Renal Part I - IGGY Ch. 67: Care of Patients with Kidney Disorders

Question 18 of 32 Which goal for a client with diabetes will best help to prevent diabetic nephropathy? a. Heed the urge to void. b. Avoid carbohydrates in the diet. c. Take insulin at the same time every day. d. Maintain glycosylated hemoglobin (HbA1c).

d Maintain glycosylated hemoglobin (HbA1c). Maintaining long-term control of blood glucose will help prevent the progression of diabetic nephropathy. Voiding when the client has the urge prevents the backflow of urine and infection. The diabetic diet is composed of carbohydrates, proteins, and fats. Although taking insulin at the same time each day may indirectly help control blood glucose, it is not the best option.

Question 30 of 32 When caring for a client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which element does the nurse anticipate will be used? a. Fresh-frozen plasma b. Platelet infusions c. 5% dextrose in water d. Normal saline solution (NSS)

d Normal saline solution (NSS) Isotonic solutions and crystalloid solutions are administered for volume expansion; 0.9% sodium chloride (NSS) and 5% dextrose in 0.45% sodium chloride may be used. Clotting factors, contained in fresh-frozen plasma, are given for bleeding, not for volume expansion. Platelet infusions are administered for deficiency of platelets. A solution hypotonic to the client's blood, 5% dextrose, is administered for nutrition or hypernatremia, not for volume expansion.

Question 22 of 32 When preparing a client for nephrostomy tube insertion, it is essential for the nurse to monitor which factor before the procedure? a. Blood urea nitrogen (BUN) and creatinine b. Hemoglobin and hematocrit (H&H) c. Intake and output (I&O) d. Prothrombin time (PT) and international normalized ratio (INR)

d Prothrombin time (PT) and international normalized ratio (INR) The procedure will be cancelled or delayed if coagulopathy in the form of prolonged PT/INR exists because dangerous bleeding may result. Nephrostomy tubes are placed to prevent and treat kidney damage; monitoring BUN and creatinine is important, but is not essential before this procedure. H&H is monitored to detect anemia and blood loss; this would not occur before the procedure. This client should be on I&O during the entire hospitalization; it is not necessary only before the procedure, but throughout the admission.

p. 1399, Physiological Integrity When providing care to a client who has undergone a nephrostomy for hydronephrosis, which observation alerts the nurse to a possible complication? A. Urine output of 15 mL/hr B. Tenderness at the surgical site C. Blood urea nitrogen (BUN) of 23 mg/dL D. Pink-tinged urine draining from the nephrostomy

Answer: A Rationale: Urine output after a nephrostomy should be at least 25 to 40 mL/hr. Tenderness is expected at a new incisional site; the slight elevation of BUN alone is not alarming or indicative of a complication specific to nephrostomy. Pink-tinged urine indicating hematuria is common after instrumentation, but frank blood or increased bleeding over time is not expected.

p. 1397, Health Promotion and Maintenance Which statement made by the client newly diagnosed with polycystic kidney disease (PKD) indicates to the nurse that additional teaching for self-management is needed? A. "I will need to increase my daily water intake." B. "I will restrict my sodium to less than 2 mg daily." C. "Now I will need to take a blood pressure drug daily." D. "If I become sexually active or plan to have a family, I will seek genetic counseling."

Answer: B Rationale: Patients with PKD waste sodium rather than retaining it. They need an increased sodium and water intake. Aggressive control of hypertension is needed to preserve kidney function. Genetic counseling is advised before having children because PKD is inherited.

p. 1406, Health Promotion and Maintenance When assessing a client with diabetic nephropathy, which question about self-management should the nurse ask to determine whether the client is currently following best practices to slow progression of this condition? A. "Have you increased your protein intake to promote healing of the damaged nephrons?" B. "Do you avoid contact sports to reduce the risk for causing trauma to your kidneys?" C. "How do you manage your diet to keep your blood glucose levels in the target range?" D. "Have you increased your fluid intake based on urine output?"

