Med- Surg III: Exam 1

ureter

A client admitted to the medical unit with impaired renal function reports severe, stabbing pain in the flank and lower abdomen. The client is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location? A. Ureter B. Urethra C. Bladder D. Meatus

Excess fluid volume related to generalized edema

A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? A. Excess fluid volume related to generalized edema B. Constipation related to immobility C. Hyperthermia related to the inflammatory process D. Risk for injury related to altered thought processes

Dipping the client's hands in warm water

A client being treated in the hospital has been experiencing occasional urinary retention. What voiding trigger technique would help this client? A.Encouraging male clients to use a urinal in bed B.Using a bedpan instead of a commode C.Performing a bladder scan after voiding D.Dipping the client's hands in warm water

Double voiding

A client has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this client's high risk for urinary retention and should implement what intervention in the client's plan of care? A. Sodium restriction B. Relaxation techniques C. Lower abdominal massage D. Double voiding

stage 3 Rationale: Stages of chronic kidney disease are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR.

A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage? A. Stage 4 B. Stage 2 C. Stage 1 D. Stage 3

- hematuria - acute pain - urinary frequency

A client has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the client's admission assessment, the nurse should be aware that what signs and symptoms are characteristic of this diagnosis? Select all that apply. A. Hematuria B. Acute pain C. Urinary frequency D. High fever E. Diarrhea

The widest part of the stoma Rationale: The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The permanent appliance should be no more than 1.6 mm (1/8 inch) larger than the diameter of the stoma and the same shape as the stoma to prevent contact of the skin with drainage.

A client has been admitted to the postsurgical unit following the creation of an ileal conduit. What should the nurse measure to determine the size of the appliance needed? A. The widest part of the stoma B. Half the width of the stoma C. The circumference of the stoma D. The length, then double it

renal tubular cells will generate new bicarbonate

A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced? A.Bicarbonate will be released from the adrenal medulla. B. Renal tubular cells will generate new bicarbonate. C. The kidneys will excrete increased quantities of acid. D. Alveoli in the lungs will synthesize new bicarbonate.

Inform the client that this is not unexpected in the short term and scan the client's bladder following each void.

A client has had a indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the client informs the nurse that the client is experiencing urinary urgency resulting in several small-volume voids. What is the nurse's best response? A.Inform the client that this is not unexpected in the short term and scan the client's bladder following each void. B.Inform the client that urgency and occasional incontinence are expected for the first few weeks post-removal. C.Obtain an order to reinsert the client's urinary catheter and attempt removal in 24 to 48 hours. D.Obtain an order for a loop diuretic in order to enhance urine output and bladder function.

Current medication use

A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what priority topic? A. Current medication use B. Allergy status C. Psychosocial stressors D. Typical diet

Encourage the client to speak openly and frankly about the diversion.

A client has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of "disturbed body image." How can the nurse best address the effects of this urinary diversion on the client's body image? A.Encourage the client to speak openly and frankly about the diversion. B.Provide the client with detailed written materials about the diversion at the time of discharge. C.Allow the client to initiate the process of providing care for the diversion. D.Emphasize that the diversion is an integral part of successful cancer treatment.

Continuous venovenous hemodialysis (CVVHD) Rationale: CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable client. Peritoneal dialysis is not the best choice, as the client may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.

A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? A. Peritoneal dialysis B. Hemodialysis C. Plasmapheresis D. Continuous venovenous hemodialysis (CVVHD)

excess fluid volume

A client is being treated for AKI and the client daily weights have been ordered. The nurse notes a weight gain of 3 pounds (1.4 kg) over the past 48 hours. What nursing diagnosis is suggested by this assessment finding? A. Sedentary lifestyle B. Adult failure to thrive C. Imbalanced nutrition: More than body requirements D. Excess fluid volume

Managing postoperative pain

A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client? A. Increasing oral intake B. Managing postoperative pain C. Managing dialysis D. Increasing mobility

Reassure the client that this is an expected phenomenon. Rationale: Because mucous membrane is used in forming the conduit, the client may excrete a large amount of mucus mixed with urine. This causes anxiety in many clients. To help relieve this anxiety, the nurse reassures the client that this is a normal occurrence after an ileal conduit procedure. Urine testing for culture or pH is not required.

