Saunders NCLEX-RN 8th Edition

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status? 1.Blood pressure 2.Apical heart rate 3.Jugular vein distention 4.Level of consciousness

1. Blood pressure The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. For kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The heart rate affects the cardiac output but can be altered by factors unrelated to kidney function. Jugular vein distention and level of consciousness are unrelated items.

The nurse is caring for a client who has been diagnosed as having an acute kidney injury (AKI) due to intrarenal causes. What diagnostic test is most effective in confirming this diagnosis? 1.Renal biopsy 2.Ultrasonography 3.Computed tomography scan 4.Magnetic resonance imaging

1.Renal biopsy Rationale: A renal biopsy is considered the best method for confirming intrarenal causes of acute kidney injury (AKI). Magnetic resonance imaging (MRI) and computed tomography (CT) scans contain contrast mediums that can be harmful to clients with this condition. An ultrasound study is not definitive and may not provide enough information.

The nurse reviews the electrolyte results of a client with chronic kidney disease and notes that the potassium level is 5.7 mEq/L (5.7 mmol/L). Which patterns would the nurse watch for on the cardiac monitor as a result of the laboratory value? Select all that apply. 1.ST depression 2.Prominent U wave 3.Tall peaked T waves 4.Prolonged ST segment 5.Widened QRS complexes

3.Tall peaked T waves 5.Widened QRS complexes

A client with prostatitis following kidney infection has received instructions on management of the condition at home and prevention of recurrence. The nurse determines that education was effective if the client makes which statement? 1."I will stop antibiotic therapy when pain subsides." 2."I will exercise as much as possible to stimulate circulation." 3."I should use warm tub baths and analgesics to increase comfort." 4."I will keep fluid intake to a minimum to decrease the need to void."

"I should use warm tub baths and analgesics to increase comfort." Treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. The nurse also teaches the client to rest, increase fluid intake, and use sitz baths or warm tub baths for comfort. Antimicrobial therapy is always continued until the prescription is finished.

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin for a urinary tract infection. The nurse should make which appropriate response? 1."Continue taking the medication; the brown urine occurs and is not harmful." 2."Take magnesium hydroxide with your medication to lighten the urine color." 3."Discontinue taking the medication and make an appointment for a urine culture." 4."Decrease your medication to half the dose, because your urine is too concentrated."

1. "Continue taking the medication; the brown urine occurs and is not harmful." Rationale: Nitrofurantoin imparts a harmless brown color to the urine, and the medication should not be discontinued until the prescribed dose is completed. Magnesium hydroxide will not affect urine color. In addition, antacids should be avoided because they interfere with medication effectiveness.

The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement by the client indicates an accurate understanding of CAPD? 1."No machinery is involved, and I can pursue my usual activities." 2."A cycling machine is used, so the risk for infection is minimized." 3."The drainage system can be used once during the day and a cycling machine for 3 cycles at night." 4."A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."

1. "No machinery is involved, and I can pursue my usual activities. "CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure.

The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting which problem? 1.Anger 2.Projection 3.Depression 4.Withdrawal

1. Anger Psychosocial reactions to CKD and hemodialysis are varied and may include anger. Other reactions include personality changes, emotional lability, withdrawal, and depression. The individual client's response may vary depending on the client's personality and support systems. The client in this question is exhibiting anger. The client's behavior is not indicative of projection; in addition, the client's statement does not reflect withdrawal or depression.

A client who has had a prostatectomy has been instructed in perineal exercises to gain control of the urinary sphincter. The nurse determines that the client demonstrates a need for further teaching when he states that he will perform which movement as part of these exercises? 1.Bearing down as if having a bowel movement 2.Tightening the muscles as if trying to prevent urination 3.Contracting the abdominal, gluteal, and perineal muscles 4.Tightening the rectal sphincter while relaxing abdominal muscles

1. Bearing down as if having a bowel movement The Valsalva maneuver (bearing down) is avoided after prostatectomy because it increases the risk of bleeding in the postoperative period. An acceptable exercise is to tighten the abdominal, gluteal, and perineal muscles as if trying to prevent urination. Another acceptable exercise is to tighten the rectal sphincter while relaxing the abdominal muscles; this prevents the Valsalva maneuver from occurring

Which finding noted in the client on continuous ambulatory peritoneal dialysis (CAPD) should be reported to the primary health care provider (PHCP)? 1.Cloudy yellow dialysate output 2.Client refusal to take the stool softener 3.Previous evening's dwell time of 8 hours 4.Peritoneal catheter site is not red, and the skin has grown around the cuff

1. Cloudy yellow dialysate output CAPD is a form of peritoneal dialysis in which exchanges are completed 4 or 5 times daily. Peritonitis is a major complication of this type of dialysis. Peritonitis can be recognized by cloudy dialysate outflow, fever, abdominal guarding (board-like abdomen), abdominal pain, pain on inflow, malaise, nausea, and vomiting. The client has the right to refuse medications, but it also is important for the nurse to explain the importance of medications to the client. Typically the dwell time during the night is for the entire time that the client sleeps, which could be around 7 to 9 hours. The peritoneal site should have intact skin. The skin grows around the peritoneal catheter cuff, and this prevents tunnel (around catheter) infections.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1.Hematocrit of 33% (0.33) 2.Platelet count of 400,000 mm3 (400 × 109/L) 3.White blood cell count of 6000 mm3 (6.0 × 109/L) 4.Blood urea nitrogen level of 15 mg/dL (5.4 mmol/L)

1. Hematocrit Synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. Used to treat anemia in chronic kidney disease. Normal hematocrit is 42-52 % for males. 37-47% for females. Therapeutic effect is seen when the hematocrit reaches between 30-33%. Normal platelet count is 150,000-400,000. Normal white count is 5000-10,000.

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1.Palpation of a thrill over the fistula. 2.Presence of a radial pulse in the left wrist. 3.Visualization of enlarged blood vessels at the fistula site. 4.Capillary refill less than 3 seconds in the nailbeds of the fingers on the left hand.

1. Palpation of a thrill over the fistula The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Enlarged visible blood vessels at the fistula site are a normal observation but are not indicative of fistula patency. Although the presence of a radial pulse in the left wrist and capillary refill less than 3 seconds in the nail beds of the fingers on the left hand indicate adequate circulation to the hand, they do not assess fistula patency.

