Renal

The nurse is preparing to care for a client receiving peritoneal dialysis. Which should be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? 1.Maintain strict aseptic technique. 2.Add heparin to the dialysate solution. 3.Change the catheter site dressing daily. 4.Monitor the client's level of consciousness.

1.Maintain strict aseptic technique. The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment.

The nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP). The client has a 3-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and should expect which urine color during the immediate postoperative period? 1.Pale pink urine 2.Dark pink urine 3.Tea-colored urine 4.Bright red blood with small clots in the urine

1.Pale pink urine

The client diagnosed with benign prostatic hyperplasia (BPH) is scheduled for a transrectal ultrasound examination and a test to measure the level of prostate-specific antigen (PSA). The client says to the nurse, "I can't remember . . . can you tell me again why I need these tests to be done?" The nurse responds, knowing that these tests are done for which purpose? 1.Specifically to predict the course of BPH 2.Help to rule out the possibility of cancer 3.Pinpoint the likelihood of developing urinary obstruction 4.Give an indication of whether intermittent self-catheterization is needed

2.Help to rule out the possibility of cancer

A client who is undergoing peritoneal dialysis calls the nurse at the renal unit and reports the presence of severe abdominal pain and diarrhea. The client also informs the nurse that the peritoneal dialysis returns are brown-tinged in color. Which would the nurse suspect? 1.Infection 2.An intact catheter 3.Bowel perforation 4.Bladder perforation

3.Bowel perforation Complications of a peritoneal catheter include infection, perforation of the bowel or bladder, and bleeding. Brown-tinged returns suggest bowel perforation, which usually is accompanied by severe abdominal pain and diarrhea. Cloudy or opaque returns suggest possible infection.

The nurse is caring for an older client. Which finding should the nurse expect to note in this client while evaluating renal function? 1.Tubular reabsorption increases 2.Urine-concentrating ability increases 3.Medications are metabolized in larger amounts 4.The glomerular filtration rate (GFR) diminishes

4.The glomerular filtration rate (GFR) diminishes

A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information? A. Low purine B. Low calcium C. High phosphorus D. High alkaline ash

B. Low calcium

Which blood test is the best indicator of kidney issues?

Creatinine levels. Creatinine rises after 50% loss of kidney function.

A male client asks the nurse what he can do to decrease the risk of BPH. The nurse explains: a. Riding a bike raises prostate specific antigen levels and may increase the risk of BPH b. Prevention of BPH is not possible because it is a normal part of aging for males c. Decreasing saturated fat in the diet, and increasing fruits and veggies in the diet may help reduce the risk for BPH d. Taking a daily vitamin E supplement has reduced the size of the prostate for some men

c. Decreasing saturated fat in the diet, and increasing fruits and veggies in the diet may help reduce the risk for BPH

What causes irritative symptoms of BPH?

inflammation or infection

The nurse is performing assessment on a client with acute kidney injury who is in the oliguric phase. Which should the nurse expect to note? Select all that apply. 1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 4. A urine output of 600 to 800 mL in a 24-hour period 5. Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)

1. Increased serum creatinine level 2. A low and fixed specific gravity 3. Increased blood urea nitrogen (BUN) level 5. Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)

The nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings should the nurse expect to note? Select all that apply. 1. Proteinuria 2. Hematuria 3. Positive ketones 4. A low specific gravity 5. A dark and smoky appearance of the urine

1. Proteinuria 2. Hematuria 5. A dark and smoky appearance of the urine

The nurse is providing instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of peritonitis, a serious complication, is most likely to be associated with which clinical manifestation? 1.Fever 2.Fatigue 3.Clear dialysate output 4.Leaking around the catheter site

1.Fever The signs of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output

The nurse is assessing a client who has returned from the postanesthesia care unit after transurethral resection of the prostate (TURP). The nurse should assess for which color in the urinary drainage tubing that indicates proper irrigation and adequate functioning of the device? 1.Pale pink 2.Dark pink 3.Bright red 4.Red with clots

1.Pale pink Focus on the subject, care of the client with continuous bladder irrigation. Recall that hemorrhage is a potential complication after any surgical procedure. Remember also that the purpose of bladder irrigation is to flush out blood and clots that could otherwise accumulate in the bladder after surgery. With this in mind, conclude that pale pink drainage would indicate sufficient irrigation flow.

The nursing student is caring for a client with benign prostatic hyperplasia (BPH). The nursing instructor asks the student to identify the clinical manifestations associated with this condition. The student needs further teaching if the student states that which finding is an early symptom of BPH? 1.Nocturia 2.Hematuria 3.Decreased force of urine stream 4.Difficulty initiating urine stream

2.Hematuria

The nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further teaching about the diuretic phase of acute kidney injury? 1. "The increase in urine output indicates the return of some renal function." 2. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." 3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." 4. "The blood urea nitrogen and creatinine levels will continue to rise during the first few days of diuresis."

3. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." The diuretic phase of acute kidney injury is characterized by an increase in urine output of more than 1000 mL in a 24-hour period.

The nurse is planning a teaching session with a client who has chronic kidney disease (CKD) about managing the condition between dialysis treatments. The nurse should plan to include the instruction that weight gain between dialysis treatments should be ideally what value? 1. 11 to 13 lbs (5 to 6 kg) 2. 4.5 to 9 lbs (2 to 4 kg) 3. 2 to 3 lbs (1 to 1.5 kg) 4. 1 to 2 lbs (0.5 to 1.0 kg)

3. 2 to 3 lbs (1 to 1.5 kg)

The nurse is planning discharge teaching for a client newly diagnosed with chronic kidney disease (CKD). Which factor will enhance the educational process? 1.Anxiety 2.Memory deficits 3.Presence of family 4.Short attention span

3.Presence of family

A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? 1.The client washes hands at least once per day. 2.The client's temperature remains lower than 101°F (38.3°C). 3.The client avoids blood pressure (BP) measurement in the left arm. 4.The client's white blood cell (WBC) count remains within normal limits.

4.The client's white blood cell (WBC) count remains within normal limits. While 3 is also important for this client, that is more aligned with risk for injury. WBC count is best indicator for infection

The nurse instructs a client with renal failure who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the menu? a. Cream of wheat, blueberries, and coffee b. Sausage and eggs, banana, and orange juice c. Bacon, cantaloupe, and tomato juice d. Cured pork, grits, strawberries, and orange juice

a. Cream of wheat, blueberries, and coffee

A client with acute renal failure develops severe hyperkalemia. Which of the following would the nurse use to treat this imbalance? a. Furosemide (Lasix) b. Amphojel (aluminum hydroxide) c. Regular insulin d. Epoetin (Procrit)

a. Furosemide (Lasix)

A client with acute renal injury has a glomerular filtration rate (GFR) of 40mL/min. Which signs and symptoms may be present in this client? Select all that apply. a. Hypervolemia b. Hypokalemia c. Increased BUN d. Decreased creatinine level e. Increased WBCs

a. Hypervolemia c. Increased BUN

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

a. Palpation of a thrill over the fistula

A client with BPH with mild obstruction tells the nurse, "my symptoms have gotten a lot worse this week." Which response by the nurse is most appropriate? a. "The prostate gland normally changes slightly in size from day to day. This may be making your symptoms worse." b. "Have you been taking any OTC medications recently?" c. "Have you talked to your doctor about surgical procedures such as transurethral resection of the prostate?" "I will talk to the doctor about ordering a PSA test."

b. "Have you been taking any OTC medications recently?"

A client with a history of end-stage renal disease (ESRD) resulting from diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which assessment should the nurse prioritize before, during, and after the client's treatment? a. Level of consciousness b. Blood pressure and fluid balance c. Temperature, heart rate, and blood pressure. d. Assessment for signs and symptoms of infection

b. Blood pressure and fluid balance

A nurse is monitoring a client receiving peritoneal dialysis. The nurse notes that the clients outflow is less than the inflow. What actions should the nurse take in this situation? Select all that apply. a. Call the physician immediately b. Check the level of the drainage bag to make sure it is lower than the clients abdomen c. Reposition the client on his or her side d. Increase the flow rate of the peritoneal dialysis solution e. Check the peritoneal dialysis system for kinks

b. Check the level of the drainage bag to make sure it is lower than the clients abdomen c. Reposition the client on his or her side e. Check the peritoneal dialysis system for kinks

A nurse is caring for client diagnosed with benign prostatic hyperplasia (BPH). What is the most relevant assessment for a client admitted to the hospital with BPH? a. Flank pain radiating in the groin b. Distention of the lower abdomen c. Perineal edema d. Urethral discharge

b. Distention of the lower abdomen

A client is diagnosed with AKI. The client is voiding 4L/day of urine. What complication(s) can arise based on the stage of AKI the client is in? Select all that apply. a. Water intoxication b. Hypotension c. Low urine specific gravity d. Hypokalemia e. Normal GFR

b. Hypotension c. Low urine specific gravity d. Hypokalemia

A client undergoing a TURP returns from surgery with a three-way urinary catheter with continuous bladder irrigation (CBI) in place. The nurse observes that the urine output has decreased and the urine is clear red with multiple clots. The client is complaining of painful bladder spasms. The most appropriate action by the nurse is to: a. Administer 4mg of IV morphine sulfate. b. Increase the flow rate of the CBI c. Manually instill 50mL of saline and remove the clots d. Administer IV antibiotics to prevent infection

