Renal System

Hypernatremia (increased sodium)

Tachycardia, dry mucus membrane decreased urinary output

Hypokalemia (decreased potassium)

Anorexia, nausea, vomiting abdominal distention

Hypercalcemia (increased calcium)

Renal calculi, coma, arrythmias, decreased reflex

RENAL DIALYSIS

Two Types of Dialysis: - Hemodialysis - Peritoneal Dialysis Continous Renal Replacement Therapy (CRRT) This type of therapy is an alternative to other types of dialysis. More focused on treating acute renal failure. HEMODIALYSIS - Used for Renal Failure - Toxic wastes are removed from the blood through surgically created access site. - Removes excess fluids and waste products and restores Electrolye balance. - The blood through an artificial semi permeable membrane. - starting the therapy depends on client symptoms not on the creatinine clearance. TYPES OF ACCESS ROUTE: AV Fistula Internal anastomosis of an artery to an adjacent vein. Take about 4-6 weeks to be ready for use. External AV Shunt One canula is insterted into an artery and another into a vein. Dialysate- is made from clear water and chemicals and is free of any waste products or drugs. Anticoagulation - to prevent blood clots from forming within the dialyzer or the blood tubing, anticoagulation is needed during HD treatments. Heparin is the most common used drug, to prevent clot from forming. Complications of Hemodialysis Disequilibrium Syndrome, and Viral Infections. Dialysis Disequilibrium Syndrome - may develop during hemodialysis or after hem dialysis has been completed. - the cause is thought to be due to rapid decrease in fluid volume and blood urea nitrogen (BUN) levels during HD. - The change in urea levels can cause cerebral edema and increased intracranial pressure Caring for Patient undergoing Hemodialysis: - weight the client before and after dialysis - know the client's dry weight - discuss with the physician whether any of the ct's meds. Is withheld until after dialysis - measure blood pressure, pulse rate, respirations and temperature. - Take note that patient is at risk for fluid volume excess or deficit. SIGNS OF FLUID OVERLOAD hypertension tachycardia dyspnea crackles in lungs distended neck veins high CVP PERITONEAL DIALYSIS The client's peritoneal membrane will be used as a semipermeable dialyzing membrane. Hypertonic dialyzing solution is instilled through a catheter that is being inserted into the patient's peritoneal cavity. Through the process of diffusion the excess amount of concentration of uremic toxins and wastes in the blood moves across the peritoneal membrane and into the dialysis solution. After a certain time, the dialysis solution (along with the toxins and waste with it) is being drained. The client will be trained to do this procedure. - occurs in the peritoneal cavity - Peritoneal Dialysis is slower than Hemodialysis, however, and more time is needed to achieve the same effect. - at times, a client may use PD until a new arteriovenous (AV) fistula matures. - PD is also the treatment of choice for adults because its more flexible. Types Of Peritoneal Dialysis Continous Ambulatory Peritoneal Dialysis The dialysate is instilled into the abdomen and left in place 4-8 hrs. When it is time to drain, the bag is rolled & fluid is drained by gravity.

Hypokalcemia (decreased calcium)

osteoporosis, fractures, muscle spasms tetany, n & v, vomiting.

Hyperkalemia (increased potassium)

Irritability, nausea and vomiting diarrhea

Hyponatremia (decreased sodium)

Muscle weaknes, Headaches Fatigue, confusion, vomiting, coma

11. After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, a male client returns to the room with continuous bladder irrigation. On the first day after surgery, the client reports bladder pain. What should nurse Andrew do first? a. Increase the I.V. flow rate. b. Notify the physician immediately. c. Assess the irrigation catheter for patency and drainage. d. Administer meperidine (Demerol), 50 mg I.M., as prescribed.

11. Answer C. Although postoperative pain is expected, the nurse should make sure that other factors, such as an obstructed irrigation catheter, aren't the cause of the pain. After assessing catheter patency, the nurse should administer an analgesic, such as meperidine, as prescribed. Increasing the I.V. flow rate may worsen the pain. Notifying the physician isn't necessary unless the pain is severe or unrelieved by the prescribed medication.

