Acute Renal Failure / Chronic Kidney Disease / UTI / Renal Calculi DAVIS

Which intervention is most important for the nurse to implement for the client with a left nephrectomy? 1. Assess the intravenous fluids for rate and volume. 2. Change surgical dressing every day at the same time. 3. Monitor the client's PT/PTT/INR level daily. 4. Monitor the percentage of each meal eaten.

1.

Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1. "I should increase my fluid intake, especially in warm weather." 2. "I should eat foods containing cocoa and chocolate." 3. "I will walk about a mile every week and not exercise often." 4. "I should take one (1) vitamin a day with extra calcium."

1.

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

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task is most appropriate for the nurse to delegate? 1. Collect a clean voided midstream urine specimen. 2. Evaluate the client's eight (8)-hour intake and output. 3. Assist in checking a unit of blood prior to hanging. 4. Administer a cation-exchange resin enema.

1

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply. 1. Increased alertness and no seizure activity. 2. Increase in hemoglobin and hematocrit. 3. Denial of nausea and vomiting. 4. Decreased urine-specific gravity. 5. Increased serum creatinine level.

1-3

The nurse is caring for a pregnant client diagnosed with acute pyelonephritis. Which scientific rationale supports the client being hospitalized for this condition? 1. The client must be treated aggressively to prevent maternal/fetal complications. 2. The nurse can force the client to drink fluids and avoid nausea and vomiting. 3. The client will be dehydrated and there won't be sufficient blood flow to the baby. 4. Pregnant clients historically are afraid to take the antibiotics as ordered.

1.

The nurse is providing discharge teaching to the client diagnosed with polycystic kidney disease. Which statement made by the client indicates the teaching has been effective? 1. "I need to avoid any activity causing a risk for injury to my kidney." 2. "I should avoid taking medications for high blood pressure." 3. "When I urinate there may be blood streaks in my urine." 4. "I may have occasional burning when I urinate with this disease."

1.

The nurse is preparing the plan of care for a client with fluid volume deficit. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Monitor vital signs every two (2) hours until stable. 2. Measure the client's oral intake and urinary output daily. 3. Administer mouth care when bathing the client. 4. Weigh the client weekly in the same clothing at the same time. 5. Assess skin turgor and mucous membranes every shift.

1. & 5.

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.

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 substance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure.

The client diagnosed with CKD has a new arteriovenous fistula in the left forearm. Which intervention should the nurse implement? 1. Teach the client to carry heavy objects with the right arm. 2. Perform all laboratory blood tests on the left arm. 3. Instruct the client to lie on the left arm during the night. 4. Discuss the importance of not performing any hand exercises.

1. Carrying heavy objects in the left arm could cause the fistula to clot by putting undue stress on the site, so the client should carry objects with the right arm.

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.

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 admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent ARF? 1. Administer normal saline IV. 2. Take vital signs. 3. Place client on telemetry. 4. Assess abdominal dressing.

1. Preventing and treating shock with blood and fluid replacement will prevent acute renal failure from hypoperfusion of the kidneys. Significant blood loss is expected in the client with a gunshot wound.

The nurse is caring for the client recovering from a percutaneous renal biopsy. Which data indicate the client is complying with client teaching? 1. The client is lying flat in the supine position. 2. The client continues oral fluids restriction while on bedrest. 3. The client uses the bedside commode to urinate. 4. The client refuses to ask for any pain medication.

1. The client needs to lie flat on the back to apply pressure to prevent bleeding.

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. 1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. 4. Insert an indwelling catheter in client after having the client empty the bladder. 5. Instruct the UAP to notify the nurse when the client urinates.

1. The health-care provider may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid. 2. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. 3. All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result.

Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi? 1. Assess the client's neurological status every two (2) hours. 2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client's creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview.

2.

The client diagnosed with ARF is placed on bedrest. 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. Bedrest helps increase the blood return to the renal circulation. 2. Bedrest reduces the metabolic rate during the acute stage. 3. Bedrest decreases the workload of the left side of the heart. 4. Bedrest aids in reduction of peripheral and sacral edema.

2

The nurse is teaching the female client diagnosed with tuberculosis of the urinary tract prior to discharge. Which information should the nurse include specific to this diagnosis? 1. Instruct the client to take the medication with food. 2. Explain condoms should be used during treatment. 3. Discuss the need for follow-up chest x-rays. 4. Encourage a well-balanced diet and fluid intake.

2 **2. Clients who have been diagnosed with tuberculosis of the renal tract should use condoms to prevent transmission of the mycobacterium. If the infection is located in the penis or urethra, abstaining from sexual activity is recommended.** 3. Follow-up chest x-rays are important for the client with tuberculosis of the lung. 4. Maintaining a well-balanced diet and fluid intake is important for recovery from any illness and for a healthy lifestyle, but it is not specifically for this diagnosis.

