Exam 2 Study Guide: 60, 61, 62, 63
For a patient with acute kidney injury, which question best assists the nurse when assessing the patient's history of hypertension? (60)
"Have you ever been told your blood pressure is high?"
When assessing a patient with a history of multiple renal calculi formations, the nurse would associate which patient statement with increasing the patient's risk for future stone development?
"I eat large amounts of protein."
Which assessment information is critical for the nurse to report to the health care provider before a patient receives extracorporeal shock wave lithotripsy (ESWL)? (61) "I have been taking cephalexin for an infection." "I previously had several ESWL procedures performed." "I take over-the-counter naproxen twice a day for joint pain." "Blood in my urine has become less noticeable, so maybe I don't need this procedure."
"I take over-the-counter naproxen twice a day for joint pain."
When teaching a patient how to provide a clean-catch urine specimen, which patient statement indicates effective teaching? (60)
"I'll start to urinate in the toilet, stop, and then urinate into the cup."
The nurse is teaching a patient with acute kidney injury how to take prescribed ferrous sulfate. Which statement made by the patient indicates a need for further teaching? (63) "I have to take the drug after dialysis." "The drug should be taken along with meals." "I must take a stool softener daily along with this drug." "My pulse should be taken daily before I take this drug."
"My pulse should be taken daily before I take this drug."
Which nurse response best answers a patient's question regarding the difference between nephritis and nephrosis after receiving a diagnosis of nephritis? (60)
"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? (61)
"Your urine will turn red or orange while on the drug."
Which information would the nurse include when teaching a patient about the administration of estrogen for treatment of urinary incontinence? (61) Use hard candy to moisten the mouth. A thin application of cream is adequate. Change positions slowly, especially in the mornings. Report urine output that is significantly lower than fluid intake.
A thin application of cream is adequate
Which role do loop diuretics have in the treatment of acute kidney injury? (63) Preserving kidney function Promoting calcium retention Regulating the glomerular filtration rate Eliminating any retained fluid from the body
Eliminating any retained fluid from the body
The nurse is assessing a female patient who has a history of recurrent urinary tract infection (UTI) after sexual intercourse. Which information would the nurse include when teaching the patient measures to prevent future infection? (61)
Empty the bladder before and after intercourse
When obtaining a patient's history, the nurse would determine that which problem is a potential risk for the patient who admits to consuming a high-protein diet for a long time? (60)
Formation of calculi or stones
Which nursing diagnosis would the nurse use for a patient with urinary incontinence related to impaired cognition and neuromuscular limitations? (61)
Functional urinary incontinence
Which condition is likely to occur in a patient who is on immunosuppressant medication? (61)
Fungal urinary tract infection
When administering medications to a patient with renal impairment during a renal scan, the nurse would correlate which medication with the patient's diluted urinary output? (60)
Furosemide diuretics such as furosemide increase the flow of urine, thereby making the urine diluted in patients with renal impairment
Which type of kidney disorder may occur in a patient diagnosed with systemic lupus erythematosus (SLE)? (62) Pyelonephritis Nephrosclerosis Glomerular disease Renovascular disease
Glomerular disease E.G.gs
Which method for achieving continence would the nurse include in the plan of care for a patient who is cognitively impaired and has urge incontinence? (61) Habit training (scheduled toileting) Credé method Bladder training Kegel exercises
Habit training (scheduled toileting)
Which assessment finding would the nurse expect for a patient with renal cell carcinoma (RCC)? One, some, or all responses may be correct. (62) Hematuria Patient report of flank pain Mass palpated on the patient's kidney Bruit on auscultation of the kidney Recent weight gain
Hematuria Patient report of flank pain Mass palpated on the patient's kidney Bruit on auscultation of the kidney
The nurse is assessing a patient brought to the emergency department after a motor vehicle collision (MVC). Which cue would the nurse notice if the patient sustained injury to the kidneys? Select all that apply. One, some, or all responses may be correct. (62) Hematuria Leukocytosis Flank bruising Abdominal pain Nausea and vomiting
Hematuria (blood in urnie) Flank bruising Abdominal pain
When preparing to perform a bladder scan to detect residual urine in a female patient, the nurse must first assess which factor? (60) Hematuria (blood in urine) Abdominal girth History of hysterectomy Presence of urinary infection
History of hysterectomy
Which factor is an indicator for a diagnosis of hydronephrosis? (62) History of nocturia Recent weight loss Urinary incontinence History of urinary stones
History of urinary stones
When reviewing the medical record of a patient with polycystic kidney disease who has CT angiography with contrast scheduled, the nurse would implement which essential intervention? (60)
Hold the metformin 24 hours before and on the day of the procedure.
For which imaging assessment would the nurse prepare a patient diagnosed with acute kidney injury (AKI) to measure the glomerular filtration rate (GFR)? (63) CT Mercaptoacetyltriglycine (MAG3) Kidney, ureter, and bladder (KUB) MRI
Mercaptoacetyltriglycine (MAG3)
Which clinical manifestation occurs because of the inability of the kidneys to concentrate urine in patients with polycystic kidney disease? (62) Oliguria Nocturia Hematuria Proteinuria
Nocturia
Which sign or symptom would the nurse expect to find during the assessment of a patient with polycystic kidney disease (PKD)? Select all that apply. One, some, or all responses may be correct. (62) Diarrhea Nocturia Flank pain Hypotension Kidney stones
Nocturia Flank Pain Kidney stones N -o F- ighting K -ids
Which assessment finding is a key feature of acute pyelonephritis? Select all that apply. One, some, or all responses may be correct. (62) Nocturia Flank pain Hypertension Abdominal discomfort Decreased ability to concentrate urine
Nocturia Flank pain Abdominal discomfort N- o F- ighting A- llowed
Which diagnostic test would the nurse review for an estimated glomerular filtration rate (GFR)? (60)
Nuclear renal scan
Which diagnostic test would the health care provider prescribe to evaluate a patient's renal perfusion and glomerular filtration rate (GFR) w/OUT exposing the patient to iodinated contrast dye? (60)
Nuclear renal scan a nuclear renal scan evaluates renal perfusion and estimates the GFR. This method also provides functional information without exposing the patient to iodinated contrast dye
Which factor is a risk factor for renal cell carcinoma (RCC)? Select all that apply. One, some, or all responses may be correct. (62) Obesity Smoking Older age Male gender Family history
Obesity Smoking Older age Male gender Family history (al of them)
Which action would the nurse take when preparing a patient for a CT scan with contrast medium? Select all that apply. One, some, or all responses may be correct. (63) Obtain a prescription for IV fluids. Review the patient's glomerular filtration rate
Obtain a prescription for IV fluids. Review the patient's glomerular filtration rate
Which symptom would be seen in a patient if a stone has reached the bladder? (61) Hematuria (blood in urine) Oliguria (small amounts or urine) Dysuria (painful urination) Anuria (kidneys not producing urine)
Oliguria (small amounts or urine) frequency and dysuria (painful urination) occur when a stone reaches the bladder
What pretreatment would be given to a patient with a known history of renal failure while administering ibuprofen? (63) Oral or IV antibiotics Oral or IV diuretic medication Oral or IV bolus of fluid volume Oral or IV H2-receptor antagonist
Oral or IV bolus of fluid volume pretreatment hydration is proven to reduce the nephrotoxic potential of many drugs. Therefore fluid intake is advised before the administration of ibuprofen, which is potentially nephrotoxic
When assessing a patient suspected of having pyelonephritis, which patient position provides the best opportunity for the nurse to auscultate the renal vessels? (60)
Supine
Which information would the nurse include when teaching a patient about the administration of phenazopyridine to reduce bladder pain and burning on urination? (61)
Take the drug with a meal the patient should take the drug with a meal to prevent GI disturbances. The patient need not report the finding of urine that appears as red or orange because this is an expected response to the drug
Which information would the nurse include when teaching a patient about the administration of trimethoprim/sulfamethoxazole to treat a urinary tract infection? Select all that apply. One, some, or all responses may be correct. (61) .
