MS3 Ch 65-69 Assignment
Nursing staff on a hospital unit are reviewing rates of health care-associated infections (HAI) of the urinary tract. Which nursing action will be most helpful in decreasing the risk for urinary HAI in patients admitted to the hospital? Avoiding unnecessary urinary catheterizations Encouraging adequate oral fluid and nutritional intake Testing urine with a dipstick daily for nitrites Providing perineal hygiene to patients daily and as needed
Avoiding unnecessary urinary catheterizations
Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider? Blood pressure 90/48 mm Hg Complaint of flank pain Temperature 100.1° F (57.8° C) Cloudy and foul-smelling urine
Blood pressure 90/48 mm Hg
Which assessment data reported by a patient is consistent with a lower urinary tract infection (UTI)? Low urine output Bilateral flank pain Burning on urination Nausea and vomiting
Burning on urination
After ureterolithotomy, a patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care? Apply continuous steady tension to the ureteral catheter. Provide teaching about home care for both catheters. Call the health care provider if the ureteral catheter output drops suddenly. Clamp the ureteral catheter off when output from the urethral catheter stops.
Call the health care provider if the ureteral catheter output drops suddenly.
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV? Calcium level Cardiac rhythm Urine volume Neurologic status
Cardiac rhythm
A 68-yr-old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching? Barrier products for skin protection Analgesic use before emptying the pouch Application of ostomy appliances Catheterization technique and schedule
Catheterization technique and schedule
A patient has arrived for a scheduled hemodialysis session. Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician? Teach the patient about fluid restrictions. Assess for causes of an increase in predialysis weight. Determine the ultrafiltration rate for the hemodialysis. Check blood pressure before starting dialysis.
Check blood pressure before starting dialysis.
Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)? Bladder distention Suprapubic discomfort Foul-smelling urine Costovertebral tenderness
Costovertebral tenderness
Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy? Left flank discomfort Left flank bruising Decreased urine output Blood in urine
Decreased urine output
The nurse observes unlicensed assistive personnel (UAP) taking the following actions when caring for a patient with a urethral catheter. Which action requires that the nurse intervene? Using an alcohol-based gel hand cleaner before performing catheter care Disconnecting the catheter from the drainage tube to obtain a specimen Cleaning around the patient's urinary meatus with soap and water Taping the catheter to the skin on the patient's upper inner thigh
Disconnecting the catheter from the drainage tube to obtain a specimen
A 37-yr-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function? Glomerular filtration rate (GFR) Blood urea nitrogen (BUN) level Urine volume Creatinine level
Glomerular filtration rate (GFR)
A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? More protein is allowed because urea and creatinine are removed by dialysis. Dietary potassium is not restricted because the level is normalized by dialysis. Unlimited fluids are allowed because retained fluid is removed during dialysis. Increased calories are needed because glucose is lost during hemodialysis.
More protein is allowed because urea and creatinine are removed by dialysis.
Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? Creatinine clearance Neurologic status Phosphate level Blood pressure
Phosphate level
A 42-yr-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first? Administer epoetin alfa (Epogen, Procrit). Insert a urinary retention catheter. Place the patient on a cardiac monitor. Give sodium polystyrene sulfonate (Kayexalate).
Place the patient on a cardiac monitor.
Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful? Poached eggs, whole-wheat toast, and apple juice Cheese sandwich, tomato soup, and cranberry juice Oatmeal with cream, half a banana, and herbal tea Split-pea soup, English muffin, and nonfat milk
Poached eggs, whole-wheat toast, and apple juice
Which action will the nurse anticipate taking for an otherwise healthy 50-yr-old who has just been diagnosed with stage 1 renal cell carcinoma? Teach the patient about chemotherapy medications. Prepare patient for a renal biopsy. Schedule for a follow-up appointment in 3 months. Provide preoperative teaching about nephrectomy.
Provide preoperative teaching about nephrectomy.
A 46-yr-old female patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole for 3 days. Which action will the nurse plan to take? Teach the patient to take the prescribed trimethoprim and sulfamethoxazole for 3 more days. Suggest that the patient use acetaminophen (Tylenol) to relieve symptoms. Remind the patient about the need to drink 1000 mL of fluids daily. Obtain a midstream urine specimen for culture and sensitivity testing.
Suggest that the patient use acetaminophen (Tylenol) to relieve symptoms.