The nurse is discussing how to prioritize care with the UAP. Which client should the nurse instruct the UAP to see first? 1. The immobile client who needs sequential compression devices removed. 2. The elderly woman who needs assistance ambulating to the bathroom. 3. The surgical client who needs help changing the gown after bathing. 4. The male client who needs the intravenous catheter discontinued.

2 **2. The elderly woman may have age-related changes (decreased bladder capacity, weakened urinary sphincter, and shortened urethra) causing urinary urgency or incontinence. The elderly client is at risk for falling while attempting to get to the bathroom, so this client should be seen first.**

The nurse is preparing a teaching care plan for the client diagnosed with nephrotic syndrome. Which intervention should the nurse include? 1. Stop steroids if a moon face develops. 2. Provide teaching for taking diuretics. 3. Increase the intake of dietary sodium. 4. Report a decrease in daily weight.

2 **2. Treatment includes diuretics to eliminate dependent edema, usually in the ankles and sacrum. Medication teaching is an appropriate intervention.**

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first? 1. Monitor the client's urinary output. 2. Assess the client's pain and rule out complications. 3. Increase the client's oral fluid intake. 4. Use a safety gait belt when ambulating the client.

2.

The clinic nurse is caring for a client diagnosed with chronic pyelonephritis who is prescribed trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, twice a day for 90 days. Which statement is the scientific rationale for prescribing this medication? 1. The antibiotic will treat the bladder spasms that accompany a urinary tract infection. 2. If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth. 3. In three (3) months, the client should be rid of all bacteria in the urinary tract. 4. The HCP is providing the client with enough medication to treat future infections.

2.

The male client diagnosed with CKD secondary to diabetes has been receiving dialysis for 12 years. The client is notified he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis treatments. Which response by the nurse is most therapeutic? 1. "You cannot just quit your dialysis. This is not an option." 2. "You're angry at not being on the list, and you want to quit dialysis?" 3. "I will call your nephrologist right now so you can talk to the HCP." 4. "Make your funeral arrangements because you are going to die."

2.

The nurse is preparing the discharge teaching plan for the male client with a left-sided nephrectomy. Which statement indicates the teaching is effective? 1. "I can't wait to start back to work next week, I really need the money." 2. "I will take my temperature and if it is above 101 I will call my doctor." 3. "I am glad I won't have to keep track of how much I urinate in the day." 4. "I am happy I will be able eat what I usually eat, I don't like this food."

2.

The nurse is caring for a client with chronic pyelonephritis. Which assessment data support the diagnosis of chronic pyelonephritis? 1. The client has fever, chills, flank pain, and dysuria. 2. The client complains of fatigue, headaches, and increased urination. 3. The client had a group B beta-hemolytic strep infection last week. 4. The client has an acute viral pneumonia infection.

2. Fatigue, headache, and polyuria as well as loss of weight, anorexia, and excessive thirst are symptoms of chronic pyelonephritis.

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

The nurse is discussing kidney transplants with clients at a dialysis center. Which population is less likely to participate in organ donation? 1. Caucasian. 2. African American. 3. Asian. 4. Hispanic.

2. Many in the African American culture believe the body must be kept intact after death, and organ donation is rare among African Americans. This is also why a client of African American descent will be on a transplant waiting list longer than people of other races. This is because of tissue-typing compatibility. Remember, this does not apply to all African-Americans; every client is an individual.

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1. Dull, aching flank pain and microscopic hematuria. 2. Nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and dull suprapubic pain with voiding. 4. The client will be asymptomatic.

2. The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin.

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.

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 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.

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

Which outcome should the nurse identify for the client diagnosed with fluid volume excess? 1. The client will void a minimum of 30 mL per hour. 2. The client will have elastic skin turgor. 3. The client will have no adventitious breath sounds. 4. The client will have a serum creatinine of 1.4 mg/dL.

3 **3. The client with fluid volume excess has too much fluid. Excess fluid is reflected by adventitious breath sounds. Therefore, an expected outcome is to have no excess fluid, as evidenced by normal, clear breath sounds.**

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.

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

. The nurse is caring for a client diagnosed with rule-out nephrotic syndrome. Which intervention should be included in the plan of care? 1. Monitor the urine for bright-red bleeding. 2. Evaluate the calorie count of the 500-mg protein diet. 3. Assess the client's sacrum for dependent edema. 4. Monitor for a high serum albumin level.

3.

