Renal/Urinary
A nurse is providing teaching to a male client who has a continent internal ileal reservoir (neobladder) following surgery to treat bladder cancer. Which of the following statements should the nurse make?
"I must insert a catheter through my stoma to drain the urine." The client should perform self-catheterization to drain the urine from the continent internal ileal reservoir. The nurse should encourage the client to perform self-catheterization before traveling or attending social events to promote confidence in social situations. Wrong "I will need to avoid foods that produce intestinal gas." There are no dietary restrictions following the creation of an internal ileal reservoir. Dietary restrictions are required following a ureterosigmoidostomy, which diverts urine output to the bowel. "I should expect to gain some weight during the next few weeks." During the first few weeks after surgical creation of a continent internal ileal reservoir, clients tend to lose a significant amount of weight. The nurse should instruct the client to collaborate with a dietitian to develop a personalized diet plan to meet their nutritional and caloric needs. "This should not affect my ability to function sexually." Creation of a continent internal ileal reservoir can affect sexual functioning. The nurse should use therapeutic communication to encourage the client and the client's partner to express their feelings and concerns.
A nurse is providing discharge teaching for a client who has chronic kidney disease (CKD). Which of the following statements should the nurse identify as an indication that the client understands the teaching?
"I will decrease my intake of foods that are high in phosphorus." A client who has CKD should limit their intake of foods that are high in phosphorus to prevent bone damage. Wrong "I will add salt to the foods I consume." A client who has CKD retains sodium and fluid, which can cause heart failure and hypertension. The client should consume foods that are low in sodium. "I will limit my intake of foods that are high in iron." A client who has CKD will often need to add supplemental iron due to decreased production of erythropoietin and mineral loss during hemodialysis. "I will limit my intake of foods that are high in iron." A client who has CKD will often need to add supplemental iron due to decreased production of erythropoietin and mineral loss during hemodialysis.
A nurse is providing teaching for a client who has chronic kidney disease (CKD). Which of the following client statements indicates an understanding of the teaching?
"I will weigh myself every morning." Clients who have CKD should weigh themselves every morning at the same time to monitor fluid balance. The client should void prior to weighing if able, wear similar clothing when obtaining weight, and use the same set of scales each time. Wrong "I will check my blood pressure once per week." A client who has CKD should measure their blood pressure daily to monitor for hypertension. "I will take a magnesium antacid if I get constipated." A client who has CKD should avoid taking magnesium hydroxide for constipation because this medication can cause magnesium toxicity. "I will use a salt substitute in my diet." A client who has CKD should avoid using salt substitutes because they contain potassium chloride and can cause hyperkalemia.
A nurse is teaching a client who has urge urinary incontinence about bladder retraining. Which of the following instructions should the nurse include?
"Increase the intervals between urination by 15 minutes per day when able to remain continent." The nurse should instruct the client to increase the length of time between urination by 15 min per day when able to remain continent. The goal is to have 3- to 4-hr intervals between urination. Wrong "If you are unable to urinate, sit on the toilet every 4 hours with water running in the sink." The sound of running water is a sensory stimulus that promotes normal micturition, but it does not reduce urinary incontinence. "Immediately empty your bladder when you have the urge to urinate." The nurse should teach the client to delay urination in order to lengthen the intervals between urination. By increasing the bladder's ability to suppress urination, the client should be able to develop continence. "If you are unable to urinate, plan to self-catheterize every 3 to 4 hours." The nurse should recommend self-catheterization for a client who has functional urinary incontinence, not urge incontinence.
A nurse is providing education regarding cyclosporine for a client who had a kidney transplant 2 days ago. Which of the following statements by the nurse is appropriate?
"You will need to continue taking this medication to protect your new kidneys." The client must take cyclosporine daily for the life of the transplanted organ. Wrong "Your risk for infection will increase if you stop taking this medication." Cyclosporine increases the client's risk for infection. Discontinuing cyclosporine places the client at risk for organ rejection. "Use an over-the-counter anti-inflammatory medication for aches and pains." Taking NSAIDs can intensify renal damage. "You might have hair loss due to the medication therapy you'll be taking." One of the most common adverse effects of cyclosporine is hirsutism.
