NCLEX Prep: Renal and GU Disorders

A client with urinary tract infection (UTI) is prescribed phenazopyridine. Which instruction would the nurse give the client? 1. "This drug will take care of the infection causing your symptoms." 2. "Your urine may turn reddish-orange and may cause staining of your clothes." 3. "Take the drug before meals to minimize GI symptoms." 4. "Always keep this drug and use it at the first symptom of a UTI."

2

The UAP tells the nurse the client with ARF has a white crystal-like layer on top of the skin. Which intervention should the nurse implement? 1. Have the assistant apply a moisture barrier cream to the skin. 2. Instruct the UAP to bathe the client in cool water. 3. Tell the UAP not to turn the client in this condition. 4. Explain this is normal and do not do anything for the client

2

The clinic nurse is caring for a client diagnosed with chronic pyelonephritis who is prescribed trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, twice a day for 90 days. Which statement is the scientific rationale for prescribing this medication? 1. The antibiotic will treat the bladder spasms that accompany a urinary tract infection. 2. If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth. 3. In three (3) months, the client should be rid of all bacteria in the urinary tract. 4. The HCP is providing the client with enough medication to treat future infections

2

The client diagnosed with ARF is admitted to the intensive care department and placed on a therapeutic diet. Which diet is most appropriate for the client? 1. A high-potassium and low-calcium diet. 2. A low-fat and low-cholesterol diet. 3. A high-carbohydrate and restricted-protein diet. 4. A regular diet with six (6) small feedings a day.

3

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1. Erythropoietin. 2. Calcium gluconate. 3. Regular insulin. 4. Osmotic diuretic

3

The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition is a cause for these findings? 1. Overhydration. 2. Anemia. 3. Dehydration. 4. Renal failure.

3

A client with a urinary diversion device is at risk for skin breakdown around the stoma. Which interventions will the nurse use with this client? Select all that apply. 1. Change urine collection device every other day. 2. Teach self-catheterization technique. 3. Empty the bag reservoir every 2 hours. 4. Monitor for foul-smelling urine. 5. Ensure appliance wafer is not more than 0.3 cm (1/8 in.) larger than stoma.

3 and 5 -1: should be changed as needed -2: not appropriate -4: appropriate for risk of infection, not this diagnosis

The nurse is caring for a client who received a renal transplant 24 hours previously. Which trend in laboratory studies indicates to the nurse that the new kidney is functioning? Select all that apply. 1. Hemoglobin 12%, increased from 11.8% 2. Serum creatinine 1.6 mg/dL, decreased from 1.9 mg/dL 3. Serum sodium 140 mEq/L, increased from 136 mEq/L 4. Serum phosphate 4.4 mg/dL, decreased from 4.8 mg/dL 5. Blood urea nitrogen level 29 mg/dL, decreased from 35 mg/dL

3 and 5 -The hematocrit is an indicator of the proportion of red blood cells in a given volume of blood. The hematocrit might decrease when cell volume of the blood is decreased because of blood loss or when the liquid portion of the blood volume increases, such as when large volumes of intravenous (IV) fluid are administered

The nurse is planning to administer furosemide 40 mg by the IV push route. What technique should the nurse use when administering this medication? 1. Push the medication steadily over 1 minute. 2. Give the medication slowly, diluted in 50 mL of NS. 3. Inject the medication over 2-3 minutes. 4. Dilute the medication with sterile water, and inject over 5 minutes.

3: the rule is to not administer no more than 20 mg/min or less, so 40 should be pushed over 2 minutes or more

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1. Administer a phosphate binder. 2. Type and crossmatch for whole blood. 3. Assess the client for leg cramps. 4. Prepare the client for dialysis.

4

The client from a long-term care facility is admitted to the medical unit with a fever, hot flushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement first? 1. Start an IV with a 20-gauge catheter. 2. Initiate antibiotic therapy IVPB. 3. Collect a urine specimen for culture. 4. Change the indwelling catheter

4

The female client in an outpatient clinic is being sent home with a diagnosis of urinary tract infection (UTI). Which instruction should the nurse teach to prevent a recurrence of a UTI? 1. Clean the perineum from back to front after a bowel movement. 2. Take warm tub baths instead of hot showers daily. 3. Void immediately preceding sexual intercourse. 4. Avoid coffee, tea, colas, and alcoholic beverages

4

The nurse has told the mother of a child being treated for nephrotic syndrome that it is important to keep the child's skin clean and dry. When the mother asks why, what rationale would the nurse include in a response? 1. The skin is fragile secondary to electrolyte deficiency. 2. Frequent urination may leave moisture on the skin that predisposes to breakdown. 3. Dietary restrictions make fighting infection hard. 4. The condition causes a reduction of gamma globulin in the body.