b. Increase the flow rate of the CBI

The nurse is caring for a client with a continuous bladder irrigation. Which is the most important nursing action? a. Monitoring urinary specific gravity to determine hydration. b. Subtracting irrigant from output to determine urine volume c. Recording urinary output every hour to determine kidney function. d. Including irrigating solution in a 24 hour urine specimen to determine urine concentration

b. Subtracting irrigant from output to determine urine volume

A client with CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. The nurse knows this is due to excessive amounts of what substance found in the blood? a. Calcium b. Urea c. Phosphate d. Erythropoietin

b. Urea

The nurse is caring for a patient with end stage renal disease. Which clinical indicator of end stage renal disease should the nurse expect? a. Polyuria b. Jaundice c. Azotemia d. Hypotension

c. Azotemia

A client with chronic renal failure has an internal venous access site for hemodialysis on her left forearm. What action will the nurse take to protect this access site? a. Irrigate with heparin every shift b. Apply warm moist packs to the area after hemodialysis c. Do not use the left arm to take blood pressure readings d. Keep the arm elevated above the levels of the hear

c. Do not use the left arm to take blood pressure readings

A patient with AKF becomes confused and irritable. The nurse understands that the most likely cause for this behavior is: a. Hyperkalemia b. Hypernatremia c. Elevated BUN d. Limited fluid intake

c. Elevated BUN

To determine the severity of the symptoms for a client with BPH, the nurse will ask the client about: a. Presence of blood in the urine b. Whether the client experiences erectile dysfunction c. Occurrence of a weak urinary stream d. Lower back and hip pain

c. Occurrence of a weak urinary stream

A client with irritative and obstructive bladder symptoms has an enlarged prostate on digital rectal examination and a PSA level of 5.0 ng/mL. The nurse anticipates the client will need teaching about: a. Uroflometry studies b. Cystouresthroscopy c. Transrectal ultrasound of the prostate (TRUS) d. MRI

c. Transrectal ultrasound of the prostate (TRUS)

A nurse is caring for a client during the oliguric phase of AKI. What would be an appropriate nursing intervention for the client? a. Weigh the client 3x per week. b. Increase dietary sodium and potassium c. Eliminate protein in the diet and replace with a high-carb diet d. Restrict fluids according to the previous days fluid loss.

d. Restrict fluids according to the previous days fluid loss.

The nurse is caring for a patient with glomerulonephritis. What should the nurse instruct the client to do to prevent recurrent attacks? a. Take showers instead of baths. b. Continue the same restrictions on fluid intake c. Avoid situations that involve physical activity d. Seek early treatment for respiratory tract infections

d. Seek early treatment for respiratory tract infections

A client is admitted to the hospital with a massive GI bleed. The client is at risk for what type of acute kidney injury? a. Post-renal b. Intra-renal c. Pre-renal d. Intrinsic renal

c. Pre-renal

A client with cancer of the prostate requests the urinal at frequent intervals but either does not void or voids in very small amounts. The nurse concludes that this is most likely caused by which factor? a. Edema b. Dysuria c. Retention d. Suppression

c. Retention

A client weighed 210 pounds (95.2 kg) on admission to the hospital. After 2 days of diuretic therapy, the client weighs 205.5 pounds (93.2 kg). How many liters of fluid has the client excreted? Record your answer using a whole number.

2 L 1 kg of weight = 1 L of fluid

After undergoing a radical retropubic prostatectomy for prostate cancer, a client is incontinent of urine. An appropriate nursing intervention is to teach the client: a. Pelvic floor muscle training b. The use of suppositories to help prevent bladder spasm c. Intermittent catheterization techniques To restrict oral intake

a. Pelvic floor muscle training

Which action is most appropriate for the nurse to document in the plan for care for a patient with an AV fistula? 1.Palpate the bruit of the AV fistula weekly to assess for thrombosis. 2.Use the AV fistula site for blood draws to prevent increased pain of multiple blood draws. 3.Take the blood pressure readings in the extremity with the AV fistula to get a more accurate reading. 4.Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis.

4.Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis.

What is the cup-like structure that collects a client's urine and is located at the end of each papilla? A. Calyx B. Capsule C. Renal cortex D. Renal columns

A. Calyx

A client is admitted to the hospital with CKD. The nurse understands that this condition is characterized by: a. Progressive irreversible destruction of the kidneys. b. A rapid decrease in urinary output with an elevated BUN level c. Increase creatinine clearance with a decrease in urinary output d. Somnolence and confusion with coma and imminent death

a. Progressive irreversible destruction of the kidneys.

What medication must patients stop before undergoing a transurethral resection of the prostate (TURP) procedure?

anticoagulants

A nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result will the nurse check to confirm the diagnosis? A. Rectal examination B. Serum phosphatase level C. Biopsy of prostatic tissue D. Massage of prostatic fluid

C. Biopsy of prostatic tissue

Which retrograde procedure involves the examination of the ureters and the renal pelvises? A. Cystogram B. Pyelogram C. Urethrogram D. Voiding cystourethrogram

B. Pyelogram A pyelogram is a retrograde examination of the ureters and the pelvis of both kidneys. A cystogram is a retrograde examination of the bladder. An urethrogram is a retrograde examination of the urethra. A voiding cystourethrogram is used to determine whether urine is flowing backward into the urethra.