1. The nurse is aware that the following findings would be further evidence of a urethral injury in a male client during rectal examination? a. A low-riding prostate b. The presence of a boggy mass c. Absent sphincter tone d. A positive Hemoccult

1. Answer B. When the urethra is ruptured, a hematoma or collection of blood separates the two sections of urethra. This may feel like a boggy mass on rectal examination. Because of the rupture and hematoma, the prostate becomes high riding. A palpable prostate gland usually indicates a nonurethral injury. Absent sphincter tone would refer to a spinal cord injury. The presence of blood would probably correlate with GI bleeding or a colon injury.

19. Nurse Claudine is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way? a. Fluid intake should be double the urine output. b. Fluid intake should be approximately equal to the urine output. c. Fluid intake should be half the urine output. d. Fluid intake should be inversely proportional to the urine output.

19. Answer B. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. For example, fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally, fluid intake isn't inversely proportional to the urine output.

NEPHROTIC SYNDROME

- There is an increased glomerular permeability allowing larger molecules to pass through the membrane into the urine. Main assessment in patients is Severe Protienuria (>3.5 G OF PROTIEN IN 24 HOURS) HYPERLIPIDEMA EDEMA HYPERTENSION HYPOALBUMINEMIA - a condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and be removed from the blood. - This process causes massive loss of protein into the urine, edema formation and decreased plasma albumin levels. Many agents and disorders are possible cause of NS. PATIENT ASSESSMENT: - main feauture is severe protienuria (>3.5 grams of protien in 24 hours) - Clients also have hypoalbuminemia (serum albumin <3 g/dl) - hyperlipidemia, lipiduria, edema and hypertension KEY FEAUTURES - massive protienuria (protien in urine) - hypoalbuminemia - edema - lipiduria - hyperlipidemia TREATMENT - treatment varies depending upon what process is causing the disorder. - Immunologic processes may improve with suppressive therapy using steroids and catatonic agents. PROVIDE BED REST DIET: MODERATE PROTIEN, LOW SODIUM LOW SATURATED FAT. MEDICATIONS: - Ace Inhibitors= to decrease protienuria - Cholesterol lowering agents- decrease hyperlipidemia - Diuretics- to control edema

1. After having transurethral resection of the prostate (TURP), a Mr. Locke returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded? a. The urine in the drainage bag appears red to pink. b. The client reports bladder spasms and the urge to void. c. The normal saline irrigant is infusing at a rate of 50 drops/minute. d. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.

1. Answer B. Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency.

2. When a female client with an indwelling urinary (Foley) catheter insists on walking to the hospital lobby to visit with family members, nurse Rose teaches how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? a. The client sets the drainage bag on the floor while sitting down. b. The client keeps the drainage bag below the bladder at all times. c. The client clamps the catheter drainage tubing while visiting with the family. d. The client loops the drainage tubing below its point of entry into the drainage bag.

2. Answer B. To maintain effective drainage, the client should keep the drainage bag below the bladder; this allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because it could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.

3. A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. b. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. d. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex.

3. Answer A. Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

6. A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: a. hematuria. b. weight loss. c. increased urine output. d. increased blood pressure.

6. Answer B. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

7. When examining a female client's genitourinary system, nurse Sally assesses for tenderness at the costovertebral angle by placing the left hand over this area and striking it with the right fist. Normally, this percussion technique produces which sound? a. A flat sound b. A dull sound c. Hyperresonance d. Tympany

7. Answer B. Percussion over the costovertebral angle normally produces a dull, thudding sound, which is soft to moderately loud with a moderate pitch and duration. This sound occurs over less dense, mostly fluid-filled matter, such as the kidneys, liver, and spleen. In contrast, a flat sound occurs over highly dense matter such as muscle; hyperresonance occurs over the air-filled, overinflated lungs of a client with pulmonary emphysema or the lungs of a child (because of a thin chest wall); and tympany occurs over enclosed structures containing air, such as the stomach and bowel.

