2210 Test 2 Chapters 65-68

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"They may be used to improve urethral resistance." Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance.

A nurse assesses a client who has had two episodes of bacterial cystitis in the last 6 months. Which questions should the nurse ask? (Select all that apply.)

- "How much water do you drink every day?" - "Do you take estrogen replacement therapy?" -. "Are you on steroids or other immune-suppressing drugs?" Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent cystitis.

A nurse teaches a client about self-catheterization in the home setting. Which statements should the nurse include in this client's teaching? (Select all that apply.)

- "Wash your hands before and after self-catheterization." - "Use lubricant on the tip of the catheter before insertion." - "Maintain a specific schedule for catheterization." The key points in self-catheterization include washing hands, using lubricants, and maintaining a regular schedule to avoid distention and retention of urine that leads to bacterial growth. A smaller rather than a larger lumen catheter is preferred. The client needs to catheterize more often than every 12 hours.

A nurse teaches a female client who has stress incontinence. Which statements should the nurse include about pelvic muscle exercises? (Select all that apply.)

- "When you start and stop your urine stream, you are using your pelvic muscles." - "Tighten your pelvic muscles for a slow count of 10 and then relax for a slow count of 10." - "Like any other muscle in your body, you can make your pelvic muscles stronger by contracting them." The client should be taught that the muscles used to start and stop urination are pelvic muscles, and that pelvic muscles can be strengthened by contracting and relaxing them.

A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug?

- Be certain to wear sunscreen and protective clothing - Drink at least 3 liters of fluids every day - Take this drug with 8 ounces of water - You will need to take all of this drug to get the benefits

An older adult client diagnosed with stress incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect?

- Dry mouth - Increased intraocular pressure - Constipation

The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation?

- Dysuria - Frequency - Nocturia - Urgency

A client diagnosed with stress incontinence is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug?

- Encourage increased fluids - Increase fiber intake - Use hard candy for dry mouth

Which interventions are helpful in preventing bladder cancer?

- Showering after working with or around chemicals - Stopping the use of tobacco - Wearing gloves and a mask when working around chemicals and fumes

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? Abrupt decrease in urine output Blood-tinged urine Incisional pain Increase in urine output

A An abrupt decrease in urine output may indicate complications such as rejection, acute kidney injury, thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output are expected findings after kidney transplantation

After teaching a client with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?

"An orange color in my urine should not alarm me." Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients think they have blood in their urine when they see this. In addition, the urine can permanently stain clothing

"I should be drinking at least 1.5 to 2.5 liters of fluids every day." To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day.

"I take over-the-counter naproxen (Aleve) twice a day for joint pain." Because a high risk for bleeding during ESWL has been noted, clients should not take nonsteroidal anti-inflammatory drugs before this procedure; the ESWL will have to be rescheduled for this client.

Which client is not a candidate for intermittent self catheterization training? A. Older female client B. Middle-aged female client who is blind C. Older male client with dementia D. Middle-aged client who has paraplegia

C -Older male client with dementia -Clients of any age with a variety of impairments and disabilities can participate in intermittent self-catheterization. The two main requirements are that the client be cognitively intact and can reach the area.

The certified Wound, Ostomy, and Continence Nurse or enterostomal therapist teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? A. Nutritional and dietary care B. Respiratory care C. Stoma and pouch care D. Wiping from front to back (asepsis)

C. Stoma and pouch care The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms. The registered dietitian teaches the cystectomy client about nutritional care. The respiratory therapist teaches the cystectomy client about respiratory care. The client with a cystectomy does not require instruction about front-to-back wiping.

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? A. Functional B. Overflow C. Stress D. Urge

C. Stress Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence. Functional incontinence is not caused by a weakened pelvic floor; rather, it is due to structural problems often resulting from injury or trauma. Overflow incontinence is caused by too much urine being stored in the bladder. Urge incontinence is caused by a problem (i.e., neurologic) with the client's urge to urinate.

The school nurse is counseling a teenage student about how to prevent kidney trauma. Which statement by the student indicates a need for further teaching? "I can't play any type of contact sports because my brother had kidney cancer." Correct "I avoid riding motorcycles." "I always wear pads when playing football." "I always wear a seat belt in the car."

Contact sports and high-risk activities should be avoided if a person has only one kidney. A family history of kidney cancer does not prohibit this type of activity. To prevent kidney and genitourinary trauma, caution should be taken when riding bicycles and motorcycles. People should wear appropriate protective clothing when participating in contact sports. Anyone riding in a car should wear a seat belt.

What role does drug therapy have as an intervention for reflex (overflow) urinary incontinence? a. Captopril (Capoten) is given to lower urine cystine levels. b. Levofloxacin (Levaquin) is given to prevent UTIs with this type of incontinence. c. Midorine (ProAmatine) is given to increase the contractile force of the bladder. d. Bethanechol chloride (Urecholine) may be used short-term after surgery.

D - Bethanechol chloride (Urecholine) may be used short-term after surgery.

Which client is at greatest risk for a fungal urinary tract infection?

D -A middle-aged man with diabetes mellitus -Clients who are severely immunocompromised or who have diabetes mellitus are more prone to fungal urinary tract infections. The client with an enlarged prostate gland would not be at greater risk. Being sexually active does not place the client at greater risk for developing an infection.

Which change in renal or urinary functioning as a result of the normal aging process increases the older client's risk for infection? a. Decreased glomerular filtration b. Decreased filtrate reabsorption c. Weakened sphincter muscles d. Urinary retention

D -Urinary retention -Incomplete bladder emptying for whatever reason increases the client's risk for urinary tract infections. This is a result of urine stasis, which provides an excellent culture medium that promotes the growth of microorganisms.

The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? A. "For the best effect, perform all of your exercises while you are seated on the toilet." B. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." C. "Results should be visible to you within 72 hours." D. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

D. "You know that you are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used. Pelvic muscle exercises can be performed anywhere and should be performed more often than 5 minutes twice daily. Noticeable results take several weeks.

Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation? Pink-tinged urine Urinary frequency Temperature of 100.8° F Lethargy

Fever, chills, or an elevated white blood cell count after cystoscopy suggest infection after an invasive procedure; the provider must be notified immediately. Pink-tinged urine is expected after a cystoscopy; gross hematuria would require notification of the surgeon. Frequency may be noted as a result of irritation of the bladder. If sedation or anesthesia was used, lethargy is an expected effect.

A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan?

Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.

When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? (Select all that apply.) Suprapubic pain Vomiting Correct Chills Correct Dysuria Correct Oliguria

Nausea and vomiting are symptoms of acute pyelonephritis. Chills along with fever may also occur, as well as burning (dysuria), urgency, and frequency. Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? Construction worker Correct Office secretary Schoolteacher Taxicab driver

Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place the construction worker at risk for dehydration and pre-renal azotemia. The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? Increased oral fluids IV fluids Privacy Health history forms

Privacy The nurse should provide privacy, assistance, and voiding stimulants, such as warm water over the perineum, as needed, for the client with urinary problems. Increased oral fluids and IV fluids would exacerbate the client's problem. Obtaining a health history is not the priority for this client's care.

During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? "Drink 2 liters of fluid and urinate at the same time every day." "Eat breakfast and go to bed at the same time every day." "Check your blood sugar and do a urine dipstick test." "Weigh yourself and take your blood pressure." Correct

Regular weight assessment monitors fluid restriction control, while blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction. Fluid intake and urination, and breakfast time and bedtime, do not need to be at the same time each day. Clients with diabetes, not kidney disease, should regularly check their blood sugar and perform a urine dipstick test.

When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next? Check vital signs. Correct Notify the surgeon. Continue to monitor. Insert a nasogastric (NG) tube.

The client's abdomen may be distended from bleeding; hemorrhage or adrenal insufficiency causes hypotension, so vital signs should be taken to see if a change in blood pressure has occurred. The surgeon should be notified after vital signs are assessed. An NG tube is not indicated for this client.

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? Adherence to therapy Handwashing Correct Monitoring for low-grade fever Strict clean technique

The most important infection control measure for the client receiving immune-suppressive therapy is handwashing. Adherence to therapy and monitoring for low-grade fever are important, but are not infection control measures. The nurse should practice aseptic technique for this client, not simply clean technique.

A client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? Decreases bacterial count Destroys white blood cells Enhances the action of antibiotics Provides comfort Correct

Urinary antiseptic drugs such as nitrofurantoin (Macrodantin) are prescribed to provide comfort for clients with pyelonephritis. Antibiotics, not antiseptics, are used to decrease bacterial count and treat pyelonephritis infection; the action of antibiotics is not enhanced with antiseptics. White blood cells, along with antibiotics, fight infection.

One of the nurse's roles is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? Children's terms that are easily understood Slang words and terms that are heard "socially" Technical and medical terminology Words that the client uses

Words that the client uses The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client. The use of children's terms is demeaning to adult clients. The use of slang terms is unprofessional. Technical terms should not be used because the client may not know what they mean.

A patient with PKD usually experience constipation. What does the nurse recommend? a. Increased dietary fiber and increased fluids b. Decreased dietary fiber and laxatives c. Daily laxatives and increased exercise d. Tap-water enemas and fiber supplements

A patient with acute glomerulonephritis is required to provide a 24-hour urine specimen. What does the nurse expect to see when looking at the specimen? a. Smoke or cola-colored urine b. Clear and very dilute urine c. Urine that is full of pus and very thick d. Bright orange-colored urine

For the patient with PKD which antihypertensive medication may be used because it helps control the cell growth aspects of PKD and reduce microalbuminuria? a. Angiotensin-converting enzyme inhibitors b. Beta blockers c. Calcium channel blockers d. Vasodilators

Which clinical manifestation in a patient with an obstruction in the urinary system is associated specifically with a hydronephrosis? a. Flank asymmetry b. Chills and fever c. Urge incontinence d. Decreased urine volume

A patient has sustained a minor kidney injury. Which structure must remain functional in order to form urine from blood? a. Medulla b. Nephron C. calyx d. capsule

A patient is in the diuretic phase of AKI. During this phase, what is the nurse mainly concerned about? a. Assessing for hypertension and fluid overload b. Monitoring for hypovolemia and electrolyte loss c. Adjusting the dosage of diuretic medications d. Balancing diuretic therapy with intake

The nurse is caring for a patient with kidney cell carcinoma who manifests paraneoplastic syndromes. What findings does the nurse expect to see in this patient? (SATA) a. Urinary tract infection b. Erythrocytosis c. Hypercalcemia d. Liver dysfunction e. Decrease sedimentation rate f. Hypertension

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What are common causes of prerenal kidney injury? (SATA) a. Urethral cancer b. Hypovolemic shock c. Enlarged prostate gland d. Sepsis e. Severe burns

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A 22-year-old patient comes to the clinic for a wellness check-up. History reveals that the patient's parent ahs the autosomal-dominant form of PKD. Which vital sign suggests that the patient should be evaluated PKD? a. Pulse of 90 beats/min b. Temperature of 99.6F c. Blood pressure of 136/88 mm Hg d. Respiratory rate of 22/min

A 24-hour urine specimen is required from a patient. Which strategy is best to ensure that all the urine is collected for the full 24-hour period? a. Instruct the UAP to collect all the urine b. Put a bedpan or commode next to the bed as a reminder c. Place a sign in the bathroom reminding everyone to save urine d. Verbally remind the patient about the test

A patient has a urinalysis ordered. When is the best time for the nurse to collect the specimen? a. In the evening b. After a meal c. In the morning d. After a fluid bolus

A patient has recently started PD therapy and reports some mild pain when the dialysate is flowing in. What does the nurse do next? a. Immediately reports the pain to the health care provider b. Try warming the dialysate in the microwave oven c. Reassure that pain should subside after the first week or two d. Assess the connection tubing for kinking or twisting

A patient is newly admitted with nephrotic syndrome and has proteinuria, edema, hyperlipidemia, and hypertension. What is the priority for nursing care? a. Consult the dietitian to provide adequate nutritional intake. b. Prevent urinary tract infection c. Monitor fluid volume and the patient's hydration status. d. Prepare the patient for a renal biopsy

A patient laboratory results show an elevated creatinine level. The patient's history reveals no risk factors for kidney disease. Which question does the nurse ask the patient to shed further light on the laboratory result? a. "How many hours of sleep did you get the night before the test?" b. "How much fluid did you drink before the test?" c. "Did you take any type of antibiotic before taking the test?" d "When and how much did you last urinate before having the test?"

For a patient with AKI, the nurse would consider questioning the order for which diagnostic test? a. Kidney biopsy b. Ultrasonography c. Computed tomography with contrast dye d. Kidney, ureter, bladder (KUB) x-ray

The nurse is reviewing laboratory results for a patient with PKD. Which laboratory abnormality indicates glomeruli involvement? a. Low specific gravity of urine b. bacteria in urine c. proteinuria d. Hematuria

Which behavior is the strongest indicator that a patient with ESKD is not coping well with the illness and may need a referral for psychological counseling? a. Displays irritability when the meal tray arrives b. Refuses to take one of the drugs because it causes nausea c. Repeatedly misses dialysis appointments d. Seems distracted when the health care provider talks about the prognosis

Which combination of drugs is the most nephrotoxic? a. ACE inhibitors and aspirin b. Angiotensin II receptor blockers and antacids c. Aminoglycoside antibiotics and NSAIDs d. Calcium channel blockers and antihistamines

Which diagnostic test incorpartes contrast dye, but does not place a patient at risk for nephrotoxicity? a. renal scan b. Renal angiogrpahy c. Voiding cystourethrogram d. Computed tomography

The nurse is taking a history on a patient with diabetes and hypertension. Because of the patient's high risk for developing kidney problems, which early sign of CKD does the nurse assess for? a. Decreased output with subjective thirst b. Urinary frequency of very small amounts c. Pink or blood-tinged urine d. Increased output of very dilute urine

12. A nurse reviews the allergy list of a client who is scheduled for an intravenous urography. Which client allergy should alert the nurse to urgently contact the health care provider? a. Seafood b. Penicillin c. Bee stings d. Red food dye

ANS: A Clients with seafood allergies often have severe allergic reactions to the standard dyes used during intravenous urography. The other allergies have no impact on the client's safety during an intravenous urography.

6. A nurse cares for adult clients who experience urge incontinence. For which client should the nurse plan a habit training program? a. A 78-year-old female who is confused b. A 65-year-old male with diabetes mellitus c. A 52-year-old female with kidney failure d. A 47-year-old male with arthritis

ANS: A For a bladder training program to succeed in a client with urge incontinence, the client must be alert, aware, and able to resist the urge to urinate. Habit training will work best for a confused client. This includes going to the bathroom (or being assisted to the bathroom) at set times. The other clients may benefit from another type of bladder training.

5. After teaching a client who has stress incontinence, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I will limit my total intake of fluids." b. "I must avoid drinking alcoholic beverages." c. "I must avoid drinking caffeinated beverages." d. "I shall try to lose about 10% of my body weight."

ANS: A Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence.

A nurse assesses a client who presents with renal calculi. Which question should the nurse ask?

"Do any of your family members have this problem?" There is a strong association between family history and stone formation and recurrence. Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask whether other family members have also had renal stones.

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? "Your diseased kidneys will be removed at the same time the transplant is performed." "The new kidney will be placed directly below one of your old kidneys." "It is essential for you to wash your hands and avoid people who are ill. "You will receive dialysis the day before surgery and for about a week after."

"It is essential for you to wash your hands and avoid people who are ill. Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential. Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery; after the surgery, the new kidney should begin to make urine.

"Not completing your medication can lead to return of your infection." Not completing the drug regimen can lead to recurrence of an infection and bacterial drug resistance. Needing to be re-treated does not mean that the client will have a prolonged treatment regimen. Some treatment modalities are given over a 3-day period. Given this client's history, larger doses for a shorter time span may be a wise plan.

An older adult woman confides to the nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond?

"That is tough. What do you think might help?" Stating that the situation is tough acknowledges the client's concerns, and asking the client to think about what might help assists the client to think of methods to solve her problem.

A nurse teaches a client who is starting urinary bladder training. Which statement should the nurse include in this client's teaching?

"Try to consciously hold your urine until the scheduled toileting time." The client should try to hold the urine consciously until the next scheduled toileting time. Toileting should occur at specific intervals during the training. The toileting interval should be no less than every hour. The interval can be increased once the client becomes comfortable with the interval.

A nurse teaches a young female client who is prescribed amoxicillin (Amoxil) for a urinary tract infection. Which statement should the nurse include in this client's teaching?

"Use a second form of birth control while on this medication." The client should use a second form of birth control because penicillin seems to reduce the effectiveness of estrogen-containing contraceptives. She should not experience increased menstrual bleeding, an irregular heartbeat, or blood in her urine while taking the medication.

The nurse and the dietitian are planning dietary intake for a patient with AKI who is currently not on dialysis therapy. The dietitian informs the nurse that 0.6 g/kg of body weight of protein are needed. The patient weighs 130 pounds. How many grams of protein should the patient receive? (Round grams to the nearest whole number.) _______ grams

For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter?

56-year-old woman who is admitted with a vaginal-rectal fistula and diabetes Rationale: This client has a wound that can be irritated by urine and whose urinary tract could become infected by the draining fistula (her diabetes increases her overall risk for infection).

The hospitalized client with a urethral retention catheter has cystitis. Which is the priority nursing diagnosis for this client? A. Risk for Infection B. Disturbed Body Image C. Risk for Impaired Skin Integrity D. Risk for Urge Urinary Incontinence

A -Risk for Infection -The most common cause of sepsis in hospitalized clients is a urinary tract infection. Ascending infections from cystitis with an indwelling catheter is a major source of such infections. Although the other diagnoses are important, they would not have life-threatening implications for the client.

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) Obtain the client's pre-hemodialysis weight. Check the arteriovenous (AV) fistula for a thrill and bruit. Document the amount the client drinks throughout the shift. Auscultate the client's lung sounds every 4 hours. Explain the components of a low-sodium diet.

A C Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

Which clinical manifestation in a client with pyelonephritis indicates that treatment has been effective? Decreased urine output Decreased white blood cells in urine Increased red blood cell count Increased urine specific gravity

A decreased presence of white blood cells in the urine indicates the eradication of infection. A decreased urine output, an increased red blood cell count, and increased urine specific gravity are not symptoms of pyelonephritis.

Which clinical manifestation in a client with pyelonephritis indicates that treatment has been effective? Decreased urine output Decreased white blood cells in urine Correct Increased red blood cell count Increased urine specific gravity

A 65-year old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? A. Smoking B. Urine with a high specific gravity C. Recurrent urinary tract infections D. History of cancer in another organ or tissue

A. Smoking Rationale: Many compounds in tobacco enter the bloodstream and affect other organs, such as the bladder. Concentrated urine is associated with kidney stones and UTIs. The urinary bladder is not a common site for metastases.

Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? Diltiazem (Cardizem) Lisinopril (Zestril) Clonidine (Catapres) Doxazosin (Cardura)

ACE Angiotensin-converting enzyme inhibitors such as lisinopril appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers such as diltiazem may indirectly prevent kidney disease by controlling hypertension, but are not specific to slowing progression of kidney disease. Vasodilators such as clonidine and doxazosin control blood pressure, but do not specifically protect from kidney disease.

4. A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, What can I do to help prevent these infections? How should the nurse respond? a. Test your urine daily for the presence of ketone bodies and proteins. b. Use tampons rather than sanitary napkins during your menstrual period. c. Drink more water and empty your bladder more frequently during the day. d. Keep your hemoglobin A1c under 9% by keeping your blood sugar controlled.

ANS: C Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the clients sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A1c of 9% is too high.

A nurse teaches a client who is recovering from a urography. Which instruction should the nurse include in this client's discharge teaching? a. "Avoid direct contact with your urine for 24 hours until the radioisotope clears." b. "You may have some dribbling of urine for several weeks after this procedure." c. "Be sure to drink at least 3 liters of fluids today to help eliminate the dye faster." d. "Your skin may become slightly yellow from the dye used in this procedure."

ANS: C Dyes used in urography are potentially nephrotoxic. A large fluid intake will help the client eliminate the dye rapidly. Dyes used in urography are not radioactive, the client should not experience any dribbling of urine, and the dye should not change the color of the client's skin.

3. A nurse reviews laboratory results for a client with glomerulonephritis. The clients glomerular filtration rate (GFR) is 40 mL/min as measured by a 24-hour creatinine clearance. How should the nurse interpret this finding? (Select all that apply.) a. Excessive GFR b. Normal GFR c. Reduced GFR d. Potential for fluid overload e. Potential for dehydration

ANS: C, D The GFR refers to the initial amount of urine that the kidneys filter from the blood. In the healthy adult, the normal GFR ranges between 100 and 120 mL/min, most of which is reabsorbed in the kidney tubules. A GFR of 40 mL/min is drastically reduced, with the client experiencing fluid retention and risks for hypertension and pulmonary edema as a result of excess vascular fluid.

2. A nurse cares for a client with autosomal dominant polycystic kidney disease (ADPKD). The client asks, Will my children develop this disease? How should the nurse respond? a. No genetic link is known, so your children are not at increased risk. b. Your sons will develop this disease because it has a sex-linked gene. c. Only if both you and your spouse are carriers of this disease. d. Each of your children has a 50% risk of having ADPKD.

ANS: D Children whose parent has the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease. ADPKD is transmitted as an autosomal dominant trait and therefore is not gender specific. Both parents do not need to have this disorder.

A client with these assessment data is preparing to undergo a computed tomography scan with contrast: Physical Assessment DX Findings Medications Flank pain Dysuria Bilateral knee pain BUN 54 mg/dL Creatinine 2.4 mg/dL Calcium 8.5 mg/dL Captopril Metformin Acetylcysteine Which medication does the nurse plan to administer before the procedure? Acetylcysteine (Mucosil) Metformin (Glucophage) Captopril (Capoten) Acetaminophen (Tylenol)

Acetylcysteine (Mucosil) This client has kidney impairment demonstrated by increased creatinine. Acetylcysteine (an antioxidant) may be used to prevent contrast-induced nephrotoxic effects. Metformin is held at least 24 hours before procedures using contrast. Although captopril and acetaminophen may be administered with a sip of water with permission of the provider, this is not essential before the procedure.

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for bladder cancer?

An 86-year-old male with a 50-pack-year cigarette smoking history The greatest risk factor for bladder cancer is a long history of tobacco use.

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? Abrupt decrease in urine output Blood-tinged urine Incisional pain Increase in urine output

An abrupt decrease in urine output may indicate complications such as rejection, acute kidney injury, thrombosis, or obstruction. Blood-tinged urine, incisional pain, and an increase in urine output are expected findings after kidney transplantation

Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? Diltiazem (Cardizem) Lisinopril (Zestril) Correct Clonidine (Catapres) Doxazosin (Cardura)

Angiotensin-converting enzyme inhibitors such as lisinopril appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers such as diltiazem may indirectly prevent kidney disease by controlling hypertension, but are not specific to slowing progression of kidney disease. Vasodilators such as clonidine and doxazosin control blood pressure, but do not specifically protect from kidney disease.

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? "Your diseased kidneys will be removed at the same time the transplant is performed." "The new kidney will be placed directly below one of your old kidneys." "It is essential for you to wash your hands and avoid people who are ill." Correct "You will receive dialysis the day before surgery and for about a week after."

Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential. Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery; after the surgery, the new kidney should begin to make urine.

A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client's right lower back. Which action should the nurse take?

Apply an ice pack to the site. The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising.

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? Auscultate for pericardial friction rub. Assess for crackles. Monitor for decreased peripheral pulses. Determine if the client is able to ambulate.

Auscultate for pericardial friction rub. The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.

B Angiotensin-converting enzyme inhibitors such as lisinopril appear to be the most effective drugs to slow the progression of kidney failure. Calcium channel blockers such as diltiazem may indirectly prevent kidney disease by controlling hypertension, but are not specific to slowing progression of kidney disease. Vasodilators such as clonidine and doxazosin control blood pressure, but do not specifically protect from kidney disease.

A male college student comes to the clinic reporting burning or difficulty with urination and a discharge from the urethral meatus. Based on the patient's chief complaint, what is the most logical question for the nurse to ask about the patient's past medical history? a. "Do you have a history of a narrow urethra or a stricture?" b. "Could you have been exposed to a sexually transmitted disease (STD)?" c. "Do you have a history of kidney stones?" d. "Have you been drinking an adequate amount of fluids?"

B - "Could you have been exposed to a sexually transmitted disease (STD)?"

Which group has the highest prevalence of urinary tract infections (UTIs)? a. Young men b. Older women c. Older men d. School-aged girls

B - Older women

Which clinical manifestation indicates to the nurse that interventions for the patient's renal colic are effective? a. Urine is pink-tinged. b. Patient reports that pain is relieved. c. Urine output is 50 mL/min. d. Bladder scan shows no residual urine.

B - Patient reports that pain is relieved.

The nurse is reviewing the laboratory results for an older adult patient with an indwelling catheter. The urine culture is pending, but the urinalysis shows greater than 105 colony-forming units, and the differential WBC count shows a "left shift." How does the nurse interpret these findings? a. Interstitial cystitis b. Urosepsis c. Complicated cystitis d. Radiation-induced cystitis

B - Urosepsis

The female client's urinalysis shows all the following results. Which should the nurse document as abnormal?

B -Ketone bodies present -Ketone bodies are byproducts of incomplete metabolism of fatty acids. Normally, there are no ketones in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy.

Which condition would trigger the release of antidiuretic hormone (ADH)?

B -Plasma osmolarity increased secondary to dehydration -Antidiuretic hormone is triggered by a rising extracellular fluid (ECF) osmolarity, especially hypernatremia.

The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? A. "A small-lumen catheter will help prevent injury to my urethra." B. "I will use a new, sterile catheter each time I do the procedure." C. "My family members can be taught to help me if I need it." D. "Proper handwashing before I start the procedure is very important."

B. "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating. The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization and is a principle that should be stressed.

The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? Hemoglobin and hematocrit (H&H) White blood cell (WBC) count Blood urea nitrogen (BUN) and creatinine Correct Lipid levels

BUN and creatinine are kidney function tests. With back-pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction; H&H monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.

The nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first? Administer heparin intravenously. Remove the urinary catheter. Notify the health care provider. Correct Irrigate the catheter with sterile saline.

Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. The nurse should monitor urine output and notify the health care provider of obvious blood clots or a decreased or absent urine output. Heparin will not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and should not be removed at this time. The Foley catheter may be irrigated with sterile saline, as ordered.

A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? Blood pressure of 118/78 mm Hg Weight loss of 3 pounds during hospitalization Dyspnea and anxiety at rest Central venous pressure (CVP) of 6 mm Hg

C Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse should assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.

Which dietary changes does the nurse suggest to a patient with urge incontinence? a. Limit fluid intake to no more than 2 L/day. b. Peel all fruit before consuming. c. Avoid alcohol and caffeine. d. Avoid smoked or salted food

C - Avoid alcohol and caffeine.

The nurse is caring for a patient who has an indwelling catheter and subsequently developed a UTI. The patient has been receiving antibiotics for several days, but develops hypotension, a rapid pulse, and confusion. The nurse suspects urosepsis and alerts the health care provider. Which diagnostic test is the provider most likely to order to confirm urosepsis? a. Culture of the drainage bag b. Culture of the catheter tip c. Blood culture d. Repeat urinalysis

C - Blood culture

The nurse is caring for an older adult patient with urinary incontinence. The patient is alert and oriented, but refuses to use the call bell and has fallen several times while trying to get to the bathroom. What is the nurse's priority concern for this patient? a. Managing noncompliance b. Accurately measuring urinary output c. Providing fall prevention measures d. Managing urinary incontinence

C - Providing fall prevention measures

Which is the result of stimulation of erythropoietin production in the kidney tissue? A. Increased blood f low to the kidney B. Inhibition of vitamin D and loss of bone density C. Increased bone marrow production of red blood cells D. Inhibition of the active transport of sodium, leading to hyponatremia

C -Increased bone marrow production of red blood cells -Erythropoietin is produced in the kidney and released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell (RBC) production in the bone marrow.

When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next? Check vital signs. Notify the surgeon. Continue to monitor. Insert a nasogastric (NG) tube.

Check vital signs. The client's abdomen may be distended from bleeding; hemorrhage or adrenal insufficiency causes hypotension, so vital signs should be taken to see if a change in blood pressure has occurred. The surgeon should be notified after vital signs are assessed. An NG tube is not indicated for this client.

To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? Construction worker Office secretary Schoolteacher Taxicab driver

Construction worker Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place the construction worker at risk for dehydration and pre-renal azotemia. The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL Crackles in the lung fields Correct Temperature of 98.8° F (37.1° C) Blood pressure of 164/98 mm Hg Correct 3+ edema of the lower extremities Correct

Crackles in the lung fields Correct Blood pressure of 164/98 mm Hg Correct 3+ edema of the lower extremities Correct Signs and symptoms of fluid retention (e.g., crackles in the lung fields and 3+ edema of the lower extremities) indicate transplant rejection. Increased blood pressure is also a symptom of transplant rejection. Increasing BUN and creatinine are symptoms of rejection; a BUN of 21 mg/dL and a creatinine of 0.9 mg/dL reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? Hematocrit of 26.7% Potassium within normal range Absence of spontaneous fractures Less fatigue

D Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia.

The nurse is teaching a man about how to prevent UTIs. What information does the nurse include? a. "Have a minimal fluid intake of 5 L daily, unless contraindicated." b. "Empty your bladder before and after sexual intercourse." c. "Make sure that spermicides are used with condoms." d. "Gently wash the genital area before intercourse."

D - "Gently wash the genital area before intercourse."

A patient has UTI symptoms but there are no bacteria in the urine. The health care provider suspects interstitial cystitis. The nurse prepares patient teaching material for which diagnostic test? a. Urography b. Abdominal sonography c. Computed tomography (CT) d. Cystoscopy

D - Cystoscopy

What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)? A. Limit fluid intake. B. Increase caffeine consumption. C. Limit sugar intake. D. Drink about 3 liters of fluid daily.

D. Drink about 3 liters of fluid daily. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs. Fluids flush the system and should not be limited. Increased caffeine intake and limiting sugar intake will not prevent UTIs.

Which age-related change can cause nocturia? Decreased ability to concentrate urine Decreased production of antidiuretic hormone Increased production of erythropoietin Increased secretion of aldosterone

Decreased ability to concentrate urine Nocturia may result from decreased kidney-concentrating ability associated with aging. Increased production of antidiuretic hormone, decreased production of erythropoietin, and decreased secretion of aldosterone are age-related changes.

What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)?

Drink about 3 liters of fluid daily. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs.

Which assessment findings does the nurse expect in a client with kidney cancer? (Select all that apply.) Erythrocytosis Hypokalemia Hypercalcemia Hepatic dysfunction Increased sedimentation rate

Erythrocytosis Correct Hypokalemia Hypercalcemia Correct Hepatic dysfunction Correct Increased sedimentation rate Correct Erythrocytosis alternating with anemia and hepatic dysfunction with elevated liver enzymes may occur with kidney cancer. Parathyroid hormone produced by tumor cells can cause hypercalcemia. An elevation in sedimentation rate may occur in paraneoplastic syndromes. Potassium levels are not altered in kidney cancer, but hypercalcemia is present.

Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) Football player in preseason practice Correct Client who underwent contrast dye radiology Correct Accident victim recovering from a severe hemorrhage Correct Accountant with diabetes Client in the intensive care unit on high doses of antibiotics Correct Client recovering from gastrointestinal influenza Correct

Football player in preseason practice Correct Client who underwent contrast dye radiology Correct Accident victim recovering from a severe hemorrhage Correct Client in the intensive care unit on high doses of antibiotics Correct Client recovering from gastrointestinal influenza Correct To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure.

The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification?

I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown.

Which urinary assessment information for a client indicates the potential need for increased fluids? Increased blood urea nitrogen Increased creatinine Pale-colored urine Decreased sodium

Increased blood urea nitrogen can indicate dehydration. Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.

When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? Mild discomfort at the insertion site Temperature 100.8° F 1+ ankle edema Anorexia

Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed. Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? Hematocrit of 26.7% Potassium within normal range Absence of spontaneous fractures Less fatigue

Less fatigue Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia.

Which information suggests that a client with diabetes may be in the early stages of kidney damage? Elevation in blood urea nitrogen (BUN) Oliguria Microalbuminuria Painless hematuria

Microalbuminuria In the early stages of diabetic nephropathy, micro-levels of albumin are first detected in the urine. Progressive kidney damage occurs before dipstick procedures can detect protein in the urine. BUN may change in response to protein and fluid intake. Oliguria is a later finding in kidney disease and may also be present in dehydration. Painless hematuria often occurs with kidney cancer.

Which age-related change can cause nocturia? Decreased ability to concentrate urine Correct Decreased production of antidiuretic hormone Increased production of erythropoietin Increased secretion of aldosterone

Nocturia may result from decreased kidney-concentrating ability associated with aging. Increased production of antidiuretic hormone, decreased production of erythropoietin, and decreased secretion of aldosterone are age-related changes.

Notify the health care provider. Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. The nurse should monitor urine output and notify the health care provider of obvious blood clots or a decreased or absent urine output. Heparin will not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and should not be removed at this time. The Foley catheter may be irrigated with sterile saline, as ordered.

A nurse cares for a client admitted from a nursing home after several recent falls. What prescription should the nurse complete first?

Obtain urine sample for culture and sensitivity. Although all interventions are or might be important, obtaining a urine sample for urinalysis takes priority. Often urinary tract infection (UTI) symptoms in older adults are atypical, and a UTI may present with new onset of confusion or falling. The urine sample should be obtained before starting antibiotics

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients?

Periodically re-evaluating the need for indwelling catheters Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTIs in the hospital setting.

Which nursing activity illustrates proper aseptic technique during catheter care?

Positioning the collection bag below the height of the bladder Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract.

When preparing a client for nephrostomy tube insertion, it is essential for the nurse to monitor which factor before the procedure? Blood urea nitrogen (BUN) and creatinine Hemoglobin and hematocrit (H&H) Intake and output (I&O) Prothrombin time (PT) and international normalized ratio (INR)

Prothrombin time (PT) and international normalized ratio (INR) The procedure will be cancelled or delayed if coagulopathy in the form of prolonged PT/INR exists because dangerous bleeding may result. Nephrostomy tubes are placed to prevent and treat kidney damage; monitoring BUN and creatinine is important, but is not essential before this procedure. H&H is monitored to detect anemia and blood loss; this would not occur before the procedure. This client should be on I&O during the entire hospitalization; it is not necessary only before the procedure, but throughout the admission.