Take this drug with 8 oz of water Drink at least 2 to 3 L of fluids every day Be certain to wear sunscreen and protective clothing You will need to take all of the drug to get the benefits
Which causative factor would the nurse associate with an athlete hospitalized with kidney dysfunction? (60)
Taking dietary supplementation with synthetic creatine
Which initial assessment finding would alarm the nurse when receiving a patient from the operating room after a cystoscopy performed under conscious sedation? (60) Lethargy Pink-tinged urine Urinary frequency Temperature of 100.8°F (38.2°C)
Temperature of 100.8°F (38.2°C)
Which information would the nurse include when providing teaching about intravesical instillation of Bacille Calmette-Guérin (BCG) to prevent the recurrence of a bladder tumor?(61) Flush the toilet three times after use. The procedure is done in an inpatient setting. Dispose of clothing that comes in contact with urine in 24 hours. The BCG virus compound is allowed to dwell in the bladder for 2 hours.
The BCG virus compound is allowed to dwell in the bladder for 2 hours
Which kidney, ureter, and bladder (KUB) x-ray finding indicates a patient abnormality? (60)
The Left kidney is much Larger than the right kidney. MEMORY TRICK: LEFT LARGER
Which age-related kidney change would the nurse expect of an older patient? (60)
The kidney loses cortical tissue
Which rationale would the nurse associate with a patient's urinalysis report reflecting a pH value of 4? (60) The patient is on a high-protein diet. The patient has a high intake of citrus fruits. The patient's urine has multiple bacteria, indicating an infection. The patient's urine specimen remained uncovered after collection.
The patient is on a high-protein diet
Which antibiotic for treating cystitis may cause side effects of sunburn and skin darkening? (61)
Sulfamethoxazole
Which diagnostic test is the first step in the assessment of incontinence in a patient? (61)
Urinalysis
Which statement by the nurse explains treatment of urethritis in a young adult who is sexually active? (61) "An estrogen cream applied to the vagina reduces irritation." "An Epsom salt bath once a day will resolve symptoms quickly." "A progesterone supplement taken orally decreases inflammation." "A broad-spectrum antibiotic will improve symptoms within 24 hours."
"A broad-spectrum antibiotic will improve symptoms within 24 hours."
Which instructions would the nurse provide to a patient who is to undergo noninvasive diagnostic imaging for suspected renovascular disease? (62) "A radionuclide scan will evaluate your kidney's vessels." "A renal artery bypass will evaluate your kidney's vessels." "A kidney, ureter, and bladder (KUB) scan will evaluate your kidney's vessels." "A magnetic resonance angiography (MRA) will evaluate your kidney's vessels."
"A radionuclide scan will evaluate your kidney's vessels."
At a health fair, the nurse is teaching attendees about acute kidney injury (AKI). Which statement made by a participant indicates a need for further teaching? (63) "The onset of AKI is sudden." "AKI is usually not reversible." "AKI involves 50% of nephrons." "Duration of AKI is around 2 to 3 weeks."
"AKI is usually not reversible."
Which information would the nurse include when providing preoperative education to a patient scheduled for extracorporeal shock wave lithotripsy? Select all that apply. One, some, or all responses may be correct. (61) "Be sure to finish all of your antibiotics." "Your urine will be strained after the procedure." "You will need to change the incisional dressing once a day." "Immediately call the health care provider if you notice bruising." "Remember to drink at least 3 L of fluid a day to promote urine flow."
"Be sure to finish all of your antibiotics." "Your urine will be strained after the procedure." "Remember to drink at least 3 L of fluid a day to promote urine flow."
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? (60)
"Can you tell me what happens with your condition?"
A male patient being treated for bladder cancer has a live virus compound instilled into the bladder as a treatment. Which instruction would the nurse provide for postprocedure home care? (61) "Please be sure to stand when you are urinating." "Do not share your toilet with family members for the next 24 hours." "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."
"Do not share your toilet with family members for the next 24 hours." the toilet should not be shared for 24 hours after this procedure because others using the toilet could be infected with the live virus that was instilled into the patient If only one toilet is available in the household, teach the patient to flush the toilet after use and to follow this by adding 1 cup of undiluted bleach to the bowl water. The bowl is then flushed after 15 minutes, and the seat and flat surfaces of the toilet are wiped with a cloth containing a solution of 10% liquid bleach. The patient must sit when he is urinating for at least 24 hours after the procedure to prevent splashing of the contaminated urine out of the commode, where it could be toxic for anyone who comes in contact with it. Underwear or other clothing that has come into contact with urine during the 24 hours after instillation should be washed separately from other clothing in a solution of 10% liquid bleach; it does not need to be discarded.
When needing a clean-catch urine specimen, which instruction would the nurse provide the patient? (60) "Save all urine for 24 hours." "Do not touch the inside of the container." "You will receive an isotope injection, and then I will collect your urine." "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup."
"Do not touch the inside of the container."
To assess the socioeconomic factors contributing to the patient's kidney disease, the home health nurse would ask which question? Select all that apply. One, some, or all responses may be correct. (60)
"Do you speak English?" "Do you have a religious preference?" "Are you able to fill your prescriptions without difficulty?"
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? (60)
"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? (60) "Older adults have a decreased serum creatinine level." "The serum creatinine level is a good indicator of kidney function." "The serum creatinine level is slightly higher in men than in women." "Athletes have a slightly higher than normal level of serum creatinine level."
"Older adults have a decreased serum creatinine level."
Which question from the nurse to the interprofessional health care team may result in reducing the incidence of hospital-acquired acute kidney injury (AKI)? (63) "Should we filter air circulation?" "Should we decrease IV fluid rates?" "Should we add low-dose dopamine to the treatment regimen?" "Should we use less radiographic contrast dye?"
"Should we use less radiographic contrast dye?"
An older-adult patient confides to the nurse, "I am so embarrassed about buying adult diapers for myself." Which response by the nurse reflects therapeutic communication? (61) "Don't worry about it. You need them." "Shop at night, when stores are less crowded." "Tell everyone that they are for your husband." "That sounds difficult. What do you think might help?"
"That sounds difficult. What do you think might help?"
Which information would the nurse include when teaching a patient with diabetic nephropathy about the pathophysiology of the condition? (62) "The severity of this condition depends on your average blood glucose level." "Diabetic neuropathy generally only occurs in patients with type 1 diabetes mellitus." "Diabetic neuropathy generally only occurs in patients with type 2 diabetes mellitus." "The severity of this condition depends on how long you have had diabetes mellitus."
"The severity of this condition depends on your average blood glucose level."
In which way would the nurse respond to a patient with stage II renal cell carcinoma who asks the nurse, "What does stage II mean?" (62) "The tumor has metastasized beyond your kidney." "The tumor has extended to the renal vein inside your kidney." "The tumor is less than 7 cm and does not involve your lymph nodes." "The tumor is bigger than 7 cm but does not involve your lymph nodes."
"The tumor is BIGGER than 7 cm but does not involve your lymph nodes."
Regarding occupational hazards and risk for renal impairment, which instruction would an occupational nurse provide a patient who works at an oil refinery and has a recent history of renal impairment? (60)
"Try to avoid direct contact of oil with your skin or mucous membranes."
Which statement regarding urosepsis is correct? (61)
"Urosepsis results as infection spreads from the urinary tract to the bloodstream."
When a patient scheduled for a radiologic examination with injected contrast dye states, "I think I had a reaction to the dye the last time I had this procedure performed," which statement would the nurse make in response? (60)
"What kind of reaction did you experience?" This question will let the nurse know the severity of the reaction and the ability to notify the patient's physician regarding the reaction. The patient will likely not know what kind of dye the radiologist administered previously.
Which statement by the nurse to a patient with diabetes regarding the risk for stone formation is correct? Select all that apply. One, some, or all responses may be correct. (61) "What you eat may contribute to the formation of stones." "Obesity is known to play a part in the formation of stones." "The chance of you developing stones is low because you are young." "Metabolic issues have a strong association with stone formation." "Family history of stones does not increase the chances of you having them."
"What you eat may contribute to the formation of stones." "Obesity is known to play a part in the formation of stones." "Metabolic issues have a strong association with stone formation."
When teaching a patient about a scheduled kidney, ureter, and bladder (KUB) x-ray, which statement would the nurse include in the teachings? (60)
"You do not need any special preparation for this test."
Which information would the nurse include when teaching a patient about pelvic muscle exercises? (61) "Results should be visible to you within 72 hours." "Limit your exercises to 5 minutes twice a day, or you will injure yourself." "For the best effect, perform all of your exercises while you are seated on the toilet." "You know that you are exercising correct muscles if you can stop urine flow in midstream."
