314: Exam 4 (Chapter 44, 46, 47)
The patient states that she "loses urine" every time she laughs or coughs. The nurse teaches the patient measures to regain urinary control. The nurse recognizes the need for further teaching when the patient states: A) "I will perform my Kegel exercises every day." B) "I joined weight watchers." C) "I drink two glasses of wine with dinner." D) "I have tried urinating every 3 hours."
"I drink two glasses of wine with dinner."
Since removal of the patient's Foley catheter, the patient has voided 50 to 100 mL every 2 to 3 hours. Which action should the nurse take first? A) Check for bladder distention B) Encourage fluid intake C) Obtain an order to recatheterize the patient D) Document the amount of each voiding for 24 hours
Check for bladder distention
The nurse notes that the patient's Foley catheter bag has been empty for 4 hours. The priority action would be to: A) Irrigate the Foley. B) Check for kinks in the tubing. C) Notify the health care provider. D) Assess the patient's intake.
Check for kinks in the tubing.
A patient with a Foley catheter carries the collection bag at waist level when ambulating. The nurse tells the patient that he or she is at risk for: (Select all that apply.) A) Infection. B) Retention. C) Stagnant urine. D) Reflux of urine.
Infection. Reflux of urine.
An older male patient states that he is having problems starting and stopping his stream of urine and he feels the urgency to void. The best way to assist this patient is to: A) Help him stand to void. B) Place a condom catheter. C) Have him practice Credé's method. D) Initiate Kegel exercises.
Initiate Kegel exercises.
To minimize the patient experiencing nocturia, the nurse would teach him or her to: A) Perform perineal hygiene after urinating. B) Set up a toileting schedule. C) Double void. D) Limit fluids before bedtime.
Limit fluids before bedtime
The patient is to have an intravenous pyelogram (IVP). Which of the following apply to this procedure? (Select all that apply.) A) Note any allergies. B) Monitor intake and output. C) Provide for perineal hygiene. D) Assess vital signs. E) Encourage fluids after the procedure.
Note any allergies. Encourage fluids after the procedure.
The postoperative patient has difficulty voiding after surgery and is feeling "uncomfortable" in the lower abdomen. Which action should the nurse implement first? A) Encourage fluid intake B) Administer pain medication C) Catheterize the patient D) Turn on the bathroom faucet as he tries to void
Turn on the bathroom faucet as he tries to void
The nurse assesses that the patient has a full bladder, and the patient states that he or she is having difficulty voiding. The nurse would teach the patient to: A) Use the double-voiding technique. B) Perform Kegel exercises. C) Use Credé's method. D) Keep a voiding diary.
Use Credé's method.
The nurse teaches a 21-year-old female patient who came to the clinic to discuss interventions to prevent a recurrence of urinary tract infections. Which statement, if made by the patient, indicates that teaching was effective? a. "I will urinate before and after having intercourse." b. "I will use vinegar as a vaginal douche every week." c. "I should drink three 8-ounce glasses of water daily." d. "I can stop the antibiotics when symptoms disappear."
a. "I will urinate before and after having intercourse." The woman should empty her bladder before and after sexual intercourse. She should avoid vaginal douches and maintain adequate oral fluid intake (15 mL per pound of body weight). All of the antibiotics should be taken as prescribed even if symptoms are no longer present.
Which client is at highest risk for developing a hospital-acquired infection? a. A client with an indwelling urinary catheter b. A client with a laceration to the left hand c. A client who's taking prednisone d. A client with Crohn's disease
a. A client with an indwelling urinary catheter The invasive nature of an indwelling urinary catheter increases the client's risk of a hospital-acquired infection. The nurse must perform careful, frequent catheter care to minimize the client's risk. Although the client with a laceration, the client who's taking prednisone, and the client with Crohn's disease have a risk of infection, the one with an indwelling catheter is at the greatest risk.
Which nursing diagnosis is a priority in the care of a patient with renal calculi? a. Acute pain b. Risk for constipation c. Deficient fluid volume d. Risk for powerlessness
a. Acute pain Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.