Which sign or symptom, when assessed in a client with chronic glomerulonephritis (GN), warrants a call to the health care provider? Mild proteinuria Third heart sound (S3) Correct Serum potassium of 5.0 mEq/L Itchy skin

S3 indicates fluid overload secondary to failing kidneys; the provider should be notified and instructions obtained. Mild proteinuria is an expected finding in GN. A serum potassium of 5.0 mEq/L reflects a normal value; intervention would be needed for hyperkalemia. Although itchy skin may be present as kidney function declines, it is not a priority over fluid excess.

A 65-year old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer?

Smoking Rationale: Many compounds in tobacco enter the bloodstream and affect other organs, such as the bladder. Concentrated urine is associated with kidney stones and UTIs.

The certified Wound, Ostomy, and Continence Nurse or enterostomal therapist teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities?

Stoma and pouch care The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms.

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise?

Stress Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence.

A nurse assesses a client with bladder cancer who is recovering from a complete cystectomy with ileal conduit. Which assessment finding should alert the nurse to urgently contact the health care provider?

The ileostomy stoma is pale and cyanotic in appearance. A pale or cyanotic stoma indicates impaired circulation to the stoma and must be treated to prevent necrosis.

What is the appropriate range of urine output for the client who has just undergone a nephrectomy? 23 to 30 mL/hr 30 to 50 mL/hr 41 to 60 mL/hr 50 to 70 mL/hr

Urine output of 30 to 50 mL/hr or 0.5 to 1 mL/kg/hr is considered within acceptable range for the client who is post nephrectomy. Output of less than 25 to 30 mL/hr suggests decreased blood flow to the kidney and the onset or worsening of acute kidney injury. A large urine output, followed by hypotension and oliguria, is a sign of hemorrhage and adrenal insufficiency.

A patient is undergoing a dialysis treatment and exhibits a progression of symptoms which include headache, nausea, and vomiting; and fatigue. How does the nurse interpret these symptoms? a. Mild dialysis disequilibrium syndrome b. Expected manifestations in ESKD c. Transient symptoms in a new dialysis patient d. Adverse reaction to the dialysate

What does the BUN test measure? a. Kidney excretion of urea nitrogen b. Urine osmolality c. Creatinine clearance d. Urine utput

Which urine characteristic listed on a urinalysis report arouses the nurses suspicion of a problem in the urinary tract? a. Cloudiness b. Straw color c. Ammonia odor d. One cast per high-powered field

Which problems occur with AKI (SATA) a. Decreased peristalsis b. Anemia c. Metabolic acidosis d. Hypokalemia e. Peripheral edema

abce

A patient with PKD reports sharp flank pain followed by blood in the urine. How does the nurse interpret these signs.symptoms? a. Infection b. Ruptured cyst c. Increased kidney size d. Ruptured renal artery aneurysm

A patient is suspected of having PKD. Which diagnostic study has minimal risks and can reveal PKD? a. Kidney-ureters-bladder (KUB) x-ray b. Urography c. Renal sonography d. Renal angiography

Which patient has the greatest risk for developing chronic pyelonephritis? a. 80-year-old woman who takes diuretics for mild heart failure b. 80-year-old man who drinks four cans of beer per day c. 36-year-old woman with diabetes mellitus who is pregnant d. 36-year-old man with diabetes insdipidus

Which patient is the most likely candidate for CVVH? a. Patient with fluid volume overload b. Patient who needs long-term management c. Patient who is critically ill d. Patient who is ready for discharge to home

Which patients narrative describes the symptoms of dysuria? a. "I have to pee all the time." b. "I have to wait before the pee starts." c. "It burns when I pee." d. "It feels like I am going to pee in my pants."

Which ethnic groups are most likely to develop end-stage kidney disease related to hypertension? (SATA) a. Caucasian American b. Asian American c. American Indians d. African Americans e. Hispanic American

A patient has been diagnosed with AKI, but the cause is uncertain. The nurse prepares patient education material about which diagnostic test? a. Flat plate of the abdomen b. Renal ultrasonography c. Computed tomography d. Kidney biopsy

Which pain management strategy does the nurse teach a patient who has pain from infected kidney cysts of PKD? a. Take nothing by mouth b. Increase the dose of NSAIDs c. Assume a high-Fowlers position d. Apply dry heat to the abdomen or flank

Place the steps of using a bedside bladder scanner in the correct order a. Select the male or female icon the bladder scanner b. Aim the scan head towards the expected location of the bladder c. Place the probe midline bout 1.5 inches above the pubic bone d. explain the purpose and what sensations to expect e. Place the ultrasound probe with gel right above the symphysis pubis f. press and release the scan button

daecbf

Place the sequence of steps of continuous ambulatory peritoneal dialysis (CAPD in the correct order a. Fluid stays in the cavity for a specified time prescribed by the health care provider b. 1 to 2 L of dialysate is infused by gravity over a 10- to 20-minute period c. Fluid flows out fo the body by gravity into a drainage bag d. Warm the dialysate bags before installation by using a heating pad to wrap the bag

dbac

The nurse is providing postdialysis care for a patient. In comparing vital signs and weight measurements to the predialysis data, what does the nurse expect to find? a. Blood pressure and weight are reduced b. Blood pressure is increased and weight is reduced c. Blood pressure and weight are slightly increased d. Blood pressure is low and weight is the same

A patient is diagnosed with a urethral stricture. The nurse prepares the patient for which temporary treatment? a. Dilation of the urethra b. Antibiotic therapy c. Fluid restriction d. Urinary diversion

A - Dilation of the urethra

B Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed. Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.

Which personal factor places the client at risk for bladder cancer? A. Has worked in a lumber yard for 10 years B. A 50 pack-year cigarette smoking history C. Numerous episodes of bacterial cystitis D. History of gonorrhea

B -A 50 pack-year cigarette smoking history -The greatest risk factor for bladder cancer is a long history of tobacco use. The other factors would not necessarily contribute to the development of this specific type of cancer.

When planning an assessment of the urethra, what does the nurse do first? Examine the meatus. Note any unusual discharge. Record the presence of abnormalities. Don gloves.

Before examination begins, body fluid precautions (gloves) must be implemented first. Examining the meatus, noting unusual discharge, or recording the presence of abnormalities are things that the nurse should do after putting on gloves.

Which factor is an indicator for a diagnosis of hydronephrosis? History of nocturia History of urinary stones Recent weight loss Urinary incontinence

Causes of hydronephrosis or hydroureter include tumors, stones, trauma, structural defects, and fibrosis. Nocturia is a key feature of polycystic kidney disease and pyelonephritis, but it is not associated with hydronephrosis. Recent weight loss and urinary incontinence may be factors in renal cell carcinoma, but are not associated with hydronephrosis.

When taking the health history of a client with acute glomerulonephritis (GN), the nurse questions the client about which related cause of the problem? Recent respiratory infection Hypertension Unexplained weight loss Neoplastic disease

Recent respiratory infection An infection often occurs before the kidney manifestations of acute GN. The onset of symptoms is about 10 days from the time of infection. Hypertension is a result of glomerulonephritis, not a cause. Weight gain, not weight loss, is symptomatic of fluid retention in GN. Cancers are not part of the cause of GN.

When planning an assessment of the urethra, what does the nurse do first? Examine the meatus. Note any unusual discharge. Record the presence of abnormalities. Don gloves. Correct

The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast: History and Physical Assessment Medications Diagnostic Findings Polycystic kidney disease Diabetes Hysterectomy Abdomen distended Negative edema Glyburide Metformin Synthroid BUN 26 mg/dL Creatinine 1.0 mg/dL HbA1c 6.9% Glucose 132 mg/dL Which intervention is essential for the nurse to perform? Obtain a thyroid-stimulating hormone (TSH) level. Report the blood urea nitrogen (BUN) and creatinine. Hold the metformin 24 hours before and on the day of the procedure. Correct Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values.

Before studies with contrast media are performed, the nurse must withhold metformin, which may cause lactic acidosis. The focus of this admission is the polycystic kidneys; a TSH level is not essential at this time. BUN and creatinine are normal. The glucose is only mildly elevated (if fasting), and the HbA1c is in an appropriate range.

The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse? Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min. Urine output over the past hour was 80 mL. Pain is at a level 4 (on a 0-to-10 scale). Dressing has a 1-cm area of bleeding.

Bleeding is a complication of radical nephrectomy; tachycardia and hypotension may indicate impending hypovolemic or hemorrhagic shock. The surgeon should be notified immediately and fluids should be administered, complete blood count should be checked, and blood administered, if necessary. A urine output of 80 mL can be considered normal. The nurse can administer pain medication, but must address hemodynamic instability and possible hemorrhage first. Administering pain medication to a client who has developed shock will exacerbate hypotension. A dressing with a 1-cm area of bleeding is expected postoperatively.

The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse? Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min. Correct Urine output over the past hour was 80 mL. Pain is at a level 4 (on a 0-to-10 scale). Dressing has a 1-cm area of bleeding.

Blood urea nitrogen (BUN) and creatinine BUN and creatinine are kidney function tests. With back-pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction; H&H monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.

The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) Restricted protein Correct Liberal sodium Restricted fluids Correct Low potassium Correct Low fat

Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.

An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? "Have you tried using the toilet at least every couple of hours?" Correct "How does that make you feel?" "We can fix that." "That happens when we get older."

By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control. The client has already stated how she feels; asking her again how she feels does not address her concern nor does it allow for nursing education. The nurse cannot assert that the problem can be fixed because this may be untrue. Suggesting that the problem occurs as we get older does not address the client's concern and does not provide for nursing education.

A 53-year-old postmenopausal woman reports "leaking urine" when she laughs, and is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? A "They can relieve your anxiety associated with incontinence." B "They help your bladder to empty." C "They may be used to improve urethral resistance." D "They decrease your bladder's tone."

C "They may be used to improve urethral resistance." Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance. Relieving anxiety has not been shown to improve stress incontinence. No drugs have been shown to promote bladder emptying, and this is not usually the problem with stress incontinence. Emptying the bladder is accomplished by the individual or, if that is not possible, by using a catheter. Decreasing bladder tone would not be a desired outcome for a woman with incontinence.

A young female patient reports experiencing burning with urination. What question does the nurse ask to differentiate between a vaginal infection and a urinary infection? a. "Have you noticed any blood in the urine?" b. "Have you had recent sexual intercourse?" c. "Have you noticed any vaginal discharge?" d. "Have you had fever or chills?"

C - "Have you noticed any vaginal discharge?"

Which statement by a patient indicates effective coping with a Kock's pouch? a. "I don't have any discomfort, but the pouch frequently overflows." b. "My wife has been irrigating the pouch daily. She likes to do it." c. "I check the pouch every 2 to 3 hours depending on my fluid and diet." d. "I never undress in front of anyone anymore, but I guess that is okay."

C - "I check the pouch every 2 to 3 hours depending on my fluid and diet."

The nurse is evaluating outcome criteria for a patient being treated for urge incontinence. Which statement indicates the treatment has been successful? a. "I'm following the prescribed therapy, but I think surgery is my best choice." b. "I still lose a little urine when I sneeze, but I have been wearing a thin pad." c. "I had trouble at first, but now I go to the toilet every 3 hours." d. "I have been using the bladder compression technique and it works."

C - "I had trouble at first, but now I go to the toilet every 3 hours."

Which patient has the highest risk for bladder cancer? a. 60-year-old male patient with malnutrition secondary to chronic alcoholism and self- neglect b. 25-year-old male patient with type 1 diabetes mellitus, who is noncompliant with therapeutic regimen c. 60-year-old female patient who smokes two packs of cigarettes per day and works in a chemical factory d. 25-year-old female patient who has had three episodes of bacterial (Escherichia coli) cystitis in the past year.

C - 60-year-old female patient who smokes two packs of cigarettes per day and works in a chemical factory

The nurse is working in a long-term care facility. Which circumstance is cause for greatest concern, because the facility has a large number of residents who are developing UTIs? a. Residents are not drinking enough fluids with meals. b. Unlicensed personnel are not assisting with toileting in a timely fashion. c. A large percentage of residents have indwelling urinary catheters. d. Many residents have severe dementia and functional incontinence.

C - A large percentage of residents have indwelling urinary catheters.

The home health nurse reads in the patient's chart that the patient has asymptomatic bacterial urinary tract infection (ABUTI). Which intervention will the nurse perform? a. Obtain an order for urinalysis and urine culture and sensitivity. b. Check the patient's medication list for appropriate antibiotic order. c. Closely monitor for conditions that cause progression to acute infection. d. Ask the patient when the ABUTI first started and when it was diagnosed.

C - Closely monitor for conditions that cause progression to acute infection.

Several patients at the clinic have just been diagnosed with UTIs. Which patients may need longer antibiotic treatment (7 to 21 days) or different agents than the typical first-line medi- cations? (Select all that apply.) a. Postmenopausal patient b. Patient with urethritis c. Diabetic patient d. Immunosuppressed patient e. Pregnant patient

C - Diabetic patient D -Immunosuppressed patient E - Pregnant patient

A patient is diagnosed with a fungal UTI. Which drug does the nurse anticipate the patient will be treated with? a. Trimethoprim/sulfamethoxazole (Bactrim) b. Ciprofloxacin (Cipro) c. Fluconazole (Diflucan) d. Amoxicillin (Amoxil)

C - Fluconazole (Diflucan)

An older adult patient with a cognitive impair-ment is living in an extended-care facility. The patient is incontinent, but as the family points out, "he will urinate in the toilet if somebody helps him." Which type of incontinence does the nurse suspect in this patient? a. Urge b. Overflow c. Functional d. Stress

C - Functional

The cystoscopy results for a patient include a small-capacity bladder, the presence of Hunner's ulcers, and small hemorrhages after bladder distention. How does the nurse interpret this report? a. Urosepsis b. Complicated cystitis c. Interstitial cystitis d. Urethritis

C - Interstitial cystitis

The nurse is caring for an obese older adult patient with dementia. The patient is alert and ambulatory, but has functional incontinence. Which nursing intervention is best for this patient? a. Help the patient to lose weight. b. Help the patient apply an estrogen cream. c. Offer assistance with toileting every 2 hours. d. Intermittently catheterize the patient.

C - Offer assistance with toileting every 2 hours.

A patient is diagnosed with urethral stricture. What findings does the nurse expect to see documented in the patient's chart for this condition? a. Pain on urination b. Pain on ejaculation c. Overflow incontinence d. Hematuria and pyuria

C - Overflow incontinence

The nurse is talking to a 68-year-old male patient who has lifestyle choices and occupational exposure that put him at high risk for bladder cancer. The nurse is most concerned about which urinary characteristic? a. Frequency b. Nocturia c. Painless hematuria d. Incontinence

C - Painless hematuria

A patient reports severe flank pain. The report indicates that urine is turbid, malodorous, and rust-colored; RBCs, WBCs, and bacteria are present; and microscopic analysis shows crystals. What does this data suggest? a. Pyuria and cystitis b. Staghorn calculus with infection c. Urolithiasis and infection d. Dysuria and urinary retention

C - Urolithiasis and infection

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? "Your diseased kidneys will be removed at the same time the transplant is performed." "The new kidney will be placed directly below one of your old kidneys." "It is essential for you to wash your hands and avoid people who are ill." "You will receive dialysis the day before surgery and for about a week after."

C Anti-rejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential. Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery; after the surgery, the new kidney should begin to make urine.

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? "I can stop my medications when my kidney function returns to normal." "If my urine output is decreased, I should increase my fluids." "The anti-rejection medications will be taken for life." "I will drink 8 ounces of water with my medications."

C Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately if this occurs. It is not necessary to take anti-rejection medication with 8 ounces of water.

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? RN who has floated from pediatrics for this shift LPN/LVN with experience working on the medical unit RN who usually works on the general surgical unit New graduate RN who just finished a 6-week orientation

C The nurse with experience in taking care of surgical clients will be most capable of monitoring the client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure. The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN should not be assigned to a client requiring IV therapy and who is at high risk for complications.

The client is going home after urography. Which instruction or precaution should the nurse teach this client? A. "Avoid direct contact with the urine for 24 hours until the radioisotope clears." B. "You are likely to experience some dribbling of urine for several weeks after this procedure." C. "Be sure to drink at least 3 L of f luids today to help eliminate the dye faster." D. "Your skin may become slightly yellow-tinged from the dye used in this procedure."

C -"Be sure to drink at least 3 L of fluids today to help eliminate the dye faster." -Dyes used in urography are potentially nephrotoxic.

The client with severe bacterial cystitis is prescribed to take cefadroxil (Duricef) and phenazopyridine (Pyridium). What will the nurse teach this client regarding the drug regimen? A. "Do not take these drugs with food or milk." B. "Stop these drugs if you think you are pregnant." C. "Do not be alarmed by the discoloration of your urine." D. "Drink a liter of cranberry juice every day."

C -"Do not be alarmed by the discoloration of your urine." -Phenazopyridine discolors urine most commonly to a deep reddish orange. Many clients think they have blood in their urine when they see this. In addition, the urine can permanently stain clothing.

The client with bladder cancer is scheduled to have intravesical chemotherapy. Which statement made by the client indicates correct understanding of this therapy?

C -"I will have few, if any, side effects from this type of chemotherapy." -Intravesical chemotherapy involves instilling the chemotherapy agents directly into the bladder. The side effects are local, not systemic.

The client is receiving treatment with nitrofurantoin (Furadantin). Which is the highest priority instruction that the nurse can provide to this client regarding accurate administration of the medication?

C -"You should shake the medication well before measuring it out." -The medication is available in a suspension that must be shaken before being measured out. The medication does not have to be mixed before taking, and it will not discolor the urine. The drug is not available in granules that are dissolved.

3. With a renal threshold for glucose of 220 mg/dL, what is the expected response when a client has a blood glucose level of 400 mg/dL? a. 400 mg/dL of excreted glucose in the urine b. 220 mg/dL of excreted glucose in the urine c. 180 mg/dL of glucose is excreted in the urine d. No excreted glucose in the urine

C -180 mg/dL of glucose is excreted in the urine -Blood glucose is freely filtered at the glomerulus. Therefore, if a client has a blood sugar level of 400 mg/dL, the filtrate in the proximal convoluted tubule will have a glucose concentration of 400 mg/dL. With a renal threshold of 220 mg/ dL, a total of 220 mg/dL of the 400 mg/dL will be reabsorbed back into the systemic circulation, and the final urine will have a glucose concentration of 180 mg/dL.

Two hours after a closed percutaneous kidney biopsy, the client reports a dramatic increase in pain. Which is the nurse's best first action? A. Repositioning the client on the operative side B. Administering prescribed opioid analgesic C. Assessing pulse rate and blood pressure D. Checking the Foley catheter for kinks

C -Assessing pulse rate and blood pressure -An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of internal hemorrhage.

To obtain a sterile urine specimen from a client with a Foley catheter, the nurse begins by applying a clamp to the drainage tubing distal to the injection port. What should the nurse do next? A. Clamp another section of the tube to create a fixed sample section for retrieval. B. Insert a 5-mL syringe into the injection port and aspirate the quantity of urine required. C. Clean the injection port cap of the catheter drainage tubing with povidone-iodine solution. D. Request assistance from the health care provider

C -Clean the injection port cap of the catheter drainage tubing with povidone-iodine solution. -It is important to clean the injection port cap of the catheter drainage tubing with an appropriate antiseptic, such as povidone-iodine solution or alcohol. This will help prevent surface contamination prior to injecting the syringe.

Which is an appropriate dietary choice for the client with uric acid renal calculi? A. Chicken salad sandwich, potato chips B. Chef salad, low sodium crackers C. Mixed green salad, melba toast D. Baked fish, steamed vegetables

C -Mixed green salad, melba toast -The only diet selection that does not contain any type of meat is the mixed green salad and melba toast. To reduce the client's level of uric acid, he or she must avoid any food that contains purine. This is found primarily in organ meats, poultry, and fish. This means that the client must avoid the chicken salad sandwich, chef salad (contains meat), and baked fish.

The client who has undergone a nephrolithotomy procedure 24 hours ago now has a fever of 101° F (38.3° C). Which is the nurse's priority intervention?

C -Notifying the physician -The elevated temperature indicates a possible infection. Treatment must be initiated as soon as possible to prevent septic complications.

The client with bladder cancer has undergone a complete cystectomy with ileal conduit. Four hours after the surgery, the nurse observes the stoma to be cyanotic. Which is the nurse's priority action?

C -Notifying the surgeon -A pale or cyanotic stoma indicates impaired circulation to the stoma and must be treated to prevent necrosis.

How is urge incontinence different from stress incontinence?

C -Stress incontinence occurs because of weak pelvic floor muscles. Urge incontinence occurs because of abnormal bladder contractions. -Clients who suffer from stress incontinence have weak pelvic floor muscles or urethral sphincters and cannot tighten their urethra sufficiently to overcome the increased detrusor pressure. Stress incontinence is common after childbirth, when the pelvic muscles are stretched and weakened from pregnancy and delivery. Urge incontinence occurs in people who cannot suppress the contraction signal from the detrusor muscle. Abnormal detrusor contractions may be a result of neurologic abnormalities or may occur with no known abnormality.

1. Confirmed by palpation and x-ray study, the client's right kidney is lower than the left kidney. What is the nurse's interpretation of this finding? a. The client has a problem involving the right kidney. b. The client has a problem involving the left kidney. c. The client has both kidneys in the normal position. d. The client is at increased risk for kidney impairment.

C -The client has both kidneys in the normal position. -Normally, the right kidney is positioned somewhat lower than the left kidney. This anatomic difference in otherwise symmetric organs is caused by liver displacement. The significance of this difference is that the right kidney is easier to palpate in an adult than is the left kidney.

Which factor represents a sign or symptom of digoxin toxicity? Serum digoxin level of 1.2 ng/mL Polyphagia Visual changes Serum potassium of 5.0 mEq/L

C Visual changes, anorexia, nausea, and vomiting are symptoms of digoxin toxicity. A digoxin level of 1.2 ng/mL is normal (0.5 to 2.0 ng/mL). Polyphagia is a symptom of diabetes. Although hypokalemia may predispose to digoxin toxicity, this represents a normal, not low, potassium value.

While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? Instruct the client to deep-breathe and cough. Document the effluent as output. Turn the client to the opposite side. Re-position the catheter.

C With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The dialyzing fluid is called peritoneal effluent on outflow. The outflow should be a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, re-position the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Instructing the client to deep-breathe and cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse should re-position the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the physician re-positions a displaced catheter.

The client has an elevated blood urea nitrogen (BUN) level and an increased ratio of blood urea nitrogen to creatinine. What is the nurse's interpretation of these laboratory results? a. The client probably has a urinary tract infection. b. The client may be overhydrated. c. The kidney may be hypoperfused. d. The kidney may be damaged.

C -The kidney may be hypoperfused. -When dehydration or renal hypoperfusion exist, the BUN level rises more rapidly than the serum creatinine level, causing the ratio to be increased, even when no renal dysfunction is present.

A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns? "Arise slowly and call for assistance when ambulating." "I must measure your intake and output." "We must save your urine because it is radioactive." "I must attach you to this cardiac monitor."

"Arise slowly and call for assistance when ambulating." Captopril can cause severe hypotension during and after the procedure, so the client should be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension. Intake and output measurement is not necessary after this procedure, unless it had been requested previously. A small amount of radionuclide is used in a renal scan; the urine is not radioactive, although the nurse should practice Standard Precautions, as always, and wear gloves. Cardiac monitoring is not needed, although the nurse should monitor for hypotension secondary to captopril.

"Avoid dark green leafy vegetables such as spinach." Rationale: Calcium oxalate stones form more easily in the presence of oxalate. Sources of oxalate include spinach, black tea, and rhubarb. Avoiding these sources of oxalate may reduce the number of stones formed.

A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? "Because the kidneys cannot get rid of fluid, blood pressure goes up." "The damaged kidneys no longer release a hormone that prevents high blood pressure." "The waste products in the blood interfere with other mechanisms that control blood pressure." "This is a compensatory mechanism that increases blood flow through the kidneys in effort to get rid of some of the waste products."

"Because the kidneys cannot get rid of fluid, blood pressure goes up." In chronic kidney disease, fluid levels increase in the circulatory system. The statements asserting that damaged kidneys no longer release a hormone to prevent high blood pressure, waste products in the blood interfere with other mechanisms controlling blood pressure, and high blood pressure is a compensatory mechanism that increases blood flow through the kidneys in attempt excrete waste products are not accurate regarding the relationship between chronic kidney disease and high blood pressure.

A nurse teaches a client with functional urinary incontinence. Which statement should the nurse include in this client's teaching?

"Buy slacks with elastic waistbands that are easy to pull down." Functional urinary incontinence occurs as the result of problems not related to the client's bladder, such as trouble ambulating or difficulty accessing the toilet. One goal is that the client will be able to manage his or her clothing independently. Elastic waistband slacks that are easy to pull down can help the client get on the toilet in time to void.

A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease? "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." "If my children have the ADPKD gene, they will have cysts by the age of 30." "My children have a 50% chance of inheriting the ADPKD gene that causes the disease."

"By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." There is no way to prevent ADPKD, although early detection and management of hypertension may slow the progression of kidney damage. Limiting salt intake can help control blood pressure. Presentation of ADPKD can vary by age of onset, manifestations, and illness severity, even in one family. Almost 100% of those who inherit a polycystic kidney disease (PKD) gene will develop kidney cysts by age 30. Children of parents who have the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease.

A confused client with pneumonia is admitted with an indwelling catheter in place. During interdisciplinary rounds the following day, which question should the nurse ask the primary health care provider?

"Can we discontinue the indwelling catheter?" An indwelling catheter dramatically increases the risks of urinary tract infection and urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are medically needed. The nurse should inquire about removing the catheter.

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? "Should we filter air circulation?" "Can we use less radiographic contrast dye?" "Should we add low-dose dobutamine?" "Should we decrease IV rates?"

"Can we use less radiographic contrast dye?" Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for postprocedure home care?

"Do not share your toilet with family members for the next 24 hours." The toilet should not be shared for 24 hours following this procedure because others using the toilet could be infected with the live virus that was instilled into the client. If only one toilet is available in the household, teach the client to flush the toilet after use and to follow this by adding 1 cup of undiluted bleach to the bowl water.

Which instruction does the nurse give a client who needs a clean-catch urine specimen? "Save all urine for 24 hours." "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." "Do not touch the inside of the container." "You will receive an isotope injection, then I will collect your urine."

"Do not touch the inside of the container." A clean-catch specimen is used to obtain urine for culture and sensitivity of organisms present; contamination by the client's hands will render the specimen invalid and alter results. Saving urine for 24 hours is not necessary for a midstream clean-catch urine specimen. After cleaning, the client should initiate voiding into the commode, then stop and resume voiding into the container. Only 1 ounce (30 mL) is needed; the remainder of the urine may be discarded into the commode. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. A clean-catch specimen for culture does not require an injection of isotope, simply cleansing of the perineum.

A nurse obtains the health history of a client with a suspected diagnosis of bladder cancer. Which question should the nurse ask when determining this client's risk factors?

"Do you smoke cigarettes?" Smoking is known to be a factor that greatly increases the risk of bladder cancer.

An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? "Have you tried using the toilet at least every couple of hours?" "How does that make you feel?" "We can fix that." "That happens when we get older."

"Have you tried using the toilet at least every couple of hours?"By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control. The client has already stated how she feels; asking her again how she feels does not address her concern nor does it allow for nursing education. The nurse cannot assert that the problem can be fixed because this may be untrue. Suggesting that the problem occurs as we get older does not address the client's concern and does not provide for nursing education.

A nurse cares for a client with urinary incontinence. The client states, "I am so embarrassed. My bladder leaks like a young child's bladder." How should the nurse respond?

"I can teach you strategies to help control your incontinence." The nurse should accept and acknowledge the client's concerns, and assist the client to learn techniques that will allow control of urinary incontinence. The nurse should not diminish the client's concerns with the use of pads or stating statistics about the occurrence of incontinence.

The school nurse is counseling a teenage student about how to prevent kidney trauma. Which statement by the student indicates a need for further teaching? "I can't play any type of contact sports because my brother had kidney cancer." "I avoid riding motorcycles." "I always wear pads when playing football." "I always wear a seat belt in the car."

"I can't play any type of contact sports because my brother had kidney cancer." Contact sports and high-risk activities should be avoided if a person has only one kidney. A family history of kidney cancer does not prohibit this type of activity. To prevent kidney and genitourinary trauma, caution should be taken when riding bicycles and motorcycles. People should wear appropriate protective clothing when participating in contact sports. Anyone riding in a car should wear a seat belt.

Which statement by a client with diabetic nephropathy indicates a need for further education about the disease? "Diabetes is the leading cause of kidney failure." "I need less insulin, so I am getting better." "My blood sugar may drop really low at times." "I must call my provider if the urine dipstick shows protein."

"I need less insulin, so I am getting better." When kidney function is reduced, insulin is available for a longer time and thus less of it is needed. Unfortunately, many clients believe this means that their diabetes is improving. It is true that diabetes mellitus is the leading cause of end-stage kidney disease among Caucasians in the United States. Clients with worsening kidney function may begin to have frequent hypoglycemic episodes. Proteinuria, which may be mild, moderate, or severe, indicates a need for follow-up.

The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective?

"I should drink 2½ liters of fluid every day." Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis.

After teaching a client with a history of renal calculi, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?

"I should drink at least 3 liters of fluid every day." Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the client is well hydrated the calcium will be excreted without issues. Dehydration increases the risk for supersaturation of calcium in the urine, which contributes to stone formation. The nurse should encourage the client to drink more fluids, not decrease calcium intake.

The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction?

"I take my medication only when I have symptoms." Clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent.

The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a correct understanding of these procedures?

"I will have to drain my pouch with a catheter." For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.

After teaching a client who has stress incontinence, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?

"I will limit my total intake of fluids." Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence.

The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective?

"I will no longer be able to have red wine with my dinner." Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client should decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming.

The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? "I must clean with the wipes and then urinate directly into the cup." "I will have to drink 2 liters of fluid before providing the sample." "I'll start to urinate in the toilet, stop, and then urinate into the cup." "It is best to provide the sample while I am bathing."

"I'll start to urinate in the toilet, stop, and then urinate into the cup."To provide a clean-catch urine sample, the client should initiate voiding, then stop, then resume voiding into the container. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. Although cleaning with wipes before providing a clean-catch urine sample is proper procedure, a step is missing. It is not necessary to drink 2 liters of fluid before providing a clean-catch urine sample. Providing a clean-catch urine sample does not involve bathing.

A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in the last 6 months. The client asks, "I never have urinary tract infections. Why is this happening now?" How should the nurse respond?

"Low estrogen levels can make the tissue more susceptible to infection." Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes, predisposing it to the development of infection.

A nurse provides phone triage to a pregnant client. The client states, "I am experiencing a burning pain when I urinate." How should the nurse respond?

"Make an appointment with your provider to have your infection treated." Pregnant clients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the client to make an appointment and have the infection treated.

The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective? "Because renal cell carcinoma usually affects both kidneys, I'll need to be watched closely." "I'll eventually require some type of renal replacement therapy." "I'll need to decrease my fluid intake to prevent stress to my remaining kidney." "My remaining kidney will provide me with normal kidney function now."

"My remaining kidney will provide me with normal kidney function now." After a nephrectomy, the second kidney is expected to eventually provide adequate kidney function, but this may take days or weeks. Renal cell carcinoma typically only affects one kidney. Renal replacement therapy is not the typical treatment for renal cell carcinoma. Fluids should be maintained to flush the remaining kidney.

A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? "Don't worry, no one else will know." "Take your time. What is bothering you the most?" "Why are you hesitant?" "You need to tell me so we can determine what is wrong."

"Take your time. What is bothering you the most?" Asking the client what is bothering him or her expresses patience and understanding when trying to identify the client's problem. Telling the client that others will not know is untrue because the client's symptoms will be in the medical record for other health care personnel to see. Asking why the client is hesitant can seem accusatory and threatening to the client. Admonishing the client to disclose his or her symptoms is too demanding; the nurse must be more understanding of the client's embarrassment.

"The anti-rejection medications will be taken for life." Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately if this occurs. It is not necessary to take anti-rejection medication with 8 ounces of water.

"Weigh yourself and take your blood pressure." Regular weight assessment monitors fluid restriction control, while blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction. Fluid intake and urination, and breakfast time and bedtime, do not need to be at the same time each day. Clients with diabetes, not kidney disease, should regularly check their blood sugar and perform a urine dipstick test.

An emergency department nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question should the nurse ask first?

"What medications are you taking?" Some types of incontinence are treated with anticholinergic medications such as propantheline (Pro-Banthine). Anticholinergic side effects include dry mouth, constipation, and urinary retention. The nurse needs to assess the client's medication list to determine whether the client is taking an anticholinergic medication

The nurse is educating a female client about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do?

"Wipe from front to back." Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection.

A nurse cares for a client who is scheduled for the surgical creation of an ileal conduit. The client states, "I am anxious about having an ileal conduit. What is it like to have this drainage tube?" How should the nurse respond?

"Would you like to speak with someone who has an ileal conduit?" The goal for the client who is scheduled to undergo a procedure such as an ileal conduit is to have a positive self-image and a positive attitude about his or her body. Discussing the procedure candidly with someone who has undergone the same procedure will foster such feelings, especially when the current client has an opportunity to ask questions and voice concerns to someone with first-hand knowledge.

The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include?

"You know that you are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used. Pelvic muscle exercises can be performed anywhere and should be performed more often than 5 minutes twice daily. Noticeable results take several weeks.

The health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug?

"Your urine will turn red or orange while on the drug." Phenazopyridine will turn the client's urine red or orange. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed, and care should be taken because it will stain undergarments.

A nurse teaches a client about self-care after experiencing a urinary calculus treated by lithotripsy. Which statements should the nurse include in this client's discharge teaching? (Select all that apply.)

- "Finish the prescribed antibiotic even if you are feeling better." - "Drink at least 3 liters of fluid each day." - "The bruising on your back may take several weeks to resolve." The client should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The client should drink at least 3 liters of fluid daily to dilute potential stone-forming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the client should expect bruising that may take several weeks to resolve.

A nurse teaches a client with a history of calcium phosphate urinary stones. Which statements should the nurse include in this client's dietary teaching? (Select all that apply.)

- "Limit your intake of food high in animal protein." - "Read food labels to help minimize your sodium intake." - "Reduce your intake of milk and other dairy products." Clients with calcium phosphate urinary stones should be taught to limit the intake of foods high in animal protein, sodium, and calcium.

