Renal key point

6. A patient with acute kidney injury has the following labs: GFR 92 mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine 1 mg/dL. The patient's 24 hour urinary output is 1.75 Liters. Based on these findings, what stage of AKI is this patient in?* A. Initiation B. Diuresis C. Oliguric D. Recovery

. Recovery

Creatinine levels - Normal

0.6 to 1.2 - males 0.5 to 1.1 - females

1. A client with glomerulonephritis is at risk of developing acute renal failure. The nurse monitors the client for which sign of this complication? a) bradycardia b) hypertension c) decreased cardiac output d) decreased central venous pressure

1) B - Acute renal failure caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of acute renal failure is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. Acute renal failure from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for renal failure.

Average Urine Gravity

1.010 to 1.030

10. A client diagnosed with cancer of the bladder has a nursing diagnosis of fear related to the uncertain outcome of upcoming cystectomy and urinary diversion. The nurse determines that this diagnosis is appropriate if the client makes which statement? a) I'm so afraid I won't live through all this b) what if I have no help at home after going through this awful surgery c) I'll never feel like myself once I can't go to the bathroom normally d) I wish I'd never gone to the doctor at all

10) A - In order for fear to be an actual diagnosis, the client must be able to identify the object of fear. In this question, the client is expressing a fear of the outcome related to surgery. The statement in option B relates to a nursing diagnosis of impaired home maintenance. Option C relates to a nursing diagnosis of disturbed body image. Option D is vague and nonspecific, and further assessment is needed to associate this statement with a nursing diagnosis

11. A nurse is developing a plan of care for a client with nephrotic syndrome. The nurse documents that which important parameter needs to be assessed on a daily basis? a) total protein levels b) weight c) blood urea nitrogen (BUN) d) activity tolerance

11) B The client with nephrotic syndrome typically presents with edema, hypoalbuminemia, and proteinuria. The nurse carefully assesses the fluid balance of the client, which includes daily monitoring of weight, intake and output, edema, and girth measurements. Albumin levels are monitored as they are ordered, as are the BUN and creatinine levels. The client's activity level is adjusted according to the amount of edema and water retention. As edema increases, the client's activity level should be restricted.

12. A client with renal malignancy (cancer) is admitted to the hospital for a diagnostic workup and probable surgery. During the admission assessment the nurse inquires about the presence of which common symptom related to this problem? a) flank pain and intermittent hematuria b) suprapubic pain and constant slight hematuria c) flank pain and foul-smelling urine d) abdominal pain and decreased urine output

12) A - Renal cancer is commonly manifested by hematuria and flank pain (not abdominal or suprapubic), and a palpable mass may be palpated on physical examination. Because the hematuria is gross but intermittent, the client may delay seeking medical treatment. Foul-smelling urine could indicate infection. Decreased urine output could indicate renal insufficiency.

13. A client has undergone urinary diversion after cystectomy for bladder cancer. The nurse assesses the urostomy stoma to ensure that it is: a) pale and pink b) pink and dry c) red and moist d) dusky to beefy colored

13) C - Following urostomy, the stoma should be red and moist. It may be edematous, but this will decrease after the first few days. A dusky or cyanotic color indicates insufficient circulation with impending necrosis and warrants notification of the surgeon immediately.

14. A nurse is caring for a client receiving hemodialysis who has an internal arteriovenous (AV) fistula. Which assessment finding would indicate to the nurse that the fistula is patent? a) white fibrin specks noted in the fistula b) palpation of a thrill over the site of the fistula c) lack of bruit over the site of the fistula d) a feeling of warmth at the site of the fistula

14) B - An internal AV fistula is created through a surgical procedure in which an artery in the arm is anastomosed to a vein. To assess patency, the nurse palpates over the fistula for a thrill and auscultates for a bruit. With an internal AV fistula, the nurse would not note white fibrin specks. A feeling of warmth at the site of the fistula may indicate an inflammatory process.

15. A nurse is caring for a client following a cystoscopy. Which assessment finding requires physician notification? a) bladder spasm b) complaints of fullness and burning in the bladder c) clots in the urine d) back pain

15) C - Back pain, bladder spasms, and feelings of fullness and burning in the bladder may be experienced by the client following a cystoscopy. Warm tub baths, mild analgesics, and antispasmodics will provide relief. Pink-tinged urine is common but any bright red bleeding or clots in the urine should be reported to the physician.

The client diagnosed with hypovolemic shock has a BP of 100/60. Fifteen minutes later the BP is 88/64. How much narrowing of the client's pulse pressure has occurred between the two readings?

16 The pulse pressure is the systolic BP minus the diastolic BP. 100-60 = 40 88-64 = 24 40-24= 16 Pulse pressure narrowing A narrowing or decreased pulse pressure is an earlier indicator of shock than a decrease in systolic BP

16. A client with chronic renal failure is on a fluid restriction and receives aluminum hydroxide gel (ALternaGEL) as a phosphate binder. The nurse determines that the client is at risk for which problem (nursing diagnosis) because of these treatment measures? a) fatigue b) deficient fluid volume c) constipation d) ineffective coping

16) C - The client with renal failure is almost certain to have a problem with constipation due to factors such as fluid restriction and dietary restrictions of most high-fiber foods (which have high potassium content). In addition, aluminum-based antacids such as aluminum hydroxide gel cause constipation as a side effect. There is no information in the question to support any of the other options, although the client with renal failure is commonly fatigued.

