Exam 3 Renal combined Suprapubic Pain and Hematuria
Kidney and bladder ultrasound
Uses sound waves to examine the kidney and bladder Can not evaluate renal function- just anatomy Can differentiate cystic and solid lesions and can visualize larger stones
A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan?
"Another method of contraception is needed until the sperm count is 0."
The nurse is collecting data on a client with a urinary tract infection (UTI). Which statements should the nurse expect the client to make? Select all that apply.
"I need to urinate frequently." "It burns when I urinate." "I need to urinate urgently."
Palliative care for prostate cancer
Analgesia External beam radiation
The client with benign prostatic hypertrophy is being transferred from the emergency department to a surgery unit. Which information should be included in the report from the nurse in the emergency department to the nurse responsible for admitting the client?
"The client was catheterized, and 1,100 mL of urine was obtained. The urine appeared cloudy, and a specimen was sent to the laboratory."
When providing client teaching about continuous bladder irrigation following prostate surgery, the nurse should tell the client:
"The purpose of the irrigation is to keep bladder drainage clear and to prevent the formation of blood clots in the bladder."
An unlicensed assistive personnel (UAP) tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that is not possible because he has a catheter in place that is draining well." The nurse should tell the UAP:
"The urge to void is usually created by the large catheter, and he may be having some bladder
A client scheduled for a vasectomy asks the nurse how soon after the procedure he can have sexual intercourse without using an alternative birth control method. How should the nurse respond?
"You can safely have unprotected intercourse when your sperm count indicates sterilization."
Normal Creatinine
0.6-1.2
The client with pyelonephritis asks the nurse, "How will I know whether the antibiotics are effectively treating my infection?" What should the nurse tell the client?
"Your health care provider will take a urine culture."
what do we keep CKD patients at hemoglobin
10, don't want to make blood too thick
normal BUN
10-20
How often is hemodialysis done?
3 times a week
Microscopic hematuria
3-4 RBCs per high powered field
Sulfamethoxazole has been prescribed to treat a client's urinary tract infection. The initial dosage is 2 g orally. The nurse has 500-mg tablets available. How many tablets should the nurse give? Record your answer using a whole number.
4
Cystogram procedure
A catheter is inserted and saline is used to distend the bladder Then, obtain the images
A nurse receives the assignment of the following clients for the shift. Following the report, which client should the nurse see first?
A client 3 days after kidney transplant with a sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L after dialysis
Retrocaval ureter
Abrupt medical deviation of the ureter at level of L2
Which of the following is a priority nursing diagnosis for the client presenting with pelvic inflammatory disease?
Acute pain.
Medications that cause glomerular microscopic hematuria
Anticoagulants Salicylates Sulfonamides Cyclophosphamide
A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows: pH 7.30 PaO2 97 PaCO2 37 HCO3 18 The nurse would expect what sets of assessment findings?
Clammy skin, blood pressure 86/46 mm Hg, headache
Testicular cancer risk factors
Cryptorchidism Testicular atrophy Inguinal hernia Infertility
The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder?
Diabetes mellitus
Nephron sparing partial nephrectomy
Done in patients with compromised renal function or patients with comorbidities that can't undergo a radical nephrectomy Small lesions
A client is diagnosed with pyelonephritis. Which nursing action is a priority for care now?
Ensure sufficient hydration.
what bacteria is HUS associated with
Escherichia coli damages red blood cells and endothelial cells
The nurse is providing preoperative instructions to a client who is having a transurethral resection of the prostate. The nurse should tell the client:
Expect blood in your urine in the first couple of days following the procedure."
Most common type of testicular cancer
Germ cell tumors
Marked microscopic
Greater than 50 RBCs per high powered field
what is the most common cause of renal failure in children
HUS
extrophy of the bladder
Herniation of the bladder through the abdominal wall
Bladder sparing treatment of invasive disease
High dose radiation (50% relapse) Radiosensitizing chemotherapy and radiotherapy (2 year survival rate- 67%)
Preparation for percutaneous nephrostomy
IV antibiotics
Side effects of brachytherapy
Impotence Incontinence
PSA
Indicative of increased risk of cancer Normal: < 4 Bone metastases: > 20
Side effects of testicular cancer treatment
Infertility due to azospermia from the chemo
Causes of hematuria
Injury Stones Glomerulonephritis Malignancy Any disease of the GU tract Lupus/systemic infections Coagulopathies Medications Genitourinary tract lesions Periurethral problems - located in pelvis or colon
anemia meds
Iron Epogen (erythropoietin)
Anemia CKD
Lethargy, dizziness, and low hematocrit are common
normal hemoglobin levels
Male: 13-18 g/100mL Female: 12-16 g/100mL
Intravenous pyelogram (IVP)
No longer done Uses a dye and takes an x-ray Has several phases- takes a long time
Is nonglomerular or glomerular hematuria more common?