A nurse teaches clients about the difference between urge incontinence and stress incontinence. Which statements should the nurse include in this education? (Select all that apply.)

- "Stress incontinence occurs due to weak pelvic floor muscles." - "Urge incontinence occurs due to abnormal bladder contractions." Clients who suffer from stress incontinence have weak pelvic floor muscles or urethral sphincter and cannot tighten their urethra sufficiently to overcome the increased detrusor pressure. Stress incontinence is common after childbirth, when the pelvic muscles are stretched and weakened from pregnancy and delivery. Urge incontinence occurs in people who cannot suppress the contraction signal from the detrusor muscle.

Which clients with long-term urinary problems does the nurse refer to community resources and support groups?

- A 32-year-old with a cystectomy - A 44-year-old with a Kock pouch - A 78-year-old with urinary incontinence

A nurse assesses a client with a fungal urinary tract infection (UTI). Which assessments should the nurse complete? (Select all that apply.)

- Assess the medical history and current medical problems. - Obtain a current list of medications. Clients who are severely immunocompromised or who have diabetes mellitus are more prone to fungal UTIs. The nurse should assess for these factors by asking about medical history, current medical problems, and the current medication list.

A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly paired with their clinical manifestation? (Select all that apply.)

- Stress incontinence - Urine loss with physical exertion - Urge incontinence - Large amount of urine with each occurrence -. Overflow incontinence - Constant dribbling of urine Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising. Urge incontinence presents with an abrupt and strong urge to void and usually has a large amount of urine released with each occurrence. Overflow incontinence occurs with bladder distention and results in a constant dribbling of urine.

Which clients with an indwelling urinary catheter does the nurse reassess to determine whether the catheterization needs to be continued or can be discontinued?

- Three-day postoperative client - Client in the stepdown unit - Incontinent older adult in long-term care

The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan?

- Try to take in 64 ounces of fluid each day. - Be sure to complete the full course of antibiotics - If urine remains cloudy, call the clinic

What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy?

- Your urine will be strained after the procedure - Be sure to finish all of your antibiotics - Remember to drink at least 3 liters of fluid a day to promote urine flow

The client passes a urinary stone that laboratory analysis indicates is composed of calcium oxalate. Based on this analysis, which instruction does the nurse specifically include for dietary prevention of the problem? A. "Increase your intake of meat, fish, and cranberry juice." B. "Avoid citrus fruits and citrus juices such as oranges." C. "Avoid dark green leafy vegetables such as spinach." D. "Decrease your intake of dairy products, especially milk."

C. "Avoid dark green leafy vegetables such as spinach." Rationale: Calcium oxalate stones form more easily in the presence of oxalate. Sources of oxalate include spinach, black tea, and rhubarb. Avoiding these sources of oxalate may reduce the number of stones formed. Citrus intake is not restricted in this type of stone and is often suggested to be increased. Dietary intake of calcium does not appear to affect calcium-based stone formation, although the client should avoid calcium mineral supplements. Moderation of meat reduces stone formation in general.

The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? A. "I must avoid drinking carbonated beverages." B. "I need to douche vaginally once a week." C. "I should drink 2½ liters of fluid every day." D. "I will not drink fluids after 8 PM each evening."

C. "I should drink 2½ liters of fluid every day." Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis. Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8:00 p.m. would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late-night fluid intake to 120 mL.

The nurse is educating a female client about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do? A. "Douche—but only once a month." B. "Use only white toilet paper." C. "Wipe from front to back." D. "Wipe with the softest toilet paper available."

C. "Wipe from front to back." Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection. Douching is an unhealthy behavior because it removes beneficial organisms as well as the harmful ones. White toilet paper helps prevent allergies, not infections. Using soft toilet paper does not prevent infection.

For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter? A. 36-year-old woman who is blind receiving diuretics B. 46-year-old man who has paraplegia and is admitted for asthma management C. 56-year-old woman who is admitted with a vaginal-rectal fistula and diabetes D. 66-year-old man who has severe osteoarthritis and high risk for falling

C. 56-year-old woman who is admitted with a vaginal-rectal fistula and diabetes Rationale: This client has a wound that can be irritated by urine and whose urinary tract could become infected by the draining fistula (her diabetes increases her overall risk for infection). All of these other clients could be managed with frequent toileting. The men could also be managed with external urine collection devices.

The advanced-practice nurse is performing a digital rectal examination (DRE) and notes that the rectal sphincter contracts on digital insertion. How does the nurse interpret this finding? a. Nerve supply to the bladder is most likely intact. b. There is adequate strength in the pelvic floor. c. A rectocele is placing pressure on the bladder. d. Abnormal function for the bladder is unlikely.

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? Increased blood urea nitrogen (BUN) Increased creatinine level Pale-colored urine Decreased sodium level

A An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.

The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? Nonsteroidal anti-inflammatory drugs (NSAIDs) Angiotensin-converting enzyme (ACE) inhibitors Opiates Calcium channel blockers

A NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.

To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? Construction worker Office secretary Schoolteacher Taxicab driver

A Physical labor and working outdoors, especially in warm weather, cause diaphoresis and place the construction worker at risk for dehydration and pre-renal azotemia. The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? Eggs Ham Eggplant Macaroni

A Suggested protein-containing foods for a client on peritoneal dialysis are milk, meat, and eggs. Although a protein, ham is high in sodium, which should be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

A The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? Client with chronic kidney failure who was just admitted with shortness of breath Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted Client with azotemia whose blood urea nitrogen and creatinine are increasing Client receiving peritoneal dialysis who needs help changing the dialysate bag

A The dyspnea of the client with chronic kidney failure may indicate pulmonary edema and should be assessed immediately. The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions, but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction? A "I take my medication only when I have symptoms." B "I always wipe front to back." C "I don't use bubble baths and other scented bath products." D "I try to drink 3 liters of fluid a day."

A "I take my medication only when I have symptoms." Clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent. Wiping front to back helps prevent UTIs because it prevents infection-causing microorganisms in the stool from getting near the urethra. Limiting bubble baths and drinking 3 liters of fluid a day help prevent UTIs.

A client who was previously diagnosed with a urinary tract infection (UTI) and started on antibiotics returns to the clinic 3 days later with the same symptoms. When asked about the previous UTI and medication regimen, the client states, "I only took the first dose because after that, I felt better." How does the nurse respond? A "Not completing your medication can lead to return of your infection." B "That means your treatment will be prolonged with this new infection." C "This means you will now have to take two drugs instead of one." D "What you did was okay; however, let's get you started on something else."

A "Not completing your medication can lead to return of your infection." Not completing the drug regimen can lead to recurrence of an infection and bacterial drug resistance. Needing to be re-treated does not mean that the client will have a prolonged treatment regimen. Some treatment modalities are given over a 3-day period. Given this client's history, larger doses for a shorter time span may be a wise plan. The client does not need to take two drugs, and this response is punitive rather than instructive. Saying that the client's actions were okay does not inform the client with respect to nonadherence. The client needed to take all the prescribed medication to make certain that the infection was properly treated.

A young woman tells the nurse that she gets frequent UTIs that seem to follow sexual intercourse. Which questions would the nurse ask? (Select all that apply.) a. "Do you use a diaphragm or spermicides for contraception?" b. "Do you feel guilty or embarrassed about your sexual activities?" c. "Have you considered abstaining from intercourse?" d. "Do you and your partner(s) wash the perineal area before intercourse?" e. "Some positions cause more irritation during sex. Have you noticed this?"

A - "Do you use a diaphragm or spermicides for contraception?" D - "Do you and your partner(s) wash the perineal area before intercourse?" E - "Some positions cause more irritation during sex. Have you noticed this?"

The nurse is teaching a patient about self-care measures to prevent UTIs. Which daily fluid intake does the nurse recommend to the patient to prevent a bladder infection? a. 2 to 3 L of water b. 3 to 6 glasses of iced tea c. 4 to 6 cups of electrolyte fluid d. 3 to 4 glasses of juice

A - 2 to 3 L of water

Teaching intermittent self-catheterization for incontinence is appropriate for which patient? a. 25-year-old male patient with paraplegia b. 35-year-old female patient with stress incontinence c. 70-year-old patient who wears absorbent briefs d. 18-year-old patient with a severe head injury

A - 25-year-old male patient with paraplegia

Which patient is mostly likely to have mixed incontinence? a. 54-year-old woman who had four full-term pregnancies b. 52-year-old man who had a stroke with neurologic deficits c. 76-year-old man with benign prostatic hyperplasia d. 25-year-old woman who has a pelvic fracture

A - 54-year-old woman who had four full-term pregnancies

The nurse is caring for a patient with an indwelling catheter. What intervention does the nurse use to minimize catheter-related infections? a. Assess the patient daily to determine need for catheter. b. Irrigate the catheter daily with sterile solution to remove debris. c. Use sterile technique when opening system to obtain urine samples. d. Apply antiseptic solutions or antibiotic ointments to the perineal area.

A - Assess the patient daily to determine need for catheter.

The nurse is teaching a woman how to prevent UTIs. What information does the nurse include? a. Clean the perineal area from front to back. b. Always use a condom if spermicides are used for contraception. c. Obtain prescription for oral estrogen for vaginal dryness. d. Avoid urinary stasis by urinating every 6 to 8 hours.

A - Clean the perineal area from front to back.

Patients who have central nervous system lesions from stroke, multiple sclerosis, or parasacral spinal cord lesions may have which type of urinary incontinence? a. Detrusor hyperreflexia b. Mixed c. Stress d. Functional

A - Detrusor hyperreflexia

The nurse is counseling a patient with recurrent symptomatic UTIs about dietary therapy. What information does the nurse give to the patient? a. Drink 50 mL of concentrated cranberry juice every day. b. Low consumption of protein may prevent recurrent UTIs. c. Caffeine, carbonated beverages, and tomato products cause UTI. d. Cranberry tablets are more effective than juice or fluids.

A - Drink 50 mL of concentrated cranberry juice every day.

The urine output of a patient with a kidney stone has decreased from 40 mL/hr to 5 mL/hr. What is the nurse's priority action? a. Ensure IV access and notify the health care provider. b. Perform the Credé maneuver on the patient's bladder. c. Test the urine for ketone bodies. d. Document the finding and continue monitoring.

A - Ensure IV access and notify the health care provider.

The nurse is teaching self-care measures to a patient who had lithotripsy for kidney stones. What information does the nurse include? (Select all that apply.) a. Finish the entire prescription of antibiotics to prevent UTIs. b. Balance regular exercise with sleep and rest. c. Drink at least 3 L of fluid a day. d. Watch for and immediately report bruising after lithotripsy. e. Urine may be bloody for several days. f. Pain in the region of the kidneys or bladder is expected.

A - Finish the entire prescription of antibiotics to prevent UTIs. B - Balance regular exercise with sleep and rest. C - Drink at least 3 L of fluid a day. E - Urine may be bloody for several days.

A patient's recurrent cystitis appears to be related to sexual intercourse. The patient seems uncomfortable talking about the situation. What communication technique does the nurse use to assist the patient? a. Have a frank and sensitive discussion with the patient. b. Give the patient reading material with instructions to call with any questions. c. Call the patient's partner and invite the partner to discuss the problem. d. Talk about other topics until the patient feels more comfortable disclosing.

A - Have a frank and sensitive discussion with the patient.

A patient reports intense urgency, frequency, and bladder pain. Urinalysis results show white blood cells (WBCs) and red blood cells (RBCs) and urine culture results are negative for infection. How does the nurse interpret these findings? a. Interstitial cystitis b. Urethritis c. Bacteriuria d. Infectious cystitis

A - Interstitial cystitis

What does the nurse include in the care plan for a patient who had pyelolithotomy? (Select all that apply.) a. Monitor the amount of bleeding from incisions. b. Restrict fluids to prevent edema and fluid overload. c. Strain the urine to monitor the passage of stone fragments. d. Encourage fluids to avoid dehydration and supersaturation. e. Monitor changes in urine output. f. Administer antibiotics to eliminate or prevent infections.

A - Monitor the amount of bleeding from incisions. C - Strain the urine to monitor the passage of stone fragments. D - Encourage fluids to avoid dehydration and supersaturation. E - Monitor changes in urine output. F - Administer antibiotics to eliminate or prevent infections.

The home health nurse is assessing an older adult patient who refuses to leave the house to see friends or participate in usual activities. She reports taking a bath several times a day and becomes very upset when she has an incontinent episode. What is the priority problem for this patient? a. Negative self-image b. Stress urinary incontinence c. Social isolation d. Potential for skin breakdown

A - Negative self-image

Which task related to care of patients who have indwelling catheters can be delegated to unlicensed assistive personnel (UAP)? a. Perform daily catheter care by washing the perineum and proximal portion of the catheter with soap and water. b. Use sterile technique when inserting the urinary catheter or when opening the system to obtain urine samples. c. Determine whether use of condom catheters is appropriate for male patients and apply the devices accordingly. d. Keep urine collection bag in a place that is readily visible to the patient, so that the patient is reassured of kidney function.

A - Perform daily catheter care by washing the perineum and proximal portion of the catheter with soap and water.

The health care provider has recommended intermittent self-catheterization for a patient with long-term problems of incomplete bladder emptying. Which information does the nurse give the patient about the procedure? a. Perform proper handwashing and cleaning of the catheter to reduce the risk for infection. b. Use a large-lumen catheter and good lubrication for rapid emptying of the bladder. c. Catheterize yourself whenever the bladder gets distended. d. Use sterile technique, especially if catheterization is done by a family member.

A - Perform proper handwashing and cleaning of the catheter to reduce the risk for infection.

The client scheduled for intravenous urography informs the nurse of the following allergies. Which one should the nurse report to the physician immediately? A. Seafood B. Penicillin C. Bee stings D. Red food dye

A - Seafood - Clients with seafood allergies often have severe allergic reactions to the standard dyes used during intravenous urography.

The nurse is reviewing a care plan for a patient who has functional incontinence. There is a note that containment is recommended, especially at night. What is the major concern with this approach? a. Skin integrity b. Cost of care and materials c. Self-esteem of the patient d. Fall risk

A - Skin integrity

A patient returns to the medical-surgical unit after having shock wave lithotripsy (SWL). What is an appropriate nursing intervention for the postprocedural care of this patient? a. Strain the urine to monitor the passage of stone fragments. b. Report bruising that occurs on the flank of the affected side. c. Continuously monitor electrocardiogram (ECG) for dysrhythmias. d. Apply a local anesthetic cream to the skin of the affected side.

A - Strain the urine to monitor the passage of stone fragments.

A middle-aged woman has urinary stress incontinence related to weak pelvic muscles. The patient is highly motivated to participate in self-care. Which interventions does the nurse include in the treatment plan? (Select all that apply.) a. Suggest keeping a detailed diary of urine leakage, activities, and foods eaten. b. Suggest wearing absorbent undergarments during the assessment process. c. Teach pelvic floor (Kegel) exercise therapy. d. Teach about vaginal cone therapy. e. Encourage drinking orange juice every day for 4 to 6 weeks. f. Refer to a nutritionist for diet therapy for weight reduction.

A - Suggest keeping a detailed diary of urine leakage, activities, and foods eaten. B - Suggest wearing absorbent undergarments during the assessment process. C - Teach pelvic floor (Kegel) exercise therapy. D - Teach about vaginal cone therapy. F - Refer to a nutritionist for diet therapy for weight reduction.

The nurse is designing a habit training bladder program for an older adult patient who is alert but mildly confused. What task associated with the training program is delegated to the UAP? a. Tell the patient it is time to go to the toilet and assist him to go on a regular schedule. b. Help the patient record the incidents of incontinence in a bladder diary. c. Change the patient's incontinence pants (or pad) every 4 hours. d. Gradually encourage independence and increase the intervals between voidings.

A - Tell the patient it is time to go to the toilet and assist him to go on a regular schedule.

A patient reports symptoms indicating a UTI. Results from which diagnostic test will verify a UTI? a. Urinalysis to test for leukocyte esterase and nitrate b. Urinalysis for glucose and red blood cells c. Urinalysis to test for ketones and protein d. Urinalysis for pH and specific gravity

A - Urinalysis to test for leukocyte esterase and nitrate

The client scheduled to have intravenous urography is a diabetic and taking the antidiabetic agent metformin. What should the nurse tell this client? A. "Call your diabetes doctor and tell him or her that you are having an intravenous urogram performed using dye." B. "Do not take your metformin the morning of the test because you are not going to be eating anything and could become hypoglycemic." C. "You must start on an antibiotic before this test because your risk of infection is greater as a result of your diabetes." D. "You must take your metformin immediately before the test is performed because the IV f fluid and the dye contain a significant amount of sugar."

A -"Call your diabetes doctor and tell him or her that you are having an intravenous urogram performed using dye." -Metformin can cause lactic acidosis and renal impairment because of an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established.

The client is being admitted with a suspected diagnosis of bladder cancer. Which question will assist in determining risk factors? A. "Do you smoke cigarettes?" B. "Do you use alcohol?" C. "Do you use recreational drugs?" D. "Do you take any prescription drugs?"

A -"Do you smoke cigarettes?" -Smoking is known to be a factor that greatly increase the risk of bladder cancer. Neither alcohol use, prescription drug use (except medications that contain phenacetin), nor recreational drug use are known to increase the risk of developing bladder cancer.

Which prevention strategy will the nurse teach the client with a risk for renal calculi? A. "Drink at least 3 to 4 L of fluid every day." B. "Avoid dairy products and other sources of calcium." C. "Avoid aspirin and aspirin-containing products." D. "Start taking antibiotics at the first sign of a stone."

A -"Drink at least 3 to 4 L of fluid every day." -Dehydration contributes to the precipitation of minerals to form a stone. Ingestion of calcium or aspirin does not cause a stone. Antibiotics neither prevent nor treat a stone.

Which statement made by the client with stress incontinence indicates a need for clarification of nutrition therapy? A. "I will limit my total intake of fluids." B. "I will avoid drinking alcoholic beverages." C. "I will avoid drinking coffee and other caffeinated beverages." D. "I will try to reduce my total body weight by at least 10%."

A -"I will limit my total intake of fluids." -Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence.

The client is beginning to undergo urinary habit training. Which is an effective instruction to give this client's caregiver? A. "Keep a continence record for at least 3 days." B. "Do not resort to running water in an attempt to prompt client." C. "Establish a toileting interval of not less than 4 hours." D. "Avoid leaving the client on the toilet for more than 15 minutes."

A -"Keep a continence record for at least 3 days." -The caregiver should keep a continence record to determine patterns in the client's voiding and incontinence episodes. The caregiver should use the power of suggestion, establish a toileting interval of not less than 2 hours, and avoid leaving the client on the toilet for more than 5 minutes.

The client is a young woman who is being treated with amoxicillin (Amoxil) for a urinary tract infection. Which is the highest priority instruction for the nurse to give the client? A. "Use a second form of birth control while on the drug." B. "You will experience increased menstrual bleeding while on this drug." C. "You may experience an irregular heartbeat while on the drug." D. "Watch for blood in your urine while taking this drug."

A -"Use a second form of birth control while on the drug." -The client should use a second form of birth control because penicillin seems to reduce the effectiveness of estrogen-containing contraceptives. She should not experience increased menstrual bleeding, an irregular heartbeat, or blood in her urine while taking the medication.

Which drug will the nurse administer to the client diagnosed with renal calculi from hyperuricemia? A. Allopurinol (Zyloprim) B. Captopril (Capoten) C. Chlorothiazide (Diuril) D. Phenazopyridine (Pyridium)

A -Allopurinol (Zyloprim) -Allopurinol inhibits the enzyme that converts purine metabolites into uric acid, thereby reducing the amount of uric acid present for precipitation into stones. The other drugs listed would not be effective.

Which client will not be able to adhere to bladder training for incontinence? A. An older man who is confused B. An older woman with diabetes C. A middle-aged man with early-stage renal failure D. A middle-aged woman with early menopause

A -An older man who is confused -For a bladder training program to succeed in urge incontinence, the client must be alert, aware, and able to resist the urge to urinate.

2. What would be the response if a person's nephrons were not able to filter normally due to scarring of the proximal convoluted tubule leading to inhibition of reabsorption? a. Increased urine output, fluid volume deficit b. Decreased urine output, fluid volume deficit c. Increased urine output, fluid volume overload d. Decreased urine output, fluid volume overload

A -Increased urine output, fluid volume deficit -The nephrons filter about 120 mL/min. Most of this filtrate is reabsorbed in the proximal convoluted tubule. If the tubule were not able to reabsorb the fluid that has been filtered, urine output would greatly increase, leading to rapid and severe dehydration.

The nurse is assessing the laboratory findings of a client with a urinary tract infection. Which finding requires immediate intervention? A. Left shift in the white blood cell (WBC) differential B. Serum white blood cell count of 8000/mm3 C. Presence of red blood cells in the urine D. Presence of white blood cells in the urine

A -Left shift in the white blood cell (WBC) differential -A left shift most commonly occurs with urosepsis, a condition that has a 15% mortality rate. Left shifts rarely occur with uncomplicated cystitis. This is the most life-threatening change in values of the laboratory findings listed.

Which client is at greatest risk for development of a bacterial cystitis? A. Older female client not taking estrogen replacement B. Older male client with mild congestive heart failure C. Middle-aged female client who has never been pregnant D. Middle-aged male client who is taking cyclophosphamide for cancer therapy

A -Older female client not taking estrogen replacement -Females at any age are more susceptible to cystitis than men because of the shorter urethra in women. Postmenopausal women who are not on hormone replacement therapy are at an increased risk for bacterial cystitis because of changes in the cells of the urethra and vagina. The middle-aged female client who has never been pregnant would not have a risk potential as high as the older female client who is using hormone replacement therapy.

Which type of incontinence is most common after a difficult vaginal delivery? A. Stress incontinence B. Urge incontinence C. Reflex incontinence D. Overflow incontinence

A -Stress incontinence -Childbirth is most likely to result in stress incontinence. There is no evidence that childbirth is likely to result in the development of urge, reflex, or overflow incontinence.

The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first?

A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention.

Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN?

A 55-year-old with incontinence who has intermittent catheterization prescribed Insertion of catheters is within the education and legal scope of practice for LPN/LVNs.

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis?

A 58-year-old female who is not taking estrogen replacement Females at any age are more susceptible to cystitis than men because of the shorter urethra in women. Postmenopausal women who are not on hormone replacement therapy are at increased risk for bacterial cystitis because of changes in the cells of the urethra and vagina. The middle-aged woman who has never been pregnant would not have a risk potential as high as the older woman who is not using hormone replacement therapy.

A nurse plans care for clients with urinary incontinence. Which client is correctly paired with the appropriate intervention?

A 58-year-old postmenopausal client who is not taking estrogen therapy - Electrical stimulation Exercise therapy and electrical stimulation are used for clients with stress incontinence related to childbirth or low levels of estrogen after menopause. Exercise therapy increases pelvic wall strength; it does not improve ambulation.

A nurse cares for adult clients who experience urge incontinence. For which client should the nurse plan a habit training program?

A 78-year-old female who is confused For a bladder training program to succeed in a client with urge incontinence, the client must be alert, aware, and able to resist the urge to urinate. Habit training will work best for a confused client. This includes going to the bathroom (or being assisted to the bathroom) at set times.

Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) Football player in preseason practice Client who underwent contrast dye radiology Accident victim recovering from a severe hemorrhage Accountant with diabetes Client in the intensive care unit on high doses of antibiotics Client recovering from gastrointestinal influenza

A B C E F To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure.

The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) Restricted protein Liberal sodium Restricted fluids Low potassium Low fat

A C D Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) Check brachial pulses daily. Auscultate for a bruit every 8 hours. Correct Teach the client to palpate for a thrill over the site. Correct Elevate the arm above heart level. Ensure that no blood pressures are taken in that arm. Correct

A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

Which instruction does the nurse give a client who needs a clean-catch urine specimen? "Save all urine for 24 hours." "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." "Do not touch the inside of the container." Correct "You will receive an isotope injection, then I will collect your urine."

A clean-catch specimen is used to obtain urine for culture and sensitivity of organisms present; contamination by the client's hands will render the specimen invalid and alter results. Saving urine for 24 hours is not necessary for a midstream clean-catch urine specimen. After cleaning, the client should initiate voiding into the commode, then stop and resume voiding into the container. Only 1 ounce (30 mL) is needed; the remainder of the urine may be discarded into the commode. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. A clean-catch specimen for culture does not require an injection of isotope, simply cleansing of the perineum.

The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day? Client with chronic kidney disease Client with heart failure Client with complete bowel obstruction Client with hyperparathyroidism Correct

A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones; this client should remain hydrated. A client with chronic kidney disease should not consume 2 to 3 liters of water because the kidneys are not functioning properly, and this could lead to fluid retention. People with heart failure typically have fluid volume excess. A client with complete bowel obstruction may experience vomiting and should be NPO.

A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? (Select all that apply.) A. "Be certain to wear sunscreen and protective clothing." B. "Drink at least 3 liters of fluids every day." C. "Take this drug with 8 ounces of water." D. "Try to urinate frequently to keep your bladder empty." E. "You will need to take all of this drug to get the benefits."

A. "Be certain to wear sunscreen and protective clothing." B. "Drink at least 3 liters of fluids every day." C. "Take this drug with 8 ounces of water." E. "You will need to take all of this drug to get the benefits." Wearing sunscreen and protective clothing is important while taking trimethoprim/sulfamethoxazole. Increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules; fluid intake prevents this complication. Clients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. Emptying the bladder is important, but not keeping it empty. The client should be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.

The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught? A. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." B. "It is a good idea for me to reduce germs by taking a tub bath daily." C. "Trying to get to the bathroom to urinate every 6 hours is important for me." D. "Urinating 1000 mL on a daily basis is a good amount for me."

A. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day. Showers, rather than tub baths, are recommended for women who have recurrent UTIs. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. Urinary output should be at least 1.5 liters daily. Ensuring this amount "out" is a good indicator that the client is drinking an adequate amount of fluid.

What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? (Select all that apply.) A. "Your urine will be strained after the procedure." B. "Be sure to finish all of your antibiotics." C. "Immediately call the health care provider if you notice bruising." D. "Remember to drink at least 3 liters of fluid a day to promote urine flow." E. "You will need to change the incisional dressing once a day."

A. "Your urine will be strained after the procedure." B. "Be sure to finish all of your antibiotics." D. "Remember to drink at least 3 liters of fluid a day to promote urine flow." After lithotripsy, urine is strained to monitor the passage of stone fragments. Clients must finish the entire antibiotic prescription to decrease the risk of developing a urinary tract infection. Drinking at least 3 L of fluid a day dilutes potential stone-forming crystals, prevents dehydration, and promotes urine flow. Bruising on the flank of the affected side is expected after lithotripsy as a result of the shock waves that break the stone into small fragments. The client must notify the health care provider if he or she develops pain, fever, chills, or difficulty with urination because these signs and symptoms may signal the beginning of an infection or the formation of another stone. There is no incision with extracorporeal shock wave lithotripsy. There may be a small incision when intracorporeal lithotripsy is performed.

Which clients with long-term urinary problems does the nurse refer to community resources and support groups? (Select all that apply.) A. A 32-year-old with a cystectomy B. A 44-year-old with a Kock pouch C. A 48-year-old with urinary calculi D. A 78-year-old with urinary incontinence E. An 80-year-old with dementia

A. A 32-year-old with a cystectomy B. A 44-year-old with a Kock pouch D. A 78-year-old with urinary incontinence Clients with a cystectomy, Kock pouch, or urinary incontinence would benefit from community resources and support groups. Others who have had their bladders removed are good sources of information and for help in establishing coping mechanisms. They can provide ideas for living with the problem or methods of curing (or minimizing) it. Urinary calculi typically are not a long-term problem that requires community resources and support groups. The older adult client with dementia would not benefit from community resources and support groups because of the client's cognitive difficulties.

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? A. Administer morphine sulfate 4 mg IV. B. Begin an infusion of metoclopramide (Reglan) 10 mg IV. C. Obtain a urine specimen for urinalysis. D. Start an infusion of 0.9% normal saline at 100 mL/hr.

A. Administer morphine sulfate 4 mg IV. Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension. An infusion of metoclopramide (Reglan) 10 mg IV should be begun after the client's pain is controlled. A urine specimen for urinalysis should be obtained and an infusion of 0.9% normal saline at 100 mL/hr should be started after the client's pain is controlled.

An older adult client diagnosed with stress incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect? (Select all that apply.) A. Dry mouth B. Increased blood pressure C. Increased intraocular pressure D. Constipation E. Reddish-orange urine color

A. Dry mouth C. Increased intraocular pressure D. Constipation Oxybutynin is an anticholinergic/antispasmodic. Side effects include dry mouth, urinary retention, constipation, and risk for increased intraocular pressure with the potential to make glaucoma worse. Alpha-adrenergic agonists and beta blockers, which may be prescribed for urinary incontinence, may cause an increase in blood pressure. Phenazopyridine, a bladder analgesic used to decrease urinary pain, causes the urine to be a reddish-orange color.

The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? (Select all that apply.) A. Dysuria B. Enuresis C. Frequency D. Nocturia E. Urgency F. Polyuria

A. Dysuria C. Frequency D. Nocturia E. Urgency Dysuria (painful urination), frequency, nocturia (frequent urinating at night), and urgency (having the urge to urinate quickly) are symptoms of UTI. Enuresis (bed-wetting) and polyuria (increased amounts of urine production) are not signs of a UTI.

Which clients with an indwelling urinary catheter does the nurse reassess to determine whether the catheterization needs to be continued or can be discontinued? (Select all that apply.) A. Three-day postoperative client B. Client in the stepdown unit C. Comatose client with careful monitoring of intake and output (I&O) D. Incontinent client with perineal skin breakdown E. Incontinent older adult in long-term care

A. Three-day postoperative client B. Client in the stepdown unit E. Incontinent older adult in long-term care Three days after surgery, the postoperative client probably should be able to urinate on his or her own. This may be influenced by the type of surgery, but most clients do not need long-term catheterization after they have surgery. The incidence of complications (colonization of bacteria) begins to increase after 48 hours postinsertion. The client in the stepdown unit is definitely one who should be considered for catheter discontinuation; he or she should be somewhat ambulatory and able to get to a bedside commode. Incontinence in older adults does not necessarily mean that they have to be catheterized. The introduction of a catheter invites the possibility of infection. These clients can often be managed with adult incontinence pads with less risk for developing a urinary tract infection. These infections in the older adult population are serious and should be avoided. The comatose client who is on strict I&O must have a urinary catheter in place to keep an accurate account of fluid balance. A client who is incontinent with no breakdown areas would be considered, but perineal skin problems in this situation make a catheter necessary for this client's skin to have a clean, dry environment for healing.

When caring for a client with nephrotic syndrome, which intervention should be included in the plan of care? Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss Correct Administering heparin to prevent deep vein thrombosis (DVT) Providing antibiotics to decrease infection Providing transfusion of clotting factors

ACE inhibitors can decrease protein loss in the urine. Heparin is administered for DVT, but in nephrotic syndrome it may reduce urine protein and kidney insufficiency. Glomerulonephritis may occur secondary to an infection, but it is an inflammatory process; antibiotics are not indicated for nephrotic syndrome. Clotting factors are not indicated unless bleeding and coagulopathy are present.

1. An emergency department nurse cares for a client who is severely dehydrated and is prescribed 3 L of intravenous fluid over 6 hours. At what rate (mL/hr) should the nurse set the intravenous pump to infuse the fluids? (Record your answer using a whole number.) ____ mL/hr

ANS: 500 mL/hr Because IV pumps deliver in units of milliliters per hour, the pump would have to be set at 500 mL/hr to deliver 3 L (3000 mL) over 6 hours. 6x = 3000 x = 500

13. A nurse cares for a client admitted from a nursing home after several recent falls. What prescription should the nurse complete first? a. Obtain urine sample for culture and sensitivity. b. Administer intravenous antibiotics. c. Encourage protein intake and additional fluids. d. Consult physical therapy for gait training.

ANS: A Although all interventions are or might be important, obtaining a urine sample for urinalysis takes priority. Often urinary tract infection (UTI) symptoms in older adults are atypical, and a UTI may present with new onset of confusion or falling. The urine sample should be obtained before starting antibiotics. Dietary requirements and gait training should be implemented after obtaining the urine sample.

A nurse cares for a client with an increased blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first? a. Assess the client's dietary habits. b. Inquire about the use of nonsteroidal anti-inflammatory drugs (NSAIDs). c. Hold the client's metformin (Glucophage). d. Contact the health care provider immediately.

ANS: A An elevated BUN/creatinine ratio is often indicative of dehydration, urinary obstruction, catabolism, or a high-protein diet. The nurse should inquire about the client's dietary habits. Kidney damage related to NSAID use most likely would manifest with elevations in both BUN and creatinine, but no change in the ratio. The nurse should obtain more assessment data before holding any medications or contacting the provider.

10. After teaching a client with a history of renal calculi, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I should drink at least 3 liters of fluid every day." b. "I will eliminate all dairy or sources of calcium from my diet." c. "Aspirin and aspirin-containing products can lead to stones." d. "The doctor can give me antibiotics at the first sign of a stone."

ANS: A Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the client is well hydrated the calcium will be excreted without issues. Dehydration increases the risk for supersaturation of calcium in the urine, which contributes to stone formation. The nurse should encourage the client to drink more fluids, not decrease calcium intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics neither prevent nor treat a stone.

5. A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should the nurse recognize as a positive response to the prescribed treatment? a. The client has lost 11 pounds in the past 10 days. b. The clients urine specific gravity is 1.048. c. No blood is observed in the clients urine. d. The clients blood pressure is 152/88 mm Hg.

ANS: A Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of 152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.

. A nurse cares for a client with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for an intravenous urography. Which action should the nurse take first? a. Contact the provider and recommend discontinuing the metformin. b. Keep the client NPO for at least 6 hours prior to the examination. c. Check the client's capillary artery blood glucose and administer prescribed insulin. d. Administer intravenous fluids to dilute and increase the excretion of dye.

ANS: A Metformin can cause lactic acidosis and renal impairment as the result of an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established. The client's health care provider needs to provide alternative therapy for the client until the metformin can be resumed. Keeping the client NPO, checking the client's blood glucose, and administering intravenous fluids should be part of the client's plan of care, but are not the priority, as the examination should not occur while the client is still taking metformin.

