#3 Renal, Urinary, Reproductive
A client with acute kidney injury states, "Why am I twitching and my fingers and toes tingling?" Which process should the nurse consider when formulating a response to this client? Acidosis Calcium depletion Potassium retention Sodium chloride depletion
Calcium depletion In kidney failure, as the glomerular filtration rate decreases, phosphorus is retained. As hyperphosphatemia occurs, calcium is excreted. Calcium depletion hypocalcemia glomerular filtration [1] causes tetany, which causes twitching and tingling of the extremities, among other symptoms. Acidosis, potassium retention, and sodium chloride depletion are not characterized by twitching and tingling of the extremities.
The primary healthcare provider prescribes 80 mg of furosemide by mouth daily. Before administering the furosemide, which action is the priority? Weigh the client. Assess skin turgor. Check the potassium lab results. Check the total intake and output for the last 24 hours
Check the potassium lab results. Potassium level should always be checked before administering furosemide. Administering furosemide in the presence of hypokalemia could cause cardiac arrhythmias.
A client is scheduled for a transurethral resection of the prostate. What should the nurse tell the client to expect after surgery? "Urinary control may be permanently lost to some degree." "An indwelling urinary catheter is required for at least a day." "Your ability to perform sexually will be impaired permanently." "Burning on urination will last while the cystostomy tube is in place."
"An indwelling urinary catheter is required for at least a day." 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 cystostomy tube is not used if a client has a transurethral resection; however, it is used if a suprapubic resection is done.
A client who has had a transurethral resection of the prostate (TURP) experiences dribbling after the indwelling catheter is removed. Which is an appropriate nursing response? "I know you're worried, but it will go away in a few days." "Increase your fluid intake and urinate at regular intervals." "Limit your fluid intake and urinate when you first feel the urge." "The catheter will have to be reinserted until your bladder regains its tone."
"Increase your fluid intake and urinate at regular intervals." The response "Increase your fluid intake and urinate at regular intervals" will improve bladder tone, which should alleviate dribbling. The response "I know you're worried, but it will go away in a few days" identifies feelings but does not actively help the client solve the problem. Limiting fluid intake and urinating at the urge do not increase bladder tone; fluids should be increased and the time between voidings should be increased gradually. Continuous bladder decompression from a catheter will reduce bladder tone; bladder tone will improve after the indwelling catheter is removed.
A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy? "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." "It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." "It decreases the need for immobility because it clears toxins in short and intermittent periods." "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."
"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion." Diffusion [1] [2] moves particles from an area of greater concentration to an area of lesser concentration; osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.
A client has glomerulonephritis. To prevent future attacks of glomerulonephritis, the nurse planning discharge teaching includes which instruction? "Restrict fluid intake." "Take showers instead of bubble baths." "Avoid situations that involve physical activity." "Seek early treatment for respiratory infections."
"Seek early treatment for respiratory infections." A common cause of glomerulonephritis is a streptococcal infection. This infection initiates an antibody formation that damages the glomeruli. Any fluid restriction is moderated as the client improves; fluid is allowed to prevent urinary stasis. The alkalinity of bubble baths is linked to urinary tract infections, not glomerulonephritis. Moderate activity is helpful in preventing urinary stasis, which can precipitate urinary infection.
During discharge teaching, a client with an ileal conduit asks how frequently the urine pouch should be emptied. Which reply by the nurse is best? "To prevent leakage and pulling of the pouch from the skin, it should be emptied every few hours." "To prevent skin irritation, it should be emptied every hour if any urine has collected in the bag." "To reduce the risk of infection, the system should be opened as little as possible; two times a day is adequate." "To reduce the cost of drainage pouches, it should be emptied once the system is switched to a bedside collection bag."
"To prevent leakage and pulling of the pouch from the skin, it should be emptied every few hours." The weight of a full bag can pull the appliance from the skin and cause leakage; it should be emptied approximately every 2 to 3 hours or when half full.
A nurse provides dietary instructions to a client with calcium oxalate kidney stones. Which instruction should the nurse give to the client? "You should limit your sodium intake." "You should limit your intake of gravies." "You should limit your intake of red wines." "You should limit your intake of organ meat."