Which diagnostic tests are used to measure the kidney size of a client with kidney dysfunction? Select all that apply. A. Cystoscopy B. Cystography C. Radiography D. Cystourethrography E. Computed tomography (CT)

C. Radiography E. Computed tomography (CT)

Which instruction should the nurse give a client who is on oral extended-release ciprofloxacin therapy for urinary tract infection? A. Chew the medication along with food B. Take a walk in morning sunlight C. Stop the drug after symptoms subside D. Refrain from taking the tablet immediately after an antacid

D. Refrain from taking the tablet immediately after an antacid Ciprofloxacin is an antibiotic used in treating urinary tract infections. The nurse should instruct the client to refrain from consuming ciprofloxacin within 2 hours of taking an antacid. Most antacids contain aluminum or magnesium, which interferes with the absorption of ciprofloxacin

A nurse is caring for the following clients. Which of these clients are at risk for acute intra-renal injury? Select all that apply. a. A 45 year old male with renal calculus. b. A 65 year old male with BPH c. A 25 year old female with glomerulonephritis. d. A 36 year old female with renal artery stenosis e. An 87 year old male who is taking an aminoglycoside medication for an infection.

c. A 25 year old female with glomerulonephritis. e. An 87 year old male who is taking an aminoglycoside medication for an infection.

A patient with acute kidney failure is to receive a very low protein diet. The nurse understands that this diet is based on the principle that: a. A high protein intake ensures an adequate daily supply of amino acids to compensate for losses. b. Essential and non essential amino acids are necessary in the diet to supply materials for tissue protein syntheses. c. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. d. Urea nitrogen cannot be used to synthesize amino acids in the body, so the nitrogen for amino acid synthesis must come from the dietary protein.

c. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.

A client with end-stage renal disease is receiving peritoneal dialysis. The nurse is monitoring the client for signs for complications associated with peritoneal dialysis. Which of the following signs may indicate complications associated with peritoneal dialysis? Select all that apply. a. Pruritis b. Oliguria c. Tachycardia d. Cloudy outflow e. Abdominal pain

d. Cloudy outflow e. Abdominal pain

The nurse is caring for a client with a diagnosis of CRF who has just been told by the physician that hemodialysis is necessary. The nurse understands that the reason why hemodialysis is necessary is because the client now has: a. Ascites b. Acidosis c. Hypertension d. Hyperkalemia

d. Hyperkalemia

A patient with CKF is to be treated with continuous ambulatory peritoneal dialysis. What indicates the purpose of this therapy? a. It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration. b. It exchanges and cleanses blood by correction of electrolytes and excretion creatinine. c. It decreases the need for immobility because it clears toxins in short and intermittent periods. d. It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion.

d. It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion.

What color urine would signify the presence of excessive bilirubin?

yellow-brown to olive-green-colored urine would signify excessive bilirubin

A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD? Select all that apply. 1.Agitation 2.Euphoria 3.Depression 4.Withdrawal 5.Labile emotions

1.Agitation 3.Depression 4.Withdrawal 5.Labile emotions

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.Check the level of the drainage bag. 2.Reposition the client to his or her side. 4.Place the client in good body alignment. 5.Check the peritoneal dialysis system for kinks.

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has chronic renal disease. 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.Increased number of white blood cells in the urine

1.Elevated creatinine level The creatinine level is the most specific laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost.

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.Visualization of enlarged blood vessels at the fistula site 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 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.

Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory studies? 1.Serum potassium, serum calcium 2.Urinalysis, hematocrit, hemoglobin 3.Culture and sensitivity testing, serum sodium 4.Urine specific gravity, intravenous pyelogram

1.Serum potassium, serum calcium Because of the potentially life-threatening outcomes associated with hyperkalemia and hypocalcemia, they are the most relevant to nursing management of the client with CKD. Note the strategic word, most. Focusing on the words providing care and late stages will direct you to the correct option. Also, recall the potentially life-threatening outcomes associated with hyperkalemia and hypocalcemia.

The nurse provides discharge instructions to a client after prostatectomy. What is the priority discharge instruction for this client? 1.Avoid driving a car for at least 1 week. 2.Increase fluid intake to at least 2.5 L/day. 3.Avoid lifting any objects greater than 30 pounds (13.6 kg). 4.Contact the health care provider (HCP) if small clots are noticed in the urine.

2.Increase fluid intake to at least 2.5 L/day. A daily intake of 2.5 L of fluid should be maintained to limit clot formation and prevent infection.