The patient with type 2 diabetes has a second UTI within one month of being treated for a previous UTI. Which medication should the nurse expect to teach the patient about taking for this infection? a. Ciprofloxacin (Cipro) b. Fosfomycin (Monurol) c. Nitrofurantoin (Macrodantin) d. Trimethoprim/sulfamethoxazole (Bactrim)
a. Ciprofloxacin (Cipro) This UTI is a complicated UTI because the patient has type 2 diabetes and the UTI is recurrent. Ciprofloxacin (Cipro) would be used for a complicated UTI. Fosfomycin (Monurol), nitrofurantoin (Macrodantin), and trimethoprim/sulfamethoxazole (Bactrim) should be used for uncomplicated UTIs.
A client comes into the emergency department with severe back pain radiating to the left lower groin region. Morphine sulfate 10 mg IV is administered as ordered. One hour later the client states that the pain is still at 8 of 10. Which actions would the nurse take? a. Contact the physician and explain that the pain is still at 8 of 10 one hour after the morphine has been administered and request a higher dosage. b. Check to ensure the correct dosage was given and ask the client if he/she has routinely taken painkillers or street drugs. c. Tell the client that the order is for every 3-4 hours and explain that an additional dose cannot be given for 2 more hours. d. Explain that a high dose of the pain medication has been administered and that it takes longer than 1 hour to exert its therapeutic effect.
a. Contact the physician and explain that the pain is still at 8 of 10 one hour after the morphine has been administered and request a higher dosage. Renal colic can be one of the most severe pain experiences. The ordered dosage of analgesic has not provided relief, so additional intervention is appropriate. Because of the severity of the pain, it is not appropriate for the client to wait until the next dose is due. Although the client is receiving a therapeutic dose, it is not effective. The interval between doses of the analgesic is too great. There may be a tolerance to the analgesic if the client has routinely taken painkillers; however, relief is still needed now.
The nurse is reviewing a client's record and notes that the health care provider has documented that the client has a renal function disorder. On review of the laboratory results, the nurse most likely would expect to note which finding? a. Elevated creatinine level b. Decreased hemoglobin level c. Decreased red blood cell count d. Decreased white blood cell count
a. Elevated creatinine level Measuring the creatinine level is a frequently used laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and red blood cell count may be noted if bleeding from the urinary tract occurs of if erythropoietic function by the kidney is impaired. An increased white blood cell count is most likely to be noted in renal disease.
After an intravenous pyelogram (IVP), the nurse should include which measure in the client's plan of care? a. Encourage adequate fluid intake. b. Administer a laxative. c. Assess for hematuria. d. Maintain bed rest.
a. Encourage adequate fluid intake. After an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent. There is no need to place the client on bed rest or administer a laxative. An IVP would not cause hematuria.
Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which measure should the nurse first recommend in an attempt to resolve the woman's incontinence? a. Kegel exercises b. Use of adult incontinence pads c. Intermittent self-catheterization d. Dietary changes including fluid restriction
a. Kegel exercises Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem, and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.
A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a Foley catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? a. Notify the HCP. b. Use a small-sized catheter. c. Administer pain medication before inserting the catheter. d. Use extra povidone-iodine solution in cleansing the meatus.
a. Notify the HCP. The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing. Therefore options b,c, and d are incorrect.
The urinalysis of a male patient reveals a high microorganism count. What data should the nurse use to determine the area of the urinary tract that is infected (select all that apply)? a. Pain location b. Fever and chills c. Mental confusion d. Urinary hesitancy e. Urethral discharge f. Post-void dribbling
a. Pain location e. Urethral discharge Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis, but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.
The nurse collects a urine specimen from a client for a culture and sensitivity analysis. What should the nurse do next? a. Send the specimen to the laboratory immediately. b. Store the specimen in the refrigerator until it can be sent to the laboratory. c. Send the specimen with the next pickup. d. Send the specimen the next time an unlicensed assistive personnel (UAP) is available.
a. Send the specimen to the laboratory immediately. A specimen for culture and sensitivity should be sent to the laboratory promptly so that a smear can be taken before organisms start to grow in the specimen.
The nurse counsels a 64-year-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the nurse teach the patient to avoid? a. Venison, crab, and liver b. Spinach, cabbage, and tea c. Milk, yogurt, and dried fruit d. Asparagus, lentils, and chocolate
a. Venison, crab, and liver Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to prevent oxalate calculi formation.