CHRONIC RENAL FAILURE

STAGES OF CHRONIC RENAL FAILURE Stage 1 Diminished Renal Reserve - renal function is reduced, but no accumulation of metablic wastes occurs. - the healthier kidney compensates for the diseased kidney - The ability to concentrate urine is decreased ♦ Results in nocturia and polyuria - Stage 2 Renal Insufficiency - metabolic waste begin to accumulate in the blood, because affected nephrons can no longer compensate. - responsiveness to diuretics is decreased, resulting in Oliguria and edema Stage 3 End Stage Renal Disease. - excessive amount of metabolic wastes such as urea and creatinine accumulate in the blood. - kidney is unable to maintain homeostasis - treatment is by dialysis Metabolic Changes - Urea and Creatinine - Sodium - Pottasium - Acid Base Balance - Calcium and Phosporus Cardiac Changes - Hypertension - Hyperlipidemia - Heart Failure - Uremic Pericarditis INTERVENTIONS - It is important to monitor renal, respiratory and cardiovascular status and the fluid balance. REMEMBER FOR NCLEX - Patient with Chronic Renal Failure would have ♣ UREMIA, ANEMIA AND ACIDOSIS DIALYSIS: Peritoneal Dialysis: ♣ Complication: can include Peritonitis Hemodialysis: ♠ Pt. may use external shunt or surgically constructed internal arterivnous fistula (long-term)

Renal Transplantation

Two types of donors: Living donors Cadaveric donors The transplanted kidney will be placed in the illiac fossa. - is usually a treatment for end stage renal disease. - the donors maybe living or a cadaver. - It is important for the tissue type to be matched - position of the kidney: Anterioir Illiac Fossa - the posibility of organ rejection can occur: Types of Rejection Hyperacute Acute Chronic Acute Rejection - Usually less than 1 yr, after transplant. - increased blood urea levels - weight gain, edema - increased blood pressure Chronic rejection - usually more that 1 year - hypertension - protienuria Major Complications: Rejection (Signs of Rejection include: Malaise, Fever, Anemia & Graft Tenderness. Infection Hypertension

10. A male client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, nurse Andy suspects that the client is at risk for: a. cardiac arrhythmia. b. paresthesia. c. dehydration. d. pruritus.

10. Answer A. As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In a client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.

Creatinine level

0.5- 1.5 mg/dl

18. A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans? a. Cottage cheese-like discharge b. Yellow-green discharge c. Gray-white discharge d. Discharge with a fishy odor

18. Answer A. The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis.

20. After trying to conceive for a year, a couple consults an infertility specialist. When obtaining a history from the husband, nurse Jenny inquires about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility? a. Chickenpox b. Measles c. Mumps d. Scarlet fever

20. Answer C. Mumps is the most significant childhood infectious disease affecting male fertility. Chickenpox, measles, and scarlet fever don't affect male fertility.

21. Nurse Eve is caring for a client who had a cerebrovascular accident (CVA). Which nursing intervention promotes urinary continence? a. Encouraging intake of at least 2 L of fluid daily b. Giving the client a glass of soda before bedtime c. Taking the client to the bathroom twice per day d. Consulting with a dietitian

21. Answer A. By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence.

21. A male client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region, which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? a. Kidney b. Ureter c. Bladder d. Urethra

21. Answer A. The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and may lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.

3. A female adult client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a. Blood urea nitrogen (BUN) level of 22 mg/dl b. Serum creatinine level of 1.2 mg/dl c. Serum creatinine level of 1.2 mg/dl d. Urine output of 400 ml/24 hours

3. Answer D. ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is demonstrated by a urine output of 400 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder. ...

