NURA 1500 Renal and Urinary Disorders

Which of the following client findings suggest a need for prostate surgery? 1. DRE reveals enlarged prostate 2. DRE reveals firm prostate with palpable irregularities 3. Repetitive episodes of acute urinary retention 4. Nocturia with fluid consumption after 2000 5. Hematuria 6. PSA of 3 ng/mL

1. DRE reveals enlarged prostate 2. DRE reveals firm prostate with palpable irregularities 5. Hematuria

A client with chronic kidney disease is receiving epoetin alfa (Epogen). Which laboratory result would indicate a therapuetic effect of the medication? 1. Hematocrit of 32% 2. Platelet count of 400,000 cells/mm3 3. Blood urea nitrogen level of 15 mg/dL 4. White blood cell count of 6000 cells/mm3

1. Hematocrit of 32% Rationale: Epoetin alfa is used to reverse anemia associated with chronic kidney disease. Therapeutic effect is seen when the hematocrit is between 30% and 33%. Options 2, 3, and 4 are not associated with the action of this medication.

A nurse working in a women's health clinic is caring for a client who reports urinary urgency and dysuria. Which of the following additional findings should the nurse identify as an indication of a urinary tract infection? 1. Vaginal discharge 2. Pyuria 3. Glucosuria 4. Elevated creatinine-kinase -MB

2. Pyuria Rationale: the nurse should identify pyuria, which is white blood cells in the urine, as a common manifestation of a UTI.

acceptable PVR for men with BPH

50 mL

Capacity of bladder

700 mL

Inguinal hernia

Aka groin hernia Condition in which soft tissue bulges through a weak point in the abdominal muscles

Diverticula

Bulging pouches in weakened bladder

Bladder neck obstruction

Connects bladder to urethra Men over 50 more likely but women may also get

Enuresis

Dx by UA or culture, chromosome ampnalysis, ultrasonography, Bladder training, limit drinks before bed, medication - imipramine, desmopressin, oxybutynin

Hydrocele

Fluid-filled sac surrounding testicle that causes swelling of scrotum

Phimosis

Foreskin over glans penis cannot be retracted Circumcision to fix

Assessment Findings of bladder trauma

Gross hematuria Pelvic fracture Supropubic pain or tenderness Inability to void, clots in urine swelling or hematoma, blood at urethral meatus Free intraperitoneal fluid on CT scan or ultrasound Unresponsiveness, intoxication

normalize electrolytes, BUN, pH, and redusce intake of medications that my alter mental status

Management of incontinence

Obstruction uropathy

May be asymptomatic Symptoms may include: Back or flank pain Hematuria Abdominal mass Kidney infection Failure to thrive UTI w/fever Vomiting

Wilm's Tumor

Peak age of occurrence 3 y/o Dark urine Abdominal pain from tumor Firm mass Increased BP Fam hx of cancer Ultrasound, CT, MRI, bone scan, chest xray, angiography, UA Chemo with or without radiation Swelling, hernia or mass in abdomen, abdominal pain, urinary retention, infection, hematuria, anemia, pallor, anorexia, fatigue, lethargy, hypertension

Four goals for successful surgical correction in the nursing management of hypospadias or any structurak defect of the urinary system

Promote future sexual reproduction minimal pain infection control demonstrate understanding by parents

hypospadias occurs in 1 of 250 live male births in the US and rates are increasing most likely due to the increase in premature births and low birth weights

TRUE

Most common site for obstruction in infants and children

UPJ - Ureteropelvic Junction Where the kidney attaches to ureters

bladder extrudes into abdominal wall

bladder exstrophy

short foreskin causing a curved penis

chordee

undescended testicles

cryptorchidism

structural abnormality of urinary system

obstructive uropathy

Lithotripsy Post Op Nursing Interventions

-Monitor vital signs frequently - kidneys are highly vascular; hemorrhage/shock are potential complications -Monitor amount, color, clarity of urine output -Maintain placement and patency of urinary catheter. A kinked or plugged catheter may result in hydroureter, hydronephrosis,and kidney damage.Decreased urinary output and flank pain are possible symptoms of obstructed urine flow. Excessive force in irrigation may cause bleeding. -Prepare for discharge - teach care of indwelling catheter; --S&S to report: urine leakage from incision for more than 4 days, symptoms of infection, pain, bright hematuria -Teach measures to reduce risk of further lithiasis

TURP Post Op Nursing Interventions

-Pain Control and antispasmodics -Foley Catheter for traction; serial urines -Intake and Output -continuous bladder irrigation (CBI) through the catheter to help keep the urine clear and free of clots or tissue - drink about a glass of water every hour while awake to dilute the urine - Incentive Spirometry to promote full lung expansion and prevent respiratory complications from sedation - Sequential compression devices to aid circulation and prevent blood clots - Plantar extension/flexion exercises and ambulation - Scrotal roll for support - Call doctor if increased scrotal or penile swelling difficulty passing urine fresh blood in your urine that does not stop with rest or increase in fluid intake pain not relieved by Tylenol chills or fever greater than 101 degrees

A nurse is caring for a client with acute pyelonephritis. Which of the following is an appropriate response by the nurse regarding home care? 1. "You should complete the entire cycle of antibiotic therapy" 2. "You should maintain complete bed rest until manifestations decrease" 3. "You should drink 1,000 mL of fluid per day" 4. "You should weight yourself daily"

1. "You should complete the entire cycle of antibiotic therapy" Rationale: It is important that the client take the full prescription of the antibiotic therapy to decrease the chance of regrow to of the causative organism. The client should not be placed on complete bed rest. Ambulatory helps prevent complications of bed rest, such as constipation and urinary stasis. The client should consume 2,000 to 3,000 mL in 24 hr Weighing yourself daily is not indicated for acute pyelonephritis. I&O should be monitored and fluids encouraged.

The nurse should provide which of the following discharge instructions to the client after prostate surgery? (Select all that apply) 1. Contact the provider if small clots are noted during urination 2. Restrict fluid intake to prevent incontinence 3. Avoid lifting objects heavier than 20lbs for at least 2 weeks 4. If urine becomes bloody, stop activity, rest, and increase fluids 5. Use stool softeners and avoid straining to have a bowel movement

1. Contact the provider if small clots are noted during urination 3. Avoid lifting objects heavier than 20lbs for at least 2 weeks 4. If urine becomes bloody, stop activity, rest, and increase fluids 5. Use stool softeners and avoid straining to have a bowel movement

A nurse is providing discharge instructions for a client who spontaneously passed a urinary calcium phosphate stone. In teaching the client about dietary modifications, the nurse should teach the client to limit which of the following in the diet? (Select all that apply) 1. Organ meats 2. Tea 3. Cheese 4. Soy sauce 5. Fish 6. Red meat 7. Spinach 8. Whole grains

2. Tea 3. Cheese 5. Fish 7. Spinach 8. Whole grains Rationale: Limit ALKALINE foods

A nurse is caring for a client who is receiving hemodialysis via the left arteriovenous fistula. Which of the following statements made by the nurse is appropriate to include while teaching the client about self-care? 1. "Check the site hourly for patency" 2. "Apply lotion to your arms" 3. "Avoid tight clothing around your arms" 4. "Sleep on the left side"

3. "Avoid tight clothing around your arms" Rationale: tight clothing may decrease the blood flow and cause clotting. It is only necessary to check the access site twice daily for adequate blood flow. The use of creams or lotions should be avoided over the access site to prevent infection. Sleeping on the same side as the access site may cause impairment of blood flow and clotting to occur.

