UWorld Urinary/Renal
The nurse caring for multiple clients who underwent renal system diagnostic testing should report which post-procedure finding to the health care provider? Values >10,000 organisms/mL indicate urinary tract infection (UTI). Burning sensation is common after cystoscopy.
1. 150 mL residual urine on bladder scan Portable ultrasonic bladder scanners are used at the bedside to determine the amount of residual urine in the bladder. Amounts >100 mL should be reported as the client may be experiencing urinary retention (Option 1) Renal arteriogram is performed with a contrast agent; excretion of the dye with oral and intravenous hydration is recommended to prevent kidney injury --> increased urinary output.
The nurse assesses a client diagnosed with chronic kidney disease who had an internal arteriovenous fistula performed on the left arm yesterday. Which assessment finding would require immediate follow-up?
1. A bruit cannot be auscultated over the fistula site Following fistula placement, it is important to monitor for patency. A palpable thrill (vibration) over the fistula or an auscultated bruit (blowing or swooshing sound caused by turbulent blood flow) indicates a patent fistula. Absence of the thrill or bruit can indicate potential clot formation in the fistula. Client reports of numbness or tingling as well as decreased capillary refill can also signal potential clotting (Option 1). Maturing of the fistula is aided by having the client perform hand exercises, such as squeezing a rubber ball, that increase blood flow through the vein.
A client with advanced kidney disease has serum potassium of 7.1 mEq/L (7.1 mmol/L) and creatinine of 4.5 mg/dL (398 µmol/L). What is the priority prescribed intervention? Severe hyperkalemia (potassium >7.0 mEq/L [7.0 mmol/L]) requires urgent treatment because cardiac muscle cannot tolerate very high potassium levels. Severe hyperkalemia increases the risk for life-threatening ventricular dysrhythmias (eg, ventricular tachycardia and fibrillation, asystole).
1. Administer IV 50% dextrose and regular insulin IV administration of 50 mL 50% dextrose with 10 units of regular insulin is the priority intervention as it is most effective in reducing the potassium level quickly. The insulin temporarily shifts the potassium from the extracellular fluid back into the intracellular fluid. The dextrose prevents hypoglycemia associated with the increase of insulin in the body and can be eliminated if the client has hyperglycemia (Option 1). If the client has ECG changes (eg, tall peaked T waves), calcium gluconate should be given before insulin/dextrose. This will stabilize the cardiac muscle until the potassium level can be reduced with insulin/dextrose. Sodium polystyrene sulfonate (Kayexalate) is administered by mouth or enema to remove potassium from the body by exchanging sodium for potassium ions in the intestines; these are then excreted in feces. This is not the priority due to the delayed onset of potassium removal
The nurse is caring for a client with multiple renal calculi. Which nursing interventions should be included in the plan of care? Select all that apply. Massage therapy to the flank should not be performed to prevent further instigation of renal colic. Other interventions, such as monitored heat therapy, would be acceptable. Ambulation and frequent mobilization are encouraged as tolerated to help facilitate the passage of calculi. NO BED REST
1. Administer analgesics at regularly scheduled intervals 2.Encourage fluid intake of up to 3 L/day 5. Strain all urine for the presence of stones When caring for a client with renal calculi, the nurse should provide adequate analgesia for pain, encourage increased fluid intake, and assist with ambulation as tolerated to promote clearance of calculi. All urine should be strained to retrieve any stones for analysis to determine preventive measures.
Place the nursing actions for performing a renal system physical assessment in the correct order. All options must be used.
1. Advise client to empty the bladder completely 4. Observe skin and contour of abdomen and lower back 2. Auscultate the renal arteries in right and left upper quadrants 5. Percuss and palpate both the right and left kidneys 3. Document the assessment of renal system function Physical assessment of the renal system includes the techniques of inspection, auscultation, percussion, and palpation, in that order. Allow the client to empty the bladder before beginning the assessment and auscultate immediately after inspection as percussion or palpation may increase bowel motility and interfere with sound transmission during auscultation. Always document the findings.
Drag the actions that are appropriate for the nurse to perform to the box on the right
1. Assess the client's diet 2. Collect the stone for evaluation When a stone is passed spontaneously, the nurse should collect the stone for evaluation to identify the stone (eg, calcium oxalate, calcium phosphate) and the cause of its formation. Clients with a history of kidney stones are at greater risk for recurrence; identifying the cause will help prevent future stone formation. The nurse should assess the client's diet because dietary and supplement recommendations are specific to the type of stone. Administering an opioid medication (eg, hydromorphone) is not indicated because the client no longer reports pain after passing the stone in the urine. Opioid medications should be reserved for clients experiencing severe pain, including clients waiting for a stone to pass. ) Lithotripsy involves delivery of external shock waves to break large stones into fragments small enough to pass in the urine. This is not indicated because the client has already passed the stone spontaneously. No indwelling catheter because client is urinating independently
The nurse is caring for a 68-year-old male client following a laparoscopic cholecystectomy 6 hours ago. The client has not urinated since surgery. Which of the following interventions are appropriate? Select all that apply. rinary retention is common after surgical intervention and is often caused by anesthesia, opioid medications, edema from lower abdominal/pelvic surgeries, and outlet obstruction due to benign prostatic hyperplasia (BPH). To prevent complications (ie, bladder overdistension), clients should void 6-8 hours postoperatively. Bladder overdistension requires prompt intervention because it can cause bladder muscle injury, urinary tract infection (UTI), and kidney injury.
1. Assist the client to ambulate to the bathroom 2.Encourage oral fluid intake 3.Obtain a prescription for intermittent urinary catheterization 4.Perform a bladder scan 5.Run the water in the bathroom sink Urinary retention is common after surgical intervention, often caused by anesthesia, opioid medications, edema from lower abdominal/pelvic surgeries, and outlet obstruction. Appropriate interventions include performing a bladder scan, ambulating to the bathroom, encouraging oral fluid intake, running the sink water, and performing intermittent urinary catherization as prescribed.
