Urinary Renal NCLEX

The nurse has reinforced instructions to the client with a cystocele about Kegel exercises. The nurse determines that the client has not fully understood the directions if the client makes which statement? "Stop and start the stream of urine several times during avoiding." "Tighten perineal muscles for up to 10 seconds several times a day." "Tighten perineal muscles for up to 5 minutes three or four times a day." "Begin voiding and then stop the stream, holding residual urine for an hour."

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

Which instruction does the nurse give a client who needs a clean-catch urine specimen?

"Do not touch the inside of the container." A clean-catch specimen is used to obtain urine for culture and sensitivity of organisms present; contamination by the client's hands will render the specimen invalid and alter results.

Which is an appropriate question to ask to determine the specific type of incontinence? "Do you feel pain when you urinate?" "Do you have any difficulty in starting your stream of urine?" "Have you needed to empty your bladder more frequently than usual?" "Have you been experiencing any urgency accompanied by dribbling or leaking urine?"

"Have you been experiencing any urgency accompanied by dribbling or leaking urine?"

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The nurse appropriately asks which question first? "Have you had any abdominal discomfort?" "Have you had any recurring bouts of diarrhea?" "Have you experienced any constipation recently?" "Have you had an increased amount of flatulence?"

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

A patient with diabetes is admitted for evaluation of kidney function becasue of recent fatigue, weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing history, the nurse identifies an early symptoms of renal insufficiency when the patient states:

"I get up several times every night to urinate."

Which statements indicate an understanding of the necessary dietary modifications of a client diagnosed with chronic kidney disease? Select all that apply. "I should avoid coffee; tea is preferable." "I should avoid eggs; a bagel is preferable." "I should avoid salt; soy sauce is preferable." "I should avoid salt; salt substitutes are preferable." "I should consume approximately 40 g of protein daily." "I should avoid carbonated sodas; milk is preferable."

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

The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught?

"I should be drinking at least 1.5 to 2.5 liters of fluids every day."

The nurse provides home care instructions to a client undergoing hemodialysis with regard to care of an arteriovenous (AV) fistula. Which statement by the client indicates an understanding of the instructions? "I should check the fistula every day by feeling it for a vibration." "I am glad that the laboratory will be able to draw my blood from the fistula." "I should wear a shirt with tight arms to provide some compression on the fistula." "I should check my blood pressure in the arm where I have my fistula every week."

"I should check the fistula every day by feeling it for a vibration." The client is instructed to monitor fistula patency daily by palpating for a vibration, known as a thrill. The client is instructed to avoid compressing the fistula with tight clothing or when sleeping and that blood pressure measurements and blood draws should not be performed on the arm with the fistula.

he 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?

"I should drink 2½ liters of fluid every day."

The nurse is talking with a client who has an arteriovenous fistula in the left arm. What statement by the client indicates a need for further teaching? "I check my fistula every day for pulsations." "I sleep on my left side with my arm tucked under my pillow." "I remind the lab personnel to take my blood from my right arm" "I will call the health care provider if I notice redness and swelling near the site"

"I sleep on my left side with my arm tucked under my pillow." When a client has an arteriovenous graft or an AVF, it is important to check the site and protect it from injury. The site should be observed for signs indicating clotting or infection, and the peripheral circulation distal to the graft should also be checked (capillary refill and color of nail beds). Palpate for a thrill (vibration in the vessel) by gently laying your fingers on the enlarged vessel. You should be able to feel a buzz or vibration. A bruit (soft swishing sound) should be clearly heard on auscultation, and the rhythm of the sound should coincide with the client's pulse. The client should sleep with that extremity free (i.e., not on the side with the arm tucked underneath the body). Care is taken never to compress the extremity containing the vascular access.

A patient diagnosed with ESRD is treated with conservative management, including erythropoietin injections. After teaching the patient about management of ESRD, the nurse determiness teaching has been effective when the patient states:

"I wil measure my urinary output each day to help calculate the amount I drink."

The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a correct understanding of these procedures?

"I will have to drain my pouch with a catheter."

A client has received instructions on self-management of peritoneal dialysis. The nurse determines that the client needs further teaching if the client makes which statement? "I will monitor my weight daily." "I will take my vital signs daily." "I will use a meticulous aseptic technique for dialysate bag changes." "I will use a strong adhesive tape to anchor the catheter dressing."

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

What statement by the patient indicates the need for further teaching before renal angiography?

"I'm glad I don't have to stay in bed after the test."

The physician has talked to te patient and his wife about the treatment plan for his bladder cancer. Later, the patient tells the nurse he does not understand what the doctor is going to do. The most appropriate response by the nurse would be:

"Tell me what you know abot the treatment."

A client with acute pyelonephritis is scheduled for a voiding cystourethrogram. After the nurse provides information about this procedure, the client states, "I can't urinate in front of other people. I have a 'bashful' kidney." What is the nurse's best response? "Everyone feels that way." "The people there are all medical professionals." "You will be screened and given as much privacy as possible." "If you cannot urinate in front of others, the test will be canceled."

"You will be screened and given as much privacy as possible." Having to void in the presence of others can be very embarrassing for clients and actually may interfere with the client's ability to void. The nurse teaches the client about the procedure to try to minimize stress from lack of preparation and gives the client encouragement and emotional support. Screens may be used in the radiology department to try to provide an element of privacy during this procedure. Since a catheter was inserted to instill the dye, it could be left in place if the client is unable to urinate.

The nurse is caring for the client with epididymitis. Which treatment modalities should be implemented? SELECT ALL THAT APPLY 1. bed rest 2. sitz bath 3. antibiotics 4. heating pad 5. scrotal elevation

1. bed rest 2. sitz bath 3. antibiotics 5. scrotal elevation

After a renal biopsy, the client complains of pain at the biopsy site that radiates to the front of the abdomen. Which would this indicate? 1. bleeding 2. infection 3. renal colic 4. normal, expected pain

1. bleeding

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. hematocrit of 33% 2. platelet count of 400,000 3. WBC count of 6000 4. BUN level 15

1. hematocrit of 33% Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is Male: 42% to 52% (0.42 to 0.52); Female: 37% to 47% (0.37 to 0.47). Therapeutic effect is seen when the hematocrit reaches between 30% and 33% (0.30 and 0.33). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

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

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

The nurse is reviewing the clients record and notes that the PHCP has documented that the client has a renal disorder. Which laboratory results would indicate a decrease in renal function? SELECT ALL THAT APPLY 1.elevated serum creatinine level 2. elevated thrombocyte cell count 3. decreased RBC count 4. decreased WBC count 5. elevated BUN level

1.elevated serum creatinine level 3. decreased RBC count 5. elevated BUN level

A sulfonamide is prescribed for a client with a UTI. During review of the clients record, the nurse notes that the client is taking warfarin sodium daily. Which prescription should the nurse anticipate for this client? 1. discontinuation of warfarin sodium 2. a decrease in the warfarin sodium dosage 3. an increase in the warfarin sodium dosage 4. a decrease in the usual dose of the sulfonamide

2. a decrease in the warfarin sodium dosage

A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigation's postoperatiely. Which are the sign/symptoms of TURP syndrome? 1. tachycardia and diarrhea 2. bradycardia and confusion 3. increased urinary output and anemia 4. decreased urinary output and bladder spasms

2. bradycardia and confusion

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply. 1. contact the nephrologist 2. check the level of the drainage bag 3. reposition the client to his or her side 4. place the client in a good body alignment 5. check the peritoneal dialysis system for kinks 6.. increase the flow rate of the peritoneal dialysis solution

2. check the level of the drainage bag 3. reposition the client to his or her side 4. place the client in a good body alignment 5. check the peritoneal dialysis system for kinks

The nurse is reviewing the medical record of a client with a diagnosis of pyelinephritis. Which disorder noted on the clients record should the nurse identify as a risk factor of this diagnosis? 1. hypoglycemia 2. diabetes mellitus 3. coronary artery disease 4. orthostatic hypotension

2. diabetes mellitus

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1. peritonitis 2. hyperglycemia 3. hyperphosphatemia 4. disequilibrium syndrome

2. hyperglycemia

The nurse is reinforcing discharge instructions to a client receiving sulfadiazine. Which should be included in the list of instructions? 1. restrict fluid intake 2. maintain a high fluid intake 3. decrease the dosage when symptoms are improving to prevent an allergic response 4. if the urine is dark brown, call the PHCP immediately

2. maintain a high fluid intake Rationale: Each dose of sulfadiazine should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfadiazine cause urine to turn dark brown or red. This does not indicate the need to notify the PHCP.

Bethanechol chloride is prescribed for a client with urinary retention. Which disorder should be a contraindication to the administration of this medication? 1. gastric atony 2. urinary strictures 3. neurogenic atony

2. urinary strictures Rationale: Bethanechol chloride can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions

Following kidney transplantation, cyclosporine (Sandimmune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. hemoglobin level 14.0 2. creatinine level 0.6 3. BUN 25 4. fasting blood glucose level of 99

3. BUN 25 Cyclosporine is an immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal creatinine level for a male is 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and for a female 0.5 to 1.1 mg/dL (44 to 97 mcmol/L). Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is Male: 14 to 18 g/dL (140 to 180 mmol/L); Female: 12 to 16 g/dL (120 to 160 mmol/L). Anormal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The normal fasting glucose is 70 to 110 mg/dL (4 to 6 mmol/L).

The nurse who is administering bethanechol chloride is monitoring for acute toxicity associated with medication. The nurse should check for which sign of toxicity? 1. dry skin 2. dry mouth 3. bradycardia 4. signs of dehydration

3. bradycardia Rationale: Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

The nurse is monitoring an older client suspected of having a UTI for signs of infection. Which signs/symptom is likely to present first? 1. fever 2. urgency 3. confusion 4. frequency

3. confusion

A client has epididymitis as a complication of a UTI . The nurse is giving the client instructions to prevent a recurrence. The nurse determines that the client needs FURTHER teaching if the client states the intention to do which action? 1. drink an increased amount of fluids 2. limit the force of the stream during voiding 3. continue to take antibiotics until all symptoms are gone

3. continue to take antibiotics until all symptoms are gone

A client is scheduled for intravenous pyelography. Which PRIORITY nursing action should the nurse take? 1. restrict fluids 2. administer a sedative 3. determine if there is a history of allergies 4. administer an oral preparation of radiopaque dye

3. determine if there is a history of allergies

A client with prostatitis resulting from kidney infection has received instructions on the management of the condition at home and prevention on recurrence. Which statement indicates that the client understood the instructions? 1. stop antibiotic therapy when pain subsides 2. exercise as much as possible to stimulate circulation 3. use warm sitz baths and analgesics to increase comfort 4. keep fluid intake to a minimum ti decrease the need to void

3. use warm sitz baths and analegesics to increase comfort

Phenazopyridine hydrochloride is prescribed for a client for symptomatic relief of pain resulting from a lower UTI. Which should the nurse reinforce to the client? 1. take the medication at bedtime 2. take the medication before meals 3. discontinue the medication if a headache occurs 4. a reddish-orange discoloration of the urine may occur

4. a reddish-orange discoloration of the urine may occur Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

A client with chronic kidney disease has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now has mental cloudiness, dementia, and complaints of bone pain. Which does this data indicate? 1. advancing uremia 2. phosphate overdose 3. folic acid deficiency 4. aluminum intoxication

4. aluminum intoxication

The client who has a cold is seen in the ER with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which class of medication? 1. diuretics 2. antibiotics 3. antitussives 4. decongestants

4. decongestants

The nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. To determine whether the client is currently experiencing an exacerbation of BP, the nurse should ask the client about the presence of which early symptom? 1. nocturia 2. urinary retention 3. urge incontinence 4. decreased force in the stream of urine

4. decreased force in the stream of urine

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? 1. hematuria and pyuria 2. dysuria and proteinuria 3. hematuria and urgency 4. dysuria and penile discharge

4. dysuria and penile discharge

A hemodialysis client with a left arm fistula is at risk for arterial syndrome. The nurse monitors this client for which signs/symptoms of this disorder? 1. edema and purpura of the left arm 2. warmth, redness, and pain in the left hand 3. aching pain, pallor, and edema of the left arm 4. pallor, diminished pulse, and pain in the left hand

4. pallor, diminished pulse, and pain in the left hand

Oxybutynin chloride is prescribed for a client with a neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication? 1. pallor 2. drowsiness 3. bradycardia 4. restlessness

4. restlessness Rationale: Toxicity (overdose) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdose.