Pyelonephritis

AN INFECTIOUS DISEASE CAUSING INFLAMMATION OF THE KIDNEY ORGAN AND TISSUE. E. Coli- has been the main organism that causes most cases Symptoms: - Chills - Flank Pain - Fever - Fatigue - Fever Treatment: Antibiotics Commonly used antibiotics include the following: Amoxicillin Cephalosporin - Cephalosporins are very similar to penicillins. Most commonly used Cephalosporins include: Keflex, Ceprozil (Cefzil), Cefadroxil (Duricef) Most Cephalosporins starts with a (cef or cep)* Other Antibiotics includes: Levofloxacin and ciprofloxacin Sulfa drugs such as sulfisoxazole/trimethoprim Levofloxacin- a type of fluoroquinolones Side Effects (Levofloxacin): dizziness sudden pain on joints diarrhea confusion hallucinations

Urinary Calculi/ Urilithiasis

URINARY CALCULI is also called urilothiasis or KIDNEY STONES, and it can results from anything from immobility, cancer, increased intake of Vitamin D, or an overactivity of the Parathyroid gland. Kidney stones is made up of: calcium magnesium phosphorus oxalate. - High urine acidity or alkalinity contributes to stone formation. SYMPTOMS (Urinary Calculi) Flank pain fever nausea and vomiting changes in the urinary output. *** There will be an increase in RBC's, WBC's and bacteria. DIAGNOSTIC TESTS for urinary calculi would include x-ray, blood tests and a 24 hour urine test. INTERVENTIONS: Non Surgical Management: - ↓ Incudes the use of laser to break the stone fragments (Extracorporeal shock wave lithotripsy (ESWL). patient is given a local anesthetic . pt. is placed in a water bath or on a soft cushion. shock waves are transmitted through the stones inside the kidney. shock waves cause the calculi to break up into smaller pieces. - ♦It is very important to strain the urine after the ESWL Procedure. * Encourage fluid intake after the procedure. * Assess for any hemorrhage Discharge Teaching (DIET) *Know for NCLEX: If Uric Acid Stone: Alkaline Ash & Low Purine Diet (limit wine, cheese & meat) Give Allopurinol as prescribed If Calcium Stone: Calium Restricted Diet (Limit Dairy Foods) Surgical Interventions: - Uretherolithotomy - Nephrolithotomy Removal of renal calculi using a nephroscope.

RENAL CELL CARCINOMA

- A cancer that originates in the kidneys. - Children will develop a kind of kidney cancer called Wilms' tumor. Assessment: - Pink, red or cola colored urine - Weight loss - Fatigue - Intermittent fever Risks - Sex: Male - Smoking - Obesity - Hypertension Tests and procedures: - Urineanalysis - computerized tomography (CT) - magnetic resonance imaging (MRI) - Kidney Biopsy (main diagnostic tests) Treatments: Surgery - Removing the affected kidney (nephrectomy) Chemotherapy Blocking blood flow to the tumor (embolization). Treatment to freeze cancer cells (cryoablation). Biological therapy (immunotherapy) uses your body's immune system to fight cancer. ♠ Manage Pain with Narcotic Analgesics or NSAID's.

POLYCYSTIC KIDNEY DISEASE

- A cyst develops in the nephron (kidneys) - It is an inherited disease of the kidneys. -IN THE DOMINANT FORM- ONLY FEW NEPHRONS HAVE CYSTS. -IN THE RECESSIVE FORM-100% OF NEPHRONS HAVE CYSTS FROM BIRTH. - Cysts in kidneys would look like a cluster of grapes - Patients would have hypertension. (Due to Renin Angiotensin System) MANIFESTATIONS IN THE PATIENT: -PAIN IS THE FIRST MANIFESTATION -FLANK PAIN IS DULL, SHARP OR INTERMITTENT -DULL ACHING PAIN- is caused by increase kidney size, from infection from the cyst. -SHARP INTERMITTENT PAIN- is when a cyst is rupture or when a stone is present. -BERRY ANEURYSM - can occur (bleeding into brain from ruptured intracranial vascular cysts) - causes severe headaches, with or without vision changes (pay extra attention to patients with severe headaches, since it can be a sign of a ruptured cyst). DIAGNOSTIC TESTS: - renal sonogrophy - computed tomography - MRI INTERVENTIONS: -BE VERY CAUTIOUS IN USING NSAIDS, BECAUSE IT CAN CAUSE BLEEDING -ANTIHYPERTENSIVES AND DIURETIC AGENTS (ACE INHIBITOR, CALCIUM CHANNEL BLOCKER, BETA BLOCKER)IS USED FOR HYPERTENSION.