Answer: C Rationale: All strategies to avoid prolonged or frequent hyperglycemia can slow progression of diabetic complications, and the open-ended question is nonjudgmental. Protein intake is likely to be advised to be decreased in response to kidney damage regardless of cause. Avoiding renal trauma is a good idea but not linked to best practices in diabetic nephropathy care. Although increasing fluid intake based on urine output may be a good idea during periods of strenuous activity or other dehydrating conditions, it is not linked to best practices for this condition.

p. 1407, Safety; Patient-Centered Care The 56-year-old African American woman is admitting for treatment of newly diagnosed renal cell carcinoma. You find her daughter in the hallway crying. She has heard that her mother has undergone genetic testing related to her cancer diagnosis and wonders if she (the daughter) is at increased risk for the same condition. She was with her mother during the renal scan before admission and is also worried that this exposure to a radioactive isotope will cause cancer in her. 4. How can you evaluate whether your information was understood by the daughter and if follow-up is needed?

Ask! Use the talk-back approach to determine whether the information about genetics and radioisotopes was understood. Ask if the information was helpful or has decreased her obvious distress about the events surrounding her mother's admission today.

p. 1407, Safety; Patient-Centered Care The 56-year-old African American woman is admitting for treatment of newly diagnosed renal cell carcinoma. You find her daughter in the hallway crying. She has heard that her mother has undergone genetic testing related to her cancer diagnosis and wonders if she (the daughter) is at increased risk for the same condition. She was with her mother during the renal scan before admission and is also worried that this exposure to a radioactive isotope will cause cancer in her. 1. Is renal cell carcinoma commonly inherited, and why is genetic testing done?

Fewer than 3% of renal cell cancers are inherited. Genetic testing is likely to be done on the tumor cells (not the patient) to determine the susceptibility of the cancer to treatment options, including targeted therapy.

p. 1407, Safety; Patient-Centered Care The 56-year-old African American woman is admitting for treatment of newly diagnosed renal cell carcinoma. You find her daughter in the hallway crying. She has heard that her mother has undergone genetic testing related to her cancer diagnosis and wonders if she (the daughter) is at increased risk for the same condition. She was with her mother during the renal scan before admission and is also worried that this exposure to a radioactive isotope will cause cancer in her. 2. Do renal scan radioisotopes require radiation precautions? Why or why not?

Renal scan isotopes do not require radiation precautions. The trace amount used in this procedure is not harmful. Of course, the nurse would wear gloves to maintain body secretion precautions.

p. 1407, Safety; Patient-Centered Care The 56-year-old African American woman is admitting for treatment of newly diagnosed renal cell carcinoma. You find her daughter in the hallway crying. She has heard that her mother has undergone genetic testing related to her cancer diagnosis and wonders if she (the daughter) is at increased risk for the same condition. She was with her mother during the renal scan before admission and is also worried that this exposure to a radioactive isotope will cause cancer in her. 3. What risk factors are associated with renal cell carcinoma?

Smoking, obesity, and exposure to certain chemicals have been linked to renal cell carcinoma. These chemicals include cadmium and other heavy metals, asbestos, benzene, and trichloroethylene (an organic solvent used in some manufacturing processes and to degrease metal).

Question 29 of 32 Which condition may predispose a client to chronic pyelonephritis? a. Spinal cord injury b. Cardiomyopathy c. Hepatic failure d. Glomerulonephritis

a Spinal cord injury Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones. Weakness of the heart muscle may cause kidney impairment, not an infection. Pyelonephritis may damage the kidney, not the liver. Glomerulonephritis may result from infection, but may not cause infection of the kidney.

Question 13 of 32 A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? a. "Because the kidneys cannot get rid of fluid, blood pressure goes up." b. "The damaged kidneys no longer release a hormone that prevents high blood pressure." c. "The waste products in the blood interfere with other mechanisms that control blood pressure." d. "This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."

a "Because the kidneys cannot get rid of fluid, blood pressure goes up." In chronic kidney disease, fluid levels increase in the circulatory system. The statements asserting that damaged kidneys no longer release a hormone to prevent high blood pressure, waste products in the blood interfere with other mechanisms controlling blood pressure, and high blood pressure is a compensatory mechanism that increases blood flow through the kidneys in attempt excrete waste products are not accurate regarding the relationship between chronic kidney disease and high blood pressure.