4 - nephrotic syndrome involves the loss of protein in the urine. Gamma globulins, which help the body fight infections, are proteins.

A client is receiving dopamine (intropin) therapy at 10 mcg/kg/min. The nurse assesses the client for evidence of which nursing diagnosis? Excess fluid volume Increased cardiac output Impaired tissue perfusion Disturbed body image

Impaired tissue perfusion related to peripheral vasoconstriction

A client is receiving mannitol. The nurse assesses the client for evidence of which clinical problem, for which the client is at risk? Dehydration Somnolence Tinnitus Fatigue

Dehydration -it is an osmotic diuretic

In caring for a female client who has a urinary tract infection (UTI) with more than 100,000 colonies of Escherichia coli bacteria, what corresponding findings would the nurse expect to see on the client's urinalysis report? Select all that apply. Positive nitrites Positive leukocyte esterase Negative red blood cells (RBCs) Negative white blood cells (WBCs) Positive glucose

Positive nitrates and positive leukocyte esterase

A client is being prescribed oxybutynin for a neurogenic bladder. The nurse determines that the client is possibly experiencing toxic effects of this medication after noting which manifestation? Restlessness Drowsiness Pallor Bradycardia

Restlessness -also, nervousness, tachycardia (not bradycardia), confusion, no skin changes

Eighteen hours after surgery, the urine output of a client who underwent removal of a pituitary tumor is markedly increased, and the urine specific gravity is 1.002. The nurse expects to note which corresponding findings when reviewing results of laboratory tests? Select all that apply. Serum sodium 148 mEq/L Serum potassium 3.4 mEq/L Serum osmolality 263 mOsm/L Blood urea nitrogen 7 mg/dL Hematocrit 51%

Serum sodium and hematocrit

The client is admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent ARF? 1. Administer normal saline IV. 2. Take vital signs. 3. Place client on telemetry. 4. Assess abdominal dressing

1

The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first? 1. Place the client in the Trendelenburg position. 2. Turn off the dialysis machine immediately. 3. Bolus the client with 500 mL of normal saline. 4. Notify the health-care provider as soon as possible

1

The telemetry monitor technician notifies the nurse of the morning telemetry readings. Which client should the nurse assess first? 1. The client in normal sinus rhythm with a peaked T wave. 2. The client diagnosed with atrial fibrillation with a rate of 100. 3. The client diagnosed with a myocardial infarction who has occasional PVCs. 4. The client with a first-degree atrioventricular block and a rate of 92

1

A client is admitted to an acute care facility due to anemia related to renal failure. Based on the nurse's knowledge about administration of hematopoietic growth factor, which action is not appropriate? 1. Gently shaking the medication for adequate mixing 2. Discarding the medication vial after the first dose 3. Giving undiluted medication as an IV bolus dose 4. Closely inspecting solution for particulate matter

1 -the nurse should NEVER shake this

A child has been admitted with acute glomerulonephritis (AGN). The nurse concludes that which positive laboratory test is the most specific indicator of this disease? 1. Elevated antistreptinolysin O (ASO) titers 2. Elevated erythrocyte sedimentation rate (ESR) 3. Presence of hematuria according to urinalysis 4. Elevated creatinine concentrations

1 -this titer indicates recent infection, which is a precursor to AGN (most common cause)

Which discharge instructions would the nurse give to address the risk of nephrotoxicity for a client who has been given a prescription for an aminoglycoside antibiotic? Select all that apply. 1. Increase fluid intake to 2000-2500 mL fluid daily. 2. Report sudden weight gain or puffy eyes. 3. Don't be concerned with edema as a normal side effect. 4. Elevated blood pressure is an expected drug effect. 5. Eat a low-protein diet while taking this antibiotic.

