Urinary

Which clinical manifestations would the nurse associate with a patient's diagnosis of an upper urinary tract infection (UTI)? Select all that apply.

Chills, fever, flank pain Rationale Upper UTI symptoms present with fever, chills, and flank pain. The patient will not be afebrile, and urine will likely be cloudy, not clear and yellow. p. 1026

The nurse identifies that a patient with chronic kidney disease (CKD) is at risk for which electrolyte disturbance? • Hypokalemia • Hyponatremia • Hypercalcemia Hyperphosphatemia*

Rationale: A patient with CKD has hyperphosphatemia due to a decrease in elimination of phosphate by the kidneys. Hyperkalemia, rather than hypokalemia, is a serious electrolyte disturbance that occurs in the patient with CKD. Hypernatremia, rather than hyponatremia, leads to hypertension and fluid retention in a patient with CKD. Hypocalcemia, not hypercalcemia, occurs in the later stages of CKD due to the inability to absorb calcium in the absence of active vitamin D.

Which clinical manifestation of acute kidney injury may cause changes in an electrocardiogram (ECG)? I Hyperkalemia • Fluid overload • Hyponatremia • Metabolic acidosis

Rationale: Acute or rapid development of hyperkalemia affects the heart and causes ECG changes, such as peaked T waves, widening of the QRS complex, and ST-segment depression. Fluid overload may lead to pulmonary edema and heart failure. Uncontrolled hyponatremia may lead to the development of cerebral edema. Metabolic acidosis causes Kussmaul respirations.

The nurse monitors for which condition in patients with bilateral ureteral obstruction? • Oliguria • Benign prostatic hyperplasia • Hydronephrosis Diabetic gastroparesis

Rationale: Bilateral ureteral obstruction results in dilation of the kidneys, which is called hydronephrosis. if left untreated, can result in acute kidney injury (AKI). Oliguria is associated with AKI, regardless of the etiology. Benign prostatic hyperplasia (BPH) is a postrenal cause of hydronephrosis and potentially AKI. Diabetic gastroparesis is a manifestation of chronic kidney disease. p. 1061

Which diagnostic test would the nurse anticipate scheduling for the patient experiencing recurrent infections from a suspected urinary tract obstruction? • Sensitivity testing • Dipstick urinalysis . Clean-catch urine sample CT scan

Rationale: CT scan (urography) or ultrasound may be obtained when there are recurrent urinary tract infections or when an obstruction of the urinary tract is suspected. Sensitivity testing is used to determine the bacteria's susceptibility to a variety of antibiotic drugs. Dipstick urinalysis is used to identify nitrites, white blood cells, and leukocyte esterase. A clean-catch urine sample is preferable for obtaining cultures. p. 1027

The nurse reviews laboratory tests that are prescribed for a patient with acute kidney injury. Which is the best indicator of renal function? • Potassium • Creatinine BUN ALT

Rationale: Creatinine is the best indicator of renal function. Creatinine is a waste product of the skeletal muscles and is excreted through the kidneys. In renal failure, the kidneys are unable to excrete creatinine, leading to a serum level greater than the normal range of 0.2 to 1.0 mL/dL. Potassium excretion and regulation are impaired in acute renal failure, and potassium may therefore be increased. However, potassium may be increased for reasons other than renal disease, whereas increased creatinine is specific to renal disease. BUN is also used to measure kidney function, but other disorders such as dehydration may cause an increase in BUN. ALT is related to liver dysfunction, not renal dysfunction. p. 1062

A patient with chronic kidney disease is at risk for anemia. The nurse identifies that the events that lead to this condition occur in which order? Correct. Elevated PTH Inhibition erythropoiesis Shortened survival RBCs Bone marrow fibrosis

Rationale: Increased PTH (made to compensate for low serum calcium levels) can inhibit erythropoiesis, shorten survival of RBCs, and cause bone marrow fibrosis, which can result in decreased numbers of hematopoietic cells.

Which medications are used to desensitize pain in the bladder wall? SATA Lidocaine (Xylocaine) Vancomycin (Vancocin) Clotrimazole (Lotrimin) Azathioprine (Imuran) Dimethyl sulfoxide (DMSO) (Cryoserv)

Rationale: Instillations of heparin and hyaluronic acid are often administered with lidocaine, which rapidly desensitizes the pain receptors in the bladder wall due to their alkalinized anesthetic effect. DMSO is directly instilled into the bladder through a small catheter, and it desensitizes the pain receptors in the bladder wall. Vancomycin combined with an aminoglycoside such as tobramycin is beneficial in the treatment of acute pyelonephritis. Clotrimazole is used for treating trichomonas infection associated with urethritis. Azathioprine is used in the treatment of Goodpasture syndrome.