A 42 year old client is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which of the following statements by the client demonstrates correct understanding of the procedure? 1. "I will be fullt awake during the procedure" 2. "Lithotripsy will reduce my chances of stone recurrence" 3. " I will report any bruising that occurs to my doctor" 4. "Straining my urine following the procedure is important"

4. "Straining my urine following the procedure is important"

The nurse is collecting data from a client who has a history of benign prostatic hyperplasia. To determine whether the client currently is experiencing this condition, the nurse should ask the client about the presence of which early symptom? 1. Nocturia 2. Urinary retention 3. Urge incontinence 4. Decreased force in the stream of urine

4. Decreased force in the stream of urine Rationale: Decreased force in the stream of urine is an early symptom of benign prostatis hyperplasia. The stream later becomes weak and dribbling. The client then may develop hemturia, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.

In the immediate postoperative period for prostate surgery, priority should be given to which of the following nursing actions? 1. Encouraging oral fluid intake 2. Administering antispasmodics 3. Monitoring the client's incision 4. Maintaining continuous bladder irrigation

4. Maintaining continuous bladder irrigation Rationale: Prevent blot clots

Oxybutynin chloride (Ditropan XL) is prescribed for a client with a neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness

4. Restlessness Rationale: Toxicity (overdosage) of oxybutynin produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frewuent side effect of the medication but does not indicate overdosage.

A nurse is caring for a client immediately following a kidney transplant. The nurse should identify which of the following client findings as a possible indication of a delay in functioning of the transplanted kidney? 1. Blood pressure 110/58 mm Hg 2. Incisional tenderness 3. Pink and bloody urine 4. Urine output 30 mL/2 hr

4. Urine output 30 mL/2 hr Rationale: a minimum urine output of 30 mL/hr is expected following a renal transplant. The nurse should monitor for adequate output or a decrease in the hourly output. Blood pressure is within expected reference range. An elevated blood pressure is an indication of rejection. Tenderness at the site is expected during early postoperative period. Monitor for wound infection. Pink and bloody urine is expected immediately after surgery. It should become clear within several days.

Calcium oxalate - alkaline stones high levels of oxalate or calcium excreted •reducing sodium •reducing animal protein, such as meat, eggs, and fish •getting enough calcium from food or taking calcium supplements with food •avoiding foods high in oxalate, such as spinach, rhubarb, nuts, and wheat bran

Acid-ash diet(protein and starch) to acidify urine

Calcium Phosphate hyperparathyroidism high levels of calcium excreted •reducing sodium •reducing animal protein •getting enough calcium from food or taking calcium supplements with food

Acid-ash diet; limit sodium

Wilm's Tumor meds

Actinomycin D, vincristine, doxorubin, cyclophosphadmide

Medications that can affect incontinence Anticholinergics - oxybutynin (Ditropan) Effects - reduced bladder contractility Side effects - constipation, urinary retention, dry mouth, increases ocular pressure (ask if pt has glaucoma)

Anticolinergics - medications that "block" the effects of acetylcholine - blocks muscarine receptors at the detrusor muscle, thus reducing bladded contractility (the neurotransmitter for the parasympathetic nervous system) on bladder/sphincter function. Reduces incontinence by causing bladder muscle relaxation and suppressing the urge to void (overactive bladder tx - decreases incontinence by delaying desire to void)

Enuresis meds imipramine (Tofranil)

Antidepressant, used to treat enuresis as well, anticholinergic, mostly metabolized by liver

Three most common medications to treat BPH Doxazosin Terazosin Tamulosin - antiadrenergic

Antihypertensives that work to decrease contractions in smooth muscle of prostate capsule and increase urine flow

Wilm's Tumor meds vincristine (Vincasar)

Antineoplastics - binds to proteins of mitotic spindle, causing metaphase arrest Cell replication is stopped as a result

Wilm's Tumor meds daktinomycin (Actinomycin D)

Antineoplastics, antitumor antibiotics Inhibits RNA synthesis by forming a complex with DNA (cell cycle phase-nonspecific) Death of rapidly replicating cells, particularly malignant ones

Ambiguous genitalia

Birth defect where outer genitals do not have the typical appearance of either a boy or girl

Medications that can affect incontinence Cholinergics - bethanechol (Urecholine) Effects - Increased bladder contractility Sympathomimetic/Adrenergic - pseudoephedrine (Sudafed) Effects - Increased urethral resistance (contraction of the smooth muscle fibers within the proximal urethral/bladder neck); a secondary effect is relaxation of the bladder wall

Cholinergics - medications that mimic the effects of acetylcholine (the neurotransmitter for parasympathetic nervouse system) on bladder/sphincter function (increases bladder emptying, increases bladder contractions - urinary tract stimulant used with urinary retention) Sympathomimetic/Adrenergic - medications that mimic the effect of the sympathetic nervous system on bladder and sphincter function

tamsulosin (Flomax) - treat BPH Assess for symptoms of prostatic hyperplasia, first dose orthostatic hypotension, monitor I&O and daily weight, edema,

Decrease symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia) Decreases contractions in smooth muscle of the prostate capsule by binding alpha 1 receptors Metabolized by liver 14 hr half life Contraindicated in hypersensitivity Use cautiously in prostate carcinoma, cattaract surgery, sulfa allergy Can cause dizziness, headache, rhinitis, orthostatic hypotension, retrograde ejaculation

Procedures to correct obstructions

Endoscope via urethra Percutaneous (antegrade) technique between hip and ribs Pyeloplasty removes scar tissue Laparoscopy

Threats to childhood

Enuresis Wilm's tumor aka nephroblastoma Glomerulonephritis Nephrosis

Enuresis meds desmopressin (DDAVP)

Hormone, antidiuretic, analogue of naturally occurring vasopressin (antidiuretic hormone); primary action is enhanced reabsorption of water in kidneys; prevention of nocturnal enuresis

Testicular torsion

Medical emergency

Postvoiding residual urine

Normal range 0-15 mL

Cryptorchidism

Testes fail to descend Prolonged related to testicular cancer and or fertility Orchipexy to fix at 12 mos

Enuresis meds oxybutynin (Ditropan)

Urinary tract antispasmodics, treats neurogenic bladder symptoms (frequent urination, urgency, nocturia, urge continence) Inhibits action of acetylcholine at postganglionic receptors, increased bladder capacity, delayed desire to void

Peritoneal fluid in scrotal sac

hydrocele

meatus on ventral surface of penis

hypospadias

penis foreskin cannot be retracted

phimosis

predisposes an individual to develop incontinence, particularly if bladder control has been marginal in the past

physiologic changes of aging

Risk factors for urinary incontinence

pregnancy vaginal delivery episiotomy menopause genitourinary surgery pelvic muscle weakness incompetent urethra due to trauma or sphincter relaxation immobility high impact exercise diabetes mellitus stroke age related changes in urinary tract morbid obesity cognitive disturbances: dementia, parkinson's disease medications: diuretics, sedatives, hypnotics, opioids caregiver or toilet unavailable

Stress incontinence

result of childbirth, pelvic surgery, atrophy Most common cause is hypermobility or significant displacement of the urethra and bladder neck during exertion so that the abdominal pressure overcomes the ability of the urethral sphincter to stay closed Caused NOT by pelvic floor relaxation/

emergency with spermatic cord rotation

testicular torsion

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. Check the level of the drainage bag 2. Reposition the client to his or her side 3. Contact the health care provider (HCP) 4. Place the client in good body alignment 5. Check the peritoneal dialysis system for kinks 6. Increase the flow rate of the peritoneal dialysis solution

1, 2, 4, 5 Rationale: If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the side or making sure that the client is in good body alignment may assist with outflow drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the HCP. Increasing the flow rate is an inappropriate action and is not associated with the amount of outflow solution.