17. A client with chronic renal failure has undergone insertion of an indwelling catheter in the abdomen for peritoneal dialysis. The nurse teaches the client to do which of the following if the peritoneal catheter dressing gets wet? a) flush the peritoneal dialysis catheter b) scrub the catheter with povidone-iodine c) reinforce the dressing d) change the dressing

17) D - Clients with peritoneal dialysis catheters are at high risk for infection. A dressing that is wet is a conduit for bacteria to reach the catheter insertion site. The nurse teaches the client to keep the dressing dry at all times. Reinforcing the dressing is not a safe practice to prevent infection. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis.

18. A client with chronic renal failure has a new medication order for epoetin alfa (Epogen). The nurse plans to give this medication in which of the following ways? a) with a full glass of water b) diluted in juice to enhance taste c) subcutaneously d) with an antacid 1

18) C - Epoetin alfa is erythropoietin that has been manufactured through the use of recombinant DNA technology. It is used to treat anemia in the client with chronic renal failure. The medication may be administered subcutaneously or intravenously.

19. A nurse is giving suggestions to a client with chronic renal failure about ways to reduce pruritus from uremia. The nurse tells the client to avoid which type of skin care product? a) lanolin-based lotion b) bath oil c) mild soap d) astringent cleansing pads

19) D - The client with chronic renal failure often has dry skin, accompanied by itching (pruritus) from uremia. The client should use mild soaps, lotions, and bath water oils to reduce dryness without increasing skin irritation. Products that contain perfumes or alcohol increase dryness and pruritus, and should be avoided.

2. A nurse provides home care instructions to a client hospitalized for a transurethral resection of the prostate (TURP). Which statement by the client indicates a need for further instructions? a) I need to avoid strenuous activity for 4 to 6 weeks b) I need to maintain a daily intake of 6 to 8 glasses of water daily c) I need to avoid lifting items greater than 30 pounds d) I need to include prune juice in my diet

2) C - The client needs to be advised to avoid strenuous activity for 4 to 6 weeks and to avoid lifting items weighing greater than 20 pounds. The client needs to consume an intake of at least 6 to 8 glasses daily of nonalcoholic fluids to minimize clot formation. Straining during defecation for at least 6 weeks after surgery is avoided to prevent bleeding. Prune juice is a satisfactory bowel stimulant.

An elderly female client with vertebral fractures who has been self-medicating with ibuprofen a NSAID presents to the ED complaining of abdominal pain, is pale and clammy, and has a pulse of 110 and a BP of 92/60. Which type of shock should the nurse suspect? 1. Cardiogenic shock 2. Hypovolemic shock 3. Neurogenic shock 4. Septic shock

2. These client's signs/symptoms make the nurse suspect the client is losing blood, which leads to hypovolemic shock, which is the most common type of shock and is characterized by decreased intravascular volume. The client's taking of NSAID medications puts her at risk for hemorrhage because NSAIDs inhibit prostaglandin production in the stomach, which increases the risk of developing ulcers, which can erode the stomach lining and lead to hemorrhaging

20. A nurse is working with a client newly diagnosed with chronic renal failure to set up schedule for hemodialysis. The client states, "This is so unfair I wouldn't have to do this for the rest of my life if you people had caught this disease in time!" The nurse interprets that the client is exhibiting: a) anger b) projection c) withdrawal d) depression

20) B - Psychosocial reactions to chronic renal failure and hemodialysis are varied and may include personality changes, emotional lability, withdrawal, depression, and anger. The individual client response may vary depending on the client's personality and support systems. The client in this question is exhibiting projection. The client is blaming the nurse and other health care personnel for the client's situation.

21. A nurse is analyzing the laboratory results of a client with chronic renal failure who is receiving epoetin alfa (Epogen). The nurse interprets that the medication is having the expected effect if the results indicate an increase in which of the following levels? a) red blood cells b) potassium c) creatinine d) phosphorus

21) A - Epoetin alfa is erythropoietin that has been manufactured through the use of recombinant DNA technology. It is used to treat anemia in the client with chronic renal failure. The other levels rise as a result of the pathology of renal failure and have nothing to do with the effects of this medication.

22. a nurse has formulated a nursing diagnosis of Risk for Infection for a hemodialysis client with an arteriovenous (AV) fistula in the right arm. The nurse determines that the client has best met the outcome criteria for this nursing diagnosis if which of the following observations is made? a) the client states her or she should do careful handwashing once a day b) the client states her or she should avoid blood pressure measurement in the right arm c) the client's temperature does not exceed 100.6F d) the client's white blood cell (WBC) count is 7500/mm3

22) D - General indicators that the client is not experiencing infection include a normal temperature and a normal WBC count. Option C is incorrect because the temperature is elevated above normal. The client should also use proper handwashing technique as a general preventive measure; however, handwashing once per day is insufficient, and is therefore incorrect. It is true that the client should avoid blood pressure measurement in the affected arm; however, this would relate more closely to the nursing diagnosis Risk for injury.

23. A nurse is developing a teaching plan for a client with chronic renal failure who has been started on hemodialysis. The nurse would plan to include which of the following pieces of information in discussions with the client? a) it's unnecessary to stay within the fluid restriction on the day before hemodialysis b) it's all right to eat unlimited protein on the day before hemodialysis c) daily medications should be taken after hemodialysis, not before d) daily medications should be double-dosed if going for hemodialysis that day

23) C - Many medications are dialyzable, which means they are removed from the bloodstream during dialysis. Because of this, many medications are withheld on the day of dialysis until after the procedure. It is not typical for medications to be "double-dosed" because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.

24. A nurse is explaining the concept of fluid restriction to a client with chronic renal failure who has started hemodialysis. The nurse tells the client that the fluid restriction is planned by adding the amount of the daily urine output (if any) and: a) 1800 to 2000 ml b) 1200 to 1500 ml c) 500 to 700 ml d) 200 to 300 ml

24) C - The usual allowable daily fluid intake of the hemodialysis client is the total of the daily urine output plus 500 to 700 mL. Options 1 and 2 identify high volumes of fluid intake, and option 4 identifies an insufficient volume. .