Which disorder would the nurse associate with a patient's clinical manifestations of urgency, urinating approximately 10 times within a 24-hour period, and eliminating 150 mL per void? Interstitial cystitis Glomerulonephritis Acute pyelonephritis Goodpasture syndrome

Rationale: Interstitial cystitis is a chronic, painful inflammatory disease of the bladder characterized by symptoms of urgency, frequency, and pain in the bladder and pelvis. The urinary frequency of 10 voids in a 24-hour period with 150 mL at each voiding deviates from the normal value of 8 voids in a 24-hour period with at least 200 mL in each voiding and indicates that the patient has urinary frequency. Glomerulonephritis is the inflammation of the glomeruli that affects both kidneys equally. Acute pyelonephritis is the inflammation of renal parenchyma and the collecting system. Goodpasture syndrome is an autoimmune disease characterized by circulating antibodies against the glomerular and alveolar membrane. p. 1031

The nurse reviews the plan of care for a patient in fluid volume overload due to chronic kidney disease. Furosemide and bumetanide have been ineffective. The nurse anticipates a prescription for which medication that is an osmotic diuretic? Mannitol Ethacrynate Chlorothiazide Spironolactone

Rationale: Mannitol is an osmotic diuretic that promotes diuresis by increasing the concentration of filtrates in the kidney and blocking reabsorption of the water by the renal tubules. Chlorothiazide is a thiazide diuretic that inhibits the reabsorption of sodium (Na +) and chloride (CI -) ions from the distal convoluted tubules. Ethacrynate is a loop diuretic that inhibits sodium (Na *), potassium (K *), and chloride (CI) reabsorption. Spironolactone is a potassium-sparing diuretic. p. 1063

Which response would the nurse provide the patient who is two days postoperative an ilea conduit loop and reports the development of mucus in their urine? *"The development of mucus is a normal occurrence." "You will need to catheterize your stoma to remove the mucus." "I will call the health care provider to verify the desired stoma outflow." • "Your lack of fluid intake thickened the drainage; increase your intake of fluids.'

Rationale: Mucus is a normal production of the intestinal liner. This will not cause any disruption in flow of the urine. Mucus in the urine is not caused by a decrease in fluid intake and is not necessary for the health care provider to assess the stoma because this is a normal finding. Catheterizing the stoma will not remove the mucus.

Which information included in a patient's electronic medical record listed below would have likely caused nephrotic syndrome? 45-year-old female Admitted with nephrotic syndrome Diabetes Depression Hypothyroidism Hypercholesterolemia

Rationale: Nephrotic syndrome is often caused by a systemic disease such as diabetes. Depression is not a common cause for nephrotic syndrome. Hypothyroidism is not a common cause for nephrotic syndrome. Hypercholesterolemia is not a documented cause for nephrotic syndrome.

Which laboratory result in a female client would cause a nurse to suspect kidney dysfunction? • Estimated glomerular filtration rate (eGFR): 100 mL/min/1.73 m 2 • Serum creatinine level: 1.1 mg/dL • Blood urea nitrogen (BUN): 20 mg/dL • 24-hour creatinine clearance: 68 mL/min

Rationale: Normal 24-h creatinine clearance is 88 to 128 mL/min for healthy women. With kidney dysfunction, the kidneys' ability to filter, or "clear," is decreased. In adults the normal eGFR number is more than 90 mL/min/1.73m 2. Normal levels of creatinine in the blood are approximately 0.5 to 1.1 mg/dL in adult females. In general, normal BUN levels in adult women are 6 to 21 mg/dL.

Which medication is the only oral agent approved for the treatment of interstitial cystitis? • Penicillin (Amoxicillin) • Pentosan (Elmiron) * • Nortriptyline (Allegron) • Amitriptyline (Elavil)

Rationale: Pentosan is the only oral agent used in the treatment of interstitial cystitis. Penicillin is used in the treatment of streptococcal infection as seen in acute poststreptococcal glomerulonephritis. Nortriptyline and amitriptyline are tricyclic antidepressants that may be used to reduce burning pain and urinary frequency. p. 1031

The nurse provides education for a group of nursing students about prerenal causes of acute kidney injury and includes which information? • Parenchymal damage occurs in prerenal oliguria. Prerenal azotemia results in increased sodium excretion. *Prerenal oliguria is caused by decreased circulatory volume. Prerenal causes of acute kidney injury increase the glomerular filtration rate.

Rationale: Prerenal oliguria is caused by a decrease in the circulatory volume due to dehydration and congestive cardiac failure. Parenchymal damage does not occur in prerenal oliguria. Prerenal azotemia results in decreased sodium excretion, which leads to increased sodium and water retention. Reduced systemic circulation is a prerenal cause that leads to a decrease in the blood flow to the kidneys. Therefore the glomerular filtration rate also decreases.

