Urinary/Renal
The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care? "I change my pouch every week." "I change the appliance in the morning." "I empty the urinary collection bag when it is two-thirds full." "When I'm in the shower I direct the flow of water away from my stoma."
"I empty the urinary collection bag when it's two-thirds full." Rationale: The urinary collection bag should be changed when it is one-third full to prevent pulling of the appliance and leakage. The remaining options identify correct statements about the care of a urinary stoma.
A nurse measures the cardiac output of a client and finds it to be 6 L/min. Which amount should the nurse calculate is the amount of blood circulating to the kidneys? 100 to 300 mL/min 500 to 1000 mL/min 1200 to 1500 mL/min 2000 to 2500 mL/min
1200 to 1500 mL/min Rationale: The kidneys normally receive about 20% to 25% of the cardiac output when the client is at rest. If the cardiac output is 6 L/min, then the kidneys receive 1.2 to 1.5 L/min, which is equal to 1200 to 1500 mL/min.
A client is admitted to the emergency department following a motor vehicle accident. The client was wearing a lap seat belt when the accident occurred and now the client has hematuria and lower abdominal pain. To assess further whether the pain is caused by bladder trauma, the nurse should ask the client if the pain is referred to which area? Hip Shoulder Umbilicus Costovertebral angle
Shoulder due to the phrenic nerve. Rationale: Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders due to phrenic nerve irritation. Bladder injury pain does not radiate to the umbilicus, costovertebral angle, or hip.
A nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that the client has properly understood the information presented when the client chooses which selections from a diet menu? Spinach salad, milk, and a banana Chicken, potatoes, and cranberries Peanut butter sandwich, milk, and prunes Linguini with shrimp, tossed salad, and a plum
Spinach salad, milk, and banana Rationale: In some client situations, the health care provider may prescribe a diet that consists of foods that yield either an alkaline or an acid residue in the urine. In an alkaline residue diet, all fruits are allowed except cranberries, blueberries, prunes, and plums.
The nurse has administered a dose of meperidine hydrochloride (Demerol), 100 mg, to a client with renal colic as treatment for pain. The nurse carefully monitors this client for which side effect of this medication? Bradycardia Hypertension Urinary retention Increased respirations
Urinary retention Rationale: Meperidine hydrochloride is an opioid analgesic. Side effects of meperidine hydrochloride include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.
A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder? Soft and swollen prostate gland Reddened, swollen, and boggy prostate gland Tender and edematous prostate gland with ecchymosis Tender, indurated prostate gland that is warm to the touch
#4 Rationale: The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder.
The nurse is teaching a client with nephrotic syndrome about managing the disorder. What should the nurse instruct the client to adjust upward or downward according to the amount of edema present? Salt intake Water intake Activity level Use of diuretics
Activity level Rationale: The client is taught to adjust the activity level according to the amount of edema. As edema decreases, activity can increase. Correspondingly, as edema increases, the client should increase rest periods and limit activity. Bed rest is recommended during periods of severe edema. The client with nephrotic syndrome usually has a standard limit set on sodium intake. Fluids are not restricted unless the client also is hyponatremic. Diuretics are prescribed on a specific schedule, and doses are not titrated according to the level of edema.
The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status? Blood pressure Apical heart rate Jugular vein distention Level of consciousness
BP Rationale: The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. For kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The heart rate affects the cardiac output but can be altered by factors unrelated to kidney function. Jugular vein distention and level of consciousness are unrelated items.
A nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food high in oxalate? Breads Poultry Chocolate Prune juice
Chocolate Rationale: Clients with oxalate stones should avoid foods high in oxalate, such as tea, instant coffee, cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and peanut butter. Large doses of vitamin C may help increase oxalate excretion in the urine.
A nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which would the nurse expect to note in this client? Decreased serum lipids Signs of fluid volume deficit Decreased protein in the urine Decreased serum albumin levels
Dec. serum albumin levels Rationale: Nephrotic syndrome describes a variety of signs and symptoms that accompany any condition that markedly impairs filtration by glomerular capillary membranes and results in increased permeability to protein. Hallmark signs and symptoms of this syndrome include increased serum lipids, edema, increased excretion of protein in the urine, and decreased serum albumin levels.
The nurse provides discharge instructions to a client after a prostatectomy. What is the priority discharge instruction for this client? Avoid driving a car for at least 1 week. Increase fluid intake to at least 2.5 L/day. Avoid lifting any objects greater than 30 pounds. Contact the health care provider (HCP) if small clots are noticed in the urine.
Increase fluid intake to at least 2.5 L/day. Rationale: A daily intake of 2.5 L of fluid should be maintained to limit clot formation and prevent infection. Driving a car and sitting for long periods are restricted for at least 3 weeks. The client should be instructed to avoid lifting objects heavier than 20 pounds for at least 6 weeks. Passing small pieces of tissue or blood clots in the urine for up to 2 weeks after surgery is expected and does not necessitate contacting the HCP.
A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a Foley catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? Notify the HCP. Use a small-sized catheter. Administer pain medication before inserting the catheter. Use extra povidone-iodine solution in cleansing the meatus.