The nurse is reviewing laboratory results for a client with chronic kidney disease before a hemodialysis treatment. The serum electrolyte levels are sodium 142 mEq/L (142 mmol/L), chloride 103 mEq/L (103 mmol/L), potassium 5.2 mEq/L (5.2 mmol/L), and bicarbonate 23 mEq/L (23 mmol/L). What action should the nurse take? 1.Take no action. 2.Order a stat hemodialysis treatment. 3.Recheck the labs because these values are all abnormal. 4.Page the primary health care provider (PHCP) with the results.

1. Take no action Rationale: No action is needed because all of the blood levels are normal for a hemodialysis client before a treatment. The normal adult ranges of serum electrolyte levels are sodium 135 to 145 mEq/L (135 to 145 mmol/L), chloride 98 to 106 mEq/L (98 to 106 mmol/L), bicarbonate (venous) 21 to 28 mEq/L (21 to 28 mmol/L), and potassium 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Although the potassium level is elevated, the normal range for potassium for a client with chronic kidney disease receiving hemodialysis is 4 to 6.5 mEq/L (4 to 6.5 mmol/L).

The ambulatory care nurse is working with a 22-year-old female client who has been diagnosed with pelvic inflammatory disease (PID). The nurse incorporates which item in a teaching plan for this client? 1.Avoid frequent douching. 2.Undergarments made of nylon are best. 3.Intrauterine devices are a good birth control method. 4.It is necessary to change sanitary pads only every 8 hours.

1.Avoid frequent douching. Rationale: The client who has been diagnosed with PID should avoid frequent douching because it decreases the natural flora that controls the growth of infectious organisms. The client should wear cotton undergarments, and clothes should not fit tightly. Intrauterine devices increase the client's susceptibility to infection. Sanitary pads should be changed at least every 4 hours. Tampons should not be used during the acute infection, and some primary health care providers may recommend avoiding them indefinitely. The client also should avoid strong soaps, sprays, powders, and similar products that will irritate the perineum.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1.Check the level of the drainage bag. 2.Reposition the client to her or his side. 3.Place the client in good body alignment. 4.Check the peritoneal dialysis system for kinks. 5.Contact the primary health care provider (PHCP). 6.Increase the flow rate of the peritoneal dialysis solution.

1.Check the level of the drainage bag. 2.Reposition the client to her or his side. 3.Place the client in good body alignment. 4.Check the peritoneal dialysis system for kinks.

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? 1.Fish 2.Plum juice 3.Fruit juice 4.Cranberries

1.Fish Rationale: Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on the primary health care provider prescription, the urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice.

The nurse has taught the client with polycystic kidney disease about management of the disorder and prevention and recognition of complications. The nurse should determine that the client understands the instructions if the client states that which should be reported to the primary health care provider (PHCP)? Select all that apply. 1.Frequent urination 2.Burning on urination 3.A temperature of 100.6º F (38.1º C) 4.New-onset shortness of breath 5.A blood pressure of 105/68 mm Hg

1.Frequent urination 2.Burning on urination 3.A temperature of 100.6º F (38.1º C) 4.New-onset shortness of breath The client with polycystic kidney disease should report any signs and symptoms of urinary tract infection, such as frequent urination, burning on urination, and elevated temperature so that treatment may begin promptly. Lowered blood pressure is not a complication of polycystic kidney disease, and it is an expected effect of antihypertensive therapy. The client would be concerned about increases in blood pressure because control of hypertension is essential. The client may experience heart failure as a result of hypertension, and thus any symptoms of heart failure, such as shortness of breath, are also a concern.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1.Hematocrit of 33% (0.33) 2.Platelet count of 400,000 mm3 (400 × 109/L) 3.White blood cell count of 6000 mm3 (6.0 × 109/L) 4.Blood urea nitrogen level of 15 mg/dL (5.25 mmol/L)

1.Hematocrit of 33% (0.33) Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is Male: 42% to 52% (0.42 to 0.52); Female: 37% to 47% (0.37 to 0.47). Therapeutic effect is seen when the hematocrit reaches between 30% and 33% (0.30 and 0.33). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

A client recently diagnosed with chronic kidney disease requiring hemodialysis has an arteriovenous fistula for access. The client asks the nurse what complications can occur with the access site. What complications should the nurse inform the client about? Select all that apply. 1.Hepatitis 2.Infection 3.Hypertension 4.Muscle cramping 5.Post-treatment blood clots

1.Hepatitis 2.Infection Rationale: Complications directly related to the access site for hemodialysis include hepatitis or infection as a result of poor infection control practices, as well as post-treatment blood loss from certain dialysis procedure practices and the removal of needles following the procedure. In addition, heparin is often given to prevent clotting of the access site; this can potentiate postdialysis bleeding. Hypotension from rapid removal of vascular volume can occur, as can muscle cramps from fluid shifting; however, these complications are not directly related to the access site.

The nurse is performing assessment on a client with acute kidney injury who is in the oliguric phase. Which should the nurse expect to note? Select all that apply. 1.Increased serum creatinine level 2.A low and fixed specific gravity 3.Increased blood urea nitrogen (BUN) level 4.A urine output of 600 to 800 mL in a 24-hour period 5.Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)

1.Increased serum creatinine level 2.A low and fixed specific gravity 3.Increased blood urea nitrogen (BUN) level 5.Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg) Increased blood urea nitrogen (BUN) level Urine osmolarity of approximately 300 mOsm/L Rationale: During the oliguric phase of acute kidney injury, serum creatinine levels increase by approximately 1 mg/dL per day, and the BUN level increases by approximately 20 mg/dL per day. The specific gravity of the urine is low and fixed, and the urine osmolarity approaches that of the client's serum level, or about 300 mOsm/L. Urine output is less than 100 mL in a 24-hour period.