A nurse is providing instructions for reducing the dietary intake of potassium to a client who has chronic kidney disease. Which of the following food selections should the nurse recommend?
. One large raw apple Of these options, one large apple is the lowest in potassium, containing 239 mg per serving. The nurse should instruct the client that there are foods from each of the food groups that are low in potassium and can be consumed, such as bread, eggs, butter, and green beans. Learning how to read nutrition labels will assist the client in making choices that meet dietary restrictions. Wrong One medium baked potato Baked potatoes are high in potassium, and a medium potato with skin contains 610 mg per serving. The nurse should instruct a client who has a potassium restriction to avoid eating white or sweet potatoes. 1 cup boiled spinach Spinach is high in potassium, containing 839 mg per serving. The nurse should instruct a client who has a potassium restriction to avoid eating spinach or broccoli. 1 cup cubed cantaloupe Cantaloupe is high in potassium, containing 431 mg per serving. The nurse should instruct a client who has a potassium restriction should avoid eating cantaloupe or oranges.
A nurse is planning care for a group of clients. Which of the following clients should the nurse plan to monitor for signs of nephrotoxicity?
A client who is receiving gentamicin for the treatment of a wound infection Aminoglycoside antibiotics can damage the cells of the proximal renal tubules, causing acute tubular necrosis. The nurse should plan to monitor this client for nephrotoxicity and acute kidney injury. Wrong A client who is receiving digoxin for the treatment of heart failure Providers should use caution when prescribing digoxin for clients who have renal impairment because the client's digoxin level can become toxic. However, the medication is not nephrotoxic. A client who is receiving methylprednisolone for the treatment of severe asthma The nurse should monitor a client who is taking methylprednisolone for fluid retention and hypokalemia. However, the medication is not nephrotoxic. A client who is receiving propranolol for the treatment of hypertension Providers should use caution when prescribing propranolol for clients who have renal impairment because the client can develop fluid overload. However, the medication is not nephrotoxic.
A nurse is monitoring a client following hemodialysis. The nurse should recognize that which of the following factors places the client at risk for seizures?
A rapid decrease in fluid A rapid decrease in fluid and electrolytes during hemodialysis can result in cerebral edema and increased intracranial pressure, placing the client at risk for seizures. This complication is called dialysis disequilibrium syndrome. Wrong Hypokalemia Hypokalemia places the client at risk for paralysis and coma, not seizures. A rapid increase of catecholamines An increase of catecholamines places the client at risk for tachycardia, not seizures. Hypercalcemia Hypercalcemia can cause paresthesia and muscle weakness, not seizures.
A nurse is planning care for a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL) to treat urolithiasis. Which of the following actions should the nurse plan to take?
Apply electrodes for cardiac monitoring. Wrong The nurse should apply electrodes for continuous monitoring of the client's cardiac rhythm during ESWL. This monitoring allows the provider to synchronize shock waves with the R wave. Wrong Monitor urine flow through a nephrostomy tube. The nurse should not expect a nephrostomy tube to be inserted for an ESWL procedure. The provider might place a ureteral stent to facilitate movement of stone fragments. Prepare to intubate the client. The nurse should plan to assist with moderate (conscious) sedation. Endotracheal intubation is not necessary for ESWL. Place the client in semi-Fowler's position. The nurse should position the client in supine position on a flat table for ESWL.
A nurse is caring for a postoperative client following arteriovenous (AV) fistula creation in her left arm. Which of the following actions should the nurse take?
Auscultate for bruits in the client's fistula every 4 hr. The nurse should auscultate for a bruit and palpate for a thrill every 4 hr to verify that the AV fistula is patent. Wrong Instruct the client to sleep on the affected side. The nurse should instruct the client to sleep on their unaffected side to prevent compression on the AV fistula site, which can compromise the vascular access. Keep the client's left arm in a dependent position. The nurse should elevate the client's left arm to reduce swelling and promote circulation. Measure blood pressure in the client's left arm every 4 hr. The nurse should use the client's right arm to measure blood pressure. Inflating the cuff on the left arm creates pressure on the operative site and can compromise the vascular access.