1 and 2 -it is not necessary to east a low-protein diet while on this antibiotic -edema and HTN should be reported; NOT normal

Which statements by a female client indicate that instruction in ways to prevent urinary tract infection (UTI) was understood? Select all that apply. 1. "I should avoid tub baths and take showers instead." 2. "I should drink 8-10 glasses of fluid per day." 3. "I should only wear nylon underpants." 4. "I should void every 6 hours while I am awake." 5. "I should use powder or talc to aid in keeping the perineal skin dry."

1 and 2 -tub baths can promote migration of bacteria in the lower urinary tract -emptying bladder every 2-4 hours i recommended

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? (Select all that apply). 1. Increased alertness and no seizure activity. 2. Increase in hemoglobin and hematocrit. 3. Denial of nausea and vomiting. 4. Decreased urine-specific gravity. 5. Increased serum creatinine level.

1, 2, 3

Which statement would the nurse make during dietary teaching to a client who has renal calculi? 1. "The presence of renal calculi is directly correlated to dietary intake." 2. "Decreasing calcium intake will prevent the formation of renal calculi." 3. "An increase in dietary protein can increase the likelihood of renal calculi." 4. "Reducing dietary intake of complex carbohydrates decreases formation of renal calculi."

3 -increased dietary protein can lead to increased risk of uric acid formation, which in turn lowers urinary pH and causes precipitation of uric acid stones

A client with renal calculi is advised to restrict calcium in the diet. The nurse determines that the client understands the restriction when the client states to avoid which types of foods? 1. Chicken, beef, and salmon 2. Green vegetables, fruit, and legumes 3. Chocolate, smoked fish, and low-fat milk 4. Eggs, meat, and poultry

3 -these are high in calcium

The client with CKD is placed on a fluid restriction of 1,500 mL/day. On the 7 a.m. to 7 p.m. shift the client drank an eight (8)-ounce cup of coffee, 4 ounces of juice, 12 ounces of tea, and 2 ounces of water with medications. What amount of fluid can the 7 p.m. to 7 a.m. nurse give to the client? _____________

720 mL. -The nurse must add up how many milliliters of fluid the client drank on the 7 a.m. to 7 p.m. shift and then subtract that number from 1,500 mL to determine how much fluid the client can receive on the 7 p.m. to 7 a.m. shift. One (1) ounce is equal to 30 mL. The client drank 26 ounces (8 + 4 + 12 + 2) of fluid, or 780 mL (26 × 30) of fluid. Therefore, the client can have 720 mL (1,500 − 780) of fluid on the 7 p.m. to 7 a.m. shift.

A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what? A) Urinary retention B) Bladder perforation C) Hemorrhage D) Nausea

A -After a cystoscopic examination, the patient with obstructive pathology may experience urine retention if the instruments used during the examination caused edema

Phenazopyridine is prescribed to a client for relief of dysuria associated with urinary tract infection. The nurse explains that the client should expect which urine characteristic while taking phenazopyridine? Decrease in volume Odor that is foul Increase in volume Color that is orange or red

Color that is orange or red

The nurse is caring for a client diagnosed with rule-out ARF. Which condition predisposes the client to developing prerenal failure? 1. Diabetes mellitus. 2. Hypotension. 3. Aminoglycosides. 4. Benign prostatic hypertrophy

2

The home healthcare nurse is visiting an older adult client who is taking torsemide twice daily. Which statements made by the client indicate the need for further teaching? Select all that apply. 1. "I will take my medication in the morning and before bedtime." 2. "I will change my position slowly, so that I don't fall." 3. "I will notify my physician if my ankles swell." 4. "I can drink coffee and tea in an effort to get enough fluid." 5. "I should expect to experience some ringing in my ears."

1, 4, 5

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? 1. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%. 2. The client who does not have a palpable thrill or auscultated bruit. 3. The client who is complaining of being exhausted and is sleeping. 4. The client who did not take antihypertensive medication this morning.