A client with a urinary tract infection is receiving ciprofloxacin by the intravenous (IV) route. The nurse appropriately administers the medication by performing which action? 1.Infusing slowly over 60 minutes 2.Infusing in a light-protective bag 3.Infusing only through a central line 4.Infusing rapidly as a direct IV push medication

1.Infusing slowly over 60 minutes

A client with a urinary tract infection is receiving ciprofloxacin by the intravenous (IV) route. The nurse appropriately administers the medication by performing which action? 1.Infusing slowly over 60 minutes 2.Infusing in a light-protective bag 3.Infusing only through a central line 4.Infusing rapidly as a direct IV push medication

1.Infusing slowly over 60 minutes Rationale: Ciprofloxacin is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin and skin structure. A single dose is administered slowly over 60 minutes to minimize discomfort and vein irritation. Ciprofloxacin is not light-sensitive, may be infused through a peripheral IV access, and is not given by IV push method.

The nurse is preparing to care for a client receiving peritoneal dialysis. Which should be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? 1.Maintain strict aseptic technique. 2.Add heparin to the dialysate solution. 3.Change the catheter site dressing daily. 4.Monitor the client's level of consciousness.

1.Maintain strict aseptic technique. The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option 4 may assist in preventing infection, this option relates to an external site.

A client with chronic kidney disease (CKD) who is receiving an antihypertensive medication is experiencing frequent hypotensive episodes. The nurse reviews the client's medication record, knowing that which medication would have the greatest tendency to cause hypotension? 1.Methyldopa 2.Epoetin alfa 3.Levothyroxine 4.Calcium carbonate

1.Methyldopa

The nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP). The client has a 3-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and should expect which urine color during the immediate postoperative period? 1.Pale pink urine 2.Dark pink urine 3.Tea-colored urine 4.Bright red blood with small clots in the urine

1.Pale pink urine Rationale:If the bladder irrigation is infusing at a sufficient rate, the urinary drainage through the Foley tubing should be pale pink. Dark pink urine indicates that the rate of the irrigation solution should be increased. Tea-colored urine is not seen after TURP but may be noted in a client with other renal disorders such as renal failure. Bright red bleeding and clots could indicate a complication, and if this is noted, it should be reported to the primary health care provider.

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1.Place the client on a cardiac monitor. 2.Notify the primary health care provider (PHCP). 3.Put the client on NPO (nothing by mouth) status except for ice chips. 4.Review the client's medications to determine if any contain or retain potassium. 5.Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

1.Place the client on a cardiac monitor. 2.Notify the health care provider (HCP). 4.Review the client's medications to determine if any contain or retain potassium. The normal potassium level is 3.5-5.0 mEq/L (3.5-5.0 mmol/L). A potassium level of 7.0 is elevated. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the HCP and also review medications to determine if any contain potassium or are potassium retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly.

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1.Place the client on a cardiac monitor. 2.Notify the primary health care provider (PHCP). 3.Put the client on NPO (nothing by mouth) status except for ice chips. 4.Review the client's medications to determine whether any contain or retain potassium. 5.Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

1.Place the client on a cardiac monitor. 2.Notify the primary health care provider (PHCP). 4.Review the client's medications to determine whether any contain or retain potassium.

The nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings should the nurse expect to note? Select all that apply. 1.Proteinuria 2.Hematuria 3.Positive ketones 4.A low specific gravity 5.A dark and smoky appearance of the urine

1.Proteinuria 2.Hematuria 5.A dark and smoky appearance of the urine In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross proteinuria and hematuria. The specific gravity is elevated, and the urine may appear dark and smoky. Positive ketones are not associated with this condition but may indicate a secondary problem.

A client is about to begin hemodialysis. Which measures should the nurse employ in the care of the client? Select all that apply. 1.Using sterile technique for needle insertion 2.Using standard precautions in the care of the client 3.Giving the client a mask to wear during connection to the machine 4.Wearing full protective clothing such as goggles, mask, gloves, and apron 5.Covering the connection site with a bath blanket to enhance extremity warmth

1.Using sterile technique for needle insertion 2.Using standard precautions in the care of the client 3.Giving the client a mask to wear during connection to the machine 4.Wearing full protective clothing such as goggles, mask, gloves, and apron Infection is a major concern with hemodialysis. For that reason, the use of sterile technique and the application of a face mask for both nurse and client are extremely important. It also is imperative that standard precautions be followed, which includes the use of goggles, mask, gloves, and apron. The connection site should not be covered; it should be visible so that the nurse can assess for bleeding, ischemia, and infection at the site during the hemodialysis procedure.

A client with a urinary tract infection (UTI) has been prescribed ciprofloxacin. The nurse notes that the client also has a prescription for theophylline written by a pulmonologist. Based on this information, the nurse should take which action? 1.Encourage intake of antacids. 2.Clarify the medication prescriptions. 3.Schedule the doses to be given together. 4.Schedule the doses to be given at the same time.

2. Clarify the medication prescription Rationale: Quinolones, such as ciprofloxacin (Cipro), prolong the half-life of caffeine and theophylline. This would make the theophylline stay in the client's system longer and could cause toxic effects. The nurse should clarify the medication prescriptions. Options 1, 3, and 4 are incorrect actions.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder? 1.Hypoglycemia 2.Diabetes mellitus 3.Coronary artery disease 4.Orthostatic hypotension

2. Diabetes mellitus Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in the remaining options are not associated risk factors.

A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse should expect to note which abnormal finding documented on the client's medical record? 1.Bradycardia 2.Hypertension 3.Decreased cardiac output 4.Decreased central venous pressure

2. Hypertension AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.

The nurse provides discharge instructions to a client after prostatectomy. What is the priority discharge instruction for this client? 1.Avoid driving a car for at least 1 week. 2.Increase fluid intake to at least 2.5 L/day. 3.Avoid lifting any objects greater than 30 lb (13.6 kg). 4.Contact the primary health care provider (PHCP) if small clots are noticed in the urine.

2. Increase fluid intake to at least 2.5 L/day. A daily intake of 2.5 L of fluid should be maintained to limit clot formation and prevent infection. Driving a car and sitting for long periods are restricted for at least 3 weeks. The client should be instructed to avoid lifting objects heavier than 20 pounds (9 kg) for at least 6 weeks. Passing small pieces of tissue or blood clots in the urine for up to 2 weeks after surgery is expected and does not necessitate contacting the HCP.