25. A nurse is caring for a client newly diagnosed with chronic renal failure who has recently begun hemodialysis. The nurse determines that the client has not tolerated the procedure optimally if the client experiences which symptoms that represent disequilibrium syndrome? a) restlessness, irritability, and generalized weakness b) headache, deteriorating level of consciousness, and seizures c) hypertension, tachycardia, and fever d) hypotension, bradycardia, and hypothermia

25) B - Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. It results from the rapid removal of solutes from the body during hemodialysis. The blood-brain barrier interferes with equally efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. It most often occurs in clients who are new to dialysis, and is prevented by dialyzing for shorter times or at reduced blood flow rates

26. A client with chronic renal failure has been on dialysis for 4 years and has been taking aluminum hydroxide (Amphojel tablets) as prescribed as part of the medication regimen. The client develops confusion and dementia, and complains of bone pain. The nurse interprets that this client is at risk for developing: a) advancing uremia b) folic acid defieciency c) phosphate overdose d) aluminum intoxication

26) D - Aluminum intoxication can occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. Symptoms include mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. This complication is treated with aluminum chelating agents, which make aluminum available to be dialyzed from the body. It is prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum.

27. A client is undergoing hemodialysis and receives heparin during the dialysis procedure. The nurse monitors the results of which of the following laboratory tests during the dialysis procedure? a) thrombin time b) bleeding time c) partial thromboplastin time (PTT) d) prothrombin time (PT)

27) C - Heparin is used as an anticoagulant during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by measuring the PTT, which measures heparin effect. The PT is measured to monitor the effect of warfarin (Coumadin) therapy. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities.

28. A client undergoing hemodialysis becomes hypotensive. The nurse immediately prepares to take which action? a) administer 1000 ml 5% dextrose in water b) administer a 250 ml normal saline bolus c) increase the blood flow into the dialyzer d) lower the client's legs and feet

28) B - To treat hypotension during hemodialysis, a normal saline bolus of up to 500 mL may be given. The client's feet and legs are raised to enhance cardiac return. Albumin may be given as per protocol to increase colloid oncotic pressure. The blood flow rate into the dialyzer may be decreased. All of these measures should improve the circulating volume and blood pressure. Five percent dextrose in water is not prescribed because it is less likely to improve the circulating volume and blood pressure.

29. A client with chronic renal failure has completed a hemodialysis treatment. The nurse measures which parameters at the completion of the hemodialysis procedure to monitor for hemodynamic stability and to determine effectiveness of fluid extraction? a) vital signs and blood urea nitrogen (BUN) b) vital signs and weight c) sodium and potassium levels d) BUN and creatinine levels

29) B - 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 "dry weight" to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol, but are not necessarily done after the hemodialysis treatment has been ended.

3. A nurse is caring for a client who has just returned to the nursing unit after an intravenous pyelogram (IVP). The nurse determines that which of the following is important in the postprocedure care of this client? a) encouraging increased intake of oral fluids b) ambulating the client in the hallway c) encouraging the client to try to avoid frequently d) maintaining the client on bedrest

3) A - Following an IVP, the client should take in increased fluids to aid in the clearance of the dye used for the procedure. It is unnecessary to void frequently after the procedure. The client is usually allowed activity as tolerated without any specific activity guidelines.

Albumin - POTS AND PHOS BIG BRO

3.5 to 5.5

30. A hemodialysis client has a newly created left arm fistula. The nurse monitors the affected extremity for which signs and symptoms that indicate a complication related to steal syndrome? a) edema and purplish discoloration b) aching pain, pallor, and edema c) warmth, redness, and pain d) pallor, diminished pulse. and pain

30) D - Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula from tissue ischemia. Warmth, redness, and pain would more likely characterize a problem with infection. The patterns described in options A and B are not usually observed because they do not relate to a complication following fistula creation.

31. 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? a) "Caution should be used when straddling the infant on a hip." b) "Vital signs should be taken daily to check for bladder infection." c) "Catheterization will be necessary when the infant does not void." d) "Circumcision has been delayed to save tissue for surgical repair."

31) D - 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 A, B, and C are unrelated to this disorder. - Test-Taking Strategy: Focus on the subject, treatment for hypospadias. Note the words indicates their understanding. Recalling that hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis will direct you to the correct option.

32. 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? a) Cover the bladder with petroleum jelly gauze. b) Cover the bladder with a nonadhering plastic wrap. c) Apply sterile distilled water dressings over the bladder mucosa. d) Keep the bladder tissue dry by covering it with dry sterile gauze.

32) B - 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 use 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 dressings soaked in solutions (that can dry out) also damage the mucosa when removed. - NCLEX Questions on Urinary Elimination Test-Taking Strategy: Focus on the subject, treatment for bladder exstrophy, and visualize this disorder. Noting the word nonadhering in the correct option will direct you to select this one.

33. NCLEX Questions on Urinary Elimination about the nurse who understands that which information collected during the assessment of a child recently diagnosed with glomerulonephritis is most often associated with the diagnosis? a) Child fell off a bike onto the handlebars b) Nausea and vomiting for the last 24 hours c) Urticaria and itching for 1 week before diagnosis d) Streptococcal throat infection 2 weeks before diagnosis

33) D - Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-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 of 1 to 2 weeks. The assessment data in options A, B, and C are unrelated to a diagnosis of glomerulonephritis. - Test-Taking Strategy: Note the strategic word most. Option A relates to a kidney injury, not an infectious process. From the remaining options, recalling that a streptococcal infection 1 to 2 weeks before the development of glomerulonephritis is the classic assessment finding will assist in directing you to the correct option.

