Urinary and Renal System: Prep U: Ch 53;54;55
check pt urine for hematuria
A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would know to perform which of the following actions?
urinary calculi
A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?
sodium polystyrene sulfonate (Kayexalate)
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:
increase carbs and limit protein
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?
cystoscopy
A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following?
place urinary cath
A client in moderate pain is admitted for possible kidney stones. The client appears diaphoretic and has frequent periods of nausea and vomiting. The client reports sudden oliguria and initial portable bladder ultrasound shows 300 mL in the bladder after the client voided 50 mL. Which action should the nurse anticipate performing first for this client?
Reassure the client the urine color is related to the medication methylopa and no further action is needed at this time.
A client is concerned after noticing the color of their urine is dark brown. The nurse is aware that the client is prescribed senna, methyldopa, and acetaminophen. Which action is an appropriate response by the nurse?
Glucose
A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine?
assess present voiding patterns
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
placement of small amounts of collagen in urethral walls to aid the closing pressure.
A client is going to have a surgical procedure called a periurethral bulking to improve urinary control. Periurethral bulking is:
increased in renal disease and urinary obstruction.
A client is having a blood urea nitrogen (BUN) test. BUN level is:
Monitor the client for an allergy to iodine contrast material
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test?
Pruritus
A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram?
"You don't need to do any fasting before this noninvasive test."
A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client?
microorganism transfer
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:
hyperphosphatemia
A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
114
A client with chronic kidney disease weighs 209 lbs (95 kg) and is prescribed 1.2 grams of protein per kg per day. Which amount of protein will the client ingest per day?
fatigue and weakness
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:
r/o infection!!
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
"Do you take multiple vitamin preparations?"
A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client?
ureters -The upper urinary tract is composed of the kidneys, renal pelvis, and ureters. The lower urinary tract consists of the bladder, urethra, and pelvic floor muscles.
A group of students is reviewing for a test on the urinary and renal system. The students demonstrate understanding of the information when they identify which of the following as part of the upper urinary tract?
acute glomerulonephritis
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?
wear a mask during exchanges
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?
urinary output 20 ml/hr
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
infection
A nurse caring for a patient with a neurogenic bladder knows to assess for the major complication of:
encourage use of IS q 2 hours
A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care?
150
A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?
notify DR. of cloudy/foul smelling urine
A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:
painless hematuria
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?
Recent history of streptococcal infection
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
Increased serum creatinine - In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find?
cloudy urine
A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered?
A GFR of 30-59 mL/min/1.73 m2
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?
Low purine diet
A patient who has been treated for uric acid stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient?
"It is appropriate to warm the dialysate in a microwave."
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
Decreased pelvic muscle tone due to multiple pregnancies
After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence?
physical and environmental conditions
An 82-year-old client experiences urinary incontinence. Which factor should the nurse assess before beginning a bladder training program for this client?
Detects calculi, cysts, or tumors
An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?
confirm all of the medications and supplements normally taken.
An older adult's most recent laboratory findings indicate a decrease in creatinine clearance. When performing an assessment related to potential causes, the nurse should:
bladder
As women age, many experience an increased sense of urgency to void, as well as an increased risk of incontinence. This is usually the result of age-related changes in which part of the renal system?
hyperkalemia. hypocalcemia. anemia
Based on the pathophysiologic changes that occur as renal failure progresses, the nurse identifies the following indicators associated with the disease. Select all that apply.
bladder retraining program
Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as what?
instruct pt q 2-3 hr timed voiding schedule
Bladder retraining following removal of an indwelling catheter begins with
citrus fruits
Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted.
low purine
Examination of a client's bladder stones reveals that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?
Assess the patient's back and shoulder areas for signs of internal bleeding.
Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse?
tall, peaked T waves
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
meticulous perineal care daily with soap and water
If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection?
restricting potassium
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include:
restricting sources of potassium
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include:
potassium
Retention of which electrolyte is the most life-threatening effect of renal failure?
costovertebral angle tenderness
The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find?
brief, hot daily shower
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education?
urinary incontinence
The most frequent reason for admission to skilled care facilities includes which of the following?
dehydration
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
An excess of urea in the blood
The nurse is able to identify which condition as uremia?
w/ food
The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication?
CT w/ contrast
The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client be assessed for an allergy to iodine?
The nursing assistant places the drainage bag on the client's abdomen for transport.
The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action made by the nursing assistant would require instruction?
renin
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?
the costovertebral angle
The nurse is caring for a client who has presented to the walk-in clinic. The client verbalizes pain on urination, feelings of fatigue, and diffuse back pain. When completing a head-to-toe assessment, at which specific location would the nurse assess the client's kidneys for tenderness?
SpO2 at 90% with fine crackles in the lung bases
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client?
"My urine will be eliminated through a stoma."
The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective?
application of ostomy pouch
The nurse is caring for a client with an ileal conduit is created after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care?
4000 > (# kg) x 1000= mL
The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number.
Hypovolemic shock caused by hemorrhage
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?
hypovolemic shock from hemorrhage
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for?
perintonitis
The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following?
decreased fluid intake
The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition?
Take the antibiotic for 3 days as prescribed.
The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do?
coffee in the AM
The nurse is encouraging the client with recurrent urinary tract infections to increase fluid intake to 8 large glasses of fluids daily. Which beverage would the nurse discourage for this client?
enuresis
The nurse is instructing a 3-year-old's parent regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as a normal finding for this age group?
hematuria
The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder?
drink liberal amounts of fluids
The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to
Perform hand hygiene prior to patient care Assist patients w/ frequent toileting Provide careful perineal care
The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply.
bleeding
The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following?
kidneys can improve over months
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury?
Specific gravity 1.035
The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is:
Administration of sodium polystyrene sulfonate [Kayexalate])
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?
Catheterization should occur every 4 to 6 hours and before bedtime.
The nurse is teaching a client how to perform self-catheterization. Which direction should the nurse include?
Gray-bronze skin color
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure?
kidney stones
The nurse reviews a client's history and notes that the client has a history of hyperparathyroidism. The nurse would identify that this client most likely would be at risk for which of the following?
oliguria
The term used to describe total urine output less than 0.5 mL/kg/hour is
Detrusor muscle
The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition?
removal of the transplanted kidney.
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:
On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. Specific gravity compares the density of urine to the density of distilled water. Which is an example of how urine concentration is affected?
Increased BUN
What is a characteristic of the intrarenal category of acute kidney injury (AKI)?
proteinuria
What is a hallmark of the diagnosis of nephrotic syndrome?
penicillin
When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic?
cola-colored urine
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
1.010 to 1.025
When fluid intake is normal, the specific gravity of urine should be:
immunocompromised
Which factor contributes to UTI in older adults?
phenzopyridine (Pyridium)
Which medication may be ordered to relieve discomfort associated with a UTI?
fever
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes?
The client voids 75 cc four hours post cystoscopy.
Which nursing assessment finding indicates the client has not met expected outcomes?
Teach client to increase fluid intake up to 3 liters per day
Which nursing intervention should the nurse caring for the client with pyelonephritis implement?
Glomerulonephritis
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?
angiography
Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys?
renal arteries thicken
Which of the following is an age-related change associated with the renal system?
deficient knowledge: procedure
Which of the following is the priority nursing diagnosis for the client preparing for a voiding cystourethrography?
latrogenic
Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications?
creatinine clearance
Which value does the nurse recognize as the best clinical measure of renal function?