The nurse is caring for a client with acute kidney injury (AKI). The nurse should test the client's urine for proteinuria to determine which type of AKI? 1.Prerenal 2.Intrinsic 3.Atypical 4.Postrenal

2. Intrinsic In intrinsic failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In prerenal failure, the specific gravity is high, and there is very little or no proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. There is no disorder known as atypical renal failure.

A client with urolithiasis is scheduled for extracorporeal shock wave lithotripsy. The nurse should tell the client that which will be necessary before the procedure is performed? 1.Insertion of a Foley catheter 2.A signed informed consent form 3.Clear liquids only on the day of the procedure 4.Administration of antihypertensive medication

2.A signed informed consent form Rationale: Extracorporeal shock wave lithotripsy is done with the client under epidural or general anesthesia. The client must sign a consent form for the procedure and must have no oral intake beginning the night before the procedure. The client needs an intravenous line for the procedure as well. Insertion of a Foley catheter is not normally performed, and there is no reason to administer antihypertensive medication for this procedure.

A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem? 1.Hypovolemia 2.Acute kidney injury 3.Glomerulonephritis 4.Urinary tract infection

2.Acute kidney injury Rationale: The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Renal injury is signaled by decreased urine output and increased blood urea nitrogen (BUN) and creatinine levels. Normal reference levels are BUN, 10 to 20 mg/dL (3.6 to 7.1 mmol/L), and creatinine, male, 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and female 0.5 to 1.1 mg/dL (44 to 97 mcmol/L). The client may need medications to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis. No data in the question indicate the presence of hypovolemia, glomerulonephritis, or urinary tract infection.

The nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an intravenous (IV) infusion at a rate of 150 mL/hour, unchanged for the last 10 hours. The client's urine output for the last 3 hours has been 90, 50, and 28 mL (28 mL is most recent). The client's blood urea nitrogen level is 35 mg/dL (12.6 mmol/L), and the serum creatinine level is 1.8 mg/dL (159 mcmol/L), measured this morning. Which nursing action is the priority? 1.Check the urine specific gravity. 2.Call the primary health care provider (PHCP). 3.Put the IV line on a pump so that the infusion rate is sure to stay stable. 4.Check to see if the client had a blood sample for a serum albumin level drawn.

2.Call the primary health care provider (PHCP). Call the health care provider. *Following abdominal aortic aneurysm resection or repair, monitor for acute kidney injury. Acute kidney injury can occur because often much blood is lost during the surgery and depending on the aneurysm location they renal arteries may be hypo-perfused for a short period of time.

The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole. Which instruction should be included in the list? 1.Advise that sunscreen is not needed. 2.Drink 8 to 10 glasses of water per day. 3.Decrease the dosage when symptoms are improving to prevent an allergic response. 4.If the urine turns dark brown, call the primary health care provider (PHCP) immediately.

2.Drink 8 to 10 glasses of water per day. Rationale: Each dose of trimethoprim-sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake to avoid crystalluria. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Clients should be advised to use sunscreen since the skin becomes sensitive to the sun. Some forms of trimethoprim-sulfamethoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the PHCP.

The nursing student is caring for a client with benign prostatic hyperplasia (BPH). The nursing instructor asks the student to identify the clinical manifestations associated with this condition. The student needs further teaching if the student states that which finding is an early symptom of BPH? 1.Nocturia 2.Hematuria 3.Decreased force of urine stream 4.Difficulty initiating urine stream

2.Hematuria Rationale: Hematuria is not an early sign of BPH. Nocturia, decreased force of urine stream, and difficulty initiating urine stream are all early signs of BPH.

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client? 1.Bradycardia 2.Hypertension 3.Decreased cardiac output 4.Decreased central venous pressure

2.Hypertension Rationale: AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.

A client is prescribed sulfamethoxazole for treatment of urinary tract infection. Identification of which other medication noted on the client's medical record requires further collaboration with the primary health care provider (PHCP)? 1.Insulin 2.Phenytoin 3.Metoprolol 4.Propranolol

2.Phenytoin Rationale: Sulfonamides can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (e.g., glipizide, glyburide). The principal mechanism is inhibition of hepatic metabolism. When combined with sulfonamides, these medications may require a reduction in dosage to prevent toxicity. Therefore, the nurse should collaborate with the PHCP regarding dose adjustment of phenytoin.

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client? 1.Prevent fluid overload. 2.Prevent loss of electrolytes. 3.Promote the excretion of wastes. 4.Reduce the urine specific gravity.

2.Prevent loss of electrolytes. In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in this phase of AKI.

The nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further teaching about the diuretic phase of acute kidney injury? 1."The increase in urine output indicates the return of some renal function." 2."The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." 3."The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." 4."The blood urea nitrogen and creatinine levels will continue to rise during the first few days of diuresis."

3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." The diuretic phase of acute kidney injury is characterized by an increase in urine output of more than 1000 mL in a 24-hour period. This increase in urine output indicates the return of some renal function; however, blood urea nitrogen and creatinine levels continue to rise during the first few days of diuresis. The diuretic phase develops about 14 days after the initial insult and lasts about 10 days.

Which client is most at risk for developing a Candida urinary tract infection (UTI)? 1.An obese woman 2.A man with diabetes insipidus 3.A young woman on antibiotic therapy 4.A male paraplegic on intermittent catheterization

3. A young woman on antibiotic therapy Candida infections, which are fungal infections, develop in persons who are on long-term antibiotic therapy because an alteration of normal flora occurs. These infections also are commonly seen in clients with blood dyscrasias, diabetes mellitus, cancer, or immunosuppression and in those with a drug addiction.

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of these data, which should the nurse specifically include in the dietary instructions? 1.Increase intake of dairy products. 2.Avoid citrus fruits and citrus juices. 3.Avoid green, leafy vegetables such as spinach. 4.Increase intake of meat, fish, plums, and cranberries.

3. Avoid green, leafy vegetables such as spinach. Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The food items in options 1, 2, and 4 are acceptable to consume.

The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? 1.Fever, diarrhea, groin pain, and ecchymosis 2.Nausea, painful scrotal edema, and ecchymosis 3.Fever, nausea, vomiting, and painful scrotal edema 4.Diarrhea, groin pain, testicular torsion, and scrotal edema

3. Fever, nausea, vomiting, and painful scrotal edema Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection, although sometimes it can be caused by trauma. The remaining options do not present all of the accurate manifestations.