Trimethoprim/Sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it developed during the course of this medication therapy? 1. nausea 2. diarrhea 3. headache 4. sore throat

4. sore throat Rationale: Clients taking trimethoprim-sulfamethoxazole should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the PHCP if these symptoms occur. The other options do not require PHCP notification.

When scheduling the administration of furosemide (Lasix), it would be in the patient's best interest to schedule the medication to be given at:

9 AM

The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first?

A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours

During an abdominal assessment of a male client, the nurse palpates a a large, round mass in the hypogastric region. What is the nurse palpating?

A distended or full bladder

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

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

An alkaline-ash diet is prescribed for a client with renal calculi. Which diet menu does the nurse advise the client to select? Chicken, rice, and cranberries A spinach salad, milk, and a banana Peanut butter sandwich, milk, and prunes Pasta with shrimp, tossed salad, and a plum

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

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

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

The priority treatment option for Miss Jones would most likely involve which of the following? A) Behavioral techniques B) Pharmacological measures C) Surgical intervention D) Use of absorbent products

A) Behavioral techniques The least invasive intervention should be attempted first. Phonological and surgical interventions are not recommended until behavioral techniques have been attempted. Using absorbent products may remove motivation from the patient and caregiver to seek Evaluation and treatment of the incontinence. They should be used only after careful evaluation by a healthcare provider

Which of the following is a nursing priority when caring for a male patient with a condom catheter? A) Preventing the tubing from kinking to maintain free urinary drainage B) Not removing the catheter for any reason C) Fastening the condom tightly to prevent the possible ability of leakage D) Maintaining bed rest at all times to prevent the catheter from slipping off

A) Preventing the tubing from kinking to maintain free urinary drainage The catheter should be allowed to drain freely through toothing that is not king. It also should be removed daily to prevent skin excoriation And should not be fastened to tightly or restriction of blood vessels in the area is likely. Confining a patient to bed rest increases the risk for other hazards related to immobility

When a person as a fever or diaphortesis, how would the urine output be described? A)Decreased and highly concentrated B)Decreased and highly dilute C)Increased and concentrated D)Increased and dilute

A)Decreased and highly concentrated Fever and diaphoresis cause the kidneys to conserve body fluids, Thus, the urine is concentrated and decreased in amount

The Doctor has order an indwelling catheter inserted in a hospitalized male "PT". The nurse is aware of which of the following considerations? A)The male urethra is more vulnerable to injury during insertion B)In the hospital, a clean technique is used for catheter insertion C)The catheter is inserted 2" to 3" into the meatus D)Since it uses a closed system, the risk for urinary infection is absent

A)The male urethra is more vulnerable to injury during insertion Because of its length the male urethra is more prone to injury and requires that the catheter be inserted 6" to 8". This procedure requires surgical asepsis to prevent introducing bacterica into the urinary tract. The placement of an indwelling catheter has a risk of UTI

A client with end-stage kidney disease (ESKD) begins peritoneal dialysis. Does the nurse observe for which signs/symptoms indicating peritonitis? Select all that apply. Nausea and vomiting Poor dialysate outflow Abdominal tenderness Cloudy peritoneal effluent Oral temperature of 38° C Clear fluid leakage at the catheter exit site

Abdominal tenderness Cloudy peritoneal effluent Oral temperature of 38° C Nausea and vomiting Peritoneal dialysis is a treatment used in clients with ESKD as an alternative to hemodialysis. The procedure involves the instillation of dialysate fluid into the peritoneal cavity where excess body wastes, fluid, and electrolytes are removed through diffusion and osmosis across the semipermeable peritoneal membrane and peritoneal capillaries. A peritoneal catheter is surgically placed into the abdominal cavity and is used to instill and drain the dialysate fluid, known as effluent. Peritonitis, or infection of the peritoneal cavity, is a possible complication of peritoneal dialysis. The effluent becomes cloudy instead of the normal clear straw color, and the client has symptoms of abdominal tenderness and pain, nausea, vomiting, and fever. Thirty-eight degrees Celsius is an elevated temperature indicating fever, a sign of infection. Poor dialysate outflow is usually caused by constipation. Leakage of clear fluid at the exit site of the peritoneal catheter is more likely to occur in obese or diabetic clients. It occurs as the client physiologically adjusts to the instillation of 2 L of dialysate fluid into the abdominal cavity.

During postoperative care of the patient with an ileoconduit, which finding represents an emergency?

Absence of bowel sounds

Which medication does the nurse plan to administer before the procedure?

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

A client who suffered a crush injury to the leg has a highly positive urine myoglobin level. The nurse plans to monitor this particular client carefully for signs of which complication? Respiratory failure Brain attack (stroke) Myocardial infarction Acute tubular necrosis

Acute tubular necrosis The normal urine myoglobin level is negative. After extensive muscle destruction or damage, myoglobin is released into the bloodstream, where it is cleared from the body by the kidneys. When a large amount of myoglobin is being cleared from the body, the renal tubules may become clogged with myoglobin, which causes acute tubular necrosis.

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first

Administer morphine sulfate 4 mg IV.

The nurse is caring for a client who had a renal biopsy. Which interventions should the nurse include in the plan of care for the client after this procedure? Select all that apply. Restricting fluids during the first 24 hours Administering pain medication as prescribed Monitoring vital signs and the puncture site frequently Testing serial urine samples with dipsticks for occult blood Ambulating the client in the room and hall for short distances

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

In reviewing the admission assessment data and primary health care provider's prescriptions for a client with peptic ulcer disease, the nurse notes that the client has a history of renal disease. Based on this data, the nurse determines which antacid should be prescribed for this client? Magnesium oxide Aluminum hydroxide Magnesium and calcium Aluminum and magnesium combination

Aluminum hydroxide Rationale: Aluminum hydroxide lowers serum phosphate by binding with dietary phosphorus to form insoluble aluminum phosphate. The phosphate is then excreted in the feces. Aluminum hydroxide will not affect the renal system as much as other antacids. The medications identified in options 1, 3, and 4 are partially excreted by the kidneys; therefore, they may cause a problem in clients with renal disease.

The nurse is caring for a client with kidney failure. The serum phosphate level is reported as 7 mg/dL. Which medication should the nurse plan to administer as prescribed to the client? Calcitonin Calcium chloride Calcium gluconate Aluminum hydroxide gel

Aluminum hydroxide gel Rationale: The normal serum phosphate level is 3 to 4.5 mg/dL. The client in this question is experiencing hyperphosphatemia. Certain medications can be given to increase fecal excretion of phosphorus by binding phosphorus from the food in the gastrointestinal tract. Aluminum hydroxide gel is one such medication. Calcium gluconate and calcium chloride are medications used in the treatment of tetany that occurs from acute hypocalcemia. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones thus keeping it out of the serum.

A client with chronic kidney disease has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now has mental cloudiness, dementia, and complaints of bone pain. Which does this data indicate? Advancing uremia Phosphate overdose Folic acid deficiency Aluminum intoxication

Aluminum intoxication Occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. This condition was formerly known as dialysis dementia.

A client diagnosed with chronic kidney disease is being treated at home with continuous ambulatory peritoneal dialysis. The client notes that there is a decrease in the catheter outflow following the prescribed 6-hour dwell time and calls the nurse to report this occurrence. The nurse should reinforce instructing the client to take which action? Ambulate in the home. Perform straight catheterization of the bladder. Immediately notify the primary health care provider. Flush the peritoneal catheter with a thrombolytic medication.

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

A client has just undergone renal biopsy. In planning care for this client, the nurse should avoid which intervention? Test urine for occult blood periodically. Administer opioid analgesics as needed. Ambulate in the room and hall for short distances. Encourage fluids to at least 3 L in the first 24 hours.

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

The most important factor to foster patient compliance with the treatment plan is to provide te patient with:

An active role in the planning

transurethral resection of the prostate

An indwelling urethral catheter is used because surgical trauma can cause edema and urinary retention, leading to additional complications, such as bleeding. Urinary control is not lost in most cases; loss of control usually is temporary if it does occur. Sexually ability usually is not affected; sexual ability is maintained if the client was able to perform before surgery. A cystotomy tube is not used if a client has a transurethral resection; however, it is used if a suprapubic resection is done.

The patient with ESRD receiving hemodialysis is at risk for:

Anemia

The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting which reaction?

Anger Psychosocial reactions to CKD and hemodialysis are varied and may include anger. Other reactions include personality changes, emotional lability, withdrawal, and depression. The individual client's response may vary depending on the client's personality and support systems.

The nurse is teaching the female client how to perform self-catheterization. Which of the following instructions is incorrect? A) It is important to maintain ascetic technique when performing this process. B) The catheterization should be performed every 4-6 hours C) If you have the urge to void in the middle of the night, try to pea. If that doesn't work, you may self-catheterize. D) Always dispose of the catheter after use

Answer: A. Patients who self-catheterize are instructed to use clean technique as aseptic technique is not feasible or as needed in the home setting. Catheterization should be performed at regular intervals. It can be performed in the middle of the night as necessary. The catheter should be disposed of after use, never reused.

The patients passed his kidney stone! During stone analysis, it is determined that the stone is composed of uric acid. Which of the following dietary restrictions would be recommended for this patient? A) Avoiding all shellfish B) Limiting calcium intake C) Restricting protein intake D) Drinking less than 1000 ml of water

Answer: A. Stones that are composed of uric acid can be prevented by consuming a low-purine diet (similar for gout). Foods high in purine include shellfish, organ meat, asparagus, and mushrooms. Limiting calcium or protein intake may be appropriate for the stone composed of calcium. Patients with previous kidney stones should be encouraged to drink plenty of fluids, more than 2 L a day

Which of the following symptoms would the nurse expect to find in the patient diagnosed with bladder cancer? A) Dysuria and urgency B) Painless hematuria C) Suprapubic pain with nausea and vomiting D) Pyuria and incontinence

Answer: B. Painless gross hematuria is the most common symptom of bladder cancer. Dysuria and urgency are common findings in UTI. Suprapubic pain with nausea and vomiting may be found with nephrolithiasis (kidney stones). Pyuria and incontinence are not associated with bladder cancer.

The client with urge incontinence asks you "How can I get rid of this process?" Which is the best response to this client? A) "It's important to accept that this is a natural part of aging" B) "You should avoid artificial sweeteners, caffeine, and alcohol" C) "It could help to void after every time you think of it" D) "Make sure you take your diuretic at bedtime. This will help you pea better"

Answer: B. these substances are bladder irritants and should be avoided. A voiding schedule is best for patient with incontinence, and patients may or not remember to void. Urinary incontinence is not a natural part of aging, and diuretics should not be taken after 4 p.m.

Which of the following signs and symptoms would the nurse expect to see in the elderly patient with a UTI? A) Back pain B) High Fever C) ALOC D) Anorexia E) Tachypnea

Answer: C, D, and E. In elderly patients, the nurse would expect to see more nonspecific signs of urinary tract infection including changes in level of consciousness, lethargy, anorexia, new incontinences, hyperventilation, and low-grade fever. Back pain may be present with UTI, but is not common in elderly patients. High fever is typically not present.

The nurse is teaching the patient who has just been given a urinary diversion (ileal conduit). Which of the following statements, if made by the patient, indicates the need for further teaching? A) I should not expect to feel pain at the stoma B) The stoma could bleed when I clean it C) I should report any signs of mucous in the urine to my doctor D) The stoma should be pink and moist

Answer: C. Because a segment of the GI system is typically used to create a urinary diversion, mucous would be expected in the urine. The stoma is vascular, and could bleed when cleaned. There are no nerve endings at the stoma, so there should be no pain. The stoma should be pink and moist like the inside of the mouth.

You are teaching a patient with urinary incontinence about the importance of increasing fluid intake. Which statement, if made by the patient, indicates correct understanding? A) "Increasing my fluid intake will help flush toxins out of my kidneys which helps prevent incontinence" B) "I should double my fluid intake over the next several days" C) "Increased fluids can help with my urinary incontinence by preventing constipation" D) "Like you said, if I drink more water my pea will no longer be bothersome to my bladder"

Answer: C. Increased fluids help by preventing constipation, reduce urge by lowering concentration of urine, and help prevent infection. Although drinking fluids can help promote excretion of toxins out of the body, this does not affect incontinence. Doubling fluid intake may be effective, but we are not aware of the patient's previous intake. Patients should be encouraged do drink 2000-3000 mL if they have no other fluid restrictions.