Question 25 of 32 A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease? a. "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." b. "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." c. "If my children have the ADPKD gene, they will have cysts by the age of 30." d. "My children have a 50% chance of inheriting the ADPKD gene that causes the disease."

a "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." There is no way to prevent ADPKD, although early detection and management of hypertension may slow the progression of kidney damage. Limiting salt intake can help control blood pressure. Presentation of ADPKD can vary by age of onset, manifestations, and illness severity, even in one family. Almost 100% of those who inherit a polycystic kidney disease (PKD) gene will develop kidney cysts by age 30. Children of parents who have the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease.

Question 3 of 32 The school nurse is counseling a teenage student about how to prevent kidney trauma. Which statement by the student indicates a need for further teaching? a. "I can't play any type of contact sports because my brother had kidney cancer." b. "I avoid riding motorcycles." c. "I always wear pads when playing football." d. "I always wear a seat belt in the car."

a "I can't play any type of contact sports because my brother had kidney cancer." Contact sports and high-risk activities should be avoided if a person has only one kidney. A family history of kidney cancer does not prohibit this type of activity. To prevent kidney and genitourinary trauma, caution should be taken when riding bicycles and motorcycles. People should wear appropriate protective clothing when participating in contact sports. Anyone riding in a car should wear a seat belt.

Question 17 of 32 When caring for a client with nephrotic syndrome, which intervention should be included in the plan of care? a. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss b. Administering heparin to prevent deep vein thrombosis (DVT) c. Providing antibiotics to decrease infection d. Providing transfusion of clotting factors

a Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss ACE inhibitors can decrease protein loss in the urine. Heparin is administered for DVT, but in nephrotic syndrome it may reduce urine protein and kidney insufficiency. Glomerulonephritis may occur secondary to an infection, but it is an inflammatory process; antibiotics are not indicated for nephrotic syndrome. Clotting factors are not indicated unless bleeding and coagulopathy are present.

Question 32 of 32 The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse? a. Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min. b. Urine output over the past hour was 80 mL. c. Pain is at a level 4 (on a 0-to-10 scale). d. Dressing has a 1-cm area of bleeding.

a Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min. Bleeding is a complication of radical nephrectomy; tachycardia and hypotension may indicate impending hypovolemic or hemorrhagic shock. The surgeon should be notified immediately and fluids should be administered, complete blood count should be checked, and blood administered, if necessary. A urine output of 80 mL can be considered normal. The nurse can administer pain medication, but must address hemodynamic instability and possible hemorrhage first. Administering pain medication to a client who has developed shock will exacerbate hypotension. A dressing with a 1-cm area of bleeding is expected postoperatively.

Question 5 of 32 When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next? a. Check vital signs. b. Notify the surgeon. c. Continue to monitor. d. Insert a nasogastric (NG) tube.

a Check vital signs. The client's abdomen may be distended from bleeding; hemorrhage or adrenal insufficiency causes hypotension, so vital signs should be taken to see if a change in blood pressure has occurred. The surgeon should be notified after vital signs are assessed. An NG tube is not indicated for this client.

Question 1 of 32 When caring for a client with polycystic kidney disease, which goal is most important? a. Preventing progression of the disease b. Performing genetic testing c. Assessing for related causes d. Consulting with the dialysis unit

a Preventing progression of the disease Preventing complications and progression of the disease is the goal. Genetic testing should be done, but this is not a priority. Assessment for related causes is an intervention, not a goal. Not all clients with polycystic kidney disease require dialysis.

Question 26 of 32 When taking the health history of a client with acute glomerulonephritis (GN), the nurse questions the client about which related cause of the problem? a. Recent respiratory infection b. Hypertension c. Unexplained weight loss d. Neoplastic disease

a Recent respiratory infection An infection often occurs before the kidney manifestations of acute GN. The onset of symptoms is about 10 days from the time of infection. Hypertension is a result of glomerulonephritis, not a cause. Weight gain, not weight loss, is symptomatic of fluid retention in GN. Cancers are not part of the cause of GN.

