Chapter 62 EAQ: Kidney Disorders, Chapter 61 EAQ: Infectious Urinary Disorders, Chapter 60 EAQ: Renal System Assessment

For a patient with acute kidney injury, which question best assists the nurse when assessing the patient's history of hypertension?

"Have you ever been told your blood pressure is high?"

Which nurse response best answers a patient's question regarding the difference between nephritis and nephrosis after receiving a diagnosis of nephritis?

"Nephritis is the inflammation of the kidney, and nephrosis is the degeneration of the kidney."

Which information would the nurse include when teaching a patient about the administration of phenazopyridine for treatment of cystitis?

"Your urine will turn red or orange while on the drug."

Which drug is recommended to treat hypertension related to polycystic disease (PKD)?

ACE inhibitors

The nurse is assessing a female patient who has a history of recurrent urinary tract infection after sexual intercourse. Which information would the nurse include when teaching the patient measures to prevent future infection?

Empty the bladder before and after intercourse

Which condition is likely to occur in a patient who is on immunosuppressant medication?

Fungal urinary tract infection

Which factor is an indicator for a diagnosis of hydronephrosis?

History of urinary stones

Which condition is the nurse concerned about for a patient whose ultrasound shows an obstruction in the upper part of the ureter?

Hydronephrosis

To determine the functional ability of the kidney, which diagnostic test is safe for patients with kidney failure?

Nuclear renal scan

Which diagnostic test would the nurse review for an estimated glomerular filtration rate (GFR)?

Nuclear renal scan

When assessing a patient suspected of having pyelonephritis, which patient position provides the best opportunity for the nurse to auscultate the renal vessels?

Supine

Which information would the nurse include when teaching a patient about the administration of phenazopyridine to reduce bladder pain and burning on urination?

Take the drug with a meal

Which instruction would the nurse provide a patient who has been prescribed amoxicillin/clavulanate for treatment of a urinary tract infection?

Take the medication with food

Which causative factor would the nurse associate with an athlete hospitalized with kidney dysfunction?

Taking dietary supplementation with synthetic creatine

Which interpretation would the nurse formulate as the cause of a patient's BUN/creatinine ratio being 4.4?

The patient has fluid volume excess

Which antibiotic for treating cystitis may cause side effects of sunburn and skin darkening?

Sulfamethoxazole

When the nurse is providing discharge instructions for a patient diagnosed with acute kidney injury, which question by the nurse best assesses the patient's understanding of the condition?

"Can you tell me what happens with your condition?"

When the nurse is assessing a patient's renal status during the admission process to a medical surgical unit, which question by the nurse best determines if the patient's urine output is adequate?

"Does your urine output usually match the amount of fluid you drink?"

Which statement by the nurse indicates a need for further education on serum creatinine?

"Older adults have a decreased serum creatinine level."

Which statement regarding urosepsis is correct?

"Urosepsis results as infection spreads from the urinary tract to the bloodstream."

When teaching a patient about a scheduled kidney, ureter, and bladder (KUB) x-ray, which statement would the nurse include in the teachings?

"You do not need any special preparation for this test."

Which clinical finding in a postmenopausal patient with urethritis would the nurse attribute to low estrogen levels?

A pelvic examination shows tissue changes

In which order would the health care provider perform a percutaneous kidney biopsy? 1. The health care provider injects a local anesthetic 2. The entry area is prepped and draped with sterile barriers 3. The patient is sedated and placed in the prone position 4. Preliminary images are obtained, and the entry site is selected 5. The biopsy device is inserted into the tissues toward the kidney

3, 4, 2, 1, 5

Which laboratory test would the nurse associate with the best indicator of kidney function?

Creatinine

Which parameter would the nurse examine to assess a patient's acid-base balance?

Bicarbonate level

The nurse would associate the kidney's release of renin with which functional response?

Blood pressure

Which complication may occur in a patient receiving ciprofloxacin treatment?

Cardiac dysrhythmia

A 76 year old patient on prolonged bedrest related to a history of stroke has an increased risk for development of which condition?

Chronic pyelonephritis

Which information would the nurse include when teaching a patient about preventing further flare-ups of cystitis?

Consume at least 2 to 3 L of fluids daily

Which goal is a priority when caring for a patient with polycystic kidney disease (PKD)?

