Combo NCLEX Renal
Most important assessment if pyleonephritis is suspected?
check temperature
calcium rich foods include:
dairy products, lentils, fish w/ fine bones, dried fruits, nuts, chocolate, cocoa, Ovaltine
oxalate rich foods include:
dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans, chocolate, instant coffee, Ovaltine, tea, worcestershire sauce
What neurological symptoms of hypokalemia would be observed in a patient?
decreased reflexes
S/s of pyleonephritis are the same as UTI except for ____
flank pain and/or pain at the costovertebral angle
A pt that presents w/UTI s/s may be experiencing what:
frequency, urgency, suprapubic pain, dysuria, hematuria, fever, confusion in older adult
interventions for UTI may include
heating pad for discomfort and Pyridium for spasms
Macrobid may be used for tx of UTI, why?
it acts as a disinfectant in the urinary tract but is not effective outside of the UT
who are the most susceptible pts for UTI?
pregnant and/or sexually active women
If pt is undergoing shockwave therapy as tx for stones what is an important teaching?
push fluids - stones will be broken up into sandlike particles
s/s fluid overload:
rapid/bounding pulse, distended neck veins, HTN, cough, SOB, crackles, HA, restlessness
AVG (arteriovenous graft)
*A synthetic graft to join the vessels.
AVF (arteriovenous fistula)
*In forearm with an anastomosis between an artery and a vein.
Nephrotic Syndrome
*Inflammatory response in the glomerulus. *Causes - bacteria/viral infections - NSAIDs - cancer and genetic predisposition - lupus - DM - strep *S/S - proteinuria - hypoalbuminemic - anasarca (total body edema) - hyperlipidemia *Tx - diuretics - ACE inhibitors to block aldosterone - Prednisone - lipid lowering drugs - low sodium - increased protein - anti-coagulation therapy for up to 6 months - dialysis
Glomerulonephritis
*Patho - inflammatory reaction in the glomerulus. - antibodies lodge in the glomerulus; get scarring and decrease filtering. - main cause: strep. *S/S - sore throat - malaise and HA d/t toxins - BUN and creatinine increased - sediment/blood/protein in urine (cola colored) - flank pain (costovertebral angle tenderness) - BP increased - facial edema - UOP decreased - urine specific gravity increased *Tx - get rid of strep - balance activity with rest - I & O - daily weights - monitor BP - fluid replacement = 24hr loss + 500mL - decreased protein, Na+ - increased carbs - dialysis
What is glomerulonephritis?
-loss of kidney function -acute lasts 5-21 days -chronic after acute phase or slowly over time
Peritonitis etiology/ cause
Cause: Localized or generalized inflammatory process of the peritoneum Primary - blood borne organisms enter peritoneal cavity Secondary - abd. Organs perforate/rupture & release contents into peritoneal cavity (ex. Appendix rupture) **Can be fatal!**
If Macrobid causes pulmonary side effects such as SOB, cough, etc when will they subside?
2-3 days after stopping
Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? a) Give medications that promote fluid retention. b) Limit sodium and water intake. c) Teach client behaviors that decrease urination. d) Assess for dehydration.
B) Limit sodium and water intake Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.
Following a renal biopsy, the client complains of pain at the biopsy site that radiates to the front of the abdomen. The nurse interprets this complaint and further assesses the client for: 1. Bleeding. 2. Infection. 3. Renal colic. 4. Bladder perforation.
1. If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding should be suspected. Hypotension, a decreasing hematocrit level, and gross or microscopic hematuria also would indicate bleeding. Signs of infection would not appear immediately following a biopsy. The biopsy site would be the flank area and not the lower abdomen. No data are given to support the presence of renal colic.
The client who has suffered a crush injury to the leg has a highly positive urine myoglobin level. The nurse assesses this particular client carefully for signs of: 1. Brain attack (stroke) 2. Acute tubular necrosis 3. Respiratory failure 4. Myocardial infarction
2. The normal urine myoglobin level is negative. After extensive muscle destruction or damage, myoglobin is released into the bloodstream, where it is cleared from the body by the kidneys. When there is a large amount of myoglobin being cleared from the body, there is a risk of the renal tubules being clogged with myoglobin, causing acute tubular necrosis. This is one form of acute renal failure.