A client is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The client is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurse's most appropriate response? A.Obtain a sterile urine sample and send it for culture. B.Report this finding promptly to the primary care provider. C.Reassure the client that this is an expected phenomenon. D.Obtain a urine sample and check it for pH.

apply moist heat to the client's lower abdomen

A client is reporting genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform? A.Apply topical lidocaine to the client's meatus, as prescribed. B. Encourage mobilization. C. Apply an ice pack to the client's perineum. D. Apply moist heat to the client's lower abdomen.

Provide adequate hydration before the procedure

A client is scheduled for a CT scan of the abdomen with contrast. The client has a baseline creatinine level of 2.3 mg/dL (203 μmol/L). In preparing this client for the procedure, the nurse anticipates what orders? A.Obtain a creatinine clearance by collecting a 24-hour urine specimen. B. Provide adequate hydration before the procedure C. Start hemodialysis immediately prior to the CT scan D.Monitor the client's electrolyte values every hour before the procedure.

reassure the client that this is not unexpected and then monitor the client for further bleeding

A client with recurrent urinary tract infections has just undergone a cystoscopy and reports slight hematuria during the first void after the procedure. What is the nurse's most appropriate action? A.Promptly inform the health care provider of this assessment finding. B. Administer a STAT dose of vitamin K, as prescribed. C.Reassure the client that this is not unexpected and then monitor the client for further bleeding. D.Position the client supine and insert a Foley catheter, as prescribed.

urinary retention

A nurse is preparing a client diagnosed with benign prostatic hyperplasia (BPH) for a lower urinary tract cystoscopic examination. The nurse should caution the client about what common temporary complication of this procedure? a: nausea b: hemorrhage c: urinary retention d: bladder perforation

functions nephrons are less than 20%

The care team is considering the use of dialysis in a client whose renal function is progressively declining. Renal replacement therapy is indicated in which situation? a: blood urea nitrogen (BUN) is above 15 mg/dl b: urinalysis (dipstick test) reveals 140 mg/dL of protein c: functioning nephrons are less than 20% d: creatinine level drops below 1.2 mg/dl (110mmol/L)

teach the client to perform pelvic floor muscles exercises

The clinic nurse is preparing a plan of care for a client with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach? A.Provide information on periurethral bulking. B.Prepare the client for an anterior vaginal repair procedure. C.Teach the client to perform pelvic floor muscle exercises. D.Provide medication teaching related to pseudoephedrine sulfate.

insertion of a suprapubic catheter

The nurse and urologist have both been unsuccessful in catheterizing a client with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the health care provider will use to drain the client's bladder? A. Insertion of a suprapubic catheter B.Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours C.Scheduling the client immediately for a prostatectomy D.Application of warm compresses to the perineum to assist with relaxation

2,270 mL/76.7 fl oz. of fluid in 24 hours

The nurse caring for a client with suspected renal dysfunction calculates that the client's weight has increased by 5 pounds (2.27 kg) in the past 24 hours. The nurse estimates that the client has retained approximately how much fluid? A. 1,300 mL/ 43.9 fl oz. of fluid in 24 hours B. 3,100 mL/104.8 fl oz. of fluid in 24 hours C. 5,000 mL/169.0 fl oz. of fluid in 24 hours D. 2,270 mL/76.7 fl oz. of fluid in 24 hours

A client with diabetes mellitus and poorly controlled hypertension

The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD? A.A client who is morbidly obese with a history of vascular disorders B. A client with a history of polycystic kidney disease C.A client with diabetes mellitus and poorly controlled hypertension D.A client with severe chronic obstructive pulmonary disease

Inform the primary care provider that the vascular supply may be compromised

The nurse is caring for a client who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's mostappropriate response? A.Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose. B.Inform the primary care provider that the vascular supply may be compromised. C.Document the presence of a healthy stoma. D.Assess the client for further signs and symptoms of infection.

keep the client NPO prior to the procedure

The nurse is caring for a client who is going to have an open renal biopsy. What nursing action should the nurse prioritize when preparing this client for the procedure? A. Discuss the client's diagnosis with the family. B. Keep the client NPO prior to the procedure. C.Administer antivirals before sending the client for the procedure. D.Bathe the client before the procedure with antiseptic skin wash.

notify the health care provider about cloudy or foul-smelling urine

The nurse is caring for a client who underwent percutaneous (endourologic) lithotripsy earlier in the day. What instruction should the nurse give the client? A.Notify the health care provider about cloudy or foul-smelling urine. B.Report any pink-tinged urine within 24 hours after the procedure. C.Report the presence of fine, sand-like particles through the nephrostomy tube. D. Limit oral fluid intake for 1 to 2 days.