The nurse is performing an assessment on a child admitted to the hospital wit a probable diagnosis of nephrotic syndrome. Which assessment finding should the nurse expect to observe? Select all that apply: 1. Pallor 2. Edema 3. Anorexia 4. Proteinuria 5. Weight loss 6. Decreased serum lipids

1,2,3,4 Pallor, edema, anorexia, proteinuria Rationale: Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.

A nurse is reviewing the laboratory reports of a client who has acute kidney injury (AKI). Which of the following findings should the nurse expect? (Select all that apply) 1. BUN 30 mg/dL 2. Urine output of 40 mL in past 3 hr 3. Potassium 3.6 mEq/L 4. Serum calcium 9.8 mg/dL 5. Hematocrit 30%

1,2,5 Rationale: this BUN level is elevated, which is an expected finding for a client who has AKI. Oliguria with a urine output of 100 to 400 mL per 24 hr is an expected finding for a client who has AKI. This potassium level is within the expected reference range. An elevated potassium level is an expected finding for a client who has AKI. This serum calcium level is within the expected reference range. A decreased serum calcium level is an expected finding for a client who has AKI. This hematocrit level is decreased, which is an expected finding for a client who has AKI.

A nurse is caring for a client who is having chronic renal failure. When providing education on nutrition, which of the following statements is appropriate for the nurse to say? 1. "You should limit you fluid intake" 2. "You should eat a didn't high in potassium" 3. "You should eat a diet high in phosphorus" 4. "You should eat a diet high in protein"

1. "You should limit you fluid intake" Rationale: the client who has chronic renal failure needs to avoid hypervolemia, or excessive fluid overload, by following the prescribed fluid restriction each day. The client should limit potassium because the kidneys are unable to excrete it, which can lead to hyperkalemia. The client should limit phosphorus because the kidneys are unable to excrete it. The client should eat a low-protein diet to avoid an increase in serum BUN levels.

A nurse is planning care for a group of clients. Which of the following client's should the nurse plan to monitor for signs of nephrotoxicity? 1. A client who is receiving gentamicin for treatment of a wound infection 2. A client who is receiving digoxin for treatment of heart failure 3. A client who is receiving methyl prednisone for treatment of severe asthma 4. A client who is receiving propranolol for treatment of hypertension

1. A client who is receiving gentamicin for treatment of a wound infection Rationale: amino glycoside antibiotics can injure cells of the proximal tubules, causing acute tubular necrosis. The nurse should plan to monitor this client for nephrotoxicity and acute kidney injury. Providers use caution when prescribing digoxin for clients who have renal impairment, but it's use does not cause nephrotoxicity. Methylprednisolone does not cause nephrotoxicity. Providers use caution when prescribing propanolol for clients who have renal impairment, but it's use does not cause nephrotoxicity.

A week after kidney transplantation, a client develops a temperature of 101 F, the blood pressure is elevated, and the kidney is tender. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment finding, the nurse suspects which complication? 1. Acute rejection 2. Kidney infection 3. Chronic rejection 4. Kidney obstruction

1. Acute rejection Rationale: Acute rejection most often occurs in the first 2 weeks after transplantation. Clincal manifestations include fever, malaise, elevated white blood cell count, acute hypertension, graft tenderness, and manifestations of dteriorating renal function. Chronic rejection occurse gradually over a period of months to years. Although kidney infection or obstruction can occur, the symptosm presented in the question do not relate specifically to thses disorders.

A nurse caring for a client who is undergoing extra corporeal shockwave lithotripsy (ESWL). Which of the following findings should the nurse report to the provider? 1. An arrhythmia on the ECG 2. 300 mL of pink-tinged urine 3. Bruising on the affected flank area 4. Gravel fragments in the urine

1. An arrhythmia on the ECG Rationale: ESWL is the application of sound, laser, or dry shock wave energies to break a stone into smaller pieces. During the procedure, clients are monitored via an ECG. Between 500 to 1,500 shock waves may be administered in 30 to 45 min. The shock waves are initiated during the R Wave of the ECG to prevent arrhythmia, and if any are dtected, this should be reported to the provider immediately. All other answers are expected findings following ESWL.

Nurse is preparing to insert an in dwelling urinary catheter for a female patient. When beginning the insertion procedure, the nurse should instruct the patient to: 1. Bear down 2. Take deep breaths 3. Sip water 4. Hold her breath

1. Bear down Rationale: bearing down as if to void relaxes the external sphincter and aids in the insertion procedure. This is the appropriate instruction for the patient. It is not necessary for the patient to take deep breaths during catheter insertion. It is not necessary for the patient to sip water during a catheter insertion. It is not necessary for the patient to hold her breath during a catheter insertion.

The nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medications? 1. Blood glucose of 200 mg/dL 2. Potassium level of 3.8 mEq/L 3. Platelet count of 300,000 cells/mm3 4. White blood cell count of 6000 cells/mm3

1. Blood glucose of 200 mg/dL Rationale: A blood glucose level of 200 mg/dL is significantly elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; gastrointestinal effects such as diarrhea, nausea, and vomiting; hypertension and hyperkalemia.

A nurse caring for a client who has undergone a non-related living donor kidney transplant. On the 5th postoperative day, the nurse notes that the client gained 1 kg of body weight since the previous day. Which of the following findings are also found in a client who is also experiencing a kidney rejection? 1. Blood pressure 160/90 mm Hg 2. serum creatinine 0.8 mg/dL 3. Sodium 137 mg/dL 4. Urinary output 100 mL/hr

1. Blood pressure 160/90 mm Hg Rationale: Kidney rejection is accompanied by kidney failure. Due to the kidney's role in fluid and blood pressure, the client experiencing rejection will tic ally be hypertensive. This serum creatinine is within the expected reference range. This sodium level is within the expected reference range. The client who is experiencing kidney rejection will typically have a decreased urine output, either anuria (no urine output) or oliguria (less than 30 ml/hr).

A nurse providing education to a client who has chronic renal failure. Which of the following should the nurse tell the client to increase in her diet? 1. Calcium 2. Phosphorus 3. Potassium 4. Sodium

1. Calcium Rationale: The client should supplement calcium in her diet because the kidneys are unable to activate calcium through the gastrointestinal tract. The client does not require additional phosphorus because it cannot be excreted by the kidneys. The client does not require additional potassium because it cannot be excreted by the kidneys. The client may have hypertension causing an inability to excrete fluid via the kidneys. Sodium promotes fluid retention; therefore, sodium consumption should be restricted for the client.

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has a renal function disorder. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Decreased white blood cell count

1. Elevated creatinine level Rationale: Measuring the creatinine level is a frquently used laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and red blood cell count may be noted if bleeding from the urinary tract occurs or if erythropoietic function by the kidney is impaired. An increased white blood cell count is most likely to be noted in renal disease.

A client with a urinary tract infection is receiving ciprofloxacin (Cipro) by the intravenous (IV) route. The nurse appropriately administers the medication by performing which action? 1. Infusing slowly over 60 minutes 2. Infusing in a light-protective bag 3. Infusing only through a central line 4. Infusing rapidly as a direct intravenous push medication

1. Infusing slowly over 60 minutes Rationale: Ciprofloxacin (Cipro) is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin and skin structure. A single dose is administered slowly over 60 minutes to minimize discomfort and vein irritation. Other solutions infusing at the same site need to be temporarily discontinued while the ciprofloxacin is infusing.

A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a Foley catheter. While preparing the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 1. Notify the HCP 2. Use a small-sized catheter 3. Administer pain medication before inserting the catheter 4. Use extra povidone-iodine solution in cleansing the meatus

1. Notify the HCP Rationale: The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of bleeding is determined by diagnostic testing. Therefore, options 2, 3, and 4 are incorrect.

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula 2. Presence of a radial pulse in the left wrist 3. Absence of a bruit on auscultation of the fistula 4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand.