"You know that you are exercising correct muscles if you can stop urine flow in midstream."
Which instruction would the nurse provide to a patient who is recovering from an endovascular renal stent placement with balloon angioplasty procedure? (62) "You should be able to go home tomorrow." "The bypass only fixed one of your kidneys." "Your total recovery may take up to 2 months." "The synthetic blood vessel graft is a permanent fix."
"You should be able to go home tomorrow." it is a nonsurgical procedure that may be used in the treatment of renovascular disease caused by renal artery stenosis. After the procedure, the patient usually remains under close observation for 24 hours to monitor for sudden blood pressure fluctuations as the kidneys adjust to increased blood flow. So, the nurse would tell the patient that he or she should be able to go home the next day, pending discharge orders from the health care provider
Which statement indicates an understanding of the nurse's teachings about the risk factors associated with kidney problems? Select all that apply. One, some, or all responses may be correct. (60)
- "The sudden onset of hypertension may lead to kidney disease." - "Iodinated contrast medium interaction may lead to kidney dysfunction." - "Pre-existing medical conditions such as diabetes mellitus increase the risk for kidney disease."
Retropubic suspension ( aka Marshall-Marchetti-Krantz or Burch colposuspension) requires a low abdominal incision and a urethral or suprapubic catheter for several days postoperatively (61)
- Elevates the urethral position and provides longer-lasting results - The operation requires a low abdominal incision and a urethral or suprapubic catheter for several days after. - Recovery takes longer, and urinary retention and detrusor instability are the most frequent complications.
Which risk factor is associated with bladder cancer? Select all that apply. One, some, or all responses may be correct. (61)
- History of cigarette smoking - Infection by Schistosoma haematobium - Exposure to textile industry chemicals
Which clinical finding would the nurse attribute to the presence of kidney stones? Select all that apply. One, some, or all response may be correct. (61)
- Smoky urine - Increased serum calcium - Increased serum phosphate Smoky or rusty urine is common in patients with kidney stones and indicates hematuria. Increases in serum calcium and phosphate levels indicate that excess minerals are present and may contribute to stone formation.
Which description portrays a characteristic of the juxtamedullary nephrons in the kidney? Select all that apply. One, some, or all responses may be correct. (60)
- They constitute 20% of all nephrons. - Their tubes dip deeply into the medulla. - They concentrate urine during low fluid intake.
Weak pelvic muscles and structural supports can cause stress urinary incontinence in a patient. Impaired cognition or neuromuscular limitations are related to functional urinary incontinence. Urge urinary incontinence is related to bladder spasms and decreased bladder capacity.
...
Which clinical finding in a postmenopausal patient with urethritis would the nurse attribute to low estrogen levels? (61)
A pelvic examination shows tissue changes
Which amount of urine output is an indicator of adequate perfusion to the remaining kidney after the removal of one of the kidneys? (62) 15 to 20 mL/hr 20 to 25 mL/hr 25 to 30 mL/hr 30 to 50 mL/hr
30 to 50 mL/hr urine output less than 30 mL/hr indicates low levels
Which patient with long-term urinary problems would the nurse refer to community resources and support groups? Select all that apply. One, some, or all responses may be correct. (61) 80-year-old with dementia 32-year-old with a cystectomy 48-year-old with urinary calculi 44-year-old with a Kock pouch 78-year-old with urinary incontinence
32-year-old with a cystectomy 44-year-old with a Kock pouch 78-year-old with urinary incontinence
The nurse provides postdialysis care to a patient. How much protein is required per day if the patient's body weight is 60 kg? (63) 25 g/day 50 g/day 75 g/day 100 g/day
75 g/day patients undergoing dialysis require 1 to 1.5 g/kg of protein intake per day to compensate for any protein lost during dialysis
What does BUN stand for? (60)
A blood urea nitrogen (BUN) test measures the amount of urea nitrogen found in your blood. Urea nitrogen is a waste product made when your liver breaks down protein. It's carried in your blood, filtered out by your kidneys, and removed from your body in your urine
What is creatinine? (60)
A compound that is produced find the metabolism of creatine and excreted in the urine
Why do you not give patients with chronic kidney disease excess amounts of water? (60)
A patient with chronic kidney disease should not consume 2 to 3 L of water because the kidneys are not functioning properly, and this could lead to fluid retention
Which factor may contribute to the development of infectious cystitis? Select all that apply. One, some, or all responses may be correct. (61)
Age Diabetes mellitus Bowel pathogens
Which chemical is directly associated with reduced urine volume in the renin-angiotensin-aldosterone pathway during an acute kidney injury? (63) Renin Aldosterone Angiotensin I Angiotensin II
Aldosterone
Which patient assessment finding may indicate adrenal insufficiency after radical nephrectomy? (62) Patient report of back pain Metallic taste in the mouth Bleeding at the surgical site Altered level of consciousness
Altered level of consciousness
After a nephrectomy for renal carcinoma, a patient has a temperature of 99.7°F (37.6°C) and a productive cough. Which action would the nurse take to prevent respiratory complications? Select all that apply. One, some, or all responses may be correct. (62) Obtain a complete blood count (CBC). Ambulate the patient in the hallway. Instruct on incentive spirometry use. Administer nebulized bronchodilators. Apply sequential compression devices (SCDs).
Ambulate the patient in the hallway. Instruct on incentive spirometry use. Administer nebulized bronchodilators.
Which drug is recommended to treat hypertension related to polycystic kidney disease (PKD)? (62) Diuretics Beta blockers Calcium channel blockers Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors act by controlling cell growth in PKD and changing renal hemodynamics through the reduction of angiotensin II production
For a patient with a kidney disorder, which potential identifiable complication would the nurse associate with a urinalysis indicating the presence of ketones? (60) Cystitis Anorexia nervosa Bleeding disorders Glomerular disorders
Anorexia nervosa the liver produces ketones, which are normally absent in the urine, because of incomplete fatty acid metabolism
Which information would the nurse include when teaching a patient about preventing further flare-ups of cystitis? (61) .
Consume at least 2 to 3 L of fluids daily
Which action would the nurse take for an 84-year-old patient who reports taking ibuprofen for arthritis and captopril for hypertension? (63) Contact the health care provider. Tell the patient to stop the ibuprofen. Document the dosage for each medication. Ask the patient if blood pressure is controlled.
Contact the health care provider
Which laboratory test would the nurse associate with the best indicator of kidney function? (60)
Creatinine
Which typical cause would the nurse associate with a patient's high urine specific gravity on a urinalysis report? (60) Diabetes insipidus Diuretic medications Increased fluid intake Antidiuretic hormone (ADH)
Antidiuretic hormone (ADH)
Which assessment would assist with the confirmation of the presence of stress incontinence? (61)
Asking the patient to cough while wearing a perineal pad
Which information would be beneficial for the nurse to include when teaching a patient with urinary incontinence? (61) Avoid using douches. Drink cranberry juice. Empty your bladder before and after sex. Avoid exercises such as running and jogging.
