ATI Learning System = Medical-Surgical: Renal and Urinary

A nurse is reinforcing teaching with a newly licensed nurse about caring for a client who has a new left arteriovenous fistula. Which of the following statements should the nurse make?

"Avoid taking blood pressures on the client's left arm."

A nurse is reinforcing teaching a client prior to a renal biopsy. Which of the following statements should the nurse make?

"You will need to be on bed rest following the procedure" [A renal biopsy involves a tissue biopsy through needle insertion into the lower lobe of the kidney. The client should maintain bed rest in a supine position with a back roll for support for 2 to 24 hr following the procedure to reduce the risk for bleeding. The nurse can elevate the head of the bed.]

A nurse is reinforcing teaching with a client prior to a cystoscopy. Which of the following statements should the nurse make?

"Expect to have pink-tinged urine after this procedure." [A cystoscopy is a procedure in which a scope is inserted into the urethra to diagnose or treat bladder problems. Following the procedure, pink-tinged urine is expected.]

A nurse is reinforcing teaching with a client who is preop prior to a transurethral resection of the prostate (TURP). Which of the following statements indicates an understanding of the information?

"I will feel the urge to urinate following this procedure." [After a TURP, the client will feel the urge to urinate. The nurse should reassure him that he will receive analgesics to help relieve this discomfort. The client might have temporary dribbling and leakage of urine following a TURP. Stress incontinence is an expected finding following a TURP due to poor sphincter control.The nurse should reassure the client that these manifestations will resolve. The client will require an indwelling urinary catheter following a TURP to monitor urine output and bleeding. Pink-tinged urine and blood clots are an expected finding for several days following a TURP. Burning upon urination and urinary frequency are expected findings after a TURP and should decrease after several days.]

A nurse is reinforcing teaching with a client who has a history of UTIs. Which of the following statements should indicate to the nurse the need for additional instructions?

"I will use a vaginal douche daily" [The client should avoid vaginal douches, bubble baths, and any substances that can increase the risk for UTIs. The client should use mild soap and water to wash the perineal area.]

A nurse is reinforcing teaching about the PSA test with a client. Which of the following statements should the nurse make?

"You don't need to fast prior to the PSA test."

A nurse is reinforcing teaching with a client who has acute pyelonephritis. Which of the following instructions should the nurse include in the teaching?

"You should complete the entire cycle of antibiotic therapy." [A client who has acute pyelonephritis should drink at least 2,000 mL per day, unless otherwise contraindicated. The client should balance rest and activity, and does not require complete bed rest. Ambulation can prevent complications of bed rest such as constipation and urinary stasis. A client who has acute pyelonephritis can take NSAIDs as needed for pain, unless otherwise contraindicated.]

A nurse is reinforcing teaching about UTIs with a client. Which of the following manifestations should the nurse include?

Back pain

A nurse is collecting data from a client who is 1 week postop following a living donor kidney transplant. Which of the following findings should indicate to the nurse that the client is experiencing acute kidney rejection?

Blood pressure 160/90 mmHg [Due to the kidney's role in fluid and blood pressure regulation, a client who is experiencing rejection can have hypertension.]

A nurse is reinforcing dietary teaching with a client who has late-stage CKD. Which of the following nutrients should the nurse instruct the client to increase in her diet?

Calcium

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that the dialysate output is less than the input, and the client's abdomen is distended. Which of the following actions should the nurse take?

Change the clients position [The client is retaining the dialysate solution after the dwell time. The nurse should ensure that the clamp is open and the tubing is not kinked, and reposition the client to facilitate the drainage of the solution from the peritoneal cavity.]

A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney injury. The client reports diarrhea, a dull headache, palpitations, and muscle tingling and weakness. Which of the following actions should the nurse take first?

Check the client's electrolyte values. [The nurse should apply the urgent versus non-urgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The nurse should check the client's most recent potassium value because these findings are manifestations of hyperkalemia, which can lead to cardiac dysrhythmias; therefore, this is the priority action.]

A nurse is collecting data from a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider?

Cloudy, yellow drainage [Cloudy drainage is an early manifestation of peritonitis and the nurse should report this finding to the provider. Other manifestations include fever and abdominal tenderness.] [Abdominal fullness is an expected finding during the dwell period, when the dialysate stays in the peritoneal cavity. A supine, low-Fowler's position can reduce abdominal pressure.]

A nurse is collecting data from a client who is postop following a transurethral resection of the prostate (TURP). After the nurse discontinues the client's urinary catheter, which of the following findings should the nurse report to the provider?

Decreased urine output [A decrease in urine output after a TURP indicates obstruction to urine flow by a clot or residual prostatic tissue and should be reported to the provider.]

A nurse is collecting data for a client who has an injury to the lower abdomen following a motor-vehicle crash. The nurse should identify that which of the following findings is a manifestation of bladder trauma?

Hematuria [Manifestations of bladder trauma include hematuria, or blood in the urine; blood at the urinary meatus; pelvic pain; and anuria, or the absence of urine.]

A nurse is reinforcing teaching with a client who has CKD. Which of the following instructions should the nurse include?

Limit fluid intake [A client who has CKD should limit fluid intake to prevent hypervolemia, or excessive fluid overload.]

A nurse is reinforcing teaching about collecting a 24-hour urine specimen for creatinine clearance with a newly licensed nurse. Which of the following instructions should the nurse include?

Place signs in the bathroom as a reminder about the test in progress [The nurse should have the client void first thing in the morning, discard the specimen, and collect all subsequent specimens for 24 hr. The nurse should instruct the client to avoid vigorous exercise, cooked meat, tea, and coffee during the 24-hr period.]

A nurse is caring for a client who has a diagnosis of renal calculi and reports severe flank pain. Which of the following is the priority nursing action?

Relieve the client's pain [The nurse should apply the urgent versus non-urgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The pain associated with renal calculi is severe and can lead to shock; therefore, this is the nurse's priority action.]

A nurse is collecting data from a client who is postop following extracorporeal shockwave lithotripsy (ESWL). The nurse should identify that which of the following findings is the pritority?

Report of palpitations [The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning - having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these can indicate a threat to life, and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority-setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority-setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. ESWL is the application of sound, laser, or dry shock wave energies to break a kidney stone into small pieces. The shock waves are initiated during the R wave of the ECG to prevent dysrhythmias. When using the airway, breathing, circulation approach to client care, the nurse should determine report of palpitations is a manifestation of dysrhythmias and is the priority finding.]

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following adverse effects?

Respiratory distress [Respiratory distress can occur during peritoneal dialysis due to fluid overload.]