1. Palpation of a thrill over the fistula Rationale: The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill shorter than 3 seconds in the nail beds of the fingers on the left had are normal findings, they do not assess fistula patency

Tacrolimus (Prograf) is prescribed for a client. Which disorder, if noted in the client's record, would indicate that the medication needs to be administered with caution? 1. Pancreatitis 2. Ulcerative colitis 3. Diabetes insipidus 4. Coronary artery disease

1. Pancreatitis Rationale: Tacrolimus (Prograf) is used with caution in immunosuppressed clients and in clients with renal, hepatic, or pancreatic function impairment. Tacrolimus is contraindicated in clients with hypersensitivity to this medication or hypersensivity to cyclosporine.

A nurse is caring for a client who has a diagnosis of renal calculi. The client reports severe right flank pain and nausea. Which of the following is a priority nursing action? 1. Relieve pain 2. Push fluids 3. Monitor I&O 4. Strain urine

1. Relieve pain Rationale: the priority nursing action for the client should be pain relief. The pain associated with renal calculi is severe and should be addressed immediately. Although the nurse should push fluids, it is not the priority action. Monitoring I&O should be part of the routine care for the client, but it is not the priority at this time. The nurse should strain the client's urine, but this action does not address the client's immediate need; therefore, this is not the priority action.

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? 1. Restrict fluids as prescribed 2. Care for the arteriovenous fistula 3. Encourage foods high in potassium 4. Administer analgesics as prescribed

1. Restrict fluids as prescribed Rationale: Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis).

A nurse is caring for a client who has nephrotic syndrome and has been taking prednisone for 3 days. Which of the following adverse effects should the nurse monitor do and report to the provider? 1. Sore throat 2. Frequent stools 3. Drowsiness 4. Tremors

1. Sore throat Rationale: glucocorticoids depress the natural immune system and increases the client's rockslide for infection. A sore throat indicate and infection.

A nurse is performing an admission assessment on a client who has severe chronic kidney disease (CKD). Which of the following findings should the nurse expect for this client? 1. Tachypnea 2. Hypotension 3. Exophthalmos 4. Insomnia

1. Tachypnea Rationale: the nurse should expect the client who has severe CKD to have tachypnea due to metabolic acidosis. The client would have hypertension due to fluid overload. Exophthalmos is not an expected finding. The client who has hyperthyroidism is expected to have exophthalmos. The client would have lethargy and drowsiness.

A nurse is planning on obtaining a urinary specimen from a patient's closed urinary system. Identify the sequence of steps the nurse should take.

1. Wipe the port with an alcohol swab 2. Insert a 10 mL syringe and needle into the port 3. Withdraw 5 mL of urine 4. Transfer the urine to a sterile specimen container 5. Transport the specimen to the laboratory Rationale: when obtaining a sterile specimen from a closed urinary system, the nurse wipes the port with an alcohol swab to decrease the amount of bacteria present, then uses a 10 mL syringe and needle to withdraw 5 mL of urine. This urine is then transferred to a sterile specimen container that is transported to the laboratory.

A nurse is providing discharge teaching for a client who has chronic kidney disease (CKD). Which of the following statements by the client indicates an understanding of the teaching? 1. "I will consume foods high in protein" 2. "I will decrease my intake of foods high in phosphorus" 3. "I will limit my intake of foods high in calcium" 4. "I will add salt to the foods I consume"

2. "I will decrease my intake of foods high in phosphorus" Rationale: Client's who have CKD should limit the intake of foods high in phosphorus due to the decrease in the kidney's ability to excrete it. Client's who have CKD could consume a diet low in protein because the phosphorus content of protein becomes elevated and can cause osteodystrophy. Client's who have CKD often need supplemental calcium and vitamin D. Client's who have CKD retain sodium and fluid. They should consume foods low in sodium.

A nurse who is preparing to insert a straight urinary catheter for a male patient should: 1. Grasp the penis at the base 2. Apply light traction to the penis 3. Hold the penis parallel to the patient's body 4. Lift the penis to a 45 degree angle to the patient's body

2. Apply light traction to the penis Rationale: lifting the penis to a position perpendicular to the body while applying light traction straightens out the urethral canal to facilitate catheter insertion. Grasping the penis at the base would not effectively straighten the urethral canal to ease catheter insertion. Holding the penis parallel to the patient's body would not effectively straighten the urethral canal to ease catheter insertion. Lifting the penis to a 45 degree angle would not effectively straighten the urethral canal to ease catheter insertion.

The nurse reviews the record of a child who is suspected to have glomerulonephritis and expects to note which finding that is associated with this diagnosis? 1. Hypotension 2. Brown-colored urine 3. Low urinary specific gravity 4. Low blood urea nitrogen level

2. Brown-colored urine Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Hypertension is also common. Blood urea nitrogen levels may be elevated. A moderately elevated to high urinary specific gravity is associated with glomerulonephritis.

A nurse is assessing a client in the oliguric anuric phase of acute renal failure. The assessment reveals a respiratory rate of 28/min, and the client reports nausea, a dull headache, palpitations, and general malaise. Which of the following is a priority action? 1. Administer an analgesic 2. Check the latest electrolyte values 3. Administer an antiemetic 4. Check oxygen levels

2. Check the latest electrolyte values Rationale: the nurse should check the client's latest potassium level since these symptoms indicate hyperkalemia, which can lead to death; therefore, this is a priority action. All other answers are not priority actions since the client is exhibiting symptoms of increased potassium level.

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse should plan which intervention? 1. Cover the bladder with petroleum jelly gauze 2. Cover the bladder with a nonadhering plastic wrap 3. Apply sterile distilled water dressings over the bladder mucosa 4. Keep the bladder tissue dry by covering it with dry sterile gauze

2. Cover the bladder with a nonadhering plastic wrap Rationale: In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying, while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The ue of petroleum jelly gauze should be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressing soaked in solutions (that can dry out) also damage the mucosa when removed.

Which of the following actions should a nurse take when removing a patient's in dwelling urinary catheter? 1. Pull the catheter out as quickly as possible 2. Deflate the balloon completely before removal 3. Make sure the patient has voided within 12 hr post removal 4. Tell the patient to expect to feel a tugging sensation on removal

2. Deflate the balloon completely before removal Rationale: If any inflation solution remains in the balloon, trauma to the urethral canal is likely with removal of the catheter. A slow, steady motion is recommended for urinary catheter removal. If the patient does not void within 6 to 8 hr of removal, it is often necessary to recatheterize the bladder. It is inappropriate to wait up to 12 hr for the patient to void. It is common for patients to feel a burning sensation as a urinary catheter is removed, but there should not be any tugging involved.

A nurse is reviewing the medical records of four client's. Which of the following conditions is a risk factor for chronic pyelonephritis? 1. Parkinson's disease 2. Diabetes mellitus 3. Peptic ulcer disease 4. Gallbladder disease

2. Diabetes mellitus Rationale: a client who has a history of diabetes mellitus is at risk for the development of chronic pyelonephritis due to reduced bladder tone. The other answers are not related to the development of chronic pyelonephritis disease.