Nonglomerular- typically due to infection or BPH
Contraindications for lithotripsy
Obesity, coagulopathies, anticoagulant use, and uncontrolled HTN
Acute Post-Streptococcal Glomerulonephritis
Occurs after a throat or skin infection with certain strains of group A alpha-hemolytic streptococci Experience a sudden onset of hematuria, edema, hypertension, and renal insufficiency Antigen-antibody complexes and complement are deposited in the glomerulus The immune complexes initiate inflammation and glomerular injury
Treatment of nonseminomatous tumors (testicular cancer)
Orchiectomy + lymph node dissection + chemotherapy More aggressive cancer= more aggressive treatment
Treatment of seminomatous tumors (testicular cancer)
Orchiectomy + radiation Chemo is used for larger spread or refractory to radiation
Staging of testicular cancer
Orchiectomy findings, CXR, chest CT, abdominal CT Tumor markers- BHCG, AFP, LDH
Risk factors for malignancy
Patients with macroscopic hematuria or marked microscopic hematuria, no infection or stone present, older age, male gender
Diagnosis of renal cell carcinoma
Percutaneous needle biopsy Cross sectional CT and MRI- determines tumor size and spread, specifically looking at lymph nodes and renal vein
2 surgical methods for prostatectomy
Perineal method Suprapubic approach
Ureteral stents
Placed during a cystoscopy to maintain the patency and cause dilation of the ureter Done with recurrent stones or infections and can be kept in for day to weeks
CT Urography
Preferred imaging study in patients with unexplained hematuria Triphasic procedure with the benefit of conventional CT with ability of IVP
Which is the correct order, from first to last, for proper placement of a urinary catheter? All options must be used
Prepare a sterile field. Lubricate the catheter adequately with a water-soluble lubricant. Insert the catheter far enough into the bladder to prevent trauma to the urethral tissue. Ensure free flow of urine.
Workup if you suspect malignancy
Probability is based on risk factors Hematuria without an identifiable cause Cytology Bladder tumor markers
Extracorporeal shock wave lithotripsy (ESWL)
Procedure used to shatter simple, smaller stones Not very successful for large stones Pulses of sonic waves pulverize the stones which are then more easily passed through the ureter and out of the body in the urine
GU cancers in men
Prostate (most common) Testicular (15-35 years) Bladder Renal cell
Calcium, phosphate, and bone changes CKD
Reduced renal phosphate excretion, decreased renal synthesis of 1,25-(OH)2 vitamin D3, and hypocalcemia Fractures
Proteinuria
Requires 24 hr urine collection Quantifies renal function and degree of proteinuria Heavy proteinuria= 3g/24 hours Sign of glomerular disease
Radical cystectomy
Resection of a segment of the ileum to form a stoma to drain the urine out of the ureters Can be curative Increased survival rate
A client is prescribed alfuzosin for benign prostatic hyperplasia (BPH). What should the nurse teach the client?
Rise slowly from a supine position.
Which nursing diagnosis is appropriate for a client with renal calculi?
Risk for infection
Renal cell cancer
Seen in men 50-70 years Most cases are nonhereditary carcinoma
Testicular cancer clinical presentation
Solid, painless, non-transilluminating testicular mass Heaviness in the scrotum
Diagnosis of prostate cancer
Suspicion with elevated PSA Staging- DRE, transurethral ultrasound Biopsy- Gleason score
Other types of non-seminoma germ cell tumors (testicular)
Teratomas Choriocarcinomas Embryonal cell carcinomas Mixed cell
potassium balance CKD
Tubular secretion increases early Once oliguria sets in, potassium retained
Seminomas (testicular)
Type of germ cell tumor, respond well to radiation
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia
A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?
Use of corticosteroids
Rezum procedure
Used for BPH Heated water vapor is sent through a catheter and obliterates the tissue The catheter is left for several days to prevent blocking the urethra from swelling after the procedure
Percutaneous thermal ablation
Used for small lesions Used for patients who are not surgical candidates
Perineal method
Used primarily when prostate cancer is limited to the prostate gland and has not spread to the lymph nodes, more common method, incision is across the perineum
Percutaneous kidney biopsy
Used to evaluate a transplanted kidney, unexplained decreased renal function, persistent blood in the urine, or protein in the urine
Immunologic studies
Used to test for glomerular disease Lupus- ANA, anti-dsDNA Post-streptococcal- ASO titer
Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate?
Validate the client's understanding of the material frequently.