The nurse gives instructions to a 62-year-old woman taking tolterodine (Detrol) to treat urinary urgency and incontinence. The nurse should include which statement? a. "Stop smoking for 2 to 3 weeks before starting to take this medication." b. "Suck on sugarless candy or chew sugarless gum if you develop a dry mouth." c. "Have your vision checked every 6 months because this drug can cause cataracts." d. "Ask your physician to prescribe an extended-release form if you have loose stools."
b. "Suck on sugarless candy or chew sugarless gum if you develop a dry mouth." Dry mouth is a common side effect of tolterodine. Patients can suck on hard candy or ice chips or chew gum if dry mouth occurs. Tobacco use does not affect the initiation of this medication. Visual changes (but not cataracts) can occur while taking this medication. Constipation may occur as a side effect of this medication.
A client with chronic kidney disease (CKD) has a blood urea nitrogen (BUN), 100 mg/dL, serum creatinine 6.5 mg/dL, potassium 6.1 mEq/L, and lethargy. Which of the following is the priority nursing assessment? a. Blood pressure b. Cardiac rhythm c. Weight changes d. Arterial blood gases
b. Cardiac rhythm Manifestations of CKD result from loss of the renal regulatory functions of filtering metabolic waste products and maintaining fluid and electrolyte balance. These laboratory results indicate CKD, but the most significant result is the potassium level. The normal range of potassium is between 3.5 and 5.0 mEq/L. A potassium level greater than 7 mEq/L may produce fatal cardiac dysrhythmias. Normal BUN level ranges from 8 to 23 mg/dL; normal serum creatinine level ranges from 0.7 to 1.5 mg/dL.
A client with acute kidney injury has a serum potassium level of 6.0 mEq/L. The nurse should plan which action as a priority? a. Check the sodium level. b. Place the client on a cardiac monitor. c. Encourage increased vegetables in the diet. d. Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration.
b. Place the client on a cardiac monitor. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse also may assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action of the nurse.
The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving orders, what should the nurse do? a. Keep the patient on bed rest. b. Use 5 mL of sterile saline to irrigate. c. Use 30 mL of water to gently irrigate. d. Have the patient turn from side to side.
b. Use 5 mL of sterile saline to irrigate. With a nephrostomy tube, if the tube is occluded and irrigation is ordered, the nurse should use 5 mL or less of sterile saline to gently irrigate it. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency.
A client undergoes cystoscopy with bladder biopsy. After the procedure, which assessment is most appropriate for the nurse to make? a. Percuss the bladder for distention. b. Assess the patency of the Foley catheter. c. Assess urine for excessive bleeding. d. Obtain a urine specimen for culture.
c. Assess urine for excessive bleeding. After cystoscopy with biopsy, the nurse would assess for excessive hematuria, which might indicate hemorrhage caused by the biopsy. Catheters are not routinely inserted after cystoscopy. The nurse would not assess for bladder distention unless the client was having difficulty voiding. Urine cultures are not routinely ordered after cystoscopy.
Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor? a. Tighten both buttocks together. b. Squeeze thighs together tightly. c. Contract muscles around rectum. d. Lie on back and lift legs together.
c. Contract muscles around the rectum. To teach pelvic floor exercises, or Kegel exercise, the nurse should instruct the patient (without contracting the legs, buttocks, or abdomen) to contract the muscles around the rectum (pelvic floor muscles) as if stopping a stool, which should result in a pelvic lifting sensation.
The most significant sign of acute renal failure is: a. Elevated body temperature. b. Increased blood pressure. c. Decreased urine output. d. Increased urine specific gravity.
c. Decreased urine output. A sudden change in urine output is typical of acute renal failure. Most commonly, the initial change is greatly decreased urine output. Later in the course of acute renal failure, the client may have marked diuresis (nonoliguric failure). A high body temperature or sudden increase in blood pressure is not typically associated with acute renal failure. Urine specific gravity usually is within a low-normal range because the kidneys have difficulty concentrating urine.
A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the health care provider (HCP)? a. Red bloody urine b. Pain related to bladder spasms c. Urinary output of 200 mL higher than intake d. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute
d. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute Frank bleeding (arterial or venous) may occur during the first day after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 mL more than intake is adequate. Bladder spasms are expected to occur following surgery. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The HCP should be notified.
The nurse is collecting data from a client who has a history of benign prostatic hyperplasia. To determine whether the client currenlty is experiencing this condition, the nurse should ask the client about the presence of which early symptom? a. Nocturia b. Urinary retention c. Urge incontinence d. Decreased force in the stream of urine
d. Decreased force in the stream of urine Decreased force in the stream of urine is an early symptom of benign prostatic hyperplasia. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.