Burns Rationale: AKI has categories that identify causation. These are prerenal, intrarenal, and postrenal. Prerenal AKI results from hypoperfusion of the kidney caused by volume depletion. Common causes are burns, hemorrhage, gastrointestinal losses, sepsis, and shock. Glomerulonephritis and ureterolithiasis (kidney stones) are associated with intrarenal causes. Pregnancy is linked to postrenal AKI (obstructions distal to the kidney).

The nurse is caring for a client whose acute kidney injury (AKI) resulted from a prerenal cause. Which condition most likely caused this client's health problem? A. Ureterolithiasis B. Burns C. Pregnancy D. Glomerulonephritis

with each meal Rationale: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be given with food to be effective.

The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time? A. With each meal B. Only when needed C. First thing in the morning D. Daily at bedtime

renin

The nurse is caring for a client with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a blood pressure (BP) of 98/52 mm Hg. The nurse should recognize that the client's kidneys will compensate by secreting what substance? A. Antidiuretic hormone (ADH) B. Angiotensin C. Aldosterone D. Renin

Empty the drainage bag at least every 8 hours. Rationale: To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection.

The nurse is caring for a client with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a client with an indwelling catheter? A.Empty the drainage bag at least every 8 hours. B.Irrigate the catheter every 8 hours with normal saline. C.Apply powder to the perineal area twice daily. D.Vigorously clean the meatus area daily.

- providing nursing care for primary disorder (trauma) - providing emotional support for the family - monitoring for complications - participating in emergency treatment of fluid and electrolyte imbalances

The nurse is caring for a client's status after a motor vehicle accident. The client has developed AKI. What are the nurse's roles in caring for this client? Select all that apply. A.Providing nursing care for primary disorder (trauma) B. Directing nutritional interventions C.Providing emotional support for the family D. Monitoring for complications E.Participating in emergency treatment of fluid and electrolyte imbalances

Avoid using moisturizing soaps and body washes when cleaning the peristomal area Rationale: The client is instructed to avoid moisturizing soaps and body washes when cleaning the area because they interfere with the adhesion of the pouch. To maintain skin integrity, a skin barrier or leaking pouch is never patched with tape to prevent accumulation of urine under the skin barrier or faceplate. Fluids should be encouraged, not limited, and the collection bag should not be allowed to become more than one-third full.

The nurse is collaborating with the wound-ostomy-continence (WOC) nurse to teach a client how to manage a new ileal conduit in the home setting. To prevent leakage or skin breakdown, the nurse should encourage which of the following practices? A.Avoid using moisturizing soaps and body washes when cleaning the peristomal area. B.Limit fluid intake to prevent production of large volumes of dilute urine. C.Empty the collection bag when it is between one-half and two-thirds full. D.Reinforce the appliance with tape if small leaks are detected.

inspection and care of the incision

The nurse is creating an education plan for a client who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan? A. Signs and symptoms of rejection B. Inspection and care of the incision C.Techniques for preventing metastasis D.The importance of increased fluid intake

Assess the client's understanding of the test results after their completion

What nursing action should the nurse perform when caring for a client undergoing diagnostic testing of the renal-urologic system? A.Assess the client's understanding of the test results after their completion. B.Ensure that the client knows the importance of temporary fluid restriction after testing. C. Withhold medications until 12 hours post-testing. D.Inform the client of the medical diagnosis after reviewing the results.

Streptococcal infection

A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event? A.Hypersensitivity to an immunization B. Menarche C. Streptococcal infection D. Psychosocial stress

stress incontinence

A 42-year-old woman comes to the clinic reporting occasional urinary incontinence when sneezing. The clinic nurse should recognize what type of incontinence? A. Overflow incontinence B. Reflex incontinence C. Functional incontinence D. Stress incontinence

- gastrointestinal symptoms - changes ini voiding - pain

A 52-year-old client is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply. A. Gastrointestinal symptoms B. Changes in voiding C. Petechiae D. Pain E. Jaundice

deficient knowledge related to care of the ileal conduit

A 52-year-old client is scheduled to undergo ileal conduit surgery. When planning this client's discharge education, what is the MOST plausible nursing diagnosis that the nurse should address? A.Risk for autonomic dysreflexia related to disruption of the sacral plexus B.Deficient knowledge related to care of the ileal conduit C.Impaired mobility related to limitations posed by the ileal conduit D.Risk for deficient fluid volume related to urinary diversion

"Kidney transplants in peoples your age are as successful as they are in younger clients."

