Exam 3
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:
"As the disease progresses, you will most likely require renal replacement therapy."
Which statement by the client indicates that more teaching on nitrofurantoin (Macrodantin) therapy is needed?
"I will not take this medication at bedtime because it causes insomnia."
A 78-year-old woman is at her annual checkup with her health care provider. She seems very embarrassed about asking if it's normal to "leak" urine when coughing or laughing, especially at her age. She has given birth to five children. What is the nurse's best response to this question? Later in the visit, the patient asks what could have caused her stress incontinence. What is the nurse's most accurate reply?
"Involuntary loss of urine or incontinence is not a normal consequence of childbirth or aging." "It may be due to weakening of the bladder neck support that is associated with childbirth."
After dialysis, the patient's daughter asks why the dialysis nurses weigh her mother before and after the dialysis treatment. What is the nurse's best response?
"It estimates the amount of fluid and sodium your mother is retaining and how much is taken off during dialysis."
The patient says that a friend mentioned taking antidepressant drugs when she had a similar problem, and asks if this could help herself. What is the nurse's best response?
"Tricyclic antidepressants such as imipramine have been helpful in relieving urinary incontinence."
What is a normal creatinine level
0.8-1.3
If a patient has gained 1kg how many mL of retained fluid is that equal to?
1000mL (1L)
What is a normal hemoglobin level
12-16
What is a normal adult GFR
125-200
How much urine should a patient that has renal calculi excrete in a day
2,000ml
What samples are needed for a creatinine clearance level
24 hour urine specimen and serum creatinine level midway through the urine collection process
Normal albumin and potassium levels
3.5-5
What is the normal urine output in an hour
30mls
What percentage of patients with end-stage kidney disease treated by dialysis or kidney transplant have diabetes mellitus?
44%
Once an indwelling urinary catheter is placed, how long before bacterial colonization begins?
48hours
The nurse identifies the patient with the greatest risk for a urinary tract infection as a
72-year-old woman hospitalized with a stroke who has a urinary catheter because of urinary incontinence.
What is a normal BUN level
8-21
The nurse coming on shift on the medical unit is taking report on four patients. What patients does the nurse know if the greatest risk for developing ESKD
A patient with diabetes and poorly controlled hypertension
Which kidney disorder is potentially reversible
AKI
What are causes of CKD
AKI, DM, metabolic disorders, hypertension, recurrent urinary obstructions
The patient is diagnosed with possible acute pyelonephritis and is admitted to the acute medical unit. What is the nurse's priority concern on admission?
Acute pain
A 35-year-old patient is admitted to the ED with fever, chills, and severe right flank pain. His heart rate is 112/min and respiratory rate is 32/min. He was recently treated for a urinary tract infection. Assessment reveals tenderness of the right costovertebral angle (CVA). 1.What diagnosis does the nurse expect? 2.What laboratory tests does the nurse anticipate?
Acute pyelonephritis Urinalysis
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client?
Anemia
A 21-year-old male reports burning and difficulty with urination. What priority question would obtain information about the patient's chief complaint?
Are you sexually active?
A patient with end-stage kidney disease (ESKD) has this serum laboratory analysis: K+ 5.9 mEq/L Na+ 152 mEq/L Creatinine 6.2 mg/dL BUN 60 mg/dL What is the priority nursing intervention?
Assess heart rate and rhythm
The patient is to have hemodialysis this morning. Which drug should be held until after the dialysis treatment?
Atenolol (Tenormin) Vasoactive drugs such as beta blockers like atenolol can cause hypotension during dialysis and are usually held until after treatment.
What assessments need to be performed for a pt with glomerular inflammation
BP and peripheral edema
Which of the following medications is indicated in the treatment of hypotonic or atonic bladder?
Bethanechol (Urecholine)
Patient education regarding a fistula or graft includes which of the following? Select all that apply.
Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing.
A 68-year-old woman has chronic kidney disease and a history of type 2 diabetes. Two weeks ago, she had surgery to place a vascular graft access for hemodialysis. Which precaution will the nurse follow to ensure the function of the AV graft?