Types of observation
Watchful waiting- only take action if symptoms develop, usually done for patients with a limited life expectancy Active surveillance- regular PSA and DREs to monitor growth/changes
KUB
X-ray of Kidney Urinary Bladder Could show larger nephrolithiasis or large masses Not done right away
A client is scheduled for an intravenous pyelogram (IVP). The evening before the procedure, the nurse learns that the client is allergic to shellfish. The nurse should:
cancel the IVP and notify the health care provider (HCP).
primary enuresis
child has never been continent
The most significant sign of acute renal failure is:
decreased urine output.
A client has cystitis. The nurse should further assess the client for:
foul-smelling urine.
Daytime enuresis
loss of urine during the day hours
What type of acidosis does someone with CKD have
metabolic acidosis
pulmonary effects of CKD
pulmonary edema crackles
flank pain indicates
pyelonephritis
plasmapheresis
removal of plasma from withdrawn blood by centrifuge
A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which of the following statements, if made by a group member, would indicate understanding of the teaching?
"I should notify the physician if urinary urgency, burning, frequency, or difficulty urinating occurs."
The nurse is instructing the unlicensed assistive personnel (UAP) about the correct technique for obtaining a clean-catch urine culture from a female client. Which statement indicates
"I will ask the client to clean her labia, void into the toilet, and then into the specimen cup."
The client with a urinary tract infection is given a prescription for trimethoprim. Which statement indicates that the client understands how to take the medication?
"I will take all the pills and then return to my doctor."
The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching?
"I will take it with meals and bedtime snacks."
A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?
"I'm allergic to shellfish."
CT urography procedure (3 phases)
1. Non-contrast images of the top of the kidneys through the bladder 2. Administer IV contrast and take images 90 seconds later 3. Images taken 12-15 minutes following IV contrast administration
Cystoscopy procedure
1. Patient is placed in lithotomy position 2. Urethra is prepped with betadine 3. Cystoscope is inserted into the urethra to bladder trigone 4. Water or saline is infused to distend the bladder to allow for better visualization 5. Inspection of bladder walls and ureteral orifices 6. Biopsies can be taken and ureteral stents can be placed
Bladder cancer
4th most common cancer in men, 9th in women Majority are transitional cell carcinoma
Prostate cancer risk factors
Advancing age African Americans FHx BPH, vasectomy, smoking, ETOH, sedentary lifestyle
The unlicensed assistive personnel (UAP) reports to the nurse that the client with an abdominal hysterectomy who returned from the recovery room 1 hour earlier has saturated the blue pad with bright red blood. What should the nurse do?
Ask the UAP to obtain vital signs while the nurse calls the surgeon.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?
Assess the AV fistula for a bruit and thrill.
A client with chronic renal failure is experiencing central nervous system (CNS) changes caused by uremic toxins. Which nursing approach would be most appropriate for addressing the changes?
Assess the client's mental status regularly.
Symptoms associated with hematuria
Asymptomatic unless there is an obstruction or inflammation
Thin membrane disease
Autosomal dominant Typically also have proteinuria
Staging for bladder cancer
Based on extent of spread into the bladder wall Biopsy, imaging, and surgical pathology TMN system
Immunoglobulin A (IgA) Nephropathy
Berger's disease - just like in adults! Glomerulonephritis from autoimmune issue Antibody complexes get stuck, just no strep here
Diagnosis of bladder cancer
Biopsy on cystoscopy
Treatment of early stage bladder cancer
Bladder sparing surgery Intravesicular chemotherapy Intravesicular immunotherapy
Risks and complications of percutaneous nephrostomy
Bleeding, infection, sepsis
A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?
Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl
Removal of ureteral stent
Can have a string attached that exits the urethra for easy removal after surgery
Diagnosis of testicular cancer
Cancer until proven otherwise Ultrasound Solid= cancer, cystic= benign Consult urology for orchiectomy
A client with chronic kidney disease (CKD) has a blood urea nitrogen (BUN), 100 mg/dL, serum creatinine 6.5 mg/dL, potassium 6.1 mEq/L, and lethargy. Which of the following is the priority nursing assessment?
Cardiac rhythm
what causes VUR
Caused by a congenital abnormality or ectopic insertion of the ureter into the bladder
Hemolytic Uremic Syndrome (HUS)
Characterized by hemolytic anemia, thrombocytopenia, acute renal failure HUS is the most common cause of acute renal failure in children
The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which action would be most important for the nurse to include in pretest preparation?
Check the client's history for allergy to iodine.