"You should limit your sodium intake." High sodium intake in clients with calcium oxalate kidney stones will reduce kidney tubular reabsorption of calcium. Therefore the nurse should instruct the client to reduce his or her sodium intake. Clients with uric acid kidney stones should decrease their intake of gravies and red wines. Clients with struvite, uric acid, and cystine types of kidney stones should limit their intake of animal proteins such as organ meats.
While performing diagnostic tests on a client with a urinary tract infection, the nurse documents the urine creatinine value as 0.9 mg/dL and serum creatinine level as 1.0 mg/dL. The volume of urine collected is 100 mL/min. What is the creatinine clearance of the client? Record your answer using a whole number.
90 Creatinine clearance (CrCl) is a diagnostic test used to assess the filtration capacity of the kidney. Creatinine clearance by the kidney approximates the glomerular filtration rate. Creatinine is a waste product of protein breakdown. It is calculated using the formula: Where urine creatinine is 0.9 mg/dL, serum creatinine level is 1.0 mg/dL, and the volume of urine is 100 mL/min:
A client has a permanent colostomy. During the first 24 hours there is no drainage from the colostomy. How should the nurse interpret this finding? Edema after the surgery is causing this. Absence of intestinal peristalsis is causing this. Decrease in fluid intake before surgery is causing this. Effective functioning of the nasogastric tube is causing this.
Absence of intestinal peristalsis is causing this. Absence of peristalsis is caused by manipulation of abdominal contents and the depressant effects of anesthetics and analgesics. Edema will not interfere with peristalsis; edema may cause peristalsis to be less effective, but some output will result. An absence of fiber has a greater effect on decreasing peristalsis than does decreasing fluids. A nasogastric tube decompresses the stomach; it does not cause cessation of peristalsis.
A client with end-stage renal disease is hospitalized. For which complications should the nurse monitor the client? Anemia Dyspnea Jaundice Hyperexcitability Hypophosphatemia
Anemia, Dyspnea Anemia results from decreased production of erythropoietin by the kidneys, which causes decreased erythropoiesis by bone marrow. Dyspnea is a result of fluid overload, which is associated with chronic kidney failure. Jaundice occurs with biliary obstruction or liver disorders, not with kidney failure. Lethargy occurs as a result of general depression of the central nervous system. Hyperphosphatemia occurs with kidney failure, not hypophosphatemia.
During the postoperative period after surgery for a kidney transplant, the client's creatinine level is 3.1 mg/dL (260 mcmol/L). What should the nurse do first in response to this laboratory result? Notify the primary healthcare provider. Obtain current blood test results. Assess for decreased urine output. Check the intravenous (IV) infusion.
Assess for decreased urine output. The expected serum creatinine range is 0.7 to 1.4 mg /dL (62 to 124 mcmol/L). The nurse should obtain additional information that may indicate acute rejection; therefore, the nurse must first assess for decreased urine output and changes in vital signs.
A client with kidney dysfunction is about to undergo renal testing using a contrast medium. Which nursing interventions should be conducted before the procedure to ensure the client's safety? Assessing the client for a history of cirrhosis Asking the client if he or she has a known shellfish allergy Assessing the client for a history of lactic acidosis Assessing the client's hydration status by checking blood pressure and respiratory rate Asking the client to discontinue metformin 12 hours before the procedure
Assessing the client for a history of cirrhosis Asking the client if he or she has a known shellfish allergy Assessing the client's hydration status by checking blood pressure and respiratory rate While interviewing a client who is about to undergo kidney procedure using a contrast medium, the nurse should assess for a history of cirrhosis. Clients with cirrhosis have an increased chance of developing kidney failure after the procedure. The nurse should confirm any known shellfish allergies because contrast dye administered during the study may cause nephrotoxicity. It is not necessary to check the client for a history of lactic acidosis when ensuring the client's safety for renal testing. If the client had lactic acidosis currently, then this would be a significant factor when ensuring the client's safety for renal testing. The nurse should also assess the client's hydration status by checking blood pressure and respiratory rate. The nurse should ask the client to discontinue metformin 24 hours before the procedure to prevent lactic acidosis.