5. A nurse contacts the health care provider after reviewing a client's laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. For which action should the nurse recommend a prescription? a. Intravenous fluids b. Hemodialysis c. Fluid restriction d. Urine culture and sensitivity

ANS: A Normal BUN is 10 to 20 mg/dL. Normal creatinine is 0.6 to 1.2 mg/dL (males) or 0.5 to 1.1 mg/dL (females). Creatinine is more specific for kidney function than BUN, because BUN can be affected by several factors (dehydration, high-protein diet, and catabolism). This client's creatinine is normal, which suggests a non-renal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse should anticipate giving the client more fluids, not placing the client on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity is not appropriate.

8. A nurse reviews laboratory results for a client who was admitted for a myocardial infarction and cardiogenic shock 2 days ago. Which laboratory test result should the nurse expect to find? a. Blood urea nitrogen (BUN) of 52 mg/dL b. Creatinine of 2.3 mg/dL c. BUN of 10 mg/dL d. BUN/creatinine ratio of 8:1

ANS: A Shock leads to decreased renal perfusion. An elevated BUN accompanies this condition. The creatinine should be normal because no kidney damage occurred. A low BUN signifies overhydration, malnutrition, or liver damage. A low BUN/creatinine ratio indicates fluid volume excess or acute renal tubular acidosis.

16. A nurse obtains the health history of a client with a suspected diagnosis of bladder cancer. Which question should the nurse ask when determining this client's risk factors? a. "Do you smoke cigarettes?" b. "Do you use any alcohol?" c. "Do you use recreational drugs?" d. "Do you take any prescription drugs?"

ANS: A Smoking is known to be a factor that greatly increases the risk of bladder cancer. Alcohol use, recreational drug use, and prescription drug use (except medications that contain phenacetin) are not known to increase the risk of developing bladder cancer.

After delegating to an unlicensed assistive personnel (UAP) the task of completing a bladder scan examination for a client, the nurse evaluates the UAP's performance. Which action by the UAP indicates the nurse must provide additional instructions when delegating this task? a. Selecting the female icon for all female clients and male icon for all male clients b. Telling the client, "This test measures the amount of urine in your bladder." c. Applying ultrasound gel to the scanning head and removing it when finished d. Taking at least two readings using the aiming icon to place the scanning head

ANS: A The UAP should use the female icon for women who have not had a hysterectomy. This allows the scanner to subtract the volume of the uterus from readings. If a woman has had a hysterectomy, the UAP should choose the male icon. The UAP should explain the procedure to the client, apply gel to the scanning head and clean it after use, and take at least two readings.

18. A nurse teaches a young female client who is prescribed amoxicillin (Amoxil) for a urinary tract infection. Which statement should the nurse include in this client's teaching? a. "Use a second form of birth control while on this medication." b. "You will experience increased menstrual bleeding while on this drug." c. "You may experience an irregular heartbeat while on this drug." d. "Watch for blood in your urine while taking this medication."

ANS: A The client should use a second form of birth control because penicillin seems to reduce the effectiveness of estrogen-containing contraceptives. She should not experience increased menstrual bleeding, an irregular heartbeat, or blood in her urine while taking the medication.

23. A nurse assesses a client who presents with renal calculi. Which question should the nurse ask? a. "Do any of your family members have this problem?" b. "Do you drink any cranberry juice?" c. "Do you urinate after sexual intercourse?" d. "Do you experience burning with urination?"

ANS: A There is a strong association between family history and stone formation and recurrence. Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask whether other family members have also had renal stones. The other questions do not refer to renal calculi but instead are questions that should be asked of a client with a urinary tract infection.

7. A nurse teaches a client about self-care after experiencing a urinary calculus treated by lithotripsy. Which statements should the nurse include in this client's discharge teaching? (Select all that apply.) a. "Finish the prescribed antibiotic even if you are feeling better." b. "Drink at least 3 liters of fluid each day." c. "The bruising on your back may take several weeks to resolve." d. "Report any blood present in your urine." e. "It is normal to experience pain and difficulty urinating."

ANS: A, B, C The client should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The client should drink at least 3 liters of fluid daily to dilute potential stone-forming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the client should expect bruising that may take several weeks to resolve. The client should also experience blood in the urine for several days. The client should report any pain, fever, chills, or difficulty with urination to the provider as these may signal the beginning of an infection or the formation of another stone.

5. A nurse teaches a client with polycystic kidney disease (PKD). Which statements should the nurse include in this clients discharge teaching? (Select all that apply.) a. Take your blood pressure every morning. b. Weigh yourself at the same time each day. c. Adjust your diet to prevent diarrhea. d. Contact your provider if you have visual disturbances. e. Assess your urine for renal stones.

ANS: A, B, D A client who has PKD should measure and record his or her blood pressure and weight daily, limit salt intake, and adjust dietary selections to prevent constipation. The client should notify the provider if urine smells foul or has blood in it, as these are signs of a urinary tract infection or glomerular injury. The client should also notify the provider if visual disturbances are experienced, as this is a sign of a possible berry aneurysm, which is a complication of PKD. Diarrhea and renal stones are not manifestations or complications of PKD; therefore, teaching related to these concepts would be inappropriate.

1. A nurse assesses a client who has had two episodes of bacterial cystitis in the last 6 months. Which questions should the nurse ask? (Select all that apply.) a. "How much water do you drink every day?" b. "Do you take estrogen replacement therapy?" c. "Does anyone in your family have a history of cystitis?" d. "Are you on steroids or other immune-suppressing drugs?" e. "Do you drink grapefruit juice or orange juice daily?"

ANS: A, B, D Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent cystitis. Family history is usually insignificant, and cranberry juice, not grapefruit or orange juice, has been found to increase the acidic pH and reduce the risk for bacterial cystitis.

2. A nurse assesses a client with nephrotic syndrome. For which clinical manifestations should the nurse assess? (Select all that apply.) a. Proteinuria b. Hypoalbuminemia c. Dehydration d. Lipiduria e. Dysuria f. Costovertebral angle (CVA) tenderness

ANS: A, B, D Nephrotic syndrome is caused by glomerular damage and is characterized by proteinuria (protein level higher than 3.5 g/24 hr), hypoalbuminemia, edema, and lipiduria. Fluid overload leading to edema and hypertension is common with nephrotic syndrome; dehydration does not occur. Dysuria is present with cystitis. CVA tenderness is present with inflammatory changes in the kidney

5. A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly paired with their clinical manifestation? (Select all that apply.) a. Stress incontinence - Urine loss with physical exertion b. Urge incontinence - Large amount of urine with each occurrence c. Functional incontinence - Urine loss results from abnormal detrusor contractions d. Overflow incontinence - Constant dribbling of urine e. Reflex incontinence - Leakage of urine without lower urinary tract disorder

ANS: A, B, D Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising. Urge incontinence presents with an abrupt and strong urge to void and usually has a large amount of urine released with each occurrence. Overflow incontinence occurs with bladder distention and results in a constant dribbling of urine. Functional incontinence is the leakage of urine caused by factors other than a disorder of the lower urinary tract. Reflex incontinence results from abnormal detrusor contractions from a neurologic abnormality.

1. A nurse reviews a client's laboratory results. Which results from the client's urinalysis should the nurse identify as normal? (Select all that apply.) a. pH: 6 b. Specific gravity: 1.015 c. Protein: 1.2 mg/dL d. Glucose: negative e. Nitrate: small f. Leukocyte esterase: positive

ANS: A, B, D The pH, specific gravity, and glucose are all within normal ranges. The other values are abnormal.

6. A nurse teaches a client with a history of calcium phosphate urinary stones. Which statements should the nurse include in this client's dietary teaching? (Select all that apply.) a. "Limit your intake of food high in animal protein." b. "Read food labels to help minimize your sodium intake." c. "Avoid spinach, black tea, and rhubarb." d. "Drink white wine or beer instead of red wine." e. "Reduce your intake of milk and other dairy products."

ANS: A, B, E Clients with calcium phosphate urinary stones should be taught to limit the intake of foods high in animal protein, sodium, and calcium. Clients with calcium oxalate stones should avoid spinach, black tea, and rhubarb. Clients with uric acid stones should avoid red wine.

A nurse prepares a client for a percutaneous kidney biopsy. Which actions should the nurse take prior to this procedure? (Select all that apply.) a. Keep the client NPO for 4 to 6 hours. b. Obtain coagulation study results. c. Maintain strict bedrest in a supine position. d. Assess for blood in the client's urine. e. Administer antihypertensive medications.

ANS: A, B, E Prior to a percutaneous kidney biopsy, the client should be NPO for 4 to 6 hours. Coagulation studies should be completed to prevent bleeding after the biopsy. Blood pressure medications should be administered to prevent hypertension before and after the procedure. There is no need to keep the client on bedrest or assess for blood in the client's urine prior to the procedure; these interventions should be implemented after a percutaneous kidney biopsy.

8. A nurse teaches a female client who has stress incontinence. Which statements should the nurse include about pelvic muscle exercises? (Select all that apply.) a. "When you start and stop your urine stream, you are using your pelvic muscles." b. "Tighten your pelvic muscles for a slow count of 10 and then relax for a slow count of 10." c. "Pelvic muscle exercises should only be performed sitting upright with your feet on the floor." d. "After you have been doing these exercises for a couple days, your control of urine will improve." e. "Like any other muscle in your body, you can make your pelvic muscles stronger by contracting them."

ANS: A, B, E The client should be taught that the muscles used to start and stop urination are pelvic muscles, and that pelvic muscles can be strengthened by contracting and relaxing them. The client should tighten pelvic muscles for a slow count of 10 and then relax the muscles for a slow count of 10, and perform this exercise 15 times while in lying-down, sitting-up, and standing positions. The client should begin to notice improvement in control of urine after several weeks of exercising the pelvic muscles.

A nurse plans care for an older adult client. Which interventions should the nurse include in this client's plan of care to promote kidney health? (Select all that apply.) a. Ensure adequate fluid intake. b. Leave the bathroom light on at night. c. Encourage use of the toilet every 6 hours. d. Delegate bladder training instructions to the unlicensed assistive personnel (UAP). e. Provide thorough perineal care after each voiding. f. Assess for urinary retention and urinary tract infection.

ANS: A, B, E, F The nurse should ensure that the client receives adequate fluid intake and has adequate lighting to ambulate safely to the bathroom at night, encourage the client to use the toilet every 2 hours, provide thorough perineal care after each voiding, and assess for urinary retention and urinary tract infections. The nurse should not delegate any teaching to the UAP, including bladder training instructions. The UAP may participate in bladder training activities, including encouraging and assisting the client to the bathroom at specific times.

2. A nurse teaches a client about self-catheterization in the home setting. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Wash your hands before and after self-catheterization." b. "Use a large-lumen catheter for each catheterization." c. "Use lubricant on the tip of the catheter before insertion." d. "Self-catheterize at least twice a day or every 12 hours." e. "Use sterile gloves and sterile technique for the procedure." f. "Maintain a specific schedule for catheterization."

ANS: A, C, F The key points in self-catheterization include washing hands, using lubricants, and maintaining a regular schedule to avoid distention and retention of urine that leads to bacterial growth. A smaller rather than a larger lumen catheter is preferred. The client needs to catheterize more often than every 12 hours. Self-catheterization in the home is a clean procedure.

A nurse assesses a client recovering from a cystoscopy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.) a. Decrease in urine output b. Tolerating oral fluids c. Prescription for metformin d. Blood clots present in the urine e. Burning sensation when urinating

ANS: A, D The nurse should monitor urine output and contact the provider if urine output decreases or becomes absent. The nurse should also assess for blood in the client's urine. The urine may be pink-tinged, but gross bleeding or blood clots should not be present. If bleeding is present, the nurse should urgently contact the provider. Tolerating oral fluids is a positive outcome and does not need intervention. Metformin would be a concern if the client received dye; no dye is used in a cystoscopy procedure. The client may experience a burning sensation when urinating after this procedure; this would not require a call to the provider.

. A nurse cares for a client who has elevated levels of antidiuretic hormone (ADH). Which disorder should the nurse identify as a trigger for the release of this hormone? a. Pneumonia b. Dehydration c. Renal failure d. Edema

ANS: B ADH increases tubular permeability to water, leading to absorption of more water into the capillaries. ADH is triggered by a rising extracellular fluid osmolarity, as occurs in dehydration. Pneumonia, renal failure, and edema would not trigger the release of ADH.

12. A nurse provides health screening for a community health center with a large population of African-American clients. Which priority assessment should the nurse include when working with this population? a. Measure height and weight. b. Assess blood pressure. c. Observe for any signs of abuse. d. Ask about medications.

ANS: B All interventions are important for the visiting nurse to accomplish. However, African Americans have a high rate of hypertension leading to end-stage renal disease. Each encounter that the nurse has with an African-American client provides a chance to detect hypertension and treat it. If the client is already on antihypertensive medication, assessing blood pressure monitors therapy.

2. A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a "shift to the left" in a client's white blood cell count. Which action should the nurse take? a. Request that the laboratory perform a differential analysis on the white blood cells. b. Notify the provider and start an intravenous line for parenteral antibiotics. c. Collaborate with the unlicensed assistive personnel (UAP) to strain the client's urine for renal calculi. d. Assess the client for a potential allergic reaction and anaphylactic shock.

ANS: B An increase in band cells creates a "shift to the left." A left shift most commonly occurs with urosepsis and is seen rarely with uncomplicated urinary tract infections. The nurse will be administering antibiotics, most likely via IV, so he or she should notify the provider and prepare to give the antibiotics. The shift to the left is part of a differential white blood cell count. The nurse would not need to strain urine for stones. Allergic reactions are associated with elevated eosinophil cells, not band cells.

3. After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I will take a laxative every night before going to bed. b. I must increase my intake of dietary fiber and fluids. c. I shall only use salt when I am cooking my own food. d. Ill eat white bread to minimize gastrointestinal gas.

ANS: B Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. Laxatives should be used cautiously. Clients with PKD should be on a restricted salt diet, which includes not cooking with salt. White bread has a low fiber count and would not be included in a high-fiber diet.

8. An emergency department nurse assesses a client with kidney trauma and notes that the clients abdomen is tender and distended and blood is visible at the urinary meatus. Which prescription should the nurse consult the provider about before implementation? a. Assessing vital signs every 15 minutes b. Inserting an indwelling urinary catheter c. Administering intravenous fluids at 125 mL/hr d. Typing and crossmatching for blood products

ANS: B Clients with blood at the urinary meatus should not have a urinary catheter inserted via the urethra before additional diagnostic studies are done. The urethra could be torn. The nurse should question the provider about the need for a catheter; if one is needed, the provider can insert a suprapubic catheter. The nurse should monitor the clients vital signs closely, send blood for type and crossmatch in case the client needs blood products, and administer intravenous fluids.

22. A nurse plans care for clients with urinary incontinence. Which client is correctly paired with the appropriate intervention? a. A 29-year-old client after a difficult vaginal delivery - Habit training b. A 58-year-old postmenopausal client who is not taking estrogen therapy - Electrical stimulation c. A 64-year-old female with Alzheimer's-type senile dementia - Bladder training d. A 77-year-old female who has difficulty ambulating - Exercise therapy

ANS: B Exercise therapy and electrical stimulation are used for clients with stress incontinence related to childbirth or low levels of estrogen after menopause. Exercise therapy increases pelvic wall strength; it does not improve ambulation. Physical therapy and a bedside commode would be appropriate interventions for the client who has difficulty ambulating. Habit training is the type of bladder training that will be most effective with cognitively impaired clients. Bladder training can be used only with a client who is alert, aware, and able to resist the urge to urinate.

7. After delegating care to an unlicensed assistive personnel (UAP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the UAP's understanding. Which action indicates the UAP needs additional teaching? a. Toileting the client after breakfast b. Changing the client's incontinence brief when wet c. Encouraging the client to drink fluids d. Recording the client's incontinence episodes

ANS: B Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse should re-educate the UAP on the technique of habit training. The UAP should continue to toilet the client after meals, encourage the client to drink fluids, and record incontinent episodes.

. After teaching a client with nephrotic syndrome and a normal glomerular filtration, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the nutritional therapy for this condition? a. I must decrease my intake of fat. b. I will increase my intake of protein. c. A decreased intake of carbohydrates will be required. d. An increased intake of vitamin C is necessary.

ANS: B In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss should be matched by increased intake of protein. The client would not need to adjust fat, carbohydrates, or vitamins based on this disorder.

A nurse reviews a female client's laboratory results. Which results from the client's urinalysis should the nurse recognize as abnormal? a. pH 5.6 b. Ketone bodies present c. Specific gravity of 1.020 d. Clear and yellow color

ANS: B Ketone bodies are by-products of incomplete metabolism of fatty acids. Normally no ketones are present in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030, and clear yellow urine are normal findings for a female client's urinalysis.

3. A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in the last 6 months. The client asks, "I never have urinary tract infections. Why is this happening now?" How should the nurse respond? a. "Your immune system becomes less effective as you age." b. "Low estrogen levels can make the tissue more susceptible to infection." c. "You should be more careful with your personal hygiene in this area." d. "It is likely that you have an untreated sexually transmitted disease."

ANS: B Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes, predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this reason. Although immune function does decrease with aging and sexually transmitted diseases are a known cause of urethritis, the most likely reason in this client is low estrogen levels. Personal hygiene usually does not contribute to this disease process.

1. A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding should alert the nurse to immediately contact the health care provider? a. Flank pain b. Periorbital edema c. Bloody and cloudy urine d. Enlarged abdomen

ANS: B Periorbital edema would not be a finding related to PKD and should be investigated further. Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or infection.

A nurse reviews the health history of a client with an oversecretion of renin. Which disorder should the nurse correlate with this assessment finding? a. Alzheimer's disease b. Hypertension c. Diabetes mellitus d. Viral hepatitis

ANS: B Renin is secreted when special cells in the distal convoluted tubule, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume, blood pressure, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension. Renin has no impact on Alzheimer's disease, diabetes mellitus, or viral hepatitis.

20. An emergency department nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question should the nurse ask first? a. "Are you drinking plenty of water?" b. "What medications are you taking?" c. "Have you tried laxatives or enemas?" d. "Has this type of thing ever happened before?"

ANS: B Some types of incontinence are treated with anticholinergic medications such as propantheline (Pro-Banthine). Anticholinergic side effects include dry mouth, constipation, and urinary retention. The nurse needs to assess the client's medication list to determine whether the client is taking an anticholinergic medication. If he or she is taking anticholinergics, the nurse should further assess the client's manifestations to determine if they are related to a simple side effect or an overdose. The other questions are not as helpful to understanding the current situation.

13. After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I will take this medication with food and plenty of water. b. I shall keep my appointment at the infusion center each week. c. Ill limit my intake of green leafy vegetables while on this medication. d. I must not take this medication if I have an infection or am feeling ill.

ANS: B Temsirolimus is administered as a weekly intravenous infusion. This medication blocks protein that is needed for cell division and therefore inhibits cell cycle progression. This medication is not taken orally, and clients do not need to follow a specific diet.

9. After teaching a client with hypertension secondary to renal disease, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I can prevent more damage to my kidneys by managing my blood pressure. b. If I have increased urination at night, I need to drink less fluid during the day. c. I need to see the registered dietitian to discuss limiting my protein intake. d. It is important that I take my antihypertensive medications as directed.

ANS: B The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions. These clients should be assessed thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by consuming fluids earlier in the day. Blood pressure control is needed to slow the progression of renal dysfunction. When dietary protein is restricted, refer the client to the registered dietitian as needed

21. A nurse teaches a client who is starting urinary bladder training. Which statement should the nurse include in this client's teaching? a. "Use the toilet when you first feel the urge, rather than at specific intervals." b. "Try to consciously hold your urine until the scheduled toileting time." c. "Initially try to use the toilet at least every half hour for the first 24 hours." d. "The toileting interval can be increased once you have been continent for a week."

ANS: B The client should try to hold the urine consciously until the next scheduled toileting time. Toileting should occur at specific intervals during the training. The toileting interval should be no less than every hour. The interval can be increased once the client becomes comfortable with the interval.

24. A nurse assesses a male client who is recovering from a urologic procedure. Which assessment finding indicates an obstruction of urine flow? a. Severe pain b. Overflow incontinence c. Hypotension d. Blood-tinged urine

ANS: B The most common manifestation of urethral stricture after a urologic procedure is obstruction of urine flow. This rarely causes pain and has no impact on blood pressure. The client may experience overflow incontinence with the involuntary loss of urine when the bladder is distended. Blood in the urine is not a manifestation of the obstruction of urine flow.

12. A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client's right lower back. Which action should the nurse take? a. Administer fresh-frozen plasma. b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results.

ANS: B The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh-frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level of intervention. Changing the client's position will not decrease bleeding.

A nurse cares for a client with a urine specific gravity of 1.018. Which action should the nurse take? a. Evaluate the client's intake and output for the past 24 hours. b. Document the finding in the chart and continue to monitor. c. Obtain a specimen for a urine culture and sensitivity. d. Encourage the client to drink more fluids, especially water.

ANS: B This specific gravity is within the normal range for urine. There is no need to evaluate the client's intake and output, obtain a urine specimen, or increase fluid intake.

A nurse assesses clients on the medical-surgical unit. Which clients are at risk for kidney problems? (Select all that apply.) a. A 24-year-old pregnant woman prescribed prenatal vitamins b. A 32-year-old bodybuilder taking synthetic creatine supplements c. A 56-year-old who is taking metformin for diabetes mellitus d. A 68-year-old taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic back pain e. A 75-year-old with chronic obstructive pulmonary disease (COPD) who is prescribed an albuterol nebulizer

ANS: B, C, D Many medications can affect kidney function. Clients who take synthetic creatine supplements, metformin, and high-dose or long-term NSAIDs are at risk for kidney dysfunction. Prenatal vitamins and albuterol nebulizers do not place these clients at risk

1. A nurse assesses a client who has a family history of polycystic kidney disease (PKD). For which clinical manifestations should the nurse assess? (Select all that apply.) a. Nocturia b. Flank pain c. Increased abdominal girth d. Dysuria e. Hematuria f. Diarrhea

ANS: B, C, E Clients with PKD experience abdominal distention that manifests as flank pain and increased abdominal girth. Bloody urine is also present with tissue damage secondary to PKD. Clients with PKD often experience constipation, but would not report nocturia or dysuria.

4. A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.) a. Clear drainage b. Bloody drainage at site c. Client reports headache d. Foul-smelling drainage e. Urine draining from site

ANS: B, D, E After a nephrostomy, the nurse should assess the client for complications and urgently notify the provider if drainage decreases or stops, drainage is cloudy or foul-smelling, the nephrostomy sites leaks blood or urine, or the client has back pain. Clear drainage is normal. A headache would be an unrelated finding.

4. A nurse assesses a client with a fungal urinary tract infection (UTI). Which assessments should the nurse complete? (Select all that apply.) a. Palpate the kidneys and bladder. b. Assess the medical history and current medical problems. c. Perform a bladder scan to assess post-void residual. d. Inquire about recent travel to foreign countries. e. Obtain a current list of medications.

ANS: B, E Clients who are severely immunocompromised or who have diabetes mellitus are more prone to fungal UTIs. The nurse should assess for these factors by asking about medical history, current medical problems, and the current medication list. A physical examination and a post-void residual may be needed, but not until further information is obtained indicating that these examinations are necessary. Travel to foreign countries probably would not be important because, even if exposed, the client needs some degree of compromised immunity to develop a fungal UTI.

3. A nurse teaches clients about the difference between urge incontinence and stress incontinence. Which statements should the nurse include in this education? (Select all that apply.) a. "Urge incontinence involves a post-void residual volume less than 50 mL." b. "Stress incontinence occurs due to weak pelvic floor muscles." c. "Stress incontinence usually occurs in people with dementia." d. "Urge incontinence can be managed by increasing fluid intake." e. "Urge incontinence occurs due to abnormal bladder contractions."

ANS: B, E Clients who suffer from stress incontinence have weak pelvic floor muscles or urethral sphincter and cannot tighten their urethra sufficiently to overcome the increased detrusor pressure. Stress incontinence is common after childbirth, when the pelvic muscles are stretched and weakened from pregnancy and delivery. Urge incontinence occurs in people who cannot suppress the contraction signal from the detrusor muscle. Abnormal detrusor contractions may be a result of neurologic abnormalities including dementia, or may occur with no known abnormality. Post-void residual is associated with reflex incontinence, not with urge incontinence or stress incontinence. Management of urge incontinence includes decreasing fluid intake, especially in the evening hours.

15. A nurse assesses a client with bladder cancer who is recovering from a complete cystectomy with ileal conduit. Which assessment finding should alert the nurse to urgently contact the health care provider? a. The ileostomy is draining blood-tinged urine. b. There is serous sanguineous drainage present on the surgical dressing. c. The ileostomy stoma is pale and cyanotic in appearance. d. Oxygen saturations are 92% on room air.

ANS: C A pale or cyanotic stoma indicates impaired circulation to the stoma and must be treated to prevent necrosis. Blood-tinged urine and serous sanguineous drainage are expected after this type of surgery. Oxygen saturation of 92% on room air is at the low limit of normal.

A nurse cares for a client who is recovering from a closed percutaneous kidney biopsy. The client states, "My pain has suddenly increased from a 3 to a 10 on a scale of 0 to 10." Which action should the nurse take first? a. Reposition the client on the operative side. b. Administer the prescribed opioid analgesic. c. Assess the pulse rate and blood pressure. d. Examine the color of the client's urine.

ANS: C An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of internal hemorrhage. A change in vital signs can indicate that hemorrhage is occurring. Before other actions, the nurse must assess the client's hemodynamic status.

9. A confused client with pneumonia is admitted with an indwelling catheter in place. During interdisciplinary rounds the following day, which question should the nurse ask the primary health care provider? a. "Do you want daily weights on this client?" b. "Will the client be able to return home?" c. "Can we discontinue the indwelling catheter?" d. "Should we get another chest x-ray today?"

ANS: C An indwelling catheter dramatically increases the risks of urinary tract infection and urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are medically needed. The nurse should inquire about removing the catheter. All other questions might be appropriate, but because of client safety, this question takes priority.

14. A nurse cares for a client who has pyelonephritis. The client states, I am embarrassed to talk about my symptoms. How should the nurse respond? a. I am a professional. Your symptoms will be kept in confidence. b. I understand. Elimination is a private topic and shouldnt be discussed. c. Take your time. It is okay to use words that are familiar to you. d. You seem anxious. Would you like a nurse of the same gender to care for you?

ANS: C Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse should encourage the client to use language that is familiar to the client. The nurse should not make promises that cannot be kept, like keeping the clients symptoms confidential. The nurse must assess the client and cannot take the time to stop the discussion or find another nurse to complete the assessment.

4. A nurse assesses a client with renal insufficiency and a low red blood cell count. The client asks, "Is my anemia related to the renal insufficiency?" How should the nurse respond? a. "Red blood cells produce erythropoietin, which increases blood flow to the kidneys." b. "Your anemia and renal insufficiency are related to inadequate vitamin D and a loss of bone density." c. "Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow." d. "Kidney insufficiency inhibits active transportation of red blood cells throughout the blood."

ANS: C Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency. The kidneys do not play a role in the transportation of red blood cells or any other cells in the blood.

1. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis? a. A 36-year-old female who has never been pregnant b. A 42-year-old male who is prescribed cyclophosphamide c. A 58-year-old female who is not taking estrogen replacement d. A 77-year-old male with mild congestive heart failure

ANS: C Females at any age are more susceptible to cystitis than men because of the shorter urethra in women. Postmenopausal women who are not on hormone replacement therapy are at increased risk for bacterial cystitis because of changes in the cells of the urethra and vagina. The middle-aged woman who has never been pregnant would not have a risk potential as high as the older woman who is not using hormone replacement therapy.

A nurse obtains a sterile urine specimen from a client's Foley catheter. After applying a clamp to the drainage tubing distal to the injection port, which action should the nurse take next? a. Clamp another section of the tube to create a fixed sample section for retrieval. b. Insert a syringe into the injection port and aspirate the quantity of urine required. c. Clean the injection port cap of the drainage tubing with povidone-iodine solution. d. Withdraw 10 mL of urine and discard it; then withdraw a fresh sample of urine.

ANS: C It is important to clean the injection port cap of the catheter drainage tubing with an appropriate antiseptic, such as povidone-iodine solution or alcohol. This will help prevent surface contamination before injection of the syringe. The urine sample should be collected directly from the catheter; therefore, a second clamp to create a sample section would not be appropriate. Every sample from the catheter is usable; there is the need to discard the first sample.

4. After teaching a client with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I will not take this drug with food or milk." b. "If I think I am pregnant, I will stop the drug." c. "An orange color in my urine should not alarm me." d. "I will drink two glasses of cranberry juice daily."

ANS: C Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients think they have blood in their urine when they see this. In addition, the urine can permanently stain clothing. Phenazopyridine is safe to take if the client is pregnant. There are no dietary restrictions or needs while taking this medication.

26. A nurse provides phone triage to a pregnant client. The client states, "I am experiencing a burning pain when I urinate." How should the nurse respond? a. "This means labor will start soon. Prepare to go to the hospital." b. "You probably have a urinary tract infection. Drink more cranberry juice." c. "Make an appointment with your provider to have your infection treated." d. "Your pelvic wall is weakening. Pelvic muscle exercises should help."

ANS: C Pregnant clients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the client to make an appointment and have the infection treated. Burning pain when urinating does not indicate the start of labor or weakening of pelvic muscles.

25. A nurse cares for a client with urinary incontinence. The client states, "I am so embarrassed. My bladder leaks like a young child's bladder." How should the nurse respond? a. "I understand how you feel. I would be mortified." b. "Incontinence pads will minimize leaks in public." c. "I can teach you strategies to help control your incontinence." d. "More women experience incontinence than you might think."

ANS: C The nurse should accept and acknowledge the client's concerns, and assist the client to learn techniques that will allow control of urinary incontinence. The nurse should not diminish the client's concerns with the use of pads or stating statistics about the occurrence of incontinence.

11. A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma. Which statement should the nurse include in this clients teaching? a. Since you only have one kidney, a salt and fluid restriction is required. b. Your therapy will include hemodialysis while you recover. c. Medication will be prescribed to control your high blood pressure. d. You need to avoid participating in contact sports like football.

ANS: D Clients with one kidney need to avoid contact sports because the kidneys are easily injured. The client will not be required to restrict salt and fluids, end up on dialysis, or have new hypertension because of the nephrectomy.

19. A nurse teaches a client with functional urinary incontinence. Which statement should the nurse include in this client's teaching? a. "You must clean around your catheter daily with soap and water." b. "Wash the vaginal weights with a 10% bleach solution after each use." c. "Operations to repair your bladder are available, and you can consider these." d. "Buy slacks with elastic waistbands that are easy to pull down."

ANS: D Functional urinary incontinence occurs as the result of problems not related to the client's bladder, such as trouble ambulating or difficulty accessing the toilet. One goal is that the client will be able to manage his or her clothing independently. Elastic waistband slacks that are easy to pull down can help the client get on the toilet in time to void. The other instructions do not relate to functional urinary incontinence.

A nurse reviews the urinalysis of a client and notes the presence of glucose. Which action should the nurse take? a. Document findings and continue to monitor the client. b. Contact the provider and recommend a 24-hour urine test. c. Review the client's recent dietary selections. d. Perform a capillary artery glucose assessment.

ANS: D Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL, which means that a person whose blood glucose is less than 220 mg/dL will not have glucose in the urine. A positive finding for glucose on urinalysis indicates high blood sugar. The most appropriate action would be to perform a capillary artery glucose assessment. The client needs further evaluation for this abnormal result; therefore, documenting and continuing to monitor is not appropriate. Requesting a 24-hour urine test or reviewing the client's dietary selections will not assist the nurse to make a clinical decision related to this abnormality.

8. A nurse plans care for a client with overflow incontinence. Which intervention should the nurse include in this client's plan of care to assist with elimination? a. Stroke the medial aspect of the thigh. b. Use intermittent catheterization. c. Provide digital anal stimulation. d. Use the Valsalva maneuver.

ANS: D In clients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure, such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh or providing digital anal stimulation requires the reflex arc to be intact to initiate elimination. Due to the high risk for infection, intermittent catheterization should only be implemented when other interventions are not successful.

A nurse cares for a client with a urine specific gravity of 1.040. Which action should the nurse take? a. Obtain a urine culture and sensitivity. b. Place the client on restricted fluids. c. Assess the client's creatinine level. d. Increase the client's fluid intake.

ANS: D Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with dehydration, decreased kidney blood flow (often because of dehydration), and the presence of antidiuretic hormone. Increasing the client's fluid intake would be a beneficial intervention. Assessing the creatinine or obtaining a urine culture would not provide data necessary for the nurse to make a clinical decision.

3. A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200 mOsm/L. Which action should the nurse take? a. Contact the provider and recommend a low-sodium diet. b. Prepare to administer an intravenous diuretic. c. Obtain a suction device and implement seizure precautions. d. Encourage the client to drink more fluids.

ANS: D Normal urine osmolality ranges from 300 to 900 mOsm/L. This client's urine is more concentrated, indicating dehydration. The nurse should encourage the client to drink more water. Dehydration can be associated with elevated serum sodium levels. Although a low-sodium diet may be appropriate for this client, this diet change will not have a significant impact on urine osmolality. A diuretic would increase urine output and decrease urine osmolality further. Low serum sodium levels, not elevated serum levels, place the client at risk for seizure activity. These options would further contribute to the client's dehydration or elevate the osmolality.

11. A nurse cares for a client who has kidney stones from secondary hyperoxaluria. Which medication should the nurse anticipate administering? a. Phenazopyridine (Pyridium) b. Propantheline (Pro-Banthine) c. Tolterodine (Detrol LA) d. Allopurinol (Zyloprim)

ANS: D Stones caused by secondary hyperoxaluria respond to allopurinol (Zyloprim). Phenazopyridine is given to clients with urinary tract infections. Propantheline is an anticholinergic. Tolterodine is an anticholinergic with smooth muscle relaxant properties.

17. A nurse cares for a client who is scheduled for the surgical creation of an ileal conduit. The client states, "I am anxious about having an ileal conduit. What is it like to have this drainage tube?" How should the nurse respond? a. "I will ask the provider to prescribe you an antianxiety medication." b. "Would you like to discuss the procedure with your doctor once more?" c. "I think it would be nice to not have to worry about finding a bathroom." d. "Would you like to speak with someone who has an ileal conduit?"

ANS: D The goal for the client who is scheduled to undergo a procedure such as an ileal conduit is to have a positive self-image and a positive attitude about his or her body. Discussing the procedure candidly with someone who has undergone the same procedure will foster such feelings, especially when the current client has an opportunity to ask questions and voice concerns to someone with first-hand knowledge. Medications for anxiety will not promote a positive self-image and a positive attitude, nor will discussing the procedure once more with the physician or hearing the nurse's opinion.

14. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for bladder cancer? a. A 25-year-old female with a history of sexually transmitted diseases b. A 42-year-old male who has worked in a lumber yard for 10 years c. A 55-year-old female who has had numerous episodes of bacterial cystitis d. An 86-year-old male with a 50-pack-year cigarette smoking history

ANS: D The greatest risk factor for bladder cancer is a long history of tobacco use. The other factors would not necessarily contribute to the development of this specific type of cancer.

10. A nurse cares for a client who is recovering after a nephrostomy tube was placed 6 hours ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour. Which action should the nurse take? a. Document the finding in the clients record. b. Evaluate the tube as working in the hand-off report. c. Clamp the tube in preparation for removing it. d. Assess the clients abdomen and vital signs.

ANS: D The nephrostomy tube should continue to have a consistent amount of drainage. If the drainage slows or stops, it may be obstructed. The nurse must notify the provider, but first should carefully assess the clients abdomen for pain and distention and check vital signs so that this information can be reported as well. The other interventions are not appropriate.

7. A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the clients blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. Which action should the nurse take? a. Position the client to lay on the surgical incision. b. Measure the specific gravity of the clients urine. c. Administer intravenous pain medications. d. Assess the rate and quality of the clients pulse.

ANS: D The nurse should first fully assess the client for signs of volume depletion and shock, and then notify the provider. The radical nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Re-positioning the client, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.

A nurse cares for a client who is having trouble voiding. The client states, "I cannot urinate in public places." How should the nurse respond? a. "I will turn on the faucet in the bathroom to help stimulate your urination." b. "I can recommend a prescription for a diuretic to improve your urine output." c. "I'll move you to a room with a private bathroom to increase your comfort." d. "I will close the curtain to provide you with as much privacy as possible."

ANS: D The nurse should provide privacy to clients who may be uncomfortable or have issues related to elimination or the urogenital area. Turning on the faucet and administering a diuretic will not address the client's concern. Although moving the client to a private room with a private bathroom would be nice, this is not realistic. The nurse needs to provide as much privacy as possible within the client's current room.

Based on the nurses knowledge of the normal function of the kidney, which large particles are not found in the urine because they are too large to filter through the glomerular capillary walls? (SATA) a. Blood cells b. Albumin c. Other proteins d. Electrolytes e. Water

Abc

A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? "I'll talk to the health care provider and have your name removed from the waiting list." "You sound frustrated with the situation." "You're right, the wait is endless for some people." "I'm sure you'll get a phone call soon that a kidney is available."

Acknowledging the client's frustration reflects the feelings the client is having and offers assistance and support. Talking to the health care provider and removing the client from the waiting list does not allow the nurse to hear more and perhaps offer therapeutic listening or a solution to the problem. Telling the client that the wait is endless for some people cuts the client off from sharing his or her concerns and accentuates the negative aspects of the situation. The waiting time for kidney matches is increasing due to a shortage of organs; the nurse should not offer false hope by suggesting that the client will get a phone call soon.

A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? "I'll talk to the health care provider and have your name removed from the waiting list." "You sound frustrated with the situation." Correct "You're right, the wait is endless for some people." "I'm sure you'll get a phone call soon that a kidney is available."

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first?

Administer morphine sulfate 4 mg IV. Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.

When caring for a client with nephrotic syndrome, which intervention should be included in the plan of care? Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss Administering heparin to prevent deep vein thrombosis (DVT) Providing antibiotics to decrease infection Providing transfusion of clotting factors

Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein lossACE inhibitors can decrease protein loss in the urine. Heparin is administered for DVT, but in nephrotic syndrome it may reduce urine protein and kidney insufficiency. Glomerulonephritis may occur secondary to an infection, but it is an inflammatory process; antibiotics are not indicated for nephrotic syndrome. Clotting factors are not indicated unless bleeding and coagulopathy are present.

After a nephrectomy, the second kidney is expected to eventually provide adequate kidney function, but this may take days or weeks. Renal cell carcinoma typically only affects one kidney. Renal replacement therapy is not the typical treatment for renal cell carcinoma. Fluids should be maintained to flush the remaining kidney.

A nurse cares for a client who has kidney stones from secondary hyperoxaluria. Which medication should the nurse anticipate administering?

Allopurinol (Zyloprim) Stones caused by secondary hyperoxaluria respond to allopurinol (Zyloprim).

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? Abrupt decrease in urine output Correct Blood-tinged urine Incisional pain Increase in urine output

An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? Increased blood urea nitrogen (BUN) Correct Increased creatinine level Pale-colored urine Decreased sodium level

When taking the health history of a client with acute glomerulonephritis (GN), the nurse questions the client about which related cause of the problem? Recent respiratory infection Correct Hypertension Unexplained weight loss Neoplastic disease

An infection often occurs before the kidney manifestations of acute GN. The onset of symptoms is about 10 days from the time of infection. Hypertension is a result of glomerulonephritis, not a cause. Weight gain, not weight loss, is symptomatic of fluid retention in GN. Cancers are not part of the cause of GN.

A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? "All of this is new. What can't you do?" "Are you afraid of dying?" "How are you doing this morning?" "What concerns do you have about your kidney disease?"

Asking the client about any concerns is open-ended and specific to the client's concerns. Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.

A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? "Don't worry, no one else will know." "Take your time. What is bothering you the most?" Correct "Why are you hesitant?" "You need to tell me so we can determine what is wrong."

Asking the client what is bothering him or her expresses patience and understanding when trying to identify the client's problem. Telling the client that others will not know is untrue because the client's symptoms will be in the medical record for other health care personnel to see. Asking why the client is hesitant can seem accusatory and threatening to the client. Admonishing the client to disclose his or her symptoms is too demanding; the nurse must be more understanding of the client's embarrassment.

Auscultate for a bruit every 8 hours. Correct Teach the client to palpate for a thrill over the site. Correct Ensure that no blood pressures are taken in that arm. Correct A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? Consuming a low-calcium diet Avoiding peas, nuts, and legumes Drinking cola beverages only once daily Increasing dairy products enriched with vitamin D

Avoiding peas, nuts, and legumes Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Calcium should not be restricted; hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

An older adult male patient reports an acute problem with urine retention. The nurse advises the patient to seek medical attention because permanent kidney damage can occur in what time frame? a. IIn less than 6 hours b. in less than 48 hours c. Within several weeks d. Within several years

B Acknowledging the client's frustration reflects the feelings the client is having and offers assistance and support. Talking to the health care provider and removing the client from the waiting list does not allow the nurse to hear more and perhaps offer therapeutic listening or a solution to the problem. Telling the client that the wait is endless for some people cuts the client off from sharing his or her concerns and accentuates the negative aspects of the situation. The waiting time for kidney matches is increasing due to a shortage of organs; the nurse should not offer false hope by suggesting that the client will get a phone call soon.

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? A "Should we filter air circulation?" B "Can we use less radiographic contrast dye?" C "Should we add low-dose dobutamine?" D "Should we decrease IV rates?"

B Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? Adherence to therapy Handwashing Monitoring for low-grade fever Strict clean technique

B The most important infection control measure for the client receiving immune-suppressive therapy is handwashing. Adherence to therapy and monitoring for low-grade fever are important, but are not infection control measures. The nurse should practice aseptic technique for this client, not simply clean technique.

Which patient has the highest risk for developing a complicated UTI? a. 26-year-old woman who is sexually active, but not currently pregnant b. 22-year-old man who has a neurogenic bladder due to spinal cord injury c. 35-year-old woman who had three full-term pregnancies and a miscarriage d. 53-year-old woman who is having some menstrual irregularities

B - 22-year-old man who has a neurogenic bladder due to spinal cord injury

For a patient who needs an indwelling catheter for at least 2 weeks, which intervention would help reduce the bacterial colonization along the catheter? a. Secure the catheter to the female patient's thigh. b. Consider the use of a coated catheter. c. Wash the urine bag and outflow tube every day. d. Apply antiseptic ointment to the catheter tubing.

B - Consider the use of a coated catheter.

The nurse is teaching a patient with urge incontinence about dietary modifications. What is the best information the nurse gives to the patient about fluid intake? a. Drink at least 2000 mL per day unless contraindicated. b. Drink 120 mL every hour or 240 mL every 2 hours and limit fluids after dinner. c. Drink fluid freely in the morning hours, but limit intake before going to bed. d. Drinking water is especially good for bladder health.

B - Drink 120 mL every hour or 240 mL every 2 hours and limit fluids after dinner.

The nurse hears in report that the patient is being treated for a fungal UTI. In addition to performing routine care and assessments, the nurse is extra-vigilant for signs/symptoms of which systemic disorder that may underlie the fungal UTI? a. Chronic cardiac disease b. Immune system compromise c. Respiratory system dysfunction d. Connective tissue disorder

B - Immune system compromise

A patient with urinary incontinence is prescribed oxybutynin (Ditropan). What precautions or instructions does the nurse provide related to this therapy? a. Avoid aspirin or aspirin-containing products. b. Increase fluids and dietary fiber intake. c. Report any unusual vaginal bleeding. d. Change positions slowly, especially in the morning.

B - Increase fluids and dietary fiber intake.

The nursing student sees an order for a urinalysis for a patient with frequency, urgency, and dysuria. In order to collect the specimen, what does the student do? a. Use sterile technique to insert a small-diameter (6 Fr) catheter. b. Instruct the patient on how to collect a clean-catch specimen. c. Tell the patient to urinate approximately 10 mL into a specimen cup. d. Take the urine from a bedpan and transfer it into a specimen cup.

B - Instruct the patient on how to collect a clean-catch specimen.

A patient is admitted for an elective orthopedic surgical procedure. The patient also has a personal and family history for urolithiasis. Which circumstance creates the greatest risk for recurrent urolithiasis? a. Giving the patient milk with every meal tray b. Keeping the patient NPO for extended periods c. Giving the patient an opioid narcotic for pain d. Inserting an indwelling catheter for the procedure

B - Keeping the patient NPO for extended periods

Which patient with incontinence is most likely to benefit from a surgical intervention? a. Patient with vaginal atrophy and altered urethral competency b. Patient with reflex (overflow) incontinence caused by obstruction c. Patient with functional incontinence related to musculoskeletal weakness d. Patient with urge incontinence or overactive bladder

B - Patient with reflex (overflow) incontinence caused by obstruction

A patient received an antibiotic prescription several hours ago and has started the medication, but requests "some relief from the burning." What comfort measures does the nurse suggest to the patient? a. Take over-the-counter acetaminophen. b. Sit in a sitz bath and urinate into the warm water. c. Place a cold pack over the perineal area. d. Rest in a recumbent position with legs elevated.

B - Sit in a sitz bath and urinate into the warm water.

A patient has agreed to try a bladder training program. What is the priority nursing intervention in starting this therapy? a. Start a schedule for voiding (e.g., every 2-3 hours). b. Teach the patient how to be alert, aware, and able to resist the urge to urinate. c. Convince the patient that the bladder issues are controlling his/her lifestyle. d. Give a thorough explanation of the problem of stress incontinence.

B - Teach the patient how to be alert, aware, and able to resist the urge to urinate.

A patient has been performing Kegel exercises for 2 months. How does the nurse know whether the exercises are working? a. Incontinence is still present, but the patient states that it is less. b. The patient is able to stop the urinary stream. c. There are no complaints of urgency from the patient. d. The patient is using absorbent undergarments for protection.

B - The patient is able to stop the urinary stream.

The employee health nurse is conducting a presentation for employees who work in a paint manufacturing plant. In order to protect against bladder cancer, the nurse advises that everyone who works with chemicals should do what? a. Shower with mild soap and rinse well before they come to work. b. Use personal protective equipment such as gloves and masks. c. Limit their exposure to chemicals and fumes at all times. d. Avoid hobbies such as furniture refinishing that further expose to chemicals.

B - Use personal protective equipment such as gloves and masks.

Which client statement indicates understanding regarding antibiotic therapy for recurrent urinary tract infections? A. "If my urine becomes lighter and clear, I can stop taking my medicine." B. "Even if I feel completely well, I should take the medication until it is gone." C. "When my urine no longer burns, I will no longer need to take the antibiotics." D. "If my temperature goes above 100° F (37.8° C), I should take twice as much medicine."

B -"Even if I feel completely well, I should take the medication until it is gone." -Antibiotic therapy is most effective, especially for recurrent urinary tract infections, when the client takes the prescribed medication for the entire course and not just when symptoms are present. The other statements demonstrate that additional teaching is needed for the client.

Which statement made by the client who has kidney stones from secondary hyperoxaluria indicates correct understanding of the role of dietary therapy for this condition? A. "No modifications are needed because this type of stone is not caused by diet." B. "I will avoid dark green leafy vegetables, chocolate, and nuts." C. "I will avoid all dairy products and vitamin D." D. "I will avoid wine, meat, and shellfish."

B -"I will avoid dark green leafy vegetables, chocolate, and nuts." -Secondary hyperoxaluria is caused by an excessive ingestion of foods containing large amounts of oxalate, such as spinach, rhubarb, Swiss chard, collard greens, cocoa, beets, wheat germ, pecans, peanuts, okra, chocolate, and lime peel.

The postmenopausal female client has had two episodes of bacterial urethritis in the last 6 months. She asks her nurse why this is happening to her now. Which is the nurse's best response? A. "Your immune system becomes less effective as you age." B. "Low estrogen levels can make the tissue more susceptible to infection." C. "You should be more careful with your personal hygiene in this area." D. "It is likely that your sexual partner is traumatizing this area."

B -"Low estrogen levels can make the tissue more susceptible to infection." -Low estrogen levels decrease moisture and the type of secretions in the perineal area, predisposing it to the development of infection. The client's immune system, personal hygiene, and sexual practices do not place her at risk for developing urethritis.

Which assessment maneuver should the nurse perform first when assessing the renal system at the same time as the abdomen?

B -Abdominal auscultation -Auscultation precedes percussion and palpation because the nurse needs to auscultate for abdominal bruits before palpation or percussion of the abdominal and renal components of a physical assessment.

The client with a renal calculus has just returned from an extracorporeal shock wave lithotripsy procedure and the nurse finds an ecchymotic area on the client's right lower back. Which is the nurse's priority intervention? A. Notifying the physician B. Applying ice to the site C. Placing the client in the prone position D. Documenting the observation as the only action

B -Applying ice to the site -The shock waves can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising.

2. The client is taking a medication for an endocrine problem that inhibits aldosterone secretion and release. To what complications of this therapy should the nurse be alert? a. Dehydration, hypokalemia b. Dehydration, hyperkalemia c. Overhydration, hyponatremia d. Overhydration, hypernatremia

B -Dehydration, hyperkalemia -Aldosterone is a mineralocorticoid that increases the reabsorption of water and sodium in the kidney at the same time that it promotes excretion of potassium. Any drug or condition that disrupts aldosterone secretion or release increases the client's risk for excessive water loss and potassium reabsorption.

3. Which of the following muscle actions results in voluntary urination? a. Detrusor contraction, external sphincter contraction b. Detrusor contraction, external sphincter relaxation c. Detrusor relaxation, external sphincter contraction d. Detrusor relaxation, external sphincter relaxation

B -Detrusor contraction, external sphincter relaxation -Voiding becomes a voluntary act as a result of learned responses controlled by the cerebral cortex. This causes contraction of the bladder detrusor muscle and simultaneous relaxation of the external urethral sphincter muscle.

The client's urine specific gravity is 1.018. Which is the nurse's best action?

B -Documenting the finding as the only action -This specific gravity is within the normal range for urine

A client presents with senile dementia, Alzheimer's type (SDAT) and incontinence. Which therapy will best help this client? A. Bladder training B. Habit training C. Exercise therapy D. Electrical stimulation

B -Habit training -Habit training is the type of bladder training that will be most effective with cognitively impaired clients. Bladder training can only be used with a client who is alert, aware, and able to resist the urge to urinate. Exercise therapy may be too difficult for the cognitively impaired client to grasp, and electrical stimulation will be traumatic for this client.

The client is an older woman who is receiving treatment with levofloxacin (Levaquin). Which is the highest priority instruction that the nurse can provide to this client?

B -How to assess her own radial pulse -The client should assess her own radial pulse at least twice daily because this class of drugs can induce serious cardiac dysrhythmias. Assessment of blood pressure and respirations will not allow the client to detect if she is experiencing cardiac side effects of the medication. She should not attempt to assess her carotid pulse because a syncopal episode could result.

4. Which of the following conditions are associated with oversecretion of rennin? a. Alzheimer's disease b. Hypertension c. Diabetes mellitus d. Diabetes insipidus

B -Hypertension -Renin is secreted when special cells in the distal convoluted tubule (DCT), called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume is low, blood pressure is low, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause the secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension.

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) Check brachial pulses daily. Auscultate for a bruit every 8 hours. Teach the client to palpate for a thrill over the site. Elevate the arm above heart level. Ensure that no blood pressures are taken in that arm.

B C E A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL Crackles in the lung fields Temperature of 98.8° F (37.1° C) Blood pressure of 164/98 mm Hg 3+ edema of the lower extremities

B D E Signs and symptoms of fluid retention (e.g., crackles in the lung fields and 3+ edema of the lower extremities) indicate transplant rejection. Increased blood pressure is also a symptom of transplant rejection. Increasing BUN and creatinine are symptoms of rejection; a BUN of 21 mg/dL and a creatinine of 0.9 mg/dL reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

The client is beginning to undergo urinary bladder training. Which is an effective instruction to give this client? A. "Use the toilet at the first urge, rather than at specific intervals." B. "Try to consciously hold your urine until the scheduled toileting time." C. "Initially try to use the toilet at least every half- hour for 24 hours." D. "The toileting interval can be increased once you have been continent

B-"Try to consciously hold your urine until the scheduled toileting time." -The client should try to hold the urine consciously until the next scheduled toileting time. Toileting should occur at specific intervals during the training. The toileting interval should be no less than every hour. The interval can be increased once the client has been continent for 3 days

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for postprocedure home care? A. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." B. "Do not share your toilet with family members for the next 24 hours." C. "Please be sure to stand when you are urinating." D. "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."

B. "Do not share your toilet with family members for the next 24 hours." The toilet should not be shared for 24 hours following this procedure because others using the toilet could be infected with the live virus that was instilled into the client. If only one toilet is available in the household, teach the client to flush the toilet after use and to follow this by adding 1 cup of undiluted bleach to the bowl water. The bowl is then flushed after 15 minutes, and the seat and flat surfaces of the toilet are wiped with a cloth containing a solution of 10% liquid bleach. The client must sit when he is urinating for at least 24 hours postprocedure to prevent splashing of the contaminated urine out of the commode, where it could be toxic for anyone who comes in contact with it. Underwear or other clothing that has come into contact with urine during the 24 hours after instillation should be washed separately from other clothing in a solution of 10% liquid bleach; it does not need to be discarded.

The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A. A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) B. A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours C. A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy D. A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

B. A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention. The 26-year-old admitted with urosepsis and slight fever, the 32-year-old scheduled for cystoscopy, and the 40-year-old with noninfectious urethritis are not at immediate risk for complications or deterioration.

A client diagnosed with stress incontinence is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? (Select all that apply.) A. Take the drug at bedtime. B. Encourage increased fluids. C. Increase fiber intake. D. Limit the intake of dairy products. E. Use hard candy for dry mouth.

B. Encourage increased fluids. C. Increase fiber intake. E. Use hard candy for dry mouth. Anticholinergics cause constipation; increasing fluids and fiber intake will help with this problem. Anticholinergics also cause extreme dry mouth, which can be alleviated with using hard candy to moisten the mouth. Taking the drug at night and limiting dairy products will not have an effect on the complications encountered with propantheline.

Which interventions are helpful in preventing bladder cancer? (Select all that apply.) A. Drinking 2½ liters of fluid a day B. Showering after working with or around chemicals C. Stopping the use of tobacco D. Using pelvic floor muscle exercises E. Wearing a lead apron when working with chemicals F. Wearing gloves and a mask when working around chemicals and fumes

B. Showering after working with or around chemicals C. Stopping the use of tobacco F. Wearing gloves and a mask when working around chemicals and fumes Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. Bathing after exposure to them is advisable. Tobacco use is one of the highest, if not the highest, risk factor in the development of bladder cancer. Increasing fluid intake is helpful for some urinary problems such as urinary tract infection, but no correlation has been noted between fluid intake and bladder cancer risk. Using pelvic floor muscle strengthening (Kegel) exercises is helpful with certain types of incontinence, but no data show that these exercises prevent bladder cancer. Precautions should be taken when working with chemicals; however, lead aprons are used to protect from radiation.

The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? (Select all that apply.) A. Cleanse the perineum from back to front after using the bathroom. B. Try to take in 64 ounces of fluid each day. C. Be sure to complete the full course of antibiotics. D. If urine remains cloudy, call the clinic. E. Expect some flank discomfort until the antibiotic has worked.

B. Try to take in 64 ounces of fluid each day. C. Be sure to complete the full course of antibiotics. D. If urine remains cloudy, call the clinic. Between 64 and 100 ounces (2 to 3 liters) of fluid should be taken daily to dilute bacteria and prevent infection. Not completing the course of antibiotics could suppress the bacteria, but would not destroy all bacteria, causing the infection to resurface. For persistent symptoms of infection, the client should contact the provider. The perineal area should be cleansed from front to back or "clean to dirty" to prevent infection. Cystitis produces suprapubic symptoms; flank pain occurs with infection or inflammation of the kidney. Awarded 0.0 points out of 3.0 possible points.

A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? A. Bladder training B. Credé method C. Habit training D. Kegel exercises

C. Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis. Bladder training, the Credé method, and learning Kegel exercises require that the client be alert, cooperative, and able to assist with his or her own training.

Which nursing activity illustrates proper aseptic technique during catheter care? A. Applying Betadine ointment to the perineal area after catheterization B. Irrigating the catheter daily C. Positioning the collection bag below the height of the bladder D. Sending a urine specimen to the laboratory for testing

C. Positioning the collection bag below the height of the bladder Correct Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract. Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized clients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation should be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.

A 32-year-old female with a urinary tract infection (UTI) reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the health care provider prescribe? A. Nitrofurantoin (Macrodantin) after intercourse B. Estrogen (Premarin) C. Trimethoprim/sulfamethoxazole (Bactrim) D. Phenazopyridine (Pyridium) with intercourse

C. Trimethoprim/sulfamethoxazole (Bactrim) Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole is effective in treating uncomplicated, community-acquired UTI in women. Drugs from the same class as nitrofurantoin reduce bacteria in the urinary tract by inhibiting bacterial reproduction (bacteriostatic action). This client needs a drug that will kill bacteria. Estrogen cream may help prevent recurrent UTIs in postmenopausal women, which this client is not (at age 32). Use of Premarin is related to problems with incontinence. Phenazopyridine (Pyridium) is not used to treat infection, but symptoms of a UTI.

A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns? "Arise slowly and call for assistance when ambulating." Correct "I must measure your intake and output." "We must save your urine because it is radioactive." "I must attach you to this cardiac monitor."

Captopril can cause severe hypotension during and after the procedure, so the client should be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension. Intake and output measurement is not necessary after this procedure, unless it had been requested previously. A small amount of radionuclide is used in a renal scan; the urine is not radioactive, although the nurse should practice Standard Precautions, as always, and wear gloves. Cardiac monitoring is not needed, although the nurse should monitor for hypotension secondary to captopril.

Which staff member does the charge nurse assign to a client who has benign prostatic hyperplasia and hydronephrosis and needs an indwelling catheter inserted? RN float nurse who has 10 years of experience with pediatric clients LPN/LVN who has worked in the hospital's kidney dialysis unit until recently RN without recent experience who has just completed an RN refresher course LPN/LVN with 5 years of experience in an outpatient urology surgery center Correct

Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center. The pediatric nurse would have little exposure to prostatic obstruction and adult catheterization. Dialysis clients do not typically have catheters inserted, so the LPN/LVN from the kidney dialysis unit would not be the best staff member to assign to the client. The nurse who has been out of practice for several years is not the best candidate to insert a catheter in a client with an enlarged prostate.

Which factor is an indicator for a diagnosis of hydronephrosis? History of nocturia History of urinary stones Correct Recent weight loss Urinary incontinence

After delegating care to an unlicensed assistive personnel (UAP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the UAP's understanding. Which action indicates the UAP needs additional teaching?

Changing the client's incontinence brief when wet Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse should re-educate the UAP on the technique of habit training. The UAP should continue to toilet the client after meals, encourage the client to drink fluids, and record incontinent episodes.

Which condition may predispose a client to chronic pyelonephritis? Spinal cord injury Correct Cardiomyopathy Hepatic failure Glomerulonephritis

Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones. Weakness of the heart muscle may cause kidney impairment, not an infection. Pyelonephritis may damage the kidney, not the liver. Glomerulonephritis may result from infection, but may not cause infection of the kidney.

Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter? Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. Remove the existing catheter and obtain a sample during the process of inserting a new Foley. Use a sterile syringe to withdraw urine from the urine collection bag. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.

Clamping the tubing, attaching a syringe to the specimen, and withdrawing at least 5 mL of urine is the correct technique for obtaining a sterile urine specimen from the client with a Foley catheter. Disconnecting the Foley catheter from the drainage tube and collecting urine directly from the Foley increases the risk for microbe exposure. A Foley catheter should not be removed to get a urine sample. Microbes may be in the urine collection bag from standing urine, so using a sterile syringe to withdraw urine from the urine collection bag is not the proper technique to obtain a urine sample.

For which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider? (Select all that apply.) Client with an allergy to shrimp Client with a history of asthma Client who requests morphine sulfate every 3 hours Client with a blood urea nitrogen of 62 mg/dL and a creatinine of 2.0 mg/dL Client who took metformin (Glucophage) 4 hours ago

Client with an allergy to shrimp Correct Client with a history of asthma Correct creatinine of 2.0 mg/dL Correct Client who took metformin (Glucophage) 4 hours ago Correct The client who will be undergoing a CT scan with contrast should be asked about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. Contrast reactions have been reported to be as high as 15% in these clients. Clients with asthma have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. The risk for contrast-induced nephropathy is increased in clients who have pre-existing renal insufficiency (e.g., serum creatinine levels greater than 1.5 mg/dL or estimated glomerular filtration rate less than 45 mL/min). Metformin must be discontinued at least 24 hours before and for at least 48 hours after any study using contrast media because the life-threatening complication of lactic acidosis, although rare, could occur. There are no contraindications to undergo CT with contrast while taking morphine sulfate. CT with contrast may help to identify the underlying cause of pain.

Client with chronic kidney failure who was just admitted with shortness of breath The dyspnea of the client with chronic kidney failure may indicate pulmonary edema and should be assessed immediately. The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions, but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

Client with hyperparathyroidism A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones; this client should remain hydrated. A client with chronic kidney disease should not consume 2 to 3 liters of water because the kidneys are not functioning properly, and this could lead to fluid retention. People with heart failure typically have fluid volume excess. A client with complete bowel obstruction may experience vomiting and should be NPO.

The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? Client who has just returned from having a kidney artery angioplasty Client with polycystic kidney disease who is having a kidney ultrasound Client who is going for a cystoscopy and cystourethroscopy Client with glomerulonephritis who is having a kidney biopsy

Client with polycystic kidney disease who is having a kidney ultrasound Kidney ultrasounds are noninvasive procedures without complications; the LPN/LVN can provide this care. A kidney artery angioplasty is an invasive procedure that requires postprocedure monitoring for complications, especially hemorrhage; a registered nurse is needed. Cystoscopy and cystourethroscopy are procedures that are associated with potentially serious complications such as bleeding and infection. These clients should be assigned to RN staff members. Kidney biopsy is associated with potentially serious complications such as bleeding, and this client should be assigned to RN staff members.

A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? Avoiding venipuncture and blood pressure measurements in the affected arm Modifications to allow for complete rest of the affected arm How to assess for a bruit in the affected arm How to practice proper nutrition

Compression of vascular access causes decreased blood flow and may cause occlusion; if this occurs, dialysis will not be possible. The arm should be exercised to encourage venous dilation, not rested. The client can palpate for a thrill; a stethoscope is not needed to auscultate the bruit at home. The nurse should take every opportunity to discuss nutrition, even as it relates to wound healing, but loss of the graft or fistula by compression or occlusion must take priority because lifesaving dialysis cannot be performed.

A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? Avoiding venipuncture and blood pressure measurements in the affected arm Correct Modifications to allow for complete rest of the affected arm How to assess for a bruit in the affected arm How to practice proper nutrition

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? "Should we filter air circulation?" "Can we use less radiographic contrast dye?" Correct "Should we add low-dose dobutamine?" "Should we decrease IV rates?"

Contrast dye is severely nephrotoxic, and other options can be used in its place. Air circulation and low-dose dopamine are not associated with nephrotoxicity. Pre-renal status results from decreased blood flow to the kidney, such as fluid loss or dehydration; IV fluids can correct this.

A client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse? _________

Correct Responses 167 drops/min 20 gtt × 500 mL = 10,000/60 min = 167 drops/min

When assessing a client with acute glomerulonephritis, which finding causes the nurse to notify the provider? Purulent wound on the leg Crackles throughout the lung fields Correct History of diabetes Cola-colored urine

Crackles indicate fluid overload resulting from kidney damage; shortness of breath and dyspnea are typically associated. The provider should be notified of this finding. Glomerulonephritis may result from infection (e.g., purulent wound); it is not an emergency about which to notify the provider. The history of diabetes would have been obtained on admission. Dark urine is expected in glomerulonephritis.

When assessing a client with acute glomerulonephritis, which finding causes the nurse to notify the provider? Purulent wound on the leg Crackles throughout the lung fields History of diabetes Cola-colored urine

Crackles throughout the lung fields Crackles indicate fluid overload resulting from kidney damage; shortness of breath and dyspnea are typically associated. The provider should be notified of this finding. Glomerulonephritis may result from infection (e.g., purulent wound); it is not an emergency about which to notify the provider. The history of diabetes would have been obtained on admission. Dark urine is expected in glomerulonephritis.

Which laboratory test is the best indicator of kidney function? Blood urea nitrogen (BUN) Creatinine Aspartate aminotransferase (AST) Alkaline phosphatase

Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best indicator of renal function. BUN may be affected by protein or fluid intake. AST and alkaline phosphatase are measures of hepatic function.

Which laboratory test is the best indicator of kidney function? Blood urea nitrogen (BUN) Creatinine Correct Aspartate aminotransferase (AST) Alkaline phosphatase

D Asking the client about any concerns is open-ended and specific to the client's concerns. Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.

Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? History of hiatal hernia Presence of diabetes and glycosylated hemoglobin of 6.8% History of basal cell carcinoma on the nose 5 years ago Presence of tuberculosis

D Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with the immune suppressants that are required to prevent rejection. A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point, and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.

When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? Pulse oximetry reading of 95% Sinus bradycardia, rate of 58 beats/min Blood pressure of 148/90 mm Hg Temperature of 101.2° F (38.4° C)

D Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever.

The health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? A "It will act as an antibacterial drug." B "This drug will treat your infection, not the symptoms of it." C "You need to take the drug on an empty stomach." D "Your urine will turn red or orange while on the drug."

D "Your urine will turn red or orange while on the drug." Phenazopyridine will turn the client's urine red or orange. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed, and care should be taken because it will stain undergarments. Phenazopyridine reduces bladder pain and burning by exerting a local analgesic/anesthetic effect on the mucosa of the urinary tract. It does treat the symptoms of bladder infection; it has no antibacterial action. Phenazopyridine should be taken with a meal or immediately after eating.

A patient has had a bladder suspension and a suprapubic catheter is in place. The patient wants to know how long the catheter will remain in place. What is the nurse's best response? a. "Typically it remains for 24 hours postoperatively." b. "It will be removed at your first clinic visit." c. "When you can void on your own, it will be removed." d. "It will be removed when you can void and residual urine is less than 50 mL."

D - "It will be removed when you can void and residual urine is less than 50 mL."

Which patient should not be advised to take cranberry juice? a. 26-year-old pregnant woman with a history of uncomplicated UTI b. 23-year-old man with history of recurrent kidney stones c. 65-year-old man with urinary retention secondary to enlarged prostate d. 33-year-old woman with dysuria associated with interstitial cystitis

D - 33-year-old woman with dysuria associated with interstitial cystitis

The nurse is teaching a patient a behavioral intervention for bladder compression. In order to correctly perform the Credé method, what does the nurse teach the patient to do? a. Insert the fingers into the vagina and gently push against the vaginal wall. b. Breathe in deeply and direct the pressure towards the bladder during exhalation. c. Empty the bladder, wait a few minutes, and attempt a second bladder emptying. d. Apply firm and steady pressure over the bladder area with the palm of the hand.

D - Apply firm and steady pressure over the bladder area with the palm of the hand.

The nurse is performing an assessment on a patient with probable stress incontinence. Which assessment technique does the nurse use to validate stress incontinence? a. Assess the abdomen to estimate bladder fullness. b. Check for residual urine using a portable ultrasound. c. Catheterize the patient immediately after voiding. d. Ask the patient to cough while wearing a perineal pad.

D - Ask the patient to cough while wearing a perineal pad.

The nurse is caring for a patient with functional incontinence. The UAP reports that "the linens have been changed four times within the past 6 hours, but the patient refuses to wear a diaper." What does the nurse do next? a. Thank the UAP for the hard work and advise to continue to change the linens. b. Call the health care provider to obtain an order for an indwelling catheter. c. Instruct the UAP to stop using the word "diaper" and instead use "incontinence pants." d. Assess the patient for any new urinary problems and ask about toileting preferences.

D - Assess the patient for any new urinary problems and ask about toileting preferences.

A patient comes to the clinic and reports severe flank pain, bladder distention, and nausea and vomiting with increasingly smaller amounts of urine with frank blood. The patient states, "I have kidney stones and I just need a prescription for pain medication." What is the nurse's priority concern? a. Controlling the patient's pain b. Checking the quantity of blood in the urine c. Flushing the kidneys with oral fluids d. Determining if there is an obstruction

D - Determining if there is an obstruction

A patient is returning from the postanesthesia care unit after surgery for bladder cancer resulting in a cutaneous ureterostomy. Where does the nurse expect the stoma to be located? a. On the perineum b. At the beltline c. On the posterior flank d. In the midabdominal area

D - In the midabdominal area

A patient has had surgery for bladder cancer. To prevent recurrence of superficial bladder cancer, the nurse anticipates that the health care provider is likely to recommend which treatment? a. No treatment is needed for this benign condition. b. Intravesical instillation of single-agent chemotherapy. c. Radiation therapy to the bladder, ureters, and urethra. d. Intravesical instillation of bacille Calmette- Guérin.