Notify the HCP Rationale: 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. Therefore options 2, 3, and 4 are incorrect.
The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the most appropriate nursing action? Monitor the client. Elevate the head of the bed. Medicate the client for nausea. Notify the health care provider (HCP).
Notify the health care provider (HCP). Disequilibrium syndrome may be caused by the rapid decreases in the blood urea nitrogen level during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs/symptoms of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified.
A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment. The nurse assesses for this occurrence by periodically checking the results of which laboratory test? Bleeding time Thrombin time Prothrombin time (PT) Partial thromboplastin time (PTT)
PTT Rationale: Heparin is the anticoagulant used most often during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by checking the PTT, which is the appropriate measure of heparin effect. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities. The PT is one test used to monitor the effect of warfarin (Coumadin) therapy.
The nurse is caring for a client just after ureterolithotomy and is monitoring the drainage from the ureteral catheter hourly. Suddenly, the catheter stops draining. The nurse assesses the client and determines that which is the least likely cause of the problem? Blood clots Ureteral edema Chemical sediment Catheter displacement
Ureteral edema Rationale: After ureterolithotomy, a ureteral catheter is put in place. Urine flows freely through it for the first 2 to 3 days. As ureteral edema diminishes, urine leaks around the ureteral catheter and drains directly into the bladder. At this point drainage through the ureteral catheter diminishes. Immediately after surgery, absence of drainage usually is caused by blockage from blood clots, mucous shreds, chemical sediment, or catheter displacement.
A client is experiencing a decrease in renal perfusion. The nurse plans care, knowing that the client could benefit from greater endogenous production of which substance that dilates the renal arteries? Serotonin Dopamine Epinephrine Norepinephrine
Dopamine Rationale: Dopaminergic receptors are found in the renal blood vessels and in the nerves. When stimulated, they dilate renal arteries and help modulate release of the neurotransmitter, dopamine. Renal artery dilation helps to improve urine output by increasing blood flow through the kidneys. Serotonin is a local hormone that is released from platelets after an injury; it constricts arterioles but dilates capillaries. Epinephrine and norepinephrine affect the beta receptors in the body.
A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? Hematuria and pyuria Dysuria and proteinuria Hematuria and urgency Dysuria and penile discharge
Dysuria and penile discharge Rationale: Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays.
Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory study? Urinalysis, hematocrit, hemoglobin Culture and sensitivity testing, serum sodium Urine specific gravity, intravenous pyelogram Fasting blood glucose, serum potassium, serum calcium
Fasting blood glucose, serum potassium, serum calcium Rationale: Because of the potentially life-threatening outcomes associated with hyperglycemia, hyperkalemia, and hypocalcemia, they are the most relevant to nursing management of the client with CKD. The diagnostic tests in the remaining options may be helpful in diagnosing CKD or in monitoring treatment but are not the most relevant. Additionally, decreased hematocrit and hemoglobin occur in CKD because of the decreased level of erythropoietin. However, a decrease in hematocrit and hemoglobin may be reflective of various health alterations.
A nurse is performing an assessment on a client with acute kidney injury who is in the oliguric phase. During this phase, the nurse understands that which manifestations are associated findings? Select all that apply. Increased serum creatinine level A low and fixed specific gravity Increased blood urea nitrogen (BUN) level Urine osmolarity of approximately 300 mOsm/L A urine output of 600 to 800 mL in a 24-hour period
Increased serum creatinine level A low and fixed specific gravity Increased blood urea nitrogen (BUN) level Urine osmolarity of approximately 300 mOsm/L Rationale: During the oliguric phase of acute kidney injury, serum creatinine levels increase by approximately 1 mg/dL per day, and the BUN level increases by approximately 20 mg/dL per day. The specific gravity of the urine is low and fixed, and the urine osmolarity approaches that of the client's serum level, or about 300 mOsm/L. Urine output is less than 100 mL in a 24-hour period.
A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition? Pyelonephritis Glomerulonephritis Trauma to the bladder or abdomen Renal cancer in the client's family
Pyelonephritis - fever - flank pain Glomerulonephritis - fever, flank pain Trauma to the bladder or abdomen - correct answer Renal cancer in the client's family - no pain Rationale: Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client described in this question. Renal cancer would not cause pain that is felt in the low abdomen; rather, the pain would be in the flank area.
The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper fluid balance if which 24-hour intake and output totals are noted? Intake 1500 mL, output 800 mL Intake 3000 mL, output 2000 mL Intake 2400 mL, output 2900 mL Intake 1800 mL, output 1750 mL
Intake 1800 mL, output 1750 mL Rationale: For the client taking a normal diet, the normal fluid intake is approximately 1200 to 1800 mL of measurable fluids per day. The client's output in the same period should be about the same and does not include insensible losses, which are extra. Insensible losses are offset by the fluid in solid foods, which also is not measured.
The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? Fever, diarrhea, groin pain, and ecchymosis Nausea, vomiting, scrotal edema, and ecchymosis Fever, nausea, vomiting, and painful scrotal edema Diarrhea, groin pain, testicular torsion, and scrotal edema
Fever, nausea, vomiting, and painful scrotal edema Rationale: Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection, although sometimes it can be caused by trauma. Epididymitis needs to be distinguished correctly from testicular torsion.