A 76-year-old client with ESKD has been told by the health care provider that it is time to consider hemodialysis until a transplant can be found. The client tells the nurse about feeling unsure about undergoing a kidney transplant. What would be an appropriate response for the nurse to make? A."I understand your hesitancy to commit to a transplant surgery. Success is relatively rare." B."Kidney transplants in peoples your age are as successful as they are in younger clients." C."Have you talked this over with your family?" D."The decision is certainly yours to make, but be sure not to make a mistake."

Hydronephrosis Rationale: If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes.

A client is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what issue? A. Hydronephrosis B. Pyelonephritis C. Nephrotoxicity D. Nephritic syndrome

The client's disease is incurable and the nurse's interventions will be supportive.

A client on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse's care of this client? A.The client is likely to respond favorably to lithotripsy treatment of the cysts. B.The client's disease is incurable and the nurse's interventions will be supportive. C.The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life. D.The client will eventually require surgical removal of his or her renal cysts.

pain management

A client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize? A. IV fluid administration B.Insertion of an indwelling urinary catheter C. Pain management D.Assisting with aspiration of the stone

Risk for infection related to presence of an indwelling urinary catheter

A client with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the client's plan of care? A.Disturbed body image related to urinary catheterization B.Risk for infection related to presence of an indwelling urinary catheter C.Impaired physical mobility related to presence of an indwelling urinary catheter D.Deficient knowledge regarding indwelling urinary catheter care

30 mL

A client with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The client weighs 60 kg. The nurse is monitoring the client's urine output hourly and notifies the health care provider when the hourly output is less than what amount? A. 100 mL B. 30 mL C. 50 mL D. 125 mL

portable bladder ultrasound

A client with difficulty voiding and elevated BUN and creatinine values has been referred by the health care provider for further evaluation. The nurse should anticipate the use of what initial diagnostic test? A. Portable bladder ultrasound B. Computed tomography (CT) C. Nuclear scan D. X-ray

renal osteodystrophy

A client with end stage renal disease (ESKD) is being treated for a right ankle fracture unrelated to a fall. The client's lab values show high phosphate levels, low calcium levels, and low vitamin D levels. What is the most likely reason for this client's fracture? A. Osteoporosis B. Hypertrophic osteoarthropathy C. Renal osteodystrophy D. Codman triangle

- decreased sodium intake - decreased protein intake - fluid restrictions

A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's diet should include which of the following modifications? Select all that apply. A. Increased potassium intake B. Decreased sodium intake C. Vitamin D supplementation D. Decreased protein intake E. Fluid restriction

- moist heat to abdomen - intermittent straight catheterization - monitor for urinary retention

A client with gross hematuria has been admitted to a surgical floor in preparation for an upper cystoscopy in the morning. What post-procedure interventions would the nurse anticipate for this client? Select all that apply. a: sedative agent administration b: NPO c: moist heat in abdomen d: intermittent straight catheterization e: monitor for urinary retention

Strain the client's urine following the procedure.

A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care? A.Insert a urinary catheter for 24 to 48 hours after the procedure. B.Monitor the client for fluid overload following the procedure. C.Strain the client's urine following the procedure. D.Administer a bolus of 500 mL normal saline following the procedure.

the client is likely to have increased serum creatinine levels Rationale: The adult GFR can vary from a normal of approximately 125 mL/min (1.67 to 2.0 mL/sec) to a high of 200 mL/min. A low GFR is associated with increased levels of BUN, creatinine, and potassium.

A client's most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding? A.The client is likely to have a decreased level of blood urea nitrogen (BUN). B.The client is likely to have increased serum creatinine levels. C. The client is likely to have irregular voiding patterns. D. The client is at risk for hypokalemia.

The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy Rationale: Yeast vaginitis occurs in many clients treated with antimicrobial agents that affect vaginal flora. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics.

