Unit 4 - Renal

ATI - 15 A nurse is planning care for a group of clients. Which of the following clients should the nurse plan to monitor for signs of nephrotoxicity? A - A client who is receiving gentamicin for the treatment of a wound infection B - A client who is receiving digoxin for the treatment of heart failure C - A client who is receiving methylprednisolone for the treatment of severe asthma D - A client who is receiving propranolol for the treatment of hypertension

A - A client who is receiving gentamicin for the treatment of a wound infection Rational A - Aminoglycoside antibiotics can damage the cells of the proximal renal tubules, causing acute tubular necrosis. The nurse should plan to monitor this client for nephrotoxicity and acute kidney injury. B - Providers should use caution when prescribing digoxin for clients who have renal impairment because the client's digoxin level can become toxic. However, the medication is not nephrotoxic. C - The nurse should monitor a client who is taking methylprednisolone for fluid retention and hypokalemia. However, the medication is not nephrotoxic. D - Providers should use caution when prescribing propranolol for clients who have renal impairment because the client can develop fluid overload. However, the medication is not nephrotoxic.

E - 63-8 The nurse is caring for client who is receiving erythropoietin. Which assessment finding indicates a positive response to the medication? A - A decrease in fatigue B - Potassium within normal range C - Absence of spontaneous fractures D - Hematocrit of 26.7%

A - A decrease in fatigue Rational The assessment finding of less fatigue is considered a positive response to erythropoietin. Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue.A hematocrit value of 26.7% is low. Erythropoietin would restore the hematocrit to at least 36% to be effective. Erythropoietin stimulates the bone marrow to increase red blood cell production and maturation, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy and do not treat anemia.

ATI - 13 A nurse is reviewing the laboratory report of a client who has acute kidney injury (AKI). Which of the following findings should the nurse expect? (Select all that apply.) A - BUN 30 mg/dL B - Urine output 40 mL in the past 3 hr C - Potassium 3.6 mEq/L D - Calcium 9.8 mg/dL E - Hematocrit 30%

A - BUN 30 mg/dL B - Urine output 40 mL in the past 3 hr E - Hematocrit 30% Rational BUN 30 mg/dL is correct. A BUN level above the expected reference range of 10 to 20 mg/dL is an expected finding of AKI. Urine output 40 mL in the past 3 hr is correct. The client's urine output indicates oliguria. The degree of oliguria varies with the stage of AKI. For the injury stage, the criterion is less than 0.5 mL/kg for 12 or more hr. Potassium 3.6 mEq/L is incorrect. The client's potassium level is within the expected reference range of 3.5 to 5 mEq/L. An elevated potassium level is an expected finding of AKI. Calcium 9.8 mg/dL is incorrect. The client's calcium level is within the expected reference range of 9 to 10.5 mg/dL. The nurse should expect a client who has AKI to have an abnormal calcium level. Hematocrit 30% is correct. A hematocrit level below the expected reference range of 42 to 52% for males and 37 to 47% for females is an expected finding of AKI.

E - 63-6 A client with end-stage kidney disease has been placed on fluid restrictions. Which assessment data indicates to the nurse that the fluid restriction has not been followed? A - Dyspnea and anxiety at rest B - Blood pressure of 118/78 mm Hg C - Central venous pressure (CVP) of 6 mm Hg D - Weight loss of 3 lb (1.4 kg) during hospitalization

A - Dyspnea and anxiety at rest Rational The assessment finding that shows that the client has not adhered to fluid restriction is dyspnea and anxiety at rest. Dyspnea is a sign of fluid overload and possible pulmonary edema. The nurse needs to assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction.Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures. 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.

E - 62-17 Which assessment findings does the nurse expect in a client with kidney cancer? Select all that apply. A - Increased sedimentation rate B - Hepatic dysfunction C - Erythrocytosis D - Hypercalcemia E - Hypokalemia

A - Increased sedimentation rate B - Hepatic dysfunction C - Erythrocytosis D - Hypercalcemia Rational Assessment findings the nurse expects to assess in a client with kidney cancer include: erythrocytosis, hypercalcemia, hepatic dysfunction, and 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 (hypokalemia) are not altered in kidney cancer.

ATI - 19 A nurse is performing an admission assessment for a client who has severe chronic kidney disease (CKD). Which of the following findings should the nurse expect? A - Tachypnea B - Hypotension C - Exophthalmos D - Insomnia

A - Tachypnea Rational A - The nurse should expect a client who has severe CKD to have tachypnea because of metabolic acidosis. B - The nurse should expect a client who has severe CKD to have hypertension because of fluid retention. C - Exophthalmos is not an expected finding of severe CKD. The nurse should expect a client who has hyperthyroidism to have exophthalmos. D - The nurse should expect a client who has severe CKD to have lethargy and drowsiness.

E - 63-9 When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider (HCP) immediately? A - Temperature of 101.2° F (38.4° C) B - Sinus bradycardia, rate of 58 beats/min C - Pulse oximetry reading of 95% D - Blood pressure of 148/90 mm Hg

A - Temperature of 101.2° F (38.4° C) Rational The nurse needs to immediately report a peritoneal dialysis client's temperature of 101.2° F (38.4° C) to the HCP. Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination. Meticulous aseptic technique must be used when caring for PD equipment.A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the HCP can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention. This is not as serious as a fever.

ATI - 11 A nurse in an emergency department is caring for a client who reports costovertebral angle tenderness, nausea, and vomiting. Which of the following laboratory values should the nurse report to the provider? A - WBC count 15,000/mm3 B - BUN 15 mg/dL C - Urine specific gravity 1.020 D - Urine pH 5.5

A - WBC count 15,000/mm3 Rational A - The WBC count is above the expected reference range and indicates the presence of an infection. The nurse should report this finding and the client's manifestations to the provider as an indication of pyelonephritis. A - A BUN level of 15 mg/dL is within the expected reference range. C - A urine specific gravity of 1.020 is within the expected reference range. D - A urine pH of 5.5 is within the expected reference range.

ATI - 25 A nurse is planning care for a client who has acute glomerulonephritis. The nurse should plan to provide which of the following interventions? A - Weigh the client daily. B - Encourage the client to drink 2 to 3 L of fluid per day. C - Instruct the client to ambulate every 2 hr. D - Check the client's blood glucose level.

A - Weigh the client daily. Rational A - The nurse should monitor fluid retention by weighing the client daily. A decrease in weight indicates the effectiveness of the therapy. B - The nurse should calculate the client's daily fluid allowance by adding 500 to 600 mL to their previous 24-hr urine output. C - The nurse should promote the client's conservation of energy and encourage them to rest as much as possible. D - The nurse should check the blood glucose levels of clients who have diabetes mellitus.

Challenge 62-3 The nurse is caring for a male client 8 hours after a nephrectomy. Which assessment data requires immediate nursing intervention? A. Abdominal distension B. Urine output 38 ml in the last hour C. Blood pressure 108/64 mmHg D. Hemoglobin 14 g/dL

A. Abdominal distension Rationale: Abdominal distension can indicate bleeding which is a significant risk following nephrectomy. The nurse will need to assess the client's vital signs, check under the bed linens to see if the client is bleeding outwardly. Then the nurse will notify the surgeon with the vital sign data and abdominal distension assessment. Urine output of 38ml in the last hour is within the acceptable range. The blood pressure is low normal and the hemoglobin is low normal for a male client (normal hgb is 14-18 g/dL).

ATI - 9 A nurse is teaching a client who has urge urinary incontinence about bladder retraining. Which of the following instructions should the nurse include? A - "If you are unable to urinate, sit on the toilet every 4 hours with water running in the sink." B - "Increase the intervals between urination by 15 minutes per day when able to remain continent." C - "Immediately empty your bladder when you have the urge to urinate." D - "If you are unable to urinate, plan to self-catheterize every 3 to 4 hours."

B - "Increase the intervals between urination by 15 minutes per day when able to remain continent." Rational A - The sound of running water is a sensory stimulus that promotes normal micturition, but it does not reduce urinary incontinence. B - The nurse should instruct the client to increase the length of time between urination by 15 min per day when able to remain continent. The goal is to have 3- to 4-hr intervals between urination. C - The nurse should teach the client to delay urination in order to lengthen the intervals between urination. By increasing the bladder's ability to suppress urination, the client should be able to develop continence. D - The nurse should recommend self-catheterization for a client who has functional urinary incontinence, not urge incontinence.

ATI - 2 A nurse is planning education about cyclosporine for a client who had a kidney transplant 2 days ago. Which of the following statements should the nurse plan to include? A - "You might have hair loss due to the medication therapy you'll be taking." B - "You will need to continue taking this medication to protect your new kidneys." C - "Use an over-the-counter anti-inflammatory medication for aches and pains." D - "Your risk for infection will increase if you stop taking this medication."

B - "You will need to continue taking this medication to protect your new kidneys." Rational A - One of the most common adverse effects of cyclosporine is hirsutism. B - The client must take cyclosporine daily for the life of the transplanted organ. C - Taking NSAIDs can intensify renal damage. D - Cyclosporine increases the client's risk for infection. Discontinuing cyclosporine places the client at risk for organ rejection.

ATI - 10 A nurse is teaching a client who has a new diagnosis of acute pyelonephritis. Which of the following instructions should the nurse include in the teaching? A - Drink up to 1,500 mL of fluid per day. B - Avoid the use of NSAIDs for pain. C - Check peripheral blood glucose levels twice per day. D - Increase dietary protein intake.

B - Avoid the use of NSAIDs for pain. Rational A - The client should drink at least 2,000 mL of fluid per day to prevent dehydration and to promote renal blood flow and urine production. B - The nurse should instruct the client to avoid the use of NSAIDs for pain because they can further damage the kidney, causing papillary necrosis and reflux. C - Unless the client also has diabetes mellitus, there is no indication to monitor blood glucose levels during treatment for acute pyelonephritis. D - The client should follow a balanced diet for adequate healing. The provider will limit protein intake if the client develops kidney impairment.

E - 63-12 To prevent prerenal acute kidney injury, which person will the nurse encourage to increase fluid consumption? A - Office secretary B - Construction worker C - School teacher D - Taxicab driver

B - Construction worker Rational Construction workers perform physical labor and work outdoors, especially in warm weather. Working in this type of atmosphere causes diaphoresis and places this worker at risk for dehydration and prerenal azotemia.The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

ATI 17 A nurse is reviewing the medical records of four clients. The nurse should identify which of the following disorders as a risk factor for chronic pyelonephritis? A - Parkinson's disease B - Diabetes mellitus C - Peptic ulcer disease D - Gallbladder disease

B - Diabetes mellitus Rational A - Parkinson's disease can cause bladder dysfunction, such as urinary incontinence or difficulty urinating, but it is not a direct cause of pyelonephritis. B - A client who has diabetes mellitus is at risk for the development of chronic pyelonephritis because of the reduced bladder tone that results from diabetic neuropathy. C - Peptic ulcer disease can cause complications, such as hemorrhage, pyloric obstruction, and perforation, but it is not a direct cause of pyelonephritis. D - Gallbladder disease can cause complications, such as pancreatitis, due to the proximity of the organs, but it is not a direct cause of pyelonephritis.

E - 63-22 While managing care for a client with chronic kidney disease, which action does the registered nurse (RN) plan to delegate to assistive personnel (AP)? Select all that apply. A - Explain the components of a low-sodium diet. B - Document the amount the client drinks throughout the shift. C - Auscultate the client's lung sounds every 4 hours. D - Check the arteriovenous (AV) fistula for a thrill and bruit. E- Obtain the client's prehemodialysis weight.

B - Document the amount the client drinks throughout the shift. E- Obtain the client's pre-hemodialysis weight. Rational Actions the RN delegates to the UAP include: obtaining the client's weight and documenting oral fluid intake. These are routine tasks that can be performed by a UAP.Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

E - 63-11 A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is important for the nurse to implement? A - Adherence to therapy B - Handwashing C - Monitoring for low-grade fever D - Strict clean technique

B - Handwashing Rational Handwashing is the most important infection control measure for the client receiving immune-suppressive therapy to perform.Adherence to therapy and monitoring for low-grade fever are important but are not infection control measures. The nurse must practice aseptic technique for this client, not simply clean technique.

ATI -6 A nurse is obtaining a urine specimen for culture and sensitivity from a client who has manifestations of a urinary tract infection. Which of the following actions should the nurse take? A - Collect the client's urine in a clean specimen container. B - Instruct the client to start urinating then pass the container into the stream. C - Obtain the client's first morning urine on the following day. D - Place the client's urine specimen in a container with a preservative.

B - Instruct the client to start urinating then pass the container into the stream. Rational A - The nurse should use a sterile specimen container for a urine culture and sensitivity test. B - The nurse should instruct the client to start urinating, then pass the container into the stream, and collect 30 to 60 mL of urine in the container. C - The nurse can collect a urine specimen for a culture and sensitivity test at any time of the day. The nurse should collect the specimen as soon as possible to promote prompt treatment of the client's condition. D - The nurse should transport the specimen within 30 min because the specimen container does not contain preservatives

E - 63-5 The nurse teaches a client who is recovering from acute kidney injury to avoid which type of medication? A - Opioids B - Nonsteroidal anti-inflammatory drugs (NSAIDs) C - Calcium channel blockers D - Angiotensin-converting enzyme (ACE) inhibitors

B - Nonsteroidal anti-inflammatory drugs (NSAIDs) Rational Clients recovering from acute kidney disease need to be taught to avoid NSAIDs. NSAIDs may be nephrotoxic to a client with acute kidney disease and must be avoided.ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opioids may be used by clients with kidney disease if severe pain is present. Excretion, however, may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.

ATI - 26 A nurse in a women's health clinic is caring for a client who reports urinary urgency and dysuria. Which of the following additional findings should the nurse identify as an indication of a urinary tract infection (UTI)? A - Vaginal discharge B - Pyuria C - Glucosuria D - Elevated creatine kinase-MB

B - Pyuria Rational A- The nurse should identify vaginal discharge as an indication of vulvovaginitis, not a UTI. B - The nurse should identify pyuria, or white blood cells in the urine, as a common manifestation of a UTI. C - The nurse should identify glucosuria as an indication of hyperglycemia, not a UTI. D- The nurse should identify an elevated creatine kinase-MB as an indication of myocardial muscle injury, not a UTI.

E - 62-18 When assessing a client with acute pyelonephritis, which finding does the nurse anticipate? Select all that apply. A - Oliguria B - Vomiting C - Dysuria D - Chills E - Suprapubic pain

B - Vomiting C - Dysuria D - Chills Rational The findings the nurse expects to find in a client with acute pyelonephritis include: vomiting, chills, and dysuria. Nausea and vomiting and chills along with fever may occur. Dysuria (burning), urgency, and frequency can also occur.Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Flank, back, or loin pain are symptoms of acute pyelonephritis. Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

Mastery Questions - 60 - 3 1. Which lab finding is indicative of renal function alterations and not dehydration? Select all that apply. A. BUN 20 ml/dL B. Creatinine 2.3 ml/dL C. Hemoglobin 14 g/dL D. Cystatin-c 105 mg/mL E. BUN - creatinine ratio 10 F. Creatinine clearance 175 ml/min

B. Creatinine 2.3 ml/dL D. Cystatin-c 105 mg/mL F. Creatinine clearance 175 ml/min Rational · BUN is within normal limits. · Creatinine is a test used to determine renal function and a level 2.3ml/dL is high. · Hemoglobin is within normal limits. · Cystatin-c is an indicator of glomerular filtration rate and a level of 1.5mg/L is higher than normal indicating renal disease. · BUN/creatinine ratio is within normal limits · Creatinine clearance is a test to measure renal function. A level of 175ml/min is higher than normal.

ATI 29 A nurse is monitoring a client following hemodialysis. The nurse should recognize that which of the following factors places the client at risk for seizures? A - Hypokalemia B - A rapid increase of catecholamines C - A rapid decrease in fluid D - Hypercalcemia

C - A rapid decrease in fluid Rational A - Hypokalemia places the client at risk for paralysis and coma, not seizures. B - An increase of catecholamines places the client at risk for tachycardia, not seizures. C - A rapid decrease in fluid and electrolytes during hemodialysis can result in cerebral edema and increased intracranial pressure, placing the client at risk for seizures. This complication is called dialysis disequilibrium syndrome. D - Hypercalcemia can cause paresthesia and muscle weakness, not seizures.