A patient in the urology clinic is diagnosed with monilial urethritis. Which action will the nurse include in the plan of care? Teach the patient about the use of antifungal medications. Teach the patient to avoid nonsteroidal antiinflammatory drugs (NSAIDs). Tell the patient to avoid tub baths until the symptoms resolve. Instruct the patient to refer recent sexual partners for treatment.
Teach the patient about the use of antifungal medications.
A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention? The LPN/LVN carries a tray containing low-protein foods into the patient's room. The LPN/LVN administers the erythropoietin subcutaneously. The LPN/LVN administers the iron supplement and phosphate binder with lunch. The LPN/LVN assists the patient to ambulate out in the hallway.
The LPN/LVN administers the iron supplement and phosphate binder with lunch.
A 62-yr-old female patient has been hospitalized for 4 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider? Urine output over an 8-hour period is 2500 mL. The blood urea nitrogen (BUN) level is 67 mg/dL. The creatinine level is 3.0 mg/dL. The glomerular filtration rate is less than 30 mL/min/1.73 m2.
The glomerular filtration rate is less than 30 mL/min/1.73 m2 ?
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the bowel sounds. blood urea nitrogen (BUN). level of consciousness (LOC). blood glucose.
bowel sounds.
The home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying. Which patient statement indicates that the teaching has been effective? "I will use a sterile catheter and gloves for each time I self-catheterize." "I will take prophylactic antibiotics to prevent any urinary tract infections." "I will buy seven new catheters weekly and use a new one every day." "I will clean the catheter carefully before and after each catheterization."
"I will clean the catheter carefully before and after each catheterization."
The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs) has been effective for a 22-yr-old female patient with cystitis when the patient states which of the following? "I will drink a quart of water or other fluids every day." "I will empty my bladder every 3 to 4 hours during the day." "I will wash with soap and water before sexual intercourse." "I can use vaginal antiseptic sprays to reduce bacteria."
"I will empty my bladder every 3 to 4 hours during the day."
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective? "I will increase my intake of fruits and vegetables to 5 per day." "I will measure my urinary output each day to help calculate the amount I can drink." "I need to get most of my protein from low-fat dairy products." "I need to take erythropoietin to boost my immune system and help prevent infection."
"I will measure my urinary output each day to help calculate the amount I can drink."
A patient is unable to void after having an open loop resection and fulguration of the bladder. Which nursing action should be implemented? Teach the patient how to do isometric perineal exercises. Restrict oral fluids to equal previous urine volume. Assist the patient to soak in a 15-minute sitz bath. Insert a straight urethral catheter and drain the bladder.
Assist the patient to soak in a 15-minute sitz bath.
When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula? Assess the quality of the left radial pulse. Auscultate for a bruit at the fistula site. Irrigate the fistula site with saline every 8 to 12 hours. Compare blood pressures in the left and right arms.
Auscultate for a bruit at the fistula site.
Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)? Avoid commercial salt substitutes. Choose high-protein foods for most meals. Have several servings of dairy products daily. Restrict fluid intake to 1000 mL daily. Take phosphate binders with each meal.
Avoid commercial salt substitutes. Choose high-protein foods for most meals. Take phosphate binders with each meal.
During routine hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? Slow down the rate of dialysis. Give prescribed PRN antiemetic drugs. Check the blood pressure (BP). Review the hematocrit (Hct) level.
Check the blood pressure (BP).
A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? Review the chart for the patient's current creatinine level. Document the QRS interval measurement. Check the medical record for the most recent potassium level. Notify the patient's health care provider.
Check the medical record for the most recent potassium level.
A patient has been diagnosed with urinary tract calculi that are high in uric acid. Which foods will the nurse teach the patient to avoid (select all that apply)? Spinach Chicken Chocolate Milk Liver Cabbage
Chicken Liver
A patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider? Intermittent hematuria Burning with urination Urinary urgency Left-sided flank pain
Left-sided flank pain
After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take? Teach the patient about normal AVG function. Report the patient's symptoms to the health care provider. Remind the patient to take a daily low-dose aspirin tablet. Elevate the patient's arm on pillows to above the heart level.
Report the patient's symptoms to the health care provider.
Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein? Start continuous pulse oximetry. Restrict physical activity to bed rest. Restrict the patient's oral protein intake. Discontinue the urethral retention catheter.
Restrict physical activity to bed rest.
Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? The patient leaves the catheter exit site without a dressing. The patient plans 30 to 60 minutes for a dialysate exchange. The patient cleans the catheter while taking a bath each day. The patient slows the inflow rate when experiencing abdominal pain.