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse should observe for which most common manifestation of this disorder? 1.Headache 2.Hypotension 3.Flank pain and hematuria 4.Complaints of low pelvic pain

3. Flank pain and hematuria The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is either colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia, and palpable kidney masses. Hypertension is another common finding and may be associated with cardiomegaly and heart failure. The client may complain of a headache, but this is not a specific assessment finding in polycystic kidney disease.

The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg because the client is at risk for developing which type of acute kidney injury? 1.Prerenal 2.Postrenal 3.Intrarenal 4.Extrarenal

3. Intrarenal Serum myoglobin levels increase in crush injuries when large amounts of myoglobin and hemoglobin are released from damaged muscle and blood cells. The accumulation may cause acute tubular necrosis, an intrarenal cause of renal failure. Prerenal causes are conditions that interfere with the perfusion of blood to the kidney. Postrenal causes include conditions that cause urinary obstruction distal to the kidney. The cause and the type of renal failure may determine the interventions used in treatment.

The nurse is admitting a client from the post-anesthesia care unit who has had percutaneous nephrolithotomy for calculi in the renal pelvis. The nurse anticipates that the client's care will most likely involve monitoring which device? 1.Ureteral stent 2.Suprapubic tube 3.Nephrostomy tube 4.Jackson-Pratt drain

3. Nephrostomy tube A nephrostomy tube is put in place after percutaneous nephrolithotomy for calculi in the renal pelvis. The client also may have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculous fragments. Options 1, 2, and 4 are incorrect.

A client is being discharged to home while recovering from acute kidney injury (AKI). Reduced dietary intake of which substance indicates to the nurse that the client understands the dietary teaching? 1.Fats 2.Vitamins 3.Potassium 4.Carbohydrates

3. Potassium The excretion of potassium and maintenance of potassium balance are normal functions of the kidneys. In the client with AKI or chronic kidney disease, potassium intake must be restricted as much as possible (to 60 to 70 mEq/day). The primary mechanism of potassium removal during AKI is dialysis. Vitamins, carbohydrates, and fats are not normally restricted in the client with AKI unless a secondary health problem warrants the need to do so. The amount of fluid permitted is generally calculated to be equal to the urine volume plus the insensible loss volume of 500 mL.

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement made by the new nursing graduate indicates an understanding of the procedure for hemodialysis? Select all that apply. 1."Sterile dialysate must be used." 2."Dialysate contains metabolic waste products." 3."Heparin sodium is administered during dialysis." 4."Dialysis cleanses the blood of accumulated waste products." 5."Warming the dialysate increases the efficiency of diffusion."

3."Heparin sodium is administered during dialysis." 4."Dialysis cleanses the blood of accumulated waste products." 5."Warming the dialysate increases the efficiency of diffusion." Heparin sodium is used during dialysis, and it inhibits the tendency of blood to clot when it comes in contact with foreign substances. Option 4 is the purpose of dialysis. The dialysate is warmed to approximately 100°F to increase the efficiency of diffusion and to prevent a decrease in the client's blood temperature. Dialysate is made from clear water and chemicals and is free from any metabolic waste products or medications. Bacteria and other microorganisms are too large to pass through the membrane; therefore, the dialysate does not need to be sterile.

Sulfisoxazole, 1 g orally twice daily, is prescribed for an adolescent with a urinary tract infection. The medication label reads "500-mg tablets." The nurse has determined that the dosage prescribed is safe. The nurse administers how many tablets per dose to the adolescent? 1.1, 2 tablet 2.1 tablet 3.2 tablets 4.3 tablets

3.2 tablets Rationale: Change 1 g to milligrams, knowing that 1000 mg = 1 g. Also, when converting from grams to milligrams (larger to smaller), move the decimal point 3 places to the right: 1 g = 1000 mg. Next, use the formula to calculate the

A client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which action should the nurse include in the client's postoperative plan of care? 1.Positioning the client on the affected side 2.Irrigating the Penrose drain using sterile procedure 3.Changing dressings frequently around the Penrose drain 4.Weighing dressings and adding the amount to the output

3.Changing dressings frequently around the Penrose drain Rationale: Frequent dressing changes around the Penrose drain are required to protect the skin against breakdown from the urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. Placing the client on the affected side will prevent a free flow of urine through the drain. A Penrose drain is not irrigated. Weighing the dressings is not necessary.

Ciprofloxacin is prescribed for a client with a Pseudomonas aeruginosa infection of the urinary tract. The primary health care provider (PHCP) should be questioned by the nurse about the prescription if which underlying condition is noted in the client's record? 1.Osteoarthritis 2.Diabetes mellitus 3.Myasthenia gravis 4.Chronic obstructive pulmonary disease (COPD)

3.Myasthenia gravis Rationale: Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in clients with myasthenia gravis. Accordingly, clients with a history of myasthenia gravis should not receive these medications. History of the remaining disease processes does not pose a problem.

The evening shift nurse is reviewing the laboratory results of a client's urine culture showing 100,000 bacterial units/mL of urine. What should be the nurse's action? 1.Notify the primary health care provider during rounds in the morning. 2.No action is needed because this is a normal value. 3.Page the primary health care provider with the results. 4.Collect another urine specimen to confirm the results.

3.Page the primary health care provider with the results. Rationale: The primary health care provider needs to be notified. A colony count of 100,000 is considered a positive culture and could be indicative of pyelonephritis if accompanied by fever and flank pain. A positive culture that is accompanied by dysuria, frequency, and urgency is indicative of cystitis. The other options are not correct and delay necessary intervention.

A man is admitted to the hospital with the diagnosis of urethritis secondary to chlamydial infection. What precaution should the nurse implement for this client? 1.Enteric 2.Contact 3.Standard 4.Reverse isolation

3.Standard Rationale: Chlamydial infection is a sexually transmitted infection and frequently is called nongonococcal urethritis in the male client. It requires no special precautions other than standard precautions. Caregivers cannot acquire the disease during administration of care, and using standard precautions is the only necessary measure.