Ms. White, the nursing instructor, is teaching her students how to prevent infection in patients with an indwelling catheter. Which student demonstrates correct understanding? A) "Hanging the urine bag above the bladder will help prevent infection" B) "It's important to avoid using soap to clean the perineum in the patient with a catheter" C) "The urine bag should be emptied at least every 8 hours" D) "The tubing to the urinary catheter should never be unhooked unless a specimen needs to be taken"

Answer: C. The bag should be emptied at least every eight hours (more if there are large amounts of urine) to prevent the risk of bacterial proliferation. The bag should NEVER be hung above the level of the bladder or set on the ground. Soap and water can be used to clean the perineal area and around the catheter, and should be done twice a day. The tubing of the catheter should NEVER be disconnected, even for a specimen.

You are helping the patient who has just had a foley catheter removed to retrain their bladder. As the nurse you would do all of the following except: A) Encourage the patient to drink measured amounts of fluids B) Palpate the bladder to assess for distention C) Teach the client to report any sweating, cold hands, or feelings of anxiety D) Straight cath the patient if the residual urine is more than 50 mL

Answer: D. A straight catheter should only be used if the residual urine is more than 100 mL (urinary retention). Immediately after the voiding attmpt the bladder should be scanned to assess for urinary retention. All other strategies can be used.

The nurse knows that all but which of the following are measures to promote urinary continence: A) Stopping smoking B) Pelvic floor exercises C) Avoiding constipation D) Taking showers not baths

Answer: D. Taking showers and not baths would be appropriate for the patient with recurrent UTI's. Smoking can increase cough which can in turn increase incontinence. Pelvic floor exercises help strengthen muscles and will help with incontinence. Constipation should be avoided as this can promote incontinence.

The patient who has just undergone knee surgery has been found to have not peed in six hours. The nurse can do all of the following to encourage the patient to void except? A) Apply a warm compress to perineum B) Offering hot fluids C) Run water in background D) Helping the patient onto the bedpan

Answer: D. The bedpan is evil for people with urinary retention. It is much more comfortable to pee in a sitting or standing position. Warmth in the form of compresses and hot beverages can help stimulate urination. Running water from a faucet may also trigger the patient to pee. IF the patient cannot void, the bladder should be scanned and catheterization may be necessary.

The client you are taking care of has just been diagnosed with nephrolithiasis. Upon assessment, which priority question should the nurse ask the client? A) Have you seen any blood in your urine? B) Are you have any pain? C) What is your typical diet? D) Have you had any burning pea?

Answer: D. This question assesses for the possibility of developing an infection, a complication of nephrolithiasis (kidney stones). Pain and hematuria would be expected in this patient. Diet can be helpful in preventing kidney stone formation, but it is not a priority question.

Which problem constitutes a medical emergency?

Anuria

A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns?

Arise slowly and call for assistance when ambulating." Captopril can cause severe hypotension during and after the procedure, so the client should be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension.

The nurse is preparing a client scheduled for an intravenous pyelogram (IVP). The nurse should take important action before the test? Administer a sedative. Encourage fluid intake. Ask about allergies to iodine or shellfish. Administer an oral preparation of radiopaque dye.

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

The nurse has a prescription to collect a 24-hour urine specimen from a client. The unlicensed assistive personnel (UAP) has been instructed on the collection technique. Which action by the UAP demonstrates the UAP needs further teaching? Places the specimen on ice Discards a urine specimen collected at the start time Asks the client to void, save the specimen, and note the start time Asks the client to save a sample voided at the end of the collection time

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

A male client has a history of urinary tract infections due to urinary retention. Which intervention should the nurse implement to decrease the risk of infection? Assist the client to stand for voiding. Withhold oral fluids after 6:00 pm daily. Ask the client to take his temperature daily. Teach the client to wash his hands properly.

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

When assessing a patient with a urinary tract infection, where would the nurse percuss to assess for possible pyelonephritis?

At the Costovertebral angle (CVA) (on back/flank between the twelfth rib and the vertebral column). Tenderness with percussion suggests pyelonephritis or polycystic kidney disease.

The nurse is preparing a subcutaneous dose of bethanechol chloride prescribed for a client with urinary retention. Before giving the dose, the nurse checks to see that which medication is available on the emergency cart? Vitamin K Acetylcysteine Atropine sulfate Protamine sulfate

Atropine sulfate Rationale: Administration of bethanechol chloride could result in cholinergic overdose. The antidote is atropine sulfate (an anticholinergic), which should be readily available for use if overdose occurs. Acetylcysteine is the antidote for acetaminophen overdose. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin.

Which of the following terms did note a patient's inability to void even though the kidneys are producing urine that enters the bladder? A) Urgency B) Retention C)Oliguria D)Dysuria

B) Retention Urgency is a strong desire to void. Oliguria is scanty or greatly diminished amount of urine voided in a given time. Dysuria is difficulty urinating

A patient has a nursing diagnoses of in paired urinary illumination related to maturational enuresis. You recognize that your patient Is which of the following? A) An older adult that is 65 years of age is incontinent B) a child older than four years of age who has an voluntary urination C) A 12-month-old child who is in voluntary urination D) A patient with Neurological damage resulting in bladder dysfunction

B) a child older than four years of age who has an voluntary urination Maturational Enuresis Is in voluntary urination after an age when content should be present. A 12-month-old child is not expected to be continent, and Incontinence and neurological damage are not maturational problems

After surgery, Ms.Young is having difficultly voiding. Which nursing action would most likely lead to an increased difficulty with voiding? A)Pouring warm water over Ms.Young's fingers B)Having Ms.Young ignore the urge to void until her bladder is full C)Using a warm bedpan when MS.Young feels the urge to void D)Stroking Ms.Young's leg or thigh

B)Having Ms.Young ignore the urge to void until her bladder is full Ignoring the urge to void makes urination even more difficult and should be avoided. The other actives are all recommend nursing actions to help promotes urination.

When collecting a urine specimen for routine urinalysis from a "PT", the nurse must keep in mind which of the following? A)A sterile specimen is required for collection B)Results may be altered of a sample if left standing at room temperature for a long time C)The external meatus requires cleaning with antiseptic soap and water before voiding D)A clean-catch midstream specimen is necessary

B)Results may be altered of a sample if left standing at room temperature for a long time Urine chemistry it altered after urine stands at room temperature for a long period of time. For a routine urinalysis, a clean specimen is adequate. The external meatus does not need to be cleaned with an antiseptic, as is required for a clean-catch midstream specimen

The nurse is caring for the client with epididymitis. Which treatment modalities should be implemented? Select all that apply. Bed rest Sitz bath Antibiotics Heating pad Scrotal elevation

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

After a renal biopsy, the client complains of pain at the biopsy site, which radiates to the front of the abdomen. Which would this indicate? Bleeding Infection Renal colic Normal, expected pain

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

A client is admitted to the surgical nursing unit following transurethral resection of the prostate (TURP) for benign prostatic hypertrophy. The client has a bladder irrigation infusing, and output is light cherry colored. The blood pressure is 134/82 mm Hg, the pulse is 84 beats per minute, and the client is afebrile with a respiratory rate of 18 breaths per minute. The licensed practical nurse (LPN) assisting in caring for the client collects assessment data 1 hour after admission to the nursing unit. The LPN notifies the registered nurse (RN) if which is noted on data collection? Red urine Pain-related to bladder spasms Urinary output of 200 mL greater than intake Blood pressure of 102/50 mm Hg, pulse 110 beats per minute

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

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

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

A client arrives at the ambulatory care clinic with low abdominal pain. A routine urine specimen reveals hematuria. The client does not have a fever. The nurse should next ask the client about history of which condition? Pyelonephritis Glomerulonephritis Renal cancer in the client's family Blow or trauma to the bladder or abdomen

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

A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. Which are the signs/symptoms of transurethral resection (TUR) syndrome? Tachycardia and diarrhea Bradycardia and confusion Increased urinary output and anemia Decreased urinary output and bladder spasms

Bradycardia and confusion TURP syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

Miss Jones is alert, ambulatory, older nursing home resident, who frequently has difficulty making it to the bathroom in time. The nurse planning her care is aware of the following? A) Incontinence is to be expected and a woman of Mrs Jones age. B)One of every 10 nursing home residents is incontinent C) Keagle exercises performed at regular intervals throughout the day maybe helpful D) An indwelling catheter should be inserted as soon as possible

C) Keagle exercises performed at regular intervals throughout the day maybe helpful Keagle exercises may help "pt" Regain control of the micturition process. Incontinence is not a normal consequence of aging, And at least half of nursing home residents may be incontinent. An indwelling catheter is the last choice of treatment

A patient taking Phenazopyridine (pyridium, a urinary track analgesic) Should be cautioned that her year and may change to what color? A) Pale yellow B) Green C) Orange red D) Brown

C) Orange red Pyridium Is noted for turning the year and orange red, and the patient needs to be aware of this

Mr. Bales is 60 years old and alert. He is timid and reluctant to talk about his urinary retention problem. Which part of this plan could create stress for Mr. Bales and possibly increase his inability to urinate? A) Assisting him in assuming his normal voiding position B) Pulling curtains around him to provide privacy during voiding C) Staying with him while voiding D) Offering a urinal or a regular schedule

C) Staying with him while voiding Mr. Bales will probably be embarrassed if the nurse remains with him as he attempts to void and is more likely to have difficulty voiding

Nursing care for a "PT" with an indwelling catheter includes which of the following A)Irrigation of the catheter with a 30mL of normal saline solution every 4hours B)Disconnecting and reconnecting the drainage system quickly to obtain a urine sample C)Encourage a generous fluid intake of not contraindicate by the "PT" conduction. D)Telling the "PT" that burning and irritation are normal, subsiding within a few days

C)Encourage a generous fluid intake of not contraindicate by the "PT" conduction. A generous fluid intake promotes healthy urinary tract function. Irrigation may introduce bacteria into the urinary tract and is not routinely ordered. The drainage system should never be disconnected to obtain a sample, this could allow bacteria to enter into the urinary tract. Burning and irritation may indicate that an infection is present and should never be disregarded.

The nurse is caring for a client who received a recent kidney transplant. Besides actual rejection of the transplant, which are some of the most important complications this client is at risk for? Select all that apply. Colitis Malignancies Respiratory disease Cardiovascular disease Susceptibility to infection Corticosteroid-related complications

Cardiovascular disease Susceptibility to infection Corticosteroid-related complications Malignancies Rationale: Rejection is one of the major problems of kidney transplant recipients. Besides recurrence of renal disease, kidney transplant clients are also at risk for malignancies, a cardiovascular disease caused by atherosclerotic vascular disease, infection, and corticosteroid-related complications. Incidences of infection usually occur within the first month of transplant.

The nurse must ambulate a client who has a nephrostomy tube attached to a drainage bag. The nurse plans to do this most safely and effectively by performing which action? Changing the drainage bag to a leg collection bag Hanging the drainage bag from a walker while ambulating Tying the drainage bag to the client's waist while ambulating Asking the client to hold the drainage bag lower than the level of the bladder

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

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply. Contact the nephrologist. Check the level of the drainage bag. Reposition the client to his or her side. Place the client in good body alignment. Check the peritoneal dialysis system for kinks. Increase the flow rate of the peritoneal dialysis solution.

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

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

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

A client receiving nitrofurantoin calls the primary health care provider's office complaining of side effects related to the medication. Which side effect indicates the need to stop treatment with this medication? Nausea Diarrhea Anorexia Chest pain

Chest pain Rationale: Gastrointestinal (GI) effects are the most frequent adverse reactions to this medication and can be minimized by administering the medication with milk or meals. Pulmonary reactions manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on the x-ray should indicate the need to stop the treatment. These symptoms resolve in 2 to 4 days following discontinuation of this medication.

A client is seen in the health care clinic and acute pyelonephritis is suspected. The nurse reviews the client's record and should expect to note which associated signs and symptoms are documented? Select all that apply. Chills Low-grade fever Pale, dilute urine General weakness Nausea and vomiting Flank pain on the unaffected side

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

A client's kidneys are retaining larger than normal amounts of sodium. The nurse is reviewing the most recent laboratory data. The nurse should expect which laboratory value to be abnormal since the client is retaining sodium? Calcium 8.8 mg/dL Chloride 112 mEq/L Potassium 4.1 mEq/L Bicarbonate 23 mEq/L

Chloride 112 mEq/L Sodium is a cation. When sodium retention is increased, the kidney also has increased reabsorption of chloride and bicarbonate, which are anions. The chloride level is elevated whereas the bicarbonate level is normal. Options 1 and 3 are incorrect because calcium and potassium are cations.

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

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

Chronic kidney disease

Chronic kidney disease is a condition in which the kidneys are unable to excrete wastes, concentrate urine, and conserve electrolytes. A component of treatment is hemodialysis. Hemodialysis requires the use of a dialyzer that is connected to a shunt, fistula, or other device that allows access to the client's bloodstream. The client's blood is transported from the body through the dialyzer, which removes wastes and excess fluids from the blood. The cleaned blood is then returned to the client's body. You will learn about chronic kidney disease and hemodialysis in your medical-surgical nursing course when you study renal disorders.

Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter?

Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine. Clamping the tubing, attaching a syringe to the specimen, and withdrawing at least 5 mL of urine is the correct technique for obtaining a sterile urine specimen from the client with a Foley catheter.

A female client has a prescription for a clean-catch urine culture. After providing a sterile specimen cup to the client, the nurse should give which instruction so that the specimen is collected properly? Void into the container saving the full amount of urine. Cleanse the labia using cleansing towels, position the container, and begin to void. Wipe the labia front to back with toilet paper and void into the sterile specimen container. Cleanse the labia using cleansing towels, begin to void into the toilet, and then collect the specimen.

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

The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day?

Client with hyperparathyroidism A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones; this client should remain hydrated.

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

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

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

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

A client has epididymitis as a complication of a urinary tract infection (UTI). The nurse is giving the client instructions to prevent a recurrence. The nurse determines that the client needs further teaching if the client states the intention to do which? Drink an increased amount of fluids. Limit the force of the stream during voiding. Continue to take antibiotics until all symptoms are gone. Use condoms to eliminate risks associated with chlamydia and gonorrhea.

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

cranberry juice effect on UTIs

Cranberry juice is excreted as hippuric acid, which helps acidify the urine (decrease the pH) and inhibit bacterial growth. Although bacterial growth may be inhibited, bacteria are not destroyed. Glomerular filtration is unaffected by cranberry juice. Cranberry juice acidifies the urine and may increase the burning sensation associated with urination when an infection is present.

Data must be collected to evaluate the effectiveness of a plan to reduce urinary incontinence and a older adult patient. Of the information below, which is the least important for the evaluation process? A) The incontinence pattern B) State of physical mobility C) Medications being taken D) Age of patient

D) Age of patient Incontinence is not a natural consequence of the aging process. All the other factors are necessary information for the plan of care.

Which of the following would the nurse incorporate into the teaching plan for a "PT" to promote healthy urinary function? A)Drinking more then 2,000mL per day will cause fluid retention B)The healthy adult should drink four to six 8oz glasses of water per day C)Children need fewer reminds to drink because of a greater thirst sensitivity D)Caffeine-containing beverages should be monitored to prevent excess intake

D)Caffeine-containing beverages should be monitored to prevent excess intake Caffeine intake should be limited because it is irritating to the bladder mucosa. It is recommend that the healthy adult drink 8-10 8 oz glasses of water. Unless a disease process is present

Mr.Chang, a hospitalized "PT" with diabetes mellitus, has developed a UTI. He is 80 years old and has an indwelling catheter in place. Which factor is most likely the cause of the UTI? A)The close proximity of the male genitalia to the rectum B)Decreased immunity C)A high urine glucose level D)The indwelling urinary catheter

D)The indwelling urinary catheter Most UTI in hospitalized "PT" are caused by the presence of indwelling catheters. Additional, although less significant, causes of UTI include a decrease in immunity elder people in the presence of glucose in the urine, Essena diabetes.

The most comon cause of renal failure is:

DM

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

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

Which patient report indicates that phenazopyridine hydrochloride (Pyridium) is being effective?

Decrease in buring

Which age-related change can cause nocturia?

Decreased ability to concentrate urine Nocturia may result from decreased kidney-concentrating ability associated with aging.

The nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. To determine if the client is currently experiencing an exacerbation of BPH, the nurse should ask the client about the presence of which early symptom? Nocturia Urinary retention Urge incontinence Decreased force in the stream of urine

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

The nurse is reviewing the client's record and notes that the health care provider has documented that the client has a renal disorder. Which laboratory results would indicate a decrease in renal function? Select all that apply. Elevated serum creatinine level Elevated thrombocyte cell count Decreased red blood cell (RBC) count Decreased white blood cell (WBC) count Elevated blood urea nitrogen (BUN) level

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

A client is scheduled for intravenous pyelography (IVP). Which priority nursing action should the nurse take? Restrict fluids. Administer a sedative. Determine if there is a history of allergies. Administer an oral preparation of radiopaque dye.

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

The nurse notes that a client's urinalysis report contains a notation of positive red blood cells (RBCs). The nurse interprets that this finding is unrelated to which is an item is part of the client's medical record? Diabetes mellitus History of kidney stones Concurrent anticoagulant therapy History of recent blow to the right flank

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

A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder? Hypoglycemia Diabetes mellitus Coronary artery disease Orthostatic hypotension

Diabetes mellitus Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder noted on the client's record should the nurse identify as a risk factor for this disorder? Hypoglycemia Diabetes mellitus Coronary artery disease Orthostatic hypotension

Diabetes mellitus Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

continuous ambulatory peritoneal dialysis (CAPD) treatment

Dialysate is introduced into the peritoneal cavity, where fluids, electrolytes, and wastes are exchanged through the peritoneal membrane. The client can dialyze alone in any location without the need for machinery and continuous technical supervision. Hemodialysis is not necessary with this procedure. Each exchange involves 2 to 3 L of dialysate intraperitoneally, not interperitoneally, for a specified time (dwell time) before being drained.

The nurse performs a catheterization immediately after the patient voids and obtains 30 ml residual urine. The next step would be to:

Document the procedure with outcome data.

A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? (Select all that apply.)

Drink at least 3 liters of fluids every day." Correct "Take this drug with 8 ounces of water." Correct "You will need to take all of this drug to get the benefits." C

The nurse is speaking with a client who underwent a minimally invasive procedure treatment for recurrent urolithiasis. Which instructions are appropriate to reinforce in the teaching plan? Select all that apply. Drink at least 3000 mL of fluid each day. Expect some intermittent hematuria to occur. Take acetaminophen if chills and fever occur. Complete the full course of prescribed antibiotics. Filter urine and collect any stones to take to the urological primary health care provider.

Drink at least 3000 mL of fluid each day. Complete the full course of prescribed antibiotics. Filter urine and collect any stones to take to the urological health care provider. Rationale: Kidney stones, or urolithiasis, are often treated with minimally invasive surgical procedures that may include placement of a stent. The stent allows passage of the stone without further irritation of the ureter. Clients should drink at least 3 L of fluid to promote passage of the stone and prevent future stone formation. Filtering the urine and retrieving the stone allows stone analysis. Further preventive treatment is prescribed based on the type of stone. It is important that clients complete the course of prescribed antibiotics to prevent infection after the procedure. Clients should contact the urological primary health care provider if hematuria or fever occur and not self-treat.

A client has been prescribed allopurinol. The nurse reinforces which information concerning the administration of the medication? Take the medication 1 hour before eating. Drink at least 8 glasses of fluid every day. Put ice on the upper and lower lips if they swell. Use an antihistamine lotion if an itchy rash develops.

Drink at least 8 glasses of fluid every day. Rationale: Clients taking allopurinol are encouraged to drink 2000 to 3000 mL of fluid a day to prevent the formation of crystals in the urine. Allopurinol is to be given with milk or immediately following meals. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, the primary health care provider should be notified because this may indicate hypersensitivity.

An older adult client diagnosed with stress incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect? (Select all that apply.)

Dry mouth Increased intraocular pressure Correct Constipation Correct Oxybutynin is an anticholinergic/antispasmodic. Side effects include dry mouth, urinary retention, constipation, and risk for increased intraocular pressure with the potential to make glaucoma worse.

The nurse suspects the client has a urinary tract infection (UTI). Which signs/symptoms suggest a UTI? Select all that apply. Dysuria Hematuria Frequency Flank pain Polydipsia Cloudy urine

Dysuria Hematuria Frequency Flank pain Cloudy urine.

The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? (Select all that apply.)

Dysuria Correct Frequency Correct Nocturia Correct Urgency

A male client has a tentative diagnosis of urethritis. The nurse collects data from the client knowing that which are signs/symptoms of this disorder? Hematuria and pyuria Dysuria and proteinuria Hematuria and urgency Dysuria and penile discharge

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

A client who underwent a kidney transplant 6 months earlier is seen in the clinic for a routine monthly appointment. The nurse reviews how the client has been doing and observes for signs/symptoms of acute rejection. Which signs/symptoms suggest acute rejection of the transplanted kidney? Select all that apply. Oliguria Swelling of the lips Tachypnea with wheezing Elevation of blood pressure over baseline Abdominal tenderness on the side of the kidney transplant Elevation of serum blood urea nitrogen (BUN) and creatinine

Elevation of blood pressure over baseline Abdominal tenderness on the side of the kidney transplant. Elevation of serum blood urea nitrogen (BUN) and creatinine. Oliguria Rationale: Acute rejection occurs 1 week to 2 years after a kidney transplant. Antibodies and white blood cells cause inflammation and vasculitis within the transplanted organ. Diagnosis is made by laboratory tests demonstrating impaired function of the organ and by changes in the donated organs found upon biopsy. Acute rejection is treated with increased immunosuppressant medication. Signs/symptoms of acute rejection of a transplanted kidney include abdominal tenderness over the transplanted kidney and decrease in organ function. Signs of decreased kidney function include oliguria (urine output between 100 and 400 mL in 24 hours), elevation in blood pressure, and elevation in the BUN and creatinine levels. Swelling of the lips is a sign of angioedema that occurs with an acute hypersensitivity reaction or anaphylaxis. Tachypnea (rapid breathing) with wheezing, the sound resulting from airway inflammation, occurs with many types of respiratory distress. It is not specific to acute rejection in a transplanted kidney.

A client diagnosed with stress incontinence is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug?

Encourage increased fluids. Correct Increase fiber intake. Correct Use hard candy for dry mouth. Anticholinergics cause constipation; increasing fluids and fiber intake will help with this problem.

Reason the dialysis solution is warmed to body temperature before it is instilled into the peritoneal cavity

Encouraging the removal of serum urea by preventing constriction of peritoneal blood vessels promotes vasodilation so that urea, a large-molecular substance, is shifted from the body into the dialyzing solution. Heat does not affect the shift of potassium into the cells. The removal of metabolic wastes is affected in kidney failure, not the metabolic processes. Excess serum potassium is removed by dialyzing with a potassium-free solution, not by heat.

The nurse making rounds discovers that there is no urine drainage from a postoperative patient's Foley catheter. The first nursing action is to:

Ensure patency

A client has an arteriovenous (AV) shunt in place for hemodialysis. The nurse should take which priority precaution, knowing that bleeding is a potential complication? Observe the site once per shift. Check the shunt for the presence of a bruit and thrill. Check the results of blood tests as they are prescribed. Ensure that small clamps are attached to the AV shunt dressing.

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

The nurse recognizes tha the most common causative organism in pyelonephritis is:

Escherichia coli.

A client with a urinary tract infection with dysuria is given a prescription for phenazopyridine hydrochloride for symptom relief. Which should the nurse reinforce instructing the client about this medication? Take the medication at bedtime. Take the medication 1 hour before meals. Expect the urine to become reddish-orange. Notify the primary health care provider if a headache occurs.

Expect the urine to become reddish orange. Rationale: Phenazopyridine hydrochloride is a urinary tract analgesic with no antimicrobial properties. It can cause a reddish orange discoloration of urine and tears and can stain undergarments and soft contact lenses. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant notifying the primary health care provider.

A client newly diagnosed with renal failure will be receiving peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is appropriate? Stop the dialysis. Slow the infusion. Decrease the amount to be infused. Explain that the pain will subside after the first few exchanges.

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

The nurse is collecting data from a client with epididymitis. The nurse should expect to note which signs and symptoms of this problem? Diarrhea, groin pain, and scrotal edema Fever, diarrhea, groin pain, and ecchymosis Fever, nausea and vomiting, and painful scrotal edema Nausea and vomiting, and scrotal edema with ecchymosis

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

The nurse is caring for a client with epididymitis. The nurse anticipates noting which group of findings on data collection? Diarrhea, groin pain, and scrotal edema Fever, diarrhea, groin pain, and ecchymosis Fever, nausea and vomiting, and painful scrotal edema Nausea, vomiting, and scrotal edema with widespread ecchymosis

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

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

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

The primary function of the kidney is:

Filtration of water and blood products

hemodialysis

Following hemodialysis the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable and for comparison to predialysis measurements. The client's blood pressure and weight are expected to be reduced as a result of fluid removal. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.

The nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the nurse the reason for a renal biopsy when other tests such as computed tomography (CT) and ultrasound are available. In formulating a response, the nurse incorporates the knowledge that a renal biopsy serves which purpose? Provides an outline of the renal vascular system Determines if the mass is growing rapidly or slowly Gives specific cytological information about the lesion Helps differentiate between a solid mass and a fluid-filled cyst

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

Propantheline bromide is prescribed for a client with bladder spasms. Which disorder, noted in the client's record, alerts the nurse to question the prescription for this medication? Glaucoma Myxedema Hypothyroidism Coronary artery disease

Glaucoma

As the nursse reviews a diet plan with a patient with diabetes mellitus and renal insufficiency, the patient states that with diabetes and renal failure there is nothing that is good to eat. The patient says,"I am going to eat what I want; I'm goingto die anyway!" The best nursing diagnosis for this patient is:

Grieving, related to actual and perceived losses.

A client with new-onset renal failure is having a first hemodialysis treatment. The nurse is especially careful to monitor the client for which signs/symptoms after the dialysis treatment? Hypertension, tachycardia, and fever Hypotension, bradycardia, and hypothermia Restlessness, irritability, and generalized weakness Headache, decreasing level of consciousness, and seizures

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

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

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

The nurse is reviewing the history and physical examination of a client diagnosed with polycystic kidney disease. Which data should the nurse expect to see? Select all that apply. Hematuria Flank or lumbar pain Client age 20 years old Palpable abdominal mass History of urinary tract infections

Hematuria Flank or lumbar pain History of urinary tract infections In polycystic kidney disease the client is generally asymptomatic under 30 to 40 years of age. This disorder begins with various types of pain: dull, aching abdominal, lower back, or flank pain (or it begins with colicky pain that begins abruptly). Characteristic symptoms also include hematuria, urinary tract infection, kidney stones, and obstructive uropathy with anuria.

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

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

The nurse is reviewing the laboratory results and physical examination of a client with acute glomerulonephritis. Which data should the nurse see? Select all that apply. Polyuria Hematuria Proteinuria Hypotension Periorbital edema Decreased specific gravity

Hematuria Proteinuria Periorbital edema A client with acute glomerulonephritis usually becomes suddenly ill with fever, chills, flank pain, widespread edema, puffiness around the eyes, visual disturbances, and marked hypertension. Diagnosis is based on physical findings. The presence of marked hypertension is a late manifestation. Diagnostic tests include urinalysis, creatinine, blood urea nitrogen (BUN), and complete blood count (CBC). The urine may be smoky, will contain red blood cells and protein, output decreased and will have an increased specific gravity. Serum creatinine and BUN levels rise above normal. If the condition is severe, hematocrit and hemoglobin will indicate anemia.

The nurse is assigned to care for a client who has returned to the nursing unit following left nephrectomy. The nurse places the highest priority on monitoring which data? Hourly urine output Oxygen saturation levels Ability to turn side to side Tolerance for sips of clear liquids

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

Which conditions place the client at risk for developing acute postrenal failure? Dehydration Hydronephrosis Rhabdomyolysis Glomerulonephritis

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

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

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

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

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

The nurse is admitting a client with chronic kidney disease (CKD) to the nursing unit. Does the nurse monitor the client for which frequent cardiovascular sign that occurs in CKD? Hypertension Hypotension Tachycardia Bradycardia

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

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?

I take over-the-counter naproxen (Aleve) twice a day for joint pain." Because a high risk for bleeding during ESWL has been noted, clients should not take nonsteroidal anti-inflammatory drugs before this procedure; the ESWL will have to be rescheduled for this client.

A client with chlamydial infection has received instructions on self-care and prevention of further infection. The nurse determines that the client needs further teaching if the client states which? I will use latex condoms to prevent disease transmission. I will return to the clinic as requested for a follow-up culture in 1 week. I will use an antibiotic prophylactically to prevent symptoms of Chlamydia. I will reduce the chance of reinfection by limiting the number of sexual partners.

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

The nurse is caring for a client diagnosed with Parkinson's disease who has prescribed benztropine mesylate daily. The nurse reinforces instructions to both the client and the spouse regarding the side effects of this medication and the need to report which side effect if it occurs? Inability to urinate Decreased appetite Shuffling, unsteady gait Irregular bowel movements

Inability to urinate Rationale: Urinary retention is a side effect of benztropine mesylate. The nurse should instruct the client or spouse about the need to monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts, and overflow incontinence. Options 2, 3, and 4 are unrelated to the use of this medication.

The nurse is evaluating the data results of a client with sepsis and acute kidney injury with related azotemia and oliguria. Which are the primary features of azotemia and oliguria? Select all that apply. Vasoconstriction Increase in cardiac output Increase in serum creatinine Increase in blood urea nitrogen (BUN) Urine output less than 0.5 mL/kg/hour Glomerular filtration rate (GFR) of 80 mL/min

Increase in serum creatinine Increase in blood urea nitrogen (BUN) Urine output less than 0.5 mL/kg/hour Rationale: Azotemia refers to an increase in serum creatinine and BUN, and oliguria is defined as a urine output less than 0.5 mL/kg/hour. Acute kidney injury with a decrease in GFR is often due to sepsis with related sepsis features. Vasodilation and a decrease in cardiac output occur with sepsis.

The nurse is providing dietary instructions to a client with renal calculi, and the laboratory analysis has revealed that the calculus is composed of uric acid. The nurse tells the client that it would be helpful to make which dietary changes? Increase intake of seafood in the diet. Increase intake of legumes in the diet. Include organ meat-type foods in the diet. Increase intake of cranberries and citrus fruits.

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

the client has undergone transurethral resection of the prostate (TURP) a few hours ago to treat symptoms of benign prostatic hypertrophy. The nurse notes bright red blood and clots in the urinary catheter drainage bag. Which response should be the nurse's initial action? Contact the client's surgeon to report the bleeding. Remove a small amount of fluid from the retention bulb. Increase the flow rate of the continuous bladder irrigation. Remove the indwelling catheter and encourage increased oral fluids.

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

Which urinary assessment information for a client indicates the potential need for increased fluids?

Increased blood urea nitrogen Increased blood urea nitrogen can indicate dehydration. Increased creatinine indicates kidney impairment.

The nurse is caring for a hemodialysis client who has been receiving treatment for several years and is not a candidate for kidney transplant. The nurse knows that the majority of deaths of hemodialysis clients are related to which causes? Select all that apply. Stroke Trauma Malignancies Infectious complications Myocardial infarction (MI) Peptic ulcer disease (PUD)

Infectious complications. Stroke. Myocardial infarction (MI). Rationale: The majority of deaths of hemodialysis clients are related to cardiovascular events such as stroke and myocardial infarction and infectious complications.

To determine glomerular filtration rate for a patient with chronic renal disease, the nurse plans to:

Initate a 24-hour collection of the patient's urine.

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

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

The nurse is reinforcing dietary instructions to a client diagnosed with acute glomerulonephritis. The nurse determines that the client understands the information presented if the client states the intention to do which action? Limit protein intake. Increase intake of high-fiber foods. Limit intake of magnesium-rich foods. Increase intake of potassium-rich foods.

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

When caring for a client with uremia, the nurse assesses for which symptom?

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

When calculating actual urinary output during continous bladder irrigations, the nurse would:

Measure the total output and deduct the amount of irrigation solution used.

A client with end-stage kidney disease (ESKD) undergoes a surgical procedure to create an arteriovenous fistula for hemodialysis in the upper extremity. The nurse should take which actions when the client returns from surgery? Select all that apply. Monitor pain and administer analgesics. Monitor bleeding and swelling at the site. Monitor for circulation above the fistula site. Measure the blood pressure in the arm every hour. Check for audible bruit and palpable thrill at the fistula site.

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

Which actions are included in the nursing care of the client undergoing peritoneal dialysis? Select all that apply Monitor vital signs including temperature. Weigh the client before and after dialysis. Check color and volume of dialysate solution. Instruct the client to remain supine until the dialysate is drained. Maintain aseptic technique when accessing the peritoneal catheter.

Monitor vital signs including temperature. Weigh the client before and after dialysis. Check color and volume of dialysate solution. Maintain aseptic technique when accessing the peritoneal catheter.

Careful preparation of the patient for an IVP is necessary. Nursing interventions would include:

NPO for about 12 hours before examination. Giving prescribed bowel prep. Instructing patient concerning IVP.

Which observations by the nurse caring for clients on a hospital medical-surgical unit should be immediately reported to the health care provider? Select all that apply. Pink-colored urine voided by a client admitted for urolithiasis Mucous shreds noted in the urine of a client who has an ileal conduit New confused mental state and pulse rate of 106 beats per minute in a 72-year-old client No urinary output for 24 hours in a client who has hemodialysis 3 times weekly A volume of 105 mL of urine over 4 hours in the collection bag of a 1-day postoperative client

New confused mental state and pulse rate of 106 beats per minute in a 72-year-old client. A volume of 105 mL of urine over 4 hours in the collection bag of a 1-day postoperative client Rationale: The nurse should report the new confusion and slightly tachycardic condition of the older client because these data suggest symptoms of a urinary tract infection requiring antibiotic therapy. The nurse should report the low urinary output in the postoperative client so interventions can be prescribed to diagnose and/or avoid acute kidney injury (AKI). Slight hematuria is an expected finding in a client with urolithiasis (renal stones). Urine with mucous shreds is an expected finding in a client with an ileal conduit because the portion of ileum that functions as the "bladder" is bowel mucosa. Some clients who receive routine hemodialysis produce small amounts of urine but others do not urinate because the kidney function is now done through hemodialysis.

The nurse is evaluating the assessment of a client's arteriovenous fistula being used for hemodialysis. Which findings would prompt the nurse to notify the health care provider immediately? Select all that apply. No thrill palpated at the fistula site No bruit auscultated at the fistula site Dialysis treatment lasting longer than 3 hours Absent pulse distal to the arteriovenous fistula Fistula site transparent dressing last changed 8 days ago

No thrill palpated at fistula site Absent pulse distal to the arteriovenous fistula No bruit auscultated at the fistula site Rationale: The primary health care provider must be notified immediately when there is no thrill or bruit assessed at the fistula site or if there is no pulse noted distal to the site. This indicates a clot. Hemodialysis treatments usually last about 3 to 4 hours. Dressings to the site are changed every 7 days, but it is not necessary to immediately notify the primary health care provider if it has not been changed in 8 days.

The priority short-term goal for disorders of the urinary system is:

Normal patterns of urinary elimation

A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the provider visited the client the day before. What action does the nurse take?

Notifies the department and the provider he 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 client is admitted to the emergency department following a fall from a horse. The health care provider (HCP) prescribes the insertion of an indwelling urinary catheter. The nurse notes blood at the urinary meatus while preparing for the procedure. Which action should the nurse take? Use a smaller catheter. Notify the primary health care provider. Administer pain medication before inserting the catheter. Use extra povidone-iodine solution in cleansing the meatus.

Notify the health care provider. The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing.

the nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first?

Notify the health care provider. Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. The nurse should monitor urine output and notify the health care provider of obvious blood clots or a decreased or absent urine output.

A client hospitalized with urolithiasis has a sudden significant decrease in urine output. The nurse should perform which action? Notify the registered nurse. Obtain a urine-specific gravity. Tell the client to drink increased fluids. Replace the Foley catheter with a new one.

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

The nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that the drainage from the outflow catheter is cloudy. The nurse notifies the registered nurse and plans to take which action? Stop the peritoneal dialysis. Institute hemodialysis temporarily. Obtain a culture and sensitivity of the drainage. Add antibiotics to the next several dialysis bags.

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

The client with chronic kidney disease who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). When should the nurse plan to administer this medication? During dialysis Just before dialysis The day after dialysis On return from dialysis

On return from dialysis Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and from having the medication removed from the bloodstream by dialysis

The nurse is reinforcing instructions to a client with renal calculi about how to change the urine pH to be more acidic. The nurse determines that the client needs further teaching if the client states which type of drink is acceptable? Prune juice Lemon juice Orange juice Cranberry juice

Orange juice Orange juice should be avoided because it will make the urine more alkaline. Changing the urine pH can prevent or reduce the incidence of renal calculi. Ascorbic acid or dietary modifications (e.g., cranberry juice, prunes, or lemon juice) can be used to acidify urine.