D - Intravesical instillation of bacille Calmette- Guérin.

A patient is considering vaginal cone therapy, but is a little hesitant because she does not understand how it works. What does the nurse tell her about how vaginal cone therapy improves incontinence? a. It mechanically obstructs urine loss from the urethra. b. It repositions the bladder to reduce compression. c. It increases the normal flora of the perineum. d. It strengthens pelvic floor muscles.

D - It strengthens pelvic floor muscles.

The health care provider verbally informs the nurse that the patient needs a fluoroquinolone antibiotic to treat a UTI. The pharmacy delivers gabapentin (Neurontin). What should the nurse do first? a. Administer the medication as ordered. b. Call the pharmacist and ask for a read back of the order. c. Call the health care provider for clarification of the order. d. Look at the written order to clarify the name of the medication.

D - Look at the written order to clarify the name of the medication.

The nurse is caring for a patient with urolithiasis. Which medication is likely to be given in the acute phase to relieve the patient's severe pain? a. Ketorolac (Toradol) b. Oxybutynin chloride (Ditropan) c. Propantheline bromide (Pro-Banthine) d. Morphine sulfate (Astramorph)

D - Morphine sulfate (Astramorph)

In which patient circumstance would the nurse question the order for the insertion of an indwelling catheter? a. Patient is critically ill and at risk for hypovolemic shock. b. Patient has urinary retention with beginnings of hydronephrosis. c. Patient was in a car accident and has a possible spinal cord injury. d. Patient has functional incontinence related to Alzheimer's disease.

D - Patient has functional incontinence related to Alzheimer's disease.

A patient has been started on oxybutynin (Ditropan) for urinary incontinence. What is the major action of this medication? a. Increases blood flow to the urethra b. Blocks acetylcholine receptors c. Causes slight numbing of the bladder d. Relaxes bladder muscles

D - Relaxes bladder muscles

A patient with a history of kidney stones presents with severe flank pain, nausea, vomiting, pallor, and diaphoresis. He reports freely passing urine, but it is bloody. The priority for nursing care is to monitor for which patient problem? a. Possible dehydration b. Impaired tissue perfusion c. Impaired urinary elimination d. Severe pain

D - Severe pain

A patient repots the loss of small amounts of urine during coughing, sneezing, jogging, or lifting. Which type of incontinence do these symptoms describe? a. Urge b. Overflow c. Functional d. Stress

D - Stress

Which urine characteristic suggests that the patient is drinking a sufficient amount of fluid? a. Urine pH is between 6 to 6.5. b. Urine has a high specific gravity. c. Urine has a faint ammonia odor. d. Urine is a pale yellow color.

D - Urine is a pale yellow color.

Which is priority discharge teaching for a client who has undergone the removal of a renal calculus? A. "Do not expect to see any blood in your urine." B. "Expect to experience pain in the bladder area." C. "Look for bruising and report it." D. "Drink at least 3 L of fluid daily and monitor urine pH."

D -"Drink at least 3 L of fluid daily and monitor urine pH." -The client should drink at least 3 L of fluid daily and monitor his or her urine pH as directed. He or she should expect to see some blood in the urine postoperatively and some bruising, but should not experience pain. If there is pain, this might signal the development of another stone and should be reported.

The caretaker of a confused client with functional incontinence asks about having an in-dwelling catheter placed. Which is the nurse's best response? A. "You must be very aggravated about this situation. I will call the physician with this request." B. "I will teach you how to insert the catheter, which should be used just at night." C. "We can teach you how to perform intermittent catheterization to drain the bladder." D. "Pads can be worn to prevent smells and leaks. Social services can help you obtain these supplies at a reasonable cost."

D -"Pads can be worn to prevent smells and leaks. Social services can help you obtain these supplies at a reasonable cost." -In-dwelling catheters are used only as a last resort because of the risk for ascending urinary tract infections and sepsis. The use of containment pads should be attempted as a means of controlling wetness first. If the client has skin breakdown, an in-dwelling catheter can be placed temporarily until the area has healed.

The client is scheduled to have renography (kidney scan). She is concerned about discomfort during the procedure. Which is the nurse's best response?

D -"The only pain associated with this procedure is a small needle stick when you are given the radioisotope." -The test involves an intravenous injection of the radioisotope and the subsequent recording of the emission by a scintillator.

The client is scheduled to undergo the surgical creation of an ileal conduit. He expresses his anxiety and fear regarding the procedure. Which is an appropriate response from the nurse?

D -"Would you like to speak with another client who has undergone this procedure?" -The goal for the client who is scheduled to undergo a procedure such as an ileal conduit is to have a positive self-image and a positive attitude about his body image. Medications for anxiety or sleep will not promote this, nor will discussing the procedure once more with his physician. However, discussing the procedure candidly with a former client will foster such feelings, especially when the current client has an opportunity to ask questions and voice concerns to someone with first-hand knowledge of the procedure.

Which client is at highest risk for developing a renal calculus? A. An older man with diabetes mellitus B. A young woman who is 6 months pregnant C. A middle-aged woman with mild congestive heart failure D. A young man who had a renal calculus 1 year ago

D -A young man who had a renal calculus 1 year ago -Age and the other conditions listed do not contribute to the formation of renal calculi. The greatest risk factor for calculus formation is a history of a previous stone.

A nurse observes that the client's left flank region is larger than the right flank region. What is the nurse's best action? a. Ask the client if he or she participates in contact sports and has been recently injured. b. Document the finding as the only action on the appropriate flowsheet. c. Apply a heating pad to the left flank after inspecting the site for signs of infection. d. Anticipate further diagnostic testing after sharing informing the physician of this finding.

D -Anticipating further diagnostic testing after informing the physician of this finding -Asymmetry of the flank or a unilateral protrusion may indicate an enlargement of a kidney. The enlargement may be benign or may be associated with a hydronephrosis or mass on the kidney.

Which is an initial priority intervention for the client with stress incontinence? A. Beginning medication teaching B. Having the client sign an informed consent form for surgery C. Assisting the client in finding a supplier of absorbent pads and undergarments D. Instructing the client to maintain a diary that records times of urine leakage, activities, and diet

D -Instructing the client to maintain a diary that records times of urine leakage, activities, and diet -Maintaining a diary detailing times of urine leakage, activities, and foods eaten will aid in the diagnostic process by showing if there is a connection between specific factors that seem to trigger the incontinent episodes. Use of medication, surgical procedures, and absorbent pads or undergarments may be used as part of the physician's treatment plan at some point, but more conservation interventions should be implemented first.

The client reports the regular use of all the following medications. Which one alerts the nurse to the possibility of renal impairment when used consistently? A. Antacids B. Penicillin C. Antihistamine nasal sprays D. Nonsteroidal anti-inflammatory drugs (NSAIDs)

D -Nonsteroidal anti-inflammatory drugs (NSAIDs) -NSAIDs inhibit prostaglandin production and decrease blood flow to the nephrons. They can cause an interstitial nephritis and renal impairmen

Which intervention is most likely to be effective in stimulating the initiation of voiding for the client with overflow incontinence? A. Stroking the medial aspect of the thigh B. Using intermittent catheterization C. Providing digital anal stimulation D. Using the Valsalva maneuver

D -Using the Valsalva maneuver -In clients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure, such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if to defecate) can initiate voiding.

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? A. "Blood in my urine has become less noticeable, so maybe I don't need this procedure." B. "I have been taking cephalexin (Keflex) for an infection." C. "I previously had several ESWL procedures performed." D. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

D. "I take over-the-counter naproxen (Aleve) twice a day for joint pain." Because a high risk for bleeding during ESWL has been noted, clients should not take nonsteroidal anti-inflammatory drugs before this procedure; the ESWL will have to be rescheduled for this client. Blood in the client's urine should be reported to the health care provider, but will not require rescheduling of the procedure because blood is frequently present in the client's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. The client's taking cephalexin (Keflex) and the fact that the client has had several previous ESWL procedures should be reported, but will not require rescheduling of the procedure.

The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a correct understanding of these procedures? A. "If I restrict my oral intake of fluids, the adjustment will be easier." B. "I must go to the restroom more often because my urine will be excreted through my anus." C. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." D. "I will have to drain my pouch with a catheter."

D. "I will have to drain my pouch with a catheter." For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter. Fluids should not be restricted. A neobladder does not require the use of an ostomy bag.

The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? A. "I am so relieved that I can continue eating my fried fish meals every week." B. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." C. "My wife will be happy to know that I can keep enjoying her liver and onions recipe." D. "I will no longer be able to have red wine with my dinner."

D. "I will no longer be able to have red wine with my dinner." Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client should decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming. Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stones consist of calcium oxalate.

An older adult woman confides to the nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? A. "Don't worry about it. You need them." B. "Shop at night, when stores are less crowded." C. "Tell everyone that they are for your husband." D. "That is tough. What do you think might help?"

D. "That is tough. What do you think might help?" Stating that the situation is tough acknowledges the client's concerns, and asking the client to think about what might help assists the client to think of methods to solve her problem. Telling the client not to worry is dismissive of the client's concerns. Telling the client to shop at night does not empower the client, and it reaffirms the client's embarrassment. Suggesting to the client that she tell everyone they are for her husband also does not empower the client; rather, it suggests to the client that telling untruths is acceptable.

Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN? A. A 42-year-old with painless hematuria who needs an admission assessment B. A 46-year-old scheduled for cystectomy who needs help in selecting a stoma site C. A 48-year-old receiving intravesical chemotherapy for bladder cancer D. A 55-year-old with incontinence who has intermittent catheterization prescribed

D. A 55-year-old with incontinence who has intermittent catheterization prescribed Insertion of catheters is within the education and legal scope of practice for LPN/LVNs. Admission assessments and intravesical chemotherapy should be done by an RN. Preoperative preparation for cystectomy and stoma site selection should be done by an RN and either a Certified Wound, Ostomy, and Continence Nurse or an enterostomal therapy nurse.

A client in the community health clinic is prescribed trimethoprim/sulfamethoxazole for cystitis. She reports that she developed hives to "something called Septra." What is the nurse's best action? A. Reassure the client that Septra is not trimethoprim/sulfamethoxazole. B. Highlight this important information in the client's medical record. C. Place an allergy alert band on the client's wrist. D. Notify the prescriber immediately.

D. Notify the prescriber immediately. Rationale: Septra is a brand name for TMP-SMX, a sulfa-based antibiotic with multiple brand names. It is inappropriate to band a wrist in a community health clinic. This information may need to be added to the client's medical record, but simply highlighting the information will not prevent an avoidable adverse drug event. The provider needs the allergy information in order to substitute another effective antibiotic.

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? A. Encouraging them to drink fluids B. Irrigating all catheters daily with sterile saline C. Recommending that catheters be placed in all clients D. Periodically re-evaluating the need for indwelling catheters

D. Periodically re-evaluating the need for indwelling catheters Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTIs in the hospital setting. Encouraging fluids, although it is a valuable practice for clients with catheters, will not necessarily prevent the occurrence of UTIs in the hospital setting. In some clients, their conditions do not permit an increase in fluids, such as those with congestive heart failure and kidney failure. Irrigating catheters daily is contraindicated; any time a closed system is opened, bacteria may be introduced. Placing catheters in all clients is unnecessary and unrealistic. This practice would place more clients at risk for the development of UTI.

A client who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? A. Discharges the client to her home for strict bedrest for the duration of the pregnancy B. Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria C. Recommends that the client refrain from having sexual intercourse until after she has delivered her baby D. Refers the client to the clinic nurse practitioner for immediate follow-up

D. Refers the client to the clinic nurse practitioner for immediate follow-up Pregnant women with UTIs require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor with adverse effects for the fetus. It is unsafe for the client to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Having sexual intercourse (or not having it) is not related to the client's problem. The client's symptoms need follow-up with a health care provider.

The nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by the health care provider for a client with a urinary tract infection (UTI), does the nurse question? A. Bactrim B. Cipro C. Noroxin D. Tegretol

D. Tegretol Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin (gatifloxacin) and Tegretol (carbamazepine). The former is used for UTI, and the latter is prescribed as an oral anticonvulsant. Bactrim (trimethoprim/sulfamethoxazole), Cipro (ciprofloxacin), and Noroxin (norfloxacin) are drugs used to treat UTI.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the home health aide (unlicensed assistive personnel [UAP])? A. Assisting the client in developing a schedule for when to take prescribed antibiotics B. Inserting a straight catheter as necessary if the client is unable to empty the bladder C. Teaching the client how to use the Credé maneuver to empty the bladder more fully D. Using a bladder scanner (with training) to check residual bladder volume after the client voids

D. Using a bladder scanner (with training) to check residual bladder volume after the client voids Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill. Assisting the client in developing a schedule for when to take prescribed antibiotics, inserting a straight catheter, and teaching the client to use the Credé maneuver all require more education and are in the legal scope of practice of the LPN/LVN or RN.

Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse should assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? Eggs Ham Eggplant Macaroni

EGGs Suggested protein-containing foods for a client on peritoneal dialysis are milk, meat, and eggs. Although a protein, ham is high in sodium, which should be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

Which assessment findings does the nurse expect in a client with kidney cancer? (Select all that apply.) Erythrocytosis Correct Hypokalemia Hypercalcemia Correct Hepatic dysfunction Correct Increased sedimentation rate Correct

Erythrocytosis alternating with anemia and hepatic dysfunction with elevated liver enzymes may occur with kidney cancer. Parathyroid hormone produced by tumor cells can cause hypercalcemia. An elevation in sedimentation rate may occur in paraneoplastic syndromes. Potassium levels are not altered in kidney cancer, but hypercalcemia is present.

When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first? Give lispro (Humalog) insulin, 12 units subcutaneously. Request a breakfast tray for the client. Infuse 0.45% normal saline at 125 mL/hr. Correct Administer captopril (Capoten).

Fluids are needed because the dye used in a CT scan with contrast has an osmotic effect, causing dehydration and potential kidney failure. Lispro is not administered until the breakfast tray arrives. A breakfast tray will be requested, but preventing complications of the procedure is done first. Because the client may be hypovolemic, the nurse should monitor blood pressure and administer IV fluids before deciding whether administration of captopril is appropriate.

When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? Abdominal girth Presence of urinary infection History of hysterectomy Hematuria

History of hysterectomy The scanner must be in the scan mode for female clients to ensure the scanner subtracts the volume of the uterus from the measurement, or in the scan mode for male clients for women who have undergone a hysterectomy. The nurse performs this procedure in response to distention or pressure in the bladder; girth is not a factor. This procedure detects urine retained in the bladder, not infection. The presence of retained urine in the bladder is assessed, regardless of hematuria.

The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast: History and Physical Medications & Dx Findings Polycystic kidney disease Diabetes Hysterectomy Abdomen distended Negative edema Glyburide Metformin Synthroid BUN 26 mg/dL Creatinine 1.0 mg/dL HbA1c 6.9% Glucose 132 mg/dL Which intervention is essential for the nurse to perform? Obtain a thyroid-stimulating hormone (TSH) level. Report the blood urea nitrogen (BUN) and creatinine. Hold the metformin 24 hours before and on the day of the procedure. Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values.

Hold the metformin 24 hours before and on the day of the procedure. Before studies with contrast media are performed, the nurse must withhold metformin, which may cause lactic acidosis. The focus of this admission is the polycystic kidneys; a TSH level is not essential at this time. BUN and creatinine are normal. The glucose is only mildly elevated (if fasting), and the HbA1c is in an appropriate range.

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? "I can stop my medications when my kidney function returns to normal." "If my urine output is decreased, I should increase my fluids." "The anti-rejection medications will be taken for life." Correct "I will drink 8 ounces of water with my medications."

Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys. Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria is a symptom of transplant rejection; the transplant team should be contacted immediately if this occurs. It is not necessary to take anti-rejection medication with 8 ounces of water.

A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? "Because the kidneys cannot get rid of fluid, blood pressure goes up." Correct "The damaged kidneys no longer release a hormone that prevents high blood pressure." "The waste products in the blood interfere with other mechanisms that control blood pressure." "This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."

In chronic kidney disease, fluid levels increase in the circulatory system. The statements asserting that damaged kidneys no longer release a hormone to prevent high blood pressure, waste products in the blood interfere with other mechanisms controlling blood pressure, and high blood pressure is a compensatory mechanism that increases blood flow through the kidneys in attempt excrete waste products are not accurate regarding the relationship between chronic kidney disease and high blood pressure.

Which information suggests that a client with diabetes may be in the early stages of kidney damage? Elevation in blood urea nitrogen (BUN) Oliguria Microalbuminuria Correct Painless hematuria

In the early stages of diabetic nephropathy, micro-levels of albumin are first detected in the urine. Progressive kidney damage occurs before dipstick procedures can detect protein in the urine. BUN may change in response to protein and fluid intake. Oliguria is a later finding in kidney disease and may also be present in dehydration. Painless hematuria often occurs with kidney cancer.

Which urinary assessment information for a client indicates the potential need for increased fluids? Increased blood urea nitrogen Correct Increased creatinine Pale-colored urine Decreased sodium

Infuse 0.45% normal saline at 125 mL/hr. Fluids are needed because the dye used in a CT scan with contrast has an osmotic effect, causing dehydration and potential kidney failure. Lispro is not administered until the breakfast tray arrives. A breakfast tray will be requested, but preventing complications of the procedure is done first. Because the client may be hypovolemic, the nurse should monitor blood pressure and administer IV fluids before deciding whether administration of captopril is appropriate.

When caring for a client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which element does the nurse anticipate will be used? Fresh-frozen plasma Platelet infusions 5% dextrose in water Normal saline solution (NSS)

Isotonic solutions and crystalloid solutions are administered for volume expansion; 0.9% sodium chloride (NSS) and 5% dextrose in 0.45% sodium chloride may be used. Clotting factors, contained in fresh-frozen plasma, are given for bleeding, not for volume expansion. Platelet infusions are administered for deficiency of platelets. A solution hypotonic to the client's blood, 5% dextrose, is administered for nutrition or hypernatremia, not for volume expansion.

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? Consuming a low-calcium diet Avoiding peas, nuts, and legumes Correct Drinking cola beverages only once daily Increasing dairy products enriched with vitamin D

Kidney failure causes hyperphosphatemia; this client must restrict phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes. Calcium should not be restricted; hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? Client who has just returned from having a kidney artery angioplasty Client with polycystic kidney disease who is having a kidney ultrasound Correct Client who is going for a cystoscopy and cystourethroscopy Client with glomerulonephritis who is having a kidney biopsy

Kidney ultrasounds are noninvasive procedures without complications; the LPN/LVN can provide this care. A kidney artery angioplasty is an invasive procedure that requires postprocedure monitoring for complications, especially hemorrhage; a registered nurse is needed. Cystoscopy and cystourethroscopy are procedures that are associated with potentially serious complications such as bleeding and infection. These clients should be assigned to RN staff members. Kidney biopsy is associated with potentially serious complications such as bleeding, and this client should be assigned to RN staff members.

LPN/LVN with 5 years of experience in an outpatient urology surgery center Catheterization of a client with an enlarged prostate, a skill within the scope of practice of the LPN/LVN, would be performed frequently in a urology center. The pediatric nurse would have little exposure to prostatic obstruction and adult catheterization. Dialysis clients do not typically have catheters inserted, so the LPN/LVN from the kidney dialysis unit would not be the best staff member to assign to the client. The nurse who has been out of practice for several years is not the best candidate to insert a catheter in a client with an enlarged prostate.

Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with the immune suppressants that are required to prevent rejection. A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point, and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.

The nurse anticipates that a client who develops hypotension and oliguria post nephrectomy may need the addition of which element to the regimen? Increase in analgesics Addition of a corticosteroid Administration of a diuretic Course of antibiotic therapy

Loss of water and sodium occurs in clients with adrenal insufficiency, which is followed by hypotension and oliguria; corticosteroids may be needed. The nurse should use caution when administering analgesics to a hypotensive client; no indication suggests that pain is present in this client. A diuretic would further contribute to fluid loss and hypotension, potentially worsening kidney function. A few doses of antibiotics are used prophylactically preoperatively and postoperatively; additional therapy is used when evidence of infection exists.

The nurse anticipates that a client who develops hypotension and oliguria post nephrectomy may need the addition of which element to the regimen? Increase in analgesics Addition of a corticosteroid Correct Administration of a diuretic Course of antibiotic therapy

Which goal for a client with diabetes will best help to prevent diabetic nephropathy? Heed the urge to void. Avoid carbohydrates in the diet. Take insulin at the same time every day. Maintain glycosylated hemoglobin (HbA1c).

Maintaining long-term control of blood glucose will help prevent the progression of diabetic nephropathy. Voiding when the client has the urge prevents the backflow of urine and infection. The diabetic diet is composed of carbohydrates, proteins, and fats. Although taking insulin at the same time each day may indirectly help control blood glucose, it is not the best option.

When caring for a client with uremia, the nurse assesses for which symptom? Tenderness at the costovertebral angle (CVA) Cyanosis of the skin Nausea and vomiting Correct Insomnia

Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue. CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.

NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.

The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? Nonsteroidal anti-inflammatory drugs (NSAIDs) Correct Angiotensin-converting enzyme (ACE) inhibitors Opiates Calcium channel blockers

When caring for a client with uremia, the nurse assesses for which symptom? Tenderness at the costovertebral angle (CVA) Cyanosis of the skin Nausea and vomiting Insomnia

Nausea and vomiting Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue. CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.

A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the provider visited the client the day before. What action does the nurse take? Asks the client to sign the informed consent Cancels the procedure Asks the client's spouse to sign the form Notifies the department and the provider

Notifies the department and the provider The client may be asked to sign the consent form in the department; notifying both the provider and the department ensures communication across the continuum of care, with less likelihood of omission of information. The provider gives the client a complete description of and reasons for the procedure and explains complications; the nurse reinforces this information. The procedure should not be cancelled without an attempt to correct the situation. The client has not received sedation, so nothing suggests that the client is not competent to consent.

A client in the community health clinic is prescribed trimethoprim/sulfamethoxazole for cystitis. She reports that she developed hives to "something called Septra." What is the nurse's best action?

Notify the prescriber immediately. Rationale: Septra is a brand name for TMP-SMX, a sulfa-based antibiotic with multiple brand names. The provider needs the allergy information in order to substitute another effective antibiotic.

A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a "shift to the left" in a client's white blood cell count. Which action should the nurse take?

Notify the provider and start an intravenous line for parenteral antibiotics. An increase in band cells creates a "shift to the left." A left shift most commonly occurs with urosepsis and is seen rarely with uncomplicated urinary tract infections. The nurse will be administering antibiotics, most likely via IV, so he or she should notify the provider and prepare to give the antibiotics.

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) Obtain the client's pre-hemodialysis weight. Correct Check the arteriovenous (AV) fistula for a thrill and bruit. Document the amount the client drinks throughout the shift. Correct Auscultate the client's lung sounds every 4 hours. Explain the components of a low-sodium diet.

Obtain the client's pre-hemodialysis weight. Correct Document the amount the client drinks throughout the shift. Correct Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) Obtain the client's pre-hemodialysis weight. Correct Check the arteriovenous (AV) fistula for a thrill and bruit. Document the amount the client drinks throughout the shift. Correct Auscultate the client's lung sounds every 4 hours. Explain the components of a low-sodium diet.

Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

A nurse assesses a male client who is recovering from a urologic procedure. Which assessment finding indicates an obstruction of urine flow?

Overflow incontinence The most common manifestation of urethral stricture after a urologic procedure is obstruction of urine flow. This rarely causes pain and has no impact on blood pressure. The client may experience overflow incontinence with the involuntary loss of urine when the bladder is distended.

Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever.

Which percussion technique does the nurse use to assess a client who reports flank pain? Place outstretched fingers over the flank area and percuss with the fingertips. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. Quickly tap the flank area with cupped hands.

Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. While the client assumes a sitting, side-lying, or supine position, the nurse forms one of the hands into a clenched fist. The other hand is placed flat over the costovertebral (CVA) angle of the client. Then, a firm thump is quickly delivered to the hand over the CVA area. Percussion is not appropriate for flank pain. Placing one hand palm up is not the correct technique. Percussion therapy, not assessment, involves tapping the flank area.

When caring for a client with polycystic kidney disease, which goal is most important? Preventing progression of the disease Correct Performing genetic testing Assessing for related causes Consulting with the dialysis unit

Preventing complications and progression of the disease is the goal. Genetic testing should be done, but this is not a priority. Assessment for related causes is an intervention, not a goal. Not all clients with polycystic kidney disease require dialysis.

When caring for a client with polycystic kidney disease, which goal is most important? Preventing progression of the disease Performing genetic testing Assessing for related causes Consulting with the dialysis unit

Preventing progression of the disease Correct Preventing complications and progression of the disease is the goal. Genetic testing should be done, but this is not a priority. Assessment for related causes is an intervention, not a goal. Not all clients with polycystic kidney disease require dialysis.

A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? Maintaining bedrest Medicating for pain Monitoring for hematuria Promoting fluid intake

Promoting fluid intake The nurse should ensure adequate hydration by urging the client to take oral fluid or by giving IV fluids. Hydration reduces the risk for kidney damage. Bedrest is not indicated for the client who has undergone a CT scan with contrast dye. CT with contrast dye is not a painful procedure, so pain medication is not indicated. The client who has undergone CT with contrast dye is not at risk for hematuria.

RN who usually works on the general surgical unit The nurse with experience in taking care of surgical clients will be most capable of monitoring the client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure. The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN should not be assigned to a client requiring IV therapy and who is at high risk for complications.

A client who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client?

Refers the client to the clinic nurse practitioner for immediate follow-up Pregnant women with UTIs require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor with adverse effects for the fetus. It is unsafe for the client to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay.

Restricted protein Correct Restricted fluids Correct Low potassium Correct Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.

Signs and symptoms of fluid retention (e.g., crackles in the lung fields and 3+ edema of the lower extremities) indicate transplant rejection. Increased blood pressure is also a symptom of transplant rejection. Increasing BUN and creatinine are symptoms of rejection; a BUN of 21 mg/dL and a creatinine of 0.9 mg/dL reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

Which condition may predispose a client to chronic pyelonephritis? Spinal cord injury Cardiomyopathy Hepatic failure Glomerulonephritis

Spinal cord injury Chronic pyelonephritis occurs with spinal cord injury, bladder tumor, prostate enlargement, or urinary tract stones. Weakness of the heart muscle may cause kidney impairment, not an infection. Pyelonephritis may damage the kidney, not the liver. Glomerulonephritis may result from infection, but may not cause infection of the kidney.

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? Eggs Correct Ham Eggplant Macaroni

Suggested protein-containing foods for a client on peritoneal dialysis are milk, meat, and eggs. Although a protein, ham is high in sodium, which should be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? (Select all that apply.) Suprapubic pain Vomiting Chills Dysuria Oliguria

Suprapubic pain Vomiting Correct Chills Correct Dysuria Correct Oliguria Nausea and vomiting are symptoms of acute pyelonephritis. Chills along with fever may also occur, as well as burning (dysuria), urgency, and frequency. Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

TB Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation; these conditions worsen with the immune suppressants that are required to prevent rejection. A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point, and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.

The nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by the health care provider for a client with a urinary tract infection (UTI), does the nurse question?

Tegretol Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin (gatifloxacin) and Tegretol (carbamazepine).

Temperature of 101.2° F (38.4° Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever.

The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first? Obtain blood urea nitrogen (BUN) and creatinine. Position the client supine. Administer pain medications. Check urine for hematuria.

The client is positioned supine for several hours after a kidney biopsy to decrease the risk for hemorrhage. BUN and creatinine would be obtained before the procedure is performed. Only local discomfort should be noted around the procedure site; severe pain would indicate hematoma. Although pink urine may develop, the nurse should position the client to prevent bleeding first; the other actions are appropriate after this procedure, but do not need to be done immediately after the biopsy.

The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first? Obtain blood urea nitrogen (BUN) and creatinine. Position the client supine. Correct Administer pain medications. Check urine for hematuria.

The client may be asked to sign the consent form in the department; notifying both the provider and the department ensures communication across the continuum of care, with less likelihood of omission of information. The provider gives the client a complete description of and reasons for the procedure and explains complications; the nurse reinforces this information. The procedure should not be cancelled without an attempt to correct the situation. The client has not received sedation, so nothing suggests that the client is not competent to consent.

A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration should be cared for by which staff member? RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma RN who is caring for a client who just returned after having renal artery balloon angioplasty RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

The client scheduled for nephrectomy is the most stable client; the RN caring for this client will have time to perform the frequent monitoring and interventions that are needed for the newly admitted client. The client receiving chemotherapy will require frequent monitoring by the RN. The client after angioplasty will require frequent vital sign assessment and observation for hemorrhage and arterial occlusion. The client with acute hypertension will need frequent monitoring and medication administration.

A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration should be cared for by which staff member? RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma RN who is caring for a client who just returned after having renal artery balloon angioplasty RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy Correct RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

For which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider? (Select all that apply.) Client with an allergy to shrimp Correct Client with a history of asthma Correct Client who requests morphine sulfate every 3 hours Client with a blood urea nitrogen of 62 mg/dL and a creatinine of 2.0 mg/dL Correct Client who took metformin (Glucophage) 4 hours ago Correct

The client who will be undergoing a CT scan with contrast should be asked about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. Contrast reactions have been reported to be as high as 15% in these clients. Clients with asthma have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. The risk for contrast-induced nephropathy is increased in clients who have pre-existing renal insufficiency (e.g., serum creatinine levels greater than 1.5 mg/dL or estimated glomerular filtration rate less than 45 mL/min). Metformin must be discontinued at least 24 hours before and for at least 48 hours after any study using contrast media because the life-threatening complication of lactic acidosis, although rare, could occur. There are no contraindications to undergo CT with contrast while taking morphine sulfate. CT with contrast may help to identify the underlying cause of pain.

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? Auscultate for pericardial friction rub. Correct Assess for crackles. Monitor for decreased peripheral pulses. Determine if the client is able to ambulate.

The client with uremia is prone to pericarditis; symptoms include inspiratory chest pain, low-grade fever, and ST-segment elevation. Crackles and tachycardia are symptomatic of fluid overload; fever is not present. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of symptoms of pericarditis that the client presents with.

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? Client with chronic kidney failure who was just admitted with shortness of breath Correct Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted Client with azotemia whose blood urea nitrogen and creatinine are increasing Client receiving peritoneal dialysis who needs help changing the dialysate bag

The dyspnea of the client with chronic kidney failure may indicate pulmonary edema and should be assessed immediately. The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions, but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? Adherence to therapy Handwashing Monitoring for low-grade fever Strict clean technique

After receiving change-of-shift report on the urology unit, which client does the nurse assess first? Client post radical nephrectomy whose temperature is 99.8° F (37.6° C) Client with glomerulonephritis who has cola-colored urine Client who was involved in a motor vehicle crash and has hematuria Client with nephrotic syndrome who has gained 2 kg since yesterday

The nurse should be aware of the risk for kidney trauma after a motor vehicle crash; this client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria because hemorrhage can be life-threatening. Although slightly elevated, the low-grade fever of the client who is post radical nephrectomy is not life-threatening in the same way as a trauma victim with bleeding. Cola-colored urine is an expected finding in glomerulonephritis. Because of loss of albumin, fluid shifts and weight gain can be anticipated in a client with nephrotic syndrome.

After receiving change-of-shift report on the urology unit, which client does the nurse assess first? Client post radical nephrectomy whose temperature is 99.8° F (37.6° C) Client with glomerulonephritis who has cola-colored urine Client who was involved in a motor vehicle crash and has hematuria Correct Client with nephrotic syndrome who has gained 2 kg since yesterday

The nurse should ensure adequate hydration by urging the client to take oral fluid or by giving IV fluids. Hydration reduces the risk for kidney damage. Bedrest is not indicated for the client who has undergone a CT scan with contrast dye. CT with contrast dye is not a painful procedure, so pain medication is not indicated. The client who has undergone CT with contrast dye is not at risk for hematuria.

The nurse should provide privacy, assistance, and voiding stimulants, such as warm water over the perineum, as needed, for the client with urinary problems. Increased oral fluids and IV fluids would exacerbate the client's problem. Obtaining a health history is not the priority for this client's care.

The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client. The use of children's terms is demeaning to adult clients. The use of slang terms is unprofessional. Technical terms should not be used because the client may not know what they mean.

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? RN who has floated from pediatrics for this shift LPN/LVN with experience working on the medical unit RN who usually works on the general surgical unit Correct New graduate RN who just finished a 6-week orientation

The nurse with experience in taking care of surgical clients will be most capable of monitoring the client receiving rapid fluid infusions, who is at risk for complications such as pulmonary edema and acute kidney failure. The pediatric float RN and the new graduate RN will have less experience in caring for this type of client. The LPN/LVN should not be assigned to a client requiring IV therapy and who is at high risk for complications.

The procedure will be cancelled or delayed if coagulopathy in the form of prolonged PT/INR exists because dangerous bleeding may result. Nephrostomy tubes are placed to prevent and treat kidney damage; monitoring BUN and creatinine is important, but is not essential before this procedure. H&H is monitored to detect anemia and blood loss; this would not occur before the procedure. This client should be on I&O during the entire hospitalization; it is not necessary only before the procedure, but throughout the admission.

When caring for a client who had a nephrostomy tube inserted 4 hours ago, which is essential for the nurse to report to the health care provider? Dark pink-colored urine Small amount of urine leaking around the catheter Tube that has stopped draining Correct Creatinine of 1.8 mg/dL

The provider must be notified when a nephrostomy tube does not drain; it could be obstructed or dislodged. Pink or red drainage is expected for 12 to 24 hours after insertion and should gradually clear. The nurse may reinforce the dressing around the catheter to address leaking urine; however, the provider should be notified if there is a large quantity of leaking drainage, which may indicate tube obstruction. A creatinine level of 1.8 mg/dL is expected in a client early after nephrostomy tube placement (due to the minor kidney damage that required the nephrostomy tube).

When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? Abdominal girth Presence of urinary infection History of hysterectomy Correct Hematuria

The scanner must be in the scan mode for female clients to ensure the scanner subtracts the volume of the uterus from the measurement, or in the scan mode for male clients for women who have undergone a hysterectomy. The nurse performs this procedure in response to distention or pressure in the bladder; girth is not a factor. This procedure detects urine retained in the bladder, not infection. The presence of retained urine in the bladder is assessed, regardless of hematuria.