Tamsulosin hydrochloride is prescribed for a client. The nurse should suspect that this medication is prescribed to relieve which condition? 1.Constipation 2.Muscle spasms 3.Urinary obstruction 4.Respiratory congestion

3.Urinary obstruction Rationale: Tamsulosin hydrochloride is used to relieve mild to moderate manifestations that occur in benign prostatic hypertrophy. The medication also improves urinary flow rates. This medication is not used to treat constipation, muscle spasms, or respiratory congestion.

The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching? 1."I should try to maintain an acid ash diet." 2."I should increase my fluid intake to 3 L per day." 3."I should take my daily dose of vitamin C to acidify the urine." 4."I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."

4. "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day." Clients with acute pyelonephritis should be instructed to try to maintain an acid ash diet, which may be of some benefit. Also, they should increase fluid intake to 3 L per day; this helps relieve dysuria and flushes bacteria out of the bladder. However, for clients with chronic pyelonephritis and renal dysfunction, an increase in fluid intake may be contraindicated. Medications such as vitamin C help acidify the urine. Juices such as cranberry, plum, and prune juice will leave an acid ash in the urine. Caffeine, alcohol, chocolate, and highly spiced foods are avoided to prevent potential bladder irritation.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1.Hypertension, tachycardia, and fever 2.Hypotension, bradycardia, and hypothermia 3.Restlessness, irritability, and generalized weakness 4.Headache, deteriorating level of consciousness, and twitching

4. Headache, deteriorating level of consciousness, and twitching Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

A client with nephrolithiasis arrives at the clinic for a follow-up visit. Laboratory analysis of the stone that the client passed 1 week earlier indicates that the stone is composed of calcium oxalate. Based on these data, what food item does the nurse instruct the client to avoid? 1.Pasta 2.Lentils 3.Lettuce 4.Spinach

4. Spinach Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. Pasta, lentils, and lettuce are acceptable to consume.

A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? 1.The client washes hands at least once per day. 2.The client's temperature remains lower than 101º F (38.3º C). 3.The client avoids blood pressure (BP) measurement in the left arm. 4.The client's white blood cell (WBC) count remains within normal limits.

4. The client's white blood cell (WBC) count remains within normal limits. General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand-washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the problem of risk for injury.

On the second postpartum day, a client complains of burning on urination, urgency, and frequency of urination. A urinalysis indicates the presence of a urinary tract infection. The nurse instructs the client regarding measures to take for the treatment of the infection. Which client statement indicates to the nurse the need for further instruction? 1."I need to urinate frequently throughout the day." 2."The prescribed medication must be taken until it is finished." 3."My fluid intake should be increased to at least 3000 mL daily." 4."Foods and fluids that will increase urine alkalinity should be consumed."

4."Foods and fluids that will increase urine alkalinity should be consumed." Rationale: A client with a urinary tract infection must be encouraged to take the prescribed medication for the entire time it is prescribed. The client should also be instructed to drink at least 3000 mL of fluid each day to flush the infection from the bladder and to urinate frequently throughout the day. Foods and fluids that acidify the urine need to be encouraged.

The nurse has given instructions about Kegel exercises to a female client with a cystocele. The nurse determines that the client needs further instruction if she makes which statement? 1."I should stop and start my stream of urine during a voiding." 2."I should tighten my perineal muscles for up to 5 minutes, 3 or 4 times a day." 3."I should tighten my perineal muscles for up to 10 seconds several times a day." 4."I should begin voiding and then stop the stream, holding residual urine for an hour."

4."I should begin voiding and then stop the stream, holding residual urine for an hour." Rationale: Kegel muscles strengthen the perineal floor and are useful in the prevention and management of cystocele, rectocele, and enterocele. Several ways to perform Kegel exercises are acceptable. One method entails starting and stopping the flow of urine during a single voiding for about 5 seconds. Also, these exercises may be done by holding perineal muscles taut for up to 10 seconds several times a day or for 5 minutes, 3 or 4 times a day. Residual urine should not be held in the bladder for long periods because this could promote urinary tract infection.

A client with epididymitis is upset about the extent of scrotal edema. Attempts to reassure the client that this condition is temporary have not been effective. The nurse should plan to address which client problem? 1.Pain related to fluid accumulation in the scrotum 2.Uneasiness related to inability to reduce scrotal swelling 3.Guilt related to the possibility of sterility secondary to scrotal swelling 4.Altered body appearance related to change in the appearance of the scrotum

4.Altered body appearance related to change in the appearance of the scrotum

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the primary health care provider (PHCP)? 1.Red, bloody urine 2.Pain rated as 2 on a 0 to 10 pain scale 3.Urinary output of 200 mL higher than intake 4.Blood pressure, 100/50 mm Hg; pulse, 130 beats per minute

4.Blood pressure, 100/50 mm Hg; pulse, 130 beats per minute Rationale: Frank bleeding (arterial or venous) may occur during the first day after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 mL more than intake is adequate. A client pain rating of 2 on a 0 to 10 scale indicates adequate pain control. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The PHCP should be notified.

The nurse is reviewing a client's medication reconciliation form in the medical record and notes that the client is taking tamsulosin at home. Which medication, if started in the hospital, should the nurse question? 1.Lisinopril 2.Valsartan 3.Metoprolol 4.Cimetidine

4.Cimetidine Rationale: Tamsulosin is used most commonly for the treatment of benign prostatic hyperplasia. This medication should not be used concurrently with cimetidine because of the risk of tamsulosin toxicity. The other medications noted do not cause interactions with this medication.

The nurse is caring for a client with a urinary tract infection (UTI). The culture report reveals the presence of Pseudomonas aeruginosa. The nurse anticipates that which medication will be prescribed to treat the infection? 1.Isoniazid 2.Rifampin 3.Ethambutol 4.Ciprofloxacin

4.Ciprofloxacin Rationale: Ciprofloxacin is an antimicrobial agent that is used to treat UTIs caused by P. aeruginosa. The medications identified in the other options are antituberculosis medications.

A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item? 1.Steak 2.Shrimp 3.Chicken liver 4.Cottage cheese

4.Cottage cheese Rationale: With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet. Intake of foods with moderate levels of purines, such as red and white meats and some seafood, also is limited. Avoiding the consumption of milk and dairy products is a recommended dietary change for calculi composed of calcium stones but is acceptable for the client with a uric acid stone.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1.Diuretics 2.Antibiotics 3.Antilipemics 4.Decongestants

4.Decongestants Rationale: In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention. Diuretics increase urine output. Antibiotics and antilipemics do not affect ability to urinate.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1.Diuretics 2.Antibiotics 3.Antilipemics 4.Decongestants

4.Decongestants Rationale:In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention. Diuretics increase urine output. Antibiotics and antilipemics do not affect ability to urinate.