The nurse is preparing to administer morning medications to a client with type 2 diabetes mellitus and end-stage renal disease who is scheduled for hemodialysis today. Which of the following medications should the nurse hold for clarification prior to administration? Click the exhibit button for additional information. 1. Atenolol 2. Calcium acetate 3. Insulin lispro 4. Vitamin E (fat-soluble vitiamin - administered to prevent leg cramps during dialysis)
1. Atenolol Medications that will be dialyzed out of the client's system (eg, water-soluble vitamins, antibiotics, digoxin) should be held and administered after hemodialysis for maximum therapeutic effect. The fluid removal that occurs during hemodialysis can cause hypotension, so antihypertensives (eg, atenolol) are typically held before hemodialysis to prevent severe hypotension unless otherwise indicated by the health care provider (Option 1).
The nurse is assessing a client who had a transurethral resection of the prostate 10 hours ago and is receiving continuous bladder irrigation. Which of the following findings would require follow-up? Transurethral resection of the prostate (TURP) is the surgical removal of prostate tissue, often used to treat obstructive benign prostatic hyperplasia. Continuous bladder irrigation (CBI) is commonly prescribed after TURP to prevent urinary obstruction due to procedure-induced blood clots. During CBI, a triple-lumen catheter is used to instill an irrigant solution to flush the bladder while simultaneously draining urine and blood into a drainage bag.
1. Bladder irrigation input and urinary output are equal for the past 2 hours Total urinary output should EXCEED CBI input because output includes both the CBI solution (not processed through the kidneys) and the normal urine output. Urinary output that is ≤ CBI input may indicate an obstruction (Option 1). The nurse should stop the CBI and assess the tubing for kinks. If none are present, the nurse should manually irrigate the bladder to dislodge any clots. If unable to flush the catheter, the nurse should notify the health care provider immediately. (Option 4) Small clots are expected for up to 36 hours after surgery. Light pink urine is also expected during the postoperative phase
The evening shift nurse reviews the preoperative checklist and latest serum laboratory values for an elderly client with a ruptured diverticulum who is scheduled for surgery in the early morning. Which laboratory value is most important for the nurse to report to the health care provider? Elevated White blood cell count (normal 4,000-11,000/mm3 [4.0-11.0 ×109/L]) is an EXPECTED finding related to ruptured diverticulum and peritonitis.
1. Creatinine level 2.5 mg/dL (221 µmol/L) Creatinine level of 2.5 mg/dL (221 µmol/L) is the most important abnormal value (normal 0.6-1.3 mg/dL [53-115 µmol/L]) OR 0.6-1.2 for the nurse to report to the health care provider. An elevated creatinine level increases the risk for intra- and postoperative complications. Nothing-by-mouth (NPO) status preoperatively, dehydration (ie, fluid shift from peritonitis), intraoperative fluid losses, antibiotic therapy, and advanced age affect renal function and increase the risk for postoperative exacerbation of kidney injury in this client.
The nurse recognizes the client will most likely require __ to _____ Dialysis (ie, renal replacement therapy) is usually initiated in the later stages of chronic kidney disease (CKD) to improve symptoms and/or survival when uremia is no longer controlled by medications.
1. Dialysis 2., Remove excess urea Dialysis mimics the function of the kidneys by using a semipermeable membrane to filter blood and remove excess fluid, electrolytes, and waste products (eg, urea). Dialysis can be performed using the client's peritoneal membrane (ie, peritoneal dialysis) or a closed system outside the client's body (ie, hemodialysis). Lactulose promotes fecal excretion of ammonia in clients with severe liver disease (eg, cirrhosis) because the damaged liver is unable to effectively convert serum ammonia into urea. In clients with normal liver function and CKD, ammonia is converted into urea, but urea cannot be eliminated by the kidneys. Although blood transfusions increase the oxygen-carrying capacity of blood, they are associated with significant complications (eg, volume overload, transfusion reactions) and should be used only for severe anemia (ie, hemoglobin <7 g/dL [70 g/L]) that cannot be corrected by other means (eg, iron supplementation, erythropoietin injections
The nurse reviews a prescription to insert an indwelling urinary catheter in a hospitalized client. Which rationale for indwelling urinary catheter insertion is most appropriate?
1. The client has acute urinary retention The use of indwelling urinary catheters should be minimized during hospitalization. Appropriate use includes urinary obstruction or retention, some perioperative circumstances, required prolonged immobilization, end-of-life comfort, and facilitating healing of an open perineal or sacral wound. Indwelling urinary catheters should not be used for convenience or as a substitute for nursing care when the client is elderly, confused, incontinent or voids frequently, For obtaining a urine culture when the client can follow instructions and void voluntarily Postoperatively for prolonged periods when other appropriate indications are not present
Click to highlight below the finding that requires follow up. DASS is a complication of AVF formation that occurs when the anastomosed (ie, conjoined) vein "steals" too much arterial blood, resulting in ischemia to the hand. Manifestations include pain, numbness, tingling, cyanosis, decreased pulses, and impaired motor function in the affected hand. The nurse should immediately notify the health care provider because prompt intervention is necessary to prevent complications of ischemia (eg, amputation)
1. tingling sensation in the left fingers Clients with an arteriovenous fistula (AVF) are at risk for infection, stenosis, and extremity ischemia. A tingling sensation in the left fingers indicates impaired circulation distal to the AVF due to dialysis access steal syndrome (DASS).
The nurse is teaching the client about lifestyle management for chronic kidney disease. Which of the following statements by the client indicates correct understanding of the teaching? Select all that apply.