ATI - 30 A nurse is caring for a postoperative client following arteriovenous (AV) fistula creation in the left arm. Which of the following actions should the nurse take? A - Measure blood pressure in the client's left arm every 4 hr. B - Keep the client's left arm in a dependent position. C - Auscultate for bruits in the client's fistula every 4 hr. D - Instruct the client to sleep on the affected side.

C - Auscultate for bruits in the client's fistula every 4 hr. Rational A - The nurse should use the client's right arm to measure blood pressure. Inflating the cuff on the left arm creates pressure on the operative site and can compromise the vascular access. B - The nurse should elevate the client's left arm to reduce swelling and promote circulation. C - The nurse should auscultate for a bruit and palpate for a thrill every 4 hr to verify that the AV fistula is patent. D - The nurse should instruct the client to sleep on their unaffected side to prevent compression on the AV fistula site, which can compromise the vascular access.

ATI - 5 A nurse is planning care for a client who has chronic kidney disease and a potassium level of 7.3 mEq/L. Which of the following interventions should the nurse plan to take? A - Initiate an IV infusion of lactated Ringer's solution. B - Give spironolactone 50 mg PO BID. C - Infuse regular insulin in dextrose 10% in water. D - Administer supplemental phosphorus.

C - Infuse regular insulin in dextrose 10% in water. Rational A - The nurse should not infuse lactated Ringer's solution because it contains potassium and is not a treatment for hyperkalemia. B - The nurse should not administer spironolactone to a client who has hyperkalemia because this medication is a potassium-sparing diuretic. Spironolactone can be used to treat diuretic-induced hypokalemia. C - The nurses should infuse regular insulin in dextrose 10% to 20% in water to a client who has hyperkalemia. The administration of insulin will drive the potassium from the extracellular fluid into the intracellular fluid to decrease the serum potassium level. The dextrose in the solution will counter the insulin to prevent hypoglycemia from occurring. D - The nurse should not administer supplemental phosphorus to a client who has chronic kidney failure due to the risk for hyperphosphatemia.

ATI - 7 A nurse is providing instructions for reducing the dietary intake of potassium to a client who has chronic kidney disease. Which of the following client food selections indicates an understanding of the teaching? A - 1 cup cubed cantaloupe B - 1 cup boiled spinach C - One medium baked potato D - One large raw apple

D - One large raw apple Rational A - Cantaloupe is high in potassium, containing 431 mg per serving. The nurse should instruct a client who has a potassium restriction should avoid eating cantaloupe or oranges. B - Spinach is high in potassium, containing 839 mg per serving. The nurse should instruct a client who has a potassium restriction to avoid eating spinach or broccoli. C - Baked potatoes are high in potassium, and a medium potato with skin contains 610 mg per serving. The nurse should instruct a client who has a potassium restriction to avoid eating white or sweet potatoes. D - Of these options, one large apple is the lowest in potassium, containing 239 mg per serving. The nurse should instruct the client that there are foods from each of the food groups that are low in potassium and can be consumed, such as bread, eggs, butter, and green beans. Learning how to read nutrition labels will assist the client in making choices that meet dietary restrictions.

E - 63-17 A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 L of normal saline infused over 2 hours. Which staff member would be assigned to care for the client? A - LPN/LVN with experience working on the medical unit. B - New graduate RN who just finished a 6-week orientation. C - RN who has floated from pediatrics for this shift. D - RN who usually works on the general surgical unit.

D - RN who usually works on the general surgical unit. Rational The RN who usually works on the general surgical unit would have the most experience in taking care of surgical clients and would be most capable of monitoring the client receiving rapid fluid infusions. This client is at risk for complications such as pulmonary edema and acute kidney failure.The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN would not be assigned to a client requiring IV therapy and who is at high risk for complications.

ATI - 20 A nurse is caring for a client immediately following a kidney transplant. The nurse should identify which of the following findings as a possible indication of a delay in functioning of the transplanted kidney? A - Blood pressure 110/58 mm Hg B - Incisional tenderness C - Pink and bloody urine D - Urine output 30 mL/2 hr

D - Urine output 30 mL/2 hr Rational A - This blood pressure reading is within the expected reference range of less than 120 mm Hg systolic and less than 80 mm Hg diastolic. Following a kidney transplant, the nurse should monitor for an elevated blood pressure as an indication of organ rejection. B - The nurse should expect tenderness at the incision site during the early postoperative period. The nurse should monitor for excessive tenderness as an indication of wound infection. However, this finding does not provide information about kidney function. C - Pink and bloody urine is an expected finding immediately after surgery. The nurse should expect the urine to become clear yellow within several days. D - The client should have a minimum urine output of 30 mL/hr. Following a renal transplant, the nurse should monitor for a decrease in the hourly urine output as an indication that the kidney is not functioning adequately.

Mastery Questions - 61-3 1. A client is diagnosed with renal colic. What would the nurse do first? a. Prepare the client for lithotripsy. b. Encourage oral intake of fluids. c. Strain the urine and send for urinalysis. d. Administer opioids as prescribed.

d. Administer opioids as prescribed. Rationale: Renal colic is severe flank pain caused from kidney stones. The pain can be most severe when the stone is moving or the ureter is obstructed. The first nursing action is to provide pain relief by administering opioids as prescribed. The client may require lithotripsy, if the stone is too large to pass on its own, however, pain relief should occur first. Renal colic is usually very severe and the client will likely be diaphoretic and nauseated. Encouraging oral fluids is not suggested until the pain is controlled. The urine should be strained and

ATI - 60-4 A nurse is caring for several clients. Which of the following clients are at risk for developing pyelonephritis? Select all A - A client who is at 32 weeks of gestation B - A client who ahs kidney calculi C - A client who has a urine pH of 4.2 D - A client who has a neurogenic bladder E - A client who has diabetes mellitus

A - A client who is at 32 weeks of gestation B - A client who ahs kidney calculi D - A client who has a neurogenic bladder E - A client who has diabetes mellitus Rational A - A client who is at 32 weeks of gestation is at risk for developing pyelonephritis because of increased pressure on the urinary system during pregnancy causing reflux or retention of urine B - A client who ahs kidney calculi is at risk for pyelonephritis becuase stones harbor bacteria C - The expected reference range for urine pH is 4.6 to 8.0. Alkaline urine promotes bacterial growth.The client who has urine pH of 4.2 has acid urine D - The client who has a neurogenic bladder can retaining urine, promoting bacteria growth and causing pyelonephritis E - The client who has diabetes mellitus is at risk of pyelonephritis because glucose that can be in the urine promotes bacterial growth

E - 61-13 A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? A - Administer morphine sulfate as prescribed. B - Infuse 0.9% normal saline at 100 mL/hr as prescribed C - Obtain a urine specimen for urinalysis as prescribed. D - Begin an infusion of metoclopramide as prescribed.

A - Administer morphine sulfate as prescribed Rational The intervention the nurse implements first for a client admitted with urolithiasis who reports "spasms of intense flank pain, nausea, and severe dizziness" is to administer morphine sulfate 4 mg IV. Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.An infusion of metoclopramide (Reglan) 10 mg IV would be begun after the client's pain is controlled. A urine specimen for urinalysis would be obtained and an infusion of 0.9% normal saline at 100 mL/hr would be started after the client's pain is controlled.

ATI - 58-4 A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increases the client's risk for surgery? Select all A - Age older than 70 years B - BMI of 41 C - Administering NPH insulin each morning D - Past history of lymphoma E - Blood pressure averaging 120/70 mm Hg

A - Age older than 70 years B - BMI of 41 C - Administering NPH insulin each morning D - Past history of lymphoma Rational A - A client older than 70 years has an increase risk for complication from surgery, lifelong immunosuppression, and organ rejection B - A client who has a BMI of 41 is morbidly obese and is at an increased risk for complications of surgery, lifelong immunosuppression, and organ rejection C - A client who requires NPH insulin for T1DM is at an increased risk for complications of surgery, lifelong immunosuppression, and organ rejection D - A client who has a history of cancer, such as lymphoma, is at an increased risk for complications of surgery, lifelong immunosuppression, and organ rejection E - Blood pressure averaging 120/70 mm Hg is within the expected reference range and does not place the client at a greater risk for complications of surgery, lifelong immunosuppression and organ rejection.

E - 60-19 The nurse is using a bladder scanner on a female client to estimate bladder volume. Which action will the nurse take? Select all that apply. A - Aim the scanner toward the client's coccyx to visualize the bladder. B - Select the female icon since the client has had a hysterectomy. C - Two readings should be completed for best accuracy. D - Gently insert the scanner probe into the vagina. E - Place a gel pad over the client's pubic area.

A - Aim the scanner toward the client's coccyx to visualize the bladder. C - Two readings should be completed for best accuracy. E - Place a gel pad over the client's pubic area.

ATI - 58 - 1 A nurse is assessing a client who has end-stage kidney disease. Which of the following findings should the nurse expect? Select all A - Anuria B - Marked azotemia C - Crackles in the lungs D - Increased calcium level E - Proteinuria

A - Anuria B - Marked azotemia C - Crackles in the lungs E - Proteinuria Rational A - Anuria is a manifestation of end-stage kidney disease B - Marked azotemia is elevated BUN and blood creatinine, which is a manifestation of end-stage kidney disease C - Crackles in the lungs can indicate the client has pulmonary edema, caused from hypovolemia due to end-stage kidney disease D - Calcium levels are decreased due to increase in blood phosphate levels when the client has end-stage kidney disease E - Proteinuria is a manifestation of end-stage kidney disease.

ATI 59-3 Aaa nurse is planning care for a client who ahs Stage 4 chronic kidney disease. Which of the following actions should the nurse include in the plan of care? Select all A - Assess for jugular vein distention B - Provide frequent mouth rinses C - Auscultate for a pleural friction rub D - Provide a high-sodium diet E - Monitor for dysrhythmias

A - Assess for jugular vein distention B - Provide frequent mouth rinses C - Auscultate for a pleural friction rub E - Monitor for dysrhythmias Rational A - Assess for jugular vein distention, which can indicate fluid overload and heart failure B - Provide frequent mouth rinses due to uremic halitosis caused by urea waste in the blood C - Auscultate for a pleural friction rub related to respiratory failure and pulmonary edema caused by acid base imbalance and fluid retention D - Monitor blood sodium and reduce the client's dietary sodium intake E - Monitor for dysrhythmias related to increase blood potassium caused by Stage 4 chronic kidney disease

ATI - 60-3 A nurse is preparing educational material to present to a female client who ahs frequent urinary tract infections. Which of the following information should the nurse include? Select all A - Avoid sitting in a wet bathing suit B - Wipe the perineal area back to front following elimination C - Empty the bladder when there is an urge to void D - Wear synthetic fabric underwear E - Take a shower daily

A - Avoid sitting in a wet bathing suit C - Empty the bladder when there is an urge to void E - Take a shower daily Rational A - The client should avoid sitting in a wet bathing suit, which can increase the risk for a UTI by colonization of bacteria in a moist, warm environment. B - The client should wipe the perineal area from front to back after elimination to prevent contaminating the urethra with bacteria C - The client should empty the bladder when there is an urge to void rather than retain urine for an extended period of time, which increase the risk for a UTI D - The client should wear cotton underwear that absorbs moisture and keeps the perineal area drier, thus decreasing colonization of bacteria that can cause a UTI E - The client should take a shower daily to promote good body hygiene and decrease colonization of bacteria in a perineal area that can cause a UTI

ATI - 57-3 A nurse is planning post procedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? Select all A - Check BUN and blood creatinine B - Administer medications thenurse withheld prior to dialysis C - Observe for findings of hypovolemia D - Assess the access iste for bleeding E - Evaluate blood pressure on the arm with AV access

A - Check BUN and blood creatinine B - Administer medications thenurse withheld prior to dialysis C - Observe for findings of hypovolemia D - Assess the access iste for bleeding Rational A - Check the BUN and blood creatinine to determine the presence and degree for uremia or waste products that remain following dialysis B - Withhold medications the treatment can partially dialyze. After the treatment, the nurse should administer the medications. Antihypertensive medications might need to be withheld until the next day if the client is hypotensive C - A client who is post-dialysis is at risk for hypovolemia due to a rapid decrease in fluid volume D - Assess the access site for bleeding becuase the client receives heparin during the procedure to prevent clotting of blood E - Never measure blood pressure on the extremity that has the AV access site because it can cause collapse of the AV fistula or graft

The nurse is caring for the following clients who are scheduled for a computed tomography (CT) scan with contrast. For which clients will the nurse communicate safety concerns to the health care provider (HCP)? Select all that apply. A - Client who took metformin 4 hours ago B - Client with an allergy to shrimp C - Client who requests morphine sulfate every 3 hours D - Client with a history of asthma E - Client with a blood urea nitrogen of 62 mg/dL (22.1 mmol/L) and a creatinine of 2.0 mg/dL (177 umol/L)

A - Client who took metformin 4 hours ago B - Client with an allergy to shrimp D - Client with a history of asthma E - Client with a blood urea nitrogen of 62 mg/dL (22.1 mmol/L) and a creatinine of 2.0 mg/dL (177 umol/L) Rational The nurse would communicate to the HCP CT scan contrast safety concerns about a client with an allergy to shrimp, a client with an asthma history, a client with an elevated BUN and creatinine, and a client who took Metformin 4 hours ago. All clients undergoing a CT scan with contrast would be asked about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. Contrast reactions have been reported to be as high as 15% in these clients. Clients with asthma have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. The risk for contrast-induced nephropathy is also increased in clients who have pre-existing renal insufficiency (e.g., serum creatinine levels greater than 1.5 mg/dL (133 umol/L) or estimated glomerular filtration rate less than 45 mL/min). Metformin must be discontinued at least 24 hours before and for at least 48 hours after any study using contrast media because the life-threatening complication of lactic acidosis, although rare, could occur.There are no contraindications to undergo CT scan with contrast while taking morphine sulfate. CT with contrast may help to identify the underlying cause of pain.

E - 60-15 The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? A - Client with polycystic kidney disease who is having a kidney ultrasound. B - Client with glomerulonephritis who is having a kidney biopsy. C - Client who is going for a cystoscopy and cystourethroscopy. D - Client who has just returned from having a kidney artery angioplasty.

A - Client with polycystic kidney disease who is having a kidney ultrasound. Rational The best client to assign to an LPN/LVN is the client with polycystic kidney disease who is having a kidney ultrasound. Kidney ultrasounds are noninvasive procedures without complications, and the LPN/LVN can provide this care.A kidney artery angioplasty is an invasive procedure that requires postprocedure monitoring for complications, especially hemorrhage. A registered nurse is needed for this client. Cystoscopy and cystourethroscopy are procedures that are associated with potentially serious complications such as bleeding and infection. These clients must be assigned to RN staff members. Kidney biopsy is associated with potentially serious complications such as bleeding, and this client would also be assigned to RN staff members.

E - 60-2 Which laboratory test will the nurse assess as the best indicator of kidney function? A - Creatinine B - Blood urea nitrogen (BUN) C - Aspartate aminotransferase (AST) D - Alkaline phosphatase

A - Creatinine Rational The laboratory test that is the best indicator of kidney function is creatinine excretion. Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best laboratory marker of renal function.BUN may be affected by protein, fluid intake, rapid cell destruction, cancer treatment, steroid therapy, and hepatic damage. AST and alkaline phosphatase are measures of hepatic function.

E - 60-3 When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? A - History of hysterectomy B - Abdominal girth C - Hematuria D - Presence of urinary infection

A - History of hysterectomy Rational Before performing bladder scanning to detect residual urine in a female client, the nurse must first determine if the client has had a hysterectomy. The scanner must be in the scan mode for female clients in order to ensure the scanner subtracts the volume of the uterus from the measurement. If the client has had a hysterectomy, the scanner should remain in the scan mode for males.The nurse performs this procedure in response to distention or pressure in the bladder; girth is not a factor. This procedure detects urine retained in the bladder, not infection. The presence of retained urine in the bladder is assessed, regardless of hematuria.

E - 60-4 The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast: History and Physical Assessment Polycystic kidney disease Diabetes Hysterectomy Abdomen distended Negative edema Medications Glyburide Metformin Synthroid Diagnostic Findings BUN 26 mg/dL (9.2 mmol/L) Creatinine 1.0 mg/dL (77 umol/L) HbA1c 6.9% Glucose 132 mg/dL (7.3 mmol/L) Which nursing intervention is essential? A - Hold the metformin 24 hours before and on the day of the procedure. B - Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values. C - Report the blood urea nitrogen (BUN) and creatinine. D - Obtain a thyroid-stimulating hormone (TSH) level.