A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic? A.The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy B.The need to expect a heavy menstrual period following the course of antibiotics C.The risk of developing antibiotic resistance after the course of antibiotics D.The need to undergo a series of three urine cultures after the antibiotics have been completed

urine samples are frequently contaminated by bacteria normally present in the urethral area

A female client's most recent urinalysis results are suggestive of bacteriuria. When assessing this client, the nurse's data analysis should be informed by what principle? A.Urine samples are frequently contaminated by bacteria normally present in the urethral area. B.Urine contains varying levels of healthy bacterial flora. C.Most UTIs in female clients are caused by viruses and do not cause obvious symptoms. D.A diagnosis of bacteriuria requires three consecutive positive results.

decreased glomerular filtration rate

A geriatric nurse is performing an assessment of body systems on an older adult client. The nurse should be aware of what age-related change affecting the renal and urinary systems? a: Increased bladder capacity b: Decreased glomerular filtration rate c: Increased ability to concentrate urine d: Urinary incontinence

- new onset of confusion - fever Rationale: Early symptoms of UTI in older adults include burning, urgency, and fever. Some clients develop incontinence and delirium with the onset of a UTI. Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none are directly suggestive of a UTI.

A gerontologic nurse is assessing a client who has numerous comorbid health problems. What assessment finding(s) should prompt the nurse to suspect a UTI? Select all that apply. A. Food cravings B. New onset of confusion C. Upper abdominal pain D. Fever E. Insatiable thirst

a biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease

A kidney biopsy has been scheduled for a client with a history of acute kidney injury. The client asks the nurse why this test has been scheduled. What is the nurse's best response? a: "A biopsy is often ordered for clients before they have a kidney transplant." b: "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease." c: "A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis." d: "A biopsy is routinely ordered for all clients with renal disorders."

"remember to drink frequently, even if you don't feel thirsty"

A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult? A."Ensure that you avoid replacing water with other beverages." B."Make sure you eat plenty of salt in order to stimulate thirst." C."Remember to drink frequently, even if you don't feel thirsty." D. "If possible, try to drink at least 4 liters of fluid daily."

urinary tract infection

A nurse is caring for a 73-year-old client with a urethral obstruction related to prostatic enlargement. When planning this client's care, the nurse should be aware of the risk of what complication? A. Enuresis B. Proteinuria C. Polyuria D. Urinary tract infection

Dehydration

A nurse is caring for a client who is in the diuresis phase of acute kidney injury. The nurse should closely monitor the client for what complication during this phase? A. Hypokalemia B. Hypocalcemia C. Dehydration D. Acute flank pain

A 24-hour urine specimen and a serum creatinine level midway through the urine collection process

A nurse is caring for a client with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples? a: A BUN and serum creatinine level on three consecutive mornings b: a fasting serum potassium level and random urine sample c: a sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values d: a 24-hour urine specimen and a serum creatinine level midway through the urine collection process

using clean techniques at home to catheterize

A nurse is caring for a female client whose urinary retention has not responded to conservative treatment. When educating this client about self-catheterization, the nurse should encourage what practice? A.Using clean technique at home to catheterize B.Self-catheterizing every 2 hours at home C.Assuming a supine position for self-catheterization D.Inserting the catheter 1 to 2 inches (2.5 to 5 cm) into the urethra

beverage limitations, pain control, and urinary expectations Rationale: After the procedure, the client should avoid caffeinated, carbonated, and alcoholic beverages because they can further irritate the bowel and cause pain. The client is encouraged to drink fluids that are not restricted to help clear any hematuria. No other dietary restrictions or limitations are needed. Symptoms of urinary pain and frequency should decrease or subside within a day after the procedure. A further recommendation for pain control is a sitz bath, not opioid use. Clients after this procedure should have instruction about urinary frequency, urgency, dysuria, hematuria, and signs of a urinary tract infection. If an antibiotic was given to the client before the procedure, then the client is encouraged to continue taking the medication.

A nurse is giving discharge instructions to a client following urodynamic testing. What are the priority topics to be addressed by the nurse? A.Protein intake, mobility limitations, and urinary expectations B.Opioid usage, urinary expectations, fat and protein limitations C.Antibiotic adherence, carbohydrate restrictions, and urinary expectations D.Beverage limitations, pain control, and urinary expectations

- the cuffs will help stabilize the catheter - the cuffs prevent the dialysate from leaking - the cuffs provide a barrier against microorganisms - the cuffs are constructed of Dacron polyester material

A nurse is providing education to the family of a client beginning peritoneal dialysis. The family ask questions concerning catheter placement and stabilization. Which information will the nurse provide about the cuffs? Select all that apply. A.The cuffs will help stabilize the catheter. B.The cuffs prevent the dialysate from leaking. C. The cuffs will absorb the dialysate. D.The cuffs are constructed of Dacron polyester material. E.The cuffs provide a barrier against microorganisms.

increased fluid intake following the test

A nurse is working with a client who will undergo invasive urologic testing. The nurse has informed the client that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria? A. Gentle massage of the lower abdomen B. Increased fluid intake following the test C.Use of an over-the-counter (OTC) diuretic after the test D. Activity limitation for the first 12 hours after the test

Arrange for biofeedback when the client is learning to perform the exercises.