A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? a. Hematuria and polyuria b. Dysuria and proteinuria c. Hematuria and urgency d. Dysuria and penile discharge
d. Dysuria and penile discharge Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays.
The nurse is caring for a 73-year-old man patient with a history of benign prostatic hyperplasia and symptoms of a possible urinary tract infection. Which diagnostic finding would support this diagnosis? a. White blood cell count is 7500 cells/µL. b. Antistreptolysin-O (ASO) titer is 106 Todd units/mL. c. Glucose, protein, and ketones are present in the urine. d. Nitrites and leukocyte esterase are present in the urine.
d. Nitrites and leukocyte esterase are present in the urine. A diagnosis of urinary tract infection is suspected if there are nitrites (indicating bacteriuria), white blood cells (WBCs), and leukocyte esterase (an enzyme present in WBCs indicating pyuria). Presence of glucose and ketones indicate uncontrolled diabetes mellitus. An elevated WBC count (>11,000 cells/µL) indicates a bacterial infection. Antistreptolysin-O (ASO) titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria.
A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is: a. Acute prostatitis. b. An overdistended bladder. c. Interstitial cystitis. d. Renal calculi.
d. Renal calculi. Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.
After a transurethral prostatectomy a patient returns to his room with a triple-lumen indwelling catheter and continuous bladder irrigation. The irrigation is normal saline at 150 mL/hr. The nurse empties the drainage bag for a total of 2520 mL after an 8-hour period. How much of the total is urine output?
1320
The RN directs the LPN/LVN to remove a Foley catheter at 1300. The nurse would check if the patient has voided by: A) 1400. B) 1600 C) 1700. D) 2300.
1700.
A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and findings is: A) Cystitis. B) Hematuria. C) Pyelonephritis. D) Dysuria.
A) Cystitis.
Elimination changes that result from inability of the bladder to empty properly may cause which of the following? (Select all that apply.) A) Incontinence B) Frequency C) Urgency D) Urinary retention E) Urinary tract infection
A) Incontinence B) Frequency C) Urgency D) Urinary retention E) Urinary tract infection
A male patient returned from the operating room 6 hours ago with a cast on his right arm. He has not yet voided. Which action would be the most beneficial in assisting the patient to void? A) Suggest he stand at the bedside B) Stay with the patient C) Give him the urinal to use in bed D) Tell him that, if he doesn't urinate, he will be catheterized
A) Suggest he stand at the bedside
Select the results (in italics) that are normal in a urinalysis. A. pH 6 B. Specific gravity 1.015 C. Protein small D. Sugar negative E. Nitrate small F. Leukocyte esterase positive G. Bilirubin negative
A, B, D, G Rationale: The abnormal values are indicative of a urinary tract infection. As a result of protein, nitrates, and leukoesterase in the urine, the nurse can expect the laboratory to analyze microscopic sediment including evaluating the sample for the presence of crystals, casts, WBCs, and RBCs.
A patient in the oliguric phase after an acute kidney injury has had a 250 mL urine output and an emesis of 100 mL in the past 24 hours. What is the patient's fluid restriction for the next 24 hours?
ANS: 950 mL The general rule for calculating fluid restrictions is to add all fluid losses for the previous 24 hours, plus 600 mL for insensible losses: (250 + 100 + 600 = 950 mL).
A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a. A fistula is much less likely to clot. b. A fistula increases patient mobility. c. A fistula can accommodate larger needles. d. A fistula can be used sooner after surgery.
ANS: A Arteriovenous (AV) fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the a. bowel sounds. b. blood glucose. c. blood urea nitrogen (BUN). d. level of consciousness (LOC).
ANS: A Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse's decision to give the medication
A 72-year-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? a. Insert urethral catheter. b. Obtain renal ultrasound. c. Draw a complete blood count. d. Infuse normal saline at 50 mL/hour.
ANS: A The patient's elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions also are appropriate, but should be implemented after the retention catheter
When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula? a. Auscultate for a bruit at the fistula site. b. Assess the quality of the left radial pulse. c. Compare blood pressures in the left and right arms. d. Irrigate the fistula site with saline every 8 to 12 hours.
ANS: A The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula
The client scheduled for intravenous urography informs the nurse of the following allergies. Which one should the nurse report to the physician immediately? A. Seafood B. Penicillin C. Bee stings D. Red food dye
ANS: A Clients with seafood allergies often have severe allergic reactions to the standard dyes used during intravenous urography.
