen from the client with a Foley catheter.

An older adult woman confides to a 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. This response acknowledges the client's concerns and attempts to help the client think of methods to solve her problem.

The 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. Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection (UTI). Which nursing action can the home health RN delegate to a home health aide? 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. 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.

A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? Blood pressure of 118/78 mm Hg Weight loss of 3 pounds during hospitalization Dyspnea and anxiety at rest Central venous pressure (CVP) of 6 mm Hg

Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse should assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? Eggs Ham Eggplant Macaroni

EGGs Suggested protein-containing foods for a client on peritoneal dialysis are milk, meat, and eggs. Although a protein, ham is high in sodium, which should be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) Football player in preseason practice Client who underwent contrast dye radiology Accident victim recovering from a severe hemorrhage Accountant with diabetes Client in the intensive care unit on high doses of antibiotics Client recovering from gastrointestinal influenza

Football player in preseason practice Correct Client who underwent contrast dye radiology Correct Accident victim recovering from a severe hemorrhage Correct Client in the intensive care unit on high doses of antibiotics Correct Client recovering from gastrointestinal influenza Correct To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure.

The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? Nonsteroidal anti-inflammatory drugs (NSAIDs) Angiotensin-converting enzyme (ACE) inhibitors Opiates Calcium channel blockers

NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.

When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? Mild discomfort at the insertion site Temperature 100.8° F 1+ ankle edema Anorexia

Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed. Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? Hematocrit of 26.7% Potassium within normal range Absence of spontaneous fractures Less fatigue

Less fatigue Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia.

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) Obtain the client's pre-hemodialysis weight. Check the arteriovenous (AV) fistula for a thrill and bruit. Document the amount the client drinks throughout the shift. Auscultate the client's lung sounds every 4 hours. Explain the components of a low-sodium diet.

Obtain the client's pre-hemodialysis weight. Correct Document the amount the client drinks throughout the shift. Correct Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? RN who has floated from pediatrics for this shift LPN/LVN with experience working on the medical unit RN who usually works on the general surgical unit New graduate RN who just finished a 6-week orientation

RN who usually works on the general surgical unit The nurse with experience in taking care of surgical clients will be most capable of monitoring the client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure. The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN should not be assigned to a client requiring IV therapy and who is at high risk for complications.

The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) Restricted protein Liberal sodium Restricted fluids Low potassium Low fat

Restricted protein Correct Restricted fluids Correct Low potassium Correct Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.

Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? History of hiatal hernia Presence of diabetes and glycosylated hemoglobin of 6.8% History of basal cell carcinoma on the nose 5 years ago Presence of tuberculosis

TB Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with the immune suppressants that are required to prevent rejection. A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point, and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.

When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? Pulse oximetry reading of 95% Sinus bradycardia, rate of 58 beats/min Blood pressure of 148/90 mm Hg Temperature of 101.2° F (38.4°

Temperature of 101.2° F (38.4° Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever.

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? Adherence to therapy Handwashing Monitoring for low-grade fever Strict clean technique

The most important infection control measure for the client receiving immune-suppressive therapy is handwashing. Adherence to therapy and monitoring for low-grade fever are important, but are not infection control measures. The nurse should practice aseptic technique for this client, not simply clean technique.

While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? Instruct the client to deep-breathe and cough. Document the effluent as output. Turn the client to the opposite side. Re-position the catheter.

Turn the client to the opposite side. With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The dialyzing fluid is called peritoneal effluent on outflow. The outflow should be a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, re-position the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Instructing the client to deep-breathe and cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse should re-position the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the physician re-positions a displaced catheter.