The patient cleans the catheter while taking a bath each day.
Which information from a patient who had a transurethral resection with fulguration for bladder cancer 3 days ago is most important to report to the health care provider? The patient is voiding every 4 hours. The patient has seen clots in the urine. The patient is anxious about the cancer. The patient is using opioids for pain.
The patient has seen clots in the urine.
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider? The patient's peritoneal effluent appears cloudy. The patient has an outflow volume of 1800 mL. The patient's abdomen appears bloated after the inflow. The patient has abdominal pain during the inflow phase.
The patient's peritoneal effluent appears cloudy.
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of bounding peripheral pulses. persistent skin tenting rapid, deep respirations. hot, flushed face and neck.
rapid, deep respirations.
To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating legumes and dried fruit. sardines and liver. spinach and chocolate. milk and cheese.
sardines and liver.
A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin 60 mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patient's serum potassium. urine osmolality. serum creatinine. blood glucose.
serum creatinine.
Before administration of calcium carbonate to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for serum creatinine. serum phosphate. total cholesterol. potassium level.
serum phosphate.
The nurse determines that further instruction is needed for a patient with interstitial cystitis when the patient says which of the following? "I should call the doctor about increased bladder pain or foul urine." "I should stop having coffee and orange juice for breakfast." "I will start taking high potency multiple vitamins every morning." "I will buy calcium glycerophosphate (Prelief) at the pharmacy."
"I will start taking high potency multiple vitamins every morning."
A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, "Do you think I should go on dialysis? Which initial response by the nurse is best? "It depends on which type of dialysis you are considering." "Tell me more about what you are thinking regarding dialysis." "Many people your age use dialysis and have a good quality of life." "You are the only one who can make the decision about dialysis."
"Tell me more about what you are thinking regarding dialysis."
A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? A fistula can be used sooner after surgery. A fistula can accommodate larger needles. A fistula is much less likely to clot. A fistula increases patient mobility.
A fistula is much less likely to clot.
Which nursing action is of highest priority for a patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain? Give antiemetics as needed for nausea. Monitor temperature every 4 hours. Administer prescribed analgesics. Encourage increased oral fluid intake.
Administer prescribed analgesics.
A 55-yr-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? Creatinine 1.6 mg/dL Blood pressure 98/56 mm Hg Oxygen saturation 89% Hemoglobin level 13 g/dL
Hemoglobin level 13 g/dL
A 72-yr-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? Draw a complete blood count. Insert urethral catheter. Obtain renal ultrasound. Infuse normal saline at 50 mL/hour.
Insert urethral catheter.
The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required? Calcium phosphate Acetaminophen Multivitamin with iron Magnesium hydroxide
Magnesium hydroxide
Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine? Phenazopyridine may cause photosensitivity Phenazopyridine may change the urine color Take phenazopyridine before sexual intercourse. Take phenazopyridine for at least 7 days.
Phenazopyridine may change the urine color
The nurse will plan to teach a 27-yr-old woman who smokes two packs of cigarettes daily about the increased risk for interstitial cystitis. bladder infection. kidney stones. bladder cancer.
bladder cancer.
The nurse teaches an adult patient to prevent the recurrence of renal calculi by avoiding dietary sources of calcium. using a filter to strain all urine. choosing diuretic fluids such as coffee and tea. drinking 2000 to 3000 mL of fluid each day.
drinking 2000 to 3000 mL of fluid each day.
When preparing a female patient with bladder cancer for intravesical chemotherapy, the nurse will teach about premedicating to prevent nausea. maintaining oral care during the treatments. obtaining wigs and scarves to wear. emptying the bladder before the medication.
emptying the bladder before the medication.
A young adult male patient seen at the primary care clinic complains of feeling continued fullness after voiding and a split, spraying urine stream. The nurse will ask about a history of recurrent bladder infection. recent kidney trauma. benign prostatic hyperplasia. gonococcal urethritis.
gonococcal urethritis.
A patient complains of leg cramps during hemodialysis. The nurse should massage the patient's legs. give acetaminophen (Tylenol). infuse a bolus of normal saline. reposition the patient supine.
infuse a bolus of normal saline.
The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will be augmenting fluid volume. maintaining cardiac output. preventing systemic hypertension. diluting nephrotoxic substances.
maintaining cardiac output.
Before administration of captopril to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's glucose. creatinine. potassium. phosphate.
potassium.