The client with urolithiasis has a history of chronic urinary tract infections. The nurse plans teaching the client to avoid which of the following? 1. Long-term use of antibiotics. 2. Wearing synthetic underwear and pantyhose. 3. High--phosphate foods, such as dairy products. 4. Foods that make the urine more acidic, such as cranberries.
2. Urolithiasis (struvite stones) can result from chronic infections. They form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Teaching should focus on prevention of infections and ingesting foods to make the urine more acidic. The client should wear cotton (not synthetic) underclothing to prevent the accumulation of moisture and to prevent irritation of the perineal area, which can lead to infection.
The client is admitted to the emergency department following a motor vehicle accident. The client was wearing a lap seat belt when the accident occurred and now the client has hematuria and lower abdominal pain. To assess further whether the pain is caused by bladder trauma, the nurse asks the client if the pain is referred to which of the following area? 1. Hip 2. Shoulder 3. Umbilicus 4. Costovertebral angle
2. Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, costovertebral angle, or hip.
Epoetin alfa (Epogen) is prescribed for a client diagnosed with chronic renal failure. The client asks the nurse about the purpose of the medication. The appropriate response would be which of the following? 1. It is used to lower your blood pressure. 2. It is used to treat anemia. 3. It will help to increase the potassium level in your body. 4. It is an anticonvulsant medication given to all clients after dialysis to prevent seizure activity.
2. Epoetin alfa is a medication that is used to treat anemia. Options 1, 3, and 4 are incorrect. Hypertension is a side effect. Hyperkalemia and seizures are adverse effects of the medication.
A client undergoing hemodialysis has an arteriovenous (AV) fistula in the left arm. A related nursing diagnosis for the client is risk for infection. The nurse should formulate which of the following outcome goals as most appropriate for this nursing diagnosis? 1. The client's temperature remains less than 101F 2. The client's WBC count remains within normal limits. 3. The client washes hands at least once per day. 4. The client states to avoid blood pressure measurement in the left arm.
2. General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand-washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the nursing diagnosis risk for injury.
A client diagnosed with polycystic kidney disease has been taught about the treatment plan for this disease. The nurse determines that the client needs additional teaching if the client states that the treatment plan includes: 1. Genetic counseling. 2. Sodium restriction. 3. Increased water intake. 4. Antihypertensive medications.
2. Individuals with polycystic kidney disease seem to waste rather than retain sodium. Thus, they need increased sodium and water intake. Aggressive control of hypertension is essential. Genetic counseling is advisable because of the hereditary nature of the disease.
The nurse is reviewing the client's record and notes that the physician has documented that the client has a renal disorder. On review of the lab results, the nurse most likely would expect to note which of the following? 1. Decreased hemoglobin level. 2. Elevated BUN 3. Decreased red blood cell count. 4. Decreased white blood cell count.
2. Measuring the blood urea nitrogen level is a frequently used laboratory test to determine renal function. The blood urea nitrogen level starts to rise when the glomerular filtration rate falls below 40% to 60%. A decreased hemoglobin level and red blood cell count may be noted if bleeding from the urinary tract occurs or if erythropoietic function by the kidney is impaired. An increased white blood cell count is most likely to be noted in renal disease.
The hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse assesses this client for which of the following manifestations? 1. Warmth, redness, and pain in the left hand. 2. Pallor, diminished pulse, and pain in the left hand. 3. Edema and reddish discoloration of the left arm. 4. Aching pain, pallor, and edema of the left arm.
2. Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth, redness, and pain probably would characterize a problem with infection. The manifestations described in options 3 and 4 are incorrect.
The client who has a history of gout also is diagnosed with urolithiasis and the stones are determined to be of uric acid type. The nurse gives the client instructions in which foods to limit, including: 1. Milk 2. Liver 3. Apples 4. Carrots
2. The client with uric acid stones should avoid foods containing high amounts of purines. This includes limiting or avoiding organ meats such as liver, brain, heart, kidney, and sweetbreads. Other foods to avoid include herring, sardines, anchovies, meat extracts, consommés, and gravies. Foods that are low in purines include all fruits, many vegetables, milk, cheese, eggs, refined cereals, sugars and sweets, coffee, tea, chocolate, and carbonated beverages.