The nurse is urging a client to cough and deep breathe after a nephrectomy. The client tells the nurse, "That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is likely a result of which contributing factor? A stress response to the ordeal of surgery A latent fear of needing dialysis if the surgery is unsuccessful Effects of circulating metabolites that have not been excreted by the remaining kidney Pain that is intensified because the location of the incision is near the diaphragm

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

The nurse is admitting a client to the nursing unit who has returned from the postanesthesia care unit following a prostatectomy. The client has a three-way Foley catheter with continuous bladder irrigation. The nurse should maintain the flow rate of the continuous bladder infusion to maintain which urine output characteristic? Red Colorless Yellow with small clots Pale yellow or slightly pink

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

A hemodialysis client with a left-arm fistula is at risk for arterial steal syndrome. The nurse monitors this client for which signs/symptoms of this disorder? Edema and purpura of the left arm Warmth, redness, and pain in the left hand Aching pain, pallor, and edema of the left arm Pallor, diminished pulse, and pain in the left hand

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

The nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic kidney disease. Which finding indicates that the fistula is patent? Palpation of a thrill over the fistula Presence of a radial pulse in the left wrist Absence of a bruit on auscultation of the fistula Capillary refill less than 3 seconds in the nail beds of the left hand

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

A client who had a prostatectomy has learned perineal exercises to gain control of the urinary sphincter. The nurse determines that the client needs further teaching if the client states that he will perform which action as part of these exercises? Perform the Valsalva maneuver. Tighten the muscles as if trying to prevent urination. Contract the abdominal, gluteal, and perineal muscles. Tighten the rectal sphincter while relaxing abdominal muscles.

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

The nursing care plan includes teaching the patient Kegel exercises. The nurse teaches the patient to alternately tighten and relax which group of muscles?

Perineal floor

The collection of subjective and objective data for the patient with acute glomerulonephritis could include:

Periorbital edema. Anorexia. Frankly sanguineous urine.

Which nursing activity illustrates proper aseptic technique during catheter care?

Positioning the collection bag below the height of the bladder

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

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

The nurse prepares to administer sodium polystyrene sulfonate to a client with chronic kidney disease for which laboratory abnormality? Sodium level of 152 mEq/L Creatinine level of 1.0 mg/dL Ammonia level of 30 mcg/dL Potassium level of 7.2 mEq/L

Potassium level of 7.2 mEq/L Rationale: Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releases sodium ions in exchange for primarily potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration.

A client with acute kidney injury (AKI) has been treated with sodium polystyrene sulfonate (Kayexalate) by mouth. The nurse evaluates this therapy as effective if which value is noted on follow-up laboratory testing? Calcium, 9.8 mg/dL Sodium, 142 mEq/L Potassium, 4.9 mEq/L Phosphorus, 3.9 mg/dL

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

The teaching priority for the patient with acute renal failure is:

Prevention of infection

A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client?

Privacy The nurse should provide privacy, assistance, and voiding stimulants, such as warm water over the perineum, as needed, for the client with urinary problems. Increased oral fluids and IV fluids would exacerbate the client's problem.

dietary instructions to a client who is being treated with continuous ambulatory peritoneal dialysis (CAPD)

Proteins eaten should be high quality to replace those lost during dialysis. A high-calorie diet is encouraged. Usually there is a modest restriction of fluids when the client is on dialysis. Usually there is a restriction of high-potassium foods when the client is on dialysis.

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

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

The nurse caring for a client taking tamsulosin determines that which finding indicates the need for follow-up? Vertigo Nasal congestion Blood pressure of 125/80 mm Hg Pulse rate of 120 beats per minute

Pulse rate of 120 beats per minute Rationale: Tamsulosin is classified as benign prostatic hyperplasia agent and acts by relaxing smooth muscle and increasing urinary flow. An adverse effect of this medication is first-dose syncope, which usually occurs within the first 30 to 90 minutes of the initial dose. This is commonly preceded by tachycardia (pulse of 120 to 160 beats per minute). Side effects of this medication include dizziness, drowsiness, nasal congestion, and vertigo.

After renal angiography, the patient assessment priority is the:

Puncture site

Which goal would have priority in planning care of the aging patient with urinary incontinence?

Recognizes the urge to void

When reading the urinalyis report, the nurse recognizes this result as abnormal:

Red Blood Cells, 15-20

A client with acute glomerulonephritis is admitted to the nursing unit. The nurse should plan to do which action immediately on admission? Ambulate the client frequently. Encourage a diet that is high in protein. Monitor the temperature every 2 hours. Remove the water pitcher from the bedside.

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

The goal for peritoneal dialysis is to:

Remove toxins and metabolic waste

What activity would be harmful for the incontinent patient?

Restricting fluid intake

A client, who had experienced significant blood loss in an automobile crash, was admitted to the hospital 2 days earlier. Does the nurse observe the client for which signs/symptoms indicate acute kidney injury (AKI)? Select all that apply. Hematuria Elevated urine specific gravity Severe spasmodic pain radiating to the groin area Rising serum blood urea nitrogen (BUN) and creatinine levels Urine output averaging 25 mL per hour while receiving an intravenous infusion at 150 mL/hour

Rising serum blood urea nitrogen (BUN) and creatinine levels Urine output averaging 25 mL per hour while receiving an intravenous infusion at 150 mL/hour. Elevated urine specific gravity Select all that apply. Rationale: Any condition that interrupts blood flow to the kidneys may cause AKI due to a prerenal etiology. Correcting fluid and blood deficits improves blood flow to the kidneys and prevents or treats AKI. Signs associated with AKI include low urinary output of concentrated urine (elevated specific gravity). The BUN and creatinine rise to levels above normal because the kidneys are not effective in clearing the waste products from the body. Hematuria and spasmodic pain are associated with urolithiasis. Hematuria occurs with multiple renal conditions including cancerous tumors in the urinary system and renal trauma.

The nurse has instructed a patient who is receiving hemodialysis about dietary manageent. Which diet choices by the patient indicate that the teaching has been successful?

Scrambled eggs, English muffin, and apple juice.

A client, on the waiting list for a renal transplant, receives hemodialysis treatment. Which findings indicate to the nurse that the treatment has been effective? Select all that apply. A thrill is palpable in the arteriovenous fistula. The client states he is fatigued and wants to sleep. Serum potassium level is within the normal range. The client's weight is 2 kilograms less than the predialysis weight. Serum blood urea nitrogen (BUN) and creatinine levels are lower than predialysis.

Serum potassium level is within the normal range. The client's weight is 2 kilograms less than predialysis weight. Serum blood urea nitrogen (BUN) and creatinine levels are lower than predialysis. Rationale: The purpose of hemodialysis is to replace the client's kidney function. Hemodialysis removes waste products and excess fluid from the body and attains electrolyte balance. An effective hemodialysis treatment removes fluid resulting in a loss of weight. Body waste products are removed as reflected in a lower serum BUN and creatinine levels. Potassium is excreted by healthy kidneys, so a normal serum potassium level signifies that dialysis treatment is effective. Fatigue and a functioning arteriovenous fistula are normal findings but do not demonstrate that the dialysis treatment was effective in achieving kidney functions. In some clients, the hemodialysis procedure leads to fatigue, and clients prefer to rest after the treatment. A palpable thrill in the arteriovenous fistula signifies that the fistula has not clotted.

renal colic

Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is caused by ureteral distention and smooth muscle spasm; relief from pain is the priority. Although the client is overweight and weight loss is desirable, it is a long-term goal. Although hematuria needs to be monitored, blood loss usually is not massive with ureteral colic. Mild hypertension is not the priority when a client is in severe pain.

A client tells the nurse she completed an educational program to manage her stress incontinence but is now discouraged. Which information from the client indicates the need for further teaching? Select all that apply. She performs the Kegel exercises every other day. She maintains her fluid intake to 3000 mL of fluid daily. She quit drinking coffee with cream but drinks diet cola. She has decreased her caloric and fat intake to lose weight. She has begun an exercise program that includes lifting weights.

She performs the Kegel exercises every other day. She quit drinking coffee with cream but drinks diet cola. She has begun an exercise program that includes lifting weights. Rationale: With stress incontinence, the client loses a small amount of urine involuntarily during activities that increase abdominal pressure such as coughing, jogging, or lifting weights. This is due to weakened pelvic muscles and the inability to tighten the urethra enough to counteract bladder contraction. Kegel exercises in which the woman contracts and relaxes the pelvic muscles to regain muscle tone should be done on a daily basis and may take up to 3 months before yielding positive results. Clients should avoid caffeine and alcohol that stimulate bladder contraction. Diet cola likely contains caffeine. The exercise program involving weight lifting also increases abdominal pressure, leading to incontinence. The client is correct to lose weight (source for increased abdominal pressure) and maintaining adequate fluid intake.

Assessment of the patient with a urinary disorder may be complicated by:

Social taboos surrounding sexuality

A client is diagnosed with polycystic kidney disease, and the nurse provides information to the client about the treatment plan. Does the nurse determine that the client needs further teaching if the client states that which component is part of the treatment plan? Sodium restriction Genetic counseling Increased water intake Antihypertensive medications

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

The nurse is reinforcing dietary instructions to a client who is currently prescribed probenecid. Which food should the nurse encourage the client to continue to eat? Liver Shrimp Spinach Scallops

Spinach Rationale: Probenecid inhibits the reabsorption of uric acid by the kidneys and promotes excretion of uric acid in the urine. Clients taking this medication are instructed to limit excessive purine intake. High-purine foods to avoid or limit include organ meats, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast. Spinach is not a high-purine food.

A male client is diagnosed with urethritis caused by chlamydial infection. The unlicensed assistive personnel (UAP) assigned to the client asks the nurse what measures are necessary to prevent a contraction of the infection during care. Which instruction should the nurse give the UAP? Enteric precautions should be instituted for the client. Gloves and masks should be used when in the client's room. Contact isolation should be initiated because the disease is highly contagious. Standard precautions are sufficient because the infection is transmitted sexually.

Standard precautions are sufficient because the infection is transmitted sexually.

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

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

Renal calculi may result from:

Stasis of urine caused by obstruction or quadriplegia. Infections of urinary tract. Hyperparathyroidism, which causes increase in calcium metabolism.

The certified Wound, Ostomy, and Continence Nurse or enterostomal therapist teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities?

Stoma and pouch care

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

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

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

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

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients?

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

Bethanechol is prescribed for the client with urinary retention, and an injectable form of bethanechol is available for use as prescribed. The nurse informs the client of the primary health care provider's prescription, knowing that the medication will be administered by which injectable route? Intravenously Intradermally Intramuscularly Subcutaneously

Subcutaneously Rationale: The injectable form of bethanechol is intended for subcutaneous administration only. Bethanechol must never be injected intramuscularly or by the intravenous route because the resulting high drug levels can cause severe toxicity resulting in bloody diarrhea, bradycardia, profound hypotension, and cardiovascular collapse.

Choose all of the correct patient teachings for the patient with cystitis.

Teach the patient to drink cranberry juice to treat and prevent UTIs. Teach the female patient to cleanse the perineal area from anterior to posterior to prevent rectal E. Coli contamination of the urethra. Encourage the patient to drink 2000 ml of fluid per day, unless contraindicated.

Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation?

Temperature of 100.8° F sign of infection!!!!

2. These crystals are uremic frost resulting from irritating toxins deposited in the client's tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost.

The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement? 1.Have the assistant apply a moisture barrier cream to the skin. 2.Instruct the UAP to bathe the client in cool water. 3.Tell the UAP not to turn the client in this condition. 4.Explain this is normal and do not do anything for the client.

client with acute kidney failure who is receiving a protein restricted diet

The amount of protein permitted in the diet (usually less than 50 g) depends on the extent of kidney function; excess protein causes an increase in urea concentration, which should be avoided Adequate calories are provided to prevent tissue catabolism that also results in an increase in metabolic waste products. In kidney failure the kidneys are unable to eliminate the waste products of a high-protein diet. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids.

1. An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct.

The client asks, "What does an elevated PSA test mean?" On which scientific rationale should the nurse base the response? 1.An elevated PSA can result from several different causes. 2.An elevated PSA can be only from prostate cancer. 3.An elevated PSA can be diagnostic for testicular cancer. 4.An elevated PSA is the only test used to diagnose BPH.

4. Normal potassium level is 3.5 to5.5 mEq/L. A level of 6.8 mEq/L is life threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires a health-careprovider order, so it is a collaborative intervention.

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1.Administer a phosphate binder. 2.Type and crossmatch for whole blood. 3.Assess the client for leg cramps. 4.Prepare the client for dialysis.

3. Carbohydrates are increased to provide for the client's caloric intake and protein is restricted to minimize protein breakdown and to prevent accumulation of toxic waste products.

The client diagnosed with ARF is admitted to the intensive care unit and placed on a therapeutic diet. Which diet is most appropriate for the client? 1.A high-potassium and low-calcium diet. 2.A low-fat and low-cholesterol diet. 3.A high-carbohydrate and restricted-protein diet. 4.A regular diet with six (6) small feedings a day.

