Adaptive Quizzing Questions - Med Surg Ch. 44-46
Which nursing instructions that promote safety are beneficial to a patient with interstitial cystitis (IC)?
"Continue the medications as prescribed, avoid clothing that creates suprapubic pressure and take the full course of antibiotics to ensure that bacteria have been eradicated." Urethritis is when vagina sprays should be avoided and high potency vitamins can irritate the bladder.
The nurse is providing instructions about pelvic floor muscle exercises to a patient with stress incontinence. Which statement made by the patient indicates the need for further teaching?
"I am doing it right when I release the muscle to urinate." What you should do: tighten the muscle quickly and squeeze hard several times until the urge is gone, sitting or lying down, 5 to 10 seconds before relaxing.
The patient with end-stage renal disease (ESRD) has decided to terminate dialysis treatments. Which is the best response by the nurse?
"I respect your decision, but believe you need to discuss options with your health care provider. Would you like me to page the health care provider to come speak with you?" The decision must be made with the health care provider.
The nurse is teaching a patient with acute urinary retention strategies to minimize risk. After teaching, the nurse asks the patient to discuss what has been learned. Which statement made by the patient needs correction?
"I should drink large volumes of fluid over a brief period."
The nurse explains dietary modifications to a patient with hematuria and kidney stones. Which statement made by the patient indicates the need for further teaching?
"I should drink two glasses of milk every day, I should include cheese in my diet, because it is rich in protein and I can have two pieces of bread with butter for breakfast and dinner."
The registered nurse is teaching a trainee nurse about providing care to a patient who is on hemodialysis. Which statements of the student nurse indicate effective learning?
"I should record the body temperature, monitor the level of consciousness and monitor the access site for discharge." Respiratory is not necessary for this and assessment of the mouth is for inflammation and dryness, not bad breath.
The nursing instructor is evaluating the statements of a student nurse about medication safety for patients with acute kidney injury. Which statement by the student nurse indicates effective learning?
"I should warn the patient about the use of over-the-counter-drugs." They are typically harmful to kidneys, specifically acetaminophen causing nephrotoxicity.
Which statement made by the student nurse regarding the management of patients with an indwelling urinary catheter indicates a need for additional teaching by the registered nurse?
"If the bag is not reused immediately, wash it with soap and water." When the collection bag is not reused immediately it should be filled with 1/2 cup of vinegar, and drained to prevent microorganisms and avoid odors.
The nurse teaches a new graduate nurse about the plan of care for a patient with chronic kidney disease (CKD) and anemia. The nurse notes that the anemia was caused by acute blood loss and that the patient is scheduled to receive a blood transfusion. Which statement made by the new graduate indicates effective learning?
"Multiple blood transfusions may lead to iron overload in the patient."
The nurse is caring for a patient who has undergone a cystoscopy. Which patient statement should be immediately reported to the primary health care provider?
"My urine is bright red in color."
The registered nurse is teaching a trainee nurse about the use of renal replacement therapy (RRT). Which statement by the trainee nurse indicates effective learning?
"RRT is recommended if there is a pericardial effusion."
An older adult patient reports urinating four times during the night. How should the nurse advise this patient?
"Record the times when you drink any fluid, keep a record of the amount of fluid you drink and seek treatment of pain, if any, which may interfere with sleep." The patient may void before going back to bed as a habit when they experience pain during their sleep.
The nursing instructor is teaching a student nurse about the therapies for hyperkalemia associated with acute kidney injury. Which statement by the student nurse indicates effective learning?
"Sodium polystyrene sulfonate is a permanent therapy." All others (insulin, sodium bicarbonate and calcium gluconate) are temporary therapies.
The nursing instructor is teaching a student nurse about sodium polystyrene sulfonate. Which statement by the student nurse indicates the need for further teaching?
"The drug is effective in treating a paralytic ileus."
The nursing instructor asks the student nurse about fluid and electrolyte changes that occur in a patient with an acute kidney injury. Which statement by the student nurse indicates effective learning?
"The patient will have increased serum creatinine levels."
A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure?
"You might have pink-tinged urine and burning after your cystoscopy." No catheterization, contrast of NPO is needed.