A client has been admitted to the hospital for urinary tract infection an dehydration. The nurse determines that the client has received adequate volume replacement if the BUN drops to: 1. 3 mg/dL 2. 15 mg/dL 3. 29 mg/dL 4. 35 mg/dL
2. The normal blood urea nitrogen level is 8 to 25 mg/dL. Values such as those in options 3 and 4 reflect continued dehydration. Option 1 reflects a lower than normal value, which may occur with fluid volume overload, among other conditions.
The client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of: 1. Pyelonephritits 2. Glomerulonephritis 3. Trauma to the bladder or abdomen 4. Renal cancer in the client's family
3. Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client in this question. Renal cancer would not cause pain that is felt in the low abdomen; rather pain would be in the flank area.
s/s of pyleonephritis:
HA, increased BP, facial/periorbital edema, lethargic, low grade temp, wt gain (edema), and protein-, hema-, olgi-, dys- uria
what is the antidote for a cholenergic medication?
Atropine
The nurse is caring for the client who has undergone renal angiography using the left femoral artery for access. The nurse determines that the client is experiencing a complication of the procedure if which of the following is observed? 1. Urine output, 50 mL/hr 2. Blood pressure, 110/74 mm Hg 3. Pallor and coolness of the left leg. 4. Absence of hematoma in the left groin.
3. Potential complications after renal angiography include allergic reaction to the dye, renal damage from the dye, and vascular complications, which include hemorrhage, thrombosis, or embolism. The nurse detects these complications by noting signs and symptoms of allergic reaction, decreased urine output, hematoma or hemorrhage at the insertion site, and/or signs of decreased circulation to the affected leg.
An adult client has had lab work done as part of a routine physical exam. The nurse interprets that the client may have a mild degree of renal insufficiency if which of the following serum creatinine levels is noted? 1. 0.2 mg/dL 2. 0.5 mg/dL 3. 1.9 mg/dL 4. 3.5 mg/dL
3. The normal serum creatinine level for adults is 0.6 to 1.3 mg/dL. The client with a mild degree of renal insufficiency would have a slightly elevated level. A creatinine level of 0.2 mg/dL is low, and a level of 0.5 mg/dL is just below normal. A creatinine level of 3.5 mg/dL may be associated with acute or chronic renal failure.
if UTI is suspected how many mls of fluid should the RN encourage daily?
3000 ml unless contraindicated ie CHF pt
A client is schedule for a excretory urogram. Which of the following would the nurse expect to be prescribed as a component of preparation for this test? 1. NPO status after midnight. 2. Administration of a sedative before the test. 3. Administration of intravenous fluids. 4. Bowel preparation to remove fecal contents.
4. An excretory urogram is an invasive test that uses contrast radiopaque dye to assess the ability of the kidneys to excrete dye in the urine. Bowel preparation is necessary to permit adequate visualization of the kidneys, ureters, and bladder. Options 1, 2, and 3 usually are not components of preparation for this test.
Physical Assessment of Renal System- PALPATION:
Renal System- PALPATION: A landmark useful in locating the kidneys is the costovertebral angle formed by the rib cage and the vertebral column. The normal-size kidney is usually not palpable. If the kidney is palpable, its size, contour, and tenderness should be noted. Kidney enlargement is suggestive of neoplasm or other serious renal pathologic condition. The urinary bladder is normally not palpable unless it is distended with urine.
A patient with an obstruction of the renal artery causing renal ischemia exhibits HTN. One factor that may contribute to HTN: a) increase renin release b) increased ADH secretion c) decreased aldosterone secretion d) increased synthesis and release of prostaglandins
A) Increase Renin Release Renin is released in resonse to decreased B/P, renal ischemia, eosinophil chemotactic factor (ECF) depletion, and other factors affecting blood suppy to the kidney. It is they catalyst of the renin-angiotensin-aldosterone system, which raises B/P when stimulated. ADH is secreted by the posterior pituitary in response to serum hyperosmolality and low blood volume. Aldosterone is secreted within the renin-angiotensin II, and kidney prostaglandins lower B/P by causing vasodilation.