A - Hold the metformin 24 hours before and on the day of the procedure. Rational The essential intervention for the nurse to perform is to withhold metformin at least 24 hours before the time of a contrast media study and for at least 48 hours after the procedure because metformin may cause lactic acidosis.The focus of this scenario is the client with polycystic kidneys. A TSH level is not essential at this time. BUN and creatinine are normal. The glucose is only mildly elevated (if fasting), and the HgbA1c is in an appropriate range.

ATI - 56-3 A nurse is caring for a client who has type 2 diabetes mellitus and will have excretory urography. Prior to the procedure, which of the following actions should the nurse take? Select all A - Identify an allergy to seafood B - Withhold metformin for 24 hr C - Administer an enema D - Obtain a blood coagulation profile E - Assess for asthma

A - Identify an allergy to seafood B - Withhold metformin for 24 hr C - Administer an enema E - Assess for asthma Rational A - Clients who have an allergy to seafood are at higher risk for an allergic reaction to the contrast media they will receive during the procedure B - Clients who take metformin are at risk for lactic acidosis from the contrast media with iodine they will receive during the procedure C - Clients should receive an enema to remove fecal contents, fluid, and gas from the colon for a more clear visualization D - A blood coagulation profile is essential for a client prior to a kidney biopsy becuase of the risk for hemorrhage form the procedure

E - 61-21 An older adult client diagnosed with urge incontinence is prescribed oxybutynin. Which side effects will the nurse tell the client to expect? Select all that apply. A - Increased intraocular pressure B - Dry mouth C - Reddish-orange urine color D - Constipation E - Increased blood pressure

A - Increased intraocular pressure B - Dry mouth D - Constipation Rational Urge incontinence is the loss of urine for no apparent reason after suddenly feeling the need or urge to urinate. Side effects of oxybutynin prescribed for urge incontinence include: dry mouth, constipation, and increased intraocular pressure with the potential to make glaucoma worse. Oxybutynin is an anticholinergic/antispasmodic medication.Alpha-adrenergic agonists and beta blockers, which may be prescribed for urinary incontinence, may cause an increase in blood pressure. Phenazopyridine, a bladder analgesic used to decrease urinary pain, causes the urine to be a reddish-orange color.

ATI - 61-2 A nurse is reviewing discharge instruction with a client who had spontaneous passage of a calcium phosphate renal calculus. Which of the following instructions should the nurse include in the teaching? Select all A - Limit intake of food high in animal protein B - Reduce sodium intake C - Strain urine for 48 hrs D - Report burning with urination to the provider E - Increase fluid intake to 3 L/day

A - Limit intake of food high in animal protein B - Reduce sodium intake D - Report burning with urination to the provider E - Increase fluid intake to 3 L/day Rational A - The client should limit the intake of food high in animal protein, which contain calcium phosphate B - The client should limit intake of sodium, which affects the precipitation of calcium phosphate in the urine C - The client does not need to continue straining the urine once the calculus has passed D - The client should report burning with urination to the provider because this can indicate a urinary tract infection E - The client should increase fluid intake to 2 to 3 L/day. A decrease in fluid intake can cause dehydration, which increases the risk of calculi formation.

ATI - 57-5 A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? Select all A - Monitor blood glucose levels B - Report cloudy dialysate return C - Warm the dialysate in a microwave oven D - Assess for shortness of breath E - Check the access site dressing for wetness F - Maintain medical asepsis when accessing the catheter insertion site

A - Monitor blood glucose levels B - report cloudy dialysate return D - Assess for shortness of breath E - Check the access site dressing for wetness Rational A - Monitor blood glucose levels because the dialysate solution contains glucose. B - Monitor for cloudy dialysate return, which indicates an infection. Clear, light-yellow solution is typical during the outflow process. C - Avoid warming the dialysate in a microwave oven, which causes uneven heating of the solution D - Assess for SOB, which can indicate inability to tolerate a large volume of dialysate E - Check the access site dressing for wetness and look for kiinking, pulling, clamping, or twisting of the tubing, which can increase the risk for exit-site infections. F - Maintain surgical, not medical, asepsis when accessing the catheter insertion site to prevent infection from contamination

E - 60-1 The nurse is caring for a client with uremia. What assessment data will the nurse anticipate? A - Nausea and vomiting B - Insomnia C - Cyanosis of the skin D - Tenderness at the costovertebral angle (CVA)

A - Nausea and vomiting Rational The signs and symptoms the nurse needs to assess for are nausea and vomiting. Other manifestations of uremia include anorexia, nausea, vomiting, muscle cramps, pruritus, fatigue, and lethargy.CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.

E - 60-9 A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the health care provider (HCP) visited the client the day before. What action will the nurse take? A - Notifies the department and the HCP. B - Asks the client's spouse to sign the form. C - Cancels the procedure. D - Asks the client to sign the informed consent.

A - Notifies the department and the HCP. Rational The nurse notifies both the HCP and the department to ensure effective communication across the continuum of care. This nursing action makes it less likely that essential information will be omitted. The client may be asked to sign the consent form in the department. The HCP gives the client a complete description of and reasons for the procedure and explains complications. The nurse reinforces this information.The procedure would not be cancelled without an attempt to correct the situation. The client has not received sedation, so nothing suggests that the client is not competent to consent and that the spouse needs to sign the form.

ATI - 58-2 A nurse is planning postoperative care for a client following a kidney transplant. Which of the following actions should the nurse include Select all A - Obtain daily weights B - Assess dressings for bloody drainage C - Replace hourly urine output with IV fluids D - Expect oliguria in the first 4 hr E - Monitor blood electrolytes

A - Obtain daily weights B - Assess dressings for bloody drainage C - Replace hourly urine output with IV fluids E - Monitor blood electrolytes Rational A - Daily weight are obtained to assess fluid status B - Drainage on the dressing is assessed to monitor for hemorrhage or hematoma C - Hourly urine output with IV fluid replacement is monitored to detect abrupt decrease in urine output, which can indicate rejection or other serious conditions of the transplant kidney D - Oliguria can indicate ischemia, acute kidney injury, rejection, or hypovolemia. Report oliguria immediately to the provider E - Electrolytes are monitored becuase electrolytes loss can occur with postoperative diuresis.

E - 60-14 A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? A - Promoting fluid intake B - Medicating for pain C - Monitoring for hematuria D - Maintaining bedrest

A - Promoting fluid intake Rational The priority nursing intervention for this client is to promote fluid intake. The nurse must ensure that the client has adequate hydration to dilute and excrete the contrast media. The nurse urges the client to take oral fluid or, if needed, administers IV fluids to the client. Hydration reduces the risk for kidney damage.Bedrest is not indicated for the client who has undergone a CT scan with contrast dye. CT with contrast dye is not a painful procedure, so pain medication is not indicated. The client who has undergone CT with contrast dye is not at risk for hematuria.

ATI - 59-2 A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a blood creatinine of 5 mg/dL. Which of the following interventions should the nurse include in the plan? Select all A - Provide a high-protein diet B - Assess the urine for blood C - Monitor for intermittent anuria D - Weight the client once per week E - Provide NSAIDs for pain

A - Provide a high-protein diet B - Assess the urine for blood C - Monitor for intermittent anuria Rational A - Provide a high-protein diet due to the high rate of protein breakdown that occurs with acute kidney injury B - Assess urine for blood, stones, and participles indicating an obstruction of the urinary structures that leave the kidney C - Assess for intermittent anuria due to obstruction or damage to kidneys or urinary structures D - Weigh the client daily to monitor for fluid retention due to acute kidney injury E - Do not administer NSAIDs, which are toxic to the nephrons in the kidney

ATI - 60-1 A nurse is planning care for a client who ahs chronic pyelonephritis. Which of the following actions should the nurse plan to take? Select all A - Provide a referral for nutrition counseling B - Encourage daily fluid intake of 1 L C - Palpate the costovertebral angle D - Monitor urinary output E - Administer antibiotics

A - Provide a referral for nutrition counseling C - Palpate the costovertebral angle D - Monitor urinary output E - Administer antibiotics Rational A - The client requires adequate nutrition to promote healing B - Encourage fluid intake for 2 L daily to maintain dilute urine C - Gently palpate the costovertebral angle for flank tenderness, which can indicate inflammation and infection D -Monitor urinary output to determine that 1 to 3 L or urine is excreted daily E - Administer antibiotics to treat the bacteriuria and decrease progressive damage to the kidney

E - 61-12 A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the home health aide (assistive personnel [AP])? A - Using a bladder scanner to check residual bladder volume after the client voids B - Inserting a straight catheter as necessary if the client is unable to empty the bladder C - Teaching the client how to use the Credé maneuver to empty the bladder more fully D - Assisting the client in developing a schedule for when to take prescribed antibiotics

A - Using a bladder scanner to check residual bladder volume after the client voids Rational The home health RN delegates the task of using a bladder scanner to check residual bladder volume after the client voids, to the UAP. Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (AP) who has been trained and evaluated in this skill.Assisting the client in developing a schedule for when to take prescribed antibiotics, inserting a straight catheter, and teaching the client to use the Credé maneuver all require more education and are in the legal scope of practice of the LPN/LVN or RN.

E - 62-7 The school nurse is counseling a teenage student about how to prevent kidney trauma. Which student statement indicates a need for further teaching? A - "I always wear pads when playing football." B - "I can't play contact sports since my brother had kidney cancer." C - "I will avoid riding motorcycles." D - "I always wear a seat belt in the car."

B - "I can't play contact sports since my brother had kidney cancer." Rational Further teaching about preventing kidney trauma is needed when the teenage student says, "I can't play any type of contact sports because my brother had kidney cancer." Contact sports and high-risk activities must 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 would be taken when riding bicycles and motorcycles. People need to wear appropriate protective clothing when participating in contact sports. Anyone riding in a car must wear a seat belt.

E - 61-4 The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which client statement indicates that teaching was effective? A- "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." B - "I will no longer be able to have red wine with my dinner." C - "I am so relieved that I can continue eating my fried fish meals every week." D - "My wife will be happy to know that I can keep enjoying her liver and onions recipe."

B - "I will no longer be able to have red wine with my dinner." Rational Teaching about low purine diets to a client with urolithiasis consisting of uric acid is effective when the client says, "I will no longer be able to have red wine with my dinner." Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client needs to decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming.Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stones consist of calcium oxalate.

E - 60-11 The nurse is teaching a client how to provide a clean-catch urine specimen. Which client statement indicates that teaching was effective? A - "I will have to drink 2 L of fluid before providing the sample." B - "I'll start to urinate in the toilet, stop, and then urinate into the cup." C - "It is best to provide the sample while I am bathing." D - "I must clean with the wipes and then urinate directly into the cup."

B - "I'll start to urinate in the toilet, stop, and then urinate into the cup." Rational Teaching is demonstrated to be effective when the client says, "I'll start to urinate in the toilet, stop, and then urinate into the cup." A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra.Although cleaning with wipes before providing a clean-catch urine sample is proper procedure, a step is missing. It is not necessary to drink 2 L of fluid before providing a clean-catch urine sample. Providing a clean-catch urine sample does not involve bathing.

E - 62-9 The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which client statement indicates that teaching has been effective? A - "Since renal cell carcinoma usually affects both kidneys, I'll need frequent biopsies." B - "My remaining kidney will provide normal kidney function in a few days or weeks." C - "I need to decrease my fluid intake to prevent stress to my remaining kidney." D - "I'll eventually require some type of renal replacement therapy."

B - "My remaining kidney will provide normal kidney function in a few days or weeks." Rational Effective discharge teaching for a client after a nephrectomy for renal cell carcinoma is indicated when the client says, "my remaining kidney will provide me with normal kidney function in a few days or weeks." After a nephrectomy, the second kidney is expected to 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 would be maintained to flush the remaining kidney.

E - 61-3 The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? A - "For the best effect, perform all of your exercises while you are seated on the toilet." B - "You are exercising correct muscles if you can stop urine flow in midstream." C - "Limit your exercises to 5 minutes twice a day, or you may injure yourself." D - "Results should be visible to you within 72 hours."

B - "You are exercising correct muscles if you can stop urine flow in midstream." Rational The nurse is telling the client about pelvic muscle exercises and says, "You are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used.Pelvic muscle exercises can be performed anywhere and would be performed at least 10 times daily to improve and maintain pelvic muscle strength. Noticeable results in pelvic muscle strength take several weeks

ATI - 61-5 A nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate calculus. To decrease the chance of recurrence, the nurse should instruct the client to avoid which of the following foods? Select all A - Red meat B - Black tea C - Cheese D - Whole grains E - Spinach

B - Black tea E - Spinach Rational A - A client who has renal calculi composed of calcium phosphate, struvite, uric acid, or cysteine should limit intake of animal protein B - A client who has a renal calculi composed of calcium oxalate should avoid intake of black tea becuase it is a source of oxalate C - A client who has a renal calculi composed of calcium phosphate or struvite should limit intake of dairy products D - A client who has renal calculi composed of struvite should limit intake of whole grains E - A client who has renal calculi composed of calcium oxalate should avoid intake of spinach becuase it is a source of oxalate

E - 62-3 When assessing a client with acute glomerulonephritis, which assessment finding causes the nurse to notify the primary health care provider? A - Purulent wound on the leg B - Crackles throughout the lung fields C - Cola-colored urine D - History of diabetes

B - Crackles throughout the lung fields Rational The nurse notifies the primary health care provider if crackles throughout the lung fields are heard in a client with acute glomerulonephritis. Crackles indicate fluid overload resulting from kidney damage. Shortness of breath and dyspnea are typically associated. The primary health care provider must be notified of this finding.Glomerulonephritis may result from infection (e.g., purulent wound); it is not an emergency about which to notify the primary health care provider. The history of diabetes would have been obtained on admission. Dark urine is expected in glomerulonephritis.

ATI - 59-4 A nurse is reveiwing client laboratory data. Which of the following findings is expected for a client who has Stage 4 chronic kidney disease? A - Blood urea nitrogen (BUN) 15 mg/dL B - Glomerular filtration rate (GFR) 20 mL/min C - BLood creatinine 1.1 mg/dL D - Blood potassium 5.0 mEQ/L

B - Glomerular filtration rate (GFR) 20 mL/min Rational A - Expect the BUN to be above the expected reference range, about 10 to 20 times the BUN findings B - The GFR is severely decreased to approximately 20 mL/min, which is indicated of stage 4 chronic kidney disease C - In stage 4 chronic kidney disease, a blood creatinine level can be as high as 15 to 30 mg/dL D - A client in stage 4 chronic kidney disease would have a blood potassium level greater than 5.0 mEq/L

E - 62-2 The nurse is preparing a client for nephrostomy tube insertion. Which factor must be assessed by the nurse before the procedure? A - Blood urea nitrogen (BUN) and creatinine B - Prothrombin time (PT) and international normalized ratio (INR) C - Intake and output (I&O) D - Hemoglobin and hematocrit (H&H)

B - Prothrombin time (PT) and international normalized ratio (INR) Rational Before insertion of a nephrostomy tube into a client, it is essential for the nurse to monitor the client's PT and 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 would be on I&O during the entire hospitalization. I&O is not necessary only before the procedure, but throughout the admission.

E - 61-8 The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows understanding of the teaching? A - "Trying to get to the bathroom to urinate every 6 hours is important for me." B - "Urinating 1000 mL on a daily basis is a good amount for me." C - "I need to be drinking at least 1.5 to 2.5 L of fluids every day." D - "It is a good idea for me to reduce germs by taking a tub bath daily."

C - "I need to be drinking at least 1.5 to 2.5 L of fluids every day." Rational The client who shows a correct understanding of avoiding UTIs says, "I need to be drinking at least 1.5 to 2.5 L of fluids every day." To reduce the number of UTIs, clients need to be drinking a minimum of 1.5 to 2.5 L of fluid (mostly water) each day.Showers, rather than tub baths, are recommended for women who have recurrent UTIs. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. Urinary output needs to be at least 1.5 L daily. Ensuring this amount "out" is a good indicator that the client is drinking an adequate amount of fluid.

E - 61-2 The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client statement indicates that the teaching was effective? A - "I need to douche vaginally once a week." B - "I will not drink fluids after 8 p.m. each evening." C - "I need to drink 2½ L of fluid every day." D - "I must avoid drinking carbonated beverages."