A nurse is working with a female client who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment? A.Ensure the client knows that surgery will be required if the exercises are unsuccessful. B.Clearly explain the potential benefits of pelvic floor muscle exercises. C.Arrange for biofeedback when the client is learning to perform the exercises. D.Contact the client weekly to ensure that they are performing the exercises consistently.

A client who has Alzheimer disease and who is acutely agitated

A nurse on a busy medical unit provides care for many clients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which client? A.A client who has Alzheimer disease and who is acutely agitated B.A client who is on bed rest following a recent episode of venous thromboembolism C.A client whose diagnosis of chronic kidney disease requires a fluid restriction D.A client who has decreased mobility following a transmetatarsal amputation

Limit the use of indwelling urinary catheters. Rationale: When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adult's risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally given. Mobility does not have a direct effect on UTI risk.

A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? A.Administer prophylactic antibiotics as prescribed. B.Limit the use of indwelling urinary catheters. C.Encourage frequent mobility and repositioning. D.Toilet residents who are immobile on a scheduled basis.

Urinary incontinence is not considered a normal consequence of aging.

A nurse's colleague has applied an incontinence pad to an older adult client who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults? A.Restricting fluid intake is recommended for older adults experiencing incontinence. B.Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. C.Urinary incontinence is not considered a normal consequence of aging. D.Diuretics should be promptly discontinued when an older adult experiences incontinence.

Encourage the client to continue this pattern of fluid intake. Rationale: Unless contraindicated, 3 to 4 L of fluids per day is encouraged to dilute the urine, decrease burning on urination, and prevent dehydration. Consequently, there is no need to supplement this fluid intake with additional calories or sodium.

An adult client has been hospitalized with pyelonephritis. The nurse's review of the client's intake and output records reveals that the client has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? A.Emphasize the need to limit intake to 2 L of fluid daily. B.Encourage the client to continue this pattern of fluid intake. C.Supplement the client's fluid intake with a high-calorie diet. D.Obtain an order for a high-sodium diet to prevent dilutional hyponatremia.

- pruritus - excoriation

An inpatient client with acute kidney injury (AKI) has moderate edema to both legs. What resulting skin conditions would increase the client's likelihood of skin breakdown? Select all that apply. A. Psoriasis B. Pruritus C. Excoriation D. Atopic dermatitis E. Urticaria

- age-related physiologic changes - chronic systemic disease - NPO status

An older adult client diagnosed with cancer is admitted to the oncology unit for surgical treatment. The client has been on chemotherapeutic agents to decrease tumor size prior to the planned surgery. The nurse caring for the client is aware that what precipitating factors in this client may contribute to acute kidney injury (AKI)? Select all that apply. A. Anxiety and agitation B. Low body mass index (BMI) C. Age-related physiologic changes D. Chronic systemic disease E. Nothing by mouth (NPO) status

Reviewing the client's medication administration record for recent changes

An older adult has experienced a new onset of urinary incontinence, and family members identify this problem as being unprecedented. When assessing the client for factors that may have contributed to incontinence, the nurse should prioritize what assessment? A.Assessing for recent contact with individuals who have UTIs B.Assessing for changes in the client's level of psychosocial stress C.Reviewing the client's 24-hour food recall for changes in diet D.Reviewing the client's medication administration record for recent changes

this finding need to be considered in light of other forms of testing

Dipstick testing of an older adult client's urine indicates the presence of protein. Which statement is true of this assessment finding? A. This finding is a risk factor for urinary incontinence. B.This finding needs to be considered in light of other forms of testing. C.This finding is likely the result of an age-related physiologic change. D. This result confirms that the client has diabetes.

the client's kidneys can produce sufficiently concentrated urine

Results of a client's 24-hour urine sample indicate osmolality of 510 mOsm/kg (510 mmol/kg), which is within reference range. What conclusion can the nurse draw from this assessment finding? A.The client's kidneys reabsorb most of the potassium that the client ingests. B.The client's kidneys are capable of maintaining acid-base balance. C.The client's kidneys are producing sufficient erythropoietin. D.The client's kidneys can produce sufficiently concentrated urine.