Retention of which electrolyte is the most life-threatening effect of renal failure? a) Potassium b) Calcium c) Phosphorous d) Sodium
A) Potassium Retention of potassium is the most life-threatening effect of renal failure.
A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse? a) Renal circulation b) Urine production c) Kidney function d) Kidney structure
A) Renal circulation A renal angiogram (renal arteriogram) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.
The nurse develops a postprocedure plan of care for a client who had a renal biopsy. The nurse avoids documenting which intervention in the plan? 1. Administering analgesics as needed. 2. Encouraging fluids to at least 3 L in the first 24 hours. 3. Testing serial urine samples with dipsticks for occult blood. 4. Ambulating the client in the room and hall for short distances.
4. Following renal biopsy, the nurse ensures that the client remains in bed for at least 24 hours. Vital signs and puncture site assessments are done frequently during this time. Encouraging fluids is done to reduce possible clot formation at the biopsy site. Serial urine samples are assayed by Hematest with urine dipsticks to evaluate bleeding. Analgesics often are needed to manage the renal colic pain that some clients feel after this procedure.
The nurse has taught the client with polycistic kidney disease about management of the disorder and prevention and recognition of complications. The nurse determines that the client understands the instructions if the client states that there is no reason to be concerned about: 1. Burning on urination. 2. A temperature of 100.6F 3. New-onset shortness of breath. 4. A blood pressure of 105/68 mmHg
4. The client with polycystic kidney disease should report any signs and symptoms of urinary tract infection so that treatment may begin promptly. Lowered blood pressure is not a complication of polycystic kidney disease, and it is an expected effect of antihypertensive therapy. The client would be concerned about increases in blood pressure because control of hypertension is essential. The client may experience heart failure as a result of hypertension, and thus any symptoms of heart failure, such as shortness of breath, are also a concern.
A client is undergoing diagnostic tests to rule out a diagnosis of renal disease. The lab results indicate a ratio of BUN to creatinine of 15:1. The nurse determines that this result indicates: 1. A fluid volume deficit 2. Liver failure 3. A fluid volume excess 4. A normal ratio
4. The normal ratio of BUN to creatinine is approximately 10:1 to 15:1. A value lower than 10:1 would indicate diminished urea concentration. A value greater than 15:1 would indicate inadequate renal function.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. b) Administer furosemide (Lasix) 20 mg I.V. c) Encourage oral fluids. d) Start hemodialysis after a temporary access is obtained.
A) Start IV fluids with normal saline solution bolus followed by a maintenance dose. Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Urine output of 250 ml/24 hours b) Temperature of 100.2° F (37.8° C) c) Serum creatinine level of 1.2 mg/dl d) Blood urea nitrogen (BUN) level of 22 mg/dl
A) Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.
Physical Assessment of Renal System- CREATININE CLEARANCE:
CREATININE CLEARANCE: Because almost all creatinine in the blood is normally excreted by the kidneys, creatinine clearance is the most accurate indicator of renal function. The result of a creatinine clearance test closely approximates that of the GFR.
Physical Assessment of Renal System- AUSCULTATION:
AUSCULTATION: With a stethoscope the abdominal aorta and renal arteries are auscultated for a bruit (an abnormal murmur), which indicates impaired blood flow to the kidneys.
Common test for renal caliculi?
CT scan
A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? a) Hyperglycemia b) Hypercalcemia c) Hyperkalemia d) Hypernatremia
C) Hyperkalemia Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia.
Glomerulonephritis is commonly related to what infection?
Strep. Intervention- prevent and treat strep quickly! Also: Immune dz such as Lupus. Vasculitis, Scarring from: HTN, Diabetic kidney dz. Intervention- control blood sugars and hypertension.
While taking Cipro or Levaquin if you experience dizziness, light sensitivity or light-headedness what might this indicate:
CNS toxicity
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a) Therapeutic index b) GI absorption rate c) Liver function studies d) Creatinine clearance
D) Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.
The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? a) Pregnancy b) Diabetes mellitus c) Neuromuscular disorders d) Hypotension
D) Hypotension Hypertension, not hypotension, is a risk factor for kidney disease.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? a) Decreased blood urea nitrogen (BUN) b) Decreased potassium c) Increased serum albumin d) Increased serum creatinine
D) Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? a) Increased red blood cell count b) Decreased serum potassium level c) Increased serum calcium level d) Increased serum creatinine level
D) Increased serum creatinine level Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.
