Exam 6

Which is an abnormal finding of the urinary system?

When striking the area, pain in the flank region is felt by the client

What is the priority nursing assessment for a client who has undergone a kidney biopsy?

perform frequent checks for hemorrhage

Which instruction would the nurse provide to help a client prevent future attacks of glomerulonephritis?

Seek early treatment for respiratory infections

Based on the assessment findings, what problem is most likely present?

The appearance and odor of the urine, elevated pH, presence of nitrates and WBCs in the urine, and elevated WBC count point to a uti

Which outcome indicates effective nursing care when a nurse assists an older adult client in squirting warm water over the perineum?

The client will not have a tendency to retain urine

Which difference bw the two methods of access will the nurse consider in planning care for a client with end stage renal disease who has an internal arteriovenous fistula in one arm and an external arteriovenous shunt in the other arm?

The graft is more subject to hemorrhage, clotting, and infection than the fistula is.

Which response would the nurse give to a client admitted for diagnostic testing to determine the extent of his or her bladder cancer who asks "if they remove my bladder, how will I be able to urinate"?

"When removing a clients bladder, a surgical opening or urostomy allows urine to drain into a collection bag."

A client admitted to the hospital in the oliguric phase of acute kidney injury. The clients urine output for the past 12 hours was 200ml. The nurse notes a prescription for 900ml of oral fluids over the next 24 hrs. Which interpretation of the amount of prescribed fluid would the nurse make?

It will compensate for both insensible and expected output over the next 24 hours.

Which test would the nurse monitor when determining whether a clients newly transplanted kidney works effectively?

Serum creatnine

Which clinical manifestation would indicate the cancer is in an early stage in a male client with a preliminary diagnosis of cancer of the urinary bladder?

hematuria

What is glomerulonephritis?

inflammation of the glomerulus = loss of kidney function

Which step will the nurse perform first on a client during assessment of the renal system?

observe the flank region for asymmetry or discoloration

Which clinical manifestation would the nurse expect the client to report when experiencing renal calculi?

- blood in the urine - frequency and urgency of urination

Which nursing actions will the nurse take to provide safe care and prevent harm for an older client experiencing increased nocturnal? SATA

A. Ensure adequate lighting and a hazard free enviornment C. Ensure the availability of a bedside toilet, bedpan, or urinal if needed. E. Discourage excessive fluid intake for 2 to 4 hours before the client goes to bed. F. Respond as soon as possible to the clients indication of the need to void.

When the nurse provides care for a client with chronic kidney failure, what assessments will be made that support a finding of fluid overload? SATA

A. Weigh the client and compare baseline B. Compare current blood pressure to baseline D. Auscultate the lung fields to determine if fluid is present E. Check for pedal and periorbital swelling

Which client does the nurse expect is most likely to produce a urinalysis with a specific gravity of 1.004?

Client who is prescribed the diuretic medication furosemide every day

Which info in the response of a client receiving peritoneal dialysis indicates understanding of the purpose of the procedure?

Removing toxins and metabolic wastes

What preprocedural instruction will the nurse provide for a client scheduled for an ultrasound ?

"Drink 500-1000 ml of water 2-3 hours before the test"

Normal Creatnine levels

0.6-1.2 *remember ^1.3 = bad kidney

For which client does the nurse expect increased production of renin?

35-year-old who sustains significant blood loss

Which condition would the nurse suspect if a clients lab report shows WBCs in the urine?

Kidney infection

Which medication turns urine reddish-orange in color?

Phenazopyridine

Which process is a function of the kidney hormones?

Renin raises blood pressure because of angiotensin and aldosterone secretion.

Which med increases the risk of hematuria?

Warfarin

Which statement made by the client identifies a regulatory function of the kidney? SATA

-acid base balance -fluid and electrolyte balance

Which intervention would the HCP prescribe to prepare a client with advanced cancer of the bladder for a cystectomy and ileal conduit?

Administration of an antibiotic

The RN supervises a new graduate nurse caring for a client with urgent incontinence. Which action by the graduate nurse requires the RN to intervene?