The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled into the peritoneal cavity. Which information will the nurse share with the client? Because it forces potassium back into the cells, thereby decreasing serum levels Because it adds extra warmth to the body because metabolic processes are disturbed Because it helps prevent cardiac dysrhythmias by speeding up removal of excess potassium Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels
Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels 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. Heating dialysis solution does not affect cardiac dysrhythmias.
Which is a primary glomerular disease? Diabetic glomerulopathy Chronic glomerulonephritis Hemolytic-uremic syndrome Systemic lupus erythematosus (SLE)
Chronic glomerulonephritis is a primary glomerular disease. Diabetic glomerulopathy, hemolytic-uremic syndrome, and systemic lupus erythematosus (SLE) are secondary glomerular diseases.
A nurse is caring for a client with end-stage kidney disease after a kidney transplant. Which finding indicates the transplant is successful? Increased specific gravity Correction of hypotension Elevated serum potassium Decreasing serum creatinine
Decreasing serum creatinine As the transplanted organ functions, nitrogenous wastes are eliminated, lowering the serum creatinine. As more urine is produced by the transplanted kidney, the specific gravity and concentration of the urine will decrease. With end-stage kidney disease, fluid retention causes hypertension; there should be a correction of hypertension, not hypotension. After the transplant, the serum potassium should correct to within expected limits for an adult.
Which medication used to treat urinary incontinence strengthens the urinary sphincters and has anticholinergic action? Midorine Duloxetine Oxybutynin Mirabegron
Duloxetine Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that strengthens urinary sphincters and has anticholinergic action. Midorine is an alpha-adrenergic-agonist, which increases the contractile force of the urethral sphincter. Oxybutynin is an antispasmodic that causes bladder muscle relaxation. Mirabegron is a beta-3 blocker that relaxes the detrusor smooth muscle, which increases bladder capacity and urinary storage.
A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? Facial flushing Edema and pruritus Dribbling after voiding and dysuria Diminished force and caliber of stream
Edema and pruritus The accumulation of metabolic wastes in the blood ( uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.
Which vascular component of the client's nephron delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta? Arcuate artery Efferent arteriole Afferent arteriole Interlobular artery
Efferent arteriole The efferent arteriole is the vascular component of the nephron that delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta. The arcuate artery is a curved artery of the renal system that surrounds the renal pyramids. The afferent arteriole is the vascular component of the nephron that delivers arterial blood from the branches of the renal artery into the glomerulus. The interlobular artery feeds the lobes of the kidney.
Which complications does the nurse expect in the client with a renal disorder who has a blood urea nitrogen (BUN)/creatinine ratio of 28? . Malnutrition Hepatic damage Kidney impairment Fluid volume deficit Obstructive uropathy
Fluid volume deficit Obstructive uropathy The normal range of blood urea nitrogen (BUN)/creatinine ratio is 6 to 25. The BUN/creatinine ratio of 28 is a higher value than the normal; the client may have complications like fluid volume deficit and obstructive uropathy. A decrease in BUN levels indicates malnutrition and severe hepatic damage. Increased serum creatinine levels indicate kidney impairment.
A client who had a transurethral resection of the prostate is transferred to the postanesthesia care unit with an intravenous (IV) line and a urinary retention catheter. For which major complication is it most important for the nurse to assess during the immediate postoperative period? Sepsis Phlebitis Hemorrhage Leakage around the IV catheter
Hemorrhage After transurethral surgery [1] [2], hemorrhage is common because of venous oozing and bleeding from many small arteries in the area. Sepsis is unusual, and if it occurs it will manifest later in the postoperative course. Phlebitis is assessed for, but it is not the most important complication. Hemorrhage is more important than phlebitis. Leaking around the IV catheter is not a major complication.
A nurse reviews the history of a client who is hospitalized with a diagnosis of urinary calculi and identifies that which factor may have contributed to the development of the calculi? Increased fluid intake Urine specific gravity of 1.017 Jogging 3 miles (4.8 km) a day History of hyperparathyroidism
History of hyperparathyroidism Hyperparathyroidism results in high serum calcium levels; as the blood is filtered through the nephron, precipitates of calcium may form calculi. Increased fluid intake will discourage stone formation by preventing stagnation of urine. A urine specific gravity of 1.017 is within the expected range of 1.010 to 1.030 and will not increase the risk of developing urinary calculi. A jogging schedule of 3 miles (4.8 km) daily reduces the risk of developing urinary calculi; activity improves glomerular filtration and inhibits calcium from leaving the bone.