Patients diagnosed with hypervolemia should avoid sweet or dry food because: a) It obstructs water elimination. b) It can cause dehydration. c) It can lead to weight gain. d) It increases the client's desire to consume fluid.
D) It increases the client's desire to consume fluid The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is rationed, and the client is advised to take limited amount of fluid when thirsty. Sweet or dry food can increase the client's desire to consume fluid. Sweet or dry food does not obstruct water elimination nor does it cause dehydration. Weight regulation is not part of hypervolemia management except to the extent that it is achieved on account of fluid reduction.
Bacterium most commonly causing UTI's?
E.coli
Common interventions related to: UTI/ Cystitis
Empty bladder/bowel regularly & completely; Avoid stagnant urine in the bladder or urethra. Drink water prior to intercourse to promote urination & empty bladder after intercourse. Clean perineal area: front to back. Drink large amt fluids daily.
If alkaline-dash diet is ordered to increase pH of urine what will it include:
Milk, veggies, beef, halibut, trout, salmon No prunes or plums
A client admitted for acute pyelonephritis is about to start antibiotic therapy. Which symptom would be expected in this client? 1) Hypertension 2) Flank pain on the affected side 3) Pain that radiates toward the unaffected side 4) No tenderness with deep palpation over the CVA
RATIONAL: 2) The client may complain of pain on the affected side because the kidney is enlarged and might have formed an abscess. Hypertension is associated with chronic pyelonephritis. Pain may radiate down the ureters or to the epigastrium. The client would have tenderness with deep palpation over the CVA.
A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which intervention is important? - 1. Strain all urine - 2. Limit fluid intake - 3. Enforce strict bed rest. - 4. Encourage a high-calcium diet
RATIONALE: 1) Urine should be strained for calculi and sent to the laboratory for analysis. Fluid intake of 3 to 4 qt. 3 to 4 L/day is encouraged to flush the urinary tract and prevent further calculi formation. Ambulation is encouraged to help pass the calculi through gravity. A low-calcium formation of calcium calculi.
A client with renal insufficiency is admitted with a diagnosis of pneumonia. He's being treated with IV antibiotics, which can be nephrotoxic. Which laboratory value(s) should be monitored closely? - 1. Blood Urea Nitrogen (BUN) and creatinine levels. - 2. Arterial Blood Gas (ABG) levels - 3. Platelet count - 4. Potassium level
RATIONALE: 1) BUN and creatinine levels should be monitored closely to detect elevations due to nephrotoxicity. ABG determinations are inappropriate for this situation. Platelets and potassium levels should be monitored according to routine.
The nurse is assessing a client who reports painful urination during and after voiding. The nurse suspects the client may have a problem with which area of the client's urinary system? - 1. Bladder - 2. Kidneys - 3. Ureters - 4. Urethra
RATIONALE: 1) Pain during or after voiding indicates a bladder problems, usually infection. Kidney and ureter pain would be in the flank area, and problems or the urethra would cause pain at the external orifice that's commonly felt at the start of voiding.
A client is hospitalized and diagnosed with acute hydronephrosis. Which complaint does the nurse expect from this client? 1) Sudden onset of acute, colicky pain 2) Sharp left flank pain 3) Sharp, throbbing pain 4) Felling of pressure and distention
RATIONALE: 1) Sudden, acute colicky pain is a clinical sign of acute hydronephrosis. Hydronephrosis occurs when urine collects in the renal pelvis and calyces due to obstruction or atrophy of the urinary tract. Flank pain most commonly indicates a kidney infection, although it may occur hydronephrosis. Distention and pressure are commonly felt in the pelvis and bladder with lower urinary tract obstructions.
When performing a physical assessment, the nurse discovers a client's urinary drainage bag lying next to him. Based on this finding, the nurse identifies which priority nursing diagnosis? - 1. Risk for infection - 2. Reflex urinary incontinence - 3. Impaired comfort - 4. Risk for compromised human dignity
RATIONALE: 1) The drainage bag shouldn't be placed alongside the client or on the floor because of the increased risk of infection caused by microorganisms. It should hang on the bed in a dependent position. The other nursing diagnoses are not appropriate for this assessment finding.