A client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. Which is the priority nursing intervention? 1.Check the shunt for the presence of bruit and thrill. 2.Observe the site once during the shift as time permits. 3.Check the results of the prothrombin time as they are determined. 4.Ensure that small clamps are attached to the arteriovenous shunt dressing.

4.Ensure that small clamps are attached to the arteriovenous shunt dressing. An external arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because 2 ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours. Checking the shunt for the presence of bruit and thrill relates to patency of the shunt. Although checking the results of the prothrombin time is important, it is not the priority nursing action.

The client in chronic kidney disease is receiving epoetin alfa. The nurse should monitor this client for which side/adverse effect of this medication? 1.Fever 2.Depression 3.Bradycardia 4.Hypertension

4.Hypertension Rationale:Epoetin alfa generally is well tolerated. The most significant adverse effect is hypertension, and its use is contraindicated in uncontrolled hypertension. Occasionally a tachycardia may occur as a side effect. This medication also may cause an improved sense of well-being.

A client with benign prostatic hyperplasia undergoes a transurethral resection of the prostate. Postoperatively the client is receiving continuous bladder irrigations. The nurse assesses the client for manifestations of transurethral resection syndrome. Which assessment data would indicate the onset of this syndrome? 1.Tachycardia and diarrhea 2.Bradycardia and confusion 3.Increased urinary output and anemia 4.Decreased urinary output and bladder spasms

Bradycardia and confusion Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting

Symptoms of BPH (benign prostatic hyperplasia)

-Initially the client has urinary difficulties (urinary retention, difficulty voiding or emptying bladder completely, frequent voiding, nocturia) -Pt may experience straining or painful urination with traces of blood in the urine

Nitrofurantoin is prescribed for an adult client to treat acute urinary tract infection (UTI). Based on the normal adult dose, how should the nurse instruct the client to take this medication? 1.50 mg every 6 hours 2.150 mg 3 times daily 3.300 mg administered at bedtime 4.1 g distributed evenly throughout the day

1.50 mg every 6 hours Rationale: For treatment of acute UTI, the adult dosage is 50 mg every 6 hours. For prophylaxis of recurrent UTI, low doses are used, such as 50 to 100 mg at bedtime for adults.

A client with end-stage renal disease (ESRD) has the problem of ineffective coping. Which nursing interventions are appropriate in working with this client? Select all that apply. 1.Acknowledge the client's feelings. 2.Assess the client and family's coping patterns. 3.Explore the meaning of the illness with the client. 4.Set limits on mood swings and expressions of hostility. 5.Give the client information when the client is ready to listen.

1.Acknowledge the client's feelings. 2.Assess the client and family's coping patterns. 3.Explore the meaning of the illness with the client. 5.Give the client information when the client is ready to listen. Clients with ESRD are likely to experience mood swings or express hostility, anger, and depression, among other responses. The nurse should acknowledge the client's feelings, allow the client to express those feelings, and be supportive. Options 1, 2, 3, and 5 are helpful and appropriate interventions for the client. Setting limits for this client is not client focused, does not allow the client to express concerns, and is nontherapeutic in this situation.

A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD? Select all that apply. 1.Agitation 2.Euphoria 3.Depression 4.Withdrawal 5.Labile emotions

1.Agitation 3.Depression 4.Withdrawal 5.Labile emotions The client with CKD often experiences a variety of psychosocial changes. These changes are related to uremia and to the stress associated with living with a chronic disease that is life threatening. Euphoria is not part of the clinical picture for the client in renal failure. Clients with CKD may have labile emotions or personality changes and may exhibit withdrawal, depression, or agitation. Delusions and psychosis also can occur.

The nurse is caring for a client with acute kidney injury (AKI) experiencing metabolic acidosis. When performing an assessment, the nurse should expect to note which breathing pattern? 1.Apnea 2.Kussmaul respirations 3.Decreased respirations 4.Cheyne-Stokes respirations

2Kussmaul respirations Clinical manifestations associated with AKI occur as a result of metabolic acidosis. The nurse would expect to note Kussmaul respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. The breathing patterns noted in options 1, 3, and 4 are not characteristic of AKI.

A client with a urinary tract infection (UTI) is given a prescription for levofloxacin. The nurse should provide the client with which information about this medication? 1."You may experience altered taste." 2."You may get dizzy, so move around slowly." 3."Pain in the back of the leg should be reported." 4."Your urine may become dark and if it does, you should call your primary health care provider."

3. "Pain in the back of the leg should be reported." Rationale: Levofloxacin is a fluoroquinolone antibiotic and is used for a variety of infections, including UTI. Adverse effects include peripheral neuropathy, rhabdomyolysis, tendonitis, tendon rupture, Clostridium difficile infection, muscle weakness in clients with myasthenia gravis, and photosensitivity. Levofloxacin can also prolong the client's QT interval, leading to dysrhythmias. Pain in the back of the leg could be indicative of tendonitis and therefore risk for tendon rupture. The other adverse effects are associated with gemifloxacin, not levofloxacin

The nurse is planning discharge teaching for a client newly diagnosed with chronic kidney disease (CKD). Which factor will enhance the educational process? 1.Anxiety 2.Memory deficits 3.Presence of family 4.Short attention span

3. Presence of family The client with CKD may have several barriers to learning. The presence of family members is helpful because they need to understand the disease and treatment and may help reinforce information with the client after the formal teaching session is over. Anxiety about the disease and its ramifications frequently interferes with learning. Physiological effects of the disease process also impair the client's mental functioning. Specifically, the client may exhibit a short attention span and have memory deficits. Mental functioning usually improves once hemodialysis has begun.