Avoid exercises such as running and jogging
Which action would the nurse teach a patient to implement after receiving captopril at the beginning of a renography procedure? (60)
Avoid rapid position changes the patient must avoid rapid position changes because of the risk for falling from orthostatic hypotension
Which action would help prevent kidney trauma in a patient with kidney disease? (62) Avoiding contact sports Eating a protein-rich diet Avoiding the use of seat belts Including adequate salt in the diet
Avoiding contact sports
Which parameter would the nurse examine to assess a patient's acid-base balance? (60)
Bicarbonate level (HCO3) Bicarbonate reabsorption in the kidneys maintains acid-base balance
Which complication would the nurse identify as a possible cause of postrenal acute kidney injury (AKI) in a patient? (63) Bladder cancer Acute tubular necrosis Pulmonary embolism Exposure to nephrotoxins
Bladder cancer Postrenal AKI is the obstruction of the urine-collecting system
The nurse would associate the kidney's release of renin with which functional response? (60)
Blood pressure
When the nurse suspects that a 62-year-old patient with kidney disease has GI bleeding, which laboratory finding would support the nurse's suspicion? (60)
Blood urea nitrogen (BUN) value of 25 mg/dL
For the patient with a kidney disorder, which possible color of urine would the nurse associate with the urinalysis indicating an increase in bilirubin levels? (60) Red Brown Very pale Dark amber
Brown
An x-ray would detect which physiologic abnormality in kidney function? (60)
Calcification
Which potential risk would the nurse associate with a patient who consumes 2 L of fluid daily while on a high-protein diet? (60)
Calculi formation
Which complication may occur in a patient receiving ciprofloxacin treatment? (61)
Cardiac dysrhythmia
Which urinalysis finding indicates the presence of a urinary tract infection (UTI)? Select all that apply. One, some, or all responses may be correct. (60) Casts Red blood cells White blood cells Combination of a positive leukocyte esterase and nitrate Presence of more than 20 epithelial cells/high-power field
Casts Red blood cells White blood cells Combination of a positive leukocyte esterase and nitrate
Which assessment finding would the nurse expect for a patient with acute pyelonephritis (inflammation of the kidney due to a bacterial infection) ? Select all that apply. One, some, or all responses may be correct. (62) Chills Dysuria Oliguria Vomiting Suprapubic pain
Chills Dysuria (burning) Vomiting C- hildren D- on't V- accum
Which preprocedure order would the nurse anticipate the health care provider prescribing completion of before performing a percutaneous kidney biopsy on a patient? (60)
Coagulation tests because of the risk for bleeding
Which intervention would the nurse implement when a patient reports an allergy to radiologic contrast dye while scheduling radiologic imaging to assess the patient's suspected renal impairment? (60)
Contact the health care provider to order a renal scan with radioisotope IV injection the renal scan with radioisotope IV injection is an imaging test that does not use an iodinated dye
To determine a patient's kidney function, which diagnostic test would the nurse review to obtain the patient's glomerular filtration rate (GFR)? (60)
Creatinine clearance
When suspecting a urinary obstruction in a patient with renal colic and an increased bilirubin level, the nurse would associate which diagnostic test with identifying the obstruction? (60) Cystoscopy Renal arteriography Cystometrography Electromyography
Cystoscopy
Renal cell carcinoma can cause which issue that can lead to severe anemia? (62) Liver damage Kidney vessel damage Blood in the urine Decrease in red blood cell production
Decrease in red blood cell production renal cell carcinoma may cause anemia because of impaired production of erythropoietin, which is responsible for the production of red blood cells
Which dietary intervention would the nurse implement for a patient diagnosed with uric acid (urate) stones? (61)
Decrease organ meat consumption.
Which causative factor would the nurse associate with a patient's high blood urea nitrogen (BUN) level? (60)
Decreased kidney perfusion
When a patient's urinalysis reports a high specific gravity, which problem would the nurse associate with the probable cause? (60) Dehydration High fluid intake High renal blood flow Low vasopressin level
Dehydration An adult's normal urine specific gravity is 1.005 to 1.030
Which factor would the nurse assess in a patient who is at risk for infectious cystitis? Select all that apply. (61)
Diabetes mellitus Corticosteroid use Antibiotic therapy Indwelling catheter Compromised immunity (all of them)
Which urinary change would the nurse expect in a patient with an enlarged prostate? (60)
Difficulty in starting the urine stream
Which diagnostic test can be used to palpate the prostate? (61)
Digital rectal examination
Which test would be used to determine whether there is tactile sensation in the anal area for a patient with a suspected urinary disorder? (61)
Digital rectal examination (DRE)
Which medication would the nurse associate with contributing to a patient's urinary incontinence? Select all that apply. One, some, or all responses may be correct. (60) Statins Diuretics Beta blockers Opioid analgesics Anticholinergic drugs
Diuretics Opioid analgesics Anticholinergic drugs
Which action by the nurse would best help the health care provider in determining the severity of a patient's kidney injury? (62) Determining the patient's pain level Checking the patient's urine for blood Documenting the mechanism of injury Assessing the appearance of the flank area
Documenting the mechanism of injury
The nurse is teaching a group of school-age children and their parents about ways to prevent kidney trauma. Which information would the nurse include? Select all that apply. One, some, or all responses may be correct. (62) Don a seat belt. Avoid contact sports. Use a helmet with biking. Wear an athletic supporter. Refrain from weightlifting.
Don a seat belt
Which action would the nurse implement first when planning an assessment of a patient's urethra? (60) Don gloves. Examine the meatus. Note any unusual discharge. Record the presence of abnormalities.
Don gloves
Which instruction would the nurse include when teaching a patient measures to decrease the risk for urinary tract infection (UTI)? (61)
Drink 2 to 3 L of fluid daily
Which information would the nurse include when teaching a patient about the administration of trimethoprim/sulfamethoxazole for treatment of urinary tract infection? Select all that apply. One, some, or all responses may be correct. (61)
Drink a full glass of water with each dose of the drug Wear sunscreen and protective clothing when out in the sun Disclose any allergies to sulfa drugs before beginning therapy
Which risk would the nurse anticipate in a patient with an age-related decrease in the glomerular filtration rate (GFR)? (60)
Drug reactions
Which side effect would the nurse include when teaching the patient about the administration of oxybutynin for treatment of stress incontinence? Select all that apply. One, some, or all responses may be correct. (61) Dry mouth Constipation Increased blood pressure Reddish-orange urine color Increased intraocular pressure
Dry mouth Constipation Increased intraocular pressure
Which term would the nurse use to document a patient's report of discomfort and pain when voiding? (60) Anuria (no production of urine) Dysuria (painful urination) Oliguria (small amounts of urine) Polyuria (large amounts of urine)
Dysuria
Which clinical manifestation would the nurse expect to find in an older patient with a urinary tract infection (UTI)? Select all that apply. One, some, or all responses may be correct. (61)
Dysuria Increasing mental confusion Sudden onset of incontinence
The nurse is teaching a group of older-adult women about signs and symptoms of a urinary tract infection (UTI). Which concept would the nurse include in the presentation? Select all that apply. One, some, or all responses may be correct. (61)
Dysuria (painful urination) Nocturia (peeing @ night) Urgency Frequency FUND
Which sample of urine is likely to be collected for accurate urinalysis for a patient with symptoms of acute glomerulonephritis? (62) Daytime sample Late night sample Early morning sample Randomly collected sample
Early morning sample
Which assessment finding would the nurse expect for a patient with chronic glomerulonephritis (acute inflammation of the kidney)? Select all that apply. One, some, or all responses may be correct. (62) Edema of the foot and ankle Flapping tremor of the fingers Itching and dryness of the skin Presence of an S3 heart sound Engorgement of the neck veins
Edema of the foot and ankle Flapping tremor of the fingers Itching and dryness of the skin Presence of an S3 heart sound Engorgement of the neck veins (all of them)
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? (60)
Electrolyte imbalance
Which phrase describes the term hydroureter (abnormally dilated)? (61)
Enlargement of the ureter caused by a stone occluding the ureter when a stone occludes the ureter and blocks the flow of urine, the ureter dilates
Which issue is considered a paraneoplastic syndrome that is common in patients with renal cell carcinoma? (62) Hypotension Erythrocytosis Decreased sedimentation rate Decreased serum calcium level
Erythrocytosis
Deficiency of which hormone may lead to anemia in patients diagnosed with renal cell carcinoma? (62) Renin Erythropoietin Parathyroid hormone Human chorionic gonadotropin
Erythropoietin the kidneys produce erythropoietin, which acts on the bone marrow to stimulate the production of mature red blood cells
Which organism is most likely to cause infectious cystitis (inflammation of the bladder? (61)
Escherichia coli Infectious cystitis is an inflammatory disease that is caused by pathogens from the bowel or the vagina
Which purpose statement would the nurse associate with a patient's scheduled electromyography? (60)
Evaluation of the perineal muscle strength
Which factor would the nurse associate with the potential cause of a patient's nephrogenic systemic fibrosis? (60)
Exposure to gadolinium-enhanced MRI
Which patient is at risk for acute kidney injury (AKI)? Select all that apply. One, some, or all responses may be correct. (63) Football player in preseason practice Patient who underwent contrast dye radiology Accident victim recovering from a severe hemorrhage Accountant with diabetes Patient in the ICU on high doses of antibiotics Patient recovering from GI influenza
Football player in preseason practice Patient who underwent contrast dye radiology Accident victim recovering from a severe hemorrhage Patient in the ICU on high doses of antibiotics Patient recovering from GI influenza
Which condition is the nurse concerned about for a patient whose ultrasound shows an obstruction in the upper part of the ureter? (62) Pyelonephritis (is a bacterial infection in the kidney and pelvis) Hydronephrosis (is an obstructive disorder of the kidney characterized by a blockage in the upper part of the ureter) Glomerulonephritis (is a group of kidney diseases characterized by inflammation of the filtering units of the kidney, called glomeruli) Polycystic kidney disease (is an inherited kidney disorder causing fluid-filled cysts to form in the kidneys; it is not associated with an obstruction in the ureter)
Hydronephrosis
Which condition may occur when a patient with nephrosclerosis takes spironolactone? (62) Hypokalemia Hyperkalemia Hyponatremia Hyperuricemia
Hyperkalemia (high potassium)
Which disorder can lead to nephrosclerosis? Select all that apply. One, some, or all responses may be correct. (62) Hypertension Nephrolithiasis Atherosclerosis Hydronephrosis Diabetes mellitus
Hypertension Atherosclerosis Diabetes mellitus H- arry A- nd D- aisy
Which finding is consistent with adrenal insufficiency as a complication of a right radical nephrectomy surgery to address renal cell carcinoma? (62) Hypokalemia Hyponatremia Very swollen, difficult-to-treat pedal edema Very high, difficult-to-control blood pressure
Hyponatremia
Which assessment finding is an early sign of adrenal insufficiency? (62) Flank pain Proteinuria Hypotension Water retention
Hypotension a decrease in blood pressure or hypotension is the first sign indicating hemorrhage and adrenal insufficiency
Which instruction would the nurse include when teaching a female patient about cystitis? Select all that apply. One, some, or all responses may be correct. (61)
If urine remains cloudy, call the clinic. Try to take in 64 oz of fluid each day. Be sure to complete the full course of antibiotics.