ACUTE RENAL FAILURE

- is a syndrome in which there is an abrupt loss of renal function that may occur over several hours or days, characterized by Uremia. The most common cause of Acute Renal Function is hypotension and hypovolemia. HYPERKALEMIA is a common complication of acute renal failure. It is life threatening if not reversed. The administration of glucose and regular insulin can prevent cardiac arrest caused by hypekalemia. A sudden but reversible loss of kidney function. Acute Renal Failure IT IS BASICALLY A RAPID DECREASE IN RENAL FUNCTION. CAUSES A COLLECTION OF METABOLIC WASTE IN THE BODY Types of Acute Renal Failure PRERENAL INTRARENAL POST RENAL Phases of Acute Renal Failure ONSET PHASE OLIGURIC PHASE DIURETIC PHASE - the patient usually has diuresis of up to 10 L/day. RECOVERY PHASE Laboratory Tests: BUN Creatinine clearance Serum creatinine Serum potassium Urinalysis Treatment DIET: High carbohydrates and low in protien, salt, and potassium. ANTIBIOTICS *** limit sodium, potassium, and phosphorus intake. Dialysis may be necessary.

5. The nurse is aware that the following laboratory values supports a diagnosis of pyelonephritis? a. Myoglobinuria b. Ketonuria c. Pyuria d. Low white blood cell (WBC) count

5. Answer C. Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Because there is often a septic picture, the WBC count is more likely to be high rather than low, as indicated in option D. Ketonuria indicates a diabetic state.

Urine Specific Gravity

1.003- 1.030

BUN level

10-20 mg/dl

10. A male client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: a. keep the client's knee on the affected side bent for 6 hours. b. apply pressure to the puncture site for 30 minutes. c. check the client's pedal pulses frequently. d. remove the dressing on the puncture site after vital signs stabilize.

10. Answer C. After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse shouldn't remove this dressing for several hours — and only if instructed to do so.

11. A female client is admitted for treatment of chronic renal failure (CRF). Nurse Juliet knows that this disorder increases the client's risk of: a. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. b. a decreased serum phosphate level secondary to kidney failure. c. an increased serum calcium level secondary to kidney failure. d. metabolic alkalosis secondary to retention of hydrogen ions.

11. Answer A. A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

12. When performing a scrotal examination, nurse Paul finds a nodule. What should the nurse do next? a. Notify the physician. b. Change the client's position and repeat the examination. c. Perform a rectal examination. d. Transilluminate the scrotum.

12. Answer D. A nurse who discovers a nodule, swelling, or other abnormal finding during a scrotal examination should transilluminate the scrotum by darkening the room and shining a flashlight through the scrotum behind the mass. A scrotum filled with serous fluid transilluminates as a red glow; a more solid lesion, such as a hematoma or mass, doesn't transilluminate and may appear as a dark shadow. Although the nurse should notify the physician of the abnormal finding, performing transillumination first provides additional information. The nurse can't uncover more information about a scrotal mass by changing the client's position and repeating the examination or by performing a rectal examination.

12. Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female client's uremia. Which finding signals a significant problem during this procedure? a. Potassium level of 3.5 mEq/L b. Hematocrit (HCT) of 35% c. Blood glucose level of 200 mg/dl d. White blood cell (WBC) count of 20,000/mm3

12. Answer D. An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

13. For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? a. Encouraging coughing and deep breathing b. Promoting carbohydrate intake c. Limiting fluid intake d. Providing pain-relief measures

13. Answer C. During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

13. A male client who has been treated for chronic renal failure (CRF) is ready for discharge. Nurse Bea should reinforce which dietary instruction? a. "Be sure to eat meat at every meal." b. "Monitor your fruit intake, and eat plenty of bananas." c. "Increase your carbohydrate intake." d. "Drink plenty of fluids, and use a salt substitute."

13. Answer C. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided. Extra carbohydrates are needed to prevent protein catabolism.