1."I am hopeful that my sibling may be a candidate to donate a kidney to me." - which includes comorbidities and adherence to treatment; an adequate tissue match is more likely with genetically related siblings (Option 1) 2."I can chew gum and suck on sugar-free hard candy to quench my thirst." -which stimulate saliva and help manage thirst because clients with CKD are often prescribed a fluid restriction due to risk of volume overload 5. "I will need routine injections to raise my number of red blood cells." - Receiving routine injections of erythropoietin-stimulating agents (eg, epoetin alfa) to treat anemia by increasing RBC production in the bone marrow 6."I will reduce my intake of foods like canned soups and frozen meals." -to decrease fluid retention and prevent excess thirst The client should LIMIT/AVOID foods high in phosphorus (eg, nuts, beans) and potassium (eg, potatoes, beans, avocados) because these substances are not adequately excreted in clients with CKD. Oral phosphate binders should be taken with food to decrease absorption of dietary phosphorus in the gastrointestinal tract.
The nurse is caring for a 72-year-old client with a history of renal calculi (straining is not a priority given history) and diabetes mellitus who was admitted for acute pyelonephritis. The nurse assesses shaking chills, temperature of 101.2 F (38.4 C), and flank pain. Which of the following is the priority nursing intervention? Acute pyelonephritis is an infection of the kidney usually caused by an extension of infection from the lower urinary tract (bladder). Chills and fever, vomiting, flank pain, and costovertebral tenderness are characteristic.
4. Obtain blood and urine cultures Blood and urine cultures should be obtained prior to initiation of antibiotic therapy whenever possible to identify the causative microorganisms and determine the most effective antibiotics (Option 4). Given this client's age and underlying diabetes, sepsis can occur quickly. Therefore, antibiotics should be given immediately after cultures are obtained (Option 1).
The nurse is caring for a client with an ileal conduit. While assisting the client in removing the external pouch, the nurse observes that the stoma appears bluish grey. What is the nurse's best action? Infection = fever, elevated white blood cell count, odor, and delayed healing. A bluish grey color = impaired perfusion, not infection. Applying an appropriate-size pouching system (approximately 0.1 in [0.25 cm] larger than the stoma) prevents decreased perfusion and skin irritation. Using a larger drainage bag, especially at night, prevents urine backflow through the stoma and reduces the risk for infection. These are important concepts of stoma care but are not the priority at this time.
4. Report the findings to the health care provider (HCP) immediately A healthy stoma should be pink to brick-red and moist, indicating vascularity and viability. If the stoma is dusky or any shade of blue, the nurse should suspect impaired perfusion and contact the HCP immediately. This finding is considered a medical emergency (Option 4).
The nurse is reviewing laboratory test results for a client with a non-healing wound. Which of the following test results would require immediate follow-up? Click the exhibit tab for additional information. serum albumin (MALNUTRITION) - 3.5 to 5.0 SAME AS POTASSIUM Nutritional deficiencies (eg, zinc, protein, vitamin C) and dehydration (HYPERNATREMIA, ELEVATED BUN) can impair wound healing. Dehydration (loss of free water) can increase serum sodium levels.
4. Serum sodium 153 mEq/L (153 mmol/L) The normal value for serum sodium is 136-145 mEq/L (136-145 mmol/L). The value listed, 153 mEq/L (153 mmol/L), is high. Increased serum sodium level (hypernatremia) has an osmotic action that causes water to be pulled from the interstitial spaces into the vascular system. Remember that "water goes where salt is." This action decreases wound healing at a cellular level, reducing the nutrients cells need for repair (Option 4).
The nurse prepares to instill dialysate for a client receiving peritoneal dialysis. Which nursing action is the priority?
4. Using sterile technique when spiking and attaching the bag of dialysate When administering PD, it is essential to use sterile technique when spiking and attaching bags of dialysate to the client's PD catheter to prevent contamination and infection (Option 4). Bacterial peritonitis, an infection of the peritoneum, is a potential complication of PD that may lead to sepsis. Signs of peritonitis should be reported to the health care provider. Proper positioning of the catheter drainage bag (ie, below the abdomen) and the client (eg, Fowler or semi-Fowler position) promotes effluent outflow but is not a priority over infection prevention.
A sexually active female client has had 3 urinary tract infections (UTIs) in 12 months. Which instructions should the nurse include in teaching the client how to prevent UTI recurrence? Select all that apply.
2. Increase daily intake of fluids 5. Void immediately after intercourse 6.Wear underwear with a cotton crotch Interventions to help prevent recurrent UTIs in sexually active female clients include avoiding use of feminine perineal products, vaginal douches, and spermicidal contraceptive jelly as it can suppress the production of vaginal flora. Protective factors include wearing cotton underwear, increasing water intake, wiping from to back to prevent bacteria from the vagine and anus into the urethra, taking all antibiotics as prescribed and voiding immediately after sexual intercourse.
A client had a percutaneous nephrolithotripsy 3 hours ago to remove left renal calculi. Since then, the indwelling urethral catheter has drained 125 mL of urine and the nephrostomy tube has drained 0 mL. The client now reports left flank pain radiating to the left groin along with severe nausea. What is the appropriate nursing intervention? Percutaneous nephrolithotripsy involves the insertion of a needle and sheath through the skin into the pelvis of the kidney. A nephroscope is inserted through the sheath to break and remove kidney stones too large to remove with other methods. Post procedure, a temporary percutaneous nephrostomy tube may be placed to prevent obstruction by stone fragments and to promote healing of injured tissue; maintaining tube patency is critical.
2. Irrigate the nephrostomy tube with sterile normal saline as prescribed This client is experiencing left flank pain and has no drainage from the nephrostomy tube, which may indicate obstruction to urine flow in the left kidney that can lead to kidney injury (pressure atrophy). Gentle irrigation of the nephrostomy tube with a small volume of sterile normal saline (as prescribed or per protocol) using aseptic technique is the appropriate intervention. If tube patency cannot be established after irrigation, the health care provider is notified (Option 2).