Which finding indicates oliguria?
< 400 mL/day
Two important functions of the distal convoluted tubules are final regulation of water balance and acid-base balance. What is required for water reabsorption in the kidney and is important in water balance?
ADH.
Which is the most common intrarenal cause of acute kidney injury?
Acute tubular necrosis.
A patient is scheduled for an intravenous pyelogram (IVP). What is the priority action by the nurse to prepare the patient for the procedure?
Administer a cathartic or enema.
A patient with acute kidney injury has been admitted to the hospital, and the nurse observes the electrocardiogram (ECG) reading shows tall peaked T waves, ST depression, and QRS widening. What nursing interventions should the nurse perform for this patient?
Administer sodium bicarbonate, regular insulin and calcium gluconate intravenously. Insulin helps the potassium move into cells, bicarb corrects the acidosis and calcium gluconate raises the threshold for excitation. Potassium should be limited to 40mEq/day and diuretics are not effective for hyperkalemia.
The nurse recognizes that which medication is the most appropriate for a patient with chronic kidney disease (CKD) who has a glycosylated hemoglobin of 5%, blood pressure of 140/95 mm Hg, and whose urinalysis reveals the presence of protein?
An angiotensin receptor blocker. This med helps to decrease proteinuria and delay the progression of CKD. Diuretics has no effect on the proteinuria.
A patient has stage 3 chronic kidney disease (CKD) and is being taught about a low potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat?
Apple, green beans, and a roast beef sandwich. Everything else (granola, dried fruit, nuts and seeds, milk, chocolate, banana, etc) are all elevated K.
A patient is brought to the emergency department with penetrating renal trauma due to a motor vehicle accident. What should be the immediate nursing action?
Assess the cardiovascular system and monitor for signs of shock. May signify massive blood loss.
Which medication does the nurse expect to be beneficial for a patient who smokes one pack of cigarettes each day and has a history of cough, crackles, and hematuria?
Azathioprine. Colestipol is hyperlipidemia, FUDR is renal cancer and acetohydroxamix acid is renal calculi.
An older male patient visits his primary health care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)?
BPH.
The nurse is attending to a patient who receives regular hemodialysis. When teaching the patient about nutritional therapy during hemodialysis, which food items should the nurse tell the patient to avoid?
Bananas, pickled tuna and barbecued red meat.
The patient has had type 1 diabetes mellitus for 25 years and now is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse finds that the patient has newly developed hypertension and difficulty with blood glucose control. The nurse should know that which diagnostic study will be most indicative of chronic kidney disease (CKD) in this patient?
Calculated GFR.
A patient has a glomerular filtration rate (GFR) of 50 mL/minute and a serum potassium level of 8 mEq/L. The nurse should monitor the patient for what complication?
Cardiac dysrhythmias. Again, hyperkalemia = renal failure.
The nurse performs an admission assessment of a patient with acute renal failure. For which common complication does the nurse assess the patient?
Cardiac dysrhythmias. This is due to increased K levels (hyperkalemia). Pts would experience anorexia, not polyphagia, hyponatremia and not hypotensive shock.
Which forms of bowel preparations are used in patients undergoing an intravenous pyelogram?
Castor oil, bisacodyl tablets and suppositories. It is super important and fleet enemas are contraindicated because Mg cannot be excreted with kidney failure.
Aldosterone acts on the distal tubule of the kidney to do what?
Cause the excretion of potassium.
A patient is instructed to have a quantitative urine protein test done. What should the nurse advise this patient about collecting the urine sample?
Collect all urine for 24 hours. Midstream is used for a urine culture, morning would not show protein and the other option does not affect it.
What advice should the nurse give to the patient collecting a urine sample for urinalysis?
Collect the first urine sample in the morning. This is best, even though it could be collected any time technically.
The night shift nurse notes that the patient's urine output has been 700 mL during the night shift while it was more than 1500 mL of clear yellow urine during the day shift. What is the priority action by the nurse?
Continue to monitor urine output. This is normal b/c the volume of urine at night is less than half that formed during the day.