Advises the client to limit fluid intake to 1500ml or less

Which finding, upon review of the medical record of a client with acute kidney failure, would the nurse determine is the likely cause of fatigue and lethargy ?

An increased BUN level

What question does the nurse ask to help interpret the result when a healthy adult clients urinalysis reveals a protein level of 0.9?

"Have you recently performed any strenuous exercise?"

What is nephrotic syndrome?

A kidney disorder that causes the body to excrete too much protein in the urine.

The nurse reviews nutrition therapy with a client with CKD. Which client statement indicates a need for further instruction?

"I make sure to eat foods like meat and eggs every day"

The nurse provides post procedure teaching for a female client who had a cystoscopy as an outpatient. Which client statement indicates the need for additional instruction

"I should expect to see blood clots in my urine for up to 24 hours

A client has been given instructions about collecting a urine specimen to test creatnine clearance. Which client statement indicates a correct understanding of the specimen collection procedure?

"I will void first and then collect all my urine in a container for 24 hours"

Choose the likely option for the information missing from the state t below by selecting from the lists of options provided

1. Anemia 2. Erythropoietin

Which client does the nurse expect is most likely to exceed the renal threshold when he or she is noncompliant with the prescribed therapeutic regimen?

55-year-old with type 2 diabetes mellitus

Nurse prepares to administer oxybutynin 30mg orally. Each tab contains 5mg. How many tabs will the nurse administer?

6

Which blood pressure reading does the nurse expect will result in compromised kidney function for a client who sustained major injuries in an automobile accident?

68/40 mm Hg

Normal BUN levels

7-20 mg/dL

What is pyelonephritis?

A bacterial infection of the kidneys

The nurse assesses a client diagnosed with CKD who had an arteriovenous fistula performed on the left arm yesterday. Which assessment finding would require immediate follow up?

A bruit cannot be auscultated over the fistula site

The nurse is screening clients for those at risk for developing bladder cancer. The nurse should recognize the client at highest risk for developing bladder cancer is a client who has

A habit of smoking one pack of cigarettes a day

Which lab values will the nurse monitor as specific indicators of a clients kidney function? SATA

A. Creatinine C. Cystatin-c D. Blood osmolarity E. BUN/ creatnine ratio

Which action is important to include when teaching a client prescribed tolterodine for an overactive bladder?

Avoid activities requiring alertness until the response to the med is known

Which priority teaching will the nurse provide to prevent harm for a client after renal biopsy?

Avoid lifting heavy objects for 1 - 2 weeks after the procedure

What instructions would the nurse give an assistive personnel about handling of a clients routine urinalysis specimen? SATA

B. Ensure the container is tightly covered D. Take the sample to the lab within 1 hr E. Put the sample in a plastic sample bag F. Refrigerate a sample that cannot be taken to the lab right away

Which test provides info on bladder capacity, bladder pressure, and avoiding reflexes?

Cystometrography

Which process would the nurse consider when formulating a response to a client with acute kidney injury who states "why am I experiencing twitching and tingling of my fingers and toes?"

Calcium depletion

The nurse is caring for a client who is receiving hemodialysis. The client reports dyspnea, chest pain, and severe anxiety. Which of the following actions should the nurse take first?

Clamp the hemodialysis access tubing

Which problem or complication does the nurse suspect when a client with chronic kidney disease develops anorexia, nausea, vomiting, muscle cramping, and pruritus?

Client has uremia

Which med strengthens the urinary sphincters?

Duloxetine

Which assessment finding in a hospitalized client with a history of CKD would alert the nurse to suspect kidney insufficiency?

Edema and pruritus (itching)

Which action will the nurse include in post procedural care for a client who has a renal scan?

Encourage oral fluids to assist with excretion of the isotope

Which type of cytokine is used to treat anemia secondary to CKD?

Erythropoietin

Which is the best technique for the nurse to use when assessing a client for bladder distention?

Gently palpate the outline of the bladder and percuss the lower abdomen toward the umbilicus until dull sounds are no longer produced.