The client scheduled to have an intravenous urogram is a diabetic and taking the antidiabetic agent metformin. What should the nurse tell this client? A. "Call your diabetes doctor and tell him or her that you are having an intravenous urogram performed using dye." B. "Do not take your metformin the morning of the test because you are not going to be eating anything and could become hypoglycemic." C. "You must start on an antibiotic before this test because your risk of infection is greater as a result of your diabetes." D. "You must take your metformin immediately before the test is performed because the IV fluid and the dye contain a significant amount of sugar."
ANS: A Metformin can cause a lactic acidosis and renal impairment as an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established.
What would be the response if a person's nephrons were not able to filter normally due to scarring of the proximal convoluted tubule leading to inhibition of reabsorption? A. Increased urine output, fluid volume deficit B. Decreased urine output, fluid volume deficit C. Increased urine output, fluid volume overload D. Decreased urine output, fluid volume overload
ANS: A The nephrons filter about 120 mL/min. Most of this filtrate is reabsorbed in the proximal convoluted tubule. If the tubule were not able to reabsorb the fluid that has been filtered, urine output would greatly increase, leading to rapid and severe dehydration.
Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)? a. Avoid commercial salt substitutes. b. Drink 1500 to 2000 mL of fluids daily. c. Take phosphate-binders with each meal. d. Choose high-protein foods for most meals. e. Have several servings of dairy products daily.
ANS: A, C, D Patients who are receiving peritoneal dialysis should have a high-protein diet. Phosphate binders are taken with meals to help control serum phosphate and calcium levels. Commercial salt substitutes are high in potassium and should be avoided. Fluid intake is limited in patients requiring dialysis. Dairy products are high in phosphate and usually are limited
A 38-year-old patient who had a kidney transplant 8 years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone). Which assessment data will be of most concern to the nurse? a. The blood glucose is 144 mg/dL. b. There is a nontender axillary lump. c. The patient's skin is thin and fragile. d. The patient's blood pressure is 150/92.
ANS: B A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The elevated glucose, skin change, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy
Before administration of captopril (Capoten) to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's a. glucose. b. potassium. c. creatinine. d. phosphate.
ANS: B Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the captopril was given or not.
A 42-year-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed actions should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).
ANS: B Because hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure
Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance
ANS: B Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2 L inflows. Which information should the nurse report immediately to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient's abdomen appears bloated after the inflow.
ANS: B Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient
A patient has arrived for a scheduled hemodialysis session. Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician? a. Teach the patient about fluid restrictions. b. Check blood pressure before starting dialysis. c. Assess for causes of an increase in predialysis weight. d. Determine the ultrafiltration rate for the hemodialysis.
ANS: B Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of the appropriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN.
Which information in a patient's history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation? a. The patient has type 1 diabetes. b. The patient has metastatic lung cancer. c. The patient has a history of chronic hepatitis C infection. d. The patient is infected with the human immunodeficiency virus.
ANS: B Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant
The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation. Which parameter will be most important for the nurse to consider? a. Heart rate b. Urine output c. Creatinine clearance d. Blood urea nitrogen (BUN) level
ANS: B Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate
The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required? a. Multivitamin with iron b. Magnesium hydroxide c. Acetaminophen (Tylenol) d. Calcium phosphate (PhosLo)
ANS: B Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of a. persistent skin tenting b. rapid, deep respirations. c. bounding peripheral pulses. d. hot, flushed face and neck.
ANS: B Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI
A 48-year-old patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which order for the patient will the nurse question? a. NPO for 6 hours before procedure b. Ibuprofen (Advil) 400 mg PO PRN for pain c. Dulcolax suppository 4 hours before procedure d. Normal saline 500 mL IV infused before procedure
ANS: B The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. The suppository and NPO status are necessary to ensure adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure
The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most important to communicate to the health care provider? a. The urine output is 900 to 1100 mL/hr. b. The patient's central venous pressure (CVP) is decreased. c. The patient has a level 7 (0 to 10 point scale) incisional pain. d. The blood urea nitrogen (BUN) and creatinine levels are elevated.
ANS: B The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant
A 62-year-old female patient has been hospitalized for 8 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider? a. The creatinine level is 3.0 mg/dL. b. Urine output over an 8-hour period is 2500 mL. c. The blood urea nitrogen (BUN) level is 67 mg/dL. d. The glomerular filtration rate is <30 mL/min/1.73m2.