2

The nurse is caring for a client with chronic pyelonephritis. Which assessment data support the diagnosis of chronic pyelonephritis? 1. The client has fever, chills, flank pain, and dysuria. 2. The client complains of fatigue, headaches, and increased urination. 3. The client had a group B beta-hemolytic strep infection last week. 4. The client has an acute viral pneumonia infection

2

The nurse is caring for a client who received a renal transplant 24 hours previously. Which trend in laboratory studies indicates to the nurse that the new kidney is functioning? Select all that apply. 1. Hemoglobin 12%, increased from 11.8% 2. Serum creatinine 1.6 mg/dL, decreased from 1.9 mg/dL 3. Serum sodium 140 mEq/L, increased from 136 mEq/L 4. Serum phosphate 4.4 mg/dL, decreased from 4.8 mg/dL 5. Blood urea nitrogen level 29 mg/dL, decreased from 35 mg/dL

2 and 5

The client receiving hemodialysis is being discharged home from the dialysis center. Which instruction should the nurse teach the client? 1. Notify the HCP if oral temperature is 102°F or greater. 2. Apply ice to the access site if it starts bleeding at home. 3. Keep fingernails short and try not to scratch the skin. 4. Encourage the significant other to make decisions for the client.

3

The male client diagnosed with CKD has received the initial dose of erythropoietin, a biologic response modifier, one (1) week ago. Which complaint by the client indicates the need to notify the health-care provider? 1. The client complains of flu-like symptoms. 2. The client complains of being tired all the time. 3. The client reports an elevation in his blood pressure. 4. The client reports discomfort in his legs and back

3

The nurse is developing a plan of care for a client diagnosed with ARF. Which statement is an appropriate outcome for the client? 1. Monitor intake and output every shift. 2. Decrease of pain by three (3) levels on a 1-to-10 scale. 3. Electrolytes are within normal limits. 4. Administer enemas to decrease hyperkalemia

3

The nurse is explaining the process of peritoneal dialysis to a client recently diagnosed with chronic kidney disease. Which statement would the nurse include in a discussion with the client? 1. "The solutes in the dialysate will enter the bloodstream through the peritoneum." 2. "The peritoneum is more permeable because of the presence of excess metabolites." 3. "The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." 4. "The metabolites will move from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration."

3 -area of high concentration (blood) to an area of low concentration (the dialysate): diffusion and osmosis

A patients 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 patient is likely to have a decreased level of blood urea nitrogen (BUN). B) The patient is at risk for hypokalemia. C) The patient is likely to have irregular voiding patterns. D) The patient is likely to have increased serum creatinine levels.

D -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 who has been prescribed nitrofurantoin reports a concern about onset of brown-colored urine to the home care nurse. Which is the best response by the nurse? 1. "The brown discoloration indicates you are not drinking enough fluids." 2. "If your urine is discolored then the medication may be past the expiration date." 3. "A brown color to the urine is consistent with drug toxicity; call the prescriber." 4. "This is an expected effect of the medication so there is no cause for concern."

4 -A brown discoloration of the urine is an expected effect of therapy with nitrofurantoin (a urinary antiseptic)

What type of renal failure would the nurse expect to see in a client who accidentally self-administered an excessive dose of tobramycin? 1. Prerenal failure 2. Postrenal failure 3. Extrarenal failure 4. Intrarenal failure

4 -prerenal causes include conditions that reduce the blood flow to the kidneys like HF and shock -intrarenal causes include medications, infection, direct damage, toxins -postrenal causes would include obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor or injury

The nurse is preparing to admit a client with urge incontinence. In writing the nursing care plan, the nurse writes interventions that target which manifestation? 1. Involuntary loss of urine because of an overfilled bladder 2. Loss of urine when coughing or sneezing 3. Inability to empty bladder 4. Inability to inhibit urine flow long enough to reach the toilet

4 -urge incontinence is the unpredictable passage of urine soon after a strong urge to void is felt -total incontinence is #1 - stress incontinence is #2 -urinary retention is #3

Which statement made by a client who has chronic kidney disease and is on hemodialysis indicates the need for further teaching? 1. "I will report any increase in my weight of 5 pounds in a 2-day period." 2. "I take my prescribed antihypertensive drugs daily." 3. "I am careful to take precautions in the arm with the AV fistula." 4. "I comply with salt restrictions in my diet by using salt substitutes."

4 -use of salt substitutes can worsen hyperkalemia; potassium intake is carefully monitored in patients with renal failure

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? A) Assessment of the quantity of the patient's urine output B) Assessment of the patient's incision C) Assessment of the patient's abdominal girth D) Assessment for flank or abdominal pain

A -After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is considered to be more suggestive of rejection than changes to the patients abdomen or incision

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

A -An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the bladder, which increases the potential of a urinary tract infection. Older male patients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure, and urinary tract infections.