A nurse is teaching a client who has a new diagnosis of acute pyelonephritis. Which of the following instructions should the nurse include in the teaching?
Avoid the use of NSAIDs for pain. The nurse should instruct the client to avoid the use of NSAIDs for pain because they can further damage the kidney, causing papillary necrosis and reflux. Wrong Drink up to 1,500 mL of fluid per day. The client should drink at least 2,000 mL of fluid per day to prevent dehydration and to promote renal blood flow and urine production. Check peripheral blood glucose levels twice per day. Unless the client also has diabetes mellitus, there is no indication to monitor blood glucose levels during treatment for acute pyelonephritis. Increase dietary protein intake. The client should follow a balanced diet for adequate healing. The provider will limit protein intake if the client develops kidney impairment.
A nurse is reviewing the laboratory report of a client who has acute kidney injury (AKI). Which of the following findings should the nurse expect? (Select all that apply.)
BUN 30 mg/dL is correct. A BUN level above the expected reference range of 10 to 20 mg/dL is an expected finding of AKI. Urine output 40 mL in the past 3 hr is correct. The client's urine output indicates oliguria. The degree of oliguria varies with the stage of AKI. For the injury stage, the criterion is less than 0.5 mL/kg for 12 or more hr. Potassium 3.6 mEq/L is incorrect. The client's potassium level is within the expected reference range of 3.5 to 5 mEq/L. An elevated potassium level is an expected finding of AKI. Calcium 9.8 mg/dL is incorrect. The client's calcium level is within the expected reference range of 9 to 10.5 mg/dL. The nurse should expect a client who has AKI to have an abnormal calcium level. Hematocrit 30% is correct. A hematocrit level below the expected reference range of 42 to 52% for males and 37 to 47% for females is an expected finding of AKI.
A nurse is planning care for a client who is postoperative following a nephrectomy. Which of the following assessments is the priority for the nurse to evaluate?
Blood pressure The greatest risk to the client is injury from acute adrenal insufficiency caused by accidental removal or damage to the adrenal gland intraoperatively. The nurse should evaluate the client for hypotension and for a decrease in urine output. Wrong Pain level The nurse should monitor and treat the client's pain to promote comfort postoperatively. However, another assessment is the priority. WBC count The nurse should check the client's WBC count postoperatively to detect infection. However, another assessment is the priority. Bowel sounds The nurse should auscultate the client's bowel sounds to determine a return to baseline functioning following anesthesia. However, another assessment is the priority. The nurse should expect minimal intestinal peristalsis for at least 24 hr following abdominal surgery.
A nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate. Upon detecting an output obstruction, which of the following actions should the nurse take first?
Check the irrigation tubing for kinks. The first action the nurse should take when using the nursing process is to assess the irrigation tubing for kinking or clots because these can prevent the outflow of fluids. Wrong Irrigate the catheter with 0.9% sodium chloride irrigation. The nurse should irrigate the catheter with 0.9% sodium chloride irrigation to attempt to clear the obstruction. However, this is not the first action the nurse should take. Notify the provider. The nurse should notify the provider of the obstruction if interventions do not resolve it. However, this is not the first action the nurse should take. Provide PRN pain medication. The nurse should provide PRN pain medication to promote the client's comfort. However, this is not the first action the nurse should take.
A nurse is assessing a client who has chronic kidney disease and has completed her third peritoneal dialysis (PD) treatment. Which of the following findings should the nurse report to the provider?