C - "I need to drink 2½ L of fluid every day." Rational Teaching an older female about interventions to decrease the risk for cystitis is effective when the client says, "I need to drink 2½ L of fluid every day." Drinking this much fluid each day flushes out the urinary system and helps reduce the risk for cystitis.Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8:00 p.m. would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late-night fluid intake to 120 mL.

ATI - 58-3 A nurse is teaching a client who is postoperative following a kidney transplant and is taking cyclosporine. Which of the following instructions should the nurse include? A - "Decrease your intake of protein-rich foods" B - "Take this medication with grapefruit juice." C - "Monitor for and report a sore throat to your provider." D - "Expect your skin to turn yellow"

C - "Monitor for and report a sore throat to your provider." Rational A - The client should not decrease protein-rich foods in the diet, which promote healing and rebuilds muscle. There are no restrictions of protein intake for a client taking cyclosporine following a kidney transplant B - The client should NOT drink grapefruit juice, which can reduce cyclosporine metabolism and cause increased cyclosporine levels C - The client should report manifestations of an infection becuase this medication causes immunosuppression D - The client should report manifestations of hepatotoxicity, such as jaundice and abdominal pain

E - 62-8 A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the best nursing response? A - "Why are you hesitant?" B - "You need to tell me so we can determine what is wrong." C - "Take your time. What is bothering you the most?" D - "Don't worry, no one else will know."

C - "Take your time. What is bothering you the most?" Rational The nurse's best response when a client is hesitant to talk about genitourinary dysfunction is "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. It is important for the nurse to encourage the client to tell his/her own story in familiar, comfortable language.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.

E - 62-6 During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? A - "Eat breakfast and go to bed at the same time every day." B - "Drink 2 L of fluid and urinate at the same time every day." C - "Weigh yourself and take your blood pressure." D - "Check your blood sugar and do a urine dipstick test."

C - "Weigh yourself and take your blood pressure." Rational When discharging the client with kidney disease, the nurse needs to tell the client to "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. The Clients with diabetes, not kidney disease, would regularly check their blood sugar and perform a urine dipstick test.

E - 61-11 Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN? A - A 46 year old scheduled for cystectomy who needs help in selecting a stoma site. B - A 48 year old receiving intravesical chemotherapy for bladder cancer. C - A 55 year old with incontinence who has intermittent catheterization prescribed. D - A 42 year old with painless hematuria who needs an admission assessment.

C - A 55 year old with incontinence who has intermittent catheterization prescribed. Rational The nurse manager assigns a 55-year-old client with incontinence who has intermittent catheterization prescribed to the experienced LPN/LVN.Admission assessments and intravesical chemotherapy would be done by an RN. Preoperative preparation for cystectomy and stoma site selection would be done by an RN and either a Certified Wound, Ostomy, and Continence Nurse or an enterostomal therapy nurse.

ATI - 61-4 A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. Which of the following assessments findings is the priority for the nurse to report to the provider? A - Flank pain that radiates to the lower abdomen B - Client reports of nausea C - Absent urine output for 1 hr D - Blood WBC count 15,000/mm3

C - Absent urine output for 1 hr Rational A - Flank pain radiating to the lower abdomen is a finding associated with renal calculi, but there is another finding that is a greater risk to the client B - Client report of nausea is a finding associated with renal calculi, but there is another finding that is a greater risk to the client C - The greatest risk to the client is damage to the kidney resulting from obstruction of urine flow by the renal calculus. Therefore, the priority finding to report to the provider is anuria. D - An elevated serum WBC is a finding associated with renal calculus and can indicate a urinary tract infection, but there is another finding that is a greater risk to the client.

ATI - 57-4 A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? A - Administer an opioid medication B - Monitor for hyperetension C - Assess level of consciousness D - Increase the dialysis exchange rate

C - Assess level of consciousness Rational A - Do not administer an opioid medication becuase it could worse the client's condition. THe provider can prescribe medication to decrease seizure activity B - Monitor for hypotension due to rapid change in fluid and electrolytes causing disequilibrium syndrome C - Assess the client's level of consciousness. A change in urea level can cause increased intracranial pressure. Subsequently, the client's level of consciousness decreases. D - Decrease the dialysis exchange rate to slow the rapid changes in fluid and electrolyte status when a client develops disequilibrium syndrome

E - 60-13 The nurse is preparing to obtain a sterile urine specimen from a client with a Foley catheter. What technique will the nurse use? A - Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. B - Use a sterile syringe to withdraw urine from the urine collection bag. C - Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine. D - Remove the existing catheter and obtain a sample during the process of inserting a new Foley.

C - Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine. Rational The nurse will employ the technique of clamping the tubing, attaching a syringe to the specimen, and withdrawing at least 5 mL of urine when obtaining a sterile urine specimen from a client with a Foley catheter.Disconnecting the Foley catheter from the drainage tube and collecting urine directly from the Foley increases the risk for microbe exposure. A Foley catheter would not be removed to get a urine sample. Microbes may be in the urine collection bag from standing urine, so using a sterile syringe to withdraw urine from the urine collection bag is not the proper technique to obtain a sterile urine specimen.

ATI - 56-4 A nurse administer captopril to a client during a renal scan. Which of the following actions should the nurse take? A - Assess for hypertension B - Limit the client's fluid intake C - Monitor for orthostatic hypotension D - Encourage early ambulation

C - Monitor for orthostatic hypotension Rational A - Captopril is an antihypertensive medication. Assess the client for hypotensive effects B - Increase the client's fluid intake can help resolve hypotensive effects following the administration of captopril C - Monitor for orthostatic hypotension because this is an adverse effect of captopril. THis result in a change in blood flow to the kidneys after the initial dose. D - The client is at risk for falls when ambulating due to the hypotensive effects of captopril. Encourage the client to remain in bed

ATI - 56-5 A nurse is reviewing the results of a client's urinalysis. The findings indicate the urine is positive for leukocyte esterase and nitrites. Which of the following actions should the nurse take? A - Repeat the test early the next morning B - Start a 24 hr urine collection for creatinine clearance C - Obtaining a clean-catch urine specimen for culture and sensitivity D - Insert an indwelling catheter urinary catheter to collect a urine specimen

C - Obtaining a clean-catch urine specimen for culture and sensitivity Rational A - Repeating the test early the next morning will not change the urinalysis results B - A 24-hr urine collection for creatinine helps to determine kidney function C - Obtain a clean-catch urine specimen for culture and sensitivity. This test will identify which antibiotics will be effective for treating the client's urinary tract infection D -Insert a urinary catheter to collect urine when a client cannot empty their bladder

E- 61-1 The nurse is performing catheter care. Which nursing action demonstrates proper aseptic technique? A - Sending a urine specimen to the laboratory for testing B - Irrigating the catheter daily C - Positioning the collection bag below the height of the bladder D - Applying Betadine ointment to the perineal area after catheterization

C - Positioning the collection bag below the height of the bladder Rational Proper aseptic technique during catheter care involves positioning the collection bag below the height of the bladder. Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract.Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized clients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation would be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.

ATI - 59-5 A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? Select all A - Reduced BUN B - Elevated cardiac enzymes C - Reduced urine output D - Elevated blood creatinine E - Elevated blood calcium

C - Reduced urine output D - Elevated blood creatinine Rational A - A manifestation of prerenal AKI is an elevated BUN caused by the retention of nitrogenous wastes in the blood B - Elevated cardiac enzymes is a manifestation of cardiac tissue injury, not AKI C - A manifestation of prerenal AKI is reduced urine output D - A manifestation of prerenal AKI isi elevated blood creatinine E - A manifestation of prerenal AKI is reduced calcium level

E - 61-6 The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a correct understanding of these procedures? A - "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." B - "If I restrict my oral intake of fluids, the adjustment will be easier." C -"I must go to the restroom more often because my urine will be excreted through my anus." D - "I will have to drain my pouch with a catheter."

D - "I will have to drain my pouch with a catheter." Rational The client who is scheduled for a neobladder and Kock pouch correctly understands the procedure when the client says, "I will have to drain my pouch with a catheter." A neobladder is a type of continent reservoir created from an intestinal graft to store urine and replace the surgically removed bladder. A Kock pouch is also a continent reservoir with a Penrose drain and a plastic Medena catheter in the stoma. The drain removes lymphatic fluid or other secretions. The catheter ensures urine drainage so that incisions can heal. For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.Urine is not excreted through the anus. Fluids would not be restricted. A neobladder does not require the use of an ostomy bag.

E - 61-9 The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? A - "Proper handwashing before I start the procedure is very important." B - "My family members can be taught to help me if I need it." C - "A small-lumen catheter will help prevent injury to my urethra." D - "I will use a new, sterile catheter each time I do the procedure."

D - "I will use a new, sterile catheter each time I do the procedure." Rational The client with a neurogenic bladder who needs to self-catheterize for bladder emptying requires further clarification when the client says, "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating.The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization and is a principle that must be stressed.

ATI - 61-3 A nurse is teaching a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which of the following statement by the client indicates understanding of the teaching? A- "I will be fully awake during the procedure." B - "Lithotripsy will reduce my chances of having stones in the future." C - "I will report any bruising that occurs to my doctor." D - "Straining my urine following the procedure is important."

D - "Straining my urine following the procedure is important." Rational A - The client receives moderate (conscious) sedation for this procedure. The client in not fully awake B - Lithotripsy does not decrease the recurrence rate of renal calculi. The procedure breaks the calculi into fragments so they will pass into urine C - Bruising is an expected finding following lithotripsy and does not need to be reported to the provider D - A client is instructed to strain urine following lithotripsy to verify that the calculi has passed

ATI - 56 - 1 A nurse is teaching a client who will have an x-ray of the kidneys, ureters, and bladder. Which of the following statements should the nurse include in the teaching? A - "You will receive contrast dye during the procedure." B - "An enema is necessary before the procedure." C - "You will need to lie a prone position during the procedure." D - "The procedure determines whether you have a kidney stone."

D - "The procedure determines whether you have a kidney stone." Rational A - Clients do not receive any contrast media for this procedure, as they would have excretory urography B - Clients do not receive an enema before this procedure, because it does not affect the gastrointestinal system C - The client will lie supine, not prone D - Explain to the client that a KUB cna identify renal calculi, strictures, calcium deposits, and obstructions of the urinary system.

E - 61-14 The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A - A 26 year old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C). B - A 32 year old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy. C - A 40 year old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed. D - A 28 year old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours.

D - A 28 year old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours. Rational After change-of-shift report, the nurse decides to first assess a 28 year old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours. Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention.The 26 year old admitted with urosepsis and slight fever, the 32 year old scheduled for cystoscopy, and the 40 year old with noninfectious urethritis are not at immediate risk for complications or deterioration.

ATI - 60-2 A nurse is caring for a client who has a urinary tract infection (UTI). Which of the following priority interventions by the nurse? A - Offer a warm sitz bath B - Recommend drinking cranberry juice C - Encourage increased fluids D - Administer an antibiotic

D - Administer an antibiotic Rational A - Offer a warm sitz bath to provide temporary relief of the manifestation of the UTI. However, another action is priority B - Recommend that the client drink cranberry juice to prevent a UTI in the future. However, another action is priority C - Encourage the client to increase fluid intake to dilute the urine, and flush the kidneys to relive the manifestations of the UTI. However, another action is the priority D - The greatest risk to the client isi injury to the renal system and sepsis from the UTI. The priority interventions is to administer antibiotics.

E - 60-8 The nurse assesses blood clots in a client's urinary catheter after a cystoscopy. What initial nursing intervention is appropriate? A - Administer heparin intravenously. B - Remove the urinary catheter. C - Irrigate the catheter with sterile saline. D - Notify the health care provider (HCP).

D - Notify the health care provider (HCP). Rational The nurse first notifies the HCP after visualizing a blood clot in a postoperative cystoscopy client's urinary catheter. Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. In addition, the nurse must monitor urine output and notify the HCP of obvious blood clots or a decreased or absent urine output.Heparin would not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and would not be removed at this time. The Foley catheter may be irrigated with sterile saline if prescribed by the HCP.

E - 61-7 Which nursing intervention or practice is effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? A - Recommending that catheters be placed in all clients B - Encouraging fluid intake C - Irrigating all catheters daily with sterile saline D - Reevaluating the need for indwelling catheters

D - Reevaluating the need for indwelling catheters Rational The nursing intervention that is effective in helping to prevent UTIs in hospitalized clients is reevaluating the need for indwelling catheters. Studies have shown that this intervention is the best way to prevent UTIs in the hospital setting.Encouraging fluids, although it is a valuable practice for clients with catheters, will not prevent the occurrence of UTIs in the hospital setting. In some clients, their conditions do not permit an increase in fluids, such as those with heart failure and kidney failure. Irrigating catheters daily is contraindicated, because any time a closed system is opened, bacteria may be introduced. Placing catheters in all clients is unnecessary and unrealistic. This practice would place more clients at risk for the development of UTI.

E - 61-17 A client who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action will the nurse take with this client? A -Discharges the client to her home for strict bedrest for the duration of the pregnancy. B - Instructs the client to drink a minimum of 3 L of fluids daily to "flush out" bacteria. C - Recommends that the client refrain from having sexual intercourse until after delivery. D - Refers the client to the clinic nurse practitioner for immediate follow-up.

D - Refers the client to the clinic nurse practitioner for immediate follow-up. Rational When a client who is 6 months pregnant comes to the prenatal clinic with a suspected UTI, the nurse needs to refer the client to the clinic nurse practitioner for immediate follow-up. Pregnant women with UTIs require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor with adverse effects for the fetus.It is unsafe for the client to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Having sexual intercourse (or not having it) is not related to the client's problem. The client's symptoms need follow-up with a primary health care provider.

Challenge 63-5 A client who performs home continuous ambulatory peritoneal dialysis reports that the drainage (effluent) has become cloudy in the past 24 hours. What is the priority nursing action? A. Remove the peritoneal catheter. B. Notify the nephrology health care provider. C. Obtain a sample of effluent for culture and sensitivity. D. Teach the client that effluent should be clear or slightly yellow.

C. Obtain a sample of effluent for culture and sensitivity. Rationale: The client most likely has beginning peritonitis. This problem needs to be confirmed and interventions started quickly. A culture is needed to identify that an infection is indeed present. Although the health care provider does need to be notified, obtaining a sample as soon as the effluent is observed is important. The peritoneal catheter should not be removed at this time because it may be needed to instill intraperitoneal antibiotics. Also, removal of this catheter in not within the scope of practice for registered nurses in most states. While teaching the client is important, the priority at this time is to address the potential infection by securing a sample for culture.

E - 63-7 When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends which food selection? A - Eggs B - Ham C - Eggplant D - Macaroni

A - Eggs Rational The nurse recommends eggs as a dietary protein need for a client on peritoneal dialysis. Other suggested protein-containing foods for this client are milk and meat.Although a protein, ham is high in sodium and needs to be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

Challenge 62-1 Which assessment data would the nurse anticipate in a client with acute pyelonephritis? Select all that apply. A. Urinary frequency B. Dysuria C. Oliguria D. Heart rate 120 E. Uremia F. Costovertebral angle tenderness

A. Urinary frequency B. Dysuria D. Heart rate 120 F. Costovertebral angle tenderness Rational Acute pyelonephritis is an active bacterial infection. The client will likely experience urinary frequency (increased in urination) and dysuria (Painful urination). The client will likely have a fever, chills and exhibit tachycardia and/or tachypnea. A heart rate of 120 indicates tachycardia. Costovertebral angle tenderness is anticipated. Uremia (build up or urea in the blood) is not anticipated with acute pyelonephritis.

Challenge 63-1 A 62-year-old client was admitted 2 days ago with traumatic injuries and hypovolemic shock. Which lab result is most important for the nurse to report to the health care provider immediately? A. Serum sodium 132 mEq/L (mmol/L) B. Serum potassium 6.9 mEq/L (mmol/L) C. Blood urea nitrogen 24 mg/dL (mmol/L) D. Hematocrit 32% (0.32 volume fraction); hemoglobin 9.2 g/dL (92 g/L)

B. Serum potassium 6.9 mEq/L (mmol/L) Rationale: All listed laboratory values are out of the normal range. However, the only value that has reached or is approaching a critical level is the serum potassium, which shows hyperkalemia. The recent trauma combined with shock is likely affecting perfusion to the kidneys. This problem (both in terms of kidney perfusion and critical potassium levels) must be addressed immediately.

