Med/Surg Ch 53 The Point
The term used to describe total urine output of less than 400 mL in 24 hours is a) anuria. b) nocturia. c) dysuria. d) oliguria.
oliguria. Explanation: Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.
The nurse is caring for a patient scheduled for urodynamic testing. Following the procedure, the nurse provides information to the patient that includes which of the following? a) "You can stop taking the prescribed antibiotic." b) "Contact the primary provider if you experience fever, chills, or lower back pain." c) "You may resume consuming caffeinated, carbonated, and alcoholic beverages." d) "You will be sent home with a urinary catheter."
"Contact the primary provider if you experience fever, chills, or lower back pain." Explanation: The patient must be made aware of the signs of a urinary tract infection after the procedure. The patient should contact the primary provider if he/she experience fever, chills, lower back pain, or continued dysuria and hematuria. The patient will have catheters placed during the procedure but will not be sent home with a catheter. The patient should be told to avoid caffeinated, carbonated, and alcoholic beverages after the procedure because these can further irritate the bladder. These symptoms usually decrease or subside by the day after the procedure. If the patient received an antibiotic medication before the procedure, the patient should be told to continue taking the complete course of medication after the procedure. This is a measure to prevent infection
The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? a) "I should remove all jewelry before the test." b) "I should let the staff know if I feel claustrophobic." c) "I will feel a warm sensation as the dye is injected." d) "I will need to drink all of the dye as quickly as possible."
"I will feel a warm sensation as the dye is injected." Explanation: A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected
The nurse is completing a full exam of the renal system. Which assessment finding best documents the need to offer the use of the bathroom? a) Bruits noted over the abdominal area b) The ingestion of 8 oz of water c) A dull sound when percussing over the bladder d) Tenderness over the kidneys
A dull sound when percussing over the bladder Explanation: A dull sound when percussing over the bladder indicates a full bladder. Because the bladder is full, the nurse would offer for the client to use the bathroom. Tenderness over the kidney can indicate an infection or stones. Bruits are an abnormal vascular sound that does not indicate the need to use the bathroom. Ingesting water does not mean that the client has to void at this time. (less)
The most frequent reason for admission to skilled care facilities includes which of the following? a) Myocardial infarction b) Stroke c) Urinary incontinence d) Congestive heart failure
Urinary incontinence Explanation: Urinary incontinence is the most common reason for admission to skilled nursing facilities.
A 32-year-old client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure and postprocedural assessments. What postprocedural assessment will you perform on the client? a) Hypersensitivity response b) All options are correct. c) Palpate pedal pulses. d) Monitor site condition.
All options are correct. Explanation: After the procedure, the physician applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the physician. Another important assessment is for hypersensitivity responses to contrast material. The client remains on bed rest for 4 to 8 hours. The nurse also monitors and documents intake and output.
Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? a) Computed tomography (CT scan) b) Cystoscopy c) Angiography d) Radiography
Angiography Explanation: Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder
The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish? a) Cystoscopy b) Radiography c) Computed tomography with contrast d) Bladder ultrasonography
Computed tomography with contrast Explanation: The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is ordered. The other options do not necessarily have a contrast medium.
Which part of the kidney contains the nephrons? a) Pelvis b) Glomerulus c) Cortex d) Medulla
Cortex Explanation: The cortex is located farthest from the center of the kidney and around the outermost edges. It contains the nephrons (the functional units of the kidney).
The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? a) Perineal pain b) Suprapubic pain c) Pain after voiding d) Costovertebal angle tenderness
Costovertebal angle tenderness Explanation: Acute pyelonephritiis is characterized by costovertebal angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis
Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to: a) Monitor for hematuria. b) Strain all urine for 48 hours. c) Encourage high fluid intake. d) Apply moist heat to the flank area.
Encourage high fluid intake. Explanation: A voiding cystogram involves the insertion of a urinary catheter, which can result in the introduction of microorganism into the urinary tract. Fluid intake is encouraged to flush the urinary tract and promote removal of microorganisms. Monitoring for hematuria, applying heat, and straining urine do not address the nursing diagnosis of risk for infection.
The nurse is instructing a 3-year-old's mother regarding abnormal findings within the urinary system. Which assessment finding would the nurse document as normal finding for this age-group? a) Hematuria b) Anuria c) Enuresis d) Dysuria
Enuresis Explanation: The nurse would be most correct to document that enuresis, the involuntary voiding during sleep or commonly called "wetting the bed," is a normal finding in a pediatric client younger than 5 years old. Dysuria (pain on urination), hematuria (red blood cells in urine), and anuria (urine output less than 50 mL/day) are all abnormal findings needing further investigation.
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? a) Assess the client's mental changes. b) Evaluate the client for periorbital edema. c) Monitor the client for signs of electrolyte and water imbalance. d) Monitor the client for an allergy to iodine contrast material.
Monitor the client for an allergy to iodine contrast material. Explanation: A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done
Retention of which electrolyte is the most life-threatening effect of renal failure? a) Phosphorous b) Potassium c) Sodium d) Calcium
Potassium Explanation: Retention of potassium is the most life-threatening effect of renal failure.
Which nursing assessment finding indicates the client has not met expected outcomes? a) The client reports a pain rating of 3 two hours post-kidney biopsy. b) The client voids 75 cc four hours post cystoscopy. c) The client consumes 75% of lunch following an intravenous pyelogram. d) The client has blood-tinged urine following brush biopsy.
The client voids 75 cc four hours post cystoscopy. Explanation: Urinary retention is an undesirable outcome following cystoscopy. A pain rating of 3 is an achieveable and expected outcome following kidney biopsy. Blood-tinged urine is an expected finding following cystoscopy due to trauma of the procedure. A client would be expected to eat and retain a meal following an intravenous pyelogram.
A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact? a) The average kidney is approximately 5 cm (2?) long and 2 to 3 cm (¾? to 1??) wide. b) The left kidney usually is slightly higher than the right one. c) The kidneys are situated just above the adrenal glands. d) The kidneys lie between the 10th and 12th thoracic vertebrae.
The left kidney usually is slightly higher than the right one. Explanation: The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.
A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: a) apply pressure to the puncture site for 30 minutes. b) check the client's pedal pulses frequently. c) keep the client's knee on the affected side bent for 6 hours. d) remove the dressing on the puncture site after vital signs stabilize.
check the client's pedal pulses frequently. Explanation: After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so
A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse? a) Distract the patient's attention from the pain. b) Asses the patient's back and shoulder areas for signs of internal bleeding. c) Enable the patient to sit up and ambulate. d) Provide analgesics to the patient.
Asses the patient's back and shoulder areas for signs of internal bleeding. Explanation: After a renal biopsy, the patient is on bed rest. It is important to assess the dressing frequently for signs of bleeding and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. Distracting the patient's attention, helping the patient to sit up or ambulate, and providing analgesics may only aggravate the patient's pain and, therefore, should not be performed by the nurse
When the bladder contains 350 mL or more of urine, this is referred to as which of the following? a) Anuria b) Functional capacity c) Specific gravity d) Renal clearance
Functional capacity Explanation: A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 350 mL or more of urine, referred to as the "functional capacity." Anuria is a total urine output of less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? a) Evaluate the client for periorbital edema. b) Assess the client's mental changes. c) Monitor the client for an allergy to iodine contrast material. d) Monitor the client for signs of electrolyte and water imbalance.
Monitor the client for an allergy to iodine contrast material. Explanation: A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done.