Physical Assessment of Renal System- PERCUSSION:
Renal System- PERCUSSION: Tenderness in the flank area may be detected by fist percussion (kidney punch). Normally a firm blow in the flank area should not elicit pain. Normally a bladder is not percussible until it contains 150 ml of urine. If the bladder is full, dullness is heard above the symphysis pubis. A distended bladder may be percussed as high as the umbilicus.
A nurse is caring for a client after a renal biopsy. The nurse observes the client for: 1) Increased activity 2) Bleeding 3) Changes in mental status 4) Increased blood pressure
RATIONALE: 2) A renal biopsy is obtained through needle insertion into the lower lobe of the kidney, which can need to hemorrhage, so the nurse needs to watch for signs and symptoms of bleeding. After the procedure, the client should remain still for 4 to 12 hours. Changes in mental status (unless the client is bleeding heavily) or blood pressure aren't related to renal biopsy.
A nurse is assessing a client diagnosed with acute pyelonephritis. Which of the following symptoms does the nurse expect to see? 1) Jaundice and flank pain 2) Costovertebral angle tenderness and chills 3) Burning sensation on urination 4) Polyuria and nocturia
RATIONALE: 2) Costovertebral angle tenderness and chills are symptoms of acute pyelonephritis (inflammation of the kidney and renal pelvis). Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection (UTI). Nocturia is associated with a lower UTI or benign prostatic hyperplasia. Polyuria is seen with diabetes mellitus, diabetes insipidus, or the use of diuretics.
A client is diagnosed with cystitis. Client teaching aimed at preventing a recurrence should include which instruction? - 1. Bathe in a tub. - 2. Wear cotton underwear. - 3. Use a feminine hygiene spray. - 4. Limit your intake of cranberry juice.
RATIONALE: 2) Cotton underwear prevents infection because it allows for air to flow to the perineum. Women should shower instead of taking a tub bath to prevent infection. Feminine hygiene spray can act as an irritant. Cranberry juice helps prevent cystitis because it increases urine acidity; alkaline urine supports bacterial growth, so cranberry juice intake should be increased, not limited.
A nurse is assessing a client who might have a UTI. What statement by the client suggests that a UTI is likely? 1) I urinate large amounts. 2) It burns when I urinate. 3) I go for hours without the urge to urinate. 4) My urine has a sweet smell.
RATIONALE: 2) Dysuria (painful urination) is a common symptom of a UTI. Voiding large amounts of urine isn't associated with UTI's; clients with UTI's commonly report frequent voiding of small amounts of urine. A client with a UTI is unlikely to be able to go for hours without urinating because UTI's increase feelings of urgency to void. Urine with a sweet acetone odor is associated with diabetic ketoacidosis. Foul-smelling urine may be a sign of infection.
A nurse is caring for a client in the immediate postoperative period after a prostatectomy. What complication requires priority assessment? 1) Pneumonia 2) Hemorrhage 3) Urine retention 4) Deep vein thrombosis
RATIONALE: 2) Immediately after a prostatectomy, , hemorrhage is a potential complication. Pneumonia may occur if the client doesn't turn, cough, and breathe deeply after surgery. Urine retention isn't a problem immediately after surgery because a catheter is in place. Thrombosis may occur later if the client doesn't ambulate.
Discharge instructions for a client treated for acute pyelonephritis should include which statement? - 1. Avoid taking any dairy products. - 2. Return for follow-up urine cultures. - 3. Stop taking the prescribed antibiotics when the symptoms subside. - 4. Recurrence is unlikely because you've been treated with antibiotics.
RATIONALE: 2) The client needs to return for follow-up urine cultures because bacteriuria may be present but asymptomatic. Intake of dairy products won't contribute to pyelonephritis. Antibiotics need to be taken for the full course of therapy regardless of the symptoms. Pyelonephritis typically recurs as a relapse or new infection and frequently recurs within 2 weeks of completing therapy.