A client being hemodialyzed suddenly becomes hort of breath and complains of chest pain. The client is tachycardic, pale, and anxious and the nurse suspects air embolism. What is the priority nursing action? 1. Monitor vital signs every 15 minutes for the next hour 2. Discontinue dialysis and notify the health care provider 3. Continue dialysis at a slower rate after checking the lines for air 4. Bolus the client with 500 mL of normal saline to break up the air embolus

2. Discontinue dialysis and notify the health care provider Rationale: If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the HCP, and administer oxygen as needed. Options 1, 3, and 4 are incorrect

The nurse performing an admission assessment on a 2-year old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension 2. Generalized edema 3. Increased urinary output 4. Frank, bright red blood in urine

2. Generalized edema Rationale: nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

A nurse is caring for a client who was brought to the emergency department following an accident. The nurse suspects a ruptured bladder. Which of the following findings is consistent with this diagnosi? 1. Anuria 2. Hematuria 3. Pyuria 4. Fever

2. Hematuria Rationale: The chief manifestations of a ruptured bladder are hematuria (blood in the urine), pelvic pain, and oliguria (low urine output). Anuria (lack of urine) is seen in urethral obstruction or renal failure. It is not a manifestation of a ruptured bladder. Pyuria(pus in the urine) is a sign of infection, not a manifestation of a ruptured bladder. Fever is a sign of infection and not a manifestation of an acute ruptured bladder.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1. Infection 2. Hyperglycemia 3. Hypophosphatemia 4. Disequilibrium syndrome

2. Hyperglycemia Rationale: An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.

A nurse is obtaining a voided urine culture and sensitivity for a client who has manifestations of a urinary tract infection. Which of the following actions should the nurse take? 1. Collect the client's urine in a clean specimen container 2. Instruct the client to initiate the flow of urine before collecting the specimen 3. Obtain the client's first morning voiding on the following day 4. Place the client's urine specimen in a container with a preservative

2. Instruct the client to initiate the flow of urine before collecting the specimen Rationale: The nurse should instruct the client to pass a sterile container into the urine stream after initiating the flow of urine. The nurse should use a sterile specimen for a urine culture and sensitivity. The nurse can collect a urine specimen for culture and sensitivity at any time during the day. The nurse does not need to place the urine specimen in a container with a preservative.

The nurse is providing discharge instructions to a client receiving sulfamethoxazole. Which instruction should be included in the list? 1. Restrict fluid intake 2. Maintain a high fluid intake 3. If the urine turns dark brown, call the HCP immediately 4. Decrease the dosage when symptoms are improving to prevent an allergic response

2. Maintain a high fluid intake Rationale: Each dose of sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfamethoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

A nurse is caring for a client who just had a transurethral resection of the prostate (TURP). Which of the following should the nurse instruct the client to report to the provider? 1. Pink-tinged urine 2. Painful urination 3. Stress incontinence 4. Retrograde ejaculation

2. Painful urination Rationale: the client should notify the provider of any signs of urinary tract infection, such as fever, urinary frequency, or painful urination. Blood clots are a normal finding following a TURP for the first 24 to 36 hr. The client should be instructed that once urine turns to a hello color, it could again become pink-tinged, especially with activity, for up to 6 weeks. Stress incontinence is an expected finding following a TURP due to poor sphincter control. A TUPR results in some degree of retrograde ejaculation, which affects fertility. The client should be informed preoperatively that this surgical procedure can result in a decreased amount or totally absent ejaculation.

A client with acute kidney injury has a serum potassium level of 6.0 mEq/L. The nurse should plan which action as a priority? 1. Check the sodium level 2. Place the client on a cardiac monitor 3. Encourage increased vegetables in the diet 4. Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration

2. Place the client on a cardiac monitor Rationale: The client with hyperkalemia as at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Fluid intake is not increased because I contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse may also assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action of the nurse.

A nurse caring for a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider? 1. White blood cell count of 6,000/mm3 2. Potassium level of 3.0 mEq/L 3. Frothy, pale yellow drainage 4. Abdominal fullness

2. Potassium level of 3.0 mEq/L Rationale: the nurse should recognize that this potassium level is slightly decreased. Potassium can be pulled out of the bloodstream during dialysis, placing the client at risk for cardio arrhythmias. This white blood cell count is within the expected reference range. A pale, yellow drainage is a normal finding and the protein content causes the drainage to be frothy. Abdominal fullness is a normal finding, especially during the dwell period after the dialysate solution has been infused into the peritoneal cavity.

Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication? 1. Gastric atony 2. Urinary strictures 3. Neurogenic aotny 4. Gastroesophageal reflux

2. Urinary strictures Rationale: Bethanechol chloride (Urecholine) can be hazardous to clients with urinary tract obstruction or wekness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin (Furadantin) for a urinary tract infection. The nurse should make which appropriate response? 1. "Discontinue taking the medication and make an appointment for a urine culture" 2. "Decrease your medication to half the dose because your urine is too concentrated" 3. "Continue taking the medication because the urine is discolored from the medication 4. "Take magnesium hydroxide (Maalox) with your medication to lighten the urine color"

3. "Continue taking the medication because the urine is discolored from the medication Rationale: Nitrofurantoin (Furadantin) imparts a harmless brown color to the urine and the medication should not be discontinued until the prescribed dose is completed. Magnesium hydroxide (Maalox) will not affect urine color. In addition, antacids should be avoided because they interfere with medication effectiveness.

A nurse is caring for a client with a history of cystitis. Which of the following statements indicates that the client needs additional teaching about the condition? 1. "I try to empty my bladder every 2 to 3 hours" 2. "I drink 2 to 3 quarts of fluids a day" 3. "I prefer to take baths instead of showers" 4. "I use an oral contraceptive for birth control"

3. "I prefer to take baths instead of showers" Rationale: Women who have frequent urinary tract infections are encouraged to take showers rather than tub baths. A tub bath is more likely to cause irritation and contamination of the urethra; therefore, leading to frequent urinary tract infections. Emptying the bladder every 2 to 3 hours is appropriate and prevents urinary stasis, which is a leading cause of urinary tract infections. A fluid intake of 2,000 to 3,000 mL/day is a deal to provide natural irrigation and prevent urinary stasis. Taking oral contraceptives does not affect the urinary tract and heads no correlation to the frequent episodes of urinary tract infections experienced by the client.

A nurse is providing teaching for a client who has chronic kidney disease (CKD). Which of the following client statements indicates an understanding of the teaching? 1. "I will monitor my blood pressure on the same day each week" 2. "I will take milk of magnesia if I'm constipated" 3. "I will weigh myself each morning" 4. "I will use a salt substitute in my diet"

3. "I will weigh myself each morning" Rationale: the client who has CKD should monitor his weight every morning at the same time to provide an accurate assessment of fluid balance. A client with CKD should monitor his blood pressure daily due to the risk for hypertension. A client who has CKD should not take milk of magnesia for constipation because of its magnesium and sodium content. A client who has CKD should avoid using a salt substitute because it contains potassium.

A nurse is caring for a client who has received hemodialysis. The nurse should identify that which of the following findings places the client at risk for seizures? 1. Hypokalemia 2. A rapid increase of catecholamines 3. A rapid decrease in fluid 4. Hypercalcemia

3. A rapid decrease in fluid Rationale: A rapid decrease in fluid can result in cerebral edema and increased intracranial pressure, placing the client at risk for seizures. Hypokalemia places the client at risk for hyporeflexia, rather than seizures. An increase of catecholamines places the client at risk for tachycardia, rather than seizures. Hyperkalemia places the client at risk for muscle weakness, rather than seizures.

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which would the nurse most likely expect to note? 1. Hematuria 2. Proteinuria 3. Bacteria 4. Glucosuria

3. Bacteria Rationale: Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic facilitates entry of bacteria into the urine. Options 1, 2, and 4 are not characteristically noted in this condition.

The nurse, who is administering bethanechol chloride (Urecholine), is monitoring for cholinergic overdose associated with the medication. The nurse should check the client for which sign of overdose? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration

3. Bradycardia Rationale: Cholinergic overdose of bethanechol chloride (Urecholine) produces manifestations of excessive muscarine stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

A nurse caring for a client who is suspected to have a urinary tract infection (UTI). The provider prescribes a urine specimen. Which of the following findings should confirm to the nurse that an upper UTI involving the kidney is present? 1. Bacteria 2. White blood cells 3. Casts 4. Ketones

3. Casts Rationale: Casts are protein structures that are present in the renal tubules. Presence of these in the urine indicates a pathological condition of the kidney. Bacteria is present in the urinalysis of any client with a UTI. White blood cells, which indicate infection, are present in a urinalysis of any client with a UTI. Ketones found in urine are associated with ketoacidosis with hyperglycemia, not a UTI.