Cystography
Checks the integrity of the bladder and can be used to determine the cause of infections and checks for tumors/stones Evaluates the anatomy of the trigone
Considerations for hematuria
Clinical presentation Degree of hematuria Age and gender of the patient (older men) Risk factors for disease
External beam radiation
Cure rates are similar to surgery for prostate cancer SE: radiation colitis, radiation burns in the perineum
Factors to consider for treatment of prostate cancer
Depends on staging and Gleason score Generally slow growing and asymptomatic Must consider: age, comorbidities, and life expectancy
The nurse is reviewing a client's record and notes that the primary health care provider has documented that the client has chronic kidney disease. On review of the laboratory results, the nurse most likely would expect to note which finding? Select all that applies.
Elevated creatinine level Decreased hemoglobin level Decreased red blood cell count
A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged I.V. pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow?
Evaluating patency of the drainage lumen
RBC casts
Glomerulonephritis
Progression of testicular cancer
Grows rapidly, lymphatic and hematogenous spread
Side effects of androgen deprivation therapy
Gynecomastia Impotence Hepatitis
Important physical exam components for hematuria
HTN - renal parenchymal disease CVA tenderness- pyelonephritis, renal distension Abdominal masses, prostate, pelvic exam Skin- visible lesions Friction rub Joint swelling
Gleason score
Histologic grading system for prostate cancer Correlates with differentiation (well-differentiated or poorly differentiated) Predictive of outcome (higher= more aggressive, poorer prognosis) Scored from 2-10
Chemotherapy for metastatic prostate cancer
Hormonally refractive patients with symptomatic metastatic disease
Treatment options of metastatic prostate cancer
Hormone therapy- concern for resistance for after 10 years Chemo Radium-223 Palliative care
A client is admitted to the hospital with severe renal colic caused by a ureteral calculus. Later that evening the client's urinary output is much less than the intake. When it is confirmed that the bladder is not distended, what should the nurse suspect developed?
Hydroureter
A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client?
Hypertension, fluid overload
Most common causes of glomerular microscopic hematuria
IgA nephropathy Thin membrane disease
Vascular endothelial growth factor (VEGF)
Important for tissue angiogenesis, encourages growth of lesions
Presentation of renal cell cancer
Incidental finding on abnormal imaging Asymptomatic Painless hematuria Flank pain, palpable abdominal mass, weight loss, or fatigue (advanced)
Suprapubic approach to prostatectomy
Incision is made in the abdomen just below the umbilicus that extends downward to the symphisis pubis Allows for the removal of more tissue including lymph nodes and the tissue surrounding the prostate Very rarely done
A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan?
Increase daily fluid intake to at least 2 to 3 L.
Intravesicular immunotherapy
Instillation of BCG vaccine into bladder Used to induce and maintain treatment More effective than chemo but has more urinary side effects Used for moderate and high risk disease
A client undergoes extracorporeal shock wave lithotripsy (ESWL) to break up and remove renal calculi. Which nursing measure is appropriate for the postoperative care of this client?
Instruct the client to anticipate hematuria for about 24 hours after the procedure. Explanation:
Percutaneous nephrostomy procedure
Interventional radiologist advances an US guided thin needle into the obstructed renal collecting system When urine backflow is observed, IV contrast is injected and x-ray images are taken of the renal collecting system A guide wire is advanced into the ureter to place a drainage tube into the system. The tube is either advanced past the stone or a collection bag is put in place to catch urine flow
A client with chronic kidney disease (CKD) is prescribed aluminum hydroxide. Which information should the nurse include while instructing the client regarding the action of this medication?
It combines with phosphorus and helps eliminate phosphates from the body
After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?
It's an abnormal finding that requires further assessment.
A client with a femoral fracture associated with osteomyelitis is immobilized for 3 weeks. The nurse assesses for the development of renal calculi. What is the rationale for the nurse's assessment?
Lack of weight-bearing activity promotes bone demineralization.
Normal excretion of RBCs
Less than 1,000 per minute
How does the gleason score work?
Look at the 2 most common patterns of cells and grade those on a scale of 1-5 Add the 2 numbers together As the pattern number increases, the gland structure is less defined (poorly differentiated)
Retrograde cystogram
Looks for reflux back into the ureters Bladder will not completely empty- shows residual urine with reflux back to the ureters
how does CKD cause anemia
Loss of nephrons results in decreased synthesis of erythropoietin (EPO) EPO stimulates red bone marrow to increase production of RBCs under hypoxic conditions
Sx of prostate cancer
Many asymptomatic, no palpable lesions, nonspecific sx, sx of urethral obstruction, bone pain
Nephrotic syndrome
Massive protein loss in urine Caused by damage to the small blood vessels in the kidneys Rare in kids but can become a chronic illness Idiopathic
Androgen deprivation therapy
Medical castration Uses GnRH agonists and androgen receptor blockers (Leuprolide) to decrease testosterone and block its action Also use androgen receptor blockers Used in conjunction with radiation
Conditions mistaken for gross hematuria
Menses Pyridium Rifampin
Acid-Base balance CKD
Metabolic acidosis when GFR 30%-40%
Which should be included in the client's plan of care during dialysis therapy?