The nurse is teaching self-management techniques to a client newly diagnosed with polycystic kidney disease. Which statement of the client indicates a need for further teaching? "I should monitor my bowel movements." "I should weigh myself once a week." "I should record my blood pressure daily." "I should notify my healthcare provider if I have fever."
I should weigh myself once a week Polycystic kidney disease is characterized by a sudden weight gain due to enlarged kidneys. Therefore the client should weigh himself or herself every day at the same time of day and with the same amount of clothing on. Bowel movements should be monitored to prevent constipation. The client should regularly record his or her blood pressure to prevent hypertension. The client should notify the healthcare provider if he or she has fever.
A nurse is assessing a client with a diagnosis of kidney failure for clinical indicators of metabolic acidosis. What should the nurse conclude is the reason metabolic acidosis develops with kidney failure? Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention Inability of the renal tubules to reabsorb water to dilute the acid contents of blood Impaired glomerular filtration, causing retention of sodium and metabolic waste products
Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The rate of respirations increases in metabolic acidosis to compensate for a low pH. The fluid balance does not significantly alter the pH. The retention of sodium ions is related to fluid retention and edema rather than to acidosis.
After a prostatectomy, a client's plan of care will include the prevention of postoperative deep vein thrombosis. Which nursing goal will best achieve prevention? Increase coagulability of the blood. Increase velocity of the venous return. Increase effectiveness of internal respiration. Increase oxygen-carrying capacity of the blood.
Increase velocity of the venous return. Because venous stasis is the major predisposing factor of pulmonary emboli, venous flow velocity should be increased through activity. Increasing the coagulability of the blood can lead to the development of deep vein thrombosis. Effectiveness of internal respiration and oxygen-carrying capacity of the blood will not affect the prevention of deep vein thrombosis.
What does the nurse find in the laboratory report of a client who is suspected of having a urinary disorder and is on steroid therapy? Increased red blood cells count Increased sodium count Increased serum creatinine levels Increased blood urea nitrogen levels
Increased blood urea nitrogen levels Steroid therapy may be used to treat urinary disorders; however, it may cause the blood urea nitrogen (BUN) levels to elevate. Increased red blood cell count occurs in polycythemia. Increased sodium does not occur with steroid use. An increase in serum creatinine levels indicates kidney impairment.
The laboratory report of a client reveals increased levels of atrial natriuretic peptide. Which other finding does the nurse anticipate to find in the client? Decreased urine output Increased concentration of urine Increased sodium excretion in urine Decreased glomerular filtration rate
Increased sodium excretion in urine Atrial natriuretic peptide is secreted by the myocyte cells in the right atrium. Atrial natriuretic peptide acts on the kidneys and causes an increase in the excretion of sodium by inhibiting aldosterone. Atrial natriuretic peptide increases urine output.
A client with ascites is scheduled to have a paracentesis. What should the nurse include in the plan of care? Instruct the client to urinate before the procedure. Shave hair around the insertion site and 2 to 3 inches (5 to 7.5 cm) beyond the site. Position the client on the side with the hips and knees flexed during the procedure. Measure the abdominal girth two fingerbreadths below the umbilicus immediately before the procedure.
Instruct the client to urinate before the procedure. The bladder should be empty to prevent injury during insertion of the trocar.
A client is admitted with a diagnosis of torsion of the testes. How should the nurse respond when the client asks, "Why do I have to have surgery right now?" "There's no other way to control the pain." "Irreversible damage occurs after a few hours." "The extreme swelling can cause the testicle to rupture." "The reduction in testicular blood flow leads to rapid death of sperm."
Irreversible damage occurs after a few hours When a testis is twisted, its blood supply is decreased. This can result in gangrene. Medication can be given to relieve pain. The testes do not rupture if edema occurs. Sperm are continually produced, so their destruction is not the concern.
The laboratory values of a client with renal calculi reveal a serum calcium within expected limits and an elevated serum purine. How should the nurse interpret these findings about the stone's composition? It contains cystine. It contains uric acid. It contains calcium oxalate. It contains magnesium ammonium phosphate.