ANS: B The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy
A 25-year-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider? a. Serum creatinine level 2.1 mg/dL b. Serum potassium level 6.5 mEq/L c. White blood cell count 11,500/µL d. Blood urea nitrogen (BUN) 56 mg/dL
ANS: B The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse also will report the other laboratory values, but abnormalities in these are not immediately life threatening
A 74-year-old who is progressing to stage 5 chronic kidney disease asks the nurse, "Do you think I should go on dialysis? Which initial response by the nurse is best? a. "It depends on which type of dialysis you are considering." b. "Tell me more about what you are thinking regarding dialysis." c. "You are the only one who can make the decision about dialysis." d. "Many people your age use dialysis and have a good quality of life."
ANS: B The nurse should initially clarify the patient's concerns and questions about dialysis. The patient is the one responsible for the decision and many people using dialysis do have good quality of life, but these responses block further assessment of the patient's concerns. Referring to which type of dialysis the patient might use only indirectly responds to the patient's question
Which intervention will be included in the plan of care for a male patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein? a. Start continuous pulse oximetry. b. Restrict physical activity to bed rest. c. Restrict the patient's oral protein intake. d. Discontinue the urethral retention catheter.
ANS: B The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry
During routine hemodialysis, the 68-year-old patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Check patient's blood pressure (BP). c. Review the hematocrit (Hct) level. d. Give prescribed PRN antiemetic drugs.
ANS: B The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions may also be appropriate based on the blood pressure obtained
The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary collaborative treatment goal in the plan will be a. augmenting fluid volume. b. maintaining cardiac output. c. diluting nephrotoxic substances. d. preventing systemic hypertension.
ANS: B The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct
The client is taking a medication for an endocrine problem that inhibits aldosterone secretion and release. To what complications of this therapy should the nurse be alert? A. Dehydration, hypokalemia B. Dehydration, hyperkalemia C. Overhydration, hyponatremia D. Overhydration, hypernatremia
ANS: B Aldosterone is a mineralocorticoid that increases the reabsorption of water and sodium in the kidney at the same time that it promotes excretion of potassium. Any drug or condition that disrupts aldosterone secretion or release increases the client's risk for excessive water loss and potassium reabsorption.
Which condition would trigger the release of antidiuretic hormone (ADH)? A. Plasma osmolarity decreased secondary to overhydration. B. Plasma osmolarity increased secondary to dehydration. C. Plasma volume decreased secondary to hemorrhage. D. Plasma volume increased with edema formation.
ANS: B Antidiuretic hormone is triggered by a rising ECF osmolarity, especially hypernatremia.
Which assessment maneuvers should the nurse perform first when assessing the renal system at the same time as the abdomen? A. Abdominal percussion B. Abdominal auscultation C. Abdominal palpation D. Renal palpation
ANS: B Auscultation precedes percussion and palpation because the nurse needs to auscultate for abdominal bruits before palpation or percussion of the abdominal and renal components of a physical assessment.
The female client's urinalysis shows all the following characteristics. Which should the nurse document as abnormal? A. pH 5.6 B. Ketone bodies present C. Specific gravity is 1.030 D. Two white blood cells per high-power field
ANS: B Ketone bodies are byproducts of incomplete metabolism of fatty acids. Normally, there are no ketones in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy.
Which of the following conditions are associated with oversecretion of rennin? A. Alzheimer's disease B. Hypertension C. Diabetes mellitus D. Diabetes insipidus
ANS: B Renin is secreted when special cells in the DCT, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume is low, blood pressure is low, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause the secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension.
The client's urine specific gravity is 1.018. What is the nurse's best action? A. Ask the client for a 24-hour recall of liquid intake. B. Document the finding as the only action. C. Obtain a specimen for culture. D. Notify the physician.
ANS: B This specific gravity is within the normal range for urine.
Which of the following muscle actions results in voluntary urination? A. Detrusor contraction, external sphincter contraction B. Detrusor contraction, external sphincter relaxation C. Detrusor relaxation, external sphincter contraction D. Detrusor relaxation, external sphincter relaxation
ANS: B Voiding becomes a voluntary act as a result of learned responses controlled by the cerebral cortex that cause contraction of the bladder detrusor muscle and simultaneous relaxation of the external urethral sphincter muscle.
Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid prescribed after kidney transplantation? a. Postural hypotension b. Recurrent tachycardia c. Knee and hip joint pain d. Increased serum creatinine
ANS: C Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.
A 37-year-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function? a. Urine volume b. Creatinine level c. Glomerular filtration rate (GFR) d. Blood urea nitrogen (BUN) level
ANS: C GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status and protein intake. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function
A 55-year-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? a. Creatinine 1.6 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg
ANS: C High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when erythropoietin (EPO) is administered to a target hemoglobin of >12 g/dL. Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider but will not affect whether the medication is administered
Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for a. potassium level. b. total cholesterol. c. serum phosphate. d. serum creatinine.
ANS: C If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered
A 64-year-old male patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. Unlimited fluids are allowed because retained fluid is removed during dialysis. c. More protein is allowed because urea and creatinine are removed by dialysis. d. Dietary potassium is not restricted because the level is normalized by dialysis.
ANS: C Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes
A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention? a. The LPN/LVN administers the erythropoietin subcutaneously. b. The LPN/LVN assists the patient to ambulate out in the hallway. c. The LPN/LVN administers the iron supplement and phosphate binder with lunch. d. The LPN/LVN carries a tray containing low-protein foods into the patient's room.
ANS: C Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency.
Which action by a 70-year-old patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing. b. The patient plans 30 to 60 minutes for a dialysate exchange. c. The patient cleans the catheter while taking a bath each day. d. The patient slows the inflow rate when experiencing abdominal pain.
ANS: C Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis
Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful? a. Split-pea soup, English muffin, and nonfat milk b. Oatmeal with cream, half a banana, and herbal tea c. Poached eggs, whole-wheat toast, and apple juice d. Cheese sandwich, tomato soup, and cranberry juice
ANS: C Poached eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV? a. Urine volume b. Calcium level c. Cardiac rhythm d. Neurologic status
ANS: C The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate
A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? a. Notify the patient's health care provider. b. Document the QRS interval measurement. c. Check the medical record for most recent potassium level. d. Check the chart for the patient's current creatinine level.
ANS: C The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening dysrhythmias
Which statement by a 62-year-old patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective? a. "I need to get most of my protein from low-fat dairy products." b. "I will increase my intake of fruits and vegetables to 5 per day." c. "I will measure my urinary output each day to help calculate the amount I can drink." d. "I need to take erythropoietin to boost my immune system and help prevent infection."
ANS: C The patient with end-stage kidney disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.
After the insertion of an arteriovenous graft (AVG) in the right forearm, a 54-year-old patient complains of pain and coldness of the right fingers. Which action should the nurse take? a. Teach the patient about normal AVG function. b. Remind the patient to take a daily low-dose aspirin tablet. c. Report the patient's symptoms to the health care provider. d. Elevate the patient's arm on pillows to above the heart level.
ANS: C The patient's complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will further decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts
A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin (Garamycin) 60 mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patient's a. blood glucose. b. urine osmolality. c. serum creatinine. d. serum potassium.
ANS: C When a patient at risk for chronic kidney disease (CKD) receives a potentially nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in assessing for the adverse effects of the gentamicin
Two hours after a closed percutaneous kidney biopsy, the client reports a dramatic increase in pain. What is the nurse's best first action? A. Reposition the client on the operative side. B. Administer prescribed opioid analgesic. C. Assess pulse rate and blood pressure. D. Check the Foley catheter for kinks.
ANS: C An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of internal hemorrhage.
With a renal threshold for glucose of 220 mg/dL, what is the expected response when a client has a blood glucose level of 400 mg/dL? A. 400 mg/dL of excreted glucose in the urine B. 220 mg/dL of excreted glucose in the urine C. 180 mg/dL of glucose is excreted in the urine D. No excreted glucose in the urine
ANS: C Blood glucose is freely filtered at the glomerulus. Therefore, if a client has a blood sugar level of 400 mg/dl, the filtrate in the proximal convoluted tubule will have a glucose concentration of 400 mg/dL. With a renal threshold of 220 mg/dl, a total of 220 mg/dL of the 400 mg/dL will be reabsorbed back into the systemic circulation, and the final urine will have a glucose concentration of 180 mg/dL.