The client diagnosed with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task is the most appropriate to delegate to the UAP? 1. Monitor the amount, color, and consistency of urine output. 2. Teach the client about care of the indwelling Foley catheter. 3. Assist the client to the car when being discharged home. 4. Take the client's postprocedural vital signs.

3.

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1. Increase water intake for the next 24 hours. 2. Take two (2) Tylenol to help decrease the temperature. 3. Come to the clinic and provide a urinalysis specimen. 4. Use a sterile 4 × 4 gauze to strain the client's urine.

3.

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1. Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2. Explain the importance of not drinking water two (2) hours before bedtime. 3. Discuss the importance of limiting vitamin D-enriched foods. 4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

3.

The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client? 1. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH. 2. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis. 3. The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate. 4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.

3.

The nurse is examining a 15-year-old female who is complaining of pain, frequency, and urgency when urinating. After asking the parent to leave the room, which question should the nurse ask the client? 1. "When was your last menstrual cycle?" 2. "Have you noticed any change in the color of the urine?" 3. "Are you sexually active?" 4. "What have you taken for the pain?"

3.

The male client diagnosed with CKD has received the initial dose of erythropoietin, a biologic response modifier, one (1) week ago. Which complaint by the client indicates the need to notify the health-care provider? 1. The client complains of flu-like symptoms. 2. The client complains of being tired all the time. 3. The client reports an elevation in his blood pressure. 4. The client reports discomfort in his legs and back.

3. After the initial administration of erythro- poietin, a client's antihypertensive medica- tions may need to be adjusted. Therefore, this complaint requires notification of the HCP. Erythropoietin therapy is con- traindicated in clients with uncontrolled hypertension. TEST-TAKING HINT: The test taker should se- lect the potentially life-threatening option or a complaint requiring the medication to be adjusted or discontinued. The nurse should notify the HCP if the medication is causing an adverse effect, not an expected side effect.

The client diagnosed with ARF is admitted to the intensive care department 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. 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. TEST-TAKING HINT: The test taker must notice adjectives. A "therapeutic" diet should cause the test taker to eliminate option "4" because it is a regular diet.

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.

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

The nurse is developing a plan of care for a client diagnosed with ARF. Which statement is an appropriate outcome for the client? 1. Monitor intake and output every shift. 2. Decrease of pain by three (3) levels on a 1-to-10 scale. 3. Electrolytes are within normal limits. 4. Administer enemas to decrease hyperkalemia.

3. Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client outcome is electrolytes within normal limits. TEST-TAKING HINT: The nurse must be knowledgeable of the nursing process. Client out- comes are used to evaluate the planning part of the nursing process. The outcomes must be measurable, client focused, and realistic.

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.

3. The client will maintain normal renal function.

The client receiving hemodialysis is being discharged home from the dialysis center. Which instruction should the nurse teach the client? 1. Notify the HCP if oral temperature is 102°F or greater. 2. Apply ice to the access site if it starts bleeding at home. 3. Keep fingernails short and try not to scratch the skin. 4. Encourage the significant other to make decisions for the client.

3. Uremic frost, which results when the skin attempts to take over the function of the kidneys, causes itching, which can lead to scratching, possibly resulting in a break in the skin. TEST-TAKING HINT: The test taker must read the question carefully. A temperature of 102°F is usually not acceptable in any client. Fostering dependence in any chronic illness is not encouraged by the nurse and so the test taker could eliminate option "4."

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

3. Venison and sardines.

The nurse is assessing a client diagnosed with urethral strictures. Which data support the diagnosis? 1. Complaints of frequency and urgency. 2. Clear yellow drainage from the urethra. 3. Complaints of burning during urination. 4. A diminished force and stream during voiding.

4 1. Frequency and urgency are signs and symptoms of a urinary tract infection. 2. Clear yellow urethral drainage is urine. 3. A complaint of burning during voiding is a sign/symptom of urinary tract infection. **4. The client with urethral strictures will report a decrease in force and stream during voiding. The stricture is treated by dilation using small filiform bougies.**

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 1. The dressing should be routinely changed as often as daily or weekly. 2. When connecting the tubing to the drainage bag, both ends should be cleaned with alcohol, not Betadine. 3. The drainage system can be cleaned daily with soap and water. **4. The nephrostomy tube should never be clamped or have kinks because an obstruction can cause pyelonephritis.**

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.

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

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.

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

The client diagnosed with CKD is receiving peritoneal dialysis. Which assessment data warrant immediate intervention by the nurse? 1. Inability to auscultate a bruit over the fistula. 2. The client's abdomen is soft, is nontender, and has bowel sounds. 3. The dialysate being removed from the client's abdomen is clear. 4. The dialysate instilled was 1,500 mL and removed was 1,500 mL.

4.