The nurse has identified the nursing diagnosis of risk for infection in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk? A) Maintain aseptic technique when administering dialysate. B) Wash the skin surrounding the catheter site with soap and water prior to each exchange. C) Add antibiotics to the dialysate as ordered. D) Administer prophylactic antibiotics by mouth or IV as ordered.

A -Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection.

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

A -Drinking fluids can help to clear hematuria. Diuretics are not used for this purpose. Activity limitation and massage are unlikely to resolve this expected consequence of testing.

A patient 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? A) Hydronephrosis B) Nephritic syndrome C) Pylonephritis D) Nephrotoxicity

A -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 nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where? A) In the ureteropelvic junction B) In the ureteral segment near the sacroiliac junction C) In the ureterovesical junction D) In the urethra

A -Obstruction of the ureteropelvic junction is most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction

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

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

The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula? A) A vein and an artery in your arm will be attached surgically. B) The arm should be immobilized for 4 to 6 days. C) One needle will be inserted into the fistula for each dialysis treatment. D) The fistula can be used 2 days after the surgery for dialysis treatment.

A -The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need time, usually 2 to 3 months, to mature before it can be used. The patient is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.

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? A) Hematuria B) Precipitous decrease in serum creatinine levels C) Hypotension unresolved by fluid administration D) Glucosuria

A -The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.

The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply. A) Dietary history B) Family history of renal stones C) Medication history D) Surgical history E) Vaccination history

A, B and C -Dietary and medication histories and family history of renal stones are obtained to identify factors predisposing the patient to stone formation. When caring for a patient with renal stones it would not normally be a priority to assess the vaccination history or surgical history, since these factors are not usually related to the etiology of kidney stones.

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

A, B, D -Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur. As well, sodium is usually restricted to 2 to 3 g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D supplementation.

The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery. When assessing the patients output from surgical drains, the nurse should assess what parameters? Select all that apply. A) Quantity of output B) Color of the output C) Visible characteristics of the output D) Odor of the output E) pH of the output

A, B, and C -others are not normally assessed after surgery

A client being discharged from the hospital is beginning medication therapy with bumetanide. The nurse instructs the client to contact the prescriber if which contraindication for use develops? Increase in peripheral edema Absence of urine output Shortness of breath Increase in blood pressure

Absence of urine output

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

All except A -A dipstick examination, which can detect from 30 to 1000 mg/dL of protein, should be used as a screening test only, because urine concentration, pH, hematuria, and radiocontrast materials all affect the results. Proteinuria is not diagnostic of diabetes and it is neither an age-related change nor a risk factor for incontinence.

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) Specific gravity of the patient's urine B) Testing for the presence of glucose in the patient's urine C) Microscopic examination of urine sediment for RBCs D) Microscopic examination of urine sediment for casts E) Testing for BUN and creatinine in the patient's urine

All except E -Urine testing includes testing for specific gravity, glucose, RBCs, and casts. BUN and creatinine are components of serum, not urine.

A client who underwent cystography 16 hours ago has a urinary output of 180 mL in the previous 8 hours. Which actions should the nurse take at this time? Select all that apply. 1. Measure the specific gravity of the urine. 2. Document the volume on the client's flowsheet. 3. Encourage the client to drink more fluids. 4. Notify the healthcare provider. 5. Compare the output to the client's intake during the previous shift.

All except for 1 -Measuring the urine specific gravity is not a routine nursing action at this time

A client is taking nalidixic acid for treatment of a urinary problem. The nurse explains to the client that the medication is best described as what type of drug? An antispasmodic A uricosuric Anti-infective An analgesic

Anti-infective

A client who has been taking bethanechol chloride for 3 days begins to complain of abdominal pain and difficulty breathing. After assigning another staff member to remain with the client, the nurse checks to see that which medication is available on the nursing unit? Phytonadione Atropine sulfate Oxybutynin Epinephrine

Atropine sulfate (antidote) -phytonadione/Vitamin K is an antidote for Warfarin -oxybutynin us used for urinary antispasmodic -epinephrine treats hypersensitivity

A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of renal failure for which the nurse should monitor the patient? A) Accumulation of wastes B) Retention of potassium C) Depletion of calcium D) Lack of BP control

B

The nurse is caring for a patient who describes changes in his voiding patterns. The patient 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 doesnt seem to be a great deal of urine flow. What would the nurse expect this patients physical assessment to reveal? A) Hematuria B) Urine retention C) Dehydration D) Renal failure

B

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

B -Before the procedure, a laxative may be prescribed to evacuate the colon so that unobstructed x-rays can be obtained

A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders? A) Monitor the patient's electrolyte values every hour before the procedure. B) Preprocedural hydration and administration of acetylcysteine C) Hemodialysis immediately prior to the CT scan D) Obtain a creatinine clearance by collecting a 24-hour urine specimen.