A nurse is caring for a client receiving peritoneal dialysis, the nurse notes that the client's dialysate output is less than the input, the abdomen is distended, and the client is reporting pain. Which of the following is an appropriate nursing action? 1. Infuse the additional amount of dialysate 2. Administer pain medication to the client 3. Change the client's position 4. Ask the client to ambulate

3. Change the client's position Rationale: dialysate solution is infused through a catheter in the abdominal wall into the peritoneal space. If the client appears to be retaining the dialysate solution, the client should change position to facilitate the drainage of the solution from there peritoneal cavity. Infusing more dialysate solution will compound the problem. The dialysate solution should be withheld. Peritoneal dialysis is often positional. Repositioning the client is needed to facilitate drainage. Pain medication is not needed in this situation. The client should not ambulated for 6 hr following peritoneal dialysis.

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 100.2 F. Which nursing action is most appropriate? 1. Encourage fluids 2. Notify the health care provider 3. Continue to monitor vital signs 4. Monitor the site of the shunt for infection

3. Continue to monitor vital signs Rationale: The client may have an elevated temprature following dialysis because the dialysis machine warms the blood slightly. Therefore, it is not necessary to notify the health care provider. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity determinations. Encouraging fluids is an unsafe action for a client with chronic kidney disease. Since an elevated temperature is expected following dialysis, monitoring the site for infection is unnecessary.

A nurse is collecting a 24-hr creatinine clearance. During the collection, the client accidentally discards a specimen. Which of the following is an appropriate action by the nurse? 1. Continue the collection, noting the loss on the lab slip 2. Add 1 hr to the collection time 3. Discard the previously collected urine and start the collection again 4. Discontinue the collection and draw a serum creatinine

3. Discard the previously collected urine and start the collection again Rationale: If a specimen is lost or contaminated in any way during the 24-hr collection period, the process must begin again. All urine voided in 24 hr must be collected, or the test results will not be valid. Continuing the collection will provide false results because the values would be based on less than 24-hr collection of all voided urine. The collection time is 24 hr and additional time should not be added true to loss of a specimen. The entire test must be restarted. A 24-hr creatinine clearance is measured by urine collection only.

The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? 1. Fever, diarrhea, groin pain, and ecchymosis 2. Nausea, vomiting, scrotal edema, and ecchymosis 3. Fever, nausea, vomiting, and painful scrotal edema 4. Diarrhea, groin pain, testicular torsion, and scrotal edema

3. Fever, nausea, vomiting, and painful scrotal edema Rationale: Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection, although sometimes it can be caused by trauma. Epididymitis needs to be distinguished correctly from testicular torsion.

The nurse is providing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item should the nurse instruct the client to exclude from the diet? 1. Red meats 2. Orange juice 3. Grapefruit juice 4. Green leafy vegetables

3. Grapefruit juice Rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, consumption of graprefruit juice can raise cyclosporine levels by 50% to 100%, thereby increasing the risk of toxicity.

A nurse is caring for a client who has chronic kidney failure and the following laboratory results: BUN 196 mg/dL, sodium 152 mEq/L, and potassium 7.3 mEq/L. Which of the following interventions should the nurse implement? 1. Initiate an IV infusion of 0.9% sodium chloride 2. Give oral spironolactone 3. Infuse regular insulin in dextrose 10% in water 4. Administer furosemide

3. Infuse regular insulin in dextrose 10% in water Rationale: the client who has an elevated potassium level should receive regular insulin with dextrose 10% in water by continuous IV infusion to facilitate moving potassium out of the extracellular fluid into intracellular fluid. The client who has an elevated sodium level should not receive fluids thst contain sodium chloride. The client who has chronic kidney failure will retain potassium at high levels. This client should not take spironolactone, a potassium-sparing diuretic. Diuretics, such as furosemide, are effective in the excretion of excessive potassium for clients who have unimpaired kidney function. For a client who has chronic kidney failure, diuretics are ineffective.

A nurse is likely to receive an order for urinary catheterization of a newly admitted patient who: 1. Has a persistent urinary tract infection 2. Has urge incontinence 3. Is in the ICU for a gastrointestinal bleed 4. Is incontinent due to cognitive decline

3. Is in the ICU for a gastrointestinal bleed Rationale: precise measurement of urinary output is crucial for managing fluid balance in patients who are critically ill. Urinary tract infections are treated with anti microbial agents, increased fluid intake, and pain management, not urinary catheterization. Treatment options for urge incontinence typically include pelvic floor exercises, medications, and bladder retraining, not urinary catheterization. Incontinence due to cognitive decline is a type of functional incontinence. Typical interventions include scheduled toile ting and absorbent products. Catheterization would be a last resort for this patient.

A nurse is applying a condom catheter for an older adult patient who is uncircumcised. Which of the following is an appropriate step in the procedure? 1. Stretching the catheter along the length of the penis 2. Securing the catheter with adhesive tape 3. Leaving a space between the penis and catheter tip 4. Repositioning the foreskin after application

3. Leaving a space between the penis and catheter tip Rationale: A space of 2.5 to 5 cm (1 to 2 in) should be left between the tip of the penis and the end of the catheter. This space helps prevent irritation of the tip of the penis and allows full drainage of urine. A condom catheter is rolled smoothly over the length of the penis, not stretched along its length. Adhesive tape does not expand with changes in the size of the penis (possibly impairing blood flow) and is painful to remove. Therefore, it should not be used to keep a condom catheter in place. No manipulation of the foreskin is required during the application of a condom catheter.

A nurse is caring for a client who has a renal tumor. The client will undergo a renal biopsy. Which of the following client care should the nurse provide? 1. Instruct the client that there is NPO 8hr following the procedure 2. Assess the client for a history of shellfish or iodine allergies prior to the procedure. 3. Maintain bed rest for 4 to 12 hr following the procedure 4. Obtain a BUN and creatinine clearance prior to the procedure.

3. Maintain bed rest for 4 to 12 hr following the procedure Rationale: A renal biopsy involves a skin biopsy through needle insertion into the lower lobe of the kidney. Bed rest will be maintained for 4 to 12 hr following the procedure. Food and fluids will be restricted 8 hr PRIOR to the procedure A contrast media is not indicated for a biopsy. Protests include a hematological study for evaluation, such as a CBC, bleeding time, PTT, platelet count and type, and a cross match for a possible blood transfusion in the event of hemorrhaging following the procedure.

A newly licensed nurse and a nurse preceptor are caring for a client who has just had an arteriovenous shunt placed in her left arm. Which of the following actions by the newly licensed nurse requires intervention by the preceptor? 1. Auscultations for Bruins in the shunt every 4 hr while the client is awake 2. Elevating the shunted arm on pillows postoperatively 3. Measuring blood pressure in the shunted arm every 4 hr 4. Palpating distal pulses of the shunted arm

3. Measuring blood pressure in the shunted arm every 4 hr Rationale: Measuring blood pressure in the shunted arm requires intervention by the preceptor. Listening for Bruins is indicated following shunt replacement. Elevating the shunted arm is indicated postoperatively to reduce swelling and promote circulation. Palpating for distal pulses is indicated following shunt placement.