A client has been given instructions about collecting a urine specimen to test creatinine clearance. Which client statement indicates a correct understanding of the specimen-collection procedure? Creatinine clearance is a measure of glomerular function and is a sensitive indicator of renal disease progression. An in-and-out catheter (straight catheter) is used for any test requiring a urine specimen when the client is unable to urinate or follow the specimen-collection procedure. Clean catch or midstream urine samples are collected for urinalysis or urine culture and sensitivity testing.
3. "I will void first and then collect all my urine in a container for 24 hours." A timed urine collection measures substances (eg, creatinine, protein, adrenal hormones) excreted in the urine over time (eg, 12 hr, 24 hr). For a 24-hour urine collection, the first urine specimen is discarded, and the time is noted. All voided urine for the next 24 hours is collected in a container and kept cool (Option 3). At the end of the 24 hours, the client should void one last time and add the specimen to the container. Blood is drawn to measure the serum creatinine level, in addition to urine creatinine. The first morning void is more concentrated and preferred for pregnancy testing, urinalysis, or urine culture and sensitivity.
The nurse assesses a client during the dwell time of a peritoneal dialysis cycle. Which assessment would require immediate intervention? During peritoneal dialysis, dialysate is infused into the abdominal cavity and the tubing is then clamped to allow the fluid to dwell for a specified period. After the dwell time, the catheter is unclamped and the fluid drains out via gravity.
3. Crackles present in the left and right lung bases During the instillation and dwell portions of the cycle, clients are monitored closely for indications of respiratory distress (eg, difficulty breathing, rapid respirations, crackles) that can result from instilling the dialysate too rapidly, overfilling of the abdomen, or fluid entering the thoracic cavity (Option 3). Crackles can also occur if over time there is more dialysate infused than is removed (fluid gain). Clients receive peritoneal dialysis due to chronic kidney failure. The client's blood pressure is likely elevated secondary to the renal failure. This assessment is important to monitor, but crackles in the lungs are the priority. dema in the extremities can also indicate volume overload. However, this could be due to many other factors (eg, blood pressure medications such as amlodipine) or fluid overload from kidney disease
The nurse is reviewing dietary teaching with a client who has chronic kidney disease. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply Dairy products (eg, milk) are high in phosphorus, and consumption of dairy products should be restricted. High-sodium foods (eg, saltine crackers, processed foods) and high-potassium foods (eg, peanut butter, bran, raisins) should be avoided by clients with CKD to prevent fluid overload and hyperkalemia.
3. I drink water, instead of soft drinks or cola, with my meals." 4."I use fresh herbs instead of salt to season my food when cooking meals. Many soft drinks and colas are high in phosphorus and should be avoided to prevent hyperphosphatemia, which can interfere with calcium balance (Option 3). Black pepper, herbs, and spices are good alternatives to salt for seasoning food for clients with CKD (Option 4)
The nurse is caring for a client with chronic kidney disease who just received hemodialysis for the first time. The client vomits once, reports a headache, and appears restless and disoriented. What is the priority nursing action? Dialysis disequilibrium syndrome (DDS) is a rare but potentially life-threatening complication of hemodialysis (HD) that occurs when solutes are removed more quickly from blood than from brain cells and cerebrospinal fluid, creating a concentration gradient that can lead to cerebral edema. DDS occurs during or immediately following a client's initial HD treatment.
3. Obtain the client's current blood pressure reading Because manifestations of DDS (eg, nausea, vomiting, headache, restlessness) and HD-induced hypotension (eg, nausea, vomiting, chest pain) can be similar, the priority nursing action is to obtain the client's blood pressure (Option 3). Treatment of DDS focuses on interventions to decrease cerebral edema and manage symptoms. DDS can be prevented by slowing the rate of HD. Serum electrolyte levels need to be closely monitored in clients receiving HD, however, this can be safely delayed until the blood pressure reading is obtained.
A nurse is caring for a client 2 days after surgical creation of an arteriovenous fistula in the forearm. Which finding should the nurse report immediately to the health care provider? Arteriovenous fistula (AVF) is a permanent hemodialysis access surgically created by connecting an artery to a vein, typically in the forearm or upper arm. This anastomosis diverts arterial blood into the vein, which increases intravenous blood flow and causes the vein to thicken and expand (ie, "mature"). The matured AVF can then sustain frequent access by large-bore needles during hemodialysis. After AVF creation, edema may occur due to venous congestion but typically improves spontaneously. Extremity elevation helps reduce edema. A loud swooshing sound (ie, bruit) auscultated over the AVF is EXPECTED due to turbulent blood flow at the arteriovenous anastomosis.
3. Pale skin of the hand of the arm with the arteriovenous fistula Arterial steal syndrome is an AVF complication that occurs when the anastomosed vein "steals" too much arterial blood, causing distal extremity ischemia. Symptoms occur distal to the AVF, including skin pallor, pain, numbness, tingling, diminished pulses, and poor capillary refill. Without prompt intervention, ischemia may lead to limb necrosis (Option 3).
The home health nurse has reviewed the most recent laboratory test results for a client with chronic kidney disease. Which of the following would be an appropriate afternoon snack to recommend for the client? Click on the exhibit button for additional information. Diary products (milk, yogurt, pudding) + certain fruits (bananas, oranges) = high in potassium and phosphorous Avocados = high in potassium chips = high in sodium
3.Oatmeal with apple slices Chronic kidney disease (CKD) is an irreversible condition characterized by a progressive decrease in kidney function that results in decreased glomerular filtration (ie, how effectively the kidneys filter blood). This causes retention of fluid, potassium, and phosphate. Laboratory values help determine the client's dietary needs. Dietary adjustments include limiting foods high in sodium, potassium, and phosphorus. Recommended foods for a client with CKD include oatmeal and apple slices, which are low in sodium, potassium, and phosphorus (Option 3)
The nurse is caring for a client who received extracorporeal shock wave lithotripsy with ureteral stent placement for treatment of a kidney stone. Which discharge instructions provided by the nurse are appropriate? Select all that apply. Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive procedure that uses high-energy acoustic shock waves to break up kidney stones into small fragments that can be excreted in the urine. The procedure is typically performed in an outpatient setting under general anesthesia. Temporary ureteral stents are often placed during the procedure to facilitate the passage of the stone fragments and prevent occlusion of the ureter. Stents are typically removed in 1-2 weeks.