Challenge 60-4 Which assessment finding would require the nurse to take immediate action in a client who is one hour post kidney biopsy? Select all that apply. A. Pink-tinged urine B. Nausea and vomiting C. Increased bowel sounds D. Reports of flank pain E. The patient is ambulating to the bathroom

A. Pink-tinged urine ???? Rational Hemorrhage is a major complication of renal biopsy. The biopsy site and urine need to be closely monitored in addition to the hemoglobin. A fall in hemoglobin may indicate internal bleeding. Pain lasting more than 12 hours may indicate a ureteral obstruction.

E - 63-2 The nurse is caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter. Which assessment finding requires nursing action? A - Mild discomfort at the insertion site B - Temperature 100.8° F (38.2° °C) C - Anorexia D - 1+ ankle edema

B - Temperature 100.8° F (38.2° °C) Rational In this client situation, the nurse reports an assessment finding of a temperature of 100.8° F (38.2° C) to the HCP. Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed.Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention and 1+ ankle edema is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.

Challenge 60-2 A client is on a 24-hour urine collection. At midpoint during the collection, the client tells the nurse that some of the urine was discarded. What action will the nurse take? Select all that apply. A. No action is required. B. Reinforce client education C. Notify the laboratory staff D. Restart the urine collection E. Document the discarded urine F. Notify the healthcare provider

B. Reinforce client education C. Notify the laboratory staff E. Document the discarded urine F. Notify the healthcare provider Rational Reinforcing patient education is important to ensure all urine is collected for the 24-hour urine test. Notifying the laboratory staff is essential in determining next steps and whether the urine collection must be restarted. Document the discarded urine as part of the 24-hour urine collection and notify the healthcare provider of the discarded urine for further instructions.

E - 62-16 What is the appropriate range of urine output for the client who has just undergone a nephrectomy? A - 30 to 50 mL/hr B - 50 to 70 mL/hr C - 23 to 30 mL/hr D - 41 to 60 mL/hr

A - 30 to 50 mL/hr Rational A 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 remaining kidney and the onset or worsening of acute kidney injury. A large urine output, followed by hypotension and oliguria, is a sign of adrenal insufficiency.

E - 61-20 The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). What teaching will the nurse include? Select all that apply. A - Dysuria B - Enuresis C - Frequency D - Polyuria E- Urgency F - Nocturia

A - Dysuria C - Frequency E- Urgency F - Nocturia Rational The signs and symptoms of UTI include: dysuria (pain or burning with urination), frequency, nocturia (frequent urinating at night), and urgency (having the urge to urinate quickly).Enuresis (bed-wetting) and polyuria (increased amounts of urine production) are not signs of a UTI.

E - 60-12 Which client assessment data indicates to the nurse that the client has a potential need for fluids? A - Increased blood urea nitrogen B - Increased creatinine C - Decreased sodium D - Pale-colored urine

A - Increased blood urea nitrogen Rational Potential for increased fluids are needed for a client with increased blood urea nitrogen. Increased blood urea nitrogen can indicate dehydration.Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.

E 62-1 The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? A - Lipid levels B - Blood urea nitrogen (BUN) and creatinine C - White blood cell (WBC) count D- Hemoglobin and hematocrit (H&H)

B - Blood urea nitrogen (BUN) and creatinine Rational In the client with hydronephrosis, the nurse monitors the client's 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.

E - 62-4 The nurse is caring a client who had a nephrostomy tube inserted 4 hours ago. Which assessment requires nursing action? A - Small amount of urine leaking around the catheter B - Creatinine of 1.8 mg/dL (160 mcmol/L) C - Dark pink-colored urine D - Tube that has stopped draining

D - Tube that has stopped draining Rational The nurse will need to inform the primary health care provider when a nephrostomy tube that was inserted 4 hours ago does not drain. It could be obstructed or dislodged.Pink or red drainage is expected for 12 to 24 hours after insertion and would gradually clear. The nurse may reinforce the dressing around the catheter to address leaking urine. However, the primary health care provider must be notified if there is a large quantity of leaking drainage, which may indicate tube obstruction. A creatinine level of 1.8 mg/dL (160 mcmol/L) is expected in a client early after nephrostomy tube placement (due to the minor kidney damage that required the nephrostomy tube).

Mastery Questions - 61-1 1. Which adverse drug effects will the nurse assess for in a hospitalized client who is prescribed an anticholinergic drug to manage incontinence? Select all that apply a. Insomnia b. Blurred vision c. Constipation d. Dry mouth e. Loss of sphincter control f. Increased sweating g. Worsening mental function

b. Blurred vision c. Constipation d. Dry mouth g. Worsening mental function Rationale: Anticholinergic drugs tend to block the parasympathetic nervous system and mimic the sympathetic nervous system responses. In addition to reducing urinary output, side effects commonly include dry mouth, reduced gastric motility, constipation, blurred vision, hypertension, increasing confusion, dizziness, and sleepiness.

Mastery Questions - 60 - 1 Which client being managed for dehydration does the nurse consider at greatest risk for possible reduced kidney function? A. An 80-year-old man who has benign prostatic hyperplasia B. A 62-year-old woman with a known allergy to contrast media C. A 48-year-old woman with established urinary incontinence D. A 45-year-old man receiving oral and intravenous fluid therapy

A. An 80-year-old man who has benign prostatic hyperplasia Rational Older adults have fewer nephrons and about half of the glomerular filtration rate of younger adults. This change increases their risk for kidney dysfunction more profoundly and persistently after dehydration of other conditions that can impair the renal system. Although an allergy to contrast media can cause problems, the adult must be exposed to it first. Tests requiring contrast media are not used to diagnose or manage dehydration. Urinary incontinence can lead to poor quality of life and skin problems but does not reduce kidney function. The client receiving hydration therapy with both oral and intravenous fluids is at risk for overhydration (fluid overload), not dehydration-induced kidney damage.

ATI - 56-2 A nurse is monitoring a client who ahs a kidney biopsy for postoperative complications. Which of the following complications should the nurse identify as causing the greatest risk to the client? A - Infection B - Hemorrhage C- Hematuria D - Pain

B - Hemorrhage Rational A - The client is at risk for infection of the kidney because a biopsy is an invasive procedure. However, another complication is the priority B - The greatest risk to the client following a kidney biopsy is hemorrhage due to a lack of clotting at the puncture site. Report this findings to the provider immediately C - The client is at risk for hematuria, which is a common complication the first 48 to 72 hr after the biopsy D - The client is at risk for pain after a kidney biopsy because blood in and around the kidney causes pressure on the nerves in the area. However, another complication is the priority

Challenge 60-3 The nurse is admitting a client undergoing a CT scan with contrast. Which finding does the nurse report as a possible immediate hypersensitivity reaction? Select all that apply. A. Nausea B. Pruritis C. Urticaria D. Laryngeal stridor E. Flushing of the skin

B. Pruritis C. Urticaria D. Laryngeal stridor E. Flushing of the skin Rational Signs and symptoms of a hypersensitivity (allergic) reaction include: itching (pruritis), urticaria (hives or wheals), erythema (redness), stridor, hoarseness, bronchospasm and anaphylactic shock (hypotension, tachycardia).

Mastery Questions - 60 - 2 Which client assessment data is essential for the nurse to report to the healthcare provider before a renal scan is performed? A. Pink-tinged urine B. Reports pregnancy C. Reports claustrophobia D. History of an aneurysm clip

B. Reports pregnancy Rational A renal scan uses radioisotopes which may be unsafe to the fetus. A renal scan may be done to evaluate pink-tinged urine and is not conducted in an enclosed or magnetic environment.

ATI - 59-1 A nurse is planning care for a client who has prerenal acute kidney injury (AKI) following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mm Hg. The nurse should expect which of the following interventions? A - Prepare the client for a CT scan with contrast dye B - Plan to administer nitroprusside C - Prepare to administer a fluid challenge D - Plan to position the client in Trendelenburn

C - Prepare to administer a fluid challenge Rational A - Do not plan for a CT scan. Contrast dye is contraindicated for a client who ahs a possible acute kidney injury B - ... C - Plan to administer a fluid challenge for hypovolemia, which is indicated by the client' low urinary output and blood pressure D - Maintain the client in supine or modified Trendelenburg position with the head elevated 10 degrees and the lower extremities elevated 20 degrees in order to promote venous return to the heart

Mastery Questions - 60 - 4 Which symptom(s) in a client during the first 12 hours after a kidney biopsy indicates to the nurse a possible complication from the procedure? A. The client experiences nausea and vomiting after drinking juice. B. The biopsy site is tender to light palpation. C. The abdomen is distended and the client reports abdominal discomfort. D. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.

D. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready. Rational The most serious complication after a kidney biopsy is excessive bleeding. Nausea and vomiting are not signs of bleeding. Some discomfort at the biopsy site is expected and not considered a complication unless there is swelling and a large amount of bruising/discoloration in the flank area. The kidneys are not in the abdomen. Bleeding from the kidney would cause flank pain and swelling, not abdominal pain and swelling. The elevated pulse rate, thready peripheral pulses, and low diastolic blood pressure are consistent with excessive bleeding.

Challenge 61-1 For which client would the nurse expect to teach intermittent catheterization? A. 35-year-old woman who has multiple sclerosis and incontinence B. 48-year-old man who is admitted for pneumonia and is on complete bedrest C. 61-year-old woman who is admitted following a fall at home and has new-onset dysrhythmia D. 74-year-old man who has lung cancer with brain metastasis and has advanced dementia.

A. 35-year-old woman who has multiple sclerosis and incontinence Rational Intermittent self-catheterization remains the preferred method of bladder emptying in patients who have incontinence as a result of a neurogenic bladder (Beauchemin et al., 2018). Multiple sclerosis can cause neurogenic bladder.

Mastery Questions - 61-4 1. For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter? a. A 35-year-old woman who was admitted with a splenic laceration and femur fracture (closed repair completed) following a car crash b. A 48-year-old man who has established paraplegia and is admitted for pneumonia c. A 61-year-old woman who is admitted following a fall at home and has new-onset dysrhythmia d. A 74-year-old man who has lung cancer with brain metastasis and is bring transitioned to hospice

d. A 74-year-old man who has lung cancer with brain metastasis and is bring transitioned to hospice Rationale: The man with advanced lung cancer and brain metastasis is dying and likely to be incontinent, in a lot of pain, and confused. An indwelling catheter can help provide comfort at this time by reducing the amount of manipulation needed to keep him and his bed dry. The other clients have no conditions for which use of a bedpan or intermittent catheterization would be contraindicated.

ATI - 58-5 A nurse is teaching a client who is scheduled for a kidney transplant about organ rejection. Which of the following statements should the nurse include? Select all A - "Expect an immediate removal of the donor kidney for a hyperacute rejection" B - "You might need to begin dialysis to monitor your kidney function for a hyperacute rejection" C - "A fever is a manifestation of an acute rejection" D - "Fluid retention is a manifestation of an acute rejection." E - "Your provider will increase your immunosuppressive medications for a chronic rejection."

A - "Expect an immediate removal of the donor kidney for a hyperacute rejection" C - "A fever is a manifestation of an acute rejection" D - "Fluid retention is a manifestation of an acute rejection." Rational A - Immediate removal of the donor kidney is treatment for hyperacute rejection B - Dialysis can be required as a conservative treatment to monitor the client's kidney function for the progression of chronic kidney failure following kidney transplant C - Fever is a manifestation of an acute rejection D - Fluid retention is a manifestation of an acute rejection E - Immunosuppressant are increased to treat an acute rejection

E - 63-10 A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? A - "It is essential for you to wash your hands and avoid people who are ill." B - "The new kidney will be placed directly below one of your old kidneys." C - "You will receive dialysis the day before surgery and for about a week after." D - "Your diseased kidney will be removed when the transplant is performed."

A - "It is essential for you to wash your hands and avoid people who are ill." Rational Teaching the client to wash hands and stay away from sick people are important points for the nurse to include in teaching for a client scheduled for a kidney transplant. Antirejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential.Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery. After the surgery, the new kidney should begin to make urine.

E - 63-19 Which client will the nurse assess as at risk for acute kidney injury (AKI)? Select all that apply. A - Client in the intensive care unit on high doses of antibiotics B - Football player in preseason practice C - Accident victim recovering from a severe hemorrhage D - Accountant with poorly controlled diabetes mellitus E - Client who underwent contrast dye radiology F - Client recovering from gastrointestinal influenza

A - Client in the intensive care unit on high doses of antibiotics B - Football player in preseason practice C - Accident victim recovering from a severe hemorrhage E - Client who underwent contrast dye radiology F - Client recovering from gastrointestinal influenza Rational To prevent AKI, all people must be urged to avoid dehydration by drinking at least 2 to 3 L of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity.Poorly controlled diabetes mellitus is a risk factor for chronic kidney disease.

E - 62-13 After receiving change-of-shift report on the urology unit, which client will the nurse assess first? A - Client who was involved in a motor vehicle collision and has hematuria. B - Client with nephrotic syndrome who has gained 2 kg since yesterday. C - Client with glomerulonephritis who has cola-colored urine. D - Client postradical nephrectomy whose temperature is 99.8° F (37.6° C).

A - Client who was involved in a motor vehicle collision and has hematuria. Rational After the change-of-shift report, the nurse first needs to assess the client who was involved in a motor vehicle collision. The nurse would 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 postradical 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.

E - 63-21 When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which nursing actions are required? Select all that apply. A - Ensure that no blood pressures are taken in that arm. B - Teach the client to palpate for a thrill over the site. C - Elevate the arm above heart level. D - Auscultate for a bruit every 8 hours. E - Check brachial pulses daily.

A - Ensure that no blood pressures are taken in that arm. B - Teach the client to palpate for a thrill over the site. D - Auscultate for a bruit every 8 hours. Rational A bruit or swishing sound and a thrill or buzzing sensation upon palpation would be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, would occur.Distal pulses and capillary refill would be checked daily. For a forearm fistula, the radial pulse is checked instead of the brachial pulse which is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

ATI - 4 A nurse is reviewing the medical history of a client who has end-stage kidney disease. The nurse should identify that which of the following factors in the client's history is a contraindication for receiving hemodialysis? A - History of hemophilia B - Difficulty with ambulation C - Decreased WBC count D - Iodine allergy

A - History of hemophilia Rational A - The nurse should identify that a history of a major bleeding disorder is a contraindication for hemodialysis. A client who has hemophilia bleeds excessively following minor breaks in the skin and is at high risk for extreme blood loss during hemodialysis treatment. B - The nurse should identify that having difficulty with ambulation is not a contraindication to the client receiving hemodialysis. C - The nurse should identify that a decreased WBC count is not a contraindication to the client receiving hemodialysis. D - The nurse should identify that an iodine allergy is not a contraindication to the client receiving hemodialysis.

ATI - 1 A nurse is caring for a client who has nephrotic syndrome and has been taking prednisone for 3 days. Which of the following findings should the nurse report to the provider as an adverse effect of prednisone? A - Sore throat B- Frequent stools C - Hearing loss D - Tremors

A - Sore throat Rational A- Glucocorticoids depress the immune system and increase the client's risk for infection. The nurse should recognize a sore throat as an indication of infection and report this finding to the provider. B - Frequent stools are not an adverse effect of prednisone therapy. The nurse should monitor the client for black, tarry stools as an adverse effect of prednisone. C - Hearing loss is not an adverse effect of prednisone therapy. The nurse should monitor the client for blurry vision and manifestations of increased intraocular pressure as adverse effects of prednisone. D - Tremors are not an adverse effect of prednisone therapy. The nurse should monitor the client for psychological alterations as adverse effects of prednisone.

Challenge 63-4 The nurse is caring for a 38 year old male with hypertension and Stage 1 CKD. The client reports lifestyle changes and feeling "better" and has stopped taking a prescribed diuretic. What is the appropriate nursing response? A. "The diuretic will reduce your blood pressure which may slow or prevent progression of your chronic kidney disease." B. "Your primary health care provider prescribed the diuretic because it will reverse the damage caused by kidney disease." C. "Taking medications is a personal decision, and you have the right to decline this prescription." D. "Since you have implemented lifestyle changes the diuretic is likely not needed."