34. 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 should the nurse most likely expect to note? a) Hematuria b) Proteinuria c) Bacteriuria d) Glucosuria

34) C - 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 A, B, and D are not characteristically noted in this condition. - Test-Taking Strategy: Note the strategic words most likely. Visualize the anatomical characteristics of epispadias to answer the question. Options A, B, and D do not relate to the potential for infection, which can be associated with epispadias.

35. The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings should the nurse expect to observe? Select all that apply. a) Pallor b) Edema c) Anorexia d) Proteinuria e) Weight loss f) Decreased serum lipids

35) A, B, C, D - Rationale: Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.

36. 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? a) Check the sodium level. b) Place the client on a cardiac monitor. c) Encourage increased vegetables in the diet. d) Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration. .

36) B - Rationale: 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. Fluid intake is not increased because it 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 also may 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. - Test-Taking Strategy: Note the strategic word priority. First, note that the potassium level is elevated. Next, use the ABCs— airway, breathing, and circulation— to direct you to the correct option.

37. A client being hemodialyzed suddenly becomes short 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? a) Monitor vital signs every 15 minutes for the next hour. b) Discontinue dialysis and notify the health care provider (HCP). c) Continue dialysis at a slower rate after checking the lines for air. d) Bolus the client with 500 mL of normal saline to break up the air embolus.

37) B - Rationale: If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the HCP, and administer oxygen as needed. Options A, C, and D are incorrect. - NCLEX Questions on Urinary Elimination Test-Taking Strategy: Note the strategic word priority. Recalling that air embolism is an emergency situation that affects the cardiopulmonary system suddenly and profoundly will direct you to the correct option.

38. NCLEX Questions on Urinary Elimination about a client who 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? a) Pyelonephritis b) Glomerulonephritis c) Trauma to the bladder or abdomen d) Renal cancer in the client's family

38) C - 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. - Test-Taking Strategy: Note the strategic word next. Eliminate options A and B because they are comparable or alike, knowing that any inflammatory disease or infection is accompanied by fever. Because this client is afebrile, these are not possible options. Use knowledge of anatomy and pain assessment to select the correct option. Pain from renal cancer is a later finding and is localized in the flank area.

39. A client is admitted to the emergency department following a motor vehicle 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? a) Hip b) Shoulder c) Umbilicus d) Costovertebral angle

39) B - Rationale: Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders due to phrenic nerve irritation. Bladder injury pain does not radiate to the umbilicus, costovertebral angle, or hip. - Test-Taking Strategy: Focus on the subject, characteristics of bladder trauma. Recalling the concepts related to dermatomes of the body and pain characteristics of bladder trauma will direct you to the correct option.

4. A nurse has collected nutritional data from a client with a diagnosis of cystitis. The nurse determines that which beverage needs to be eliminated from the client's diet to minimize the recurrence of cystitis? a) fruit juice b) tea c) water d) lemonade

4) B - Caffeine and alcohol can irritate the bladder. Therefore, alcohol and caffeine-containing beverages such as coffee, tea, and cocoa are avoided to minimize the risk. Water helps flush bacteria out of the bladder, and an intake of six to eight glasses per day is encouraged. Lemonade and fruit juice are acceptable items to drink.

40. 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 for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? a) Notify the HCP. b) Use a small-sized catheter. c) Administer pain medication before inserting the catheter. d) Use extra povidone-iodine solution in cleansing the meatus

40) A - 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 the bleeding is determined by diagnostic testing. Therefore options B, C, and D are incorrect.

41. 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. a) Check the level of the drainage bag. b) Reposition the client to his or her side. c) Contact the health care provider (HCP). d) Place the client in good body alignment. e) Check the peritoneal dialysis system for kinks. f) Increase the flow rate of the peritoneal dialysis solution

41) A, B, D, E - 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 drainage bag needs to be lower than the client's abdomen to enhance gravity 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. - Test-Taking Strategy: Focus on the subject, outflow is less than inflow, and use the principles related to gravity flow and preventing obstruction to flow to answer this question. This will assist in determining the correct interventions.

42. A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess the client for which manifestations of this complication? a) Warmth, redness, and pain in the left hand b) Aching pain, pallor, and edema of the left arm c) Edema and reddish discoloration of the left arm d) Pallor, diminished pulse, and pain in the left hand

42) D - 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 ischemia. Warmth and redness probably would characterize a problem with infection. The manifestations described in options B and C are incorrect. - Urinary NCLEX Questions Test-Taking Strategy: Focus on the subject, arterial steal syndrome. You must understand steal syndrome and know the signs and symptoms to answer this question. Recalling that steal syndrome results from vascular insufficiency after creation of a fistula will direct you to the correct option.

43. Urinary NCLEX Questions about the nurse who 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? a) Elevated creatinine level b) Decreased hemoglobin level c) Decreased red blood cell count d) Decreased white blood cell count

43) A - Rationale: Measuring the creatinine level is a frequently 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. - Test-Taking Strategy: Note the strategic words most likely. Recalling the relationship between the creatinine level and renal function will direct you to the correct option.

44. 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? a) Encourage fluids. b) Notify the health care provider. c) Continue to monitor vital signs. d) Monitor the site of the shunt for infection.

44) C - Rationale: The client may have an elevated temperature 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. - Test-Taking Strategy: Note the strategic words most appropriate. Focus on the data in the question. Recalling that an elevation in temperature is expected following dialysis will direct you to the correct option.

45. 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? a) Monitor the client. b) Elevate the head of the bed. c) Medicate the client for nausea. d) Notify the health care provider

45) D - 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.