1. "Contact your health care provider if you develop a fever or chills." 3."Increase your fluid intake to help flush out the kidney stone fragments." 4. It is common to have some blood in the urine up to 24 hours after this procedure.". Expect to see blood in the urine (hematuria). Urine color should progress from bright red to pink-tinged during the first several hours. Hematuria is concerning if the urine remains bright red for a prolonged period (eg, >24 hours) (Option 4). 5. "You may develop some bruising on your back or on the side of your abdomen."
The nurse reinforces teaching about self-management strategies for a client with urge incontinence. Which of the following statements indicate that teaching has been effective? Select all that apply.
1. "I am going to join a walking program to lose excess weight." 2. "I may have dry mouth as a side effect from the oxybutynin." 4. "I should perform Kegel exercises several times daily." 5. "I will void every 2 hours until I am having fewer accidents." Urge incontinence (UI), also known as overactive bladder, occurs when the bladder contracts randomly, causing a strong, sudden urge to urinate that is followed by urine leakage. UI may occur without cause or may result from spinal cord injury and impairment of the bladder (eg, interstitial cystitis) or neurological system (eg, Parkinson disease, stroke). Interventions for clients with UI include: Management of urge incontinence includes loss of excess weight, anticholinergic medications (eg, oxybutynin) to decrease bladder spasms, avoidance of bladder irritants, pelvic floor exercises, and bladder training. Dry mouth is a common adverse effect of anticholinergic medications.
1030: The client states, "I get a sudden urge to urinate and cannot delay it long enough to get to the restroom. I end up urinating on myself." The problem has worsened over the past month. She voids 10-12 times during the day and awakens two or three times during the night to urinate, resulting in loss of sleep and social isolation. Urine leakage does not occur while laughing or sneezing. The client reports no pelvic or flank pain, dysuria, fever, or nausea. Urge incontinence (UI) (ie, overactive bladder) occurs when the bladder contracts randomly, causing a strong, sudden urge to urinate followed by urine leakage. UI may occur without cause or may result from neurologic system dysfunction (eg, Parkinson disease, stroke), bladder disorders (eg, cystitis), spinal cord injury, or bladder outlet obstruction.
Expected: Administer an antispasmodic (tolterodine, oxybutynin, Assess the client's readiness to quit smoking, Advise the client to avoid alcoholic beverages, Instruct the client to perform pelvic floor exercises, Teach timed voiding and urge suppression techniques NOT Expected: Request a prescription for a pessary, Administer an antibiotic, Suggest a low-fiber diet Pessaries are not expected for clients with UI. Pessaries (eg, intravaginal support devices) are used to support the pelvic floor and relieve pressure on the bladder for clients with stress incontinence related to pelvic organ prolapse - Antibiotics are used for treatment of urinary tract infections and are not expected for clients with UI without signs of infection (eg, positive urine culture). -Encouraging a low-fiber diet is not expected. The client should be encouraged to consume a high-fiber diet to prevent constipation and bladder outlet compression
Chronic kidney disease (CKD) is an irreversible condition characterized by a progressive decrease in kidney function (≥3 months) that results in decreased glomerular filtration rate (GFR) (ie, how effectively the kidneys filter blood). CKD is most often caused by poorly controlled diabetes mellitus and hypertension. Decreased GFR results in fluid retention, electrolyte abnormalities, and accumulation of waste products in the blood (ie, uremia). Manifestations of worsening CKD includ
Manifestations of worsening CKD include a persistent metallic taste in the mouth d/t increased ammonia levels (urea --> ammonia) , difficulty with memory and concentration d/t accumulation of waste products , bilateral crackles in the lungs (fluid overload)/distended neck veins/edema/hypertension, loss of appetite (anorexia)/nausea and vomiting, and decreased urine production (voiding 1-2 day) d/t decreased renal excretion and filtration Hyperthyroidism: Eyes that are protruding bilaterally (ie, exophthalmus), a nonmobile, nontender mass below the larynx (ie, goiter), and hyperactive bowel sounds or Borborygmi
The nurse assesses a client receiving peritoneal dialysis. Which assessment findings are most important for the nurse to report to the health care provider? Select all that apply. During peritoneal dialysis (PD), a catheter is placed into the peritoneal cavity to infuse dialysate (dialysis fluid); the tubing is then clamped to allow the fluid to dwell for a specified period. After the dwell time, the catheter is unclamped and the fluid (effluent) drains out via gravity.
1) Cloudy outflow 2) Low-grade fever 5) Tachycardia Cloudy outflow (effluent), tachycardia, and low-grade fever are signs of peritonitis, an infection of the peritoneal cavity and a major concern with PD. - Bloody fluid can indicate intestinal perforation or that the client may be menstruating. Brown effluent can indicate fecal contamination from perforation. All these findings need to be reported to the health care provider. NO oliguria or pruritus - Oliguria (very low urine output) is associated with acute or chronic kidney failure and is the reason the client is receiving peritoneal dialysis. -Pruritus (itching) is a common finding in clients with kidney failure, and may occur due to dry skin, neuropathy, or skin deposits of waste products (eg, urea, calcium-phosphate) that are normally removed via the kidney.