Question 24 of 32 Which assessment findings does the nurse expect in a client with kidney cancer? Select all that apply. a. Erythrocytosis b. Hypokalemia c. Hypercalcemia d. Hepatic dysfunction e. Increased sedimentation rate

a, c, d, e Erythrocytosis, Hypercalcemia, Hepatic dysfunction, Increased sedimentation rate Erythrocytosis alternating with anemia and hepatic dysfunction with elevated liver enzymes may occur with kidney cancer. Parathyroid hormone produced by tumor cells can cause hypercalcemia. An elevation in sedimentation rate may occur in paraneoplastic syndromes. Potassium levels are not altered in kidney cancer, but hypercalcemia is present.

Question 8 of 32 Which statement by a client with diabetic nephropathy indicates a need for further education about the disease? a. "Diabetes is the leading cause of kidney failure." b. "I need less insulin, so I am getting better." c. "My blood sugar may drop really low at times." d. "I must call my provider if the urine dipstick shows protein."

b "I need less insulin, so I am getting better." When kidney function is reduced, insulin is available for a longer time and thus less of it is needed. Unfortunately, many clients believe this means that their diabetes is improving. It is true that diabetes mellitus is the leading cause of end-stage kidney disease among Caucasians in the United States. Clients with worsening kidney function may begin to have frequent hypoglycemic episodes. Proteinuria, which may be mild, moderate, or severe, indicates a need for follow-up.

Question 2 of 32 A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? a. "Don't worry, no one else will know." b. "Take your time. What is bothering you the most?" c. "Why are you hesitant?" d. "You need to tell me so we can determine what is wrong."

b "Take your time. What is bothering you the most?" Asking the client what is bothering him or her expresses patience and understanding when trying to identify the client's problem. Telling the client that others will not know is untrue because the client's symptoms will be in the medical record for other health care personnel to see. Asking why the client is hesitant can seem accusatory and threatening to the client. Admonishing the client to disclose his or her symptoms is too demanding; the nurse must be more understanding of the client's embarrassment.

Question 10 of 32 What is the appropriate range of urine output for the client who has just undergone a nephrectomy? a. 23 to 30 mL/hr b. 30 to 50 mL/hr c. 41 to 60 mL/hr d. 50 to 70 mL/hr

b 30 to 50 mL/hr Urine output of 30 to 50 mL/hr or 0.5 to 1 mL/kg/hr is considered within acceptable range for the client who is post nephrectomy. Output of less than 25 to 30 mL/hr suggests decreased blood flow to the kidney and the onset or worsening of acute kidney injury. A large urine output, followed by hypotension and oliguria, is a sign of hemorrhage and adrenal insufficiency.

Question 23 of 32 The nurse anticipates that a client who develops hypotension and oliguria post nephrectomy may need the addition of which element to the regimen? a. Increase in analgesics b. Addition of a corticosteroid c. Administration of a diuretic d. Course of antibiotic therapy

b Addition of a corticosteroid Loss of water and sodium occurs in clients with adrenal insufficiency, which is followed by hypotension and oliguria; corticosteroids may be needed. The nurse should use caution when administering analgesics to a hypotensive client; no indication suggests that pain is present in this client. A diuretic would further contribute to fluid loss and hypotension, potentially worsening kidney function. A few doses of antibiotics are used prophylactically preoperatively and postoperatively; additional therapy is used when evidence of infection exists.

Question 27 of 32 The RN is working with unlicensed assistive personnel (UAP) in caring for a group of clients. Which action is best for the RN to delegate to UAP? a. Assessing the vital signs of a client who was just admitted with blunt flank trauma and hematuria b. Assisting a client who had a radical nephrectomy 2 days ago to turn in bed c. Helping the provider with a kidney biopsy for a client admitted with acute glomerulonephritis d. Palpating for bladder distention on a client recently admitted with a ureteral stricture

b Assisting a client who had a radical nephrectomy 2 days ago to turn in bed UAP would be working within legal guidelines when assisting a client to turn in bed. Although assessment of vital signs is within the scope of practice for UAP, the trauma victim should be assessed by the RN because interpretation of the vital signs is needed. Assisting with procedures such as kidney biopsy and assessment for bladder distention are responsibilities of the professional nurse that should not be delegated to staff members with a limited scope of education.