Which change associated with age contributes to the development of urinary tract infections (UTIs)? Select all that apply. One, some, or all responses may be correct. (61)
Immunity Fecal incontinence Decreased estrogen
A female patient has acquired a urinary tract infection (UTI) for the second time. Which information would the nurse include when teaching the patient measures to prevent future infections? Select all that apply. One, some, or all responses may be correct. (61)
Increase water intake. Wear loose-fitting cotton underwear. Take prescribed antibiotics as directed, and schedule a follow-up appointment.
Which urinalysis datum indicates the potential need to increase the patient's fluid intake? (60) Pale-colored urine Decreased sodium Increased creatinine Increased blood urea nitrogen (BUN)
Increased blood urea nitrogen (BUN) Increased BUN can indicate dehydration. Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.
When the nurse is reviewing the urinalysis report of a patient, which finding supports the nurse's interpretation that the patient may have cystitis? (60) Increased protein Increased glucose Increased ketones Increased red blood cells
Increased red blood cells Cystitis is the inflammation of the bladder, which can cause hematuria (presence of red blood cells in the urine). Increased proteins in the urine indicate infection, glomerular disorder, and stress. Increased glucose in the urine indicates hyperglycemia. An increased level of ketones in the urine indicates diabetic ketoacidosis and anorexia nervosa.
Which clinical manifestation would the nurse expect to find while assessing a patient who has renovascular disease? Select all that apply. One, some, or all responses may be correct. (62) Increased serum creatinine Decreased serum creatinine Increased glomerular filtration rate (GFR) Decreased GFR Low blood pressure that is symptomatic High blood pressure that is difficult to control
Increased serum creatinine Decreased GFR High blood pressure that is difficult to control
An important component of the nursing assessment for patients at risk for acute kidney injury includes monitoring. Which alteration in laboratory values would the nurse expect to find in a patient with kidney disease? (63) Increased hematocrit Increased serum calcium Increased serum potassium Decreased serum magnesium
Increased serum potassium
When a patient with diabetes returns to the medical unit after CT with contrast dye, which prescribed intervention would the nurse implement first? (60)
Infuse 0.45% normal saline at 125 mL/hr because the dye used in a CT scan with contrast has an osmotic effect, causing dehydration and potential kidney failure
Which action would the nurse anticipate taking in the diuretic phase of acute kidney injury (AKI)? (63) Administering hyperalimentation Stopping all IV fluids Initiating electrolyte replacement Inserting an indwelling urinary catheter
Initiating electrolyte replacement
Which statement describes how the nurse would perform a physical assessment of a patient's kidneys and bladder? (60)
Inspect for asymmetry in the costovertebral angle (CVA).
Which primary nursing intervention is appropriate for a patient with an acute kidney injury who has increased blood osmolarity? (63)
Isotonic saline infusion blood osmolarity is increased when the solute concentration in the blood is elevated under hypovolemic conditions. The primary nursing intervention is to administer an isotonic saline infusion to raise the fluid levels of the body
Which factor would classify a renal cell carcinoma (RCC) tumor as stage III? (62) It is within the renal capsule. It is smaller than 7 cm. It has extended beyond Gerota fascia. It has invaded the renal vein and lymph nodes.
It has invaded the renal vein and lymph nodes
Aging does NOT affect which anatomic structure or function of the kidney? (60)
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? (60)
Kidney disease
Which condition would the nurse associate with a patient whose laboratory results indicate a serum creatinine level of 1.8 mg/dL? (60)
Kidney impairment normal creatinine for an adult man is 0.6 to 1.2 mg/dL, and for an adult woman it is 0.5 to 1.1 mg/dL
Which complication of polycystic kidney disease (PKD) may result in high blood pressure? (62) Kidney calculi Kidney abscess Kidney ischemia Necrosis of the kidney
Kidney ischemia
A ureterosigmoidostomy diverts urine to which area? (61) Large intestine Surgically created pouch Directly to the skin surface through a stoma Portion of the intestine and let out through a stoma
Large intestine
When reviewing the urinalysis report of a patient, which finding indicates the presence of a urinary tract infection (UTI) for this patient? (60) Casts Crystals Leukocyte esterase Red blood cells
Leukocyte esterase
Which instruction would the nurse give to a patient at discharge after hospitalization for an acute kidney injury (AKI)? Select all that apply. One, some, or all responses may be correct. (63) Increase the intake of foods rich in sodium. Increase the intake of potassium-rich foods. Increase fluid consumption to flush waste. Limit the intake of foods containing phosphorus. Report a daily weight gain of 2 lb or more.
Limit the intake of foods containing phosphorus. Report a daily weight gain of 2 lb or more.
Which drug may be used to treat persistent high blood pressure for a patient with polycystic kidney disease (PKD)? (62) Losartan Lisinopril Diltiazem Hydralazine
Lisinopril
Hydroureter is caused by obstruction in which location? (62) Throughout the ureter Upper part of the ureter Lower part of the ureter Outer parameter of the ureter
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 45 mL/min secondary to kidney disease? (60)
Maintain an adequate fluid intake a normal GFR is 120 mL/min for a healthy young adult and 65 mL/min for an older adult
Which aspect of a patient's renal function is most important for the nurse to assess? (60)
Maintenance of body fluid volume Maintaining body fluid volume is the most important function of the kidneys
Which purpose statement would the nurse associate with scheduled radiography of the kidneys, ureters, and bladder (KUB)? (60)
Measure the size of both kidneys.
When preparing to assess a patient with a portable bladder scanner, which explanation would the nurse provide the patient regarding the purpose of the sonography? (60) Assesses for obstruction Detects tumors and cysts Evaluates kidney blood flow Measures postvoid residual urine
Measures postvoid residual urine
Which drug may interact with warfarin if prescribed for a patient with urinary incontinence? (61) Midodrine Oxybutynin Mirabegron Imipramine
Mirabegron is a selective beta blocker that has some potential to increase blood pressure. It is one of the drugs that can be prescribed for treating urinary incontinence. As the patient is already on warfarin therapy, prescribing mirabegron may be contraindicated because it would interact with warfarin and may cause the risk for bleeding in the patient
Which intervention would the nurse implement for a patient after a retrograde cystography? (60)
Monitor for manifestations of infection.