B -Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The nurse would not monitor the patients electrolytes every hour preprocedure. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.

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

B -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.

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

B -The patient requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. -Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this patient. Dialysis is not necessary following kidney surgery.

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 ordered. B) Limit the use of indwelling urinary catheters. C) Encourage frequent mobility and repositioning. D) Toilet residents who are immobile on a scheduled basis.

B -When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adults 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 administered. Mobility does not have a direct effect on UTI risk.

The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply. A) Percuss for pain in the right lower abdominal quadrant. B) Assess for the presence of peripheral edema. C) Auscultate the patients apical heart rate for dysrhythmias. D) Assess the patients BP. E) Assess the patients orientation and judgment.

B and D -Most patients with acute glomerular inflammation have some degree of edema and hypertension. Dysrhythmias, RLQ pain, and changes in mental status are not among the most common manifestations of acute glomerular inflammation.

The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia and hemorrhagic shock in the patient. When assessing for bleeding, what assessment parameter should the nurse evaluate? A) Oral intake B) Pain intensity C) Level of consciousness D) Radiation of pain

C -Bleeding is a major complication of kidney surgery. If undetected and untreated, this can result in hypovolemia and hemorrhagic shock. The nurses role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.

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

C -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 patient. Peritoneal dialysis is not the best choice, as the patient may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.

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

C -Hyperkalemia, a common complication of acute kidney injury, is life-threatening if immediate action is not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.

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

C -The patient should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy

The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology? A) Potassium and sodium B) Bicarbonate and urea C) Glucose and protein D) Creatinine and chloride

C -The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. -Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. -Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.

The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated? A) A 64-year-old patient with chronic glomerulonephritis B) A 57-year-old patient with proteinuria C) A 42-year-old patient with morbid obesity D) A 16-year-old patient with signs of kidney transplant rejection

C -There are several contraindications to a kidney biopsy, including bleeding tendencies, uncontrolled hypertension, a solitary kidney, and morbid obesity. -Indications for a renal biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.

An 84-year-old woman diagnosed with cancer is admitted to the oncology unit for surgical treatment. The patient has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery. The nurse caring for the patient is aware that what precipitating factors in this patient may contribute to AKI? Select all that apply. A) Anxiety B) Low BMI C) Age-related physiologic changes D) Chronic systemic disease E) NPO status

C and D -Changes in kidney function with normal aging increase the susceptibility of elderly patients to kidney dysfunction and renal failure. In addition, the presence of chronic, systemic diseases increases the risk of AKI. -Low BMI and anxiety are not risk factors for acute renal disease. NPO status is not a risk, provided adequate parenteral hydration is administered.

A client is in the intensive care unit following a serious closed head injury. Mannitol is administered to decrease developing intracranial pressure. What is the priority manifestation the nurse should assess for after the drug is given? Hypotension Cardiovascular collapse Seizures Electrolyte imbalance

Cardiovascular collapse -it is an osmotic diuretic and collapse can occur due to the amount of fluid that can be lost; this is life-threatening event and therefore is a priority while others can occur too but are not priority

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

D

The care team is considering the use of dialysis in a patient whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations? A) When the patient's creatinine level drops below 1.2 mg/dL (110 mmol/L) B) When the patients' blood urea nitrogen (BUN) is above 15 mg/dL C) When approximately 40% of nephrons are not functioning D) When about 80% of the nephrons are no longer functioning

D

The nurse is caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure? A) Discuss the patients diagnosis with the family. B) Bathe the patient before the procedure with antiseptic skin wash. C) Administer antivirals before sending the patient for the procedure. D) Keep the patient NPO prior to the procedure.