Which option would the nurse offer a client with acute glomerulonephritis who reports thirst?

Hard candy

Which finding would the nurse expect when assessing a client who has a ureteral calculus?

Hematuria with sharp pain when voiding

Which potential complication would the nurse suspect in a client admitted with severe renal colic secondary to a ureteral calculus that has less urinary output than intake over the past 8 hours and a bedside bladder scan indicating 40ml of residual urine?

Hydroureter

Which abnormal finding would the nurse monitor for during the oliguric phase of acute kidney injury?

Hyperkalemia

Which clinical manifestation indicates the need for immediate hemodialysis in a client with CKD?

Hyperkalemia

Which statement by the wife of a client receiving hemodialysis who undergoes surgery to create an arteriovenous fistula indicates that further teaching is required?

I have to take his BP every day in the arm with the fistula

Which info would the nurse consider when planning care for the postoperative client who has a newly constructed conduit diversion (ideal conduit)?

Ileal diversion conduits may provide urinary incontinence

Nurse is reinforcing education for a client undergoing an extracorporeal shock wave lithotripsy for renal calculi about what to expect following the procedure. Which statement made by the nurse is appropriate ?

It is normal to have bruising on your flank where the procedure was performed

Which statement indicates the nurse has a correct understanding of kidney ultrasound?

Kidney ultrasonography makes use of sound waves and has minimal risk

The RN is caring for a client with renal calculi. To which health care professional will the RN delegate the task of administering oral medications to this client?

LPN

Which assessment will the nurse complete before notifying the health care provider about an older adult clients blood osmolarity result of 313?

Looking for signs of dehydration

Which part of the renal system does furosemide exerts its effects?

Loop of Henle

Which response would the nurse give to a client with end stage renal disease who states, "I heard that it is inevitable that I will need a kidney transplant. If so, which one of my kidneys will be removed?"

Neither of your kidneys will be removed unless they become infected

Underline the assessment findings that concern you? -UTI CASE STUDY

New onset of incontinence, confusion. Foul-smelling urine. Few loose stools. General abdominal discomfort. Temp of 99.4

Home health nurse reviewed most recent lab results for a client with CKD. Which of the following would be appropriate afternoon snack to recommend for the client ?

Oatmeal with apple slices

Which term would the nurse use to document a client experiencing urinary incontinence via involuntary loss of small amounts (25-35ml) of urine from an over distended bladder?

Overflow incontinence

Which response would the nurse give to a client with an acute kidney injury who has peritoneal dialysis prescribed and asks why the procedure is necessary?

PD helps perform some of the work usually performed by your kidneys

What is the most common symptom that prompts clients to seek medical attention for problems with the kidneys or urinary tract?

Pain in flank or abdomen, or pain when urinating

A nurse is caring for a client 2 days after a surgical creation of an arteriovenous fistula in the forearm. Which finding should the nurse report immediately to the HCP?

Pale skin of the hand of the arm with the arteriovenous fistula

A client in LTC who is incontinent of urine reports pain due to rheumatoid arthritis. Which client need would the nurse identify as the primary consideration in the care of this client?

Relief of pain

Which clinical finding is the priority requiring collaboration with the primary HCP when a nurse reviews the medical record of an older adult client admitted with chronic kidney disease?

Potassium of 6

Which element would the nurse teach the client with chronic kidney disease to limit as an intervention to control uremia associated with end stage renal disease?

Protein

Which finding is expected in a client diagnosed with early glomerulonephritis?

Proteinuria

Which nursing intervention helps prevent complications associated with a shortened urethra revealed by a recent intravenous pyelogram?

Providing thorough perineal care after each voiding

Which rationale supports the nurses instruction that a client with CKD is to avoid all salt substitutes ?

Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats

Which condition would the nurse suspect if the client reports passing urine involuntarily while coughing?

Stress incontinence

Which type of incontinence can be improved by teaching the client kegel exercises ?

Stress incontinence

Which statement made by the student nurse regarding the gross anatomy and physiology of the kidneys indicates the need for additional teaching?