Prolonged use of which type of drug is known to result in pyelonephritis? (62) Antibiotics Antihypertensives Oral hypoglycemics NSAIDs
NSAIDs
The nurse teaches a patient who is recovering from acute kidney disease to avoid which medication? (63) Opiates Calcium channel blockers NSAIDs Angiotensin-converting enzyme (ACE) inhibitors
NSAIDs
Which sign of uremia would the nurse expect to find when assessing a patient with glomerulonephritis (acute kidney inflammation)? Select all that apply. One, some, or all responses may be correct. (62) Nausea Vomiting Anorexia Hypotension Hypothermia
Nausea Vomiting Anorexia
Which symptom would the nurse assess when providing care for a patient with uremia? (60)
Nausea and vomiting
What treatment is preferred for a patient with kidney trauma who has a grade 5 injury? (62) Drug therapy Fluid therapy Nephrectomy Angiographic embolization
Nephrectomy
Which component on a patient's urinalysis report leads the nurse to suspect the patient has a urinary tract infection? (60) Nitrites Crystals Ketones Red blood cells
Nitrites
A patient reports experiencing involuntary loss and constant dribbling of urine because of an enlarged prostate. Which condition would the nurse document in the medical record? (61) Urge incontinence Stress incontinence Reflex incontinence Overflow incontinence
Overflow incontinence the urethra in the patient is obstructed because of the enlarged prostate; the urethra fails to relax sufficiently to allow the urine to flow, resulting in incomplete bladder emptying or complete urinary retention.
Which pain characteristic would the nurse associate with a patient's renal colic pain? (60)
Pain radiating into the perineal area
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? (60) Pink-tinged urine Increased urine output Increased blood pressure Pain radiating to the flank
Pain radiating to the flank Pain at the biopsy site that radiates to the flank and around the site of the abdomen indicates internal bleeding or a hematoma is forming around the kidney
The nurse is caring for a patient with metastatic renal cell carcinoma. Which cue would the nurse expect to see during the assessment? Select all that apply. One, some, or all responses may be correct. (62) Pallor Anemia Hematuria Weight loss Gynecomastia
Pallor Anemia Hematuria Weight loss Gynecomastia (all of them)
Which assessment finding by the nurse would assist in diagnosing a patient reporting continuous radiating pain into the groin? Select all that apply. One, some, or all responses may be correct. (60)
Pallor (unhealthy appearance) Diaphoresis (sweating) Hypotension
Which event causes hypercalcemia for patients with renal cell carcinoma? (62) Thyroxin hormone is released by the tumor. Bone resorption occurs because of the tumor. Bone breakdown occurs because of the tumor. Parathyroid hormone is released by the tumor.
Parathyroid hormone is released by the tumor.
The blood pressure of four hypotensive patients is given below. Which patient is at risk for developing an acute kidney injury because of renal hypoperfusion? Patient A Patient B Patient C Patient D
Patient A
When preparing to assess four assigned patients, the nurse understands that which patient may incur harm if he or she palpates the urinary system? (60)
Patient having a kidney aneurysm palpation may harm a patient having a kidney aneurysm because it may result in rupture and renal failure
Which patient with an indwelling urinary catheter would the nurse reassess to determine if continued catheterization is necessary? Select all that apply. One, some, or all responses may be correct. (61)
Patient in postanesthesia care 3-day postoperative patient Incontinent older adult in long-term care
Which patient has the highest risk for fungal urinary tract infection? (61)
Patient on corticosteroids corticosteroids suppress immune function and increase the risk for fungal urinary tract infection
Which patient is at risk if the nurse attempts to palpate the patient's kidney? (60)
Patient with a TUMOR in the kidney In a patient with a tumor, the nurse should not palpate the kidney as the assessment may harm the patient
Which of the assigned patients would the nurse encourage to consume 2 to 3 L of fluid each day? (60)
Patient with hyperparathyroidism A major feature of hyperparathyroidism is hypercalcemia, which predisposes a patient to kidney stones; this patient should remain hydrate
When determining patient assignments for the day shift, the charge nurse would assign which patient to a licensed practical nurse/licensed vocation nurse (LPN/LVN)? (60)
Patient with polycystic kidney disease who is having a kidney ultrasound Kidney ultrasounds are noninvasive procedures without complications; the LPN/LVN can provide this care
Which action would the nurse implement when assessing the renal system of a patient reporting left flank pain? (60)
Percuss the right flank before the left If the patient reports flank pain, the nurse should percuss the nontender flank first. In this case, the nurse should percuss the right flank before the left
When the nurse is performing an assessment on a patient with a suspected kidney injury, which rationale best supports auscultating before percussing or palpating the patient? (60)
Percussion and palpation before auscultating may increase bowel sounds, making it more difficult to hear vascular sounds
Which nonsurgical method would the nurse teach a patient to manage stress incontinence? Select all that apply. One, some, or all responses may be correct. (61) Perform Kegel exercises. Reduce excess body weight. Practice vaginal cone therapy. Walk to strengthen pelvic muscles. Use artificial sweeteners instead of sugar.
Perform Kegel exercises. Reduce excess body weight. Practice vaginal cone therapy.
Which nursing intervention or practice is most effective in helping to prevent urinary tract infections (UTI) in hospitalized patients? (61)
Periodically re-evaluating the need for indwelling catheters
A patient with an acute kidney injury is often managed in the ICU by an interprofessional health care team. During the acute phase, the team would include which professional? Select all that apply. One, some, or all responses may be correct. (63) Pharmacist Nephrologist Physical therapist Nephrology nurse Registered dietitian nutritionist Occupational therapist
Pharmacist Nephrologist Nephrology nurse Registered dietitian nutritionist
Which medication for treating a urinary tract infection may cause red-colored urine when voiding? (61)
Phenazopyridine red = rid
Which finding would the nurse anticipate when assessing the perineal area of a female patient who suspected of having a urinary tract infection? (61)
Pink urethral meatus
When performing a bedside ultrasound of a patient's bladder, which action would the nurse implement? (60)
Place 5 mL of conducting gel on the round dome of the scan head for moisture
Which percussion technique would the nurse use to assess a patient who reports flank pain? (60)
Place one hand with the palm DOWN flat over the flank area, and use the other fisted hand to thump the hand on the flank.
Which kidney disease is associated with a higher incidence of cerebral aneurysms? (62) Pyelonephritis Acute kidney injury Glomerulonephritis Polycystic kidney disease
Polycystic kidney disease **aneurysms can make things POP (like PCOS on ovary)
For a patient reporting right flank pain, which action would the nurse implement when preparing to percuss the patient's flank area? (60)
Position the patient in sitting position, clench the hand into a fist, and firmly thump the patient's costovertebral area
Which nursing activity illustrates proper aseptic technique during catheter care? (61)
Positioning the collection bag below the height of the bladder
Dehydration causes which type of acute kidney injury (AKI)? (63) Prerenal AKI Postrenal AKI Intrarenal AKI Intrinsic renal AKI
Prerenal AKI sources outside of the kidney creating conditions that decrease perfusion are categorized as prerenal
Which result would lead the nurse to determine that a urine specimen taken for a urine culture has been contaminated? (61)
Presence of more than 20 epithelial cells/high-power field the presence of 105 colony-forming units indicates the presence of a UTI. If other symptoms of a UTI are observed in the patient, the presence of 103 colony-forming units may also indicate a UTI
Which description would the nurse associate with urine turbidity on a urinalysis report? (60) Presence of proteins Highly concentrated urine Presence of red blood cells Increased urinary bilirubin level
Presence of proteins the presence of nitrites in the urine is indicative of a urinary tract infection
Which information would the nurse include when teaching a patient with reflux urinary incontinence about the Credé method? (61) Use a warm sitz bath. Press over the bladder area. Run water in the sink simultaneously. Breathe to increase abdominal pressure.