Cloudy dialysate effluent Cloudy or opaque drainage is an early manifestation of peritonitis. The nurse should notify the provider immediately because infection can be a life-threatening complication. Wrong Greater outflow of dialysate than inflow The nurse should expect a greater outflow of dialysate fluid. Dialysate fluid is hypertonic. Therefore, it draws fluid from the body. Weight loss Dialysate fluid is hypertonic. Therefore, it draws fluid from the body. Each liter of fluid PD removes is equivalent to 1 kg of body weight. Report of pain during inflow Clients who undergo PD usually have pain at the beginning of each treatment, during the inflow of the dialysate. The client should no longer have this pain at the beginning of each exchange within 1 to 2 weeks of beginning PD.
A nurse is caring for a client who has acute kidney injury (AKI). Which of the following serum laboratory findings should the nurse report to the provider?
Creatinine 4 mg/dL A serum creatinine level above the expected reference range of 0.5 to 1.3 mg/dL indicates impaired kidney function. Therefore, the nurse should report this finding to the provider. The nurse should expect the creatinine level to decrease to within the expected reference range with successful treatment of AKI. Wrong Calcium 9 mg/dL The nurse should recognize that the client's calcium level is within the expected reference range of 9 to 10.5 mg/dL. However, the nurse should continue to monitor a client who has AKI for calcium imbalance. Potassium 5 mEq/L The nurse should recognize that the client's potassium level is within the expected reference range of 3.5 to 5 mEq/L. However, the nurse should continue to monitor a client who has AKI for potassium imbalance. Amylase 84 units/L The nurse should recognize that the client's serum amylase level is within the expected reference range of 30 to 220 units/L. Increased levels can indicate pancreatic inflammation. Amylase is not routinely monitored for a client who has AKI.
A nurse is performing an admission assessment of a client who has acute glomerulonephritis. The nurse should expect which of the following findings?
Dark-colored urine MY Clients who have acute glomerulonephritis usually excrete urine that is a dark, reddish-brown color. Low blood pressure Clients who have acute glomerulonephritis usually retain sodium and fluid, which leads to elevations in blood pressure. Polyuria Clients who have acute glomerulonephritis usually have a decreased urine output. Weight loss Clients who have acute glomerulonephritis usually gain weight due to fluid retention.
A nurse is caring for a client the night before a scheduled intravenous urography. Which of the following is the nurse's priority intervention?
Determine if the client has an allergy to iodine or shellfish. The greatest risk to the client is injury or death from a severe allergic reaction to radiopaque contrast media. The nurse should determine if the client has an allergy to iodine or shellfish, which can indicate that the client is at high risk for an allergic reaction to the contrast media. Wrong Inform the client that a warm sensation can occur when the contrast dye is injected. The nurse should inform the client to expect a warm sensation when the contrast dye is injected to help reduce anxiety before and during the procedure. However, another action is the priority. Place the informed consent document in the client's medical record. The nurse should place the informed consent document in the client's medical record to ensure that it is available for the procedure. However, another action is the priority. Tell the client to increase fluid intake following the procedure. The nurse should tell the client to increase fluid intake following the procedure to reduce the risk for contrast-induced nephropathy. However, another action is the priority.
A nurse is reviewing the medical records of four clients. The nurse should identify which of the following disorders as a risk factor for chronic pyelonephritis?
Diabetes mellitus A client who has diabetes mellitus is at risk for the development of chronic pyelonephritis because of the reduced bladder tone that results from diabetic neuropathy. Wrong Parkinson's disease Parkinson's disease can cause bladder dysfunction, such as urinary incontinence or difficulty urinating, but it is not a direct cause of pyelonephritis. Peptic ulcer disease Peptic ulcer disease can cause complications, such as hemorrhage, pyloric obstruction, and perforation, but it is not a direct cause of pyelonephritis. Gallbladder disease Gallbladder disease can cause complications, such as pancreatitis, due to the proximity of the organs, but it is not a direct cause of pyelonephritis.
A nurse is reviewing the medical history of a client who has end-stage kidney disease. The nurse should identify that which of the following factors in the client's history is a contraindication for receiving hemodialysis?