It contains uric acid. Purines are precursors of uric acid, which crystallizes. Cystine stones are caused by a rare hereditary defect resulting in defective absorption of cysteine in the gastrointestinal tract and kidneys (inborn error of cystine metabolism). Serum purine will not be elevated if the stone is composed of calcium oxalate. A struvite stone sometimes is called a magnesium ammonium phosphate stone and is precipitated by recurrent urinary tract infections.
The nurse is providing care to a client who has had a transurethral resection of the prostate (TURP). Which goal is the priority? Maintain patency of the cystostomy tube. Prevent wound hemorrhage and infection. Maintain patency of the indwelling catheter. Prevent the abdominal dressing from draining.
Maintain patency of the indwelling catheter. Indwelling catheter patency promotes bladder decompression, which prevents distention and bleeding; continuous flow of an irrigant limits clot formation and promotes hemostasis. Maintaining patency of the cystostomy tube is not associated with a TURP; a cystostomy tube is a catheter that is placed directly into the bladder through a suprapubic incision. No abdominal incision is made because the resection is performed via the urethra. Although hemorrhage and infection may occur, no wound is observed because the surgery was performed via the urethra.
A client with an invasive carcinoma of the bladder is receiving radiation to the lower abdomen in an attempt to shrink the tumor before surgery. What should the nurse do, considering the side effects of radiation? Observe the feces for the presence of blood. Monitor the blood pressure for hypertension. Administer enemas to remove sloughing tissue. Provide a high-bulk diet to prevent constipation.
Observe the feces for the presence of blood. Radiation may damage the bowel mucosa, causing bleeding. Blood pressure changes are not expected during radiation therapy. Enemas are contraindicated with lower abdominal radiation because of the damaged intestinal mucosa. Diarrhea, not constipation, occurs with radiation that influences the intestine.
A male client reports dysuria, nocturia, and difficulty starting the urinary stream. A cystoscopy and biopsy of the prostate gland have been scheduled. After the procedure the client reports an inability to void. Which action should the nurse take? Insert a urinary retention catheter. Palpate above the pubic symphysis. Limit oral fluids until the client voids. Assure the client that this is expected.
Palpate above the pubic symphysis. A full bladder is palpable with urinary retention and distention, which are common problems after a cystoscopy because of urethral edema. More conservative nursing methods, such as running water or placing a warm cloth over the perineum, should be attempted to precipitate voiding; catheterization carries a risk of infection and is used as the last resort. Fluids dilute the urine and reduce the chance of infection after cystoscopy and should not be limited. Although urinary retention can occur, it is not expected; the nurse must assess the extent of bladder distention and discomfort.
Which hormone is released in response to low serum levels of calcium? Renin Erythropoietin Parathyroid hormone Atrial natriuretic peptide
Parathyroid hormone If serum calcium levels decline, the parathyroid gland releases parathyroid hormone to maintain calcium homeostasis. Renin is a hormone released in response to decreased renal perfusion; this hormone is responsible for regulating blood pressure. Erythropoietin is released by the kidneys in response to poor blood flow to the kidneys; it stimulates the production of red blood cells. Atrial natriuretic peptide is produced by the right atrium of the heart in response to increased blood volume. This hormone then acts on the kidneys to promote sodium excretion, which decreases the blood volume.
A client develops acute glomerulonephritis after a recent streptococcal infection. The nurse should expect to find which clinical manifestation during the health history and physical examination? Nocturia Periorbital edema Increased appetite Recent weight loss
Periorbital edema Periorbital edema occurs because of the retention of fluid. The client will experience oliguria, not nocturia. The client will develop anorexia related to elevated toxic substances in the blood. The client will have a weight gain because of the retention of fluid.
The client diagnosed with a fistula between the bowel and urinary bladder reports passing air and bubbles during urination. What does the nurse anticipate the client's condition to be? Nocturia Oliguria Pneumaturia Stress incontinence
Pneumaturia The occurrence of gas along with urination is called pneumaturia and could result from the formation of a fistula between the bowel and urinary bladder. Frequent urination during the night is called nocturia and is associated with conditions such as heart failure and diabetes mellitus. In medical conditions such as severe dehydration and shock, the urine output is reduced to 100 to 400 mL/day and this is termed oliguria. Weak sphincter control, urinary retention, and estrogen deficiency are some causes for stress incontinence or involuntary urination during increased pressure situations.