A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease? "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." Correct "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." "If my children have the ADPKD gene, they will have cysts by the age of 30." "My children have a 50% chance of inheriting the ADPKD gene that causes the disease."

There is no way to prevent ADPKD, although early detection and management of hypertension may slow the progression of kidney damage. Limiting salt intake can help control blood pressure. Presentation of ADPKD can vary by age of onset, manifestations, and illness severity, even in one family. Almost 100% of those who inherit a polycystic kidney disease (PKD) gene will develop kidney cysts by age 30. Children of parents who have the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease.

Which sign or symptom, when assessed in a client with chronic glomerulonephritis (GN), warrants a call to the health care provider? Mild proteinuria Third heart sound (S3) Serum potassium of 5.0 mEq/L Itchy skin

Third heart sound (S3) S3 indicates fluid overload secondary to failing kidneys; the provider should be notified and instructions obtained. Mild proteinuria is an expected finding in GN. A serum potassium of 5.0 mEq/L reflects a normal value; intervention would be needed for hyperkalemia. Although itchy skin may be present as kidney function declines, it is not a priority over fluid excess.

A client with these assessment data is preparing to undergo a computed tomography scan with contrast: Physical Assessment Diagnostic Findings Medications Flank pain BUN 54 mg/dL Captopril Dysuria Creatinine 2.4 mg/dL Metformin Bilateral knee pain Calcium 8.5 mg/dL Acetylcysteine Which medication does the nurse plan to administer before the procedure? Acetylcysteine (Mucosil) Correct Metformin (Glucophage) Captopril (Capoten) Acetaminophen (Tylenol)

This client has kidney impairment demonstrated by increased creatinine. Acetylcysteine (an antioxidant) may be used to prevent contrast-induced nephrotoxic effects. Metformin is held at least 24 hours before procedures using contrast. Although captopril and acetaminophen may be administered with a sip of water with permission of the provider, this is not essential before the procedure.

To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure.

The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? "I must clean with the wipes and then urinate directly into the cup." "I will have to drink 2 liters of fluid before providing the sample." "I'll start to urinate in the toilet, stop, and then urinate into the cup." Correct "It is best to provide the sample while I am bathing."

To provide a clean-catch urine sample, the client should initiate voiding, then stop, then resume voiding into the container. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. Although cleaning with wipes before providing a clean-catch urine sample is proper procedure, a step is missing. It is not necessary to drink 2 liters of fluid before providing a clean-catch urine sample. Providing a clean-catch urine sample does not involve bathing.

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? Hematocrit of 26.7% Potassium within normal range Absence of spontaneous fractures Less fatigue Correct

Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia.

Trimethoprim/sulfamethoxazole (Bactrim) Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole is effective in treating uncomplicated, community-acquired UTI in women. Drugs from the same class as nitrofurantoin reduce bacteria in the urinary tract by inhibiting bacterial reproduction (bacteriostatic action). This client needs a drug that will kill bacteria.

Tube that has stopped draining The provider must be notified when a nephrostomy tube does not drain; it could be obstructed or dislodged. Pink or red drainage is expected for 12 to 24 hours after insertion and should gradually clear. The nurse may reinforce the dressing around the catheter to address leaking urine; however, the provider should be notified if there is a large quantity of leaking drainage, which may indicate tube obstruction. A creatinine level of 1.8 mg/dL is expected in a client early after nephrostomy tube placement (due to the minor kidney damage that required the nephrostomy tube).

Turn the client to the opposite side. With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The dialyzing fluid is called peritoneal effluent on outflow. The outflow should be a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, re-position the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Instructing the client to deep-breathe and cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse should re-position the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the physician re-positions a displaced catheter.

The RN is working with unlicensed assistive personnel (UAP) in caring for a group of clients. Which action is best for the RN to delegate to UAP? Assessing the vital signs of a client who was just admitted with blunt flank trauma and hematuria Assisting a client who had a radical nephrectomy 2 days ago to turn in bed Helping the provider with a kidney biopsy for a client admitted with acute glomerulonephritis Palpating for bladder distention on a client recently admitted with a ureteral stricture

UAP would be working within legal guidelines when assisting a client to turn in bed. Although assessment of vital signs is within the scope of practice for UAP, the trauma victim should be assessed by the RN because interpretation of the vital signs is needed. Assisting with procedures such as kidney biopsy and assessment for bladder distention are responsibilities of the professional nurse that should not be delegated to staff members with a limited scope of education.

The RN is working with unlicensed assistive personnel (UAP) in caring for a group of clients. Which action is best for the RN to delegate to UAP? Assessing the vital signs of a client who was just admitted with blunt flank trauma and hematuria Assisting a client who had a radical nephrectomy 2 days ago to turn in bed Correct Helping the provider with a kidney biopsy for a client admitted with acute glomerulonephritis Palpating for bladder distention on a client recently admitted with a ureteral stricture

What is the appropriate range of urine output for the client who has just undergone a nephrectomy? 23 to 30 mL/hr 30 to 50 mL/hr Correct 41 to 60 mL/hr 50 to 70 mL/hr

A nurse plans care for a client with overflow incontinence. Which intervention should the nurse include in this client's plan of care to assist with elimination?

Use the Valsalva maneuver. In clients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure, such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if to defecate), can initiate voiding.

Using a bladder scanner (with training) to check residual bladder volume after the client voids Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill.

Which factor represents a sign or symptom of digoxin toxicity? Serum digoxin level of 1.2 ng/mL Polyphagia Visual changes Serum potassium of 5.0 mEq/L

Visual changes, anorexia, nausea, and vomiting are symptoms of digoxin toxicity. A digoxin level of 1.2 ng/mL is normal (0.5 to 2.0 ng/mL). Polyphagia is a symptom of diabetes. Although hypokalemia may predispose to digoxin toxicity, this represents a normal, not low, potassium value.

Which factor represents a sign or symptom of digoxin toxicity? Serum digoxin level of 1.2 ng/mL Polyphagia Visual changes Correct Serum potassium of 5.0 mEq/L

Which statement by a client with diabetic nephropathy indicates a need for further education about the disease? "Diabetes is the leading cause of kidney failure." "I need less insulin, so I am getting better." Correct "My blood sugar may drop really low at times." "I must call my provider if the urine dipstick shows protein."

When kidney function is reduced, insulin is available for a longer time and thus less of it is needed. Unfortunately, many clients believe this means that their diabetes is improving. It is true that diabetes mellitus is the leading cause of end-stage kidney disease among Caucasians in the United States. Clients with worsening kidney function may begin to have frequent hypoglycemic episodes. Proteinuria, which may be mild, moderate, or severe, indicates a need for follow-up.

Which percussion technique does the nurse use to assess a client who reports flank pain? Place outstretched fingers over the flank area and percuss with the fingertips. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. Correct Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. Quickly tap the flank area with cupped hands.

While the client assumes a sitting, side-lying, or supine position, the nurse forms one of the hands into a clenched fist. The other hand is placed flat over the costovertebral (CVA) angle of the client. Then, a firm thump is quickly delivered to the hand over the CVA area. Percussion is not appropriate for flank pain. Placing one hand palm up is not the correct technique. Percussion therapy, not assessment, involves tapping the flank area.

With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The dialyzing fluid is called peritoneal effluent on outflow. The outflow should be a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, re-position the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help. Instructing the client to deep-breathe and cough will not promote dialysate drainage. Increased abdominal pressure from coughing contributes to leakage at the catheter site. The nurse needs to measure and record the total amount of outflow after each exchange. However, the nurse should re-position the client first to assist with complete dialysate drainage. An x-ray is needed to identify peritoneal dialysis catheter placement. Only the physician re-positions a displaced catheter.

A 53-year-old patient is newly diagnosed with renal artery stenosis. What clinical manifestation is the nurse most likely to observe when the patient first seeks health care? a. Sudden onset of hypertension b. Urinary frequency and dysuria c. Nausea and vomiting d. Flank pain and hematuria

A patient ahs had one kidney removed as a treatment for kidney cancer. the patient spouse asks, "Does the good kidney take over immediately? I know a person can live with just one kidney." What is the nurse's best response? a. "The other kidney will provide adequate function, but this may take days or weeks" b "The other kidney alone isn't able to provide adequate function so supplemental therapies will be needed" c. "That's a good question. Remember to ask your doctor next time he or she comes in" d "It varies a lot, but within a few days we expect every to normalize"

A patient had a cystoscopy. After the procedure, what does the nurse expect to see in this patient? a. Pink-tinged urine b. Blood urine c. Very dilute urine d. Decreased urine output

A patient had a nephrostomy and a nephrostomy tube is in place. what is included in the postoperative care of this patient? a. Assess the amount of drainage in the collection bag b. Irrigate the tube to ensure patency c. Keep the patient NPO for 6 to 8 hours d. Review the results fo the clotting studies

A patient has been receiving erythropoietin (Epogen). Which statement by the patient indicates that the therapy is producing the desired effect? a. "I can do my housework with less fatigue" b. "I have been passing more urine than I before" c. "I have less pain and discomfort now" d. "I can swallow and eat much better than before."

A patient has come to the clinic for follow-up of acute pyelonephritis. Which action does the nurse reinforce to the patient? a. Complete all antibiotic regimens b. Report episode of nocturia c. Stop taking the antibiotic when pain is relieved d. Avoid taking any over-the-counter drugs

A patient has returned to the medical-surgical unit after having a dialysis treatment. The nurse notes that the patient is also scheduled for an invasive procedure on the same day. What is the primary rationale for delaying the procedure for 4 to 6 hours? a. The patient was heparinized during dialysis b. The patient will have cardiac dysrhythmias after dialysis c. The patient will be incoherent and unable to give consent d. The patient needs routine medications that were delayed

A patient is admitted for acute glomerulonephritis. In reviewing the patient's past medical history, which systemic conditions does the nurse suspect may have caused acute glomerulonephritis and will include in the overall plan of care? a. Systemic lupus erythematosus and diabetic nephropathy b. Myocardial infarction and atrial fibrillation c. Ischemic stroke and hemiparesis d. Blunt trauma to the kidney with hematuria

A patient is diagnosed with hydronephrosis. What is a complication that could result from this condition? a. Damage to the nephrons b. Kidney cancer c. Kidney stone d. Structural defects

A patient is newly diagnosed with type 2 diabetes mellitus. which screening recommendation does the nurse give to the patient regarding the early detection of diabetic kidney disease? a. Urine should be tested annually for protein and microalbuminuria b. Blood urea nitrogen and serum creatinine should test within 5 years c. Urine should be tested within 5 years for protein and microalbuminuria d. Urine should be tested annually for protein, glucose, and blood

A patient is scheduled for a CT with iodinated contrast medium. Which medication is discontinued 24 hours before the procedure and for at least 48 hours until kidney function has been reevaluated? a. Glucophage (Metformin) b. Morphine (MS Contin) c. Furosemide (Lasix) d. Oral acetylcysteine (Mucomyst)

A patient reports straining to pass very small amounts of urine today, despite a normal fluid intake, and reports having the urge to urinate. The nurse palpates the bladder and finds that it is distended. which condition is most likely to be associated with these findings? a. urethral stricture b. Hydroureter c. Hydronephrosis d. PKD

A patient sustained extensive burns and depletion of vascular volume. The nurse expects which changes in vital signs and urinary function? a. Decreased urine output, hypotension, tachycardia b. Increased urine output, hypertension, tachycardia c. Bradycardia, hypotension, polyuria d. Dysrhythmias, hypertension, oliguria

A patient with AKI has a high rate of catabolism. What is this related to? a. Increased levels of catecholamines, cortisol, and glucagon b. Inability to excrete excess electrolytes c. Conversion of body fat into glucose d. Presence of retained nitrogenous wastes

A patient with AKI is receiving TPN. What is the therapeutic goal of using TPN? a. Preserve lean body mass b. Promote tubular reabsorption c. Create a negative nitrogen balance d. Prevent infection

A patient with CKD develops severe chest pain, an increased pulse, low-grade fever, and a pericardial friction rub with a cardiac dysrhythmia and muffled heart tones. The nurse immediately alerts the health care provider and prepares fo which emergency procedure? a. Pericardiocentesis b. CVVH c. Kidney dialysis d. Endotracheal intubation

A patient with CKD has a potassium level of 8 mEq/L. The nurse notifies the health care provider after assessing for which sing/symptoms? a. Cardiac dysrhythmias b. Respiratory depression c. Tremors or seizures d. Decreased urine output

A patient with PKD has nocturia. What does the nurse encourage the patient to do? a. Drink at least 2 litres of fluid daily b. restrict fluid in the evening c. Drink 1000 mL early in the morning d. add a pinch of salt to water in the evenings

According to the RIFLE classification. How would the nurse interpret the following data? Serum creatinine increased x 1.5 or GFR decrease > 25%; Urine output is <0.5 mL/kg/hr for more than 6 hours. a. Risk stage b. Injury stage c. Failure stage d. ESKD

IN order to assist a patient in the prevention of osteodystrophy, which intervention does the nurse perform? a. Administer phosphate binders with meals b. Encourage high-quality protein foods c. Administer iron supplements d. Encourage extra milk at mealtimes

Impairment in the thirst mechanisms associated with aging makes an older adult patient more vulnerable to which disorder? a. Hypernatremia b. Hypocalcemia c. Hyperkalemia d. Hypoglycemia

Limiting fluid intake would have what effect on urine? a. Increases the concentration of urine b. Makes the urine less irritating c. Decreases the risk for urine infection d. decreases the pH of urine

Mastering voluntary micturtition is a normal developmental task for which person? a. a healthy 20-month-old toddler b. a 56-year-old women with stress incontinence c. a healthy 8-year-old child d. a 25-year-old with a spinal cord injury

The community health nurse is designing programs to reduce kidney problems and kidney injury among the general public. In order to do so, the nurse targets health promotion and compliance with therapy for people with which conditions? a.Diabetes mellitus and hypertension b. Frequent episodes of sexually transmitted disease c. Osteoporosis and other bone disease d. Gastroenteritis and poor eating habits

The health care team is using a collaborative and interdisciplinary approach to design a treatment plan for a patient with PKD. What is the top priority? a. Controlling hypertension b. Preventing rupture of cysts c. Providing genetic counseling d. Identifying community resources

The home health nurse is evaluating the home setting for a patient who wishes to have in-home hemodialysis. What is important to have in the home setting to support this therapy? a. Specialized water treatment system to provide a safe, purified water supply b. Large dust-free space to accommodate and store the dialysis equipment c. Modified electrical system to provide high voltage to power the equipment d. Specialized cooling system to maintain strict temperature control

The home health nurse is visiting a patient who independently performs PD. Which question does the nurse ask the patient to assess for the major complication associated with PD? a. "Have you noticed any signs or symptoms of infection?" b. "Are you having any pain during the dialysis treatments" c. "Is the dialysate fluid slow or sluggish?" d. "Have you noticed any leakage around the catheter?"

The nurse hears in report that the patient is having renal colic pain. Whne performing the physical assessment of this patient during a severe pain episode, what additional sign/symptoms may the nurse expect to observe? a. Diaphoresis b. Redness over the flank c. Jaundice d. Bruit in the renal artery

The nurse is assessing a patient for bladder distention. What technique does the nurse use? a. Gently palpate for the outline of the bladder, percuss the lower abdomen, continue toward the umbilicus until dull sounds are no longer produced b. gently palpate for the outline of the bladder, auscultate for sounds in the lower abdomen c. Place one hand under the back and palpate with the other hand over the bladder, percuss the lower abdomen until tympanic sounds are no longer produced. d. Use the hand to depress the bladder as the patient takes a deep breath, then percuss

The nurse is caring for a patient requiring PD> In order to monitor the patient's weight, what does the nurse do? a. Check the weight after a drain and before the next fill to monitor the patients "dry weight" b. Calculate the "dry weight" by weighing the patient every day and comparing the measurements to baseline c. Determine "dry weight" by comparing the patient's weight to a standard weight chart based on height and age d. Weigh the patient each day and count fluid intake and dialysate volume to determine the patients "dry weight"

The nurse is caring for a patient who had hypovolemic shock secondary to trauma in the ED 2 days ago. Based on the pathophysiology of hypovolemia and prerenal azotemia, what does the nurse assess at least every hour? a. Urinary output b. Presence of edema c. Urine color d. Presence of pain

The nurse is caring for a patient with AKI and notes a trend of increasingly elevated BUN levels.How does the nurse interpret this information? a. Breakdown of muscle for protein which leads to an increase in azotemia b. Sign of urinary retention and decreased urinary output c. Expected trend that can be reversed by increasing dietary protein d. Ominous sign of impending irreversible kidney failure

The nurse is caring for a patient with AKI who does not have signs or symptoms fo fluid overload. A fluid challenge is performed to promote kidney perfusion by doing what? a. Administering normal saline 500 to 1000 mL infused over 1 hour b. Administering drugs to suppress aldosterone release c. Instilling warm, sterile normal saline into the bladder d. Having the patient drink several large glasses of water

The nurse is caring for a postoperative patient and is evaluating the patient's intake and output as a measure to prevent AKI. The patient weighs 60 kilograms and has produced 180 mL of urine in the past 4 hours. HWat should the nurse do? a. Perform other assessments related to fluid status and record the output b. Call the health care provider and obtain an order for a fluid bolus c. Encourage the patient to drink more fluid, so that the output is increased d. Compare the patient weight to baseline to determine fluid retention

The nurse is caring for several patients on a medical-surgical unit. None of the patients currently has any acute or chronic kidney problems. Which patient has the greatest risk to develop AKI? a. 73-year-old male who has hypertension and peripheral vascular disease b. 32-year-old female who is pregnant and has gestational diabetes c. 49-year-old male who is obese and has a history of skin cancer d. 23-year-old female who has been treated for a urinary tract infection

The nurse is caring for the patient with kidney cell carcinoma. What does the nurse expect to find documented about the patient initial assessment? a. Flank pain, gross hematuria, palpable kidney mass, and renal bruit b. Gross hematuria, hypertension, diabetes, and oliguria c. Dysuria, polyuria, dehydration, and palpable kidney mass d. Nocturia and urinary retention with difficulty starting stream

The nurse is evaluating a patient's treatment response to erythropoietin (Epogen). Which hemoglobin reading indicates that the goal is being met? a. Around 10 g/dL b. Greater than 20 g/dL c. Upward trend d. At baseline for gender

The nurse is review ABG results of a patient with acute glomerulonephritis. the pH of the same is 7.35. As acidosis is likely to be present because of hydrogen ion retention and loss of bicarbonate, how does the nurse interpret this data? a. Normal pH with respiratory compensation b. Acidosis with failure of respiratory compensation c. Alkalosis with failure of metabolic compensation d. Normal pH with metabolic compensation

The nurse is reviewing the laboratory results for a patient with chronic glomerulonephritis. the serum albumin level is low. What else does the nurse expect to see? a. Proteinuria b. Elevate haematocrit c. High specific gravity d. Low white blood cell count

The nurse is reviewing the laboratory results of a patient with chronic glomerulonephritis. The phosphorus level is 5.3 mg/dL. What else does the nurse expect to see? a. Serum calcium level below the normal range b. Serum potassium level below the normal range c. Falsely elevated serum sodium level d. Elevate serum levels for all other electrolytes

The nurse is reviewing the results of a patient ultrasound of the kidney. The report reveals an enlarged kidney which suggests which possible problem? a. Polycystic kidney b. Kdienyinfection c. Renal carcinoma d. Chronic kidney disease

The nurse is reviewing urinalysis results for a patient who is in the early stage of CKD, What results might the nurse expect to see? a. Excessive protein, glucose, red blood cells, and white blood cells b. Increased specific gravity with a dark amber discoloration c. Dramatically increased urine osmolarity d. Pink tinged urine with obvious small blood clots

The nurse is talking to a patient with ESKD. The patient frequently displays weight gain and increased blood pressure beyond the baseline measurements. Which question is the nurse most likely to ask to determine if the patient is doing something that is contributing to these assessment findings? a. "Are you controlling your salt intake?" b. "Are you following the protein restrictions?" c. "Have you been eating a lot of sweets" d. "Have you been exercising regularly?"

The nurse monitors a CKD patients daily weights because of the risk for fluid retention. What instruction does the nurse give to the UAP? a. Weigh the patient daily at the same time each day, same scale, with the same amount of clothing b. Weigh the patient daily and add 1 kilogram of weight for the intake of each liter of fluid c. Weigh the patient in the morning before breakfast and weigh the patient at night just before bedtime d. Ask the patient what his or her normal weight is and then weight the patient before and after each voiding

The nurse performs a dipstick urine test for a patient being evaluated for kidney problems. Glucose is present in the urine. How does the nurse interpret this result? a. Blood glucose level is greater than 220 mg/dL b. The kidneys are failing to filter any glucose c. The patient is at risk for hypoglycemia d. The renal threshold has not been exceeded

The off-going nurse is giving shift report to the oncoming nurse about the care of a patient who had a nephrostomy tube placed 3 days ago and it is to remain in place until the urinary obstruction is resolved. What is the most important point to clearly communicate about the urine drainage? a. "Urine is draining only into the collection bag, not the bladder; therefore the minimum expected drainage is 30 mL/hr" b. "For the first 24 hours postoperatively, the amount of urinary drainage was assessed every hour." c. "The surgeon placed ureteral tubes so all the urine may pass through the bladder or all of the urine might go directly into the collection bag" d "The nephrostomy site has not been leaking any blood or urine and you should continue to monitor the site for leakage"

The patient with CKD reports chronic fatigue and lethargy with weakness and mild shortness of breath with dizziness when rising to a standing position. In addition, the nurse notes pale mucous membranes. Based on the patient's illness and the presenting symptoms, which laboratory result does the nurse expect to see? a. Low hemoglobin and hematocrit b. low white cell count c. Low blood glucose d. Low oxygen saturation

What is the best description of CAPD? a. Daily infusion of four 2 L exchanges of dialysate every 4 to 6 hours while awake b. Is a form of automated dialysis that uses an automated cycling machine c. Functions of the cycling machine are programmed to the patient's needs d. This form decreases the risk of peritonitis and poor dialysate flow

Which data indicates that the patient with diabetes is achieving the goals of care to prevent the development of microalbuminuria and delay the progression to end-stage kidney disease? a. A1C <7%, BP is 125/75 mm Hg, LDL cholesterol is 90 mg/dL b. A1C >7%, BP is 140/80 mm Hg, LDL cholesterol is 200 mg/dL c. A1C <7%, BP is 130/80 mm Hg with proteinuria 2.0 g/24 hours d. A1C >7%, BP is 120/70 mm Hg, LDL cholesterol is 300 mg/dL

Which disorder could be a complication from AKI? a. Heart failure b. Diabetes mellitus c. Kidney cancer d. Compartment syndrome

Which patient has the greatest risk of developing a kidney abscess? a. Patient is diagnosed with acute pyelonephritis b. Patient has flank asymmetry related to hydronephrosis c. Patient developed a urinary tract infection secondary to a urinary catheter d. Patient is diagnosed with hypertension and nephrosclerosis

Which patient is most likely to have a decreased calcium level? a. Patients with kidney disease b. Patients with cystitis c. Patients with a Foley catheter d. Patients with urinary retention

Which patient is most likely to produce urine with a specific gravity of less than 1.005? a. Takes diuretic medication everyday b. Has dehydration secondary to vomiting c. Is hypovolemic due to blood loss d. Has syndrome of inappropriate antidiuretic horome

Which renal change associated with aging does the nurse expect an older adult patient to report a. Nocturanl polyuria b. Micturition c. Hematuria d. Dysuria

Why may a patient with PKD experience constipation? a. Polycystic kidneys enlarge and put pressure on the large intestine b. patient becomes dehydrated because the kidneys are dysfunctional c. Constipation is a side effect from the medication given to treat PKD d. Patients with PKD have special dietary restrictions that cause constipation

an elderly patient has been in bed for several days after a fall. The nurse encourages ambulation to stimulate the movemnt of urine through the ureter by what phenomenon? a. Peristalsis b. Gravity c. Pelvic pressure d. Back flow

the nurse is talking to a group of older women about changes in the urinary system related to aging. what symptoms is likely to be the common concern for this group? a. Incontinence b. Hematuria c. Retention d. Dysuria

The nurse is caring for a patient receiving gentamicin. Because this drug has potential for nephrotoxicity, which laboratory results does the nurse monitor? (SATA) a. BUN b. Creatinine c. Drug peak and trough levels d. PT e. Platelet count f. Hemoglobin and hematocrit

abc

Which are the most accurate ways to monitor kidney function in the patient with CKD? (SATA) a. Monitoring intake and output b. Checking urine specific gravity c. Reviewing BUN and serum creatinine levels d. Reviewing x-ray reports e. Consulting the dietitian's notes

abc

Which diagnostic tests and results does the nurse expect to see with acute glomerulonephritis? (SATA) a. Urinalysis revealing hematuria b. Urinalysis revealing proteinuria c. Microscopic red blood cell casts d. Serum albumin levels increased e. serum potassium decreased

abc

The nurse is assessing a patient with uremia. Which gastrointestinal changes does the nurse expect to find? (SATA) a. Halitosis b. Hiccups c. Anorexia d. Nausea e. Vomiting f. Salivation

abcde

A patient is brought to the ED after being involved in a fight in which the patient was kicked and punched repeatedly in the back. What does the nurses include in the initial physical assessment? (SATA) a. Take complete vital signs b. Check apical and peripheral pulses c. Inspect both flanks for asymmetry or penetrating injuries fo the lower chest or back d. Inspect the abdomen for bruising or penetrating wound e. Deeply palpate the abdomen for signs of rigidity f. Inspect the urethra for gross bleeding

abcdf

In collaboration with the registered dietitian, the nurse teaches the patient about which diet recommendations for management of CKD? (SATA) a. Controlling protein intake b. Limiting fluid intake c. Restricting potassium d. Increasing sodium e. Restricting phosphorus f. Reducing calories

abce

A patient can develop intrarenal kidney injury from which causes? (SATA) a. Vasculitis b. Pyelonephritis c. Strenuous exercise d. Exposure to nephrotoxins e. Bladder cancer

abd

The nurse is developing a teaching plan for a patient with PKD. Which topics does the nurse include? (SATA) a. Teach how to measure and record blood pressure b. Assist to develop a schedule for self-administering drugs c. Instruct to take and record weight twice a month d. Explain the potential side effects of the drugs e. Review high-protein, low-fat diet plan.

abd

Which characteristics are associated with ESKD? (SATA) a. Severe fluid overload b. Renal osteodystrophy c. Nephrons compensate d. Dialysis or transplant needed to maintain homeostasis e. Excessive waste products

abde

A patient with CKD is taking digoxin (Lanoxin). Which signs of digoxin toxicity does the nurse vigilantly monitor for? (SATA) a. Nausea and vomiting b. Visual changes c. Respiratory depression d. Restlessness or confusion e. Headache or fatigue f. Tachycardia

abdef

What laboratory values would the nurse interpret for a patient experiencing problems with urinary elimination as a result of acute pyelonephritis? (SATA) a. Observe complete blood count for elevation of differentials b. Observe for elevation of BUN nd serum creatinine levels c. Observe for electrolyte imbalances, such as hypokalemia d. Observe arterial blood gases for alkalosis and respiratory compensation e. Observe urinalysis for baceria, leukocyte esterase, nitrate, or red blood cells

abe

What might the nurse notice if the patient is experiencing reduced perfusion and altered urinary elimination related to AKI? (SATA) a. Hemodynamic instability, especially persistent hypotension and tachycardia b. Urine output of less than 0.5 mL/kg/hour for 6 or more hours c. Serum creatinine below baseline or admission values d. Urien may be clear o have a pale yellow color e. Abnormal serum and urine potassium and sodium values

abe

When shock or other problems cause an acute reduction in blood flow to the kidneys, how do the kidneys compensate? (SATA) a. Constrict blood vessels in the kidneys b. Activate the renin-angiotensin-aldosterone pathway c. Release beta blockers d. Dilate blood vessels throughout the body e. Release antidiuretic hormones

abe

the nurse is taking a history on a patient with a change in urinary patterns. in additon to medical and surgical history, what does the nurse ask the patient about to complete the assessment? (SATA) a. Occupation exposure to toxins b. Use of illicit substances, such as cocaine c. Financial resources for payment of treatments d. Likelihood of complying with treatment recommendations e. Recent travel to geographic regions that pose infectious disease risks

abe

The nurse is caring for a patient in the intensive care unit who sustained blood loss during a traumatic accident. For early identification of signs and symptoms that would suggest the development of kidney dysfunction, what does the nurse observe for? (SATA) a. Hypotension b. Bradycardia c. Decreased urine output d. Decreased cardiac output e. Increased central venous pressure

acd

Which signs/symptoms does the nurse expect to see in the patient with AKI that has progressed in severity? (SATA) a. Oliguria b. Hypotension c. Shortness of breath d. Pulmonary crackles e. Weight loss

acd

The nurse is interviewing a patient with suspected PKD. What questions does the nurse ask the patient? (SATA) a. "Is there any family history of PKD or kidney disease?" b. "Do you have a history of sexually transmitted disease?" c. "Have you had any constipation or abdominal discomfort? d. "Have you noticed a change in urine color or frequency?" e. "Have you had any problems with headaches?" f. "Is there a family history of sudden death from a myocardial infarction?"

acde

Which patients with CKD are candidates for intermittent hemodialysis (SATA) a. Patients with fluid overload who does not respond to diuretics b. Patient with injury stage according to the RIFLE classification c. Patient with symptomatic toxin ingestion d. patient with uremic manifestations, such as decreased cognition e. Patient with symptomatic hyperkalemia and calciphylaxis

acde

The nurse is taking a history of a patient at risk for kidney failure. What does the nurse ask the patient about during the interview? (SATA) a. Exposure to nephrotoxic chemicals b. Increased appetite c. History of diabetes mellitus, hypertension, systemic lupus erythematosus d. Recent surgery, trauma, or transfusions e. Leakage of urine when coughing or laughing f. Recent or prolonged use of antibiotics and NSAIDs

acdf

Kidney tissue changes in chronic glomerulonephritis are caused by which factors? (SATA) a. Ischemia b. Fluid overload c. Hypertension d. Obstruction e. Infection

ace

A patient has undergone a kidney biopsy. In the immediate postprocedural period, the nurse notifies the health care provider about which findings? (SATA) a. Hematuria with blood clots b. Localized pain at the site c. "Tamponade effect" d. Decreasing urine output e. Flank pain f. Decreasing blood pressure

adef

The home health nurse is reviewing the medication list of a patient with CKD. The nurse calls the health care provider as a reminder that the patient might need which nutritional supplements? (SATA) a. Iron b. Magnesium c. Phosphorus d. Calcium e. Vitamin D f. Water-soluble vitamins

adef

A patient and family are trying to plan a schedule that coordinates with the patient dialysis regimen. The patient asks, "How often will I have to go and how long does it take?" What is the nurse's best response? a. "If you are compliant with the diet and fluid restrictions, you spend less time in dialysis; about 12 hours a week" b. "Most patients require about 12 hours per week; this is usually divided into three 4-hour treatment" c. "It varies from patient to patient. You will have to call your health care provider for specific instructions" d "If you gain a large amount fo fluid weight, a longer treatment time may be needed to prevent severe side effects"

A patient had a renal scan. What is included in the postprocedural care for this patient? a. Administer laxatives to cleanse the bowel b. Encourage oral fluids to assist excretion of isotope c. Administer captopril (Capoten) to increase blood flow d. Insert a urinary catheter to measure urine output

A patient has chronic glomerulonephritis. In order to assess for uremic symptoms, what does the nurse do? a. Evaluate the BUN b. Ask the patient to extend the arms and hyperextend the wrists c. Gently palpate the flank for asymmetry and tenderness d. Auscultate for the presence of an S3 heart sound

A patient has late-stage chronic glomerulonephritis. Which educational brochure would be the most appropriate to prepare for the patient? a. "How to Take Yoru Antiinfective Medications" b. "Important Points to Know about Dialysis" c. "What Are the Side Effects of Radiation Therapy?" d. "Precautions to Take During Immunosuppressive Therapy"

A patient has undergone a kidney biopsy. what does the nurse monitor for in the patient related to this procedure? a. Nephrotoxicity b. Hemorrhage c. Urinary retention d. Hypertension

A patient is diagnosed with chronic glomerulonephritis. the patients spouse reports that the patient is irritable, forgetful, and has trouble concentrating. Which assessment finding does the nurse expect on further examination? a. Increased respiratory rate b. Elevated blood urea nitrogen c. High white count with a left shift d. Low blood pressure and bradycardia

A patient is diagnosed with kidney cancer and the health care provider recommends the best therapy. which treatment does the nurse anticipate teaching the patient about? a. Chemotherapy b. Surgical removal c. Hormonal therapy d. Radiation therapy

A patient is diagnosed with renal artery stenosis. Which sound does the nurse expect to hear by auscultation when a bruit is present in a renal artery? a. Quiet, pulsating sound b. Swishing sound c. Faint wheezing d. NO sound at all

A patient receives dialysis therapy and the health care provider has ordered sodium restriction to 3 g daily. What does the nurse teach the patient? a. Add smaller amounts of salt at the table or during cooking b. Identify foods that are high in sodium (e.g., bacon, potato chips, fast foods). c. Avoid foods that have a metallic, salty, or bitter taste d. Eat larger amounts of bland foods with very minimal amounts of spicing

A patient returns to the unit after a renal scan. Which instruction about the patient urine does the nurse give to the UAP caring for the patient? a. It is radioactive, so it should be handled with special biohazard precautions b. It does not place anyone at risk because of the small amount of radioactive material c. its radioactivity is dangerous only to those who are pregnant d. it is potentially dangerous if allowed to sit for prolonged periods in the command

A patient with CKD is restless, anxious, and short of breath. The nurse hears crackles that begin at the base of the lungs. The pulse rate is increased and the patient has frothy, blood-tinged sputum. What does the nurse do first? a Facilitate transfer to the ICU for aggressive treatment b. Place the patient in a high-Fowlers position c. Continue to monitor vital signs and assess breath sounds d. Administer a loop diuretic such as furosemide (Lasix)

A patient with diabetic nephropathy reports having frequent hypoglycemic episodes "so my doctor reduced my insulin, which means my diabetes is improving." What is the nurse's best response? a. "Congratulations! You must be following the diet and lifestyle instructions very carefully" b. "When kidney function is reduced, the insulin is available for a longer time and thus less of it is needed" c. "You should probably talk to your doctor again. You have been diagnosed with nephropathy and that changes the situation" d "Let me get you a brochure about the relationship of diabetes and kidney disease. it is a complex topic and hard to understand"

A patient with prerenal azotemia is administered to a fluid challenge. IN evaluating response to the therapy, which outcome indicates that the goal was met? a. Patient reports feeling better and indicate an eagerness to go home b. Patient produces urine soon after the initial bolus c. The therapy is completed without adverse effects d. The health care provider orders a diuretic when the challenge is complete

After a nephrectomy, one adrenal gland remains. Based on this knowledge , which type of medication replacement therapy does the nurse expect if the remaining adrenal gland function is insufficient? a. Potassium b. Steroid c. Calcium d. Estrogen

After the nurse instructs a patient with PKD on home care, the patient knows to contact the health care provider immediately when what sign/symptoms occur? a. Urine is a clear, pale yellow color b. Weight has increased by 3 pounds in 2 days c. Two days have passed since the last bowel movement d. Morning systolic blood pressure has decreased by 5 mmHg.