Monitor the client's blood pressure.
Radical nephrectomy
Most common treatment for renal cell carcinoma, curative
Urinalysis
Must look at urinalysis and microscopic exam, dipstick is not good enough Must be mid-stream fresh specimen, must be done at least 48 hours after exercise
Nonglomerular causes of microscopic hematuria
Neoplasm Nephrolithiasis Cystic kidney disease Papillary necrosis Disease involving the ureter, bladder, or prostate Periureteral disease
A client presents to the emergency department with shortness of breath, bloody sputum, weight gain, generalized edema, and a blood pressure of 150/110. The nurse reviews the client's laboratory results and determines that the client has impaired renal function. Which diagnosis will the nurse most likely observe written in the client's electronic medical record?
Nephrotic syndrome
Most common type of germ cell tumors
Nonseminomas, more aggressive and spread more quickly
Prostatectomy
Not done for localized disease 2 surgical methods
Lithotripsy procedure
One method- patient is in a water bath while shock waves are transmitted Other method- patient lies on a soft cushion or membrane Most devices use either x-rays or US to pinpoint the stone during treatment Needs some form of anesthesia - can be painful Outpatient procedure with short recovery time (few days)
Adverse consequences of radiation and GnRH agonists (treatment of prostate cancer)
Osteoporosis Muscle wasting Hot flashes Sexual dysfunction Fatigue
CKD also causes:
Osteoporosis less calcium
Workup for suspected glomerular disease
Proteinuria on urinalysis Immunologic studies Biopsy
WBC casts
Pyelonephritis Interstitial nephritis
Brachytherapy
Radioactive beads are implanted Poorer long term prognosis and outcomes than external beam radiation Done if there are comorbidities r they can not tolerate the side effects of external beam radiation
Assessment of a 36-year-old woman who has malaise and dysuria reveals a temperature of 100° F (37.4° C) and painful blisters on the outside of her vagina. The client tells the nurse she had intercourse with a new partner 5 days ago. What should the nurse do?
Refer the client to a health care provider (HCP).
What are important nursing care measures for a client with diabetes who is admitted with end-stage renal failure?
Restrict sodium and potassium and restrict fluids as ordered.
vesicoureteral reflux (VUR)
Retrograde flow of urine from the bladder into the ureters Reflux encourages infected urine from the bladder to be swept up into the kidneys Leads to frequent pyelonephritis
Cystoscopy
Scope to visualize the inside of the bladder
A client was treated for a streptococcal throat infection 2 weeks ago. The client now has been diagnosed with acute poststreptococcal glomerulonephritis. The client asks the nurse how he could have prevented this condition. What should the nurse tell the client?
See your health care provider (HCP) for an early diagnosis and treatment of a sore throat."
Sodium and water balance with CKD
Sodium excretion increases with obligatory water excretion leading to sodium deficit and volume loss Concentration and dilution ability diminishes
Surgery for localized prostate cancer
Standard of care- radical prostatectomy Higher risk of erectile dysfunction and incontinence
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?
Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
HUS manifestations
Sudden onset of pallor, bruising or purpura, irritability, and oliguria Slight fever, anorexia, vomiting, diarrhea (with the stool characteristically watery and blood stained), abdominal pain, mild jaundice, and circulatory overload Seizures and lethargy indicate CNS involvement renal failure comes quickly
When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?
The client keeps the drainage bag below the bladder at all times.
After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?
The client reports bladder spasms and the urge to void.
how does e. coli affect endothelium
The endothelial lining of the glomerulus becomes swollen and occluded with fibrin clots The damaged red cells are removed from the circulation by the spleen, causing acute hemolytic anemia The microcirculation develops numerous thrombi
A nurse preceptor is observing a new graduate during care of a client in contact isolation. Which action by the new graduate indicates a need for further teaching about handling infectious materials?
The nurse uses alcohol gel to clean her hands after changing linen soiled with urine and feces.
Bladder sparing surgery
Transurethral resection of the lesion Should be treatment for all patients non-muscle invasive disease
A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?
Transurethral resection of the prostate (TURP)
Important history components for hematuria
Trauma Passage of clots FHx SHx- esp. smoking Occupational history
Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation?
Urination is not painful
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)?
Urine output of 250 ml/24 hours
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?
Use sterile technique when irrigating the catheter.