Check for a bruit and thrill by auscultation and palpation over the site.
Which statement about sulfonamide therapy is true?
Clients on sulfonamide therapy need to increase their fluid intake.
What is the first sign of peritonitis
Cloudy dialysate drainage
Which condition is often misdiagnosed in the older adult patient with acute glomerulonephritis?
Congestive heart failure
What is a patient with nephrotic syndrome specifically at risk for
DVT due to a hypercoaguable state
After dialysis, which instruction should the nurse provide to the student nurse who is helping to provide care for the patient?
Expect the patient's temperature to be higher after dialysis. The dialysis machine slightly warms the blood
What is the parameter used to diagnose CKD
GFR less than 60ml/min for 3 months
What symptoms are produced with a UTI
GI symptoms, pain, changes in voiding
What is the difference between glomeruloneohritis and nephrotic syndrome
Glo- red blood cell loss and mild protein loss Neph- MAJOR protein loss
The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?
Hematuria
A football player is thought to have sustained an injury to his kidney. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?
Hematuria is the most common manifestation of the renal trauma and blood losses may be microscopic, so laboratory analysis is essential
Which assessment parameter requires immediate attention in a patient with polycystic kidney disease?
Hypertension
How would you describe a kegel exercise and how often should the patient perform them
Kegel exercises are when you squeeze your pelvic floor muscles to help strengthen them. You should do 3 sets of 15 exercises 3 times a day.
Which teaching points should the nurse be sure to include for a patient with urine leaking? (Select all that apply.)
Kegel exercises can help strengthen the muscles that prevent urine leakage.
Clients taking methenamine (Urex) for urinary tract infections are counseled to drink cranberry juice in order to
Lower the pH of urine
A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase?
Oliguria
What other bacteria commonly cause cystitis? What symptoms are common with cystitis?
Other bacteria include S. anerus, K. pneumoniae, Proteus, Enterobacter. Signs/Symptoms of cystitis may include urinary frequency, cloudy urine, odorous urine, and blood-tinged urine.
Which patient is at greatest risk of developing a kidney stone?
Overweight caucasian male
A client with a urinary tract infection is complaining of pain with urination. The nurse would anticipate the client's receiving
Phenazopyridine (Pyridium)
As the patient is preparing to discharge, the patient should be taught to restrict which elements in her diet? (Select all that apply.)
Potassium, phosphorus, protein
What is the most effective way of preventing contrast induced AKI
Prehydration with normal saline
What are the categories of AKI and what causes them?
Prerenal: blood loss Intrarenal: trauma Postrenal: bladder obstruction
What is chronic kidney disease
Progressive, irreversible kidney injury; kidney function does not recover
What are the functions of the kidneys
Regulatory function Glomerular filtration Tubular reabsorption Tubular secretion
What hormones do the kidneys excrete?
Renin Prostaglandin Erythropoietin Vitamin D
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client?
SpO2 at 90% with fine crackles in the lung bases
What are the stages of CKD
Stage 1- at risk >90ml/min Stage 2- mild 60-89 Stage 3- moderate 30-50 Stage 4- severe 15-29 Stage 5- end stage <15
A patient has a glomerular filtration of 43 ml/min based on this GFR, the nurse interprets that the patients chronic kidney disease is at what stage
Stage 3
The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient.
Taking a BP reading on the affected arm can damage the fistula
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
Tall, peaked T waves
The nurse is caring for an acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of actue kidney injury
The patients average urine output has been 10 mL/hr for several hours
True or False: Patients with diabetes who also have chronic kidney disease require less insulin to treat hyperglycemia than a patient with diabetes who does not have chronic kidney disease.
True
Which clinical data requires immediate nursing intervention to prevent progression of acute kidney injury?