3. Regular insulin, along with glucose, will drive potassium into the cells,thereby lowering serum potassium levels temporarily.

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1.Erythropoietin. 2.Calcium gluconate. 3.Regular insulin. 4.Osmotic diuretic.

2. Bed rest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine).

The client diagnosed with ARF is placed on bed rest. The client asks the nurse, "Why do I have to stay in bed? I don't feel bad." Which scientific rationale supports the nurse's response? 1.Bed rest helps increase the blood return to the renal circulation. 2.Bed rest reduces the metabolic rate during the acute stage. 3.Bed rest decreases the workload of the left side of the heart. 4.Bed rest aids in reduction of peripheral and sacral edema.

4. The white blood cell count is elevated;normal is 5,000 to 10,000/mm3.

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1.A serum potassium level of 3.8 mEq/L. 2.A urinalysis shows microscopic hematuria. 3.A creatinine level of 0.8 mg/100 mL. 4.A white blood cell count of 14,000/mm3.

3. Dehydration results in concentrated serum, causing laboratory values to increase because the blood has normal constituents but not enough volume to dilute the values to within normal range or possibly lower.

The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition is a cause for these findings? 1.Overhydration. 2.Anemia. 3.Dehydration. 4.Renal failure.

3. Venison, sardines, goose, organ meats,and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones.

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent re-occurrence? 1.Beer and colas. 2.Asparagus and cabbage. 3.Venison and sardines. 4.Cheese and eggs.

2. Elevating the scrotum on a towel for support is a task which can be delegated to the UAP.

The client is one (1) day postoperative TURP. Which task should the nurse delegate to the UAP? 1.Increase the irrigation fluid to clear clots from the tubing. 2.Elevate the scrotum on a towel roll for support. 3.Change the dressing on the first postoperative day. 4.Teach the client how to care for the continuous irrigation catheter.

1 Fever, chills, and costovertebral pain are symptoms of a urinary tract infection (acute pyelonephritis), which requires a urine culture first to confirm the diagnosis.

The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test should the nurse expect the HCP to prescribe first? 1.A midstream urine for culture. 2.A sonogram of the kidney. 3.An intravenous pyelogram for renal calculi. 4.A CT scan of the kidneys.

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

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

1. The nurse should place the client's chair with the head lower than thebody, which will shunt blood to the brain; this is the Trendelenburg position.

The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first? 1.Place the client in the Trendelenburg position. 2.Turn off the dialysis machine immediately. 3.Bolus the client with 500 mL of normal saline. 4.Notify the health-care provider as soon as possible.

1, 3, 4 The nurse should assess the drain postoperatively. The head of the bed should be lowered and the foot should be elevated to shunt blood to the central circulating system. The surgeon needs to be notified of the change in condition.

The client returned from surgery after having a TURP and has a P 110, R 24, BP90/40, and cool and clammy skin. Which interventions should the nurse implement?Select all that apply. 1.Assess the urine in the continuous irrigation drainage bag. 2.Decrease the irrigation fluid in the continuous irrigation catheter. 3.Lower the head of the bed while raising the foot of the bed. 4.Contact the surgeon to give an update on the client's condition. 5.Check the client's postoperative creatinine and BUN.

3. This is usually the length of time clients need to wait prior to having sexual intercourse; this is the information the client wants to know.

The client who is postoperative TURP asks the nurse, "When will I know if I will be able to have sex after my TURP?" Which response is most appropriate by the nurse? 1."You seem anxious about your surgery." 2."Tell me about your fears of impotency." 3."Potency can return in six (6) to eight (8) weeks." 4."Did you ask your doctor about your concern?"

4. The nurse should always assess any complaint before dismissing it as a commonly occurring problem.

The client with a TURP who has a continuous irrigation catheter complains of the need to urinate. Which intervention should the nurse implement first? 1.Call the surgeon to inform the HCP of the client's complaint. 2.Administer the client a narcotic medication for pain. 3.Explain to the client this sensation happens frequently. 4.Assess the continuous irrigation catheter for patency.

The use of peritoneal dialysis for the treatment of chronic kidney disease would be contraindicated for which clients? The client with cataracts The client with varicose veins The client with type 2 diabetes mellitus The client with chronic obstructive pulmonary disease (COPD)

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

The use of peritoneal dialysis for the treatment of chronic kidney disease would be contraindicated for which client? The client with hypothyroidism The client with severe emphysema The client with type 2 diabetes mellitus The client with severe peripheral vascular disease

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

1. Clients who have urinary incontinenceare often embarrassed, so it is the responsibility of the nurse to approach this subject with respect and consideration.

The elderly client being seen in the clinic has complaints of urinary frequency,urgency, and "leaking." Which priority intervention should the nurse implement when interviewing the client? 1.Ensure communication is nonjudgmental and respectful. 2.Set the temperature for comfort in the examination room. 3.Speak loudly to ensure the client understands the nurse. 4.Ensure the examining room has adequate lighting.

3 Glomerular filtration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third filtration capacity.

The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? 1.The blood urea nitrogen is 15 mg/dL. 2.The creatinine level is 1.2 mg/dL. 3.The glomerular filtration rate is 40 mL/min. 4.The 24-hour creatinine clearance is 100 mL/min.

4. Use of the bladder training drill is helpful in stress incontinence. The client is instructed to void at scheduled intervals. After consistently being dry, the interval is increased by 15 minutes until the client reaches an acceptable interval.

The elderly client recovering from a prostatectomy has been experiencing stress incontinence. Which independent nursing intervention should the nurse discuss with the client? 1.Establish a set voiding frequency of every two (2) hours while awake. 2.Encourage a family member to assist the client to the bathroom to void. 3.Apply a transurethral electrical stimulator to relieve symptoms of urinary urgency. 4.Discuss the use of a "bladder drill," including a timed voiding schedule.

4 Coffee, tea, cola, and alcoholic beverages are urinary tract irritants.

The female client in an outpatient clinic is being sent home with a diagnosis of urinary tract infection (UTI). Which instruction should the nurse teach to prevent a recurrence of a UTI? 1.Clean the perineum from back to front after a bowel movement. 2.Take warm tub baths instead of hot showers daily. 3.Void immediately preceding sexual intercourse. 4.Avoid coffee, tea, colas, and alcoholic beverages.

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

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

The nurse is assisting in planning a teaching session with a client diagnosed with urethritis caused by infection with Chlamydia. The nurse should plan to include which point in the teaching session? The most serious complication of this infection is sterility. Sexual partners during the last 12 months should be notified and treated. Medication therapy should be continued for 2 months without interruption. The infection can be prevented by using spermicide to alter the pH in the perineal area.

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

2. This client's dialysis access is compromised and he or she should be assessed first.

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? 1.The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%. 2.The client who does not have a palpable thrill or auscultated bruit. 3.The client who is complaining of being exhausted and is sleeping. 4.The client who did not take antihypertensive medication this morning.

1. Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal sub-stance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure.

The nurse is caring for a client diagnosed with ARF. Which laboratory values are most significant for diagnosing ARF? 1.BUN and creatinine. 2.WBC and hemoglobin. 3.Potassium and sodium. 4.Bilirubin and ammonia level.

2. Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of pre-renal failure(before the kidney).

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure? 1.Diabetes mellitus. 2.Hypotension. 3.Aminoglycosides. 4.Benign prostatic hypertrophy

2. Bladder spasms are common, but being relieved with medication indicates the condition is improving.

The nurse is caring for a client with a TURP. Which expected outcome indicates the client's condition is improving? 1.The client is using the maximum amount allowed by the PCA pump. 2.The client's bladder spasms are relieved by medication. 3.The client's scrotum is swollen and tender with movement. 4.The client has passed a large, hard, brown stool this morning.

2. When an elderly client's mental status changes to confused and irritable, the nurse should seek the etiology, which may be a UTI secondary to an indwelling catheter. Elderly client soften do not present with classic signs and symptoms of infection.

The nurse is caring for an elderly client who has an indwelling catheter. Which data warrant further investigation? 1.The client's temperature is 98.0˚F. 2.The client has become confused and irritable. 3.The client's urine is clear and light yellow. 4.The client feels the need to urinate.

3 The client should be taught to take all the prescribed medication anytime a prescription is written for antibiotics.

The nurse is discharging a client with a health-care facility acquired urinary tract infection. Which information should the nurse include in the discharge teaching? 1.Limit fluid intake so the urinary tract can heal. 2.Collect a routine urine specimen for culture. 3.Take all the antibiotics as prescribed. 4.Tell the client to void every five (5) to six (6) hours.

3. The drainage bag should be kept below the level of the bladder to prevent reflux of urine into the renal system; it should not be placed on the bed.

The nurse is observing the UAP providing direct care to a client with an indwelling catheter. Which data warrant immediate intervention by the nurse? 1.The UAP secures the tubing to the client's leg with tape. 2.The UAP provides catheter care with the client's bath. 3.The UAP puts the collection bag on the client's bed. 4.The UAP cares for the catheter after washing the hands.

3 A long-term complication of glomerulonephritis is it can become chronic if unresponsive to treatment,and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal.

The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal? 1.The client will have a blood pressure within normal limits. 2.The client will show no protein in the urine. 3.The client will maintain normal renal function. 4.The client will have clear lung sounds.

2. Increasing the irrigation fluid will flush out the clots and blood.

The nurse observes red urine and several large clots in the tubing of the normal saline continuous irrigation catheter for the client who is one (1) day postoperative TURP. Which intervention should the nurse implement? 1.Remove the indwelling catheter. 2.Titrate the NS irrigation to run faster. 3.Administer protamine sulfate IVP. 4.Administer vitamin K slowly.

1. A client with a peaked T wave could be experiencing hyperkalemia. Changes in potassium levels can initiate cardiac dysrhythmias and instability.

The telemetry monitor technician notifies the nurse of the morning telemetry readings. Which client should the nurse assess first? 1.The client in normal sinus rhythm with a peaked T wave. 2.The client diagnosed with atrial fibrillation with a rate of 100. 3.The client diagnosed with a myocardial infarction who has occasional PVCs. 4.The client with a first-degree atrioventricular block and a rate of 92.

The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective?

To provide a clean-catch urine sample, the client should initiate voiding, then stop, then resume voiding into the container.

The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? (Select all that apply.)

Try to take in 64 ounces of fluid each day. Correct Be sure to complete the full course of antibiotics. Correct If urine remains cloudy, call the clinic.

Bethanechol chloride is prescribed for a client. When should the nurse tell the client to take the medication? With meals Two hours after meals With a snack in the afternoon At bedtime with crackers and cheese

Two hours after meals Rationale: Administration of bethanechol with meals can cause nausea and vomiting in the client. To avoid this problem, oral doses should be administered 1 hour before meals or 2 hours after meals.

A long-term care nurse notes that an older client who is normally alert has become progressively confused and irritable. What diagnostic tests should the nurse anticipate the health care provider to prescribe? Select all that apply. Urinalysis Lipid profile Chemistry profile Coagulation studies Stool for occult blood Complete blood count

Urinalysis Complete blood count Confusion may be one of the first signs of cystitis or UTI in older adults. If a patient who is normally alert becomes confused, assess the urine for cloudiness, foul odor, or hematuria (blood in the urine), and check for signs of infection (fever, increased white blood cell [WBC] count).

The clinical findings in the oliguric phase of acute renal failure include:

Urinary output increases

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

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

The nurse is assessing a client with suspected acute kidney injury. Which finding would support a diagnosis of acute intrarenal failure? Urine output of 30 mL/hr for the past 24 hours Urine analysis positive for casts and cellular debris Renal ultrasound indicating the presence of ureteral calculi Blood urea nitrogen (BUN) level of 48 mg/dL and creatinine level of 1.2 mg/dL

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

The nurse is caring for a hospitalized client following cystoscopy. Which discharge instructions are given to the client? Select all that apply. Use antispasmodics for pain. Restrict oral fluids for 1 to 2 days. Expect pink-tinged urine for 1 week. Take sitz baths for voiding discomfort. Report severe pain to the health care provider.

Use antispasmodics for pain. Take sitz baths for voiding discomfort. Report severe pain to the health care provider.

In postoperative care of the patient with an arteriovenous shunt, the nurse should:

Use strict surgical asepsis for dressing changes.

A client with prostatitis resulting from kidney infection has received instructions on the management of the condition at home and prevention of recurrence. Which statement indicates that the client understood the instructions? Stop antibiotic therapy when the pain subsides. Exercise as much as possible to stimulate circulation. Use warm sitz baths and analgesics to increase comfort. Keep fluid intake to a minimum to decrease the need to void.