Intravesicular chemotherapy
Useful as prophylaxis in intermediate risk patients Used for multiple lesions or recurrent low grade lesions
Glomerular causes of microscopic hematuria
Very high fever Vigorous exercise IgA nephropathy Thin membrane disease Rheumatoid arthritis Vasculitis Bacterial endocarditis Bleeding disorders Medications
Nephroblastoma (Wilms tumor)
Wilms tumor is an embryonal tumor of the kidney Wilms tumor arises from the proliferation of abnormal renal stem cells Inherited and sporadic forms Usually found by parent due to abdominal swelling
IVP procedure
X-rays are taken in the supine position First image is taken before the contrast medium is injected and another is taken when the contrast medium is injected Series of x-rays are taken over an hour and possibly additional images the next day
Gross (macroscopic) hematuria
You can see it, exceeds 1,000,000 RBCs per minute Often the first sign of GU cancer Significant GY tract disease- transitional cell bladder carcinoma, adenocarcinoma of prostate, common cancers
Chordee
a downward curvature of the penis, often associated with hypospadias
The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which snack is most appropriate?
a gelatin dessert
Which client is at highest risk for developing a urinary tract infection?
a man with an indwelling urinary catheter
renal agenesis
absence of one or both kidneys
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it:
allows the client to be more independent.
A charge nurse is completing day-shift client care assignments on the genitourinary floor. A new graduate is present for her first day on the unit. An agency nurse and an experienced nurse are also present on the unit. The charge nurse should assign the new graduate to the care of:
an elderly client with bladder cancer awaiting surgery, an elderly client who had a prostatectomy and bladder irrigation 2 days ago, and an elderly client with renal insufficiency.
A male client reports having impotence. The nurse examines the client's medication regimen and determines that a contributing factor to impotence could be:
antihypertensives.
A client who had transurethral resection of the prostate has dribbling urine after his Foley catheter is removed on the second postoperative day. The nurse notes that the client had 200 mL of urine output in the last 8 hours with a 1,000 mL intake. The nurse should first:
assess for bladder distention.
Eight hours after an abdominal hysterectomy, the client has not voided and says to the nurse, "I do not think I can urinate." The nurse should first:
assess the client's bladder.
The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink:
at least 3,000 mL of fluids daily.
A nurse is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to:
breathe deeply.
what is uremia
buildup of waste products in the blood
A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for:
cardiac arrest.
UTI in kids
caused by E. coli, the most common pathogen, ascends the urethra in cystitis or the ureter in pyelonephritis Cystitis Acute and chronic pyelonephritis
When teaching a client with chronic renal failure who is taking antibiotics about signs and symptoms of potential nephrotoxicity to report, the nurse should encourage the client to promptly report which changes in the color of the urine? Select all that apply.
cloudy smoky pink
polycystic kidney disease
condition in which the kidney contains many cysts and is enlarged
Hypospadias and Epispadias
congenital defect where the urinary meatus is below/above its normal location
The client with acute renal failure is recovering and asks the nurse, "Will my kidneys ever function normally again?" The nurse's response is based on knowledge that the client's renal status will most likely:
continue to improve over a period of weeks.
Which abnormal blood value would not be improved by dialysis treatment?
decreased hemoglobin concentration
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should assess the client for which alteration in fluid and electrolyte balance?
decreased serum sodium level
who has extreme levels of hyperkalemia
dialysis patients
The nurse should specifically assess a client with prostatic hypertrophy for:
difficulty starting the flow of urine.
The nurse is assessing a client who has benign prostatic hypertrophy (BPH). The nurse should ask the client if he has:
difficulty starting the urinary stream.
The nurse finds a container with the client's urine specimen sitting on a counter in the bathroom. The client states that the specimen has been sitting in the bathroom for at least 2 hours. The nurse should:
discard the urine and obtain a new specimen.
A female client who has a urinary diversion tells the nurse, "This urinary pouch is embarrassing. Everyone will know that I am not normal. I do not see how I can go out in public anymore." The most appropriate nursing goal for this client is to:
express fears about the urinary diversion.
The client is on a fluid restriction of 500 mL/day plus replacement for urine output. Because the client's 24-hour urine output yesterday was 150 mL, the total fluid allotment for the next 24 hours is 650 mL. How should the nurses distribute this fluid over the next 24 hours?
given in small amounts throughout each shift
A client is admitted to the recovery room after cystoscopy with biopsy. Before the nurse can discharge the client, the nurse should be sure the client:
has voided.