14. Nurse Wayne is aware that the following statements describing urinary incontinence in the elderly is true? a. Urinary incontinence is a normal part of aging. b. Urinary incontinence isn't a disease. c. Urinary incontinence in the elderly can't be treated. d. Urinary incontinence is a disease.

14. Answer B. Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.

14. A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure? a. Phosphate binders b. Insulin c. Antibiotics d. Cardiac glycosides

14. Answer D. Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

15. A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), Dr. Smith orders diagnostic tests of the vaginal discharge. Which STD must be reported to the public health department? a. Chlamydia b. Gonorrhea c. Genital herpes d. Human papillomavirus infection

15. Answer B. Gonorrhea must be reported to the public health department. Chlamydia, genital herpes, and human papillomavirus infection aren't reportable diseases.

2. Nurse Myrna is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to: a. initiate a stream of urine. b. breathe deeply. c. turn to the side. d. hold the labia or shaft of penis.

2. Answer B. When inserting a urinary catheter, facilitate insertion by asking the client to breathe deeply. Doing this will relax the urinary sphincter. Initiating a stream of urine isn't recommended during catheter insertion. Turning to the side or holding the labia or penis won't ease insertion, and doing so may contaminate the sterile field. ...

15. The client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Nurse Yoly is aware that the following nursing interventions is appropriate? a. Tell the client to try to urinate around the catheter to remove blood clots. b. Restrict fluids to prevent the client's bladder from becoming distended. c. Prepare to remove the catheter. d. Use aseptic technique when irrigating the catheter.

15. Answer D. If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. Encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is only removed with a physician's order.

16. A female client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim-sulfamethoxazole). Nurse Don should provide which medication instruction? a. "Take the medication with food." b. "Drink at least eight 8-oz glasses of fluid daily." c. "Avoid taking antacids during co-trimoxazole therapy." d. "Don't be afraid to go out in the sun."

16. Answer B. When receiving a sulfonamide such as co-trimoxazole, the client should drink at least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of sulfonamides. To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy.

16. A male client with acute pyelonephritis receives a prescription for co-trimoxazole (Septra) P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen? a. Urine output increases to 2,000 ml/day. b. Flank and abdominal discomfort decrease. c. Bacteria are absent on urine culture. d. The red blood cell (RBC) count is normal.

16. Answer C. Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore, absence of bacteria on urine culture indicates that the drug has achieved its desired effect. Although flank pain may decrease as the infection resolves, this isn't a reliable indicator of the drug's effectiveness. Co-trimoxazole doesn't affect urine output or the RBC count.

17. A male client is admitted for treatment of glomerulonephritis. On initial assessment, Nurse Rose detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include: a. generalized edema, especially of the face and periorbital area. b. green-tinged urine. c. moderate to severe hypotension. d. polyuria.

17. Answer A. Generalized edema, especially of the face and periorbital area, is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.

17. A 26-year-old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She's placed on trimethoprim-sulfamethoxazole (Bactrim) to treat possible infection. Another medication is prescribed to decrease the pain and frequency. Which of the following is the most likely medication prescribed? a. nitrofurantoin (Macrodantin) b. ibuprofen (Motrin) c. acetaminophen with codeine d. phenazopyridine (Pyridium)

17. Answer D. Phenazopyridine may be prescribed in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is a urinary antiseptic with no analgesic properties. While ibuprofen and acetaminophen with codeine are analgesics, they don't exert a direct effect on the urinary mucosa.

18. A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the nurse is aware that the functions of the three lumens include: a. Continuous inflow and outflow of irrigation solution. b. Intermittent inflow and continuous outflow of irrigation solution. c. Continuous inflow and intermittent outflow of irrigation solution. d. Intermittent flow of irrigation solution and prevention of hemorrhage.

18. Answer A. When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

19. A 24-year old female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. b. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. d. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex.

19. Answer A. Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

20. Nurse Vic is monitoring the fluid intake and output of a female client recovering from an exploratory laparotomy. Which nursing intervention would help the client avoid a urinary tract infection (UTI)? a. Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg b. Limiting fluid intake to 1 L/day c. Encouraging the client to use a feminine deodorant after bathing d. Encouraging the client to douche once a day after removal of the indwelling urinary catheter

19. Answer A. Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

22. A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: a. confusion, headache, and seizures. b. acute bone pain and confusion. c. weakness, tingling, and cardiac arrhythmias. d. hypotension, tachycardia, and tachypnea.