The nurse is teaching patients who are at an increased risk of urinary tract infections (UTIs) about the use of cranberry products in preventing UTIs. What important instructions should the nurse include in the teaching?
Cranberry juice is more effective than cranberry capsules, cranberry products have a protective effect in preventing UTIs and drinking an adequate amount of fluid is important to prevent UTIs.
A patient who is prone to urinary tract infections asks the nurse about herbal preparations that may prevent UTIs. What at-home remedy should the nurse suggest to this patient?
Cranberry.
Which effect of aging on the urinary system is most likely to affect the action of bumetanide?
Decreased function of the loop of Henle. Acts on the loop of Henle to decrease Na and Cl.
Which assessment finding of a patient with chronic kidney disease indicates to the nurse that hemodialysis is having the desired effect?
Decreased serum creatinine and weight loss.
The nurse recognizes that which test helps to detect microalbuminuria in patients with chronic kidney disease (CKD)?
Dipstick test. Microalbuminuria is a type of proteinuria.
The nurse is teaching people at the retirement village about avoiding urinary tract infections (UTIs). One person asks how much fluid one should drink each day. The nurse determines that the patient weighs 140 pounds (63.6 kg). Taking into account how much fluid is obtained from food, calculate how many ounces of fluid this person should drink each day total. Fill in the blank using a whole number.
Divide the weight in pounds by 2, then multiply this number by 80%, because 20% of a person's fluid is obtained from food. So 140/2 = 70, 70 x.80 = 56 ounces to be drunk each day, or seven 8-ounce glasses of water.
A nurse is delivering a lecture on organ donation. She is explaining about the selection criteria for kidney donors. What are the donor characteristics that the nurse should discuss with the group?
Donors should not have diabetes, must have ABO compatibility and should have matching leukocyte antigen complexes. It is unsafe to be a first-degree relative unless the family member has matching leukocyte antigen complexes, and different size bodies causes no problems.
A patient, who is taking aspirin, is scheduled for renal biopsy. What are the responsibilities of the nurse when preparing this patient for the procedure?
Draw blood for typing and cross matching, ensure the consent form is signed and ask the patient to stop the aspirin before the procedure. A full bladder is a bad idea and preparation of the bowel is not necessary.
An older adult patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should the nurse document this abnormal assessment finding?
Dysuria.
The nurse is preparing a lecture for nursing students on healthcare-associated urinary tract infections (UTIs). Education should include identification of which organism as the primary cause?
E. coli.
The patient in the intensive care unit is receiving gentamicin for pneumonia from Pseudomonas. What assessment results should the nurse report to the health care provider?
Elevated creatinine level. It is toxic to the kidneys.
Which clinical action plan is most appropriate for a patient in stage 3 of chronic kidney disease?
Evaluation and treatment of complications. Diagnosis is stage 1, estimation of progress is stage 2 and RRT is stage 5.
The nurse recalls that the reason that patients with chronic kidney disease experience arterial stiffness is what?
Excessive calcium deposition in vascular smooth layer.
The nurse is performing peritoneal dialysis for a patient with chronic kidney disease. Which phase does the nurse document that occurs with the prescribed amount of fluid inflow?
Fill.
A patient reports waking up five to six times a night to urinate and urinating large amounts each time. The nurse anticipates that which diagnostic test will be prescribed?
Glucose levels.
A patient is admitted with urethral diverticula. Which of the following clinical manifestations would the nurse expect to document?
Gross hematuria, post-voiding dribbling and urinary incontinence.
A patient has glomerulonephritis. The nurse recalls that which common complications of the disorder tend to recur frequently?
HTN and edema.
The nurse is preparing a patient for peritoneal dialysis. What nursing action is appropriate at this time?
Have the patient empty the bladder and bowel. Need to be empty before inserting the catheter.
What are the complications of hemodialysis?
Hepatitis, muscle cramps and light-headedness.
What are the complications of peritoneal dialysis?
Hernias, peritonitis and exit site infection.
Which assessment finding is a consequence of the oliguric phase of acute kidney injury (AKI)?
Hyperkalemia.
Which predisposing factor is associated with small renal calculi that become trapped in the ureter?