An elderly client with a diagnosis of chronic renal failure is being discharged to home with his wife. The home health nurse visits the hospital before discharge to discuss home safety with the client, who reports decreased mobility and a need for greater assistance with activities of daily living. The nurse focuses her home-safety teaching on:
having adequate lighting, removing cluttered paths, and using nonskid bathroom surface
Which factor would put the client at increased risk for pyelonephritis?
history of diabetes mellitus
A physician enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8-hour shift if she covers the set with a paper, sterile drape. This action by the nurse is:
inappropriate because irrigation requires strict sterile technique.
endocrine and reproduction CKD
infertility
glomerulonephritis
inflammation of the glomeruli of the kidney
To reduce urethral irritation, where should the nurse tape the female client's Foley catheter?
inner thigh
nighttime enuresis
loss of urine during the night hours
The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate?
low-protein, low-sodium, low-potassium
The client has a continuous bladder irrigation after a transurethral resection. A major goal related to the irrigation is to:
maintain catheter patency.
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 ml. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:
microorganism transfer.
Lactic dehydrogenase (LDH)
more general marker (nonspecific) for testicular cancer
neurologic alterations CKD
neuropathy tingling in hands and feet
secondary enuresis
onset of wetting after established urinary continence
A client is to receive belladonna and opium suppositories, as needed, postoperatively after transurethral resection of the prostate (TURP). The nurse should give the client these drugs when he demonstrates signs of:
pain from bladder spasms.
A client who is 70 years of age and lives alone has stress incontinence. To prevent incontinence, the nurse advises the client to:
perform perineal muscle exercises (i.e., Kegel exercises).
Most common cancer in men
prostate cancer
hypoplastic or dysplastic kidneys
small kidney with decreased number of nephrons
The nurse teaches the client how to recognize an infection in the shunt by telling the client to assess the shunt each day for:
swelling at the shunt site.
An elderly male client has been taking doxazosin 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first:
take his blood pressure lying, standing, and sitting.
The client with first-time bacterial cystitis is being treated with an antibiotic to be taken for 7 days. The nurse should instruct the client to:
take the entire prescription as ordered.
hyrdoureter
the distention of the ureter with urine that cannot flow because the ureter is blocked
why do they keep CKD patients a little anemic
to make sure the blood isnt too thick
cardiovascular effects CKD
too much fluid in the body, raises BP
Integumentary CKD
uremia itchy and dry skin
Whichis an initial clinical manifestation of gonorrhea in men?
urethral discharge
The nurse should tell a client who is to obtain a midstream urine specimen to:
void directly into the sterile specimen container after voiding a small amount into the toilet.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
The client will have an abdominal hysterectomy tomorrow. Which information will be most important for the nurse to give to the client prior to admission to the hospital?
what she can eat and drink before admission
The nurse collects a urine specimen from a client for a culture and sensitivity analysis. What should the nurse do next?
Send the specimen to the laboratory immediately.
Risk factors for bladder cancer
Smoking Aromatic amines
Risk factors for renal cell cancer
Smoking, HTN, obesity, DM
The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which approach would be best?
Spend time with the client addressing her concerns and then stay with her while she talks with her husband.
Radiation therapy for prostate cancer
Standard of care for local disease Can be external beam or brachytherapy
embryonal cancers
manifest before age 5 or 6
An 18-year-old female is to have a pelvic exam. Which response by the nurse would be best when the client says that she is nervous about the upcoming pelvic examination?
"Can you tell me more about how you are feeling?"
Which statements by a female client would indicate that she is at high risk for a recurrence of cystitis?
"I can usually go 8 to 10 hours without needing to empty my bladder."
A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs?
"I should take at least 1,000 mg of vitamin C each day."
The nurse is instructing an unlicensed assistive personnel (UAP) to collect a urine specimen from an indwelling catheter. Which statement indicates that the UAP understands the instructions?
"I will get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container."
During a clinic visit, the mother of an infant with hydrocele states that the infant's scrotum is smaller now than when he was born. After teaching the mother about the infant's condition, which statement by the mother indicates that the teaching has been effective?
"It seems like the fluid is being reabsorbed."
What can you visualize for each step of a CT urography?
1. Calculi, fat-containing lesions, parenchymal calcifications, and hemorrhage; establishes a baseline 2. Small renal masses 3. Opacification and distension of collecting systems, ureters, and bladder; evaluates urothelium
A client with marked oliguria is ordered a test dose of 0.2 g/kg of 15% mannitol solution intravenously over 5 minutes. The client weighs 132 lb. How many grams would the nurse administer? Record your answer as a whole number.
12
The nurse is explaining the physiologic reasons for taking vitamin D and calcium supplements to a client with renal failure. Which statement made by the nurse is appropriate? 1."There will be a decrease in the inactive forms of vitamin D in your body." 2."There will be a decrease in the active metabolite of vitamin D in your body." 3."There will be an increase in the conversion of skin cholesterol into vitamin D." 4."There will be an increase in the vitamin D associated intestinal absorption of calcium."