22. Answer A. Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

22. A female client with an indwelling urinary catheter is suspected of having a urinary tract infection. Nurse Angel should collect a urine specimen for culture and sensitivity by: a. disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container. b. wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle. c. draining urine from the drainage bag into a sterile container. d. clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine.

22. Answer B. Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic solution is used to reduce the risk of introducing microorganisms into the catheter. Tubing shouldn't be disconnected from the urinary catheter. Any break in the closed urine drainage system may allow the entry of microorganisms. Urine in urine drainage bags may not be fresh and may contain bacteria, giving false test results. When there is no urine in the tubing, the catheter may be clamped for no more than 30 minutes to allow urine to collect.

23. Dr. Marquez prescribes norfloxacin (Noroxin), 400 mg P.O. twice daily, for a client with a urinary tract infection (UTI). The client asks the nurse how long to continue taking the drug. For an uncomplicated UTI, the usual duration of norfloxacin therapy is: a. 3 to 5 days. b. 7 to 10 days. c. 12 to 14 days. d. 10 to 21 days.

23. Answer B. For an uncomplicated UTI, norfloxacin therapy usually lasts 7 to 10 days. Taking the drug for less than 7 days wouldn't eradicate such an infection. Taking it for more than 10 days isn't necessary. Only a client with a complicated UTI must take norfloxacin for 10 to 21 days.

23. Nurse Grace is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? a. Rashes on the palms of the hands and soles of the feet b. Cauliflower-like warts on the penis c. Painful red papules on the shaft of the penis d. Foul-smelling discharge from the penis

23. Answer D. Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

24. Nurse Ethel is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client: a. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. b. retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. c. retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level. d. retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level.

24. Answer A. Kayexalate is a sodium exchange resin. Thus the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema causes diarrhea, which increases potassium loss and decreases the potential for Kayexalate retention.

24. Nurse Joy is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: a. limit oral fluid intake for 1 to 2 weeks. b. report the presence of fine, sandlike particles through the nephrostomy tube. c. notify the physician about cloudy or foul-smelling urine. d. report bright pink urine within 24 hours after the procedure.

24. Answer C. The client should report the presence of foul-smelling or cloudy urine. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal due to residual stone products. Hematuria is common after lithotripsy.

25. When caring for a male client with acute renal failure (ARF), Nurse Fatima expects to adjust the dosage or dosing schedule of certain drugs. Which of the following drugs would not require such adjustment? a. acetaminophen (Tylenol) b. gentamicin sulfate (Garamycin) c. cyclosporine (Sandimmune) d. ticarcillin disodium (Ticar)

25. Answer A. Because acetaminophen is metabolized in the liver, its dosage and dosing schedule need not be adjusted for a client with ARF. In contrast, the dosages and schedules for gentamicin and ticarcillin, which are metabolized and excreted by the kidney, should be adjusted. Because cyclosporine may cause nephrotoxicity, the nurse must monitor both the dosage and blood drug level in a client receiving this drug.

25. A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should nurse Bea include in a bladder retraining program? a. Establishing a predetermined fluid intake pattern for the client b. Encouraging the client to increase the time between voidings c. Restricting fluid intake to reduce the need to void d. Assessing present elimination patterns

25. Answer D. The guidelines for initiating bladder retraining include assessing the client's intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should actually be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

4. A 55-year old client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, nurse Gail asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? a. Transurethral resection of the prostate (TURP) b. Suprapubic prostatectomy c. Retropubic prostatectomy d. Transurethral laser incision of the prostate

4. Answer A. TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; they all require an incision. ...

4. A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should nurse Katrina conclude? a. The skin wasn't lubricated before the pouch was applihttp://quizlet.com/create_set/ed. b. The pouch faceplate doesn't fit the stoma. c. A skin barrier was applied properly. d. Stoma dilation wasn't performed.