The nurse reinforces teaching during a staff education conference for graduate nurses (GNs) who will be providing care to clients receiving hemodialysis. Which of the following statements made by a GN indicate correct understanding of the teaching? Select all that apply Hemodialysis is a treatment to filter wastes and water from your blood, as your kidneys did when they were healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, and calcium, in your blood.
1. "Anticoagulants are used to prevent the blood from clotting in the dialyzer." 2."Antihypertensive medications may be held until after hemodialysis." -Withholding antihypertensives medications prior to HD may decrease risk for developing hypotension (Option 2) 4."Hemodialysis removes excess fluid, electrolytes, and wastes, from the client's blood." 5."The client's blood pressure should not be taken on the arm with an arteriovenous fistula." Hemodialysis (HD) removes excess fluid and electrolytes by filtering the client's heparinized blood through a dialyzer. Hypotension is common, requiring frequent blood pressure measurements and the withholding of blood pressure medications prior to HD. Blood pressure is measured on the arm opposite the arteriovenous fistula or graft.
A 65-year-old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L (7.5 mmol/L) and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia? Hyperkalemia can be asymptomatic but may cause fatigue, generalized weakness, or in severe cases muscle paralysis and/or dysrhythmias. Management includes preventing life-threatening dysrhythmias and correcting serum potassium levels.
1. Intravenous calcium gluconate Intravenous calcium gluconate is administered to hyperkalemic clients with ECG changes (eg, peaked T waves). Calcium gluconate itself does not decrease the serum potassium level but temporarily stabilizes the myocardium by raising the threshold for dysrhythmia occurrence (provides immediate protection from dsyrhythmias). Once the nurse stabilizes the client by administering calcium gluconate, other prescriptions may then be implemented to decrease serum potassium level (eg, intravenous regular insulin with dextrose, sodium polystyrene sulfonate, hemodialysi
Complete the following sentence by choosing from the list of options. The nurse recognizes the client is at risk fo Findings consistent with acute nephrolithiasis include the presence of stones in the genitourinary tract and positive RBCs, pink-tinged urine, and sediment on urinalysis. L
1. Pyelonephritis The presence of a stone in the genitourinary tract is characteristic of acute nephrolithiasis. Stones occur when salts within the urine crystalize and create a solid deposit. Most stones pass with normal urination; however, when stones become larger (ie, >5 mm) the risk for obstruction increases. Obstruction can cause urinary stasis and allow pathogens to colonize the upper urinary tract, increasing the risk for pyelonephritis.
The nurse is performing discharge teaching on nutritional therapy for a client with chronic kidney disease. Which statement indicates that further teaching is needed?
2. "I can use a salt substitute because I am required to restrict both sodium and potassium in my daily diet." Clients with chronic kidney disease (CKD) are at risk for fluid overload and hyperkalemia (HIGH POTASSIUM). Clients should avoid salt substitutes, which typically contain potassium chloride and may contribute to hyperkalemia (Option 2). To avoid further complications and prevent progressive kidney damage, clients with CKD are advised to follow certain dietary restrictions, including: - Sodium restriction - Avoid high-sodium foods such as cured meats, pickled foods, canned soups, frankfurters, cold cuts, soy sauce, and salad dressings (Option 1). - Potassium restriction - Avoid high-potassium foods such as raw carrots, tomatoes, and orange juice (Option 3). - Fluid intake monitoring - Monitor fluid intake closely and accurately, being careful to include foods that are liquid-based (eg, popsicles, gelatin), because fluid is often restricted (Option 4). Low-protein diet - Eat 0.6-0.8 g/kg/day of protein to help prevent progression of kidney disease. If the client is already on hemodialysis, increased protein intake is recommended to prevent malnutrition. - Low-phosphorus diet - Avoid foods high in phosphorus (eg, chicken, turkey, dairy).(Option 4).
Which of the following observations by the charge nurse would require immediate follow-up?
2. A nursing assistant hangs a urinary drainage bag on the wheelchair handle when transporting a client To maintain gravity flow, the drainage bag should be hung below the level of the bladder. Impaired urine flow can lead to urinary retention and distension of the bladder. The nurse should immediately follow-up if the drainage bag is hung above the level of the bladder (eg, wheelchair handle) because this will impede urine flow (Option 2). Fluid intake of 3000 mL/day should be encouraged in clients after surgery involving the urinary system. Increased fluid intake ensures the maintenance of a high urinary output, reducing the risk for infection and calculi. Dilute urine is less irritating to the skin surrounding the stoma site.
The nurse provides post-procedure teaching for a female client who had a cystoscopy as an outpatient. Which client statement indicates the need for additional instruction? During a cystoscopy, a urinary tract specialist (urologist) uses a scope to view the inside of the bladder and urethra. Doctors use cystoscopy to diagnose and treat urinary tract problem A cystoscopy is a procedure that uses a flexible fiber-optic scope inserted through the urethra into the urinary bladder with the client in the lithotomy position.
4. "I should expect to see blood clots in my urine for up to 24 hours. Complications associated with cystoscopy include urinary retention, hemorrhage, and infection. Therefore, clients are instructed to notify the health care provider (HCP) immediately if they have bright red blood when urinating, blood clots, inability to urinate, fever >100.4 F (38 C) and chills, or abdominal pain unrelieved by analgesia. These conditions necessitate evaluation by the HCP and may require antibiotic therapy or the insertion of a urinary catheter to irrigate the bladder, remove clots, or drain the bladder (Option 4). Clients can expect pink-tinged urine, frequency/burning, dysuria, and abdominal discomfort for up to 48 hours after cystoscopy. They are instructed to increase fluid intake, avoid alcohol and caffeine, take a mild analgesic and tub/sitz bath to relieve discomfort, and notify the HCP immediately of inability to void, gross hematuria, blood clots, fever, chills, or severe pain.