5. A client with pyelonephritis is being discharged from the hospital, and the nurse provides instructions to the client to prevent recurrence. The nurse determines that the cleint understands the information that was given if hte client states an intention to: a) increase fluids for 2 days if signs and symptoms of a urinary tract infection develop b) take the prescribed antibiotics until all symptoms subside c) return to the physician's office for scheduled follow-up urine cultures d) decrease fluid intake if frequent urination occurs

5) C - The client with pyelonephritis should take the full course of antibiotic therapy that has been prescribed and return to the physician's office for follow-up urine cultures if so instructed. The client should learn the signs and symptoms of a urinary tract infection, and report them immediately if they occur. The client should also drink 3 L of fluid per day. After you reviewed your answers through its rationale, you can go to the next page to continue your review: Renal System NCLEX Questions (6-10)

6. A nurse is giving a client with polycystic kidney disease instructions in replacing elements lost in the urine as a result of impaired kidney function. The nurse instructs the client to increase intake of which of the following in the client? a) sodium and potassium b) sodium and water c) water and phosphorus d) calcium and phosphorus

6) B - Clients with polycystic kidney disease waste sodium rather than retain it and therefore need an increase in sodium and water in the diet. Potassium, calcium, and phosphorus do not need to be increased in this condition.

BUN levels - normal

7 to 20 mg/dL (2.5 to 7.1 mmol/L)

7. A nurse has provided instructions to a female client with cystitis about measures to prevent recurrence. The nurse determines that the client needs further instruction if the client verbalizes to: a) take bubble baths for more effective hygiene b) wear underwater made of cotton or with cotton panels c) drink a glass of water and void after intercourse d) avoid wearing pantyhose while wearing socks

7) A - Measures to prevent cystitis include increasing fluid intake to 3 L per day; consuming an acid-ash diet; wiping front to back after urination; using showers instead of tub baths; drinking water and voiding after intercourse; avoiding bubble baths, feminine hygiene sprays, or perfumed toilet tissue or sanitary pads; and wearing clothes that "breathe" (cotton pants, no tight jeans, no pantyhose under slacks). Other measures include teaching pregnant women to void every 2 hours, and teaching menopausal women to use estrogen vaginal creams to restore vaginal pH.

8. A nurse has provided instructions to a client with a nephrotostomy tube regarding home care after hospital discharge. The nurse determines that the client understands the instructions if the client verbalizes to drink approximately how many 8-ounce glasses of water per day? a) 2 b) 8 c) 16 d) 20

8) B - The client with a nephrostomy tube needs to have adequate fluid intake to dilute urinary particles that could cause calculus and to provide mechanical flushing of the kidney and tube. The nurse encourages the client to take in 2000 mL of fluid per day, which is roughly equivalent to eight 8-ounce glasses of water. Option A identifies a fluid intake volume that is too low and would not provide mechanical flushing of the kidney and tube. Options C and D identify very large volumes of fluid intake; these volumes are unnecessary and could possibly place undo distention on the renal pelvis.

9. A client with nephrolithiasis (kidney stone) arrives at a clinic for a follow-up visit. The laboratory analysis of the stone that the client passed 1 week ago indicates that the stone is composed of calcium oxalate. The nurse tells the client to avoid consuming which food item? a) lentils b) strawberries c) lettuce d) pasta

9) B - Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. Of the options provided, the client will be instructed to avoid strawberries.

Creatinine Clearance levels

97-137 mL/min for healthy men 88-128 mL/min for healthy women .

3. A 65 year old male patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You're assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidneys?* A. Lisinopril B. Metoprolol C. Amlodipine D. Verapamil

A

4. A 76 year old female is admitted due to a recent fall. The patient is confused and agitated. The family members report that this is not normal behavior for the patient. They explain that the patient is very active in the community and cares for herself. Based on the information you have gathered about the patient, which physician's order takes priority?* A. "Collect a urinalysis" B. "Collect a T3 and T4 level" C. "Insert a Foley Catheter" D. "Keep patient NPO"

A

4. Which patient below is at MOST RISK for developing acute glomerulonephritis?* A. A 3 year old male who has a positive ASO titer. B. A 5 year old male who is recovering from an appendectomy. C. An 18 year old male who is diagnosed with HIV. D. A 6 year old female newly diagnosed with measles.

A

9. A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a:* A. Low protein, low sodium, low potassium, low phosphate diet B. High protein, low sodium, low potassium, high phosphate diet C. Low protein, high sodium, high potassium, high phosphate diet D. Low protein, low sodium, low potassium, high phosphate diet

A

During a head-to-toe assessment on a patient with a possible urinary tract infection, you perform costovertebral angle percussion. The costovertebral angle is found?* A. between the bottom of the 12th rib and spine B. between the right upper quadrant and umbilicus C. between the sternal notch and angle of Louis D. between the ischial spine and umbilicus

A

10. On your nursing care plan for a patient with a urinary tract infection, which of the following would be appropriate nursing interventions? SELECT-ALL-THAT-APPLY:* A. Encourage voiding every 2-3 hours while awake. B. Restrict fluid intake to 1-2 liters per day. C. Monitor intake and output daily. D. The patient verbalizes the importance of using vaginal sprays to decrease reoccurrence of urinary tract infections prior to discharge home.

