Ch 45b EAQ
When providing care for a patient with glomerulonephritis, the nurse would monitor for the presence of which commonly recurring clinical manifestations? Fever and edema Urinary tract infections (UTIs) Hypertension and edema Upper respiratory infections
Hypertension and edema Rationale - Hypertension and edema, along with headaches and oliguria, are common complications of glomerulonephritis and tend to recur. Fever, UTI, and upper respiratory infections are not primarily associated with glomerulonephritis.
Which dietary recommendation would the nurse provide a patient newly diagnosed with nephrotic syndrome? Low-fat dietary intake Lower intake of pyrenes Moderate-protein diet Diet high in carbohydrates
Moderate-protein diet Rationale - Most patients with nephrotic syndrome are advised to consume a moderate-protein diet to replace protein lost through the kidneys and to correct hypoalbuminemia and development of edema. Low-fat, low-pyrene, or high-carbohydrate diets are not specific recommendations related to nephrotic syndrome. A moderate- protein diet includes 1 to 2 g/kg/day. If urine protein losses are high (more than 10 g/day), recommend more protein.
Which nursing interventions would the nurse implement when providing postoperative care for a patient who experienced a nephrectomy secondary to a renal tumor? Select all that apply. Record urine output. Weigh the patient daily. Monitor abdominal distention. Instruct the patient to minimize coughing. Allow oral intake immediately after operation. Provide adequate pain relief through analgesics.
Record urine output. Weigh the patient daily. Monitor abdominal distention. Provide adequate pain relief through analgesics. Rationale - A nursing importance is to record hourly fluid intake and output to assess kidney function of the patient. Abdominal distention is commonly present in patients who have had abdominal surgery due to paralytic ileus caused by manipulation and compression of bowel during surgery but needs monitoring. The patient may be reluctant to turn, cough, and deep breathe because of the incisional pain. Administer adequate pain medication to ensure patient's comfort and ability to perform coughing and deep-breathing exercises. A nursing intervention is to weigh the patient daily because a significant change in daily weight can indicate a retention of fluids. Restrict oral intake until bowel sounds are present (usually 24 to 48 hours after surgery).
When performing a physical examination on a patient suspected of having urinary tract calculi, the nurse would associate the presence of which clinical manifestation with the suspected diagnosis? Fever Abdominal distention Sharp pain in the flanks Bacteria on a urine analysis
Sharp pain in the flanks Rationale - The first symptom of a kidney stone is usually severe pain in the flank area, back, or lower abdomen. Abdominal distention and fever may occur later during the disease process if urinary tract obstructions or an infection occurs. Bacteria on urine analysis is not a predictor of urinary calculi but is observed when a patient has a urinary tract infection.
Which intervention would the nurse implement when providing care for an adult patient recently diagnosed with polycystic kidney disease (PKD)? Suggest genetic counseling resources for the patient's children. Assist the patient in coping with the rapid progression of the disease. Expect the patient to have polyuria and poor urine concentration abilities. Implement strategies for the patient's pending complications of deafness and blindness.
Suggest genetic counseling resources for the patient's children. Rationale - PKD is one of the most common genetic diseases, and the nurse should suggest genetic counseling. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.
Which diagnostic assessment reports would the nurse review when preparing to provide care for a patient with acute pyelonephritis? Select all that apply. Urethral angiogram Palpation for umbilical pain Urinalysis with urine culture and sensitivity CT scan of kidneys Radiograph of the kidneys, ureters, and bladder Complete blood count (CBC) and differential white blood cell (WBC) count
Urinalysis with urine culture and sensitivity CT scan of kidneys Complete blood count (CBC) and differential white blood cell (WBC) count Rationale - A CT scan of kidneys is the modality of choice in evaluation of acute pyelonephritis. Urinalysis with culture and sensitivity is a test used to diagnose the presence of harmful bacteria in the urinary system, as well as to determine the antibiotics to which the bacteria is most sensitive. A CBC with WBC differential is useful in determining how well a person's body is fighting off infection. A urethral angiogram is not used for diagnosing pyelonephritis. Though a patient may have umbilical pain, it is not a common finding in pyelonephritis. However, palpation of the costovertebral angle causes flank pain in these patients. Radiographic images of the kidneys, ureters, and bladder are not helpful in diagnosing pyelonephritis, as results are generally inconclusive.