4. Answer B. If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

5. A female client with suspected renal dysfunction is scheduled for excretory urography. Nurse July reviews the history for conditions that may warrant changes in client preparation. Normally, a client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding would call for the client to be well hydrated instead? a. Cystic fibrosis b. Multiple myeloma c. Gout d. Myasthenia gravis

5. Answer B. Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don't necessitate changes in client preparation for excretory urography. ...

6. Nurse Kim is caring for a client who had a cerebrovascular accident (CVA). Which nursing intervention promotes urinary continence? a. Encouraging intake of at least 2 L of fluid daily b. Giving the client a glass of soda before bedtime c. Taking the client to the bathroom twice per day d. Consulting with a dietitian

6. Answer A. By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence.

7. Nurse Lea is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? a. Rashes on the palms of the hands and soles of the feet b. Cauliflower-like warts on the penis c. Painful red papules on the shaft of the penis d. Foul-smelling discharge from the penis

7. Answer D. Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

8. Nurse Agnes is reviewing the report of a client's routine urinalysis. Which value should the nurse consider abnormal? a. Specific gravity of 1.03 b. Urine pH of 3.0 c. Absence of protein d. Absence of glucose

8. Answer B. Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, its color ranging from pale yellow to deep amber.

8. A male client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should nurse Olivia assess first? a. Blood pressure b. Respirations c. Temperature d. Pulse

8. Answer D. An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also can delay assessing respirations and temperature because these aren't affected by the serum potassium level.

Calcium

9- 11 mg/ dl

9. A male client is scheduled for a renal clearance test. Nurse Maureen should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: a. 1 minute. b. 30 minutes. c. 1 hour. d. 24 hours.

9. Answer A. The renal clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

9. Nurse Hazel is ware that the following is an appropriate nursing diagnosis for a client with renal calculi? a. Ineffective tissue perfusion b. Functional urinary incontinence c. Risk for infection d. Decreased cardiac output

9. Answer C. Infection can occur with renal calculi from urine stasis caused by obstruction. Options A and D aren't appropriate for this diagnosis, and retention of urine usually occurs, rather than incontinence.

Glomerulonephritis

A NON BACTERIAL INFLAMMATION OF THE KIDNEY'S GLUMEROLUS. Usually a result of an antigen antibody response to a beta hemolytic streptococci (this means that the patient usually had strep throat 2-3 weeks prior). SERUM CREATININE LEVEL BLOOD UREA NITROGEN BUN ASSESSMENT - Monitor the patient for dark color, cloudy appearance and foul odor urine. - WBC blood count will be above 10,000/ mm3 - Blood culture will be positive for presence of bacteria. - Azotemia= presence of nitrogenous waste products in the blood. Wilms Tumor (Nephroblastoma) - a common intraabdominal tumors of the childhood. - usually associated with genitourinary anomalies. Assessment: - patient will have a swelling or mass within the abdomen. - the patient will have hypertension, hematuria, pallor and anorexia NEVER AND DO NOT palpate the abdomen of the patient. Urine Culture and Sensitiviy CREATININE CLEARANCE TEST CREATININE CLEARANCE TEST, EVALUATES HOW WELL THE KIDNEYS REMOVE CREATININE BLOOD IS DRAWN AFTER TAKING THE URINE SAMPLE. Bladder Ultrasonography Intravenous Pyelography AN X RAY PROCEDURE USES A RADIOPAQUE DYE ASSESS FOR ALLERGIES Renal Angiography - an IV injection of radiopaque dye is inserted into the renal artery - INJECTION OF A RADIOPAQUE DYE - OBTAIN INFORMED CONSENT. - ASSESS FOR ALLERGIES - WITHOLD FOOD AFTER MIDNIGHT - INFORM PT. ABOUT THROAT IRRITATION Uric Acid Test URIC ACID TEST IS A 24 HR. URINE COLLECTION TO DIAGNOSE FOR GOUT. Interventions: Manage Pain- (give analgesics) Administer Antibiotics Increase the patients's fluid intake (2-3 L/day)