Urine specific gravity of 1.001 mm Hg
What is Lithotripsy
Uses sound, laser, or dry shock wave energy to break stones into small fragments, Patient undergoes conscious sedation, Topical anesthetic cream applied to skin site, Continuous ECG monitoring
What patient is most likely to experience renal compromise assessed by decreased urine production
a pt with a blood pressure of 92/46 for 12 hours
What is nephrotic syndrome
a type of kidney disease characterized by increased glomerular permeability and is manifested by massive proteinuria
What is uremic syndrome caused by
accumulation of wastes
What preparation is indicated before a renal angiography
administration of a laxative
What is the main type of protein lost in nephrotic syndrome
albumin
What does a low GFR indicate?
an increase in BUN, creatinine, and potassium
What does inadequate erythropoietin production cause
anemia
What should be done to minimize risk of infection for a pt receiving peritoneal dilaysis
aseptic technique
The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize
assessment of the quantity of the patients urine output
How can the nurse best promote successful treatment from pelvic flood exercises
biofeedback
What are nursing considerations for a patient on kayexalate and erythropoietin
blood clots and increased BP
When caring for a patient who has just returned from a cystoscopy, it is most important for the nurse to observe for
bright red urine
What is azotemia and in what condition does it typically occur
build up of BUN and creatinine- AKI
What is included in the teaching plan for a pt following a nephrectomy
care for wound
What is disequilibrium syndrome
caused by hemodialysis, wastes removed too quickly
What are S/S of disequilibrium syndrome
cerebral edema, headache, seizure
What can you do to facilitate movement of fluid during peritoneal dilaysis
change pt position
A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective?
cipro
What are high potassium foods that should be avoided when managing AFR
citrus fruits
What is done to measure bacteremia in urine
clean-catch midstream urine sample
What are the functions of hemodialysis
cleanse blood of waste remove excess fluid maintains/restores buffer system of the body corrects electrolyte imbalances
What needs to be done before a kidney biopsy is performed
coagulation studies
What does a patient with acute nephritic syndromes urine typically look like
coke
Which therapy is best for a pt with a hemodynamic status
continuous dialysis
What diet modifications need to be done for a pt starting to receive dialysis
decrease sodium, decrease protein, fluid restriction
What is an age related change affecting the renal or urinary system
decreased glomerular filtration rate
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
dehydration
A female patient following a round of antibiotics might be at risk for:
developing a yeast infection
A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following?
diabetes
What is a person with a flaccid bladder instructed to do in order to promote full emptying
double voiding
What is the major manifestation of nephrotic syndrome
edema
What are types of protein with high biologic value
eggs, fish, and meats
What nursing action can help prevent infection for a patient with an indwelling cath
emptying the bag every 8 hours
A patient admitted with nephrotic syndrome is being cared for on the medical unit. When writing this patients care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include
excess fluid volume related to generalized edema
Which of the following is a cause of a calcium renal stone?
excessive intake of vitamin D
What is a nephron
functional unit of the kidney, which forms urine from blood
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?
glomerulonephritis
What should a pt that has a fever following a ESWL be directed to do
go to ER
What is nephrosclerosis
hardening of the renal arteries
What is functional incontinence
has the function to urinate but cannot identify the need to void or ambulate to the restroom
What are the primary presenting features of acute glomerular inflammation
hematuria, edema, azotemia(excess nitrogenous waste in blood), and proteinuria
Incomplete emptying of the bladder due to an obstruction can cause
hydronephrosis
What is a possible major complication following kidney surgery
hypovolemic shock due to hemorrhage
Prompt management of renal calculi is most important when the stones are located where
in the uteropelvic junction
What is a UTI in the upper system called
in ureters: ureteritis in kidneys: pyelonephritis
What is a UTI in the lower urinary system called
in urethra: urethritis in bladder: cystitis
What does the patient need to do before an ultrasound of lower urinary tract
increase fluid to produce a full bladder
What is a diet consideration for a patient with nephrotic syndrome
increase protein because they are losing it
For a pt that just had a brush biopsy what assessment finding should prompt you to notify the dr
increased temp
What are key features of chronic kidney disease
metallic taste in mouth, anorexia, nausea, vomiting, muscle cramps, 'frost' on skin, itching, hiccups, edema, lethargy
What intervention can help to relieve pain following a cystoscopy
moist heat applied to abdomen
In what patient in a renal biopsy contraindicated
morbidly obese
What are characteristics of benign nephrosclerosis
more common in older adults. It is associated with atherosclerosis and hypertension
What is osmolarity?
most accurate measurement of how well the kidneys are able to dilute and concentrate urine
What is an expected characteristic of urine following an ileal conduit
mucous
How long does a fistula need to heal before you can use it
needs 2-3 months to heal before it can be used.