Which urinalysis finding indicates a urinary tract infection? Presence of crystals Presence of bilirubin Presence of ketones Presence of leukoesterase
Presence of leukoesterase Leukoesterases are released by white blood cells as a response to an infection or inflammation. Therefore, the presence of this chemical in urine indicates a urinary tract infection. The presence of crystals in the urine indicates that the specimen had been allowed to stand. Presence of bilirubin in the urine indicates anorexia nervosa, diabetic ketoacidosis, and prolonged fasting. The presence of ketones indicates diabetic ketoacidosis.
The nurse is caring for a client who has been diagnosed with glomerulonephritis. Which initial urinary finding supports this diagnosis? Anuria Dysuria Polyuria Proteinuria
Proteinuria Protein in the urine (proteinuria) and hematuria (blood in the urine) are classic manifestations of the onset of glomerulonephritis because of the increased permeability of the vascular bed in the kidneys.
While reviewing the result of an intravenous pyelogram, the nurse discovers that the client has a shortened urethra. The client also complains of urinary incontinence. Which nursing intervention is beneficial for the client? Providing thorough perineal care after each voiding Encouraging the client to use the toilet or bedpan every 2 hours Responding quickly to the client's indication of the need to void Providing privacy, assistance, and voiding stimulants over the perineum
Providing thorough perineal care after each voiding Weakened urinary sphincters and shortened urethras are age-related physiologic changes in older adults. Because a shortened urethra has an increased potential for bladder infections, the nurse should provide thorough perineal care after each voiding. Encouraging the client to use the toilet or bedpan every two hours will help to avoid overflow urinary incontinence. Responding quickly to the client's indication of the need to void will help to alleviate urinary stress incontinence episodes. Providing privacy, assistance, and voiding stimulants over the perineum will help to initiate voiding in the client.
A nurse is teaching about the function of the loop of Henle. Which function should the nurse include? Secretion of ammonia in the descending limb Secretion of hydrogen in the descending limb Reabsorption of sodium in the ascending limb Reabsorption of water in the ascending limb
Reabsorption of sodium in the ascending limb serum levels of sodium in the body. Ammonia is secreted from the distal tubule. The secretion of hydrogen occurs in the proximal and distal tubules of the nephron. Reabsorption of water is carried out in the descending limb of the loop of Henle.
A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet. What is the rationale for the nurse's instruction? A person's body tends to retain fluid when a salt substitute is included in the diet. Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca.
Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen (BUN) and creatinine levels; these are the result of protein metabolism. There is no such substance in salt substitutes that interferes with the transfer of fluid across capillary membranes.
Which finding would the nurse expect in the urinalysis report of a client with diabetes insipidus? pH of urine: 9 Specific gravity of urine: 0.4 Red blood cells in urine: 6 hpf White blood cells in urine: 8 hpf
Specific gravity of urine: 0.4 The normal specific gravity of urine lies between 1.003 and 1.030. The specific gravity of urine of clients with diabetes insipidus is low due to the impaired functioning of antidiuretic hormone. The pH of normal urine ranges from 6.5 to 7.0. A pH higher than 8 indicates a urinary tract infection (UTI). Normal urine contains between 0 and 4 hpf of red blood cells (RBCs). A count greater than 4 hpf indicates tuberculosis, cystitis, neoplasm, and glomerulonephritis. In a normal urine sample, white blood cells (WBCs) lie in the range of 0 to 5 hpf. Any increase in the number of WBCs indicates a urinary tract inflammation.
While reviewing the diagnostic test reports of a client with a kidney tumor, the nurse finds that the tumor has spread to the renal vein and lymph nodes. Which stage of kidney tumor is indicated by this finding? Stage I Stage II Stage III Stage IV
Stage III
A male client has discharge from the penis. Gonorrhea is suspected. To obtain a specimen for a culture, what should the nurse do? Instruct the client to provide a semen specimen. Swab the discharge when it appears on the prepuce. Instruct the client how to obtain a clean catch specimen of urine. Swab the drainage directly from the urethra to obtain a specimen.