The nurse is caring for a client with acute kidney injury (AKI). The nurse should test the client's urine for proteinuria to determine which type of AKI? 1.Prerenal 2.Intrinsic 3.Atypical 4.Postrenal

2.Intrinsic

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement made by the new nursing graduate indicates an understanding of the procedure for hemodialysis? Select all that apply. 1."Sterile dialysate must be used." 2."Dialysate contains metabolic waste products." 3."Heparin sodium is administered during dialysis." 4."Dialysis cleanses the blood of accumulated waste products." 5."Warming the dialysate increases the efficiency of diffusion."

3."Heparin sodium is administered during dialysis." 4."Dialysis cleanses the blood of accumulated waste products." 5."Warming the dialysate increases the efficiency of diffusion."

The health care provider writes prescriptions for a client with chronic kidney disease (CKD). Which prescription should the nurse question? 1.Insert a saline lock. 2.Obtain a daily weight. 3.Provide a high-protein diet. 4.Administer a calcium supplement with each meal.

3.Provide a high-protein diet. Protein is restricted pre-dialysis. Once a patient goes on dialysis, then they will be given higher protein in their diet.

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include? 1."It is acceptable to eat whatever you want on the day before hemodialysis." 2."It is acceptable to exceed the fluid restriction on the day before hemodialysis." 3."Medications should be double-dosed on the morning of hemodialysis because of potential loss." 4."Several types of medications should be withheld on the day of dialysis until after the procedure."

4."Several types of medications should be withheld on the day of dialysis until after the procedure."

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 rated as 2 on a 0-10 pain scale 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 A rapid pulse with a low blood pressure is a potential sign of excessive blood loss.

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia? 1.Nocturia 2.Scrotal edema 3.Occasional constipation 4.Decreased force in the stream of urine

4.Decreased force in the stream of urine

What is the primary purpose of conducting a cystoscopy in a client with decreased and difficult urination? A. To ascertain the size of the kidneys B. To ascertain the protein content in urine C. To ascertain the presence of urethral wall abnormality D. To ascertain the total amount of catecholamines excreted

C. To ascertain the presence of urethral wall abnormality Cystoscopy is a procedure in which a cystoscope is used to visualize and examine the inner walls of the urinary bladder and ureter. The cystoscope is introduced into the client's ureter to detect the presence of urethral wall abnormalities or occlusions.

A client is about to begin hemodialysis. Which measures should the nurse employ in the care of the client? Select all that apply. 1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron 5. Covering the connection site with a bath blanket to enhance extremity warmth

1. Using sterile technique for needle insertion 2. Using standard precautions in the care of the client 3. Giving the client a mask to wear during connection to the machine 4. Wearing full protective clothing such as goggles, mask, gloves, and apron Infection is a major concern with hemodialysis. For that reason, the use of sterile technique and the application of a face mask for both nurse and client are extremely important. It also is imperative that standard precautions be followed, which includes the use of goggles, mask, gloves, and apron.

The nurse provides home care instructions to a client undergoing hemodialysis with regard to care of a newly created arteriovenous (AV) fistula. Which client statement indicates that teaching was effective? 1."I should check the fistula every day by feeling it for a vibration." 2."I am glad that the laboratory will be able to draw my blood from the fistula." 3."I should wear a shirt with tight arms to provide some compression on the fistula." 4."I should check my blood pressure in the arm where I have my fistula every week."

1."I should check the fistula every day by feeling it for a vibration."

The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option? 1.A client with severe heart failure 2.A client with a history of ruptured diverticula 3.A client with a history of herniated lumbar disk 4.A client with a history of 3 previous abdominal surgeries

1.A client with severe heart failure

A nurse is preparing to administer a dose of PhosLo (calcium acetate) to a client with CKD. This med should have a beneficial effect on with lab value? a. Sodium b. Potassium c. Magnesium d. Phosphorus

d. Phosphorus

After a transurethral prostatectomy, a client returns to the postanesthesia care unit with a three-way indwelling catheter with continuous bladder irrigation. Which nursing action is the priority? A. Observing the suprapubic dressing for drainage B. Maintaining the client in the semi-Fowler position C. Monitoring for bright red blood in the drainage bag D. Encouraging fluids by mouth as soon as the gag reflex returns

C. Monitoring for bright red blood in the drainage bag Blood clots are normal 24 to 36 hours after surgery, but bright red blood can indicate hemorrhage. The surgery is performed through the urinary meatus and urethra; there is no suprapubic incision. It is unnecessary to keep the client in the semi-Fowler position. The client is initially allowed nothing by mouth and then advanced to a regular diet as tolerated. Continuous irrigation supplies enough fluid to flush the bladder.