Which disorder includes the inflammation of renal parenchyma and the collecting system Pyelonephritis * • Interstitial cystitis • Urethral diverticula • Glomerulonephritis

Rationale: Pyelonephritis is an inflammation of the renal parenchyma and the collecting system. Interstitial cystitis is a chronic, painful inflammatory disease of the bladder. Urethral diverticula are the localized outpouchings of the urethra. Glomerulonephritis is the inflammation of the glomeruli. p. 1025

Which are postrenal causes of acute kidney injury? Select all that apply.

Rationale: Renal calculi, spinal cord disease, and BPH are postrenal causes of acute kidney injury. Intrarenal causes of acute kidney injury include kidney ischemia and myoglobin released from muscle cells. P. 1060

Which condition is a result of severe metabolic acidosis in patients with acute kidney injury? Asterixis Proteinuria • Hydronephrosis * Kussmaul respirations

Rationale: Severe acidosis causes a patient to take deep and rapid breaths- called Kussmaul respirations--in an effort t increase the exhalation of carbon dioxide. Asterixis is a neurologic change associated with acute kidney injury due to the accumulation of metabolic waste in the brain and nervous system. Dysfunction of the glomerular membrane due to acute kidney injury leads to proteinuria. Hydronephrosis refers to dilation of the kidneys and is a postrenal cause of acute kidney injury. p. 1062

Which information included in a patient's electronic medical record would increase the patient's risk for glomerulonephritis? Pt: 20-year-old male Admitted with acute glomerulonephritis Background: Streptococcal sore throat Benign prostatic hyperplasia Tuberculosis Trichomonas

Rationale: Streptococcal sore throat is a risk factor for glomerulonephritis. Tuberculosis is a risk factor for genitourinary tuberculosis. Trichomonas is a risk factor for urethritis. Benign prostatic hyperplasia is a risk factor for a urinary tract infection. p. 1033

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse recalls that ultrafiltration in peritoneal dialysis is achieved by which method? • Increasing the pressure gradient • Increasing osmolality of the dialysate* Decreasing the glucose in the dialysate • Decreasing the concentration of the dialysate

Rationale: Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis, the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the bloodstream.

Which urinary disorder commonly occurs in Jewish men? • Bladder cancer • Uric acid stones Urinary tract calculi • Urinary incontinence

Rationale: Uric acid stones are most common in Jewish men who have a family history or incidence of gout. Bladder cancer is more common in Caucasian men. Urinary tract calculi are more common in Caucasians than in African Americans. Urinary incontinence is underreported because culturally it is seen as a social hygiene problem causing patient embarrassment. p. 1036

When collecting a urine sample for analysis and a culture with sensitivity (C&S) from a patient admitted with suprapubic pain and dysuria, which instruction would the nurse provide the patient? • After drinking 1 liter of water, wash your hands and collect the urine sample. When you complete your breakfast, immediately collect the next voided urine. Clean your periurethral area, begin voiding, and then catch a sample of your urine. Use the antiseptic cloth to clean your periurethral area before collecting the sample.

Rationale: clean-catch, or midstream, sample should be collected to prevent contamination of urine with bacteria present in the vagina or penis. Clean the periurethral area, begin to void, and catch a midstream sample of urine. The periurethral area should be cleaned, but the use of antiseptic should be avoided because it can contaminate the sample and provide a false positive. A sample should not be collected directly after a meal or after drinking a liter of water because food and water can affect the normal chemical composition of a patient's urine.

Which difference between the two methods of access will the nurse consider in planning care for a client with end-stage renal disease who has an internal arteriovenous fistula in one arm and an external arteriovenous shunt in the other arm? *• The graft is more subject to hemorrhage, clotting, and infection than the fistula is. • BP readings can be taken in the arm with the fistula but not in the one with the shunt. • IV fluids can be administered in the arm with the shunt but not in the one with the fistula. The fistula should have a light dressing, and the shunt should be covered thoroughly with a heavy dressing.

Rationale: external shunt may come apart with possible hemorrhage; clotting is a potential hazard. Frequent handling increases the risk of infection. BP readings should not be obtained in the extremity that has a shunt or fistula because of the pressure exerted on the circulatory system during the procedure. IV fluids should not be infused in the extremity with the shunt or the fistula to avoid pressure from the tourniquet and to lessen the chance of phlebitis. The ends of the shunt cannula should be left exposed for rapid reconnection in the event of disruption.

ESKD/CRF) Hemodialysis Principles

• Diffusion: Removes toxins and wastes in the blood. From the blood to the dialyzer.*** • Osmosis: Removes fluid from (the blood). ** Water moves from the blood to the dialysate bath) • Ultrafiltration: Fluid moves under high pressure to an area of lower pressure. Negative pressure or a suctioning force to the dialysis membrane. Is much more efficient than osmosis for fluid removal. Is necessary to remove fluid**** • The cleansed blood is returned to the body with the goal of removing fluid, balancing electrolytes, and managing acidosis