Swab the drainage directly from the urethra to obtain a specimen. Swabbing the drainage directly from the urethra obtains a specimen uncontaminated by environmental organisms. Instructing the client to provide a semen specimen is not as accurate as obtaining the purulent discharge from the site of origin. Swabbing the discharge when it appears on the prepuce will contaminate the specimen with organisms external to the body. Teaching the client how to obtain a clean catch specimen of urine will dilute and possibly contaminate the specimen.
Which laboratory finding is suggestive of mild kidney disease in male clients? Serum creatinine - 0.9 mg/dL Urinary albumin - 24 mg/mmol Blood urea nitrogen (BUN) - 18 mg/dL Blood urea nitrogen (BUN)/creatinine ratio - 23
Urinary albumin - 24 mg/mmol Increased levels of albumin in the urine indicate mild or moderate kidney disease. The normal levels of albumin in the urine range between 2.0 and 20 mg/mmol in men and between 2.8 and 28 mg/mmol in women. An albumin level of 24 mg/mmol is higher than the normal range for men. Therefore a urinary albumin of 24 mg/mmol suggests mild kidney failure. The normal levels of serum creatinine range between 0.6-1.2 mg/dL in men and between 0.5-1.1 mg/dL in women. Therefore a serum creatinine value of 0.9 mg/dL is normal. Blood urea nitrogen (BUN) in the range of 10-20 mg/dL is normal. Therefore a BUN value of 18 mg/dL is a normal finding. The normal range of a BUN/creatinine ratio is between 6 and 25. Therefore a BUN/creatinine ratio of 23 is a normal value.
To prevent bleeding after a suprapubic prostatectomy, the client should be instructed to avoid straining on defecation. Which foods should the nurse encourage the client to eat to help prevent constipation during the recovery period? Milk Apples Oatmeal Green peas Scrambled eggs
apples, oatmeal, green peas Apples, oatmeal, and green peas are high in fiber, which helps prevent constipation. Milk and milk products can be constipating; they do not contain bulk. Scrambled eggs contain little dietary fiber and do not prevent constipation.
A client is admitted with renal calculi. Which clinical manifestations does a nurse expect the client to report? Blood in the urine Irritability and twitching Dry, itchy skin and pyuria Frequency and urgency of urination Pain radiating from the kidney to a shoulder
blood in the urine, frequency and urgency of urination
A nurse evaluates that a client with chronic kidney disease understands an adequate source of high biologic-value (HBV) protein when the client selects which food from the menu? Apple juice Raw carrots Cottage cheese Whole wheat bread
cottage cheese Cottage cheese contains more protein than the other choices. Apple juice is a source of vitamins A and C, not protein. Raw carrots are a carbohydrate source and contain beta-carotene. Whole wheat bread is a source of carbohydrates and fiber.
What is the action of vasopressin? Promotes sodium reabsorption Reabsorbs water into the capillaries Promotes tubular secretion of sodium Stimulates bone marrow to make red blood cells
reabsorbs water into the capillaries Vasopressin is also known as an antidiuretic hormone (ADH). It helps in the reabsorption of water into the capillaries. Aldosterone promotes sodium reabsorption. Natriuretic hormones promote tubular secretion of sodium. Erythropoietin stimulates bone marrow to make red blood cells (RBCs).
A nurse is caring for a male client who is scheduled for a dilation of the urethra. Which structure surrounding the male urethra should the nurse include in a teaching program when explaining the procedure? Epididymis Prostate gland Seminal vesicle Bulbourethral gland
prostate gland The prostate gland is shaped like a ring, with the urethra passing through its center. The epididymis lies along the top and sides of the testes. The seminal vesicles are on the posterior surface of the bladder. The bulbourethral gland lies below the prostate.
A client has end-stage kidney disease and is receiving hemodialysis. During dialysis the client reports nausea and a headache and appears confused. Operating on prescribed protocols, which action will the nurse take? Give an analgesic. Administer an antiemetic. Decrease the rate of exchange. Discontinue the procedure immediately.
decrease the rate of exchange These are signs and symptoms of disequilibrium syndrome [1] [2], which results from rapid changes in composition of the extracellular fluid; the rate of exchange should be decreased. Although an analgesic may relieve the headache, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Although administering an antiemetic may relieve the nausea, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Discontinuing the procedure is unnecessary; reducing the rate of exchange should reduce the adaptations of disequilibrium syndrome.