History of hemophilia The nurse should identify that a history of a major bleeding disorder is a contraindication for hemodialysis. A client who has hemophilia bleeds excessively following minor breaks in the skin and is at high risk for extreme blood loss during hemodialysis treatment. Wrong Difficulty with ambulation The nurse should identify that having difficulty with ambulation is not a contraindication to the client receiving hemodialysis. Decreased WBC count The nurse should identify that a decreased WBC count is not a contraindication to the client receiving hemodialysis Iodine allergy The nurse should identify that an iodine allergy is not a contraindication to the client receiving hemodialysis.
A nurse is caring for a client who has chronic kidney failure and the following laboratory results: BUN 196 mg/dL, sodium 152 mEq/L, and potassium 7.3 mEq/L. Which of the following interventions should the nurse implement?
Infuse regular insulin in dextrose 10% in water. The nurses should infuse regular insulin in dextrose 10% to 20% in water to a client who has hyperkalemia. The administration of insulin will drive the potassium from the extracellular fluid into the intracellular fluid to decrease the serum potassium level. The dextrose in the solution will counter the insulin to prevent hypoglycemia from occurring. Wrong Initiate an IV infusion of lactated Ringer's solution. The nurse should not infuse lactated Ringer's solution because it contains potassium and is not a treatment for hyperkalemia. Give spironolactone 50 mg PO BID. The nurse should not administer spironolactone to a client who has hyperkalemia because this medication is a potassium-sparing diuretic. Spironolactone can be used to treat diuretic-induced hypokalemia. Administer supplemental phosphorus. The nurse should not administer supplemental phosphorus to a client who has chronic kidney failure due to the risk for hyperphosphatemia.
A nurse is obtaining a urine specimen for culture and sensitivity from a client who has manifestations of a urinary tract infection. Which of the following actions should the nurse take?
Instruct the client to start urinating then pass the container into the stream. The nurse should instruct the client to start urinating, then pass the container into the stream, and collect 30 to 60 mL of urine in the container. Wrong Collect the client's urine in a clean specimen container. The nurse should use a sterile specimen container for a urine culture and sensitivity test. Obtain the client's first morning urine on the following day. The nurse can collect a urine specimen for a culture and sensitivity test at any time of the day. The nurse should collect the specimen as soon as possible to promote prompt treatment of the client's condition. Place the client's urine specimen in a container with a preservative. The nurse should transport the specimen within 30 min because the specimen container does not contain preservatives.
A nurse working in a women's health clinic is caring for a client who reports urinary urgency and dysuria. Which of the following additional findings should the nurse identify as an indication of a urinary tract infection (UTI)?
Pyuria The nurse should identify pyuria, or white blood cells in the urine, as a common manifestation of a UTI. Wrong Vaginal discharge The nurse should identify vaginal discharge as an indication of vulvovaginitis, not a UTI. Glucosuria The nurse should identify glucosuria as an indication of hyperglycemia, not a UTI. Elevated creatine kinase-MB The nurse should identify an elevated creatine kinase-MB as an indication of myocardial muscle injury, not a UTI
A nurse is caring for a client who has nephrotic syndrome and has been taking prednisone for 3 days. Which of the following adverse effects should the nurse monitor for and report to the provider?
Sore throat Glucocorticoids depress the immune system and increase the client's risk for infection. The nurse should recognize a sore throat as an indication of infection and report this finding to the provider. Wrong Frequent stools Frequent stools are not an adverse effect of prednisone therapy. The nurse should monitor the client for black, tarry stools as an adverse effect of prednisone. Hearing loss Hearing loss is not an adverse effect of prednisone therapy. The nurse should monitor the client for blurry vision and manifestations of increased intraocular pressure as adverse effects of prednisone. Tremors Tremors are not an adverse effect of prednisone therapy. The nurse should monitor the client for psychological alterations as adverse effects of prednisone.
A nurse is caring for a client following extracorporeal shock wave lithotripsy (ESWL) for the treatment of calcium phosphate kidney stones. Which of the following actions is appropriate for the nurse to take?