Hyperoxaluria.
The nurse identifies that a patient with chronic kidney disease is at risk for which electrolyte disturbance?
Hyperphosphatemia. Due to decreased elimination.
The nurse suspects that which electrolyte abnormality is the cause of edema in a patient with chronic kidney disease?
Hyponatremia. K is cardiac, Mg is reflexes and mental status, and phosphate is calcium and vitamin D.
The nurse reviews a plan of care for a patient with diagnosis of chronic kidney disease who is undergoing hemodialysis. Which part of the plan should the nurse question?
IV of 0.9% sodium chloride at 125 mL/hour The kidneys are unable to remove excessive water - this would make risk for complications greater.
During the physical assessment of a patient, where should a nurse palpate to locate the kidneys?
In the angle formed by the rib cage and the vertebral column.
Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse should know that ultrafiltration in peritoneal dialysis is achieved by which method?
Increasing osmolality of the dialysate.
A nurse is attending to a post-renal transplant patient. The nurse finds that the patient's urine output is very high. What are the reasons for this diuresis?
Initial renal tubular dysfunction, abundance of fluids administered and the new kidney's ability to filter BUN. Rejection would be decreased urine and blood sugar would not drastically increase urine output.
A patient with acute kidney injury has been prescribed insulin to treat hyperkalemia. The patient is worried about the consequences of taking intravenous insulin. What should the nurse explain to console this patient?
Insulin administration could prevent serious cardiac problems and glucose would be administered simultaneously to prevent hypoglycemia.
The nurse should monitor for which adverse effect of erythropoietin in patients with kidney failure?
Iron deficiency. Paralytic ileus is a side effect of the med administered for hyperkalemia, parathyroid is ENRD and systemic lupus erythematosus leads to CRF, it is not an effect of CRF.
A nephrostomy tube (catheter) has been inserted in a patient with ureteric obstruction, and irrigation has been ordered. What precautions should the nurse take regarding care for the nephrostomy tube?
Irrigation must be done under strict aseptic precautions, the catheter should not be kinked, compressed, or clamped and attention should be given to any complaints of excessive pain in the area. No more than 5 mL of sterile saline and excessive drainage should be checked.
Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which measure should the nurse first recommend in an attempt to resolve the woman's incontinence?
Kegel exercises.
A diabetic patient comes to the emergency department with complaints of facial puffiness for the past three days, swelling in the legs, and difficulty breathing. The laboratory report states the blood glucose level as 260 mg/dL and the serum creatinine level as 3.9 mg/dL. What does the nurse suspect from these findings?
Kidney failure. Injury has twofold increased creatinine, complete loss if more than four weeks and more than three months is ESRD.
A patient complains of reduced urine output and abdominal pain. The primary health care provider suspects acute kidney injury. Which diagnostic test will the health care provider suggest as an initial test to confirm the diagnosis?
Kidney ultrasound. Does not involve contrasts.
A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. What is an expected assessment finding for this patient during this early stage of recovery?
Large urine output. All others are alarming.
What instructions should the nurse give to a patient who is about to have a renal computed tomography (CT) scan?
No activity restrictions or dietary restrictions are required and no pain or discomfort will be felt during the test.
The nurse is educating a donor who is willing to donate a kidney to a family member. The nurse explains the positioning during the procedure and describes that the flank will be exposed. For what surgical procedure will the nurse prepare the donor?
Open nephrectomy.
Which nursing interventions should the nurse include in the care plan of a patient with acute kidney failure?
Perform skin care, wash the mouth frequently and change the patient's position frequently. You would still want to limit the potassium to 40 mEq/day (low) and restrict fluid intake to prevent fluid overload and edema.
The nurse reviews the laboratory results of a patient with renal failure. Which findings correspond with the patient's diagnosis?
Phosphorus 6.0 mg/dL; Potassium 6.2 mEq/L. Think high K.
The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD) should know that this medication should have a beneficial effect on which laboratory value?
Phosphorus. There are inversely related.
The nurse recognizes which laboratory data as the most significant indicator that a patient is responding positively to peritoneal dialysis?