A client with acute kidney injury moves into the diuretic phase after 1 week of therapy. For which clinical indicators during this phase should the nurse assess the client? Skin rash Dehydration Hypovolemia Hyperkalemia Metabolic acidosis
dehydration, hypovolemia In the diuretic phase, fluid retained during the oliguric phase is excreted and may reach 3 to 5 L daily; dehydration and hypovolemia may occur unless fluids are replaced. Skin rash is not associated with the diuretic phase. Hyperkalemia develops in the oliguric phase when glomerular filtration is inadequate. Metabolic acidosis occurs in the oliguric, not diuretic, phase.
What are the general manifestations associated with clients who have urinary system disorders? Facial edema Excessive thirst Stress incontinence Nausea and vomiting Elevated blood pressure
excessive thirst, N/V, elevated blood pressure
While reviewing the urinalysis reports of an elderly client, the nurse finds white blood cells (WBCs) in the urine. Which condition might the client have? Pyelonephritis Kidney trauma Kidney infection Acute tubular necrosis
kidney infection The presence of white blood cells (WBCs) in the urine is indicates a kidney or urinary tract infection. The presence of red blood cells (RBCs) in the urine indicates pyelonephritis, kidney trauma, or acute tubular necrosis.
A client has been admitted with a urinary tract infection. The nurse receives a urine culture and sensitivity report that reveals the client has vancomycin-resistant enterococcus (VRE). After notifying the primary healthcare provider, which action should the nurse take to decrease the risk of transmission to others? Insert a Foley catheter. Initiate droplet precautions. Move the client to a private room. Use a high-efficiency particulate air (HEPA) respirator when entering the room.
move the client to a private room Clients with VRE should be moved to a private room to decrease transmission to others. VRE has been identified in the urine, not respiratory secretions. Contact isolation should be implemented. A Foley catheter should not be inserted because it will predispose the client to develop an additional infection. A HEPA respirator is not required when entering the room.
A nurse is teaching a birthing/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation? Inhibin Estrogen Prolactin Progesterone
prolactin Prolactin is the hormone that initiates and produces milk during lactation. Inhibin prevents the secretions of follicle stimulating hormone and gonadotropin releasing hormone. Estrogen and progesterone are the sex hormones produced by the ovaries.
The primary healthcare provider suspects pituitary gland dysfunction in a female client. Which diagnostic test would the primary healthcare provider suggest to the client? Estradiol test Prolactin test Sims-Huhner test Papanicolaou (Pap) test
prolactin test A prolactin test is used to detect pituitary gland dysfunction that causes amenorrhea. Therefore the primary healthcare provider would suggest that the client have a prolactin test to determine if the client does or does not have any pituitary gland dysfunction.
A client has undergone pelvic surgery and the nurse removes the catheter in a week according to instructions. In the follow up within several hours, which finding in the client indicates a need for reinsertion of catheter? Anuria Polyuria Retention Incontinence
retention The inability of the client to urinate in spite of the bladder being filled with urine is called retention. Generally clients who have undergone pelvic surgery and have the catheter removed experience urinary retention. The catheter should be reinserted if the client is unable to void. Anuria is the drastic decrease in urine output to less than 100 mL in a day and is a sign of end-stage kidney disease or acute kidney injury. Polyuria is anticipated in a client who is diagnosed with diabetes mellitus or insipidus, and the client eliminates large volumes of urine at a time. Incontinence or the loss of ability over voluntarily control of urination is a sign of conditions such as neurogenic bladder or bladder infection.
The older adult client with a weakened urinary sphincter is at risk for which condition? Bladder distention Skin irritation Tendency to fall or trip over objects Urinary retention
skin irritation The weakening of the urinary sphincter results in involuntary dribbling of urine, which increases the risk of skin irritation and infections. Therefore maintaining thorough hygiene in the perineum area reduces the chance of occurrence of infection or skin rash. The nurse should observe for signs of bladder distention in clients who have a tendency to retain urine. Keeping a bedside light at night is an intervention to prevent night falls in clients who have nocturia. A weakened urinary sphincter will cause loss of urine.