Controlling hypertension

To determine a patient's kidney function, which diagnostic test would the nurse review to obtain the patient's glomerular filtration rate (GFR)?

Creatinine clearance

Which age-related change would the nurse associate with a patient's report of nocturia?

Decreased ability to concentrate urine

Which diagnostic test can be used to palpate the prostate?

Digital rectal examination

Which instruction would the nurse include when teaching a patient measures to decrease the risk for UTI?

Drink 2 to 3 L of fluid daily

Which risk would the nurse anticipate in a patient with an age-related decrease in the glomerular filtration rate (GFR)?

Drug reactions

Which finding is typical of chronic glomerulonephritis?

Dyspnea

Which organism is most likely to cause infectious cystitis?

E. coli

Which sample of urine is likely to be collected for accurate urinalysis for a patient with symptoms of acute glomerulonephritis?

Early morning sample

For a patient with a genetic malformation of the proximal convoluted tubules (PCTs) of the nephrons, which alteration would the nurse anticipate as a direct result of the malformation?

Electrolyte imbalance

Which factor would the nurse associate with the potential cause of a patient's nephrogenic systemic fibrosis?

Exposure to gadolinium-enhanced MRI

Which clinical manifestation occurs because of the inability of the kidneys to concentrate urine in patient with polycystic kidney disease?

Nocturia

Which assessment finding would the nurse expect for a patient with chronic pyelonephritis?

Hyperkalemia

Which diagnostic test is most important for a patient with hydronephrosis before a nephrostomy?

INR

Which laboratory test must be performed before a nephrostomy?

INR, PT, PTT

Which assessment finding would the nurse anticipate for a patient with polycystic kidney disease (PKD)?

Increased abdominal girth

Which information would the nurse provide to a patient after a renal echography that indicates hydronephrosis?

It is caused by an obstruction in the renal pelvis

Which statement by the nurse indicates understanding of hydronephrosis?

It may occur because of an obstruction caused by kidney stones

Aging does not affect which anatomic structure or function of the kidney?

Juxtamedullary nephron functions

When the nurse is providing emergency department care for a patient with a severely elevated serum creatinine level, which pathologic condition may increase the patient's serum creatinine level?

Kidney disease

Which condition would the nurse associate with a patient whose laboratory results indicate a serum creatinine level of 1.8 mg/dL?

Kidney impairment

Which complication of polycystic kidney disease (PKD) may result in high blood pressure?

Kidney ischemia

Hydroureter is caused by obstruction in which location?

Lower part of the ureter

Which priority intervention would the nurse implement when providing care for a patient with a glomerular filtration rate (GFR) of 45mL/min secondary to kidney disease?

Maintain an adequate fluid intake

Which aspect of a patient's renal function is most important for the nurse to assess?

Maintenance of body fluid volume

Which purpose statement would the nurse associate with scheduled radiography of the kidneys, ureters, and bladder (KUB)?

Measure the size of both kidneys

Which symptom would the nurse assess when providing care for a patient with uremia?

Nausea and vomiting

Which statement by a nurse indicates understanding of the etiology and genetic risk for polycystic kidney disease (PKD)?

PKD can occur in those with no family history of the disease

When a patient is recovering from a kidney biopsy, which clinical manifestation would the nurse associate with the patient's internal bleeding or a hematoma?

Pain radiating to the flank

Which patient is at risk if the nurse attempts to palpate the patient's kidney?

Patient with a tumor in the kidney

Which nursing intervention or practice is most effective in helping to prevent UTIs in hospitalized patients?

Periodically re-evaluating the need for indwelling catheters

Which medication for treating a urinary tract infection may cause red-colored urine when voiding?

Phenazopyridine

Which finding would the nurse anticipate when assessing the perineal area of a female patient who suspected of having a UTI?

Pink urethral meatus

Which kidney disease is associated with a higher incidence of cerebral aneurysms?

Polycystic kidney disease

Which nursing activity illustrates proper aseptic technique during catheter care?

Positioning the collection bag below the height of the bladder

Which result would lead the nurse to determine that a urine specimen taken for a urine culture has been contaminated?

Presence of more than 20 epithelial cells/high power field

Which is the priority goal when caring for a patient with polycystic kidney disease (PKD)?

Prevent progression of the disease

Which kidney hormone regulates intrarenal blood flow by vasodilation or vasoconstriction?