The client is 12 hours postoperative renal surgery. Which data warrant immediate intervention by the nurse? 1. The abdomen is soft, nontender, and rounded. 2. Pain is not felt with dorsal flexion of the foot. 3. The urine output is 60 mL for the past two (2) hours. 4. The client's trough vancomycin level is 24 mcg/mL.

4.

The nurse caring for a client diagnosed with CKD writes a client problem of "noncompliance with dietary restrictions." Which intervention should be included in the plan of care? 1. Teach the client the proper diet to eat while undergoing dialysis. 2. Refer the client and significant other to the dietitian. 3. Explain the importance of eating the proper foods. 4. Determine the reason for the client not adhering to the diet.

4.

The nurse is developing a nursing care plan for the client diagnosed with CKD. Which nursing problem is priority for the client? 1. Low self-esteem. 2. Knowledge deficit. 3. Activity intolerance. 4. Excess fluid volume.

4. Excess fluid volume is priority because of the stress placed on the heart and vessels, which could lead to heart failure, pulmonary edema, and death.

The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question is most important for the nurse to ask during the admission interview? 1. "Have you recently traveled outside the United States?" 2."Did you recently begin a vigorous exercise program?" 3."Is there a chance you have been exposed to a virus?" 4."What over-the-counter medications do you take regularly?"

4. Medications such as NSAID and some herbal remedies are nephrotocic; therefore, asking about medications is appropriate

The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? 1. Ask if the client is allergic to shellfish or iodine. 2. Keep the client NPO eight (8) hours prior to the ultrasound. 3. Ensure the client has a signed informed consent form. 4. Explain the test is noninvasive and there is no discomfort.

4. No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied which produces sound waves, resulting in a picture.

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.

4. Normal potassium level is 3.5 to 5.5 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-care provider order, so it is a collaborative intervention.

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? 1. Fluid volume loss. 2. Knowledge deficit. 3. Impaired urinary elimination. 4. Alteration in comfort.

4. Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin.

The client from a long-term care facility is admitted to the medical unit with a fever, hot flushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement first? 1. Start an IV with a 20-gauge catheter. 2. Initiate antibiotic therapy IVPB. 3. Collect a urine specimen for culture. 4. Change the indwelling catheter.

4. Unless the nurse can determine the catheter has been inserted within a few days, the nurse should replace the catheter and then get a specimen. This will provide the most accurate specimen for analysis.

The nurse performs bladder irrigation through an indwelling catheter. The nurse instilled 90 mL of sterile normal saline. The catheter drained 710 mL. What is the client's output? ________

620mL

The client with CKD is placed on a fluid restriction of 1,500 mL/day. On the 7a.m. to 7 p.m. shift the client drank an eight (8)-ounce cup of coffee, 4 ounces of juice, 12 ounces of tea, and 2 ounces of water with medications. What amount of fluid can the 7 p.m. to 7 a.m. nurse give to the client? _____________

720mL

The nurse is inserting an indwelling catheter into a female client. Which interventions should be implemented? Rank in the order of performance. 1. Explain the procedure to the client. 2. Set up the sterile field. 3. Inflate the catheter bulb. 4. Place absorbent pads under the client. 5. Clean the perineum from clean to dirty with Betadine.

In order of performance: 1, 4, 2, 3, 5. 1. The procedure should be explained to the client. 4. Incontinence pads should be placed under the client before beginning the sterile part of the procedure. 2. The sterile field must be set up prior to checking the bulb and cleaning the client's perineum. 3. The bulb of the catheter should be tested to make sure it will inflate and deflate prior to inserting the catheter into the client. 5. During the procedure, the perineum is swiped with Betadine swabs from front to back and also down the middle, then side to side with new swabs (clean to dirty).

The client diagnosed with a fluid and electrolyte disturbance in the emergency department is exhibiting peaked T waves on the STAT electrocardiogram. Which interventions should the nurse implement? List in order of priority. 1. Assess the client for leg and muscle cramps. 2. Check the serum potassium level. 3. Notify the health-care provider. 4. Arrange for a transfer to the telemetry floor. 5. Administer Kayexalate, a cation resin.

In order of priority: 1, 2, 3, 5, 4. 1. The nurse should assess to determine if the client is symptomatic of hyperkalemia. 2. A peaked T wave is indicative of hyperkalemia; therefore, the nurse should obtain a potassium level. 3. Hyperkalemia is a life-threatening situation because of the risk of cardiac dysrhythmias; therefore, the nurse should notify the health-care provider. 5. Kayexalate is a medication that will help remove potassium through the gastrointestinal system and should be administered to decrease the potassium level. 4. The client should be monitored continuously for cardiac dysrhythmias, so a transfer to the telemetry unit is warranted.