Strain all of the client's urine. The nurse should strain all of the client's urine following ESWL to monitor for stone fragments that have left the client's body. Wrong Limit the client's fluid intake to 1.5 L per day. The nurse should encourage the client to drink at least 3 L per day to promote urine flow, decrease the risk for stone precipitation, and prevent dehydration. Provide the client with an increased animal protein diet. The nurse should decrease the client's intake of animal proteins to prevent further calcium phosphate stone formation. Monitor the client's urine for ketones. The nurse should monitor for urine ketones for a client who has diabetic ketoacidosis.
A nurse is performing an admission assessment of a client who has severe chronic kidney disease (CKD). Which of the following findings should the nurse expect?
Tachypnea The nurse should expect a client who has severe CKD to have tachypnea because of metabolic acidosis. Wrong Hypotension The nurse should expect a client who has severe CKD to have hypertension because of fluid retention. Exophthalmos Exophthalmos is not an expected finding of severe CKD. The nurse should expect a client who has hyperthyroidism to have exophthalmos. Insomnia The nurse should expect a client who has severe CKD to have lethargy and drowsiness.
A nurse is caring for a client immediately following a kidney transplant. The nurse should identify which of the following client findings as a possible indication of a delay in functioning of the transplanted kidney?
Urine output 30 mL/2 hr The client should have a minimum urine output of 30 mL/hr. Following a renal transplant, the nurse should monitor for a decrease in the hourly urine output as an indication that the kidney is not functioning adequately. Wrong Pink and bloody urine Pink and bloody urine is an expected finding immediately after surgery. The nurse should expect the urine to become clear yellow within several days. Incisional tenderness The nurse should expect tenderness at the incision site during the early postoperative period. The nurse should monitor for excessive tenderness as an indication of wound infection. However, this finding does not provide information about kidney function. Blood pressure 110/58 mm Hg This blood pressure reading is within the expected reference range of less than 120 mm Hg systolic and less than 80 mm Hg diastolic. Following a kidney transplant, the nurse should monitor for an elevated blood pressure as an indication of organ rejection.
A nurse is preparing to assess a client who received hemodialysis 1 hr ago. Which of the following assessments should the nurse perform first?
Vital signs When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority information to assess is the client's vital signs. After hemodialysis, the client is at risk for hemodynamic instability, which includes hypotension, dysrhythmia, and hemorrhage. Wrong Creatinine level The nurse should provide ongoing monitoring of kidney function to track the progress of the client's kidney disease. However, another assessment is the priority. Body weight The nurse should compare the client's body weight before and after dialysis to determine the amount of fluid lost. However, another assessment is the priority. Potassium level The nurse should check the client's potassium level following hemodialysis and report it to the provider if it is outside the expected reference range. However, another assessment is the priority
A nurse working in the emergency department is caring for a client who reports costovertebral angle tenderness, nausea, and vomiting. For which of the following laboratory values should the nurse notify the provider?
WBC count 15,000/mm3 The WBC count is above the expected reference range and indicates the presence of an infection. The nurse should report this finding and the client's manifestations to the provider as an indication of pyelonephritis. Wrong BUN 15 mg/dL A BUN level of 15 mg/dL is within the expected reference range. Urine specific gravity 1.020 A urine specific gravity of 1.020 is within the expected reference range. Urine pH 5.5 A urine pH of 5.5 is within the expected reference range.
A nurse is planning care for a client who has acute glomerulonephritis. The nurse should plan to provide which of the following interventions.
Weigh the client daily. The nurse should monitor fluid retention by weighing the client daily. A decrease in weight indicates the effectiveness of the therapy. Wrong Encourage the client to drink 2 to 3 L of fluid per day. The nurse should calculate the client's daily fluid allowance by adding 500 to 600 mL to their previous 24-hr urine output. Instruct the client to ambulate every 2 hr. The nurse should promote the client's conservation of energy and encourage them to rest as much as possible. Check the client's blood glucose level. The nurse should check the blood glucose levels of clients who have diabetes mellitus.