A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? Fish Plum juice Fruit juice Cranberries
Fish Rationale: Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on health care provider prescription, the urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice.
The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg because the client is at risk for developing which type of acute kidney injury? Prerenal Intrarenal Postrenal Extrarenal
Intrarenal Rationale: Serum myoglobin levels increase in crush injuries when large amounts of myoglobin and hemoglobin are released from damaged muscle and blood cells. The accumulation may cause acute tubular necrosis, an intrarenal cause of renal failure. Prerenal causes are conditions that interfere with the perfusion of blood to the kidney. Postrenal causes include conditions that cause urinary obstruction distal to the kidney. The cause and the type of renal failure may determine the interventions used in treatment.
A nurse is preparing a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care? Increase the amount of protein in the diet. Increase the amount of potassium in the daily diet. Maintain a diet high in calories with frequent snacks. Encourage the client to eat a large breakfast and smaller meals later in the day.
Maintain a diet high in calories with frequent snacks. Rationale: Uremia usually is accompanied by nausea, anorexia, and an unpleasant taste in the mouth. Most clients experience more nausea and vomiting in the morning. Therefore to maintain optimal nutrition, it is best for these clients to eat a diet that is high in calories with frequent snacks and a light breakfast in the morning and larger meals later in the day. Dietary management usually is aimed at restricting protein, sodium, and potassium.
A nurse is developing a plan of care for a client with a diagnosis of nephrotic syndrome whose glomerular filtration rate (GFR) is normal. Which interventions should be appropriate components of the care plan? Select all that apply. Monitor daily weight. Maintain sodium restrictions. Maintain a diet low in protein. Monitor intake and output (I&O). Maintain bed rest when edema is severe.
Monitor daily weight. Maintain sodium restrictions Monitor I/Os Maintain bed rest when edema is severe - promote diuresis. Rationale: Controlling edema is a critical aspect of therapeutic management of nephrotic syndrome. If the GFR is normal, dietary intake of proteins is needed to restore normal plasma oncotic pressure and thereby decrease edema. Daily measurement of weight and abdominal girth, and careful monitoring of intake and output will determine whether weight loss is caused by diuresis or protein loss. Dietary modifications may include salt restriction and fluid restriction and are based on the client's symptoms. Bed rest is prescribed to promote diuresis when edema is severe.
The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement, if made by the client, indicates an accurate understanding of CAPD? No machinery is involved, and I can pursue my usual activities." "A cycling machine is used, so the risk for infection is minimized." "The drainage system can be used once during the day and a cycling machine for three cycles at night." "A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."
No machinery is involved, and I can pursue my usual activities." Rationale: CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure.
A nurse is monitoring the urine output of a client whose Foley catheter has drained less than 30 mL in an hour. The nurse plans care, knowing that the client's low serum protein level could alter glomerular filtration because of which type of pulling pressure that plasma proteins exert? Oncotic pressure Osmotic pressure Filtration pressure Hydrostatic pressure
Oncotic Pressure Rationale: The pulling pressure within the capillaries that is exerted by the plasma proteins is referred to as the oncotic pressure. Osmotic pressure is the movement of water along a pressure gradient. Filtration pressure is the pressure that is exerted with ultrafiltration, in which the pressure within the capillaries is greater than the pressure outside them; this results in fluids being pushed across the membrane into Bowman's capsule. Hydrostatic pressure in the capillaries allows fluid to be filtered out of the blood in the glomerulus
A cystectomy is performed for a client with a diagnosis of bladder cancer, and a Kock pouch is created for urinary diversion. In preparing a discharge teaching plan for the client, the nurse should include which instruction in the plan? Dietary restrictions Technique of catheterization External pouch and application care Proper administration of prophylactic antibiotics
Technique of catheterization Rationale: Kock's pouch is a continent internal ileal reservoir. The nurse instructs the client about the technique of catheterization. Dietary restrictions are not required. There is no external pouch. Antibiotics are not required unless an infection is present; also, antibiotics are prescribed by the health care provider.
A client is about to begin hemodialysis. Which measure(s) should the nurse employ in the care of the client? Select all that apply. Using sterile technique for needle insertion Using standard precautions in the care of the client Giving the client a mask to wear during connection to the machine Wearing full protective clothing such as goggles, mask, gloves, and apron Covering the connection site with a bath blanket to enhance extremity warmth
Using sterile technique for needle insertion Using standard precautions in the care of the client Giving the client a mask to wear during connection to the machine Wearing full protective clothing such as goggles, mask, gloves, and apron Rationale: Infection is a major concern with hemodialysis. For that reason, the use of sterile technique and the application of a face mask for both nurse and client are extremely important. It also is imperative that standard precautions be followed, which includes the use of goggles, mask, gloves, and an apron. The connection site should not be covered; it should be visible so that the nurse can assess for bleeding, ischemia, and infection at the site during the hemodialysis procedure.