Question 9 of 32 When assessing a client with acute glomerulonephritis, which finding causes the nurse to notify the provider? a. Purulent wound on the leg b. Crackles throughout the lung fields c. History of diabetes d. Cola-colored urine

b Crackles throughout the lung fields Crackles indicate fluid overload resulting from kidney damage; shortness of breath and dyspnea are typically associated. The provider should be notified of this finding. Glomerulonephritis may result from infection (e.g., purulent wound); it is not an emergency about which to notify the provider. The history of diabetes would have been obtained on admission. Dark urine is expected in glomerulonephritis.

Question 19 of 32 Which clinical manifestation in a client with pyelonephritis indicates that treatment has been effective? a. Decreased urine output b. Decreased white blood cells in urine c. Increased red blood cell count d. Increased urine specific gravity

b Decreased white blood cells in urine A decreased presence of white blood cells in the urine indicates the eradication of infection. A decreased urine output, an increased red blood cell count, and increased urine specific gravity are not symptoms of pyelonephritis.

Question 20 of 32 Which factor is an indicator for a diagnosis of hydronephrosis? a. History of nocturia b. History of urinary stones c. Recent weight loss d. Urinary incontinence

b History of urinary stones Causes of hydronephrosis or hydroureter include tumors, stones, trauma, structural defects, and fibrosis. Nocturia is a key feature of polycystic kidney disease and pyelonephritis, but it is not associated with hydronephrosis. Recent weight loss and urinary incontinence may be factors in renal cell carcinoma, but are not associated with hydronephrosis.

Question 28 of 32 Which sign or symptom, when assessed in a client with chronic glomerulonephritis (GN), warrants a call to the health care provider? a. Mild proteinuria b. Third heart sound (S3) c. Serum potassium of 5.0 mEq/L d. Itchy skin

b Third heart sound (S3) S3 indicates fluid overload secondary to failing kidneys; the provider should be notified and instructions obtained. Mild proteinuria is an expected finding in GN. A serum potassium of 5.0 mEq/L reflects a normal value; intervention would be needed for hyperkalemia. Although itchy skin may be present as kidney function declines, it is not a priority over fluid excess.

Question 15 of 32 When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? Select all that apply. a. Suprapubic pain b. Vomiting c. Chills d. Dysuria e. Oliguria

b, c, d Vomiting, Chills, Dysuria Nausea and vomiting are symptoms of acute pyelonephritis. Chills along with fever may also occur, as well as burning (dysuria), urgency, and frequency. Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

Question 31 of 32 The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? a. Hemoglobin and hematocrit (H&H) b. White blood cell (WBC) count c. Blood urea nitrogen (BUN) and creatinine d. Lipid levels

c Blood urea nitrogen (BUN) and creatinine BUN and creatinine are kidney function tests. With back-pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction; H&H monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.

Question 14 of 32 After receiving change-of-shift report on the urology unit, which client does the nurse assess first? a. Client post radical nephrectomy whose temperature is 99.8° F (37.6° C) b. Client with glomerulonephritis who has cola-colored urine c. Client who was involved in a motor vehicle crash and has hematuria d. Client with nephrotic syndrome who has gained 2 kg since yesterday

c Client who was involved in a motor vehicle crash and has hematuria The nurse should be aware of the risk for kidney trauma after a motor vehicle crash; this client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria because hemorrhage can be life-threatening. Although slightly elevated, the low-grade fever of the client who is post radical nephrectomy is not life-threatening in the same way as a trauma victim with bleeding. Cola-colored urine is an expected finding in glomerulonephritis. Because of loss of albumin, fluid shifts and weight gain can be anticipated in a client with nephrotic syndrome.