Potassium of 4.1 mEq/L. All values should be returning to normal values (K = 3.5-5.0, creatinine = 0.2-1.0, BUN = 10-20) and calcium is not affected by PD.
A patient experiences fever, chills, flank pain, and costovertebral tenderness to percussion. The nurse recognizes that the clinical manifestations are associated with a particular renal problem and identifies risk factors for the condition. What is a patient risk factor that the nurse would identify?
Pregnancy-induced physiologic changes in the urinary system. This condition is acute pyelonephritis.
Which statement about acute kidney injury is correct?
Prerenal oliguria is caused by decreased circulatory volume.
In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which physiologic processes are performed by the kidneys?
Production of renin, activation of vitamin D and erythropoietin production.
Which is the most important nursing intervention when educating a patient about how to prevent acute poststreptococcal glomerulonephritis?
Promoting early diagnosis and treatment of sore throats and skin lesions. Bowel evacuation is UTIs, good hygiene is bacterial infections, secondary for this condition and antibiotic will not prevent it.
Which nursing intervention should the nurse implement while preparing a high-risk patient with contrast-induced nephropathy for magnetic resonance imaging?
Provide plenty of fluids. Hydrate to prevent contrast accumulation in the nephrons. Fatty foods, high calories and protein should be given.
The nurse is caring for the patient receiving hemodialysis. What action by the nurse is a priority?
Recording the vital signs every 30 to 60 minutes.
The nurse recognizes that which intervention would help a patient with stage 5 chronic kidney disease who experiences restless leg syndrome, altered mental ability, seizures, coma, and a blood urea nitrogen (BUN) level of 35 mg/dL?
Refer the patient for dialysis.
Hemodialysis is planned for a patient who has end-stage kidney disease. The patient is scheduled for the creation of an internal arteriovenous fistula and the placement of an external arteriovenous shunt to be used until the fistula heals. What postoperative nursing care is appropriate for this patient?
Regularly check the positioning of the external shunt, do not take the blood pressure on the extremity of the shunt, and ensure that IV fluids are not infused in the arm with the shunt. There are no respiratory complications and the shunt should be left exposed.
The nurse is assessing a patient with hematuria. What possible causes does the nurse anticipate for this condition?
Renal calculi, blood dyscrasias and GI tract cancer.
What are the postrenal causes of acute kidney injury?
Renal calculi, renal trauma and prostate cancer. Kidney ischemia and myoglobin release are intrarenal.
A patient is admitted with extreme left flank pain. During the admission interview, the nurse learns that the patient is training for a marathon and is on a high-protein diet and drinks a lot of milk. What does the nurse suspect is the likely cause of the pain experienced by the patient?
Renal calculi.
When teaching a patient about the ways to manage nephrotic syndrome, which instructions should the nurse include?
Restrict dietary salt intake, clean edematous skin carefully and avoid exposure to infected persons. Small, frequent meals are better, as well as not increasing water intake.
The nurse reviews the medical record of a patient with chronic kidney disease (CKD) and notes a history of taking cholecalciferal, a vitamin D level of 20 mg/mL, a calcium level of 13 mg/dL, and a phosphorous level of 5 mg/dL. Based on the laboratory results, the nurse anticipates that what medication will be prescribed?
Sevelamer carbonate. Calcitriol is for hypocalcemia, calcium would increase calcium levels, and polystyrene sulfonate causes hyperkalemia.
The nurse prepares to discharge a patient who has a renal calculus. What is the most important instruction for the nurse to include in the patient's teaching?
Strain all urine at home for stones. Further treatment requires identifying the stones contents, so they must be strained out.
A patient reports the presence of blood in the urine, discharge of pus from the genital organs, and lower abdominal pain. After a diagnosis is made, surgery is performed as a treatment strategy. The nurse should monitor the patient for what postoperative complication?
Stress incontinence. Urosepsis is long use of indwelling catheter, septic shock is also due to urosepsis and ESKD is from chronic pyelonephritis.
A patient with end-stage chronic kidney disease is scheduled for hemodialysis. What recommendation should the nurse give to the patient?
Take folic acid supplementation. This is depleted during dialysis, so a supplement can help prevent anemia.