A nurse is teaching a female client how to prevent the recurrence of urinary tract infection. The nurse should teach her to do which action? 1) Wipe from back to front after urination or a bowel movement. 2) Urinate every 2 to 3 hours. 3) Drink at least 8 oz (236.6ml) of fluid each day. 4) Take daily bubble baths.
RATIONALE: 2) The nurse should instruct the client to void every 2 to 3 hours to flush bacteria from the urethra and prevent urinary stasis in the bladder. Wiping from front to back (Not back to front) after a bowel movement or urination moves bacteria away from the urethral meatus. Drink 2 to 3 quarts (2 to 3L) of fluid per day helps flush bacteria out of the urinary tract. The nurse should tell the client to avoid bubble baths because they can irritate the urethra, increasing the risk of inflammation and infection.
A nurse is instructing a client with renal calculi about recommended daily fluid consumption. The nurse would be most helpful by telling the client to drink approximately: 1) 4 cups per day 2) 8 cups per day 3) 12 cups per day 4) 16 cups per day
RATIONALE: 3) A client with renal calculi should drink 3L (12 cups) of fluid per day.
A client is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. What finding is the nurse most likely to find in the client's history? 1) Renal calculi 2) Renal trauma 3) Recent sore throat 4) Family history of acute glomerulonephritis
RATIONALE: 3) Recent sore throat. Typically, acute glomerulonephritis occurs 2 to 3 weeks after a strep throat infection. The Most Common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body. Renal calculi and renal trauma aren't known to cause acute glomerulonephritis. A family history isn't associated with the development of acute glomerulonephritis.
Which client is at greatest risk for developing a UTI? 1) A 35 year old woman with an arm fracture. 2) An 18 year old woman asthma. 3) A 50 year old postmenopausal woman. 4) A 28 year old woman with angina.
RATIONALE: 3) Women are more prone to UTI's after menopause. Urinary stasis may develop due to a loss of pelvic muscle tone and prolapse of the bladder or uterus. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. While chronic diseases, including diabetes mellitus and impaired immunity, increase the risk of UTI, angina, asthma, and fractures don't increase the risk of UTI.
types of urinary tract caliculi
calcium oxalate (30-45%) calcium phosphate (8-10%) struvite (10-15%) cystine (1-2%)
A nurse is writing the teaching plan for a client with cystitis who's receiving phenazopyridine (Pyridium). What instruction should the nurse include? 1) Call the physician if urine turns orange-red 2) Take phenazopyridine just before urination to relieve pain 3) Discontinue prescribed antibiotics after painful urination is relieved 4) Stop taking phenazopyridine after painful urination is relieved.
RATIONALE: 4) Phenazopyridine is taken to relieve dysuria because it provides an analgesic and anesthetic effect on the urinary tract mucosa. The client can stop taking it after the dysuria is relieved. Warn the client that the dye in the drug (azo dye) may temporarily turn the urine red or orange but that isn't cause for calling the physician. Phenazopyridine is usually taken three times per day for 2 days. It isn't taken just before voiding. Antibiotics must be taken for the full course of therapy, even if the burning on urination is relieved.
During a health history, which statement by a client indicates a risk of renal calculi? - 1. "I've been drinking a lot of cola soft drinks lately." - 2. "I've been jogging more than usual." - 3. "I've had more stress since we adopted a child last year." - 4. "I'm a vegetarian and eat cheese two or three times each day."
RATIONALE: 4) Renal calculi are commonly composed of calcium. Diets high in calcium may predispose a person to renal calculi. Milk and milk products are high in calcium. Cola soft drinks don't contain ingredients that would increase the risk of renal calculi. Jogging and increased stress aren't considered risk factors for renal calculi formation.
A nurse is instructing a client with oxalate renal calculi. What foods should the nurse urge the client to eliminate from his diet? 1) Citrus fruits, molasses, and dried apricots 2) Milk, cheese, and ice cream 3) Sardines, liver and kidney 4) Spinach rhubarb and asparagus
RATIONALE: 4) To reduce the formation of oxalate calculi, urge the client to avoid foods high in oxalate, such as spinach, rhubarb, and asparagus. Other oxalate- rich foods to avoid include tomatoes, beets, chocolate, cocoa, celery, and parsley. Citrus fruits, molasses, dried apricots, milk, cheese, ice cream, sardines and organ meats do NOT produce oxalate and do NOT need to be omitted from the client's diet.