The nurse has completed teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse should determine that education was effective if the client states to record which parameters daily? 1.Pulse and respiratory rate 2.Amount of activity and sleep 3.Intake and output (I&O) and weight 4.Blood urea nitrogen (BUN) and creatinine levels

3.Intake and output (I&O) and weight

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status? 1.Blood pressure 2.Apical heart rate 3.Jugular vein distention 4.Level of consciousness

1.Blood pressure Remember that the kidneys play a role in controlling the blood pressure. The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. For kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output

The nurse has taught the client with polycystic kidney disease about management of the disorder and prevention and recognition of complications. The nurse should determine that the client understands the instructions if the client states that which should be reported to the health care provider (HCP)? Select all that apply. 1.Frequent urination 2.Burning on urination 3.A temperature of 100.6°F (38.1°C) 4.New-onset shortness of breath 5.A blood pressure of 105/68 mm Hg

1.Frequent urination 2.Burning on urination 3.A temperature of 100.6°F (38.1°C) 4.New-onset shortness of breath The client with polycystic kidney disease should report any signs and symptoms of urinary tract infection, such as frequent urination, burning on urination, and elevated temperature so that treatment may begin promptly. Pt is more likely to be hypertensive so 5 can be elminated.

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.Peritonitis 2.Hyperglycemia 3.Hyperphosphatemia 4.Disequilibrium syndrome

2.Hyperglycemia Focus on the subject, a complication associated with an extended dwell time. Noting the client's diagnosis and recalling that the dialysate solution contains glucose will direct you to the correct option.

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client? 1.Bradycardia 2.Hypertension 3.Decreased cardiac output 4.Decreased central venous pressure

2.Hypertension Focus on the subject, manifestations of AKI. Recalling that renal failure is accompanied by fluid overload will assist in eliminating decreased central venous pressure. Fluid overload is accompanied by tachycardia (because the heart works harder to pump the volume), so bradycardia can be eliminated. Regarding the remaining choices, knowing that hypertension accompanies AKI from intrarenal causes, whereas decreased cardiac output accompanies AKI attributable to prerenal causes, will direct you to the correct option.

A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse should expect to note which abnormal finding documented on the client's medical record? 1.Bradycardia 2.Hypertension 3.Decreased cardiac output 4.Decreased central venous pressure

2.Hypertension Focus on the subject, manifestation associated with glomerulonephritis and AKI. Begin to answer this question by recalling that kidney failure is accompanied by fluid overload. This would guide you to eliminate option 4 first. Because fluid overload increases the workload of the heart as a pump (tachycardia), option 1 can be eliminated next. Choose correctly between the remaining options after recalling that hypertension accompanies AKI because of intrarenal causes, whereas decreased cardiac output accompanies AKI because of prerenal causes.

In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should the nurse anticipate? 1.Glycosuria 2.Polyphagia 3.Crackles auscultated in the lungs 4.Blood pressure of 98/58 mm Hg

3.Crackles auscultated in the lungs Focus on the subject, CKD. Recall that the kidneys' function is to maintain the body's fluid and electrolyte balance and that when the kidneys are unable to function, the client will experience fluid volume overload and electrolyte imbalances. This will direct you to the correct option.

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse should observe for which most common manifestation of this disorder? 1.Headache 2.Hypotension 3.Flank pain and hematuria 4.Complaints of low pelvic pain

3.Flank pain and hematuria The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is either colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia, and palpable kidney masses. Hypertension is another common finding and may be associated with cardiomegaly and heart failure. Note the relationship between the word kidney in the name of the disorder and the word flank in the correct option.

The nurse is creating a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care? 1.Increase the amount of protein in the diet. 2.Increase the amount of potassium in the daily diet. 3.Maintain a diet high in calories with frequent snacks. 4.Encourage the client to eat a large breakfast and smaller meals later in the day.

3.Maintain a diet high in calories with frequent snacks. Uremia usually is accompanied by nausea, anorexia, and an unpleasant taste in the mouth. Most clients experience more nausea and vomiting in the morning. Therefore, to maintain optimal nutrition, it is best for these clients to eat a diet that is high in calories with frequent snacks and a light breakfast in the morning and larger meals later in the day.

The client with chronic kidney disease has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. Which action should the nurse immediately take? 1. Change the dressing. 2. Reinforce the dressing. 3. Flush the peritoneal dialysis catheter. 4. Scrub the catheter with povidone-iodine.

1. Change the dressing. Note the strategic word, immediately. Also, note the subject, a wet dressing for an indwelling abdominal catheter for peritoneal dialysis. Recalling that this client is at risk for infection and knowing that it is better to change a wet dressing than to reinforce it will direct you to the correct option.

A client has chronic kidney disease (CKD) that does yet not require dialysis. Which client statement indicates the need for further teaching? 1."I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." 2."The amount of fluid I can have every day depends on the amount of urine I put out." 3."I will weigh myself on my bathroom scale every morning right after I have urinated." 4."I should report a gain in weight, trouble with my breathing, or increased leg swelling."