When assessing the cognitive-perceptual pattern during a health history interview, which questions would the nurse ask the patient diagnosed with renal calculi? Select all that apply. "Do you experience urinary frequency?" "Do you experience pain in your genitalia?" "Do you have a family history of renal calculi?" "Do you experience colicky pain in your abdomen?" "Do you take purine-rich foods like sardines or sweet bread?"
"Do you experience pain in your genitalia?" "Do you experience colicky pain in your abdomen?" Rationale - While assessing the effect of renal calculi on a patient's cognitive-perceptual pattern, the appropriate questions to ask are if the patient has experienced any pain in his or her genitalia and any colicky pain in his or her abdomen or flank. Interviewing the patient about urinary frequency will determine the patient's elimination pattern. Inquiring about the patient's family history of renal calculi will determine health perception and health management. Asking the patient about his or her dietary intake of purine-rich food will determine the patient's nutritional-metabolic pattern.
Which question has the most importance when the nurse admits a patient with a diagnosis of acute glomerulonephritis? "Have you recently had strep throat?" "How much fluid do you drink in a day?" "Do you have susceptibility to allergies?" "Have you had any contact with anyone who has measles?"
"Have you recently had strep throat?" Rationale - Glomerulonephritis is an inflammatory process, usually resulting from antibodies reacting with group A hemolytic streptococcal antigens, the organism responsible for strep throat. Allergies, fluid intake, and measles exposure are not germane to the diagnosis of acute glomerulonephritis, but potentially relevant to the hospital's global admission process of a patient.
Which prescribed medication would the nurse teach the patient is the treatment for alkaline urine and development of struvite stones within the kidney? Captopril (Capoten) Allopurinol (Zyloprim) Potassium citrate (Urocit K) Acetohydroxamic acid (Lithostat)
Acetohydroxamic acid (Lithostat) Rationale - Klebsiella, Pseudomonas, and Proteus are microorganisms whose persistent bacterial presence produces a chemical action and converts urine to an alkaline status which contributes to the formation of struvite stones with staghorn configuration. Administration of antimicrobial agents to treat the infection; and administer acetohydroxamic acid to reduce urine alkalinity by inhibiting the chemical action of the bacteria; thus, impeding development of the struvite stone renal calculi. Captopril is an Angiotensin converting enzyme inhibitor (ACE) used to treat hypertension and/or fluid volume excess. Captopril has potentially nephrotoxic properties and not associated with treatment of renal calculi. Administer allopurinol to prevent hyperuricemia and formation of calcium oxalate renal stones. Administer potassium citrate to maintain alkaline urine that has calcium oxalate crystals entrapped in the kidney. Alpha-penicillamine and tiopronin prevent cystine crystallization.
Which intervention would the nurse include as a priority when developing a plan of care for the patient admitted with acute pyelonephritis? Schedule a follow-up urine culture for seven days post discharge. Assist the patient with identifying foods to help prevent future infections. Administer parenteral antibiotics as prescribed by the health care provider. Teach the patient the importance of taking all doses of the prescribed medications.
Administer parenteral antibiotics as prescribed by the health care provider. Rationale - Administration of the antibiotic is going to help counter the infectious process. Education and identifying the source is important, but it is not the priority, nor is scheduling the follow-up urine culture test.
Which action would the nurse implement immediately when a patient arrives via ambulance to the emergency department with penetrating renal trauma secondary to a motor vehicle accident? Obtain and assess urine sample for hematuria and myoglobinuria. Monitor intake and output of fluids; initiate an IV infusion. Provide IV pain relief and comfort with patient positioning. Assess patient's cardiovascular system and monitor for signs of shock.
Assess patient's cardiovascular system and monitor for signs of shock. Rationale - Because the patient may have suffered significant blood loss following this accident, assessment of the cardiovascular system and monitoring the patient for signs of shock are the most urgent actions that the nurse should perform. Other interventions such as assessing urine sample, monitoring fluids, and providing pain relief can be performed once the patient is stable. An IV infusion should be in place as the patient arrived via ambulance.