D

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

D -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 administered with food to be effective.

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

D -PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Nephritic syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders.

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? A) Constipation related to immobility B) Risk for injury related to altered thought processes C) Hyperthermia related to the inflammatory process D) Excess fluid volume related to generalized edema

D -The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is Excess fluid volume related to generalized edema. Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen.

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

D -The most common subjective presenting symptom of UTI in older adults is generalized fatigue. -The most common objective finding is a change in cognitive functioning. -Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none is directly suggestive of a UTI.

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

D -The nurse should ensure that the patient understands the results that are presented by the physician. -Informing the patient of a diagnosis is normally the primary care providers responsibility. -Withholding fluids or medications is not normally required after testing.

An adult patient has been hospitalized with pyelonephritis. The nurses review of the patient's intake and output records reveals that the patient 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) Supplement the patient's fluid intake with a high-calorie diet. B) Emphasize the need to limit intake to 2 L of fluid daily. C) Obtain an order for a high-sodium diet to prevent dilutional hyponatremia. D) Encourage the patient to continue this pattern of fluid intake.

D -Unless contraindicated, 3 to 4 L of fluids per day is encouraged to dilute the urine, decrease burning on urination, and prevent dehydration. No need to supplement this fluid intake with additional calories or sodium.

The healthcare provider has prescribed oxybutynin for a 65-year-old female with urinary frequency and urgency. The nurse teaching the client about drug side effects should explain that which manifestations are associated with this medication? Select all that apply. Dizziness Increased bruising Diarrhea Dry mouth Blurred vision

Dizziness, dry mouth and blurred vision -it is an antispasmodic medication used to restore normal voiding patterns in clients with spasms of urinary bladder -it produces anticholinergic effects, but it does not cause increased bruising nor diarrhea

A client who was just admitted to the nursing unit has a uric acid level of 9.5 mg/dL. Which question would the nurse ask initially? "Do you have a history of gallbladder disease?" "Do you drink large amounts of green tea?" "Do you have a history of gout?" "Do you have any pains in the flank area?"

Do you have a history of gout?

The nurse is admitting a client with a hypertensive emergency and a history of renal insufficiency. The nurse should ensure that which diuretic is readily available for use if prescribed? Furosemide Hydrochlorothiazide Chlorthalidone Spironolactone

Furosemide -indicated for clients with low GFR, other drugs are not; The antihypertensive action involves renal and peripheral vasodilation, a temporary increase in glomerular filtration rate (GFR)

A client who requires diuretic therapy has a creatinine clearance less than 30 mL/min. The nurse checks the medication administration record, expecting to find a prescription for which diuretic? Mannitol Spironolactone Chlorothiazide Furosemide

Furosemide -others are not helpful for this

The nurse has an order to administer a first dose of epoetin to a client with chronic renal failure. The nurse would make note of which laboratory test results to establish a baseline? Select all that apply. Hemoglobin of 9% Hematocrit of 26% White blood cell count 3,000 Creatinine 3.2 mEq/L Blood urea nitrogen 56 mg/dL

Hemoglobin and Hematocrit (H/H)

The nurse is reviewing the medication administration record for a client newly admitted for congestive heart failure. The client is receiving hydrochlorothiazide. Which conditions should concern the nurse in relation to administration of this medication? Select all that apply. Hyponatremia Hypokalemia Hypouricemia Hyperchloremia Hyperglycemia

Hyponatremia, hypokalemia and Hyperglycemia

The nurse caring for a client undergoing a hemodialysis procedure places high priority on evaluating the client frequently for what common complication during the treatment? Hyperglycemia Infection and fever Dialysis dementia Hypotension

Hypotension -changes in serum osmolality and rapid removal of fluid from the intravascular compartment

The client beginning medication therapy with sulfisoxazole needs instructions for its use. What client teaching should the nurse include about the medication? Call the prescriber if the urine turns dark brown. Maintain a high fluid intake. Restrict salt intake. Decrease the dosage when symptoms are improving.

Maintain a high fluid intake.

The nurse notes while taking an admission history that a client is taking acetazolamide. The nurse next questions the client about a history of which medical condition? Hypertensive crisis Congestive heart failure (CHF) Open-angle glaucoma Peripheral vascular disease

Open-angle glaucoma -decreases the rate of aqueous humor and reduced intraocular pressure