The right kidney is a little longer and narrower than the left kidney

While collecting a clients urine sample, which condition would the nurse suspect if the sample has a strong odor of ammonia?

UTI

Which annual examinations to screen for kidney problems would the nurse recommend for an African-American client?

Urinalysis, microalbuminuria, and serum creatinine

Which clinical indicator during the postoperative period of a client who had a successful nephrolithotomy to remove renal calculi would the nurse monitor and report immediately to the primary HCP?

Urinary output of 20-30

Based on these findings, you recognize that A.S. May be experiencing ____ and the HCP will order ___ and ___ to determine if this problem is the cause of her symptoms.

Urinary tract infection; CBC and UA with C&S

Which type of urinary condition would cholinergic agonists be prescribed for?

Urine retention

Which instruction will the nurse give the AP about when it is best to collect a clients urinalysis sample?

With the first morning void

For which circumstance will the nurse select the male icon for a female client when performing a bladder scan?

Woman with a history of hysterectomy

Which specific instruction would the nurse provide to a client with urinary incontinence who is prescribed amitriptyline?

You should rise slowly when getting up from a sitting or lying position

Which hormone influences kidney function ?

aldosterone

When a clients kidney hormonal function is not working properly, which condition does the nurse expect to occur?

anemia

Which condition can be prevented when a client with chronic kidney disease receives medication to manage anemia?

chronic fatigue

Which clinical manifestation would the nurse expect the client who has CKD with hypocalcemia to exhibit?

- fractures - osteomalacia - eye calcium deposits

Identify 2 possible causes for K.Bs low grade fever

-dehydration -viral illness -UTI -sepsis

Which equipment and actions will the nurse use to assess a female clients urethra prior to inserting a urinary catheter? SATA

A. Ensure a good light source is available B. Record any discharge from the meatus C. Assess for lesions or rashes and record D. Ask about discomfort with urination E. Remind the client to wipe from front to back F. Wear well fitting gloves during the assessment

Which symptom will the nurse expect when caring for an older male client with an enlarged prostate?

Difficulty starting urine stream

Which substances will the nurse consider an abnormal finding in a clients routine urine sample? SATA

B. RBCs C. Proteins E. Albumin

Which over the counter product will the nurse further explore with a client, for potential impact on kidney function?

acetaminophen

Which questions will the nurse ask a client with a blood urea nitrogen (BUN) of 26 to identify non renal factors that may contribute to this lab result? SATA

B. "Have you noticed any blood in your stool or vomited any blood?" C. 'Have you been on a high protein diet or been drinking high protein drinks" E. "Are you taking or have you recently taken any steroid medications?" F. " have you recently experienced any physical or emotional stress?

What sound does the the nurse expect to hear when listening over the renal artery of a client who has renal artery stenosis?

swishing sound

Which topics will the nurse be sure to ask about when taking a history of a client with a change in urinary patterns? SATA

A. History of chronic health problems such as diabetes and HTN D. Occupational exposure to toxins and use of illicit substances E. Recent travel to geographic regions that pose infectious disease risk F. Previous kidney or urologic problems, including tumors, infections, stones

Which actions will the nurse include in post procedural care for a client who had a cystoscopy with general anesthesia? SATA

A. Monitor for airway and breathing B. Provide frequent vital sign checks including temperature C. Record and monitor for any changes in urine output E. Irrigate the urinary catheter with sterile saline if prescribed F. Encourage the client to take oral fluids to increase urine output

Which actions will the nurse take to ensure that a clients 24 hour urine collection is completed is completed appropriately? SATA

A. Teach the client that a 24 hour collection of urine is necessary to quantify or calculate the rate of clearance of a particular substance B. Check with the lab or procedure manual for proper technique to maintain the 24 hour collection. C. Do not remove urine from the collection container for other specimens during the 24 hour period. D. On initiation of the collection, ask the client to void, discard the urine, and note the time, then begin the collection E. Twenty-four hours after initiation and add that urine to the container F. Place signs appropriately, then inform all personnel or family caregivers that the test is in progress