The nurse is reviewing the medication history of four patients in a health care setting. What should the nurse include when providing education about each patient's medication?
That Patient C should monitor for dark, smoky-colored urine. The patient has a pulmonary embolism and is on anticoagulants.
The nurse is attending to a patient who is planned to receive a kidney transplant. How should the nurse explain the postoperative care to the patient?
The patency of the vascular access must be maintained, the kidney may not function immediately postoperatively and a urinary catheter will be present preoperatively in order to monitor urinary output postoperatively.
A patient with chronic kidney failure has a hemoglobin (Hgb) level of 8.0 g/dL. What should the nurse infer about the reason for this laboratory result?
The patient has a deficiency of erythropoietin. This results in low RBCs and anemia. Renal hypertension does not cause anemia, bone metabolism is due to vitamin D deficiency, and renin is unrelated to anemia.
The nurse is reviewing the urinalysis report of a patient. What does the nurse infer from the patient's report?
The patient has a urinary tract infection.
The urinalysis reports of a patient indicate the presence of ketones in the patient's urine. What conditions could this finding indicate?
The patient is starving, has severe diarrhea and carbohydrate metabolism is altered. TB causes RBCs in urine and liver disorder is bilirubin.
The nurse is assessing a patient with bladder cancer scheduled for a radical cystectomy. What factors are considered related to this procedure?
The tumor is invasive, involves the trigone and there is no metastasis beyond the bladder area. Partial cystectomy is large tumor and only one area of the bladder.
The nurse administers a drug that inhibits atrial natriuretic peptide (ANP) to a patient. The nurse expects what effects of the medication?
The urine will be concentrated. Accelerates reabsorption of Na and H20, causing highly concentrated urine.
A patient is diagnosed with an early urinary tract infection (UTI). When planning for trimethoprim/sulfamethoxazole treatment for this patient, which factors does the nurse evaluate?
This drug is relatively inexpensive, it can be taken twice daily and e. coli is resistant to this medication. It is macrodantin (nitrofurantoin) that is given 3 to 4 times a day and requires avoiding sunlight, not trimethoprim (sulfamethoxazo).
The nurse is caring for a 120-pound (54.54kg) patient who is at risk for a urinary tract infection. The nurse estimates, in ounces, the recommended fluid intake for the patient in a 24-hour period. Taking into account fluids obtained from food, how many fluid ounces should the nurse recommend? Record the answer using a whole number.
To estimate the amount of fluid intake that a patient should have in 24 hours, divide the person's weight in pounds by 2, then multiply this number by 80%, because 20% of a person's fluid is obtained from food. So 120/2 = 60, 60 x.80 = 48 ounces to be drunk each day, or six 8-ounce glasses of water.
The nurse reviews the assessment findings of a patient with a renal disorder who is scheduled for a renal biopsy. Which parameter will result in the cancellation of the procedure?
Uncontrolled HTN
Which condition should the nurse suspect in a patient with chronic kidney disease (CKD) who develops osteomalacia?
Uremic red eye. Calcium deposits in the eye, leading to irritation causing this condition. Asterixis is motor neuropathy, uremic frost is urea and BUN, and gastroparesis is malnutrition.
Which surgical procedure is beneficial to treat a patient who is diagnosed with an obstructive urethral stricture?
Urethroplasty.
The patient is in the diuretic phase of acute kidney injury. What education should the nurse provide to the patient regarding this phase?
Urine output is increased, it will last no more than three weeks and there is a possibility that the fluid volume will be reduced in the body.
Which urinalysis result should the nurse recognize as an abnormal finding?
WBC 9/hpf. Normally below 5/hpf.
The nurse instructs a patient with hyperphosphatemia to avoid what food item?
Yogurt
A patient has a history of calcium phosphate renal calculi. The nurse provides teaching about recommended food choices. The patient says, "So I need to eat foods low in calcium like yogurt, oranges, chicken, cranberry juice, spinach, and eggs?" Which of the patient's food choices, indicate that further instruction is required?
Yogurt and spinach. Eggs, oranges, chicken and cranberry juice do not have high levels of calcium.