A client with urolithiasis (struvite stones) has a history of chronic urinary tract infections. What should the nurse plan to teach the client to avoid? 1.Antibiotics 2.Foods that make the urine more acidic 3.Wearing synthetic underwear and pantyhose 4.Fruits such as currants, blueberries, and cranberries

3. Wearing synthetic underwear and pantyhose Urolithiasis (struvite stones) can result from chronic infections. They form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Teaching should focus on preventing infections and ingesting foods to make the urine more acidic. Foods such as currants, blueberries, and cranberries are acidic. The client should wear cotton, not synthetic, underclothing to prevent the accumulation of moisture and to prevent irritation of the perineal area, which can lead to infection. Antibiotics are not associated with chronic urinary tract infections.

The nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food? 1.Breads 2.Poultry 3.Chocolate 4.Prune juice

3.Chocolate Rationale: Clients with oxalate stones should avoid foods high in oxalate, such as tea, instant coffee, cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and peanut butter. Large doses of vitamin C may help increase oxalate excretion in the urine.

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia? 1.Nocturia 2.Scrotal edema 3.Occasional constipation 4.Decreased force in the stream of urine

4. Decreased force in the stream of urine Decreased force in the stream of urine is an early symptom of benign prostatic hyperplasia. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur. Constipation or scrotal edema is not associated with benign prostatic hyperplasia.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1.Monitor the client. 2.Elevate the head of the bed. 3.Assess the fistula site and dressing. 4.Notify the primary health care provider (PHCP).

4. Notify the health care provider (HCP). Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified. Monitoring the client, elevating the head of the bed, and assessing the fistula site are correct actions, but the priority action is to notify the HCP.

A client experiencing end-stage kidney disease has an arteriovenous (AV) fistula placed surgically for hemodialysis. Which action is most appropriate for the nurse to document in the plan for care of the AV fistula? 1.Palpate the bruit of the AV fistula weekly to assess for thrombosis. 2.Use the AV fistula site for blood draws to prevent increased pain of multiple blood draws. 3.Take the blood pressure readings in the extremity with the AV fistula to get a more accurate reading. 4.Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis.

4. Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis. An AV fistula is a vascular access system that is required for hemodialysis. It is a device established for clients who need long-term hemodialysis. It is created by connecting an artery to a vein inside the body to create a vessel that can handle the amount of blood flow necessary for effective dialysis. Bleeding, clotting, and infection are risks with all vascular devices. It also is very important to avoid any activity that would promote the status of blood or increase the risk for infection. Taking the blood pressure in the affected arm, carrying heavy objects in the arm, and lying on the arm at night could increase the risk for clotting in the fistula. To check circulation of the fistula, the nurse should palpate or feel for the thrill or auscultate (listen with a stethoscope) for the bruit. It is important to do this at least daily to ascertain the patency of the fistula. To avoid infection, that extremity is never used for peripheral intravenous access (placement of an intravenous line) or for blood draws. Strict aseptic technique is used in accessing the fistula for dialysis.

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart problem can affect the kidneys. The nurse should formulate a response using what fact about the kidneys? 1.The kidneys get fatigued from having to filter too much fluid. 2.The kidneys can react adversely to moderate doses of furosemide. 3.The kidneys will shut down easily if serum levels of digoxin are high. 4.The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

4. The kidneys generally require and receive about 20% to 25% of the resting cardiac output. Heart failure is referred to as a prerenal cause of acute kidney injury because heart failure results in decreased blood flow to the kidneys. The kidneys normally receive about 20% to 25% of the cardiac output and require adequate perfusion to function properly. With a significant or prolonged decrease in blood supply, the kidneys can fail. Options 1 and 3 are incorrect. As for option 2, large doses of furosemide resulting in severe dehydration may lead to decreased kidney perfusion, but moderate doses of furosemide do not cause prerenal acute kidney injury, and furosemide may be used to treat acute kidney injury.

The nurse is caring for a client with a bladder infection. The nurse plans care understanding that the primary risk factor for spread of infection in this client is dysfunction of which structure? 1.Urethra 2.Nephron 3.Glomerulus 4.Ureterovesical junction

4. Ureterovesical junction The ureterovesical junction is the point at which the ureters enter the bladder. At this juncture, the ureter runs obliquely for 1.5 to 2 cm through the bladder wall before opening into the bladder. This anatomical pathway prevents reflux of urine back into the ureter and, in essence, acts as a valve to prevent urine from traveling back into the ureter and up to the kidney.

A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis. The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply. 1.Peritoneal dialysis 2.Analysis of the urinary stone 3.Intravenous opioid analgesics 4.Insertion of a nephrostomy tube 5.Placement of a ureteral stent with ureteroscopy

4.Insertion of a nephrostomy tube 5.Placement of a ureteral stent with ureteroscopyUrolithiasis is the condition that occurs when a stone forms in the urinary system. Hydronephrosis develops when the stone has blocked the ureter and urine backs up and dilates and damages the kidney. Priority treatment is to allow the urine to drain and relieve the obstruction in the ureter. This is accomplished by placement of a percutaneous nephrostomy tube to drain urine from the kidney and placement of a ureteral stent to keep the ureter open. Peritoneal dialysis is not needed since the kidney is functioning. Stone analysis will be done later when the stone has been retrieved and analyzed. Opioid analgesics are necessary for pain relief but do not treat the obstruction.

Tamsulosin hydrochloride has been prescribed for a client with benign prostatic hypertrophy (BPH). How should the nurse instruct the client to take the medication? 1.With breakfast 2.With a glass of milk 3.With the lunchtime meal 4.Thirty minutes after a meal

4.Thirty minutes after a meal Rationale: Tamsulosin hydrochloride is a medication that will relieve mild to moderate manifestations of BPH and improve urinary flow rates. The medication should be administered 30 minutes after meals because food decreases the peak plasma concentration and lengthens the time to achieve peak plasma medication concentrations. Therefore, options 1, 2, and 3 are incorrect.

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia? 1.Nocturia 2.Scrotal edema 3.Occasional constipation 4.Decreased force in the stream of urine

Rationale: Decreased force in the stream of urine is an early symptom of benign prostatic hyperplasia. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur. Constipation or scrotal edema is not associated with benign prostatic hyperplasia.

Bethanechol chloride is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication? 1.Gastric atony 2.Urinary strictures 3.Neurogenic atony 4.Gastroesophageal reflux

Urinary strictures Rationale:Bethanechol chloride (Urecholine) can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.