A,C

2. A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply:* A. Hypervolemia B. Hypokalemia C. Increased BUN level D. Decreased Creatinine level

A,C

9. You're caring for a patient with an indwelling catheter. The patient complains of spasm like pain at the catheter insertion site. Which of the following options below are other signs and symptoms the patient could experience or the nurse could observe if a urinary tract infection was present? SELECT-ALL-THAT-APPLY:* A. Increased WBC B. Crystalluria C. Positive McBurney's Sign D. Feeling the need to void even though a catheter is present E. Dark and cloudy urine F. Cramping

A,D,E,F

11. While educating a group of nursing students about the stages of acute kidney injury, a student asks how long the oliguric stage lasts. You explain to the student this stage can last?* A. 1-2 weeks B. 1-3 days C. Few hours to 2 weeks D. 12 months

A. 1-2 weeks

9. Which patient below with acute kidney injury 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 350 mL/day. B. A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output 600 mL/day. C. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output 4 L/day. D. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output 550 mL/day.

A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day.

Which type of fluid is most appropriate for volume replacement for a patient with non-hemorrhagic hypovolemic shock? a.) Lactated Ringers (LR) b.) 10% Dextrose in Water (D 10 W) c.) One-half Normal Saline (1/2% NS) d.) Packed Red Blood Cells (PRBC)

A. Lactated RIngers

a mainstay of therapy for virtually all forms of shock is

A: A person experiencing shock may have lost a significant amount of body fluid which needs to be replaced.

5. Which of the following are NOT a sign and symptom of acute glomerulonephritis (poststreptococcal)? SELECT-ALL-THAT-APPLY:* A. Hypotension B. Increased Glomerular filtration rate C. Cola-colored urine D. Massive proteinuria E. Elevated BUN and creatinine F. Mild swelling in the face or eyes

ABD

9. Which of these findings is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has been successful? a. Hemoglobin is within normal limits. b. Urine output is 60 mL over the last hour. c. Pulmonary artery wedge pressure (PAWP) is normal. d. Mean arterial pressure (MAP) is 65 mm Hg

ANS: B Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful. The hemoglobin level, PAWP, and MAP are useful in determining the effects of fluid administration, but they are not as useful as data indicating good organ perfusion. DIF: Cognitive Level: Application REF: 1733-1735 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

Which of the following causes of circulatory insufficiency can lead to shock as a result of decreased plasma volume?

All of the options are causes of circulatory insufficiency that could lead to shock. A, B, and C: Penetrating trauma with blood loss, gastrointestinal bleeding, and anaphylaxis because of medications could cause circulatory insufficiency leading to shock

A nurse would assign which nursing diagnosis to any patient diagnosed with shock?

Altered Tissue Perfusion

A patient who is in hypovolemic shock has the following clinical signs: Heart rate 120 beats/minute, blood pressure 80/55 mmHg and urine output 20ml/hr. After administering an IV fluid bolus, which of these signs if noted by the healthcare provider is the best indication of improved perfusion?

An increase in the urine output indicates that perfusion is improving

1. ______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine.* A. Urea B. Creatinine C. Potassium D. Magnesium

B

2. A patient with CKD- Chronic Kidney Disease has a low erythropoietin (EPO) level. The patient is at risk for?* A. Hypercalcemia B. Anemia C. Blood clots D. Hyperkalemia

B

2. While providing care to a pediatric patient with acute glomerulonephritis, you note the urine output to be 10 mL/hr. The patient weighs 30 lbs. As the nurse, you will want to limit what type of foods from the patient's diet?* A. Calcium-rich foods B. Potassium-rich foods C. Purine -rich foods D. None of the above because the patient's urinary output is normal based on the patient's weight.

B

5. A patient with Stage 5 CKD Chronic Kidney Disease is experiencing extreme (itchy) pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood?* A. Calcium B. Urea C. Phosphate D. Erythropoietin

B

6. A patient with a urinary tract infection is taking Bactrim (Sulfamethoxazole/Trimethoprim). As the nurse you know it is important that the patient consumes 2.5 to 3 L of fluid per day to prevent which of the following complications?* A. Brown urine B. Crystalluria C. Renal Stenosis D. Renal Calculi

B

8. While assessing morning labs on your patient with CKD Chronic Kidney Disease. You note the patient's phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be?* A. Elevated B. Low C. Normal D. Same as the phosphate level

B

7. A 36 year old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply:* A. Water intoxication B. Hypotension C. Low urine specific gravity D. Hypokalemia E. Normal GFR

B,C,D

1. A 5 year old male is admitted with acute glomerulonephritis. On assessment, you note mild edema predominately in the face and tea-colored urine. The patient's blood pressure is 165/110, heart rate 95, oxygen saturation 98% on room air, and temperature 98.9 'F. In your nursing care plan, what nursing interventions will you include in this patient's plan of care? SELECT-ALL-THAT-APPLY:* A. Initiate and maintain a high sodium diet daily. B. Monitor intake and output hourly. C. Encourage patient to ambulate every 2 hours while awake. D. Assess color of urine after every void. E. Weigh patient every daily on a standing scale. F. Encourage the patient to consume 4 L of fluid per day.

B,D,E

A 64-year-old woman is admitted to the emergency department vomiting bright red blood. The patient's vital signs are blood pressure 78/58 mm Hg, pulse 124 beats/minute, respirations 28 breaths/minute, and temperature 97.2° F (36.2° C). Which physician order should the nurse complete first? a-Obtain a 12-lead ECG and arterial blood gases. b-Rapidly administer 1000 mL normal saline solution IV. c-Administer norepinephrine (Levophed) by continuous IV infusion. d-Carefully insert a nasogastric tube and an indwelling bladder catheter.

B-Isotonic crystalloids, such as normal saline solution, should be used in the initial resuscitation of hypovolemic shock. Vasopressor drugs (e.g., norepinephrine) may be considered if the patient does not respond to fluid resuscitation and blood products. Other orders (e.g., insertion of nasogastric tube and indwelling bladder catheter and obtaining the diagnostic studies) can be initiated after fluid resuscitation is initiated.