Press over the bladder area
Which complication would the nurse monitor for in a pregnant patient who is diagnosed with cystitis? (61)
Preterm labor Cystitis is associated with a risk for acute pyelonephritis during pregnancy, which can increase the risk for preterm labor
For the older-adult patient in the emergency department with a distended bladder and an inability to void, which priority intervention would the nurse implement? (60)
Privacy the nurse should provide privacy, assistance, and voiding stimulants, such as warm water over the perineum, as needed, for the patient with urinary problems
Which kidney hormone regulates INTRArenal blood flow by vasodilation or vasoconstriction? (60)
Prostaglandins
Which kidney hormone regulates INTRArenal blood flow by vasodilation or vasoconstriction? (60)
Prostaglandins - (regulates INTRArenal blood flow by vasodilation or vasoconstriction)
Which component on the urinalysis report would the nurse consider a normal finding? Select all that apply. One, some, or all responses may be correct. (60)
Protein Red blood cells White blood cells
When preparing a patient for a kidney biopsy, the nurse would complete which required assessment before sending the patient for the procedure? Select all that apply. One, some, or all responses may be correct. (60)
Prothrombin time (PT) Blood pressure Hemoglobin Platelet count - The patient is at risk for bleeding after a kidney biopsy, so performing coagulation studies such as platelet count, activated partial prothrombin time (aPPT), PT, and bleeding time before the biopsy is a requirement. - Hypertension puts the patient at an increased risk for bleeding, so the health care provider may prescribe administration of antihypertensive medications before the procedure. - The patient's hemoglobin is determined to assess the need for a blood transfusion.
It is essential for the nurse to monitor which factor when preparing a patient for a nephrostomy tube insertion? (62) Intake and output (I&O) Hemoglobin and hematocrit (H&H) Blood urea nitrogen (BUN) and creatinine Prothrombin time (PT) and international normalized ratio (INR)
Prothrombin time (PT) and international normalized ratio (INR) the procedure will be cancelled or delayed if coagulopathy in the form of prolonged PT/INR exists because dangerous bleeding may result
Which surgical procedure uses abdominal, vaginal, or combined approach to treat intrinsic sphincter deficiencies in a patient with stress urinary incontinence? (61)
Pubovaginal sling p 1334 - A sling made of synthetic or fascial material is placed under the ureterovesical junction to elevate the bladder neck. - The operation uses an abdominal, vaginal, or combined approach to treat intrinsic sphincter deficiencies. - Temporary or permanent urinary retention is common after surgery.
The nurse provides care for a patient admitted with an acute kidney injury as the result of thoracic and abdominal trauma sustained in a motor vehicle accident. For which cardiovascular complications would the nurse monitor the patient? (63) Bleeding Thrombosis Hypocalcemia Pulmonary embolism
Pulmonary embolism
Which procedure is preferred for the removal of a large stone from the kidney pelvis? (62) Nephrostomy Ureteroplasty Nephrectomy Pyelolithotomy
Pyelolithotomy
Which procedure may be done for a patient with pyelonephritis (pull out) to remove the obstructing kidney stone? (62) Nephrostomy (is performed when a stricture causes hydronephrosis and cannot be treated by urologic methods; it diverts the urine to the outside and prevents further damage to the kidney) Pyelolithotomy Nephrectomy (is the process of surgically removing the kidney) Ureteroplasty (is the repair or revision of the ureter; it is done for patients with poor ureteric valve closure or dilated ureters)
Pyelolithotomy (pull out stone)
Which factor in the medical history would the nurse ask about in a patient with urethritis (inflamed urethra)? Select all that apply. One, some, or all responses may be correct. (61)
Pyuria Painful urination Sexually transmitted infection (STI)
Which action by the nurse is most effective for controlling pain for cystitis? (61)
Requesting spasmolytic medication prescriptions spasmolytic drugs, such as oxybutynin chloride and propantheline bromide, are important for control of pain for smooth muscle relaxation. Control of pain is more effective when drugs are given at regularly scheduled intervals or by a constant delivery system
Which pathology may result in acute kidney injury (AKI) from a prerenal etiology? (63) Reduced perfusion Damage to kidney tissue Obstruction of urine flow Chronic kidney disease
Reduced perfusion
Which action may cause complications for a patient with polycystic kidney disease? (62) Reducing fluid intake Maintaining healthy weight Performing regular exercise Adhering to a sodium-restricted diet
Reducing fluid intake polycystic kidney disease is an inherited disorder in which fluid-filled cysts develop in the nephrons. Reduced fluid intake may lead to dehydration, which can worsen kidney function
A patient who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). Which action would the nurse take? (61)
Refers the patient to the clinic health care provider for immediate follow-up
Which statement describes how the medication mirabegron works to reduce urge incontinence? (61)
Relaxes the detrusor smooth muscle *which shows its action by relaxing the detrusor smooth muscle to increase bladder capacity and urine storage
Which assessment finding would the nurse expect for a patient with early renal cell carcinoma (RCC)? (62) Bloody urine Gynecomastia Renal bruit on auscultation Sharp, intermittent flank pain
Renal bruit on auscultation
Which complication may occur in a patient with asymptomatic bacteriuria? (61)
Renal insufficiency
Which action would the nurse implement when providing care for a patient who has a urinary catheter after undergoing a cystoscopy to remove an enlarged prostate gland? (60) Ask the patient to avoid oral fluids. Tell the patient to expect urinary frequency. Report any fever to the health care provider. Tell the patient to expect blood clots in the urine.
Report any fever to the health care provider
Which intervention would the nurse perform for a patient with kidney trauma who has a considerable loss of blood? (62) Take vital signs every 30 minutes. Measure and record urine output every 30 minutes. Report urethral bleeding before urinary catheterization. Monitor the patient for nausea when fluids are administered.
Report urethral bleeding before urinary catheterization.
Which complication would the nurse expect in an older patient with an indwelling catheter for urinary continence? (61)
Risk for infection
Which information would the nurse teach a patient about obtaining a voided urine specimen for a urinalysis? (60)
Send the specimen to the laboratory as soon as possible
Which laboratory parameters are DECREASED in acute kidney injury (AKI)? (63) Serum calcium Serum potassium Serum magnesium Serum phosphorus
Serum calcium
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? (60)
Serum creatinine the breakdown of muscle and other proteins produce a waste product, serum creatinine. Because protein breakdown is usually constant, the serum creatinine level is the best indicator of kidney function
Which risk factor would the nurse assess for in a patient diagnosed with acute kidney injury (AKI)? Select all that apply. One, some, or all responses may be correct. (63) Shock Sepsis Hypertension Cardiac surgery Prolonged mechanical ventilation
Shock Sepsis Cardiac surgery Prolonged mechanical ventilation
Which information is needed for the nurse to respond to the patient's question, "Will this stone be able to pass on its own?" Select all that apply. One, some, or all responses may be correct. (61) Size of the stone The patient's body mass index (BMI) Location of the stone Composition of the stone The patient's history of stones
Size of the stone Location of the stone Composition of the stone
Which anatomic difference would the nurse associate with a decreased glomerular filtration rate in an African-American patient when compared with a white patient? (60)
Small blood vessel anatomy African Americans are more likely than white Americans to have genetically decreased glomerular filtration rates with age because of the difference in the anatomic structure of the small blood vessels, which results in less blood flow to the kidneys
Which food would the nurse instruct the patient with urinary calcium oxalate stones to avoid to prevent future stone formation? Select all that apply. One, some, or all response may be correct. (61) Spinach Black tea Sardines Rhubarb Organ meats
Spinach Black tea Rhubarb
Which condition may predispose a patient to chronic pyelonephritis? (62) Hepatic failure Cardiomyopathy Spinal cord injury Glomerulonephritis
Spinal cord injury
Which method of emptying the bladder is helpful for a patient with a large cystocele? (61)
Splinting - the patient with a large cystocele or prolapse of the bladder into the vagina may use splinting to reduce renal urinary incontinence. - This is achieved by inserting fingers into the vagina and lifting the cystocele to urinate
Which stage of kidney tumor includes extension into the Gerota fascia? (62) Stage I Stage II Stage III Stage IV
Stage IV stage I or II kidney tumors remain in the kidney with no lymph node involvement a stage III tumor may penetrate the major veins or perinephric tissues, but not beyond Gerota fascia
Which care principles regarding discharge activities would the certified Wound, Ostomy, and Continence Nurse (CWOCN) teach a patient who has had a cystectomy (surgery to remove bladder)? (61)
Stoma and pouch care
Which intervention would be helpful in preventing bladder cancer? Select all that apply. One, some, or all response may be correct. (61)
Stopping the use of tobacco Showering after working with or around chemicals Wearing gloves and a mask when working around chemicals and fumes
Which type of incontinence is characterized by the involuntary loss of urine during activities that increase abdominal or detrusor (muscle) pressure? (61)
Stress
Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? Urge Stress Overflow Functional
Stress -KANGAROOS- -SING- Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence.