Prostaglandins

Which procedure is preferred for the removal of a large stone from the kidney pelvis?

Pyelolothotomy

When taking the health history of a patient with acute glomerulonephritis, the nurse would question the patient about which related cause of the problem?

Recent respiratory infection

Which complication may occur in a patient with asymptomatic bacteriuria?

Renal insufficiency

Which complication would the nurse expect in an older patient with an indwelling catheter for urinary continence?

Risk for infection

Which laboratory result would the nurse use as the best indicator of kidney function when providing care for a patient who developed glomerulonephritis after a streptococcal infection?

Serum creatinine

Which laboratory parameter indicates impaired kidney function?

Serum creatinine of 3.1 mg/dL

Which condition may predispose a patient to chronic pyelonephritis?

Spinal cord injury

Which type of physiologic change in the kidney would the nurse associate with nocturnal polyuria?

Tubular changes

Which age-related change to the renal system would the nurse recognize as the likely cause of a patient's reports of nocturia disrupting sleep and daytime urgency with low-volume output?

Tubular changes with aging decrease the ability to concentrate urine

Which test would be performed if urine reflux is suspected?

Voiding cystourethrography

Which information would be revealed in a urinalysis on a patient who has pyuria?

White blood cells in the urine

Which instruction would the nurse include when educating a female patient about hygiene measures to reduce her risk for a urinary tract infection?

Wipe from front to back

Which instruction would the nurse include when teaching a female patient about cystitis? (SATA) a. If urine remains cloudy, call the clinic b. Try to take in 64 oz of fluid each day c. Be sure to complete the full course of antibiotics d. Expect some flank discomfort until the antibiotic has worked e. Cleanse the perineum from back to front after using the bathroom

a, b, c

Which patient(s) with an indwelling urinary catheter would the nurse reassess to determine if continued catheterization is necessary? (SATA) a. Patient in post-anesthesia care b. 3 day postoperative patient c. Incontinent older adult in long term care d. Incontinent patient with perineal skin breakdown e. Comatose patient with hourly intake and output monitoring

a, b, c

When preparing a patient for a kidney biopsy, the nurse would complete which required assessment before sending the patient for the procedure? (SATA) a. Prothrombin time (PT) b. Blood pressure c. Hemoglobin d. Bladder scan e. Platelet count

a, b, c, e

Which assessment finding is a key feature of acute pyelonephritis? (SATA) a. Nocturia b. Flank pain c. Hypertension d. Abdominal discomfort e. Decreased ability to concentrate urine

a, b, d

Which laboratory finding(s) suggest the onset of nephrotic syndrome for a patient with altered kidney function? (SATA) a. Lipiduria b. Severe proteinuria c. Decreased coagulation d. Increased serum lipid level e. Increased serum albumin level

a, b, d

Which information would the nurse include when teaching a patient about the administration of trimethoprim/sulfamethoxazole to treat a UTI? (SATA) a. Take this drug with 8oz of water b. Drink at least 2 to 3L of fluids every day c. Try to urinate frequently to keep the bladder empty d. Be certain to wear sunscreen and protective clothing e. You will need to take all of the drug to get the benefits

a, b, d, e

Which factor may contribute to the development of infectious cystitis? (SATA) a. Age b. Peritonitis c. Diabetes mellitus d. Bowel pathogens e. Elevated erythropoietin levels

a, c, d

The nurse is teaching a group of older adult women about signs and symptoms of a UTI. Which concept would the nurse include in the presentation? (SATA) a. Dysuria b. Enuresis c. Nocturia d. Urgency e. Polyuria f. Frequency

a, c, d, f

A female patient has acquired a UTI for the second time. Which information would the nurse include when teaching the patient measures to prevent future infections? (SATA) a. Increase water intake b. Take a vitamin A supplement daily c. Wear loose-fitting cotton underwear d. Clean the perineal area from back to front e. Take prescribed antibiotics as directed, and schedule a follow-up appointment

a, c, e

Which information would the nurse include when teaching a patient about the administration of trimethoprim/sulfamethoxazole for treatment of urinary tract infection? (SATA) a. Monitor the pulse twice daily while taking this drug b. Drink a full glass of water with each dose of the drug c. Avoid taking the drug within 2 hours of taking an antacid d. Wear sunscreen and protective clothing when out in the sun e. Disclose any allergies to sulfa drugs before beginning therapy

b, d, e