1."I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." Conservative treatment of CKD slows progression of the disease and includes reducing the protein, sodium, potassium, and phosphorus in the diet and controlling the blood pressure. It is important to reduce the sodium in the diet. Salt substitutes usually are potassium-based and should not be used by a client with CKD because of the risk of hyperkalemia.

A client who has had a prostatectomy has been instructed in perineal exercises to gain control of the urinary sphincter. The nurse determines that the client demonstrates a need for further teaching when he states that he will perform which movement as part of these exercises? 1.Bearing down as if having a bowel movement 2.Tightening the muscles as if trying to prevent urination 3.Contracting the abdominal, gluteal, and perineal muscles 4.Tightening the rectal sphincter while relaxing abdominal muscles

1.Bearing down as if having a bowel movement

The nurse is conducting an interview of an older client and is concerned about the possibility of benign prostatic hyperplasia (BPH). Which are characteristics of this disorder? Select all that apply. 1.Nocturia 2.Incontinence 3.Enlarged prostate 4.Nocturnal emissions 5.Decreased desire for sexual intercourse

1.Nocturia 2.Incontinence 3.Enlarged prostate

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1.Place the client on a cardiac monitor. 2.Notify the health care provider (HCP). 3.Put the client on NPO (nothing by mouth) status except for ice chips. 4.Review the client's medications to determine if any contain or retain potassium. 5.Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

1.Place the client on a cardiac monitor. 2.Notify the health care provider (HCP). 4.Review the client's medications to determine if any contain or retain potassium. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the HCP and also review medications to determine if any contain potassium or are potassium retaining. Note the strategic word, priority. First, note that the potassium level is significantly elevated to select options 2 and 4. Also, use the ABCs-airway, breathing, and circulation-to select option 1.

A client with chronic kidney disease has completed a hemodialysis treatment. The nurse should use which standard indicators to evaluate the client's status after dialysis? 1.Vital signs and weight 2.Potassium level and weight 3.Vital signs and blood urea nitrogen level 4.Blood urea nitrogen and creatinine levels

1.Vital signs and weight Following dialysis the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's predialysis weight to determine effectiveness of fluid extraction.

The nurse is caring for a client with acute kidney injury (AKI) experiencing metabolic acidosis. When performing an assessment, the nurse should expect to note which breathing pattern? 1.Apnea 2.Kussmaul respirations 3.Decreased respirations 4.Cheyne-Stokes respirations

2.Kussmaul respirations

The nurse caring for a client immediately after transurethral resection of the prostate (TURP) notices that the client has suddenly become confused and disoriented. Which is the priority nursing action for this client? 1.Reorient the client. 2.Notify the health care provider (HCP). 3.Ensure that a clock and calendar are in the room. 4.Increase the flow rate of the intravenous infusion.

2.Notify the health care provider (HCP).

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 38.5°C (101.2°F). Which nursing action is most appropriate? 1.Encourage fluid intake. 2.Notify the health care provider. 3.Continue to monitor vital signs. 4.Monitor the site of the shunt for infection.

2.Notify the health care provider. Note the strategic words, most appropriate. Focus on the data in the question. Note the temperature elevation. This warrants notification of the HCP, who may prescribe diagnostic tests or medications.

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client? 1.Prevent fluid overload. 2.Prevent loss of electrolytes. 3.Promote the excretion of wastes. 4.Reduce the urine specific gravity.

2.Prevent loss of electrolytes. In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Also note the strategic word, primary. Knowing that during this phase the client experiences a high urine output will direct you to the correct option.

A client diagnosed with polycystic kidney disease has been taught about the treatment plan for this disease. The nurse should determine that the client needs further teaching if the client states that which is included in the treatment plan? 1.Genetic counseling 2.Sodium restriction 3.Increased water intake 4.Antihypertensive medications

2.Sodium restriction Individuals with polycystic kidney disease seem to waste rather than retain sodium. Unless the client has problems with uncontrolled hypertension, increased sodium and water intake is needed. Antihypertensive medications are prescribed to control hypertension. Genetic counseling is advisable because of the hereditary nature of the disease.

The nurse is preparing to perform a discharge teaching with a client who is started on hemodialysis. Which information should the nurse provide regarding the hemodialysis schedule? 1. 5 hours of treatment 2 days per week 2. 2 hours of treatment 6 days per week 3. 3 to 4 hours of treatment 3 days per week 4. 2 to 3 hours of treatment 5 days per week

3. 3 to 4 hours of treatment 3 days per week

A client is being discharged to home while recovering from acute kidney injury (AKI). Reduced dietary intake of which substance indicates to the nurse that the client understands the dietary teaching? 1.Fats 2.Vitamins 3.Potassium 4.Carbohydrates

3.Potassium The excretion of potassium and maintenance of potassium balance are normal functions of the kidneys. In the client with AKI or chronic kidney disease, potassium intake must be restricted as much as possible (to 60 to 70 mEq/day).