When preparing discharge instructions, which renal problem would the nurse associate with the patient's scleroderma and subsequent hypertension? Obstructive uropathy Goodpasture syndrome Chronic glomerulonephritis Calcium uropathy urinary calculi
Chronic glomerulonephritis Rationale - Hypertension occurs with chronic glomerulonephritis, which may be found in patients with scleroderma. Obstructive uropathy, Goodpasture syndrome, and calcium oxalate urinary calculi are not related to scleroderma and do not cause hypertension.
For which prescribed endourologic procedure would the nurse provide instructions when scheduling the removal of a patient's small stones? Cystoscopy Cystolitholapaxy Cystoscopic lithotripsy Percutaneous nephrolithotomy
Cystoscopy Rationale - "Endourologic" or endourology is a minimally invasive technique available to treat kidney stones. Cystoscopy is the removal of small stones in the bladder. Cystolitholapaxy is a procedure to break large stones with an instrument called a lithotrite. Cystoscopic lithotripsy uses an ultrasonic lithotrite to pulverize stones to break up large stones and eliminate them. Percutaneous nephrolithotomy is the insertion of a nephrostomy tube into the kidney pelvis.
When preparing information related to food choices for a patient with a history of calcium phosphate renal calculi, which food choices would the nurse recommend the patient select? Select all that apply. Eggs Yogurt Oranges Chicken Spinach Cranberry juice
Eggs, Oranges, Chicken, Cranberry juice Rationale - Milk and milk products are the richest sources of calcium. Dark-green, leafy vegetables are also high in calcium. Omitting the choices of yogurt and spinach demonstrates knowledge about a calcium-restricted diet. Oranges, chicken, cranberry juice, and eggs do not contain high levels of calcium and are not restricted from the patient's diet.
When providing discharge instructions for a patient with a β-hemolytic streptococcal infection, which potential complication would the nurse teach the patient regarding adherence to the aggressive treatment plan? Pneumonia Glomerulonephritis Fibrosis of the lungs Pheochromocytoma
Glomerulonephritis Rationale - Glomerulonephritis may occur after a β-hemolytic streptococcal infection. The disease process involves an unusual antigen-antibody reaction in the glomeruli of the kidneys, which causes the condition. Pneumonia, lung fibrosis, and pheochromocytoma are not caused by a β-hemolytic streptococcal infection.
Which renal disorder would the nurse associate with an abrupt rise of a 22-year-old patient's BP from 110/68 mm Hg, obtained two months earlier for a new job's physical, to the current BP of 154/96 mm Hg, obtained at the health fair? Recent renal trauma Renal artery stenosis Renal vein thrombosis Benign nephrosclerosis
Renal artery stenosis Rationale - Renal artery stenosis contributes to an abrupt rise in BP, especially in people under 30 or over 50 years of age. Renal trauma usually causes hematuria. Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome. Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension.
Which disorder would the nurse associate with the underlying cause of a patient's renal vein thrombosis? Hypertension Renal cell cancer Fibromuscular hyperplasia Large tumors in the peritoneal cavity
Renal cell cancer Rationale - Renal vein thrombosis may occur unilaterally or bilaterally. Renal cell cancer is one of the possible causes of renal vein thrombosis. Vascular changes from hypertension can lead to benign nephrosclerosis. Fibromuscular hyperplasia results in renal artery stenosis. Large tumors in the peritoneal cavity are extrinsic factors that can cause urethral strictures.
Which immune diseases cause glomerulonephritis? Select all that apply. Scleroderma Diabetic nephropathy Goodpasture syndrome Wegener's granulomatosis Systemic lupus erythematosus (SLE)
Scleroderma Goodpasture syndrome Systemic lupus erythematosus (SLE) Rationale - Scleroderma, Goodpasture syndrome, and SLE are immune diseases that cause glomerulonephritis. Diabetic nephropathy results in scarring of glomeruli. Wegener's granulomatosis is a form of vasculitis that causes glomerulonephritis.
After notifying the health care provider, which prescribed intervention would the nurse implement when providing care for a patient whose nephrostomy tube is not draining? Have the patient turn from side to side every hour. Use 5 mL of sterile saline to irrigate the affected tube. Use 30 mL of a carbonated liquid (cola) to gently irrigate. Enforce strict bed rest with the tube in a dependent position.
Use 5 mL of sterile saline to irrigate the affected tube. Rationale - With a nephrostomy tube, if the tube is occluded and irrigation is prescribed, the nurse should use 5 mL or less of sterile saline to irrigate it gently. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions, not cola, are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency.