A. "The diuretic will reduce your blood pressure which may slow or prevent progression of your chronic kidney disease." Rationale: Blood pressure control is critical in the treatment of patients with CKD - lowering the blood pressure reduces the risk of stroke, MI, and progression of CKD. Stage 1 CKD already indicates some irreversible damage. Management of blood pressure at this stage of CKD can greatly slow its progression. A diuretic does not improve kidney function or reverse CKD damage. It does not alter the course of CKD progression. It does improve elimination of fluid, and fluid overload can contribute to hypertension. While personal values and preferences are essential decision points in determining a plan of care for each adult, it is also important that the client be well informed. While this client has had lifestyle changes, they may not be enough to control hypertension. The control of hypertension can slow progression of CKD. Drug therapy reduces vessel damage.

E - 62-15 The RN is working with assistive personnel (AP) in caring for a group of clients. Which action is best for the RN to delegate to AP? 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 - Palpating for bladder distention on a client recently admitted with a ureteral stricture D - Helping the primary health care provider with a kidney biopsy for a client admitted with acute glomerulonephritis

B - Assisting a client who had a radical nephrectomy 2 days ago to turn in bed Rational The best action for the RN is to have the AP assist a client who had a radical nephrectomy 2 days ago to turn in bed. The AP 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 AP, the trauma victim would 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 would not be delegated to staff members with a limited scope of education.

E - 63-16 A client with a recently created vascular access for hemodialysis is being discharged. Which teaching will the nurse include in the discharge instructions? A - How to practice proper nutrition? B - Avoiding venipuncture and blood pressure measurements in the affected arm C - How to assess for a bruit in the affected arm? D - Modifications to allow for complete rest of the affected arm

B - Avoiding venipuncture and blood pressure measurements in the affected arm Rational The nurse must teach the client to avoid venipunctures and blood pressure measures in the arm that contains the newly created vascular access device. Compression of vascular access causes decreased blood flow and may cause occlusion. If this occurs, lifesaving dialysis will not be possible.The arm with the access device must be exercised to encourage venous dilation, not rested. The client can palpate for a thrill, but a stethoscope is needed to auscultate the bruit at home. The nurse needs to take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the venous access device must take priority.

ATI - 61-1 A nurse is completing the admission assessment of a client who has renal calculi. Which of the following findings should the nurse expect? A - Bradycardia B - Diaphoresis C - Nocturia D - Bradypnea

B - Diaphoresis Rational A - Tachycardia is a manifestation associated with a client who has renal calculi B - Diaphoresis is a manifestation associated with a client who ahs renal calculi C - Oliguria is a manifestation associated with a client who ahs renal calculi D - Tachypnea is a manifestation associated with a client who has renal calculi

Mastery Questions - 62-2 When assessing a client with acute glomerulonephritis, which question will the nurse ask to determine whether the client is following best practices to slow progression of kidney damage? A. "Do you avoid contact sports while you are taking cyclosporine?" B. "How are you evaluating the amount of daily fluid you drink?" C. "Have you contacted anyone from our dialysis support services?" D. "Have you increased your protein intake to promote healing of the damaged nephrons?"

B. "How are you evaluating the amount of daily fluid you drink?" Rational Protein intake may be increased early in Chronic Kidney Disease (CKD) and reduced late in CKD. Since you do not have information about the extent of CKF (stage), this question may be incorrect. Cyclosporine is a cytotoxic agent that reduces immune responses, which would require the client to avoid sick contacts. Because the client needs to find a balance between too much and too little fluid intake (both are harmful), this is a good question to see how the individual ensures adequate kidney blood flow (perhaps with systemic blood pressure assessment) while providing sufficient intake to eliminate waste (perhaps through urine volume or color or via staying within a target of fluid intake. A target fluid intake is generally 1.5 to 2 L daily if not receiving dialysis). The client may not progress to needing dialysis; this intervention is usually reserved until the last stage of CKD before dialysis occurs; there is no indication that CKD has been staged at this point.

ATI 27 A nurse is providing teaching to a client who has chronic kidney disease (CKD). Which of the following statements by the client indicates an understanding of the teaching? A - "I will check my blood pressure once per week." B - "I will take a magnesium antacid if I get constipated." C - "I will weigh myself every morning." D - "I will use a salt substitute in my diet."

C - "I will weigh myself every morning." Rational A - A client who has CKD should measure their blood pressure daily to monitor for hypertension. B - A client who has CKD should avoid taking magnesium hydroxide for constipation because this medication can cause magnesium toxicity. C - Clients who have CKD should weigh themselves every morning at the same time to monitor fluid balance. The client should void prior to weighing if able, wear similar clothing when obtaining weight, and use the same set of scales each time. D - A client who has CKD should avoid using salt substitutes because they contain potassium chloride and can cause hyperkalemia.

E - 63-4 A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? A - Monitor for decreased peripheral pulses. B - Determine if the client is able to ambulate. C - Auscultate for pericardial friction rub. D - Assess for crackles.

C - Auscultate for pericardial friction rub Rational The additional assessment needed for the client with uremia is to auscultate the pericardium for friction rub. Clients with CKD are prone to pericarditis. Signs/symptoms of pericarditis include inspiratory chest pain, tachycardia, narrow pulse pressure, low-grade fever, and pericardial friction rub.Crackles and tachycardia are symptomatic of fluid overload. Fever is not present with fluid overload. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of signs/symptoms of pericarditis that the client presents with.

ATI - 12 A nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate. Upon detecting an output obstruction, which of the following actions should the nurse take first? A - Irrigate the catheter with 0.9% sodium chloride irrigation. B - Notify the provider. C - Check the irrigation tubing for kinks. D - Provide PRN pain medication.

C - Check the irrigation tubing for kinks. Rational A - The nurse should irrigate the catheter with 0.9% sodium chloride irrigation to attempt to clear the obstruction. However, this is not the first action the nurse should take. B - The nurse should notify the provider of the obstruction if interventions do not resolve it. However, this is not the first action the nurse should take. C - The first action the nurse should take when using the nursing process is to assess the irrigation tubing for kinking or clots because these can prevent the outflow of fluids. D - The nurse should provide PRN pain medication to promote the client's comfort. However, this is not the first action the nurse should take.

E - 62-14 The nurse is caring for a client with hemorrhage secondary to kidney trauma. Which element does the nurse anticipate will be used for volume expansion? A - Platelet infusions B - 5% dextrose in water C - Normal saline solution D - Fresh-frozen plasma

C - Normal saline solution Rational To provide volume expansion to a client with hemorrhage secondary to kidney trauma, the nurse expects that normal saline solution will be used. Isotonic solutions and crystalloid solutions are administered for volume expansion. 0.9% sodium chloride (NS) and 5% dextrose in 0.45% sodium chloride may also be given. Lactated Ringer's solution may be used if the client has no liver damage.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.

Mastery Question 63-2 The nurse is providing discharge teaching to a client recovering from kidney transplantation. Which client statement indicates understanding? A. "I can stop my medications when my kidney function returns to normal." B. "If my urine output decreases I will increase my fluids." C. "The antirejection medications will be taken for life." D. "I will drink 8 ounces (236 ml) of water with my medications."

C. "The antirejection medications will be taken for life." Rationale: When the client states that antirejection medications must be taken for life, it indicates that the kidney transplant client understands the discharge teaching. Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria (decreased urine output) is a symptom of transplant rejection. If this occurs, the transplant team must be contacted immediately. It is not necessary to take antirejection medication with 8 ounces (236 mL) of water.

E - 63-14 A client is being treated for kidney failure. Which nursing statement encourages the client to express his or her feelings? A - "All of this is new. What can't you do?" B - "How are you doing this morning?" C - "Are you afraid of dying?" D - "What concerns do you have about your kidney disease?"

D - "What concerns do you have about your kidney disease?" Rational Asking the client about any concerns regarding your disease is an open-ended statement and specific to the client's concerns.Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.

E - 63-3 Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? A - Increasing dairy products enriched with vitamin D B - Drinking cola beverages only once daily C - Consuming a low-calcium diet D - Avoiding peas, nuts, and legumes

D - Avoiding peas, nuts, and legumes Rational To prevent renal osteodystrophy in a chronic kidney disease client, the nurse needs to instruct the client to avoid peas, nuts, and legumes. Kidney failure causes hyperphosphatemia, so phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes must be restricted.Calcium would not be restricted. Hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

ATI - 16 A nurse is planning care for a client who is postoperative following a nephrectomy. Which of the following assessments is the nurse's priority? A - Bowel sounds B - WBC count C - Pain level D - Blood pressure

D - Blood pressure Rational A - The nurse should auscultate the client's bowel sounds to determine a return to baseline functioning following anesthesia. However, another assessment is the priority. The nurse should expect minimal intestinal peristalsis for at least 24 hr following abdominal surgery. B - The nurse should check the client's WBC count postoperatively to detect infection. However, another assessment is the priority. C - The nurse should monitor and treat the client's pain to promote comfort postoperatively. However, another assessment is the priority. D - The greatest risk to the client is injury from acute adrenal insufficiency caused by accidental removal or damage to the adrenal gland intraoperatively. The nurse should evaluate the client for hypotension and for a decrease in urine output.

ATI 14 A nurse is caring for a client who is scheduled for an intravenous urography. Which of the following interventions is the nurse's priority? A - Tell the client to increase fluid intake following the procedure. B - Place the informed consent document in the client's medical record. C - Inform the client that a warm sensation can occur when the contrast dye is injected. D - Determine if the client has an allergy to iodine or shellfish.

D - Determine if the client has an allergy to iodine or shellfish. Rational A - The nurse should tell the client to increase fluid intake following the procedure to reduce the risk for contrast-induced nephropathy. However, another action is the priority. B - The nurse should place the informed consent document in the client's medical record to ensure that it is available for the procedure. However, another action is the priority. C - The nurse should inform the client to expect a warm sensation when the contrast dye is injected to help reduce anxiety before and during the procedure. However, another action is the priority. D - The greatest risk to the client is injury or death from a severe allergic reaction to radiopaque contrast media. The nurse should determine if the client has an allergy to iodine or shellfish, which can indicate that the client is at high risk for an allergic reaction to the contrast media.

ATI 28 A nurse is caring for a client following extracorporeal shock wave lithotripsy (ESWL) for the treatment of calcium phosphate kidney stones. Which of the following actions should the nurse take? A - Monitor the client's urine for ketones. B -Provide the client with an increased animal protein diet. C -Limit the client's fluid intake to 1.5 L per day. D - Strain all of the client's urine.

D - Strain all of the client's urine. Rational A - The nurse should monitor for urine ketones for a client who has diabetic ketoacidosis. B - The nurse should decrease the client's intake of animal proteins to prevent further calcium phosphate stone formation. C - The nurse should encourage the client to drink at least 3 L per day to promote urine flow, decrease the risk for stone precipitation, and prevent dehydration. D - The nurse should strain all of the client's urine following ESWL to monitor for stone fragments that have left the client's body.

E - 63-1 While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action will the nurse implement? A - Document the effluent as output. B - Instruct the client to cough. C - Reposition the catheter. D - Turn the client to the opposite side.

D - Turn the client to the opposite side. Rational The nurse's first action in this situation is to turn the client to the opposite side. With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The peritoneal effluent or outflow generally is a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, reposition the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help.Instructing the client to cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse needs to reposition the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the health care provider repositions a displaced catheter.

E - 61-5 An older adult woman confides to the nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? A - "That is tough. What do you think might help?" B - "Tell everyone that they are for your husband." C - "Shop at night, when stores are less crowded." D - "Don't worry about it. You need them."

A - "That is tough. What do you think might help?" Rational When an older women says to the nurse, "I am so embarrassed about buying adult diapers for myself," the nurse says "That is tough. What do you think might help?" Stating that the situation is tough acknowledges the client's concerns, and asking the client to think about what might help assists the client to think of methods to solve her problem.Telling the client not to worry is dismissive of the client's concerns. Telling the client to shop at night does not empower the client, and it reaffirms the client's embarrassment. Suggesting to the client that she tell everyone they are for her husband also does not empower the client. Rather, it suggests to the client that telling untruths is acceptable.

Challenge 60-1 When obtaining a health history and physical assessment from a 68 year-old male client who has a history of an enlarged prostate, which finding does the nurse consider significant? Select all that apply? A. Distended bladder B. Absence of a bruit C. Frequency of urination D. Dribbling urine after voiding E. Chemical exposure in the workplace

A. Distended bladder C. Frequency of urination D. Dribbling urine after voiding Rational A distended bladder, urinary frequency, and dribbling urine after voiding are significant findings for a client with an enlarged prostate. The nurse would expect the absence of bruit- as a bruit is considered an abnormal finding. Although chemical exposure in the workplace may cause kidney damage, it is not associated with an enlarged prostate.

E - 61-22 A client diagnosed with urge incontinence is started on tolterodine. What interventions will the nurse suggest to alleviate the side effects of this drug? Select all that apply. A - Limit the intake of dairy products. B - Use hard candy for dry mouth. C - Encourage increased fluids. D - Increase fiber intake. E - Take the drug at bedtime.

B - Use hard candy for dry mouth. C - Encourage increased fluids. D - Increase fiber intake. Rational Interventions the nurse suggests to alleviate the side effects of tolterodineinclude: encouraging increased fluids, increasing fiber intake, and using hard candy for dry mouth. Anticholinergics cause constipation. Increasing fluids and fiber intake will help with this problem. Anticholinergics also cause extreme dry mouth, which can be alleviated with using hard candy to moisten the mouth.Taking the drug at night and limiting dairy products will not have an effect on the complications encountered with propantheline.

Challenge 61-4 A 68-year-old male client is seeing the primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? A. A five-pack year history of smoking 45 years ago B. Difficulty starting and stopping the urine stream C. A 30-year occupation as a long-distance truck driver D. A recent colon cancer diagnosis in his 72-year-old brother

C. A 30-year occupation as a long-distance truck driver Rationale: Although cigarette smoking is a risk factor for bladder cancer, a 5-pack year history more than 45 years ago is not significant as a potential cause of cancer. Bladder cancer does not appear to have a familial or genetic predisposition. Difficulty starting or stopping urination is a symptom, usually of prostate issues, not a harbinger of bladder cancer. The latest research indicates exposure to gasoline and diesel fuel is a major risk factor for bladder cancer.

E - 61-10 A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for post procedure home care? A - "Underwear worn during the procedure and for 12 hours afterward should be discarded." B - "Please be sure to stand when you are urinating." C - "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." D - "Do not share your toilet with family members for the next 24 hours."

D - "Do not share your toilet with family members for the next 24 hours." Rational The nurse tells the client who is being treated for bladder cancer and had a live virus compound instilled into his bladder not to share his toilet with family members for the next 24 hours. The toilet must not be shared for 24 hours following this procedure because others using the toilet could be infected with the live virus that was instilled into the client. If only one toilet is available in the household, teach the client to flush the toilet after use and to follow this by adding 1 cup (236 mL) of undiluted bleach to the bowl water. The bowl is then flushed after 15 minutes, and the seat and flat surfaces of the toilet are wiped with a cloth containing a solution of 10% liquid bleach.The client must sit while urinating for at least 24 hours postprocedure to prevent splashing of the contaminated urine out of the commode, where it could be toxic for anyone who comes in contact with it. Underwear or other clothing that has come into contact with urine during the 24 hours after instillation must be washed separately from other clothing in a solution of 10% liquid bleach. It does not need to be discarded.

E - 62-19 The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment data requires further nursing action? Select all that apply. A - Blood pressure is 98/56 mm Hg. B - Urine output over the past hour was 80 mL. C - Heart rate is 118 beats/min. D - Dressing has a 1-cm area of bleeding. E - Abdominal distention. F - Pain is at a level 4 (on a 0--10 scale).

A - Blood pressure is 98/56 mm Hg. C - Heart rate is 118 beats/min. E - Abdominal distention. F - Pain is at a level 4 (on a 0--10 scale). Rational A blood pressure of 98/56 mm Hg, and a heart rate of 118 beats/min in a client who just returned to the unit after a radical nephrectomy, alarms the nurse and requires immediate nursing action in the form of additional assessment. Bleeding is a complication of radical nephrectomy. Tachycardia and hypotension may indicate impending hypovolemic or hemorrhagic shock. The surgeon must be notified immediately and fluids must be administered, complete blood count needs to be checked, and blood administered, if necessary. The nurse will also address the client's pain level after addressing the potential for hemorrhage. Abdominal distention requires additional assessment as this can also be a sign of hemorrhage.A urine output of 80 mL can be considered normal. 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.