Type of kidney disease recognized by increased glomerular permeability
nephrotic syndrome
What does dullness of the bladder indicate
not fully emptying
What is PKD (Polycystic Kidney Disease)?
numerous fluid-filled cysts in the kidneys that destroy the nephrons - has an inherited genetic cause
What is typically the first manifestation of PKD
pain
What is the primary goal when a patient has a kidney stone
pain relief
What is the most common symptom of bladder cancer
painless hematuria
What are characteristic of malignant nephrosclerosis
patients usually have a diastolic BP greater than 130 mmHg, typically in young adults and rapidly progesses
Which drug is NOT nephrotoxic
penicillin
What are some risk factors for UTIs
pregnancy, gout, diabetes, female gender, bladder tumors, calculi (stones) in the ureters or kidneys
What orders will be in place for a pt prior to a of abdomen with contrast
preprocedure hydration and administer acetylcysteine
What is most often the cause of nephrosclerosis
prolonged hypertension, diabetes, and the aging process
A client has been diagnosed with acute glomerulonephritis. This condition causes:
proteinuria
What is a hallmark of the diagnosis of nephrotic syndrome?
proteinuria
What are the typical signs/symptoms of glomerulonephritis
pt typically exhibit no symptoms, UA to diagnose
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
recent history of streptococcal infection
What are some changes of the kidneys with advanced age
reduced kidney mass, reduced blood flow, and decreased GFR
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for:
removal of transplanted kidney
How will lost bicarbonate be replaced by the kidneys
renal tubular cells will generate new bicarbonate
For a pt with low blood pressure, the kidneys will compensate by excreting which hormone
renin
What is the most life threatening effect of renal failure that the nurse needs to monitor for
retention of potassium
What function does the kidney perform to assist in acid base balance
returning bicarbonate to the body's circulation
What effect does CKD have on the size of the kidney
slightly smaller in size
What do you do if a pt experiences an emergent situation due to dialysis
slow/stop dialysis, L side laying in Trendelenburg, administer O2, monitor VS, administer emergency drugs
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:
sodium polystyrene sulfonate (Kayexalate)
Peeing when sneezing is what type of incontinence
stress
To evaluate the effectiveness of treatment for the patient with nephrotic syndrome, the nurse assesses
the abdominal girth daily.
What is one of the earliest manifestations of AKI
the inability to concentrate urine, low SG
What is the nurses response to a pt producing copious amounts of dilute urine following a kidney transplant
this is a normal finding
What is the preferred technique for diagnosing PKD
ultrasound
A patient with impaired renal function is feeling sharp stabbing pain in the flank and lower abdomen. The patient is being assessed for renal calculi, where might the stone be located?
ureter
A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?
urinary calculi
What is the most common complication following a cystoscopic exam
urinary retention
What is oliguria
urine output less than 400mL in 24 hours or 0.5ml/kg/hr
A female patients most recent urinalysis results are suggestive of bacteriuria. What does the nurse know about this result
urine samples are commonly contaminated by bacteria normally present in the urethral ares
The nurse is working on the renal transplant unit. To reduce the risk of infection in the patient with a transplanted kidney, it is imperative for the nurse to do what?
wash hands carefully and frequently
Renal replacement is indicated in which patient
when 80% of nephrons are no longer functioning
What is urge incontinence
when urgency occurs but cannot control voiding in time to reach toilet
The nurse is caring for a patient with a history of systemic lupus erythematosus who has recently been diagnosed with end stage kidney disease The patient has an elevated phosphorous level and has been prescribed calcium acetate to bind the phosphorous. The nurse should teach the patient to take the prescribed medication at what time?
with each meal