For the patient with renal calculi, on which problem would the nurse focus interventions when developing a plan of care? Acute pain Risk for constipation Deficient fluid volume Risk for powerlessness
Acute pain Rationale - Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.
To avoid further complications, which dietary restrictions would the nurse teach a patient with uric acid stones? Select all that apply. Avoid cheese. Avoid herring. Avoid spinach. Avoid sardines. Avoid dried fruits.
Avoid herring. Avoid sardines. Rationale - Herring and sardines are rich in purines that produce uric acid as the waste product and result in the formation of uric acid-related renal calculi. A patient with calcium phosphate stones should avoid cheese because it is rich in calcium. To reduce calcium oxalate stone formation, patients should avoid spinach. Teach a patient to avoid dried fruits to prevent the formation of calcium phosphate stones.
Which instruction would the nurse verify for patient understanding prior to their discharge home with a renal calculus? Maintain bed rest with bathroom privileges. Continue to strain all urine at home for stones. Perform relaxation exercises to ease flank pain. Sustain a clear-liquid diet for the next 72 hours.
Continue to strain all urine at home for stones. Rationale - The renal calculus could pass after the patient is discharged and be expelled in the urine. Laboratory analysis of the stone reveals the exact contents and will guide further treatment. Bed rest is not recommended or necessary. A clear-liquid diet may not be necessary if the patient can tolerate the usual diet. Having the patient perform relaxation exercises to ease pain is secondary in importance to straining the urine.
Which interventions would the nurse implement to manage a patient with calcium oxalate urinary tract calculi? Select all that apply. Increase overall fluid intake. Decrease sodium intake. Limit dietary oxalate intake. Reduce intake of dietary purines. Administer α-penicillamine and tiopronin.
Increase overall fluid intake. Decrease sodium intake. Limit dietary oxalate intake. Rationale - Dehydration is a leading factor in the formation of all urinary tract calculi, including calcium oxalate stones. Drinking enough fluids will dilute the urine and make it harder for chemicals to build up and form crystals. Decrease the daily sodium intake because sodium can cause fluid retention and reduce the outflow of urine. Reduce dietary oxalate because the urinary calculi diagnosed are calcium oxalate. Advise a reduction in dietary purines in cases of uric acid calculi. In the case of cystine stones, caused by a rare hereditary defect resulting in an inborn error of cystine metabolism, administer α-penicillamine and tiopronin.
Which therapeutic medical intervention would the nurse anticipate scheduling for a patient with renal calculi? Lithotripsy Myelogram Renal sonogram IV pyelogram
Lithotripsy Rationale - Lithotripsy (also known as extracorporeal shock wave) is a noninvasive therapeutic treatment in which high- energy shock waves are used to crush or pulverize renal calculi in the renal pelvis, ureter, and bladder. Once crushed into smaller particles, the calculi can be more easily eliminated from the genitourinary tract with the aid of increased fluids and pain medication. The myelogram is a neurologic diagnostic procedure most commonly used for spinal issues. The renal sonogram and IV pyelography are diagnostic tools for renal problems, but they are not medical interventions.
Which precipitating factor is a common cause of pyelonephritis in patients admitted to the medical unit from a long-term care facility? Fever Gram-negative bacilli Urinary tract catheterization Urethral trauma from childbearing
Urinary tract catheterization Rationale - For residents of long-term care facilities, urinary tract catheterization is a common cause of pyelonephritis. Fever is a symptom of pyelonephritis but does not cause the pyelonephritis. Gram-negative bacilli cause urinary tract infections, not pyelonephritis. Urethral trauma from childbearing can cause urethral diverticula, not pyelonephritis.
Which clinical manifestations would the nurse assessing a patient with renal calculi expect to identify? Polyuria and fever Vomiting and flank pain Hematuria and diarrhea Abdominal pain and constipation
Vomiting and flank pain Rationale - In addition to severe flank pain and possible abdominal pain, nausea and vomiting are associated with renal calculi because the nerves that innervate the kidneys also serve the stomach. Constipation, polyuria, and diarrhea are not associated with renal calculi. Sometimes these patients may experience abdominal pain and fever. Patients with renal calculi may also have hematuria.