A. Ruse caring for a client who has acute kidney injury. Which of the following laboratory findings should the nurse report to the provider? 1. Serum potassium 5.0 mEq/L 2. Serum calcium 9.0 mg/dL 3. Serum creatinine 4.0 mg/dL 4. Serum amylase 84 IU/L

3. Serum creatinine 4.0 mg/dL Rationale: the nurse should report the client's serum creatinine level to the provider. This finding is outside of the expected reference range. The client's serum potassium level is within the expected reference range. The client's serum calcium level is within the expected reference range. The client's serum amylase level is within the expected reference range.

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition? 1. Pyelonephritis 2. Glomerulonephritis 3. Trauma to the bladder or abdomen 4. Renal cancer in the client's family

3. Trauma to the bladder or abdomen Rationale: Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client described n this question. Renal cancer would not cause pain that is felt in the low abdomen; rather, the pain would be in the flank area.

A client is admitted to the emergency department following a motor veehicle accident. The client was wearing a lap seat belt when the accident occurred and now the client has hematuria and lower abdominal pain. To assess further whether the pain is caused by bladder trauma, the nurse should ask the client if the pain is referred to which area? 1. Hip 2. SHoulder 3. Umbilicus 4. Costovertebral angle

3. Umbilicus Rationale: Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client described in this question. Renal cancer would not cause pain that is felt in the low abdomen; rather, the pain would be in the flank area.

The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan? 1. "Caution should be used when straddling the infant on the hip" 2. "Vital signs should be taken daily to check for bladder infection" 3. "Catheterization will be necessary when the infant does not void" 4. "Circumcision has been delayed to save tissue for surgical repair"

4. "Circumcision has been delayed to save tissue for surgical repair" Rationale: Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant should not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. Options 1,2, and 3 are unrelated to this disorder.

A nurse is teaching a client who is scheduled for a vasectomy about the procedure. Which of the following client statements indicates an understanding of the procedure? 1. "I should avoid having sex for at least two weeks after the surgery" 2. "I will no longer be capable of producing sperm" 3. "If I reverse this surgery, I will be as fertile as before" 4. "I need to have two follow-up negative sperm counts"

4. "I need to have two follow-up negative sperm counts" Rationale: sperm can remain viable in the vas deferent for up to 6 months; therefore, to ensure that the client is fertile, most sources recommend two follow-up negative sperm counts. Sexual intercourse following a vasectomy can usually resume after 1 week. However, contraceptive must be used until after sperm analyses are negative. Sperm production continues in the testes after a vasectomy, but without the vas deferent, there is no pathway for ejaculation of the sperm. The client needs to understand that the vasectomy is intended to be permanent. Although reanastomosis of the vas deferent is usually successful, fertility rates decline with the passage of time.

A nurse caring for a client who is to undergo a cystoscope. When educating the client on post-procedure expectations, which of the following should the nurse state? 1. "It will be necessary to keep the sutures clean" 2. "You will be placed in a dorsal recumbent position" 3. "Expect to be on bed rest for 24 hours" 4. "Pink-tinged urine and burning while urinating can be expected

4. "Pink-tinged urine and burning while urinating can be expected tosspot is a direct look inside the client's bladder through w small camera that is inserted through the urethra. It is a common test used to look for causes of bleeding in the urine and other bladder problems. Following the procedure, pink-tinged urine and burning on urination can be expected. There are no surgical incisions made during cystoscope; therefore, no sutures are involved. The client will be placed in a lithotomy position. This position provides maximal exposure of the genitalia and facilitates insertion of the cystoscope. Bed rest may be prescribed for a short period of time depending on the type of anesthetic administered.

A nurse is providing education about prostate health to a group of client's. Which of the following is an appropriate statement for the nurse to make in regard to a prostate specific antigen (PSA) test? 1. "You should fast for 8 hours prior to having a PSA specimen obtained" 2. "Yearly PSA screening should begin at age 40 in all men" 3. "Normal PSA values decrease as you get older" 4. "The PSA test should not be performed for 48 hours following a digital rectal exam"

4. "The PSA test should not be performed for 48 hours following a digital rectal exam" Rationale: Digital examination prior to blood testing may lead to elevated levels of PSA. PSA is a glycoproteins that is found only in cytoplasm of the epithelial cells of the prostate. Fasting is not necessary prior to this procedure. The American Urologic Association recommends that all men being yearly testing at the age of 50. Men with a strong family history of prostate cancer or men of African descent should discuss with their provider the possible benefits of initiating testing at a younger age. Older men may have slightly higher PSA measurements than younger men.

A nurse who is preparing a teaching plan for a male client who has a continent internal ileal reservoir following surgery to treat bladder cancer. Which of the following statements should the nurse include in the teaching plan? 1. "This should not affect your ability to have sexual intercourse" 2. "You should empty your new bladder when it feels full" 3. "You will need to avoid foods that produce intestinal gas" 4. "You must insert a catheter through your stoma to drain the urine

4. "You must insert a catheter through your stoma to drain the urine Rationale: the client must use intermittent catheterization to drain urine from the continent ileal reservoir. Creation of a continent internal leal reservoir can cause impotence in men. The nurse should use therapeutic communication to encourage the client and his partner to express their feelings and concerns. There is no sensation of bladder fullness in a continent internal ileal reservoir. The client must learn to void on a scheduled basis. There is no need to avoid certain foods. The continent internal ileal reservoir is not attached to the gastrointestinal tract. Ureterosigmoidostomy or conduit surgery use the bowel for output.

Phenazopyridine (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse should provide the client with which information regarding this medication? 1. Take the medication at bedtime 2. Take the medication before meals 3. Discontinue the medication if a headache occurs 4. A reddish orange discoloration of the urine may occur

4. A reddish orange discoloration of the urine may occur Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

A. Use is planning care for a client who is scheduled to undergo extra ordeal shock wave lithotripsy (ESWL) for urolithiasis. Which of the following actions should the nurse plan to take? 1. Place the client in a semi-Fowler' position 2. Assist with the client's intubation 3. Begin a 24-hr urine specimen collection after the procedure 4. Apply electrodes for cardiac monitoring

4. Apply electrodes for cardiac monitoring Rationale: the nurse should apply electrodes for continuous monitoring of the client's cardiac rhythm during ESWL. This's monitoring allows the provider to deliver shock waves that are synchronized with the R wave.

A nurse is planning care for a client who is postoperative following a nephrectomy. Which of the following assessments is the priority for the nurse to evaluate? 1. Bowel sounds 2. WBC count 3. Pain level 4. Blood pressure

4. Blood pressure Rationale: the greatest risk to the client is acute adrenal insufficiency. The adrenal gland can be removed or damaged during nephrectomy. The nurse should evaluate the client for hypotension, decreased urine output, and decreased level of consciousness

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the health care provider (HCP)? 1. Red bloody urine 2. Pain related to bladder spasms 3. Urinary output of 200 mL higher than intake 4. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute

4. Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute Rationale: Frank bleeding (arterial or venous) may occur during the first day after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 mL more than intake is adequate. Bladder spasms are expected to occur following surgery. A rapid pulse with a low blodd pressure is a potential sign of excessive blood loss. The HCP should be notified.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1. Diuretics 2. Antibiotics 3. Antitussives 4. Decongestants

4. Decongestants Rationale: In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants, The client should be questioned about the use of these edications if the client has urinary retention. Retention also can be precipitated by other factors, such as alcoholic beverages, infection, bed rest, and becoming chilled.

A nurse caring for a client the night before a scheduled intravenous urography. Which of the following is the nurse's priority intervention? 1. Inform the client about dietary limitations 2. Place the informed consent document in the client's record 3. Administer a bowel preparation to the client 4. Determine if the client has an allergy to iodine or shellfish

4. Determine if the client has an allergy to iodine or shellfish Rationale: the greatest risk to the client is injury or death from an allergic reaction to radiopaque contrast media. The nurse should determine if the client has an allergy to iodine or shellfish, which indicates the client is at high risk of having an allergic reaction to the contrast media.