E - 63-23 The nurse is caring for a client following a kidney transplant. Which assessment data indicate to the nurse possible rejection of the kidney? Select all that apply. A - Crackles in the lung fields B - Temperature of 98.8° F (37.1° C) C - Blood pressure of 164/98 mm Hg D - Blood urea nitrogen (BUN) 21 mg/dL (7.5 mmol/L), creatinine 0.9 mg/dL (80 mcmol/L) E - 3+ edema of the lower extremities

A - Crackles in the lung fields C - Blood pressure of 164/98 mm Hg E - 3+ edema of the lower extremities Rational Signs and symptoms indicating rejection of a transplanted kidney include: crackles in the lung fields, blood pressure of 164/78 mm Hg, and 3+ edema of lower extremities. These are assessment findings related to fluid retention and transplant rejection.Increasing BUN and creatinine are symptoms of rejection; however, a BUN of 21 mg/dL (7.5 mmol/L) and a creatinine of 0.9 mg/dL (80 mcmol/L) reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

Mastery Question 63-3 A client with a recently created vascular access for hemodialysis is being discharged. Which discharge teaching will the nurse include? A. Do not allow blood pressure measurements in the affected arm. B. Elevate the affected arm allowing for total rest of the extremity. C. Assess for a bruit in the affected arm on a daily basis. D. Sleep on the affected side to protect the access device.

A. Do not allow blood pressure measurements in the affected arm. Rationale: The nurse must teach the client to avoid blood pressure measures in the arm that contains the newly created vascular access device. Compression of vascular access causes decreased blood flow and may cause occlusion. If this occurs, dialysis will not be possible. The arm with the access device must be exercised to encourage venous dilation, not rested. The client can palpate for a thrill, but a stethoscope is needed to auscultate the bruit at home. The nurse will teach the patient to sleep on the opposite side- to avoid compressing the affected extremity.

Mastery Questions - 62-3 When providing care to a client who has undergone a nephrostomy for hydronephrosis, which observation alerts the nurse to a possible complication? Select all that apply A. Urine output of 15 mL for the first hour and then diminishes B. Tenderness at the surgical site C. Pink-tinged urine draining from the nephrostomy D. A hematocrit value 3% lower than the preoperative value E. Sudden onset of abdominal pain that worsens after abdominal palpation F. Blood pressure of 180/90 that persists despite administration of pain medication

A. Urine output of 15 mL for the first hour and then diminishes D. A hematocrit value 3% lower than the preoperative value E. Sudden onset of abdominal pain that worsens after abdominal palpation F. Blood pressure of 180/90 that persists despite administration of pain medication Rationale: Low output is concerning immediately after nephrostomy placement; most clients have a diuresis. After nephrostomy placement, most clients have bloody urine (red- or pink-tinged) for several hours. There is pain and tenderness at the surgical site but bleeding at the site is not common. New onset of abdominal pain with rebound tenderness may indicate a perforation, an uncommon but potentially life-threatening complication of manipulating the needles during nephrostomy placement. Similarly, blood loss either through the nephrostomy or surgical site can be related to a clinical important decrease in hematocrit; diuresis means that the change in hematocrit is unlikely to be from hemodilution. Inform the provider whenever this change occurs post-operatively. Hypertension can contribute to bleeding risk and occurrence; generally, as will most post-operative or post-interventional procedures, a reasonable blood pressure goal is 120-140/80-90.

ATI - 8 A nurse is providing discharge teaching to a client who has chronic kidney disease (CKD). Which of the following statements by the client indicates an understanding of the teaching? A - "I will consume foods that are high in protein." B - "I will decrease my intake of foods that are high in phosphorus." C - "I will limit my intake of foods that are high in iron." D - "I will add salt to the foods I consume."

B - "I will decrease my intake of foods that are high in phosphorus." Rational A - A client who has CKD should consume a diet that is low in protein. Protein restriction can help preserve kidney function and prevent uremia, which results from a buildup of the waste products from protein catabolism. B - A client who has CKD should limit their intake of foods that are high in phosphorus to prevent bone damage. C - A client who has CKD will often need to add supplemental iron due to decreased production of erythropoietin and mineral loss during hemodialysis. D - A client who has CKD retains sodium and fluid, which can cause heart failure and hypertension. The client should consume foods that are low in sodium.

Challenge 63-3 The nurse is preparing a client with stage 3 CKD for discharge. Which client statement indicates the need for further teaching? A. "I will be sure to attend my follow up appointment with my nephrologist." B. "I will increase my protein intake so my body can heal." C. "I will weigh myself daily and call the doctor if my weight increases by 2 pounds or more. D. "I will take my blood pressure each day and keep a daily log."

B. "I will increase my protein intake so my body can heal." Rationale: While it is common to think of protein as necessary to heal, the client with CKD will often have protein restrictions. Protein restriction early in the course of the disease prevents some of the problems of CKD and may preserve kidney function. Protein is restricted on the basis of the degree of kidney and waste elimination impairment (reduced glomerular filtration rate [GFR]) and the severity of the symptoms.

Mastery Question 63-1 1. Which client will the nurse identify at risk for acute kidney injury? Select all that apply. A. 68 year old male with diabetes mellitus. B. 16 year old male football player in preseason practice. C. 27 year old female recovering from shock following a car accident. D. 52 year old male with newly diagnosed hypertension. E. 30 year old female in intensive care receiving multiple intravenous antibiotics

B. 16 year old male football player in preseason practice. C. 27 year old female recovering from shock following a car accident. E. 30 year old female in intensive care receiving multiple intravenous antibiotics Rationale: To prevent AKI, all people must be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes and hypertension may cause chronic kidney injury (not acute).

Challenge 63-2 The nurse is caring for a 74 year old client scheduled for a cardiac catheterization with contrast dye. What nursing action is appropriate? Select all that apply. A. Assess creatinine clearance using a 24 hour urine collection test. B. Assess for co-existing conditions of diabetes, heart failure, and kidney disease. C. Collaborate with the provider about whether IV fluids should be infused before the test D. Notify the provider regarding changes in serum creatinine from 0.2 to 0.4 mg/dL in 24 hours. E. Alert the provider to a glomerular filtration rate (GFR) < 60 mL/min/1.73 m2

B. Assess for co-existing conditions of diabetes, heart failure, and kidney disease. C. Collaborate with the provider about whether IV fluids should be infused before the test E. Alert the provider to a glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 Rationale: Assessment of risk factors, such as co-existing conditions that can increase the risk of AKI is an important part of preventing contrast induced nephropathy. Pre-existing conditions that are associated with impaired kidney function include diabetes, heart failure, and advanced age. Clients with a history of kidney disease may not tolerate the contrast dye without subsequent harm. IV fluids are commonly used prior to procedures with contrast dye to ensure adequate intravascular volume and reduce kidney hypoperfusion. This also dilutes the contrast and promotes faster elimination of the contrast. A GRF less than 60mL/min/1.73 m2 requires the nurse to alert the provider as this is indicative of existing kidney disease and significant impairment in kidney function. Creatinine can be assessed using a serum test, a 24-hour collection is not warranted. The serum creatinine is normal and does not require nursing action.

Mastery Questions - 62-1 Which question will the nurse ask the client who has a urinary tract infection to assess the risk for pyelonephritis? A. What drugs do you take for asthma? B. How long have you had diabetes? C. How much fluid do you drink daily? D. Do you take your antihypertensive drugs at night or in the morning?

B. How long have you had diabetes? Rational Pyelonephritis risk is increased in the client with diabetes and a urinary tract infection (UTI). While it is important to know all the drugs that a client takes, neither asthma drugs nor asthma itself increases the risk for pyelonephritis. Although insufficient fluid intake may make a UTI worse, it does not increase the risk for pyelonephritis. Antihypertensives are not a risk factor for pyelonephritis.

Challenge 62-2 The nurse is reviewing the client's laboratory data prior to a nephrostomy tube insertion. Which data requires the nurse to take action? A. White blood cells in the urine B. INR of 2.1 C. Hematocrit 44% D. Creatinine 0.8 mg/dL

B. INR of 2.1 Rationale: The INR is high and could lead to bleeding during insertion of the nephrostomy tube. This laboratory data requires the nurse to take action by notifying the provider. The INR (part of the client's clotting factors) will need to be corrected prior to the procedure. White blood cells would be anticipated as this may be the cause (recurrent infection) for the tube placement. The hematocrit and creatinine values are within normal limits.

ATI - 3 A nurse is assessing a client who has chronic kidney disease and has completed the third peritoneal dialysis (PD) treatment. Which of the following findings should the nurse report to the provider? A - Greater outflow of dialysate than inflow B - Weight loss C - Cloudy dialysate effluent D - Report of pain during inflow

C - Cloudy dialysate effluent Rational A - The nurse should expect a greater outflow of dialysate fluid. Dialysate fluid is hypertonic. Therefore, it draws fluid from the body. B - Dialysate fluid is hypertonic. Therefore, it draws fluid from the body. Each liter of fluid PD removes is equivalent to 1 kg of body weight. C - Cloudy or opaque drainage is an early manifestation of peritonitis. The nurse should notify the provider immediately because infection can be a life-threatening complication. D - Clients who undergo PD usually have pain at the beginning of each treatment, during the inflow of the dialysate. The client should no longer have this pain at the beginning of each exchange within 1 to 2 weeks of beginning PD.

ATI 24 A nurse is caring for a client who has acute kidney injury (AKI). Which of the following serum laboratory findings should the nurse report to the provider? A - Potassium 5 mEq/L B - Calcium 9 mg/dL C - Creatinine 4 mg/dL D - Amylase 84 units/L

C - Creatinine 4 mg/dL Rational A - The nurse should recognize that the client's potassium level is within the expected reference range of 3.5 to 5 mEq/L. However, the nurse should continue to monitor a client who has AKI for potassium imbalance. B - The nurse should recognize that the client's calcium level is within the expected reference range of 9 to 10.5 mg/dL. However, the nurse should continue to monitor a client who has AKI for calcium imbalance. C - A serum creatinine level above the expected reference range of 0.5 to 1.3 mg/dL indicates impaired kidney function. Therefore, the nurse should report this finding to the provider. The nurse should expect the creatinine level to decrease to within the expected reference range with successful treatment of AKI. D - The nurse should recognize that the client's serum amylase level is within the expected reference range of 30 to 220 units/L. Increased levels can indicate pancreatic inflammation. Amylase is not routinely monitored for a client who has AKI.

ATI 18 A nurse is performing an admission assessment of a client who has acute glomerulonephritis. The nurse should expect which of the following findings? A - Low blood pressure B - Polyuria C - Dark-colored urine D - Weight loss

C - Dark-colored urine Rational A - Clients who have acute glomerulonephritis usually retain sodium and fluid, which leads to elevations in blood pressure. B - Clients who have acute glomerulonephritis usually have a decreased urine output. C - Clients who have acute glomerulonephritis usually excrete urine that is a dark, reddish-brown color. D - Clients who have acute glomerulonephritis usually gain weight due to fluid retention.

E - 63-15 The nurse is caring for a client with kidney failure. Which assessment data indicates the need for increased fluids? A - Decreased sodium level B - Pale-colored urine C - Increased blood urea nitrogen (BUN) D - Increased creatinine level

C - Increased blood urea nitrogen (BUN) Rational An increase in BUN can be an indication of dehydration, and a needed increase in fluids.Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted and does not indicate that an increase in fluids is necessary. Sodium is increased, not decreased, with dehydration.

E - 63-20 The nurse is teaching dietary modification to a client with acute kidney injury (AKI). What dietary teaching will the nurse include? Select all that apply. A - Liberal sodium B - Low fat C - Restricted fluids D - Restricted protein E - Low potassium

C - Restricted fluids D - Restricted protein E - Low potassium Rational A client with acute kidney injury needs to modify the diet to include restricted protein, restricted fluids, and low potassium. Breakdown of protein leads to azotemia and increased blood urea nitrogen. For the client who does not require dialysis, 0.6 g/kg of body weight or 40 g/day of protein is usually prescribed. For clients who do require dialysis, the protein level needed will range from 1 to 1.5 g/kg. Fluid is restricted during the oliguric stage. The daily amount of fluid permitted is calculated to be equal to the urine volume plus 500 mL. Potassium intoxication may occur, so dietary potassium is also restricted. Dietary potassium is restricted to 60 to 70 mEq/kg (70 mmol/kg).Sodium is restricted during AKI because oliguria causes fluid retention. Dietary sodium recommendations range from 60 to 90 mEq/kg (60 to 90 mmol/kg). Fats may be used for needed calories when proteins are restricted.

E - 63-13 Discharge teaching has been provided for a client recovering from kidney transplantation. Which client statement indicates understanding of the teaching? A - "I will drink 8 ounces (236 mL) of water with my medications." B - "I can stop my medications when my kidney function returns to normal." C - "If my urine output is decreased, I should increase my fluids." D - "The antirejection medications will be taken for life."

D - "The antirejection medications will be taken for life." Rational When the client states that antirejection medications must be taken for life, it indicates that the kidney transplant client understands the discharge teaching. Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys.Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria (decreased urine output) is a symptom of transplant rejection. If this occurs, the transplant team must be contacted immediately. It is not necessary to take antirejection medication with 8 ounces (236 mL) of water.

ATI 21 A nurse is planning care for a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL) to treat urolithiasis. Which of the following actions should the nurse plan to take? A - Place the client in semi-Fowler's position. B - Prepare to intubate the client. C - Monitor urine flow through a nephrostomy tube. D - Apply electrodes for cardiac monitoring.

D - Apply electrodes for cardiac monitoring. Rational A - The nurse should position the client in supine position on a flat table for ESWL. B - The nurse should plan to assist with moderate (conscious) sedation. Endotracheal intubation is not necessary for ESWL. C - The nurse should not expect a nephrostomy tube to be inserted for an ESWL procedure. The provider might place a ureteral stent to facilitate movement of stone fragments. D - The nurse should apply electrodes for continuous monitoring of the client's cardiac rhythm during ESWL. This monitoring allows the provider to synchronize shock waves with the R wave.

E - 63-18 The RN has just received change-of-shift report. Which client will the nurse assess first? A - Client with azotemia whose blood urea nitrogen and creatinine are increasing. B - Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted. C - Client receiving peritoneal dialysis who needs help changing the dialysate bag. D - Client with chronic kidney failure who was just admitted with shortness of breath.

D - Client with chronic kidney failure who was just admitted with shortness of breath. Rational After the change-of-shift report, the nurse must first assess the newly admitted client with chronic kidney failure and shortness of breath, the dyspnea of the client with chronic kidney failure may indicate pulmonary edema and must be assessed immediately.The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

ATI 22 A nurse is preparing to assess a client who received hemodialysis 1 hr ago. Which of the following assessments should the nurse perform first? A - Potassium level B - Body weight C - Creatinine level D - Vital signs

D - Vital signs Rational A - The nurse should check the client's potassium level following hemodialysis and report it to the provider if it is outside the expected reference range. However, another assessment is the priority. B - The nurse should compare the client's body weight before and after dialysis to determine the amount of fluid lost. However, another assessment is the priority. C - The nurse should provide ongoing monitoring of kidney function to track the progress of the client's kidney disease. However, another assessment is the priority. D - When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority information to assess is the client's vital signs. After hemodialysis, the client is at risk for hemodynamic instability, which includes hypotension, dysrhythmia, and hemorrhage.

ATI 23 A nurse is providing teaching to a male client who has a continent internal ileal reservoir following surgery to treat bladder cancer. Which of the following client statements indicates an understanding of the teaching? A - "This should not affect my ability to function sexually." B - "I should expect to gain some weight during the next few weeks." C - "I will need to avoid foods that produce intestinal gas." D- "I must insert a catheter through my stoma to drain the urine."

D- "I must insert a catheter through my stoma to drain the urine." Rational A - Creation of a continent internal ileal reservoir can affect sexual functioning. The nurse should use therapeutic communication to encourage the client and the client's partner to express their feelings and concerns. B - During the first few weeks after surgical creation of a continent internal ileal reservoir, clients tend to lose a significant amount of weight. The nurse should instruct the client to collaborate with a dietitian to develop a personalized diet plan to meet their nutritional and caloric needs. C - There are no dietary restrictions following the creation of an internal ileal reservoir. Dietary restrictions are required following a ureterosigmoidostomy, which diverts urine output to the bowel. D - The client should perform self-catheterization to drain the urine from the continent internal ileal reservoir. The nurse should encourage the client to perform self-catheterization before traveling or attending social events to promote confidence in social situations.