The client is going home after urography. Which instruction or precaution should the nurse teach this client? A. "Avoid direct contact with the urine for 24 hours until the radioisotope clears." B. "You are likely to experience some dribbling of urine for several weeks after this procedure." C. "Be sure to drink at least 3 L of fluids today to help eliminate the dye faster." D. "Your skin may become slightly yellow-tinged from the dye used in this procedure."
ANS: C Dyes used in urography are potentially nephrotoxic.
6. What is the result of stimulation of erythropoietin production in the kidney tissue? A. Increased blood flow to the kidney B. Inhibition of vitamin D and loss of bone density C. Increased bone marrow production of red blood cells D. Inhibition of the active transport of sodium, leading to hyponatremi
ANS: C Erythropoietin is produced in the kidney and released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell (RBC) production in the bone marrow.
Confirmed by palpation and x-ray study, the client's right kidney is lower than the left kidney. What is the nurse's interpretation of this finding? A. The client has a problem involving the right kidney. B. The client has a problem involving the left kidney. C. The client has both kidneys in the normal position. D. The client is at increased risk for kidney impairment.
ANS: C Normally, the right kidney is positioned somewhat lower than the left kidney. This anatomic difference in otherwise symmetric organs is caused by liver displacement. The significance of this difference is that the right kidney is easier to palpate in an adult than is the left kidney.
The client has an elevated blood urea nitrogen (BUN) level and an increased ratio of blood urea nitrogen to creatinine. What is the nurse's interpretation of these laboratory results? A. The client probably has a urinary tract infection. B. The client may be overhydrated. C. The kidney may be hypoperfused. D. The kidney may be damaged.
ANS: C When dehydration or renal hypoperfusion exist, the BUN level rises more rapidly than the serum creatinine level, causing the ratio to be increased, even when no renal dysfunction is present.
A patient complains of leg cramps during hemodialysis. The nurse should first a. massage the patient's legs. b. reposition the patient supine. c. give acetaminophen (Tylenol). d. infuse a bolus of normal saline.
ANS: D Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.
After receiving change-of-shift report, which patient should the nurse assess first? a. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange b. Patient with stage 4 chronic kidney disease who has an elevated phosphate level c. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L d. Patient who has just returned from having hemodialysis and has a heart rate of 124/min
ANS: D The patient who is tachycardic after hemodialysis may be bleeding or excessively hypovolemic and should be assessed immediately for these complications. The other patients also need assessments or interventions but are not at risk for life-threatening complications
A nurse observes that the client's left flank region is larger than the right flank region. What is the nurse's best action? A. Ask the client if he or she participates in contact sports and has been recently injured. B. Document the finding as the only action on the appropriate flowsheet. C. Apply a heating pad to the left flank after inspecting the site for signs of infection. D. Anticipate further diagnostic testing after sharing informing the physician of this finding
ANS: D Asymmetry of the flank or a unilateral protrusion may indicate an enlargement of a kidney. The enlargement may be benign or may be associated with a hydronephrosis or mass on the kidney.
Which change in renal or urinary functioning as a result of the normal aging process increases the older client's risk for infection? A. Decreased glomerular filtration B. Decreased filtrate reabsorption C. Weakened sphincter muscles D. Urinary retention
ANS: D Incomplete bladder emptying for whatever reason increases the client's risk for urinary tract infections as a result of urine stasis providing an excellent culture medium that promotes the growth of microorganisms.
The client reports the regular use of all the following medications. Which one alerts the nurse to the possibility of renal impairment when used consistently? A. Antacids B. Penicillin C. Antihistamine nasal sprays D. Nonsteroidal anti-inflammatory drug
ANS: D NSAIDs inhibit prostaglandin production and decrease blood flow to the nephrons. They can cause an interstitial nephritis and renal impairment.
The client is scheduled to have a renogram (kidney scan). She is concerned about discomfort during the procedure. What is the nurse's best response? A. "Before the test you will be given a sedative to reduce any pain." B. "A local anesthetic agent will be used, so you might feel a little pressure but no pain." C. "Although this test is very sensitive, there is no more discomfort than you would have with an ordinary x-ray." D. "The only pain associated with this procedure is a small needle stick when you are given the radioisotope
ANS: D The test involves an intravenous injection of the radioisotope and the subsequent recording of the emission by a scintillator.
The patient is incontinent, and a condom catheter is placed. The nurse should take which action? A) Secure the condom with adhesive tape B) Change the condom every 48 hours C) Assess the patient for skin irritation D) Use sterile technique for placement
Assess the patient for skin irritation