Avoid further interventions at this time, as this is an acceptable finding.

The nurse has implemented a bladder retraining program for an older adult client. The nurse places the client on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the client typically has approximately 50 mL of urine remaining in the bladder after voiding. What would be the nurse's best response to this finding? A. Place an indwelling urinary catheter. B.Press on the client's bladder in an attempt to encourage complete emptying. C.Avoid further interventions at this time, as this is an acceptable finding. D.Perform a straight catheterization on this client.

- family history of renal stones - dietary history - medication history

The nurse is assessing a client admitted with renal stones. During the admission assessment, what parameters should the nurse address? Select all that apply. A. Surgical history B. Family history of renal stones C. Dietary history D. Vaccination history E. Medication history

the client's bladder is not completely empty

The nurse is assessing a client's bladder by percussion. The nurse elicits dullness after the client has voided. How should the nurse interpret this assessment finding? a: the client had kidney enlargement b: the client's bladder is not completely empty c: the client has a fluid volume deficit d: the client has a ureteral obstruction

level of consciousness

The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate? A. Pain intensity B. Level of consciousness C. Radiation of pain D. Oral intake

Hyperkalemia

The nurse is caring for a client in acute kidney injury (AKI). Which complication would most clearly warrant the administration of polystyrene sulfonate? A. Hyperkalemia B. Hypercalcemia C. Hypernatremia D. Hypomagnesemia

Assessment of the quantity of the client's urine output

The nurse is caring for a client postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? A. Assessment of the client's abdominal girth B. Assessment of the quantity of the client's urine output C. Assessment for flank or abdominal pain D. Assessment of the client's incision

Taking a BP reading on the affected arm can damage the fistula

The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is MOST important for the nurse to be aware of when providing care for this client? A.The client should not feel pain during initiation of dialysis B.Using a stethoscope for auscultating the fistula is contraindicated C.Taking a BP reading on the affected arm can damage the fistula D.The client feels best immediately after the dialysis treatment

2,000 mL

The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day? A. 2,000 mL B. 3,500 mL C. 2,750 mL D. 1,250 mL

administration of a laxative

The nurse is caring for a client scheduled for renal angiography following a motor vehicle accident. What client preparation should the nurse most likely provide before this test? A. Administration of IV potassium chloride B. Administration of Gastrografin C. Administration of a laxative D. Administration of a 24-hour urine test

glucose and protein

The nurse is caring for a client suspected of having renal dysfunction. When reviewing laboratory results for this client, the nurse interprets the presence of which substances in the urine as most suggestive of pathology? a: bicarbonate and urea b: creatinine and chloride c: potassium and sodium d: glucose and protein

urine retention

The nurse is caring for a client who describes changes in voiding patterns. The client states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesn't seem to be much urine flow." What would the nurse expect this client's physical assessment to reveal? A. Kidney injury B. Urine retention C. Dehydration D. Hematuria

Temperature 37.9 C (100.2 F) orally

The nurse is caring for a client who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the health care provider? A. Scant hematuria B. Renal colic C. Temperature 37.9°C (100.2°F) orally D. Infiltration of the client's intravenous catheter

in the ureteropelvic junction

The nurse is caring for a client who had been diagnosed with renal calculi. Prompt management of renal calculi is MOST important when the stone is located where? a: in the ureteral segment near the sacroiliac junction b: in the ureteropelvic junction c: in the urethra d: in the ureterovesical junction

increased urine specific gravity

The nurse is caring for a client who has a fluid volume deficit. When evaluating this client's urinalysis results, what should the nurse normally anticipate? a: decrease in BUN b: less ADH released c: decreased urine osmolality d: increased urine specific gravity

- quantity of output - color of the output - visible characteristics of the output

The nurse is caring for a client who has just returned to the postsurgical unit following renal surgery. When assessing the client's output from surgical drains, the nurse should physically assess what parameter(s)? Select all that apply. A. Quantity of output B. Color of the output C. Visible characteristics of the output D. Specific gravity of the output E.Potential hydrogen (pH) of the output

Assess the client for signs of bleeding and inform the primary provider.