3. You're assessing morning lab values on a female patient who is recovering from a myocardial infraction. Which lab value below requires you to notify the physician?* A. Potassium level 4.2 mEq/L B. Creatinine clearance 35 mL/min C. BUN 20 mg/dL D. Blood pH 7.40

B. Creatinine Clearance 35 Ml/min

10. You're developing a nursing care plan for a patient in the diuresis stage of AKI. What nursing diagnosis would you include in the care plan?* A. Excess fluid volume B. Risk for electrolyte imbalance C. Urinary retention D. Acute pain

B. Risk for electrolyte imbalance

7. You are providing education to a patient with CKD Chronic Kidney Disease about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply:* A. "This medication will help keep my calcium level normal." B. "I will take this medication with meals or immediately after." C. "It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication." D. "This medication will help prevent my phosphate level from increasing."

B.D

1. A 55 year old male patient is diagnosed with chronic kidney disease. The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as?* A. Stage 1 B. Stage 3 C. Stage 4 D. Stage 5

C

3. A patient who is experiencing poststreptococcal glomerulonephritis has edema mainly in the face and around the eyes. As the nurse, you know to expect the edema to be more prominent during the?* A. Evening B. Afternoon C. Morning D. Bedtime

C

4. Which patient below is NOT at risk for developing chronic kidney disease?* A. A 58 year old female with uncontrolled hypertension. B. A 69 year old female with diabetes mellitus. C. A 45 year old male with polycystic ovarian disease. D. A 78 year old female with an intrarenal injury.

C

A 36 year old female, who is 29 weeks pregnant, reports she is experiencing burning when voiding. The physician orders a urinalysis. Which statement by the patient demonstrates she understands how to collect the specimen?* "I'll hold the cup firmly against the urethra while collecting the sample." B. "I will cleanse back to front with the antiseptic wipe before peeing in the cup." C. "First, I will pee a small amount of urine in the toilet and then collect the rest in the cup." D. "I will be sure to drink a lot of fluids to keep the urine diluted before peeing into the cup."

C

The physician orders a urine culture on your patient in room 5505 with a urinary tract infection. In addition, the patient is ordered to start IV Bactrim (Sulfamethoxazole/Trimethoprim). How will you proceed with following this order?* A. First, hang the antibiotic, and then collect the urine culture. B. First, hang the antibiotic and when the antibiotic is finished infusing collect the urine culture. C. First, collect the urine culture, and then hang the antibiotic. D. First, collect the urine culture and then hold the dose of the antibiotic until the urine culture is back from the lab.

C

5. Select all the patients below that are at risk for acute intra-renal injury?* A. A 45 year old male with a renal calculus. B. A 65 year old male with benign prostatic hyperplasia. C. A 25 year old female receiving chemotherapy. D. A 36 year old female with renal artery stenosis. E. A 6 year old male with acute glomerulonephritis. F. An 87 year old male who is taking an aminoglycoside medication for an infection.

C,E,F

12. A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient?* 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

4. A 55 year old male patient is admitted with a massive GI bleed. The patient 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

Which of the following medications is least likely to alter the usual presentation of patients presenting with hypovolemic shock?

Cephalexin is an antibiotic, which could not alter the presentation of a patient with hypovolemic shock since it is for infection. A: Metoprolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins)

10. The kidneys are responsible for performing all the following functions EXCEPT?* A. Activating Vitamin D B. Secreting Renin C. Secreting Erythropoietin D. Maintaining cortisol production

D

6. Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient's telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality?* A. Phosphate 3.2 mg/dL B. Calcium 9.3 mg/dL C. Magnesium 2.2 mg/dL D. Potassium 7.1 mEq/L

D

7. You're providing discharge teaching to a female patient on how to prevent urinary tract infections. Which statement is INCORRECT?* A. "Void immediately after sexual intercourse." B. "Avoid wearing tight fitting underwear." C. "Try to void every 2-3 hours." D. "Use scented sanitary napkins or tampons during menstruation."

D

8. A patient, who is having spasms and burning while urinating due to a UTI, is prescribed "Pyridium" (Phenazopyridine). Which option below is a normal side effect of this drug?* A. Hematuria B. Crystalluria C. Urethra mucous D. Orange colored urine

D

You're assessing your patients during morning rounding. Which patient below is at MOST risk for developing a urinary tract infection?* A. A 25 year old patient who finished a regime of antibiotics for strep throat 10 weeks ago. B. A 55 year old female who is post-opt day 7 from hip surgery. C. A 68 year old male who is experiencing nausea and vomiting. D. A 87 year old female with Alzheimer's disease who is experiencing bowel incontinence.

D

A massive gastrointestinal bleed has resulted in hypovolemic shock in an older patient. What is a priority nursing diagnosis? a-Acute pain b-Impaired tissue integrity c-Decreased cardiac output d-Ineffective tissue perfusion

D- The many deleterious effects of shock are all related to inadequate perfusion and oxygenation of every body system. This nursing diagnosis supersedes the other diagnoses.

7. Within the past month, the admission rate of patients with poststreptococcal glomerulonephritis has doubled on your unit. You are proving an in-service to your colleagues about this condition. Which statement is CORRECT about this condition?* A. "This condition tends to present 6 months after a strep infection of the throat or skin." B. "It is important the patient consumes a diet rich in potassium based foods due to the risk of hypokalemia." C. "Patients are less likely to experience hematuria with this condition." D. "This condition is not caused by the streptococcal bacteria attacking the glomerulus, but by the immune system's response to the bacteria by creating an antigen-antibody complex which inflames the glomerulus." SUBMIT

D.