Which characteristic of acute kidney injury would the nurse expect a patient to exhibit? Select all that apply. One, some, or all responses may be correct. (63) Sudden onset Gradual onset May not progress Quickly progressing Nephron involvement between 50% and 95%
Sudden onset May not progress Nephron involvement between 50% and 95%
Which factor may contribute to renovascular disease? Select all that apply. One, some, or all responses may be correct. (62) Thrombosis Atherosclerosis Blood vessel hyperplasia Renal artery stenosis (RAS) Renal vessel aneurysms
Thrombosis Atherosclerosis Blood vessel hyperplasia Renal artery stenosis (RAS) Renal vessel aneurysms (all of them)
What is the role of alarms in renal replacement therapy? (63) To detect hypotension To detect hypovolemia To detect hypoperfusion To detect an air embolus
To detect an air embolus
Which statement describes the rationale for instructing a patient diagnosed with a urinary disorder to voluntarily start and stop urine flow during a void at least twice? (61)
To determine pelvic muscle strength
For which purpose would a patient with a kidney disorder have a diagnostic renal scan performed? (60)
To evaluate renal perfusion
For which reason would a cortisol hormonal replacement be prescribed for patients with renal cell carcinoma after the surgical removal of one kidney (nephrectomy)? (62) To manage pain To prevent infections To manage adrenal insufficiency To improve function of second kidney
To manage adrenal insufficiency
Which statement describes the purpose of periurethral injection of collagen or siloxane in the treatment of a patient with stress urinary incontinence? (61)
To provide support around the bladder neck - Implantation of small amounts of an inert substance through several small injections provides support around the bladder neck. - The procedure can be done in an ambulatory care setting and can be repeated as often as needed. - Certain compounds may migrate after injection; an allergy test to bovine collagen must be performed before implantation.
Which nephrotoxic NSAID can cause acute kidney injury (AKI) in patients? (63) Tolmetin Cisplatin Rifampin Vancomycin Tolmetin
Tolmetin
The use of which medication is contraindicated in the treatment of urinary incontinence in a patient with glaucoma? Select all that apply. One, some, or all responses may be correct. (61) Midodrine Trospium Mirabegron Oxybutynin Tolterodine
Trospium Oxybutynin Tolterodine T- ip O- ver T- op
Which type of physiologic change in the kidney would the nurse associate with nocturnal polyuria in older adults? (60)
Tubular changes MEMORY TRICK: NOCTURNAL POLYURIA IS TOTALLY TUBULAR Tubule length decreases in older adults, which reduces the ability to filter blood and excrete waste products. These changes may result in an inability to produce concentrated urine, leading to nocturnal polyuria
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 urine output? (60)
Tubular changes with aging decrease the ability to concentrate urine
The urinalysis report of a patient with acute kidney injury (AKI) reveals the presence of red blood cell casts and hemoglobin. Which etiology of AKI would the nurse anticipate? (63) Myocardial infarction Atherosclerosis Hypovolemic shock Tubular damage in kidneys
Tubular damage in kidneys
To obtain information about the cause of a patient's urinary incontinence and retention, which test would the nurse expect the health care provider to prescribe? (60) Urine stream testing Retrograde pyelography Retrograde urethrography Urethral pressure profilometry (UPP)
Urethral pressure profilometry (UPP) UPP, or urethral pressure profile, provides information about the nature of urinary incontinence or urinary retention
Which type of incontinence is also known as an overactive bladder (OAB)? (61)
Urge
Which amount of daily fluid intake is recommended for a patient recovering from acute kidney injury? (63) Urine output with an additional 300 mL Urine output with an additional 500 mL Urine output with an additional 700 mL Urine output with an additional 1000 mL
Urine output with an additional 500 mL
When assessing urinary incontinence in a patient with kidney dysfunction, the nurse would use which diagnostic test? (60)
Urine stream testing
Which diagnostic test would the nurse associate with evaluation of a patient's pelvic muscle strength? (60)
Urine stream testing
To which principle would the nurse adhere to minimize catheter-associated urinary tract infections (CAUTIs)? (61)
Use of intermittent catheterization for postoperative urinary retention
A patient has urinary incontinence due to protrusion of pelvic organs into the vaginal lumen. Which treatment strategy would be beneficial for the patient in this situation? (61) Vaginal cone Vaginal pessary Magnetic resonance Electrical stimulation
Vaginal pessary a prolapse occurs when the supportive tissue in the vagina weakens and stretches, allowing the pelvic organs to protrude into the vaginal lumen. A ring-shaped pessary inserted into the vagina is helpful when the prolapsed uterus or bladder is contributing to urinary incontinence
Which test would be performed if urine reflux is suspected? (61) Voiding cystourethrography
Voiding cystourethrography
Which factor would the nurse attribute to stress incontinence? (61)
Weak pelvic muscles
For which stage of tumor growth would the nurse anticipate simple excision for a patient with urothelial cancer? (61)
When the tumor is confined to the bladder mucosa p 1349 - Urothelial cancers are malignant tumors of the urothelium. - Most urothelial cancers occur in the bladder. - Tumors confined to the bladder mucosa are treated by a simple excision. - Tumors that have spread to the muscle layer are treated with chemotherapy, radiation therapy, and radical cystectomy with urinary diversion. - Tumors that are deep in the bladder mucosa, but not in the muscle layer, are treated with excision and intravesical chemotherapy - If the tumor has spread to the surrounding tissue, it also spreads to the distant organs, ultimately leading to death.
Which information would be revealed in a urinalysis on a patient who has pyuria (puss in the urine from bacteria)? (61)
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 (UTI)? (61)
Wipe from front to back
When discussing urinary and sexual hygiene with adult patients, the nurse would use which terms when referring to the patient's reproductive body parts? (60) Words that the patient uses Technical and medical terminology Easily understood children's terms "Socially" heard terms and slang words
Words that the patient uses
Urge incontinence is caused by? (61)
a problem with the patient's urge to urinate
What do the presence of nitrites indicate in urine? (60)
a urinary tract infection
Functional incontinence is not caused by? (61)
a weakened pelvic floor; rather it is due to structural problems often resulting from injury or trauma
Nephrostomy (62)
allows urine to be drained by a tube surgically inserted through the skin into the kidneys
What is pyelonephritis? (60)
bacterial infection of the kidneys
Needle bladder neck suspension (aka Pereyra or Stamey procedure) uses a?
combined vaginal approach with a needle and a small suprapubic skin incision - Elevates the urethral position and provides longer-lasting results without a long operative time - The combined vaginal approach with a needle and a small suprapubic skin incision does not allow direct vision of the operative site; however - the high complication rates may be due to the selection of patients who, because of their medical condition, are not good candidates for longer retropubic procedures.
what does an Ultrasonography [US] measure? (60)
identifies kidney size or obstruction in the kidneys
What is glomerulonephritis? (60)
inflammation of the glomerulus
Nephrectomy (62)
is a surgical procedure to remove the kidney or a part of a kidney
Ureteroplasty (62)
is the surgical reconstruction of the ureters
What does MRI measure? (60)
is used to stage cancer
What does a CT measure? (60)
measures the kidney size and assesses obstruction in the kidneys
Which urinalysis finding would the nurse recognize as normal? Select all that apply. One, some, or all responses may be correct. (60) pH of 6.0 Foul smell Clear urine Pale yellow urine 4 to 5 red blood cells (RBCs) per high-power field (HPF)
pH of 6.0 Clear urine Pale yellow urine
what does Pink-tinged urine mean? (60)
the presence of blood or hematuria in the urine
Overflow incontinence is caused by? (61)
too much urine being stored in the bladder
a Midurethral sling procedure uses a? (61)
vaginal approach to improve the symptoms of stress incontinence p 1334 - A tensionless vaginal sling is made from polypropylene mesh (or other materials) and placed near the uretero-vesical junction to increase the angle, which inhibits movement of urine into the urethra with lower intra-vesical pressures. - This ambulatory surgery procedure uses a vaginal approach to improve symptoms of stress incontinence. - Temporary or permanent urinary retention is common after surgery.