The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent assessment reveals increased sedation, shortness of breath, hypotension, and low urine output over the last 2 hours. What is the nurse's best response? A.Perform a full neurological assessment and notify the primary care provider. B.Increase the frequency of taking vital signs, monitor urine output, and notify the provider. C.Palpate the client's torso bilaterally for flank pain and notify the primary care provider. D.Assess the client for signs of bleeding and inform the primary provider.

- microscopic examinations of urine sediments for casts - microscopic examination of urine sediment for RBCs - specific gravity of the client's urine - testing for the presence of glucose in the clients urine Rationale: Urine testing includes testing for specific gravity, glucose, RBCs, and casts. BUN and creatinine are components of serum, not urine.

The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply. A. Testing for BUN and creatinine in the client's urine B. Microscopic examination of urine sediment for casts C. Microscopic examination of urine sediment for RBCs D. Specific gravity of the client's urine E. Testing for the presence of glucose in the client's urine

increased fluid intake to produce a full bladder

The nurse is providing preprocedure teaching about an ultrasound. The nurse informs the client that in preparation for an ultrasound of the lower urinary tract the client will require what action? a: injection of radioisotope b: IV administration of radiopaque contrast agent c: sedation and intubation d: increased fluid intake to produce a full bladder

bladder dysfunction Rationale: The deep tendon reflexes of the knee are examined for quality and symmetry. This is an important part of testing for neurologic causes of bladder dysfunction because the sacral area, which innervates the lower extremities, is in the same peripheral nerve area responsible for urinary continence. Neurologic function does not directly influence the course of renal calculi, BPH or UTIs.

The nurse is reviewing the electronic health record of a client with a history of incontinence. The nurse reads that the health care provider assessed the client's deep tendon reflexes. What condition of the urinary/renal system does this assessment address? A. Recurrent urinary tract infections (UTIs) B. Benign prostatic hyperplasia (BPH) C. Bladder dysfunction D. Renal calculi

The prevalence of UTIs in older men approaches that of women in the same age group.

The nurse is teaching a health class of older adults about urinary tract infections (UTI)s. What characteristic of UTIs should the nurse cite? A.Men of all ages are less prone to UTIs, but typically experience more severe symptoms. B.Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic. C.The prevalence of UTIs in older men approaches that of women in the same age group. D.The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs.

wash hands carefully and frequently

The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to take what action? A. Wash hands carefully and frequently. B. Instruct the client to wear a face mask. C. Bar visitors from the client's room. D. Ensure immediate function of the donated kidney.

The client's suprapubic region is dull on percussion.

The nurse is working with a client whose health history includes occasional episodes of urinary retention. What assessment finding would suggest that the client is currently retaining urine? A.The client claims to void large amounts of urine two to three times daily. B.The client takes a beta adrenergic blocker for the treatment of hypertension. C. The client is uncharacteristically drowsy. D.The client's suprapubic region is dull on percussion.

A 42-year-old with morbid obesity

The nurse on a nephrology unit is caring for a diverse group of clients. For which client would a kidney biopsy most likely be contraindicated? A. A 57-year-old client with proteinuria B. A 42-year-old client with morbid obesity C. A 64-year-old client with chronic glomerulonephritis D.A 16-year-old client with signs of kidney transplant rejection

restricted protein intake as prescribed Rationale: Protein is restricted to 60 g/day, while sodium is restricted to 3 to 4 g/day. Low-calcium diets are generally not recommended except for true absorptive hypercalciuria. The client should avoid intake of oxalate-containing foods and there is no need to increase potassium intake.

The nurse on a urology unit is working with a client who has been diagnosed with calcium oxalate renal calculi. When planning this client's health education, what nutritional guidelines should the nurse provide? A. Restrict protein intake as prescribed. B.Encourage intake of food containing oxalates. C.Increase intake of potassium-rich foods. D. Follow a low-calcium diet.

Polycystic kidney disease (PKD)

The nurse performing the health interview of a client with a new onset of periorbital edema has completed a genogram, noting the health history of the client's siblings, parents, and grandparents. This assessment addresses the client's risk of what kidney disorder? A. Polycystic kidney disease (PKD) B. Acute glomerulonephritis C. Nephritic syndrome D. Nephrotic syndrome

smoking cessation Rationale: People who smoke are significantly more likely to develop bladder cancer than those who do not smoke. High alcohol intake and low vitamin intake are not noted to contribute to bladder cancer.

The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer? A. Smoking cessation B.Maintenance of a diet high in vitamins and nutrients C. Reduction of alcohol intake D. Vitamin D supplementation