Mastery Questions - 61-2 A 28-year-old female client states, "I don't know why I get cystitis every year, I don't drink much at work so I can avoid using the public toilet." Which teaching by the nurse is most likely to reduce her risk for cystitis? Select all that apply. a. Reinforce her choice to avoid using a public toilet b. Teach her to shower immediately after having sexual intercourse c. Suggest that she drink at least 2-3 L of fluid throughout the day d. Urge her to change her method of birth control from oral contraceptives to a barrier method e. Instruct her to always wipe her perineum from front to back after each toilet use f. Reinforce that she should complete the entire course of antibiotics as prescribed g. Instruct her to empty her bladder immediately before intercourse

c. Suggest that she drink at least 2-3 L of fluid throughout the day e. Instruct her to always wipe her perineum from front to back after each toilet use f. Reinforce that she should complete the entire course of antibiotics as prescribed g. Instruct her to empty her bladder immediately before intercourse Rationale: A is incorrect because using a public toilet, even sitting on the seat, does not lead to cystitis or a UTI. Showering after intercourse does not affect the development of UTIs. Showering BEFORE intercourse can reduce the number of perineal organisms and reduce the risk for UTI. Oral contraceptives do not increase the risk for UTI; however, some barrier methods (especially a cervical cap or diaphragm) can increase because of the increased manipulation of tissues in the area. Drinking more fluids throughout the day dilute the urine and increase the frequency of urination, and both responses help reduce the number of organisms in the bladder.

E - 60-10 An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the best nursing response? A - "Have you tried using the toilet every couple of hours?" B - "How does that make you feel?" C - "We can fix that." D - "That happens when we get older."

A - "Have you tried using the toilet every couple of hours?" Rational The nurse's best response to a client who states, "I feel like a child who sometimes pees her pants," is to ask the client if she uses the toilet at least every couple of hours. By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control.The client has already stated how she feels. Asking her again does not address her concern, nor does it allow for nursing education. The nurse cannot assert that the problem can be fixed because this may be untrue. Suggesting that the problem occurs as we get older does not address the client's concern and does not provide for any client teaching

ATI - 57-1 A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include ini teh teaching? A - Hemodialysis restores kidney function B - Hemodialysis replaces hormonal function of the renal system C - Hemodialysis allows an unrestricted diet D - Hemodialysis returns a balance to blood electrolytes.

D - Hemodialysis returns a balance to blood electrolytes. Rational A - Hemodialysis does not restore kidney function, but it sustains the life of a client who has kidney disease B - Hemodialysis does not replace hormonal function of the renal system due to tissue damage causing dysfunction of the renin-angiotensin-aldosterone system C - Hemodialysis does not allow an unrestricted diet. It requires a diet high in folate and more protein that predialysis restrictions allowed, and low in sodium, potassium, and phosphorus. D - Explain to the client that hemodialysis restore electrolyte balance by removing excess sodium, potassium, fluids, and waste products, and also restores acid-base balance.

E - 61-23 A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? Select all that apply. A - "You will need to take all of these drugs to get the benefits." B - "Drink at least 3 L of fluids every day." C - "Be certain to wear sunscreen and protective clothing." D - "Take this drug with 8 ounces (236 mL) of water." E - "Try to urinate frequently to keep your bladder empty."

A - "You will need to take all of these drugs to get the benefits." B - "Drink at least 3 L of fluids every day." C - "Be certain to wear sunscreen and protective clothing." D - "Take this drug with 8 ounces (236 mL) of water." Rational The nurse tells the client with a UTI who is taking trimethoprim/sulfamethoxazole to be certain to wear sunscreen protection clothing, drink at least 3 L of fluid every day, take the drug with 8 ounces (236 mL) of water, and take all of these drugs to get the benefits. Wearing sunscreen and protective clothing is important while taking trimethoprim/sulfamethoxazole, because increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules, so fluid intake prevents this complication. Clients must be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon, to prevent bacterial resistance and infection recurrence.Emptying the bladder is important, but not keeping it empty. The client would be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.

ATI - 57-2 A nurse is preparing to initiate hemodialysis for aaa client who has acute kidney injury. Which of the following actions should the nurse take? Select all A - Review the medications the client currently takes B - Assess the AV fistula for a bruit C - Calculate the client's hourly urine output D - Measure the client's weight E - Check blood electrolytes F - Use the access site area for venipuncture

A - Review the medications the client currently takes B - Assess the AV fistula for a bruit D - Measure the client's weight E - Check blood electrolytes Rational A - Reviewing the medication the client is currently takes can help determine which medication to withhold until after dialysis B - Assessing the AV fistula for a bruit determines the patency of the fistula for dialysis C - The client's hourly urine output can vary with the remain kidney function and does not determine the need for dialysis D - Measuring the client's weight before dialysis is essential for comparing it with the client's weight after dialysis E - Checking the blood electrolytes determines the need for dialysis F - Never use the access site area for venipuncture because compression from the tourniquet can cause loss of the vascular access

E -60-5 The nurse is caring for client who has just returned from the operating room for cystoscopy performed under conscious sedation. Which assessment finding requires immediate nursing action? A - Temperature of 100.8° F (38.2° C) B - Lethargy C - Pink-tinged urine D - Urinary frequency

A - Temperature of 100.8° F (38.2° C) Rational The nurse is immediately concerned when a postoperative cystoscopy client who had conscious sedation returns to the unit with a temperature of 100.8° F (38.2° C). Fever, chills, or an elevated white blood cell count after cystoscopy suggest infection after an invasive procedure. The provider must be notified immediately.Pink-tinged urine is expected after a cystoscopy. Frequency may be noted as a result of irritation of the bladder. Gross hematuria would require notification of the surgeon. If sedation or anesthesia was used, lethargy is an expected effect.

Challenge 61-3 A client with diabetes has the following assessment changes after a percutaneous nephrolithotomy procedure. Which change requires immediate nursing intervention? A. Difficulty breathing and an oxygen saturation of 88% on 2 L of oxygen by nasal cannula B. A point-of-care blood glucose of 150 mg/dL and client report of thirst C. A decreased hematocrit by 1% (compared with preoperative values and hematuria) D. An oral temperature of 38° C (101° F) and cloudiness of urine draining from the nephrostomy tube after IV administration of a broad-spectrum antibiotic

A. Difficulty breathing and an oxygen saturation of 88% on 2 L of oxygen by nasal cannula Rationale: All changes are somewhat abnormal but the only one that raises the level of concern to a point at which it should be immediately is the difficulty breathing and drop in oxygen saturation. This is NOT an expected problem associated with the procedure and is potentially life-threatening. The blood glucose elevation, thirst, temperature elevation, cloudiness of the urine, and slight decrease in hematocrit are expected and do not pose an immediate threat.

E - 61-18 The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which client statement requires further teaching? A - "I try to drink 3 L of fluid a day." B - "I take my medication when I have symptoms." C - "I don't use bubble baths." D - "I wipe front to back."

B - "I take my medication when I have symptoms." Rational Further teaching is need for a female client with a UTI taking an antibiotic drug regimen when the client says, "I take my medication only when I have symptoms." clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent.Wiping front to back helps prevent UTIs because it prevents infection-causing microorganisms in the stool from getting near the urethra. Limiting bubble baths and drinking 3 L of fluid a day help prevent UTIs.

E - 62-10 A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which client statement indicates to the nurse that the client needs further education? A - "My children have a 50% chance of inheriting the ADPKD gene that causes the disease." B - "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." C - "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." D - "If my children have the ADPKD gene, they will have cysts by the age of 30."

B - "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." Rational Further teaching about ADPKD when a mother of two says, "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.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.

E - 60-6 The nurse is teaching a client who needs a clean-catch urine specimen. What teaching will the nurse include? A - "Save all urine for 24 hours." B - "Do not touch the inside of the container." C - "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." D - "You will receive an isotope injection, then I will collect your urine."

B - "Do not touch the inside of the container." Rational Before obtaining a clean-catch urine specimen, the nurse instructs the client not to touch the inside of the container. A clean-catch specimen is used to obtain urine for culture and sensitivity of organisms present. Contamination by any part of the client's anatomy will render the specimen invalid and alter results.Saving urine for 24 hours is not necessary for a midstream clean-catch urine specimen. After cleaning, the client needs to initiate voiding into the commode, then stop and resume voiding into the container. Only 1 ounce (30 mL) is needed. The remainder of the urine may be discarded into the commode. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. A clean-catch specimen for culture does not require injection of an isotope before urine is collected.

E - 60-18 The nurse is teaching a class about kidney and urinary changes that occur with age. What teaching will the nurse include? Select all that apply. A - Drug clearance is often increased which produces more drug reactions. B - Glomerular filtration rate decreases which increases the risk for fluid overload. C - Urinary sphincters lose tone and weaken with age. D - Blood flow to the kidneys increases promoting nocturia. E - The ability to concentrate urine decreases which creates urgency.

B - Glomerular filtration rate decreases which increases the risk for fluid overload. C - Urinary sphincters lose tone and weaken with age. E - The ability to concentrate urine decreases which creates urgency. Rational Blood flow to the kidneys decreases (not increases) with age. Nocturnal polyuria is associated with tubular changes that cause a decrease in the concentration of urine. Drug clearance is often decreased which is what leads to more drug reactions.

E - 61-15 A client with cognitive impairment has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? A - Kegel exercises B - Habit training C - Credé method D - Bladder training

B - Habit training Rational Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.Bladder training, the Credé method, and learning Kegel exercises require that the client be alert, cooperative, and able to assist with his or her own training.

ATI - 60-5 A nurse is reviewing urinalysis results for four clients. Which of the following results indicated a urinary tract infection? A - Positive for hyaline casts B - Positive for leukocyte esterase C - Positive for ketones D - Positive for crystals

B - Positive for leukocyte esterase Rational A - Hyaline casts in the urine can indicate proteinuria and can occur following exercise B - A positive leukocyte esterase indicates a urinary tract infection C - Ketones in the urine is a manifestation of poorly controlled diabetes mellitus or starvation D - Crystals in the urine can indicate a potential for kidney stones formation

E - 60-7 Which client will the nurse encourage to consume 2 to 3 L of fluid each day? A - Client with heart failure B - Client with chronic kidney disease C - Client with complete bowel obstruction D - Client with hyperparathyroidism

D - Client with hyperparathyroidism Rational The nurse encourages the client with hyperparathyroidism to drink 2 to 3 L of fluid each day. A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones. This client must remain hydrated.A client with chronic kidney disease would not consume 2 to 3 L of water because the kidneys are not functioning properly. Consuming that much fluid could lead to fluid retention. People with heart failure typically have fluid volume excess. A client with complete bowel obstruction may experience vomiting and would be NPO.

E - 62-12 When caring for a client 24 hours after a nephrectomy, the nurse assesses abdominal distention. Which action will the nurse perform next? A - Insert a nasogastric (NG) tube. B - Notify the surgeon. C - Check vital signs. D - Continue to monitor.

C - Check vital signs. Rational After noting a distended abdomen in a client who had a nephrectomy 24 hours ago, the nurse next needs to check the client's vital signs. The client's abdomen may be distended from bleeding. Hemorrhage or adrenal insufficiency causes hypotension, so vital signs must be taken to see if a change in blood pressure has occurred.The surgeon would be notified after vital signs are assessed. Just continuing to monitor is not appropriate. An NG tube is not indicated for this client.

E - 61-19 The nurse is teaching a class about cancer prevention. Which interventions will the nurse include that can prevent bladder cancer? Select all that apply. A - Using pelvic floor muscle exercises B - Drinking 2½ L of fluid a day C - Stopping the use of tobacco D - Wearing a lead apron when working with chemicals E - Wearing gloves and a mask when working around chemicals and fumes F - Showering after working with or around chemicals

C - Stopping the use of tobacco E - Wearing gloves and a mask when working around chemicals and fumes F - Showering after working with or around chemicals Rational The interventions that are helpful in preventing bladder cancer are: showering after working with or around chemicals, stopping the use of tobacco, and wearing gloves and a mask when working around chemical and fumes. Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. Bathing after exposure to them is advisable. Tobacco use is one of the highest, if not the highest, risk factor in the development of bladder cancer.Increasing fluid intake is helpful for some urinary problems such as urinary tract infection, but no correlation has been noted between fluid intake and bladder cancer risk. Using pelvic floor muscle strengthening (Kegel) exercises is helpful with certain types of incontinence, but no data show that these exercises prevent bladder cancer. Precautions must be taken when working with chemicals. However, lead aprons are used to protect from radiation.

Challenge 61-2 The nurse is caring for an 80-year-old female client with recurrent cystitis. Which teaching will the nurse include in the plan of care? Select all that apply. A. Drink citrus juices daily. B. Douche regularly; a minimum of two times weekly. C. Encourage fluid intake of 2-3 L of fluid throughout the day. D. Instruct her to always wipe the perineum from front to back after each toilet use. E. Reinforce that she should complete the entire course of antibiotics as prescribed. F. Instruct her to empty her bladder immediately before and after having intercourse.

C. Encourage fluid intake of 2-3 L of fluid throughout the day. D. Instruct her to always wipe the perineum from front to back after each toilet use. E. Reinforce that she should complete the entire course of antibiotics as prescribed. Rationale When teaching a female patient about preventing cystitis, the nurse will include increasing fluids every day to help flush out the bladder, wiping from front to back after toileting to prevent fecal matter and microorganisms from entering the urethral meatus, taking the full course of antibiotics to prevent risk of organism resistance, and to empty her bladder before and after intercourse due to possible irritation of the urethral meatus and exposure to another individual's microorganisms.

E - 62-11 A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the most appropriate nursing response? A - "The damaged kidneys no longer release a hormone that prevents high blood pressure." B - "The waste products in the blood interfere with mechanisms that control blood pressure." C - "There is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products." D - "Because the kidneys cannot get rid of fluid, blood pressure goes up."

D - "Because the kidneys cannot get rid of fluid, blood pressure goes up." Rational The nurse's best response to a client with chronic kidney disease and high blood pressure is, "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.

E - 61-16 A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the primary health care provider before the ESWL procedure begins? A - "I have been taking cephalexin for an infection." B - "I previously had several ESWL procedures performed." C - "Blood in my urine has decreased, so maybe I don't need this procedure." D - "I take over-the-counter naproxen twice a day for joint pain."

D - "I take over-the-counter naproxen twice a day for joint pain." Rational For a client admitted for ESWL, it is most critical for the nurse to report to the primary health care provider that the client takes over-the-counter naproxen twice a day for joint pain. Because a high risk for bleeding during ESWL has been noted, clients would not take nonsteroidal anti-inflammatory drugs before this procedure. The ESWL will have to be rescheduled for this client.Blood in the client's urine would be reported to the primary health care provider but will not require rescheduling of the procedure because blood is frequently present in the client's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. The client's taking cephalexin (Keflex) and the fact that the client has had several previous ESWL procedures would be reported, but will not require rescheduling of the procedure.

E - 60-16 When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention will the nurse implement first? A - Administer captopril. B - Request a breakfast tray for the client. C - Administer lispro (Humalog) insulin, 10 units subcutaneously. D - Infuse 0.45% normal saline at 125 mL/hr.

D - Infuse 0.45% normal saline at 125 mL/hr. Rational After a diabetic client returns to the unit after a CT scan, the first intervention implemented by the nurse is to infuse 0.45% normal saline at 125 mL/hr. Fluids are needed because the iodinated dye used in a CT scan with contrast has an osmotic effect, causing dehydration and potential kidney failure.Lispro is not administered until the breakfast tray arrives. A breakfast tray will be requested, but preventing complications of the procedure is done first. Because the client may be hypovolemic, the nurse needs to monitor blood pressure and administer IV fluids before deciding whether administration of captopril is appropriate.

E - 62-5 Which assessment data in a client with chronic glomerulonephritis (GN) warrants the nurse to contact the primary health care provider? A - Itchy skin B - Serum potassium of 5.0 mEq/L (5.0 mmol/L) C - Mild proteinuria D - Third heart sound (S3)

D - Third heart sound (S3) Rational When a third heart sound (S3) is heard in a client with chronic glomerulonephritis, the nurse needs to contact the primary health care provider. S3 indicates fluid overload secondary to failing kidneys. The primary health care provider would be notified and instructions obtained.Mild proteinuria is an expected finding in GN. A serum potassium of 5.0 mEq/L (5.0 mmol/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.