An older adult male patient has a history of an enlarged prostate. the patient is most liekly to report which symptoms associated with this condition? a. Inability to sense the urge to void b. Difficulty starting the urine stream c. Excreting large amounts of very dilute urine d. Burning sensation when urinating

As a patient with ESKD experiences isosthenuria, what must the nurse be alert for? a. The diuretic stage b. Fluid volume overload c. Dehydration d. Alkalosis

As a result of kidney failure, excessive hydrogen ions cannot be excreted. With acid retention, the nurse is most likely y to observe what type of respiratory compensation? a. Cheyne-Stokes respiratory pattern b. Increased depth of breathing c. Decreased respiratory rate and depth d. Increased arterial carbon dioxide levels

Damage to which renal structure or tissues can change the acutal production of urine? a. kidney parenchyma b. convulted tubules c. calyces d. ureters

During the day, the nursing student is measuring urine output and observing for urine characteristics in a patient. Which abnormal finding is the most urgent, which must be reported to the supervising nurse? a. Specific gravity is decreased b. Output is decreased c. pH is decreased d. Color has changed

In PKD, the effect on the renin-angiotensin system in the kidney has which result? a. adrenal insufficiency b. increased blood pressure c. increased urine output d. Oliguria

In which circumstance is the regulatory role of aldosterone most important in order for the person to maintain homeostasis? a. person is having pain related to a kidney stone b. person has been hiking in the desert for several hours c. person experiences stress incontinence when coughing d. person experiences a burning sensation during urination

Ketones in the urine may indicate which occurrence or process? a. Increased glomerular membrane permeability b. Chronic kidney infection c. Body's use of fat for cellular energy d. Urianry tract infection

The health care provider informs the nurse that there is a change in orders because the patient has a decrease in creatine clearance rate. what change does the nurse anticipate? a. fluid restriction b. reduction of drug dosage c. limitation on activity level d. modification of diet

The night shift nurse sees a patient with kidney failure sitting up in bed. The patient states, "I feel a little short of breath at night or when I get up to walk to the bathroom." What assessment does the nurse do? a. Check for orthostatic hypotension because of potential volume depletion b. Auscultate the lungs for crackles, which indicate fluid overload c. Check the pulse and blood pressure for possible decreased cardiac output d. Assess for normal sleep pattern and need for a PRN sedative

The nurse is assessing a patient with possible acute glomerulonephritis. During the inspection fo the hands, face, and eyelids, what is the nurse primarily observing for? a. Redness b. Edema c. Rashes d. Dryness

The nurse is assessing a patient's extremity with an arteriovenous graft. The nurse notes a thrill and a bruit, and the patient reports numbness and a cool feeling in the fingers. How does the nurse interpret this information in regards to the graft? a. The graft is functional and these symptoms are expected b. The patient has "steal syndrome" and may need surgical intervention c. The graft is patent, but the blood is flowing in the wrong direction d. The patient needs to increase active use of hands and fingers

The nurse is caring for a patient with AKI that developed after a severe anaphylactic reaction. What is a primary treatment goal of the initial phase that will help to prevent permanent kidney damage for this patient? a. Correct fluid volume by administering IV normal saline b. Maintain a mean arterial pressure (MAP) of 65 mm Hg. c. Prevent kidney infections by administering antibiotics d. Give antihistamines to prevent allergic response

The nurse is caring for a patient with ESKD and dialysis has been initiated. Which drug order does the nurse question? a. Erythropoietin b. Diuretic c. ACE inhibitor d. Calcium channel blocker

The nurse is caring for a patient with a nephrostomy. the nurse notifies the health care provider about which assessment finding? a. Urine drainage is red-tinged 4 hours post-surgery b. The amount of drainage decreases and the patient has back pain c. There is a small steady drainage for the first 4 hours postsurgery. d. The nephrostomy site looks dry and intact

The nurse is caring for a patient with dehydration. Which laboratory test results does the nurse anticipate to see for this patient? a. BUN and creatinine ratio stay the same b. BUN rises faster than creatinine level c. Creatinine rises faster than BUN d. BUN and creatinine have a direct relationship

The nurse is caring for a postoperative nephrectomy patients. the nurse notes during the first several hours of the shift a marked and steady downward trend in blood pressure. how does the nurse interpret this finding? a. Hypertension has been corrected b. Internal hemorrhage is possible c. The other kidney is failing d. This is an expected response to medication

The nurse is caring for the kidney transplant patient who is 3-day post surgery. The nurse notes a sudden and abrupt decrease in urine. The nurse alerts the health care provider because this is a sign of which anomaly a. Rejection b. Thrombosis c. Stenosis d. Infection

The nurse is interviewing a 35-year-old women who needs evaluation for a potential kidney problem. The woman reports she has been pregant twice and has two healthy children. what would the nurse ask about health problems that occurred during pregnancy? a. "How much weight did you gain during the preganncy? b. "Were you treated for gestational diabetes?" c. "Did both of your pregnancies go to full-term? d. "Did you have a urinary catheter inserted during labor?"

The nurse is performing an assessment of the renal system. What is the first step in the assessment process? a. Percuss the lower abdomen; continue toward the umbilicus b. Observe the flank region for asymmetry or discoloration c. Listen for a bruit over each renal artery d. Lightly palpate the abdomen in all quadreants

The nurse is preparing to assess a female patients urethra prior to the insertion of a Foley catheter. In addition to gloves, which equipment does the nurse obtain to perform the initial assessment? a. Glass slide b. Good light source c. Speculum d. Cotton ball

The nurse is reviewing a patient's laboratory results. IN the early phase of CKD, the patient is at risk for which electrolyte abnormality? a. Hyperkalemia b. Hyponatremia c. Hypercalcemia d. Hypokalemia

The nurse is reviewing the medication list and appropriate dose adjustments made for a patient with CKD. The nurse would question the use and/or dosage adjustment of which type of medication? a. Antibiotics b. Magnesium antacids c. Oral antidiabetics d. Opioids

The nurse is reviewing the patient's history, assessment findings, and laboratory results for a patient with suspected kidney problems. which manifestation is the main feature of nephritic syndrome? a. Flank asymmetry b. Proteinuria greater than 3.5 g of protein in 24 hours c. Serum sodium 148 mmol/L d. Serum cholesterol (total) 190 mg/dL

The nurse is taking a history on a 55-year-old patient who denies any serious chronic health problems Which sudden onset sign/symptoms suggests possible kidney disease in this patient? a. Weakness b. Hypertension c. Confusion d. Dysrhythmia

The nurse is talking to an older adult male patient who is reasonably healthy for his age, but has BPH. Which condition does the BPH potentially place him at risk for? a. Prerenal acute kidney injury b. Postrenal acute kidney injury c. Polycystic kidney disease d. Acute glomerulonephritis

The nurse is teaching a patient about performing PD at home. In order to identify the earliest manifestation of peritonitis, what does the nurse instruct the patient to do? a. Monitor temperature before starting PD b. Check the effluent for cloudiness c. Be aware of feelings of malaise d. Monitor for abdominal pain

The nurse is teaching a patient scheduled for an ultrasonography. What preprocedural instruction does the nurse give the patient? a. void just before the test begins b. drink water to fill the bladder c. stop routine medications d have nothing to eat or drink after midnight

The nurse reads in the assessment note made by the advanced-practice nurse that the "left kidney cannot be palpated." How does the nurse interpret this notation? a. The left kidney is smaller than normal, which indicates CKD b. The left kidney is normally deeper and often cannot be palpated c. The palpation of kidneys should be repeated by another provider d. The patient is too obese for this type of examination

The nurse reads in the patient's chart that he has acute-on-chronic kidney disease. How does the nurse interpret this information? a. Kidney disease has progressed to the need for dialysis or transplant b. Patient has chronic kidney disease and has sustained an acute kidney injury c. Acute kidney injury requires aggressive management to prevent chorionic disease d The condition could be acute or chronic; further diagnostic testing is needed

The nurse sees that an older patient has a blood osmolarity of 303 mOsm/L. Which additional assessment will the nurse make before notifying the health care provider about the laboratory results? a. Patients mental stauts b. Signs of dehydration c. Patients temeprature d. Odor of the urine

The nurse tells the patient that the health care provider recommends a fluid intake of at least 2 liters per day. The nurse then asks the patient to report on fluid intake over the past 24 hours to assess typical intake. The patient reports 15 ounces of coffee and 10 ounces of juice for breakfast; 10 ounces of skim milk for a midmorning snack, 12 ounces of protein shake for lunch, 1/2 liter of sports drink in the afternoon and 3 ounces of wine for dinner. After calculating the 24-hour fluid intake, what does the nurse tell the patient? a. Fluid consumptions should be increased by at least 2 more servings b. Fluid consumption is meeting the 2 liters/day recommendation c. Fluid consumption exceeds recommendation, therefore eliminate the wine d. Fluid consumption only includes liquids such as water, juice, or milk

The student nurse is assisting in the postoperative care of a patient who had a recent nephrectomy. The student demonstrates a reluctance to move the patient to change the linens because "the patient seems so tired." The nurse remind the student that a priority assessment for this patient is to assess for which factor? a skin breakdown on the patient back b. Blood on the linens beneath the patient c. Urinary incontinence and moisture d. The patient ability to move self in bed

Vitamin D is converted to its active form in the kidney. If this function fails, which electrolyte imbalance will occur? a. Hyperkalemia b. Hypocalcemia c. Hypernatremia d. Hypoglycemia

What is an advantage of a renal scan compared to a CT scan for diagnosing the perfusion, function, and structure of the kidneys? a. renal scan is more readily tolerated by elderly patients and small children b. Renal scan is preferred if the patient is allergic to iodine or has impaired kidney function c. renal scans are more likely to detect pathologic changes that CT scans do not detect d. renal scan requires less pre- and postprocedural care than CT scan

When patients have problems with kidneys or urinary tract, what is the most common symptoms that prompts them to seek medical attention? a. Change in the frequency or amount of urinartion b. Pain in flank or abdomen or pain when urinating c. Noticing a change in the color or odor of the urine d. Exposure to a nephrotoxic substance

Which ethnic group has the highest risk for kidney failure and needs special attention for patient teaching related to hypertension and sodium intake? a. caucasian American b. African Americans c. asian americans d Native Americans

Which factor/manifestation is primarily associated with acute pyelonephritis? a. Obstruction caused by hydroureter b. Active bacterial infection c. Decreased urine specific gravity d. Alcohol abuse

Which hormone is released from the posterior pituitary and makes the distal convoluted tubule and the collecting duct permeable to water to maximize reabsorption and produce concentrated urine? a. Aldosterone b. Vasopressin c. Bradykinins d. Natriuretic

Which patient history fact is considered causative for acute glomerulonephritis? a. Urinary incontinence 6 months ago b. Strep throat 3 weeks ago c. Kidney stones 2 years ago d. Mild hypertension diagnosed 1 year ago

Which patient is most likely to exceed the renal threshold if there is noncompliance with the prescribed therapeutic regimen? a. Has recurrent kidney stone formation b. has type 2 diabetes mellitus c. has functional urinary incontinence d. has biliary obstruction

Which personal action is most likely to cause the kidenys to produce and release erythropoietin? a. person moves to a low desert area where the humidity is very low b. person moves to a high-altitude area where atmospehric oxygen is low c. Person drinks an excessive amount of fluid that resutls in fluid overload d. person eats a large high-protein meal after a rigourous exercise workout

Which test is the best indicator of kidney function? a Urine osmolarity b. serum creatinine c. Urine pH d. BUN

the nurse is assessing a patient who reports chills, high fever, and flank pain with urinary urgency and frequency. On physical examination, the patient has costovertebral angle tenderness, pulse is 10 beats/min, and respirations are 28/min. How does the nurse interpret these findings? a. COmplcaited cystitis b. Acute pyelonephritis c. Chronic pyelonephritis d. Acute glomerulonephritis

the nurse is caring for a paitent who sustained major injuries in an automobile accident. Which blood pressure will result in compromised kidney function, in particualr the glomerular filtration rate (GFR)? a. 150/70 mm Hg b. 70/40 mm Hg c. 80/60 mm Hg d. 140/80 mm Hg

the nurse is reviewing the laboratory results for a patient being evaluated for trouble with passing urine. The urinalysis shows tubular epithelial cells on microscopic examination. How does the nurse interpret this finding? a. The obstruction is resolving b. The obstruction is prolonged. c. Glomerular filtration rate is reduced d. Glomerular filtration rate is adequate

what is the average urine output of a healthy adult for a 24-hour period? a. 500 to 1000 mL per day b. 1500 to 2000 mL per day c. 3000 to 5000 mL per day d. 5000 to 7000 mL per day

which patients are likely to be excluded from receiving a transplant? (SATA) a. Patient who had breast cancer 6 years ago b. Patient with advanced and uncorrectable heart disease c. Patient with a chemical dependency d. Patient who is 70 years old and has a living related donor e. Patient with diabetes mellitus

A patient with PKD would exhibit which signs/symptoms? (SATA) a. Frequent urination b. Increased abdominal girth c. Hypertension d. Kidney stones e. diarrhea

bcd

The nurse is caring for patients with nephrotic syndrome. What interventions are included in the plan of care for this patient? (SATA) a. Fluid should be restricted b. Administer mid diuretics c. Assess for edema d. Administer antihypertensive medications e. Frequently assess the patient mental status

bcd

What are the characteristics of continuous venovenous hemofiltration (CVVH)? (SATA) a. Requires placement of arterial and venous access b. Uses a pump to drive blood from the patient catheter into the dialyzer c. Risk for air embolus d. More commonly used for patients who are critical ill e. Most convenient method for home care patients

bcd

A patient has been informed by the health care provider that treatment will be needed for renal artery stenosis. The nurse prepares to teach about a variety of treatment options. What treatment swill the nurse include in the teaching plan? (SATA) a. Kidney transplant b. Hypertension control c. Balloon angioplasty d. Renal artery bypass surgery e. Synthetic blood vessel graft f. Percutaneous ultrasonic pyelolithotomy

bcde

During PD, the nurse notes slowed dialysate outflow. What does the nurse do to troubleshoot the system? (SATA) a. Ensure that the drainage bag is elevated b. Inspect the tubing for kinking or twisting c. Ensure that clamps are open d. Turn the patient to the other side e. Make sure the patient is in good body alignment f. Instruct the patient to stand or cough

bcde

What are the key features associated with chronic pyelonephritis? (SATA) a. Abscess formation b. Hypertension c. Inability to conserve sodium d. Decreased urine-concentrating ability, resulting in nocturia e. Tendency to develop hyperkalemia and acidosis

bcde

What might the nurse notice of the patient is experiencing problems with urinary elimination as a result of acute pyelonephritis? (SATA) a. Patient urinates large amounts of dilute urine b. Patient reports pain and burning on urination c. Patient reports back or flanks pain d. Urine is cloudy and foul smelling e. Urine may be darker or smoke or have obvious blood in it

bcde

A daughter is considering donating a kidney her mother for organ transplant what information does the nurse give to the daughter about the criteria for donation? (SATA) a. Age limit is at least 21 hours b. Systemic disease and infection must be absent c. There must be no history of cancer d. Hypertension or kidney disease must be absent e. There must be adequate kidney function as determined by diagnostic studies f. The donor must understand the surgery and be willing to give up the organ

bcdef

The nurse is caring fro a patient with an arteriovenous fistula. What is included in the nursing care for this patient? (SATA) a. Keep small clamps handy by the bedside b. Encourage routine range-of-motion exercises c. Avoid venipuncture or IV administration on the arm with the access device d. Instruct the patient to carry heavy objects to build muscular strength e. Assess for manifestations of infection of the fistula f. Instruct the patient to sleep on the side with the affected arm in the dependent position

bce

Postrenal kidney injury can result from which conditions? (SATA) a. Septic shock b. Cervical cancer c. Nephrolithiasis or ureterolithiasis d. Heart failure e. Neurogenic bladder f. Prostate cancer

bcef

The nurse is assessing a patient with a chronic kidney problem. The nurse notes that the patient has pedal edema and periorbital edema. What additional assessments will the nurse make to assess for fluid overload? (SATA) a. Obtain a urine specimen b. Compare current blood pressure to baseline c. Measure the residual urine with a bladder scanner d. Weigh the patient and compare to baseline e. Auscultate lung fields to determine if fluid is present

bde

A patient has sustained a kidney injury. In order to assist the patient to undergo the best diagnostic test to determine the extent of injury, what does the nurse do? a. Obtain a clean-catch urine specimen for urinalysis b. Give an IV fluid bolus before renal arteriography c. Give an explanation of computed tomography d. Obtain a blood sample for hemoglobin and hematocrit

A patient is diagnosed with acute pyelonephritis. What is the priority for nursing care for this patient? a. Providing information about the disease process b. Controlling hypertension c. Managing pain d. Preventing constipation

A patient is diagnosed with interstitial nephritis. Which nursing action is relevant and specific for this patient's medical condition? a. Avoid analgesic use b. Use disposable gloves c. Monitor for fever d. Place the patient in isolation

A patient is diagnosed with renal osteodystrophy. What does the nurse instruct the UAP to do in relation to this patient diagnosis? a. Assist the patient with toileting every 2 hours b. Gently wash the patient's skin with a mild soap and rinse well c. Handle the patient gently because of risk for fractures d. Assis the patient with eating because of loss of coordination

A patient returning to the unit after a left radical nephrectomy for kidney cell carcinoma reports having some soreness on the right side. What does the nurse tell the patient? a. "The right kidney was reported to take over the function of both kidneys" b. "I'll call your doctor for an order to increase your pain medication" c. "The soreness is likely to be from being positioned on your right side during surgery" d "Would you like to talk with someone who had this surgery last year and now is fully recovered"

A patient with PKD reports a severe headache and is at risk for a berry aneurysm. What is the nurse's priority action? a. Assess the pain and give a PRN pain medication b. Reassure the patient that this is an expected aspect of the disease c. Assess for neurologic changes and check vital signs d. Monitor for hematuria and decreased urinary output

A patient with PKD reports nocturia. What is the nocturia caused by? a. Increased fluid intake in the evening b. Increased hypertension c. Decreased urine-concentrating ability d. Detrusor irritability

A patient with a history of PKD reports dull, aching flank pain and the urinalysis is negative for infection. The health care provider tells the nurse that the pain is chronic and related to enlarging kidneys compressing abdominal contents. What nursing intervention is best for this patient? a. Administer trimethoprim/sulfamethoxazole (Bactrim) b. Apply cool compresses to the abdomen or flank c. Teach methods of relaxation such as deep-breathing d. Administer around-the-clock nonsteroidal anti-inflammatory drugs (NSAIDs)

A patient with chronic pyelonephritis returns to the clinic for follow-up. With behavior indicates the patient is meeting the expected outcomes to conserve existing kidney fucntion? a. drinks a liter of fluid every day b. Consider buying a home blood pressure cuff c. Reports taking antibiotics as prescribed d d. Takes pain medication on a regular basis

After a nephrectomy, a patient has a large urine output because of adrenal insufficiency. what does the nurse anticipate the priority intervention for this patient will be? a. ACE inhibitor to control the hypertension and decrease protein loss in urine b. Straight catheterization or bedside bladder scan to measure residual urine c. IV fluid replacement because of subsequent hypotension and oliguria d. IF infusion of temsirolimus (Torisel), to inhibit cell division

An older adult male patient calls the clinic because he has "not passed any urine all day long." What is the nurse's best response? a. "Try drinking several large glasses of water and waiting a few more hours." b. "If you develop flank pain or fever, then you should probably come in" c. "You could have an obstruction, so you should come in to check out" d. "I am sorry, but I Really can't comment about your problem over the phone"

In addition to kidney disease, which patient condition causes the BUN to rise above the noraml range? a. Anemia b. Asthama c. Infection d. Malnutrtion

Several patients are scheduled for testing to diagnose potential kidney problems. Which test requires a patient to have a urinary catheter inserted before the test? a. Urine stream testing b. Computed tomography c. Cystography d. Renal scan

The ED nurse is preparing a patient with kidney trauma for emergency surgery. What is the best task to delegate to the UAP? a. Set the automate blood pressure machine to cycle every 2 hours b. Inform the family about surgery and assist them to the surgery waiting area c. GO to the blood bank and pick up the units of packed red cells d Insert a urinary catheter if there is no gross bleeding at the urethra

The community health nurse is talking to a group of African-American adults about renal health. The nurse encourages the participants to have which type of yearly examination to screen for kidney problems a. Kidney ultrasound b. Serum creatinine and blood urea nitrogen c. Urinalysis and microalbuminuria d. 24-hour urine collection

The health care provider advises the patient that diagnostic testing is needed to identify the possible presence of a renal abscess. Which test does the nurse prepare the patient for? a. Renal arteriography b. Cystourethrogram c. Radionuclide renal scan d. Urodynamic flow studies

The health care provider ahs ordered intraperitoneal heparin for a patient with a new PD catheter to prevent clotting of the catheter by blood and fibrin formation. How does the nurse advise the patient? a. Watch for bruising or bleeding from the gums b. Make a follow-up appointment for coagulation studies c. Intraperitoneal heparin does not affect clotting times d. Heparin will be given with a small subcutaneous needle

The intensive care nurse is caring for the kidney transplant patient who was just transferred from the recovery unit. Which finding is the most serious within the first 12 hours after surgery and warrants immediate notification of the transplant surgeon? a. Diuresis with increased output b. Pink and bloody urine c. Abrupt decrease in urine d. Small clots in bladder irrigation fluid

The nurse and nutritionist are evaluating the diet and nutritional therapies for a patient with kidney problems. BUN levels for this patient are tracked because of the direct relationship to the intake and metabolism of which substance? a. Lipids b. Carbohydrates c. Protein d. Fluids

The nurse is assessing a patient with glomerulonephritis and notes crackles in the lung fields and neck vein distention. The patient reports mild shortness of breath. Based on these findings, what does the nurse do next? a. Check for CVA tenderness or flank pain b. Obtain a urine sample to check for proteinuria c. Assess for additional signs of fluid overload d. Alert the health care provider about the respiratory symptoms

The nurse is assessing a patient with kidney injury and notes a marked increase in the rate and depth of breathing. The nurse recognized this as Kussmaul respiration, which is the body's attempt to compensate for which condition? a. Hypoxia b Alkalosis c. Acidosis d. Hypoxemia

The nurse is caring for a patient with CKD. The family asks about when renal replacement therapy will begin. What is the nurse's best response? a. "As early as possible to prevent further damage in stage I" b. When there is reduced kidney function and metabolic wastes accumulate" c. "When the kidneys are unable to maintain a balance in body functions." d. "It will be started with diuretic therapy to enhance the remaining function"

The nurse is caring for the patient after a nephrectomy. The nurse notes that the urine flow was 50 mL/hr at the beginning fo the shift, but several hours later has dropped to 30 mL. What would the nurse do first? a. Notify the health care provider for an order for an IV fluid bolus b. Document the finding and continue to monitor for downward trend c. Check the drainage system for kinks or obstructions to flow d. Obtain the patient's weight and compare it to baseline

The nurse is determining whether a patient has a history of hypertension because of the potential for kidney problems. Which question is best to elicit this information? a. "Do you have high blood pressure?" b. "Do you take any blood pressure medications?" c. "Have you ever been told that your blood pressure was high?" d. "When was the last time you had your blood pressure checked"

The nurse is monitoring a patient's PD treatment. The total outflow is slightly less than the inflow. What does the nurse do next? a. Instruct the patient to ambulate b. Notify the health care provider c. Record the difference as intake d. Put the patient on fluid restriction

The nurse is planning the care for several patients who are undergoing diagnostic testing. Which patient is likely to need the most time for postprocedural care? a will have a kidney, ureter, and bladder x-ray b. Needs a kidney ultrasound c. Will have a cystoscopy d. Needs urine for culture and sensitivity

The nurse is taking a nutritional history on a patient. The patient states, "I really don't drink as much water as I should." What is the nurses best response? a. "We should probably all drink more water than we do." b. "Its an easy thing to forget; just try to remember to drink more." c. "What would encourage you to drink the recommneded 2 literes per day?" d. "Id like you to read this brochure about kidney health and fluids."

The nurse is talking to a group of healthy young college students about maintaining good kidney health and preventing AKI. Which health promotion point is the nurse most likely to emphasize this group? a. "Have your blood pressure checked regularly" b. "Find out if you have a family history of diabetes" c. "Avoid dehydration by drinking at least 2 to 3 L of water daily" d. "Have annual testing for microalbuminuria and urine protein"

The nurse notes an abnormal laboratory test finding for a patient with CKD and alerts the health care provider. The nurse also consults with the registered dietitian because an excessive dietary protein intake is directly related to which factor? a. Elevated serum creatinine level b. Protein presence in the urine c. Elevated BUN level d. Elevated serum potassium level

What change in diabetes therapy may be needed for a patient who has diabetic nephropathy? a. Fluid restriction b. Decreased activity level c. Decreased insulin dosages d. Increased caloric intake

What does an increase in the ratio of BUN to serum creatinine indicate? a. Highly suggestive of kidney dysfunction b. definitive for kidney infection c. Suggests kidney factors causing an elevation in BUN d. Suggests nonkidney factors causing an elevation in serum creatinine

What type of breath odor is most likely to be noted in a patient with CKD? a. Fruit smell b. Fecal smell C Smell like urine d. Smells like blood

Which description of the autosomal-dominant form of PKD is correct? a. 25% of patients with this form of PKD develop acute kidney failure by age 30 b. The dominant form is responsive to newer gene therapy treatment c. 50% of people with this form of PKD develop kidney disease by age 50 d. most people with this form of PKD die in young adulthood

Which description of the recessive form of PKD is correct? a. Prognosis is better for the recessive form compared to the dominant form b. 100% of people with this form of PVD develop kidney failure around age 50 c. Most people with this form of PKD die in early childhood d. The recessive form only manifests if other kidney problems occur

A healthy 34-year-old male with no physical complaints has a BUN of 26 mg/dL. Which questions would the nurse ask to identify nonrenal factors that could be contributing to this laboratory result? (SATA) a. "Did you drink a lot of extra fluid before the blood sample was drawn?" b. "Have you been on a severe protein- or calorie-restricted diet?" c. "Are you taking or have you recently taken any steroid medications?" d. "Have you recently experienced any physical or emotional stress?" e. "Have you noticed any blood in the stool or have you vomited any blood?"

cde

A healthy female patient has no physical symptoms, but urinalysis results reveal a protein level of >0.8 mg/dL and a white blood cell count of 4 per high-powered field. What question would the nurse ask the patient in order to assist the health care provider to correctly interpreting the urinalysis results? a. "Have you ever been treated for a urinary tract infection?" b. "Do you have a family history of cardiac or biliary disease?" c. "Are you sexually active and if so, do you use condoms?" d. "Have you recently performed any strenuous exercise?"

A patient appears very uncomfortable with the nurses questions about urinary functions and patterns. what is the best technique for the nurse to use to elixit relevant information and decrease the patients discomfort ? a. Defere the questions until a later time b. Direct the questions toward a family member c. Use anatomic or medical terminology d. Use the patients own terminology

A patient diagnosed with renal cell carcinoma that has metastasized to the lungs is considered to be in which stage of cancer? a. I b. II c. III d. IV

A patient has AKI related to nephrotoxins. In order to maintain cell integrity, improve GFR, and improve blood flow to the kidneys, which type of medication does the nurse anticipate the health care provider will prescribe? a. Loop diuretics b. Alpha-adrenergic blockers c. Beta blockers d. Calcium channel blockers

A patient has a family history of the autosomal-dominant form of PKD and ahs therefore been advised to monitor for and report symptoms. What is an early symptom of PKD? a. Headache b. Pruritus c. Edema d. Nocturia

A patient is scheduled for retrograde urethrography. Postprocedural care is similar to postprocedural care given for which test? a. Ultrasonography b. Computed tomography c. Renal angiogram d. Cystoscopy

A patient is very ill and is admitted to the intensive care unit with rapidly progressing glomerulonephritis. the nurse monitors the patient for manifestations of which organ system failure? a. Immune system b. Cardiovascular system c. Neurologic system d. Renal system

A patient reports flank pain and tenderness. What technique does the nurse use to assess for costovertebral angle tenderness? a. Percuss the nontender flank and assess for rebound b. Thump the CVA area with the flat surface of the hand c. Thump the CVA area with a clenched fist d. Place one palm over the CVA area, thump with other fist

A patient with AKI is ill and has a poor appetite. What would the health care team try first? a. IV normal saline to prevent dehydration b. Familiar food brought by the family c. Nasogastric tube for enteral feedings d. Oral supplements designed for kidney patients

A patient with acute glomerulonephritis has edema fo the face. the blood pressure is moderately elevated and the patient has gained 2 pounds within the past 24 hours. the patient reports fatigue and refuses to eat. what is the priority for nursing care? a. cluster care to allow rest periods for the patient b. obtain a dietary consult to plan an adequate nutritional diet c. monitor urine output with accurate intake and output amounts d. assess for signs and symptoms fo fluid volume overload

A patient with chronic kidney disease (CKD) devleops anorexia nausea and vomiting, muscle cramping, and purritus. How does the nurse interepret these findings? a. Oliguria b. Azotemia c. Anuria d. Uremia

All patients with hypertension or diabetes should have yearly screenings for which factor? a. Creatinine b. BUN C. Glycosuria d. Microalbuminuria

For a patient with acute glomerulonephritis, a 24-hour urine test was initiated nd the GFR results are pending. What are the clinical implications of the test results? a. GFR is normal; the therapy can be discontinued b. GFR is high; the patient is at risk for dehydration c. GFR is low; the patient is at risk for infection d. GFR is low; the patient is at risk for fluid overload

Increased BUN and creatinine, hyperkalemia, and hypernatremia are all characteristics of which stage of kidney disease? a. Stage 1 CKD b. Mild CKD c. Moderate CKD d. ESKD

The health care provider tells the nurse that the patient with PKD has salt wasting. Which intervention is the nurse likely to sue related to nutrition therapy? a. talk to the patient about seasonings that are alternatives for salt b. help the patient select a lunch tray with low-sodium items c. Obtain an order for fluid restriction to prevent loss of sodium during urination d. Advise that a low sodium diet is not currently necessary

The nurse is assessing a patient who has just returned from hemodialysis. Which assessment finding is cause for greatest concern? a. Feeling of malaise b. Headache c. Muscle cramps in the legs d. Bleeding at the access site

The nurse is assessing the skin of a patient with ESKD. Which clinical manifestation is considered a sign of very late, premorbid, advanced uremic syndrome? a. Ecchymoses b. Sallowness c. Pallor d. Uremic frost

The nurse is assisting an inexperienced health care provider to assess a patient who has an aneurysm. The nurse would intervene if the provider performed which action? a. Inspected the flank for bruising or redness b. listened for a bruit over the renal artery c. Auscultated the abdomen for bowel sounds d. Palapated deeply to locate masses or tenderness

The nurse is caring for a patient who had a nephrectomy yesterday. To manage the patient's pain, what is the best plan for analgesia therapy? a. Limit narcotics because of respiratory depression b. Give an oral analgesic when the patient can eat c. Alternate parenteral and oral medications d. Give parenteral medications on a schedule

The nurse is caring for a patient with an arteriovenous fistula. What instructions are give to the UAP regarding the care of this patient? a. Palpate for thrills and auscultate for bruits every 4 hours b. Check for bleeding at needle insertion sites c. Assess the patient distal pulses and circulation d. Do not take blood pressure readings in the arm with fistula

The nurse is caring for the kidney transplant patient in the immediate postoperative period. During this initial period, the nurse will assess the urine output at least every hour for how many hours? a. First 8 hours b. First 12 hours c. First 24 hours d. First 48 hours

The nurse is taking a history on a patient with chronic glomerulonephritis. What is the patient most likely to report? a history of antibiotic allergy b. intense flank pain c. poor appetite and weight loss d. occasional edema and fatigue

The nursing student is explaining principles of hemodialysis to the nursing instructor. Which statement by the student indicates a need for additional study and research on the topic? a. "Dialysis works as molecules from an area of higher concentration move to an area of lower concentration" b. "Blood and dialyzing solution flow in opposite directions across an enclosed semipermeable membrane" c. "Excess water, waste products, and excess electrolytes are removed from the blood" d. "Bacteria and other organisms can also pass through the membrane, so the dialysate must be kept sterile."

What is the common problem of hydronephrosis, hydroureter, and urethral stricture in kidney function? a. Dilute urine b. Tubular cell damage c. Dehydration d. Obstruction

Which abnormal finding would be associated with chronic kidney disease? a. Hematuria b. Pus in the urine c. Blood at the urethral meatus d. Decreased urine specific gravity

Which event is most likely to trigger renin production? a. patient particpiates in strenuous exercise b. Patient becomes anxious and nervous. c. Patient has urge to urinate during the night d. patient sustains significant blood loss

Which hematologic disorder is most likely to occur if the hormonal function of the kidneys is not working properly? a. Leukemia b. Thrombocyopenia c. Neutrpenia d. Anemia

Which nursing intervention is applicable for a patient with acute glomerulonephritis? a. Restricting visitors who have infections b. assessing the incision site c. inspecting the vascular access d measuring weight daily

Which over-the-counter product used by a patient does the nurse further explore for potential impact on kideny function? a. Mouthwash with alcohol b. Fiber supplement c. Vitamin C d. Acetaminophen

Which patient with kidney problems is the best candidate for peritoneal dialysis (PD)? a. Patient with peritoneal adhesions b. Patient with a history fo extensive abdominal surgery c. Patient with peritoneal membrane fibrosis d. Patient with a history of difficulty with anticoagulants

2210 Test 2 Chapters 65-68

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