A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day. The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based on the client's statement? 1.The client has an accurate understanding of the procedure and aftercare. 2.The client does not realize how painful removal of the dialysis catheter will be. 3.The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. 4.The client is not aware that the alternative access site is left in place prophylactically for 2 months.

3.The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use.

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 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 admitting a client who has an arteriovenous (AV) fistula in the right arm for hemodialysis. Which nursing intervention is the best way to prevent injury to the AV site? 1. Putting a large note about the access site on the front of the medical record 2. Applying an allergy bracelet to the right arm, indicating the presence of the fistula 3. Telling the client to inform all caregivers who enter the room about the presence of the access site 4. Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm"

4. Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm"

A client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. Which is the priority nursing intervention? 1.Check the shunt for the presence of bruit and thrill. 2.Observe the site once during the shift as time permits. 3.Check the results of the prothrombin time as they are determined. 4.Ensure that small clamps are attached to the arteriovenous shunt dressing.

4.Ensure that small clamps are attached to the arteriovenous shunt dressing.

A client has just had a Foley catheter removed and is to be started on a bladder retraining program. Which intervention will provide the most useful information about the client's ability to empty the bladder? 1.Calculating total fluid intake for the shift 2.Recording the amount of the client's voidings 3.Assisting the client to the bathroom every 2 hours 4.Measuring postvoid residual using a bladder scan

4.Measuring postvoid residual using a bladder scan

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 priority nursing action? 1.Monitor the client. 2.Elevate the head of the bed. 3.Assess the fistula site and dressing. 4.Notify the health care provider (HCP).

4.Notify the health care provider (HCP).

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart problem can affect the kidneys. The nurse should formulate a response using what fact about the kidneys? 1.The kidneys get fatigued from having to filter too much fluid. 2.The kidneys can react adversely to moderate doses of furosemide. 3.The kidneys will shut down easily if serum levels of digoxin are high. 4.The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

4.The kidneys generally require and receive about 20% to 25% of the resting cardiac output. Heart failure is referred to as a prerenal cause of acute kidney injury because heart failure results in decreased blood flow to the kidneys. The kidneys normally receive about 20% to 25% of the cardiac output and require adequate perfusion to function properly. With a significant or prolonged decrease in blood supply, the kidneys can fail.

The nurse is performing bedside sonography for a female client who underwent a hysterectomy. Which nursing intervention needs correction? A. Using the female icon on the bladder scanner B. Placing an ultrasound gel pad right above the pubic bone C. Pointing the scan head so the ultrasound is projected towards the client's coccyx D. Placing the midline of the probe over the abdomen about 1.5 inches (3.8 cm) above the pubic bone

A. Using the female icon on the bladder scanner The male icon should be selected for men and for women who have undergone a hysterectomy.

After prostate surgery a client's indwelling catheter and continuous bladder irrigation (CBI) are to be removed. The nurse discusses with the client the procedure and what to expect after the removal. Which statement by the client indicates teaching by the nurse is understood? A. "I probably will have dilute urine." B. "I probably will be unable to urinate." C. "I probably will produce dark red urine." D. "I probably will experience some burning on urination."

D. "I probably will experience some burning on urination." Because of the trauma to the mucous membranes of the urinary tract, burning on urination is an expected response that should subside gradually.

Which of the following clients with AKI is in the oliguric stage of AKI? a. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/creatinine, hyperkalemia, edema, and urinary output of 350ml/day. b. A 45 year old female who has metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output of 600 ml/day. c. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output of 4L/day. d. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output of 550 ml/day.

a. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/creatinine, hyperkalemia, edema, and urinary output of 350ml/day.

A patient with acute kidney failure states, "why am I twitching and my fingers and toes tingling?" The nurse should respond, "this is caused by...: a. Acidosis b. Calcium depletion c. Potassium retention d. Sodium chloride depletion

b. Calcium depletion

A client is in the diuretic phase of AKI. The nurse should monitor for which serum electrolyte imbalances? a. Hyperkalemia and hyponatremia b. Hyperkalemia and hypernatremia c. Hypokalemia and hyponatremia d. Hypokalemia and hypernatremia

c. Hypokalemia and hyponatremia

A client with AKI has a urinary output of 350ml/day. The client's lab results show an increased BUN and creatinine level, along with potassium level of 6mEq/L. What type of diet is most appropriate for the client? a. Low-sodium, high-protein, and low potassium b. High-protein, low-potassium, and low-sodium c. Low-protein, low-potassium, and low-sodium d. High-protein and high-potassium

c. Low-protein, low-potassium, and low-sodium

What causes obstructive symptoms of BPH?

prostate enlargement