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

The nurse is assigned to care for a client who has just returned to the nursing unit after having hemodialysis for the first time. The nurse monitors the client carefully for which signs and symptoms of disequilibrium syndrome? Vomiting and headaches Lethargy and hypertension Hypertension and sleepiness Abdominal pain and hypotension

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

The nurse is caring for a 58-year-old client with renal failure who is on peritoneal dialysis. Which finding is considered most important by the nurse, requiring health care provider notification? BUN: 40 mg/dL WBC 15,000 mm3 ECG: First-degree heart block Heart rate: 96 beats per minute

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

A client with acute kidney injury secondary to heart failure develops fluid volume excess. Which signs and symptoms should the nurse expect to see? Select all that apply. Weak pulse Weight gain Decreased hematocrit Distended jugular veins Decreased breath sounds on auscultation Decreased specific gravity with high volume

Weight gain Decreased hematocrit Distended jugular veins Decreased specific gravity with high volume

4. Clients with acute bacterial prostatitis will frequently experience a sudden onset of fever and chills. Clients with chronic prostatitis have milder symptoms.

Which data support to the nurse the client's diagnosis of acute bacterial prostatitis? 1.Terminal dribbling. 2.Urinary frequency. 3.Stress incontinence. 4.Sudden fever and chills.

4. The nephrostomy tube should never be clamped or have kinks because an obstruction can cause pyelonephritis.

Which intervention should the nurse implement when caring for the client with a nephrostomy tube? 1.Change the dressing only if soiled by urine. 2.Clean the end of the connecting tubing with Betadine. 3.Clean the drainage system every day with bleach and water. 4.Assess the tube for kinks to prevent obstruction.

4. This is a potentially life-threatening problem.

Which nursing diagnosis is priority for the client who has undergone a TURP? 1.Potential for sexual dysfunction. 2.Potential for an altered body image. 3.Potential for chronic infection. 4.Potential for hemorrhage.

A client contacts the health care provider's office to report she is not feeling well, has burned with urination, and suspects she may have a urinary tract infection. The nurse instructs the client to collect a urine specimen for testing. Which urinalysis findings indicate the presence of a urinary tract infection? Select all that apply. Nitrites, present Turbidity, clear Ketones, moderate White blood cells, 10 Specific gravity, 1.025 Leukocyte esterase, present

White blood cells, 10 Leukoesterase, present Nitrites, present

A urinary analgesic is prescribed for a client with a urinary tract infection. When should the nurse tell the client that it is best to take the medication? With meals At bedtime One hour before meals In the morning before breakfast

With meals Rationale: A urinary antiseptic is administered with meals to decrease gastrointestinal side effects. Options 2, 3, and 4 are incorrect.

Aluminum hydroxide is prescribed for the client with chronic kidney disease (CKD). When should the nurse instruct the client to take this medication? With meals At bedtime On an empty stomach In the morning on arising

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

What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? (Select all that apply.)

Your urine will be strained after the procedure." Correct "Be sure to finish all of your antibiotics." "Remember to drink at least 3 liters of fluid a day to promote urine flow."

A female patient being admitted with pneumonia has a history of neurogenic bladder as a result of a spinal cord injury. Which action will the nurse plan to take first? a. Ask about the usual urinary pattern and any measures used for bladder control. b. Assist the patient to the toilet at scheduled times to help ensure bladder emptying. c. Check the patient for urinary incontinence every 2 hours to maintain skin integrity. d. Use intermittent catheterization on a regular schedule to avoid the risk of infection.

a

Which medication taken at home by a 47-year-old patient with decreased renal function will be of most concern to the nurse? a. ibuprofen (Motrin) b. warfarin (Coumadin) c. folic acid (vitamin B9) d. penicillin (Bicillin LA)

a NSAIDs are nephrotoxic and should be avoided in patients with impaired renal function

A patient has elevated blood urea nitrogen (BUN) and serum creatinine levels. Which bowel preparation order would the nurse question for this patient who is scheduled for a renal arteriogram? a. Fleet enema b. Tap-water enema c. Senna/docusate (Senokot-S) d. Bisacodyl (Dulcolax) tablets

a High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure

The nurse is caring for a 68-year-old hospitalized patient with a decreased glomerular filtration rate who is scheduled for an intravenous pyelogram (IVP). Which action will be included in the plan of care? a. Monitor the urine output after the procedure. b. Assist with monitored anesthesia care (MAC). c. Give oral contrast solution before the procedure. d. Insert a large size urinary catheter before the IVP.

a Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patient's urine output.

What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with a creatinine clearance result of 60 mL/min? a. 60 mL/min b. 90 mL/min c. 120 mL/min d. 180 mL/min

a The creatinine clearance approximates the GFR

The mother of a 2 year old tells the nurse her child was born deaf. The most appropriate action for the nurse is to

assess the child's urinary elimination patterns

A female patient with a suspected urinary tract infection (UTI) is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen, the nurse will a. have the patient empty the bladder completely, then obtain the next urine specimen that the patient is able to void. b. teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup. c. insert a short sterile "mini" catheter attached to a collecting container into the urethra and bladder to obtain the specimen. d. clean the area around the meatus with a povidone-iodine (Betadine) swab, and then have the patient void into a sterile container.

b

A patient gives the nurse health information before a scheduled intravenous pyelogram (IVP). Which item has the most immediate implications for the patient's care? a. The patient has not had food or drink for 8 hours. b. The patient lists allergies to shellfish and penicillin. c. The patient complains of costovertebral angle (CVA) tenderness. d. The patient used a bisacodyl (Dulcolax) tablet the previous night.

b

The nurse caring for a patient after cystoscopy plans that the patient a. learns to request narcotics for pain. b. understands to expect blood-tinged urine. c. restricts activity to bed rest for a 4 to 6 hours. d. remains NPO for 8 hours to prevent vomiting.

b

How will the nurse assess for flank tenderness in a 30-year-old female patient with suspected pyelonephritis? a. Palpate along both sides of the lumbar vertebral column. b. Strike a flat hand covering the costovertebral angle (CVA). c. Push fingers upward into the two lowest intercostal spaces. d. Percuss between the iliac crest and ribs along the midaxillary line.

b Checking for flank pain is best performed by percussion of the CVA and asking about pain.

The nurse completing a physical assessment for a newly admitted male patient is unable to feel either kidney on palpation. Which action should the nurse take next? a. Obtain a urine specimen to check for hematuria. b. Document the information on the assessment form. c. Ask the patient about any history of recent sore throat. d. Ask the health care provider about scheduling a renal ultrasound.

b The kidneys are protected by the abdominal organs, ribs, and muscles of the back, and may not be palpable under normal circumstances, so no action except to document the assessment information is needed

A 79-year-old man has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care? a. Limit fluid intake to no more than 1000 mL/day. b. Leave a light on in the bathroom during the night. c. Ask the patient to use a urinal so that urine can be measured. d. Pad the patient's bed to accommodate overflow incontinence.

b The patient's age and diagnosis indicate a likelihood of nocturia

The nurse assessing the urinary system of a 45-year-old female would use auscultation to a. determine kidney position. b. identify renal artery bruits. c. check for ureteral peristalsis. d. assess for bladder distention.

b The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic aneurysm

Which assessment of a 62-year-old patient who has just had an intravenous pyelogram (IVP) requires immediate action by the nurse? a. The heart rate is 58 beats/minute. b. The patient complains of a dry mouth. c. The respiratory rate is 38 breaths/minute. d. The urine output is 400 mL after 2 hours.

c

A patient passing bloody urine is scheduled for a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate? a. "Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys." b. "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney." c. "Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray." d. "Your doctor will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked."

c In a cystoscope and cystogram procedure, a cystoscope is inserted into the bladder for direct visualization, and then contrast solution is injected through the scope so that x-rays can be taken.

A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take first? a. Notify the patient's health care provider. b. Teach correct midstream urine collection. c. Ask the patient about current medications. d. Question the patient about urinary tract infection (UTI) risk factors.

c A red-orange color in the urine is normal with some over-the-counter (OTC) medications such as phenazopyridine (Pyridium).

A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is scheduled for a creatinine clearance test. Which equipment will the nurse need to obtain? a. Urinary catheter b. Cleaning towelettes c. Large container for urine d. Sterile urine specimen cup

c Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection

Which information from a patient's urinalysis requires that the nurse notify the health care provider? a. pH 6.2 b. Trace protein c. WBC 20 to 26/hpf d. Specific gravity 1.021

c The increased number of white blood cells (WBCs) indicates the presence of urinary tract infection or inflammation

When a patient's urine dipstick test indicates a small amount of protein, the nurse's next action should be to a. send a urine specimen to the laboratory to test for ketones. b. obtain a clean-catch urine for culture and sensitivity testing. c. inquire about which medications the patient is currently taking. d. ask the patient about any family history of chronic renal failure.

c- some medications may give false-positive readings.

To assess whether there is any improvement in a patient's dysuria, which question will the nurse ask? a. "Do you have to urinate at night?" b. "Do you have blood in your urine?" c. "Do you have to urinate frequently?" d. "Do you have pain when you urinate?"

d

When working in the urology/nephrology clinic, which patient could the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Patient who is scheduled for a renal biopsy after a recent kidney transplant b. Patient who will need monitoring for several hours after a renal arteriogram c. Patient who requires teaching about possible post-cystoscopy complications d. Patient who will have catheterization to check for residual urine after voiding

d

Which statement by a patient who had a cystoscopy the previous day should be reported immediately to the health care provider? a. "My urine looks pink." b. "My IV site is bruised." c. "My sleep was restless." d. "My temperature is 101."

d

Which nursing action is essential for a patient immediately after a renal biopsy? a. Check blood glucose to assess for hyperglycemia or hypoglycemia. b. Insert a urinary catheter and test urine for gross or microscopic hematuria. c. Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function. d. Apply a pressure dressing and keep the patient on the affected side for 30 minutes.

d A pressure dressing is applied and the patient is kept on the affected side for 30 to 60 minutes to put pressure on the biopsy side and decrease the risk for bleeding.

A 32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for a. renal failure. b. kidney stones. c. pyelonephritis. d. bladder cancer.

d Exposure to the chemicals involved with working as a hairdresser and in smoking both increase the risk of bladder cancer

A nurse is providing education to a patient with a history of renal caliculi. What should the nurse include?

drink enough fluids in 24 hours to produce 2 quarts of urine

Objectives of Healthy People 2020 is to reduce the rate of new cases of ESRD. What activities are recommended to achieve this?

early identification of people at risk, control of diabetes and hypertension, education related to diet and exercise

Where should the nurse place their stethoscope to assess the renal arteries for the presence of bruits?

extended midclavicular line

In discussion with the patient with ESRD about dietary needs, the nurse recognies that foods highest in potassium include:

grapefruit, tomatoes, oranges, and bananas.

When performing an assessment on a client the nurse notes tenderness to blunt percussion of the costovertebral angle. What might this finding suggest?

inflammation of the kidneys

An elderly female tells the nurse "I wish I could have a good night's sleep without having to get up every two hours to urinate." The nurse realizes that the client is experiencing

nocturia

The nurse is assessing the client for urinary incontinence. The client is at risk for

psychosocial problems

An elderly client reports that is she incontinent of urine when she coughs of sneezes. The client is experiencing

stress incontinence

What findings might the nurse note when performing an assessment on a client with long standing renal disease?

the client appears fatigued, peripheral edema, indication of pruritis, crackles at the bases of the lungs

A client has been diagnosed with a kidney stone lodged within the medulla of the right kidney. What will the stone most likely affect?

the collection of urine

taping an indwelling catheter for a male client to prevent pressure on the urethra at the penoscrotal junction

the lower abdomen or the inner aspect of the thigh are the recommended sites to eliminate the penoscrotal angle and prevent the formation of a urethrocutaneous fistula

A 55 year old female tells the nurse "Since I stopped having my menstrual periods about a year ago I've noticed a leakage of urine". What should the nurse explain to the client?

there is a decrease in estrogen after menopause which affects the strength of the pubic muscles and can lead to urine leakage

A client three weeks postpartum comes into a clinic with complains of urinary frequency and burning with urination. What can the nurse explain to the patient about these symptoms?

these are consistent with a UTI, after having a baby the bladder may not completely empty, increasing risk of UTI

When performing an assessment on an adult client the nurse is unable to palpate both kidneys. What does this finding suggest?

this is a normal, expected finding

The mother of a 4 year old boy states "I can't believe he's still wetting the bed at night". The nurse tells the mother

this is not unusual for children of his age

One of the nurse's roles is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts?

use words the client uses.