After reviewing the urinalysis report data on a client, which question is most appropriate for the nurse to ask? Click on the exhibit button for additional information. Urine specific gravity range: 1.005 to 1.030 Amber color - concentrated urine - dehydration The presence of a few (0-5 per high power field) WBCs on urinalysis is normal.
4. "What has your fluid intake been for the last 24 hours?" This client's urinalysis reveals that the client is most likely dehydrated. Amber color indicates concentrated urine. The specific gravity evaluates the ability of the kidneys to concentrate solutes in the urine. The normal urine specific gravity value ranges from 1.003 to 1.030. Causes of increased specific gravity include fluid deficit.
The nurse cares for a client scheduled for a percutaneous left kidney biopsy as an outpatient. Which intervention should the nurse include in the client's post-procedure care plan? A kidney biopsy involves obtaining a tissue sample for pathological evaluation to determine the cause of certain kidney diseases (eg, nephritis, transplant rejection). The kidney has extensive vasculature (similar to the liver); therefore, bleeding from the biopsy site is the major complication following a percutaneous kidney biopsy Blood urea nitrogen (BUN) and creatinine levels would not change significantly within 30-60 minutes. These are usually measured once every 24 hours and rarely every 12 hours. Post-procedure, the client should be positioned on the affected (left) side for 30-60 minutes to provide pressure and help prevent bleeding. The client is usually placed in the prone position during the procedure to facilitate access to the kidney. NOT PRONE POSITION
4. Monitor vital signs every 15 minutes for the first hour Before the procedure, the client must give informed consent and discontinue all anticoagulants (eg, heparin, warfarin, rivaroxaban) and antiplatelet agents (eg, aspirin, clopidogrel, nonsteroidal anti-inflammatory drugs) for at least one week. The client should be typed and crossmatched for blood (although the need for a transfusion is rare). Blood pressure should be well-controlled. After the procedure, the nurse should monitor vital signs at least every 15 minutes for the first hour as tachycardia, tachypnea, and hypotension can indicate blood loss. The nurse should also assess the puncture site dressing for bleeding (Option 4).
For each finding below, click to specify if the finding is consistent with the disease process of acute nephrolithiasis, appendicitis, or poststreptococcal glomerulonephritis. Each finding may support more than one disease process.
Acute Nephrolithiasis (kidney stones): hematuria, Tachycardia, Nausea and vomiting, Pain radiating to the groin - Acute nephrolithiasis (ie, kidney stones) is the presence of solid deposits composed of salts and minerals that form in the kidney and travel through the genitourinary system. Stones can obstruct the ureters and disrupt the ureteral epithelium, leading to hematuria (ie, RBCs in the urine). Additional manifestations include tachycardia, pain radiating to the groin, and nausea and vomiting due to severe pain. Appendicitis (RLQ): tachycardia, nausea and vomiting - Characteristic abdominal pain begins in the umbilical area and migrates to the right lower quadrant (ie, McBurney point). The body's inflammatory response to appendicitis causes leukocytosis, tachycardia, and fever. Distension and pressure within the intestine induce nausea, vomiting, and anorexia. Poststreptococcal Glomerulonephritis: Hematuria, Proteinuria, Tachycardia, Nausea and vomiting - PSGN) is a noninfectious kidney disease that occurs when immune complexes are deposited in the glomeruli following infection with certain strains of group A beta-hemolytic Streptococcus, resulting in decreased glomerular filtration. Clinical manifestations of PSGN can occur up to 6 weeks after the initial infection and include hematuria, proteinuria, tachycardia, nausea, and vomiting.
The client is admitted to the medical-surgical unit. For each potential intervention, click to specify if the intervention is appropriate or not appropriate for the care of the client. Ketorolac is used to relieve moderately severe pain, usually after surgery. Ketorolac is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation
Appropriate: Administer ketorolac, Strain the client's urine, Administer ondansetron -Administering pain medications (eg, NSAIDs [ketorolac], opioids) to treat renal colic. -Straining the client's urine to monitor for spontaneous passage of the kidney stone. Most kidney stones <5 mm pass spontaneously; however, when stones are larger or an obstruction occurs in the upper urinary tract, spontaneous resolution becomes less likely. -Administering antiemetics (eg, ondansetron) to alleviate nausea and vomiting caused by severe pain. Not appropriate: Maintain bed res. tInitiate NPO status - Maintaining bed rest is not appropriate. The nurse should encourage the client to move around to promote blood circulation and prevent complications (eg, blood clots), as well as the passing of kidney stones. - Initiating NPO status is not appropriate unless kidney stone removal (eg, lithotripsy) is required. Lithotripsy may be necessary if stones are larger in size (ie, >10 mm) and are causing infection, impaired kidney function, and severe, persistent pain.
Emergency Department The client reports persistent nausea, blood in the urine, and right-sided flank pain that started 1 day ago. The client describes the pain as a sharp, stabbing sensation that comes and goes and rates it as 9 on a scale of 0-10. The flank pain radiates to the groin. The client has mitral valve prolapse and gastroesophageal reflux disease and recently recovered from a viral infection. The client drinks 2-4 glasses of wine per week. The client is alert and oriented × 4 and appears restless, changing position from sitting to lying down frequently. S1 and S2 are present on auscultation; there is a heart murmur. Lungs are clear bilaterally. The abdomen is nondistended and nontender on palpation; there is no rebound tenderness. Vital signs are T 98.9 F (37.2 C), P 102, RR 20, BP 145/90, and SpO2 98% on room air.
Concerning findings include: - Blood in the urine (ie, hematuria), which most often indicates inflammation or infection in the kidney or urinary tract. Conditions that cause hematuria include acute nephrolithiasis (ie, kidney stones), glomerulonephritis, or urinary tract infections. - Right-sided flank pain (ie, costovertebral angle tenderness) that radiates to the groin (ie, renal colic), which can be caused by acute nephrolithiasis, kidney infection, or injury.