A client newly diagnosed with chronic kidney disease has just been started on peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is most appropriate? 1. Stop the dialysis 2. Slow the infusion 3. Decrease the amount to be infused 4. Disequilibrium syndrome

4. Disequilibrium syndrome Rationale: Pain during the inflow of dialysate is common suring the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? 1. Hematuria and pyuria 2. Dysuria and proteinuria 3. Hematuria and urgency 4. Dysuria and penile discharge

4. Dysuria and penile discharge Rationale: Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent disharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays

Following kidney transplantation, cyclosporine (Sandimmune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Normal hemoglobin level 2. Decreased creatinine level 3. Decreased white blood cell count 4. Elevated blood urea nitrogen level

4. Elevated blood urea nitrogen level Rationale: Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. Cyclosporine does not depress the bone marrow.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating level of consciousness, and twitching

4. Headache, deteriorating level of consciousness, and twitching Rationale: Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes fro the brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and oset of symptoms. The syndrome most often occurs in client's who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

The nurse provided discharge instructions to the parents of a 2-year old child who had orchipexy to correct cryptorchidism. Which statement by the parents indicate that further teaching is necessary? 1. "I'll check his temperature" 2. "I'll give him medication so he'll be comfortable" 3. I'll check his voiding to be sure there's no problem" 4. I'll let him decide when to return to his play activities"

4. I'll let him decide when to return to his play activities" Rationale: Cryptorchidism is a condition in which one or both testes fail to descend through the inguinal canal into the scrotal sac. Surgical correction may be necessary. All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury. This prevents dislodging of the suture, which is internal. Normally, 2-year olds want to be active; allowing the child to decide when to return to his play activities may prevent healing and cause injury. The parents should be taught to monitor the temperature, provide analgesics as needed, and monitor the urine output.

A nurse is assessing a patient's in dwelling urinary catheter drainage at the end of the shift and notes the output is considerably less than fluid intake. Which of the following actions should the nurse take first after checking for kinks? 1. Irrigate the catheter 2. Assess for peripheral edema 3. Palp ate for bladder distinction 4. Milk the catheter

4. Milk the catheter Rationale: Output that is considerably less than intake is a sign that the catheter is blocked. The first action the nurse should take is to milk the tubing by squeezing then releasing the drainage tube, starting from near the patient and moving toward the drainage bag. This should dislodge any buildup of blood, pus, or sediment. If the catheter is blocked, the provider might have to prescribe catheter irrigation; however, this is not the first action the nurse should take. Assessing the extremities for peripheral edema is an appropriate action, but it is not the first action the nurse should take. Palpating the bladder for distinction is an appropriate action, but it is not the first action the nurse should take.

A 7-year old child is seen in a clinic, and the primary health care provider documents a diagnosis of primary nocturia enuresis. The nurse should provide which information to the parents? 1. Primary nocturnal enuresis does not respond to treatment 2. Primary nocturnal enuresis is caused by a psychiatric problem 3. Primary nocturnal enuresis requires surgical intervention to improve the problem 4. Most children outgrow the bed-wetting problem without therapeutic intervention

4. Most children outgrow the bed-wetting problem without therapeutic intervention Rationale: Primary nocturnal enuresis occurs in a child who has never been dry at night for extended periods. The condition is common in children, and most children eventually outgrown bed-wetting without therapeutic intervention. The child is unable to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system. The condition is not caused by a psychiatric problem.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the most appropriate nursing action? 1. Monitor the client 2. Elevate the head of the bed 3. Medicate the client for nausea 4. Notify the health care provider (HCP)

4. Notify the health care provider (HCP) Rationale: Disequilibrium syndrome may be caused by the rapid decreases in the blood urea nitrogen level during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs/symptoms of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified.

A hemodialysais client with a left are fistula is at risk for arterial steal syndrome. The nurse should assess the client for which manifestations of this complication? 1. Warmth, redness, and pain in the left hand 2. Aching pain, pallor, and edema of the left arm 3. Edema and reddish discoloration of the left arm 4. Pallor, diminished pulse, and pain in the left hand

4. Pallor, diminished pulse, and pain in the left hand Rationale: Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue eschemia. Warmth and redness probably would characterize a problem with infection. The manifestations described in options 2 and 3 are incorrect.

A nurse is caring for a client who is receiving peritoneal dialysis. Which of the following is a complication of this procedure? 1. Constipation 2. Metabolic acidosis 3. Hypoglycemia 4. Peritonitis

4. Peritonitis Rationale: Peritonitis is a complication of peritoneal dialysis, prevention of this complication requires using sterile technique, closed-sterile instillation and drainage systems, and obtaining frequent cultures of the peritoneal drainage. Constipation is not a complication of peritoneal dialysis. Due to electrolyte shifts, diarrhea is a complication that can occur. Metabolic alkalosis can occur if the dialysis is prolonged since dialysis contains 45 mEq/L of sodium acetate or lactate, and are both metabolized to bicarbonate. Hyperglycemia is a complication found in clients who have diabetes mellitus and clients receiving hypertonic dialysate.

Trimethoprim-sulfamethoxazole (TMP-SMZ; Bactrim) is precribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4. Sore throat Rationale: Clients taking rimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs/symptoms of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the HCP if these occur. The other options do not require HCP notification.

The nurse understands that which information collected during the assessment of a child recently diagnosed with glomerulonephritis is most often associated with the diagnosis? 1. Child fell off a bike unto the handlebars 2. Nausea and vomiting for the last 24 hours 3. Urticaria and itching for 1 week before diagnosis 4. Streptococcal throat infection 2 weeks before diagnosis

4. Streptococcal throat infection 2 weeks before diagnosis Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A beta-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, a child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval unrelated to a diagnosis of glomerulonephritis.

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the cleint's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder? 1. Soft and swollen prostate gland 2. Reddened, swollen, and boggy prostate gland 3. Tender and edematous protate gland with ecchymosis 4. Tender, indurated prostate gland that is warm to the touch

4. Tender, indurated prostate gland that is warm to the touch Rationale: The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder.

When providing perineal care for a female patient who has an indwelling urinary catheter, which of the following areas should the nurse cleanse last? 1. The urethral meatus 2. The labia minora 3. The perineum 4. The anus

4. The anus Rationale: The basic aseptic principle applicable to perineal care is to cleanse from the area of least contamination to the area that is the most contaminated. The anal area is typically contaminated with California bacteria and should be cleansed last. The urethral meatus is the first area the nurse should cleanse when giving perineal care. Cleansing the labia minors last would violate a basic principle of asepsis. Cleansing the perineum last would violate a basic principle of asepsis.

Nitrofurantoin (Macrodantin) is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints? 1. The client may have contracted the flu 2. The client is experiencing anaphylaxis The client is experiencing expected effects of the medication 4. The client is experiencing a pulmonary reaction requiring cessation of the medication

4. The client is experiencing a pulmonary reaction requiring cessation of the medication Rationale: Nitrofurantoin can induce two kinds of pulmonary reactions: acute and subacute. Acute reactions, which are most common, manifest with dyspnea, chest pain, chills, fever, cough, and alveolar infiltrates. These symptoms resolve 2 to 4 days after discontinuing the medication. Acute pulmonary responses are thought to be hypersensitivity reactions. Subacute reactions are rare and occur during prolonged treatment. Symptoms (e.g., dyspnea, cough, malaise) usually regress over weeks to months following nitrofurantoin withdrawal. However, in some clients, permanent lung damage may occur. The remaining options are incorrect interpretations.

meatus on dorsal surface of penis

epispadias