6. TRUE or FALSE: Poststreptococcal glomerulonephritis is a type of NEPHROTIC SYNDROME, which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate.* True False

False

8. True or False: All patients with acute renal injury will progress through the oliguric stage of AKI but not all patients will progress through the diuresis stage.* True False

False

Which of the following intravenous solutions is least useful, and possibly harmful, as the initial resuscitation solution in a patient with a head injury who has blood loss?

Hypertonic saline Hypertonic saline takes out the water out of the cells which could further lead to dehydration and shock

Common cause of PRE renal failure

Hypervolemic shock

kidney transplantation client needs to take which drugs for the rest of their life?

Immune suppressants

Peritonitis

Inflammation of the membrane lining the abdominal wall and covering the abdominal organs.

Patients getting treated for an ortho problem (broken bone) should be advised to take which medication when in kidney failure

NEPHROX - Aluminum hydroxide lowers serum phosphate levels by binding phosphorus present in food. High blood phosphate levels cause hypocalcemia and osteodystrophy; this makes a client prone to fracture.

Nephrotoxin examples -

NSAIDS and Acetominophen

Prevent further damage to kidney failure - avoid these

Nephrotoxins

nephrolithOTOMY (to remove)

Percutaneous nephrolithotomy is a minimally-invasive procedure to remove stones from the kidney by a small puncture wound through the skin. It is most suitable to remove stones of more than 2 cm in size and which are present near the pelvic region

signs of pulmonary edema

Restlessness, anxiety, tachycardia, dyspnea, and crackles at the bases of the lungs are early manifestations of pulmonary edema, Initial treatment of pulmonary edema consists of placing the client in high Fowler's position and administering oxygen.

Creatinine Clearance

The kidneys' ability to handle creatinine, which helps to estimate the glomerular filtration rate (GFR) -- the rate of blood flow through the kidneys

UREmiA

a raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys. Associated with Respiratory rate of 40 breaths/min

Glomerulonephritis

acute inflammation of the kidney, typically caused by an immune response.

bacterial cystitis

aka UTI

Hypovolemic shock

aka volume depletion

polycystic kidney disease

are noncancerous sacs containing water-like fluid. They can grow very large. Many people with this condition have kidney failure by age 60. Symptoms include high blood pressure, back or side pain, and a swollen abdomen. Treatments include medication to control blood pressure, pain relievers, and cyst removal. A kidney transplant might be neede

Which of the following assessment findings is an early indication of hypovolemic shock? a.) Diminished bowel sounds b.) Increased urinary output c.) Tachycardia d.) Hypertension

c.) Tachycardia Rationale: Tachycardia is an early symptom as the body compensates for a declining blood pressure the heart rate increases to circulate the blood faster to prevent tissue hypoxia.

A patient with massive trauma and possible spinal cord injury is admitted to the ED. The nurse suspects that the patient may be experiencing neurogenic shock in addition to hypovolemic shock, based on the finding of a.) cool, clammy skin. b.) shortness of breath. c.) heart rate of 48 beats/min d.) BP of 82/40 mm Hg.

c.) heart rate of 48 beats/min Rationale: The normal sympathetic response to shock/hypotension is an increase in heart rate. The presence of bradycardia suggests unopposed parasympathetic function, as occurs in neurogenic shock. The other symptoms are consistent with hypovolemic shock.

A patient with hypovolemic shock has a urinary output of 15 ml/hr. The nurse understands that the compensatory physiologic mechanism that leads to altered urinary output is a.) activation of the sympathetic nervous system (SNS), causing vasodilation of the renal arteries. b.) stimulation of cardiac -adrenergic receptors, leading to increased cardiac output. c.) release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention. d.) movement of interstitial fluid to the intravascular space, increasing renal blood flow.

c.) release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention. Rationale: The release of aldosterone and ADH lead to the decrease in urine output by increasing the reabsorption of sodium and water in the renal tubules. SNS stimulation leads to renal artery vasoconstriction. -Receptor stimulation does increase cardiac output, but this would improve urine output. During shock, fluid leaks from the intravascular space into the interstitial space.

When compensatory mechanisms for hypovolemic shock are activated, the nurse would expect which two patient findings to normalize? a.) Intensity of peripheral pulses and body temperature. b.) Peripheral pulses and heart rate (HR). c.) Metabolic alkalosis and oxygen saturation. d.) Cardiac output (CO) and blood pressure (BP).

d.) Cardiac output (CO) and blood pressure (BP).

An adult patient with hypovolemic shock is given 2 liters of IV fluid. Which outcomes indicate to the nurse that the fluid is having the desired effect? Select all that apply.

he patient is normotensive. The patient's cardiac monitor reveals sinus rhythm. The patient is alert and oriented.

A patient presents with a 5-day history of nausea, vomiting, diarrhea, and fever. He has not been able to take fluids by mouth. The nurse provides care based on this patient's risk for which problem?

hypovolemic shock

Any drug or condition that disrupts aldosterone secretion or release does what???

increases the client's risk for excessive water loss and potassium reabsorption.

Both NSAIDs and glomerulonephritis can damage the kidney, leading to

inter renal failure

HyperURICemia

is an excess of uric acid in the blood

autosomal dominant polycystic kidney disease

is an inherited condition that causes small, fluid-filled sacs called cysts to develop in the kidneys. 50% chance of children inheriting from parent

renal calculi - aka

kidney stones

Heart failure can lead to

prerenal failure, which is due to decreased blood flow to the kidneys.

cardiac tamponade

pressure on the heart caused by fluid in the pericardial space

Cell damage and death due to hypovolemic shock may be a function of

reperfusion injury

Creatinine is a

waste product from the normal breakdown of muscle tissue