A client returns from the operating room after extensive abdominal surgery. He has 1,000ml of lactated Ringer's solution infusing via central line. The physician orders the I.V. fluid to be infused at 125ml/hr plus the total output of the previous hour. The drip factor of the tubing is 15gtt/min. The client's output for the previous hour was 75m. via Foley catheter, 50ml via NG tube, and 10ml via Jackson-Pratt tube. How many drops per minute should the nurse set the I.V. flow rate at to deliver the correct amount of fluid? Record as a whole number. ______ ggt/minute.
RATIONALE: 65ggt/min. First calculate the volume to be infused in milliliters: 75ml + 50ml + 10ml = 135ml total output for the previous hour; 135ml + 125ml ordered as a constant flow = 260ml to be infused over the next hour. Next, used the formula: Volume to be infused/ Total minutes to be infused x Drip Factor = Drops per min. In this case, 260ml divided by 60min x 15 ggt/min = 65 ggt/min
After a retropubic prostatectomy, a client needs continuous bladder irrigation. The client has an I.V. of D5W infusing at 40ml/hr and a triple lumen urinary catheter with normal saline solution infusing at 200,l/hr. A nurse empties the urinary catheter drainage bag 3 times during an 8 hr period, for a total of 2780ml. How many milliliters does the nurse calculate as urine? Round to the nearest whole number. ________ ml
RATIONALE: During 8 hrs, 1600ml of bladder irrigation has been infused (200ml x 8hrs = 1600ml/8hrs). The nurse then subtracts this amount of infused bladder irrigation from the total volume in the drainage bag (2780ml - 1600ml = 1180ml) to determine urine output.
Physical Assessment of Renal System- INSPECTION: Skin, Mouth, Face & extremities, Abdomen, Weight, General State of Health
Renal System- INSPECTION: SKIN: pallor, yellow-gray cast, excoriations, changes in turgor, bruises, texture (e.g., rough, dry skin) MOUTH: stomatitis, ammonia breath odor FACE & EXTREMITIES: generalized edema, peripheral edema, bladder distention, masses, enlarged kidneys ABDOMEN: striae, abdominal contour for midline mass in lower abdomen (may indicate urinary retention) or unilateral mass (occasionally seen in adult, indicating enlargement of one or both kidneys from large tumor or polycystic kidney) WEIGHT: weight gain secondary to edema; weight loss and muscle wasting in renal failure GENERAL STATE OF HEALTH: fatigue, lethargy, and diminished alertness
T or F Macrobid should be given with milk?
True
T or F calcium stones are alkaline:
True - this pt would need acid dash diet
Physical Assessment of Renal System- URODYNAMIC TESTS:
URODYNAMIC TESTS: study the storage of urine within the bladder and the flow of urine through the urinary tract to the outside of the body.
A clinical situation in which the increased release of erythropoietin would be expected is: a) hypoexmia b) hypotension c) hyperkalemia d) fluid overload
a) Hypoexmia Erythropoietin is released when the oxygen tension of the renal blood supply is low and stimulates production of red blood cells in the bone marrow. Hypotension causes activation of the renin-angiotensin-aldosterone system, as well as release of ADH. Hyperkalemis stimulates release of aldosterone from the adrenal cortex, and fluid overload does not directly stimulate factors affecting the kidney.
Uric acid stone (excess purine) would require what kind of diet?
alkaline ash
If pt is scheduled for an IVP what allergy should you assess for?
allergy to iodine or seafood
if pt is on acid-dash diet to decrease pH of urine what will it include:
bread, cereal, whole grains, cranberries, legumes, tomatoes,oysters, fish, poultry, pastries
While taking Bactrim what side effect would be a concern:
sore throat
Pts taking Pyridium should be taught what?
that a reddish orange discoloration of urine may occur.
what symptom is different for older pts suffering from UTI?
they are more likely to present with confusion and not abd pain.
If pt has renal insufficiency what would you assess for?
this is end-stage kidney disease, kidneys aren't functioning; assess for psychosocial changes - depression, anxiety, ability to cope, suicide, withdraw from loved ones