The nurse is conducting a pain assessment on a client with dysuria. Which pain description is most likely associated with pyelonephritis? Pain in pyelonephritis is dull, constant, and maximal at the costovertebral angle area. Pain from renal stones is excruciating, sharp, and often radiates toward the groin from the flank. Suprapubic pain indicates bladder distension or cystitis. Spasms can be seen with infection (cystitis) or manipulation of the bladder.
Dull flank pain; extending toward the umbilicus Urinary tract infections (UTIs) can occur in the kidneys (pyelonephritis), bladder (cystitis), and/or urethra (urethritis). Pyelonephritis (inflammation of the kidney parenchyma) causes flank pain that is experienced in the back at the costovertebral angle (the angle between the lower ribs and adjacent vertebrae) and may spread toward the umbilicus. Cystitis alone DOES NOT cause nausea/vomiting or chills. Presence of these (N/V, CHILLS), fever, and signs and symptoms of a lower UTI (dysuria, urgency, and frequency) indicate pyelonephritis.
The client reports to the clinic for hemodialysis treatment. For each potential intervention, click to specify if the intervention is expected or not expected for the care of the client.
Expected: Weigh the client before and after dialysis, Assess distal pulses in the left arm before accessing the arteriovenous fistula, Apply a pressure dressing to the arteriovenous fistula after hemodialysis access is removed - to determine the volume of fluid removed during dialysis and retained between treatments -to confirm adequate circulation within the AVF -ue to the risk of bleeding from arterial puncture Not Expected: Administer antihypertensive medications prior to starting dialysis, Place the blood pressure cuff above the arteriovenous fistula during dialysis -the risk of hypotension from rapid fluid removal during hemodialysis. They are usually administered after hemodialysis -ecause constricting blood flow on the limb with the AVF can cause damage and clotting. The blood pressure cuff should be placed on the unaffected limb.
The nurse has provided discharge teaching. For each of the statements made by the client, click to specify whether the statement indicates correct understanding or incorrect understanding of the discharge teaching provided. SODIUM NOT CALCIUM SHOULD BE RESTRICTED
Incorrect Understanding: "I will drink up to 1 L of water per day." "I should increase my intake of sodium.""I will limit my intake of cottage cheese, beans, and yogurt." - lients should drink 2-3 L of water per day to help increase urine output, prevent dehydration, and dilute crystals that can form stones. - Clients with a history of kidney stones should decrease sodium intake. Excess sodium increases excretion of calcium in the urine and increases the risk for stone formation. - Limiting intake of high-calcium foods (eg, cottage cheese, beans, yogurt) demonstrates incorrect understanding. Calcium binds to oxalate in the intestine and is excreted in stool. Decreased calcium intake can increase intestinal absorption of oxalate, which is then filtered by the kidneys and excreted in urine, and may cause stone formation. Correct understanding: "I will limit my intake of spinach, potatoes, and tofu.""I will go for walks daily to help prevent the stones from recurring." - Limiting dietary intake of high-oxalate foods (eg, spinach, potatoes, tofu) to prevent recurrence of calcium oxalate stones - Engaging in regular physical activity (eg, daily walks) to help increase blood flow to the kidneys and improve filtration of waste
For each laboratory test, click to specify if the laboratory test is expected to be decreased or increased for a client with chronic kidney disease. As what was mentioned before, if BUN increases but the creatinine level is normal, the main reason is dehydration and NOT acute renal failure. Now, if the BUN and creatinine are both elevated, this means that you have a kidney problem
Increased: BUN (blood urea nitrogen) POTASSIUM, CREATININE Decreased: Glomerular Filtration Rate, Calcium
The nurse is caring for a 76-year-old male in the emergency department. The client reports lower abdominal pressure and has been unable to urinate for the past 12 hours. He has recently experienced straining during urination and a weak, intermittent stream with dribbling of urine. The client reports worsening nocturia and urinary urgency for the past 6 months with no dysuria. The suprapubic area is distended and tender on palpation. There is no costovertebral angle tenderness or flank pain. The prostate is nontender, symmetric, smooth, firm, and enlarged on digital rectal examination. Benign prostatic hyperplasia (BPH) occurs when the prostate enlarges and compresses the urethra, causing difficulties with voiding. Manifestations include urinary urgency, frequency, and hesitancy; dribbling urine after voiding; nocturia; and urinary retention. Treatment includes: Manifestations of cystitis (ie, inflammation of the bladder) include urgency, frequency, and pelvic pain. However, the client's abnormal prostate examination and urinary retention are more concerning for BPH. Phenazopyridine/Pyridium, Azo Urinary Pain Relief, a urinary analgesic, can be used to relieve urinary tract discomfort.
Potential Conditions: Benign prostatic hyperplasia Actions to Take: Administer Tamsulosin, Perform urinary catheterization Client Statements: "This medication may cause erectile dysfunction." "I will urinate sitting down, relax for a few minutes, and then try to urinate again." - Administering tamsulosin, an alpha-adrenergic blocker that increases urine flow by relaxing smooth muscle in the prostate and bladder neck. Adverse effects include erectile dysfunction and orthostatic hypotension. - Performing urinary catheterization as needed for urinary retention because stagnant urine increases the risk of infection - Implementing techniques to increase urine flow, including urinating sitting down, relaxing for a few minutes, and then trying to urinate again
Ileal Conduit (Urostomy)
is a surgical technique that uses an excised piece of the client's ileum to create an INCONTINENT URINARY DIVERSION. connects to ureters and drains urine
costovertebral angle tenderness
the angle between the lower ribs and adjacent vertebrae angle formed by the 12th rib and the vertebral column on the posterior thorax, overlying the kidney