Question 12 of 32 Which information suggests that a client with diabetes may be in the early stages of kidney damage? a. Elevation in blood urea nitrogen (BUN) b. Oliguria c. Microalbuminuria d. Painless hematuria

c Microalbuminuria In the early stages of diabetic nephropathy, micro-levels of albumin are first detected in the urine. Progressive kidney damage occurs before dipstick procedures can detect protein in the urine. BUN may change in response to protein and fluid intake. Oliguria is a later finding in kidney disease and may also be present in dehydration. Painless hematuria often occurs with kidney cancer.

Question 6 of 32 A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration should be cared for by which staff member? a. RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma b. RN who is caring for a client who just returned after having renal artery balloon angioplasty c. RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy d. RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

c RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy The client scheduled for nephrectomy is the most stable client; the RN caring for this client will have time to perform the frequent monitoring and interventions that are needed for the newly admitted client. The client receiving chemotherapy will require frequent monitoring by the RN. The client after angioplasty will require frequent vital sign assessment and observation for hemorrhage and arterial occlusion. The client with acute hypertension will need frequent monitoring and medication administration.

Question 7 of 32 When caring for a client who had a nephrostomy tube inserted 4 hours ago, which is essential for the nurse to report to the health care provider? a. Dark pink-colored urine b. Small amount of urine leaking around the catheter c. Tube that has stopped draining d. Creatinine of 1.8 mg/dL

c Tube that has stopped draining The provider must be notified when a nephrostomy tube does not drain; it could be obstructed or dislodged. Pink or red drainage is expected for 12 to 24 hours after insertion and should gradually clear. The nurse may reinforce the dressing around the catheter to address leaking urine; however, the provider should be notified if there is a large quantity of leaking drainage, which may indicate tube obstruction. A creatinine level of 1.8 mg/dL is expected in a client early after nephrostomy tube placement (due to the minor kidney damage that required the nephrostomy tube).

Question 16 of 32 The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective? a. "Because renal cell carcinoma usually affects both kidneys, I'll need to be watched closely." b. "I'll eventually require some type of renal replacement therapy." c. "I'll need to decrease my fluid intake to prevent stress to my remaining kidney." d. "My remaining kidney will provide me with normal kidney function now."

d "My remaining kidney will provide me with normal kidney function now." After a nephrectomy, the second kidney is expected to eventually provide adequate kidney function, but this may take days or weeks. Renal cell carcinoma typically only affects one kidney. Renal replacement therapy is not the typical treatment for renal cell carcinoma. Fluids should be maintained to flush the remaining kidney.

Question 21 of 32 During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? a. "Drink 2 liters of fluid and urinate at the same time every day." b. "Eat breakfast and go to bed at the same time every day." c. "Check your blood sugar and do a urine dipstick test." d. "Weigh yourself and take your blood pressure."

d "Weigh yourself and take your blood pressure." Regular weight assessment monitors fluid restriction control, while blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction. Fluid intake and urination, and breakfast time and bedtime, do not need to be at the same time each day. Clients with diabetes, not kidney disease, should regularly check their blood sugar and perform a urine dipstick test.

Question 4 of 32 Which staff member does the charge nurse assign to a client who has benign prostatic hyperplasia and hydronephrosis and needs an indwelling catheter inserted? a. RN float nurse who has 10 years of experience with pediatric clients b. LPN/LVN who has worked in the hospital's kidney dialysis unit until recently c. RN without recent experience who has just completed an RN refresher course d. LPN/LVN with 5 years of experience in an outpatient urology surgery center

d LPN/LVN with 5 years of experience in an outpatient urology surgery center Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center. The pediatric nurse would have little exposure to prostatic obstruction and adult catheterization. Dialysis clients do not typically have catheters inserted, so the LPN/LVN from the kidney dialysis unit would not be the best staff member to assign to the client. The nurse who has been out of practice for several years is not the best candidate to insert a catheter in a client with an enlarged prostate.

Question 11 of 32 A client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? a. Decreases bacterial count b. Destroys white blood cells c. Enhances the action of antibiotics d. Provides comfort

d Provides comfort Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis. Antibiotics, not antiseptics, are used to decrease bacterial count and treat pyelonephritis infection; the action of antibiotics is not enhanced with antiseptics. White blood cells, along with antibiotics, fight infection.