2."There will be a decrease in the active metabolite of vitamin D in your body."
The nurse is completing an intake and output record for a client who is receiving continuous bladder irrigation after transurethral resection of the prostate. How many milliliters of urine should the nurse record as output for her shift if the client received 1,800 ml of normal saline irrigating solution and the output in the urine drainage bag is 2,400 ml? Record your answer using a whole number.
600
what age group and gender are utis common in children
7-11 year old girls
A registered nurse and a nursing assistant are caring for a group of clients. Which client's care may safely be delegated to the nursing assistant?
A client diagnosed with renal calculi who must ambulate four times daily and drink plenty of fluids
Which client is at highest risk for developing a hospital-acquired infection?
A client with an indwelling urinary catheter
Beta human chorionic gonadotropin (BHCG)
Elevated in choriocarcinoma and mixed cell testicular cancers Used to monitor treatment
Alpha fetoprotein (AFP)
Elevated in embryonal cell carcinoma, used to monitor treatment for testicular cancer
A nurse writes a goal of preventing renal calculi in a care plan for a client with paraplegia. Which information most likely caused the nurse to write this goal?
Accelerated bone demineralization
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem?
Acute kidney injury
Radium-223
Emits short range alpha particles targeting bony metastases, treatment for prostate cancer
A nurse is admitting an older female client to the gynecology surgical unit. When the nurse asks the client what medication she is taking at home, the client responds that she is taking a little red pill in the morning and a white capsule at night for her blood pressure. What action by the nurse is focused on safe, effective care of this client?
Ask a family member to bring the medications from home in the original vials for proper identification and administration times.
A client has nephropathy. The health care provider (HCP) prescribes a 24-hour urine collection for creatinine clearance. Which action is necessary to ensure proper collection of the specimen?
Collect the urine in a preservative-free container and keep it on ice.
WBCS and bacteria in urine
Cystitis
Treatment of invasive bladder cancer
Radical cystectomy Bladder-sparing treatments
VUR diagnostics
Diagnosed by a voiding cystourethrogram (VCUG) and an intravenous pyelogram (IVP)
uteropelvic junction obstruction
Dilated renal pelvis without ureteral dilation is observed in patients with
A client is scheduled for an intravenous pyelogram (IVP). In preparation for the procedure, what should the nurse ask the client?
Do you have any allergies?"
Percutaneous nephrostomy
Drains fluid from the kidney and allows for administration of medications Done with hydronephrosis
Voiding cystourethrogram (VCUG)
Examines the urethra and bladder while the bladder fills and empties Can also determine whether the flow of urine is normal when the bladder empties
phosphate binders
Examples: Phos-Lo, Aluminum hydroxide Take with meals, not if NPO Watch for signs of aluminum toxicity
A nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?
Fluid intake should be about equal to the urine output.
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
Increase your fluid intake to 2 to 3 L per day.
A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which client statement indicates effective teaching?
My fallopian tubes will be tied off through a small abdominal incision."
Treatment options for localized prostate cancer
Observation Radiation Surgery Androgen-deprivation therapy
Indications for ureteral stents
Obstruction Promote healing Identify ureters prior to surgery
Indications for percutaneous nephrostomy
Obstructive uropathy
Treatment of renal cell carcinoma
Radical nephrectomy Nephron-sparing partial nephrectomy Percutaneous thermal ablation Inhibition of vascular endothelial growth factor (VEGF)
Treatment of locally advanced disease (prostate cancer)
Radiation therapy + GnRH agonist (continued indefinitely) Develops hormonal resistance (after 10+ years) Can remain on the medication if they are older but can cause hormonal resistance in younger patients May pursue intermittent therapy (reinitiate the medication as PSA increases again)
The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client?
Use the unaffected arm for blood pressure measurements.
A client with stress incontinence asks the nurse what kind of diet she should follow at home. The nurse should recommend that the client:
avoid alcohol and caffeine.
what supplements should you take for CKD
calcium and vitamin D supplements
Urinary tract infection (UTI) is a potential problem after spinal cord injury. To prevent an UTI, the nurse should encourage the client to:
drink at least 2,000 mL of fluid daily.
The primary reason for lubricating the urinary catheter generously before inserting it into a male client is that this technique helps reduce:
friction along the urethra when the catheter is being inserted.
A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding, or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:
stress incontinence.
A client has stress incontinence. Which data from the client's history contributes to the client's incontinence?
the client's history of three full-term pregnancies
horseshoe kidney
the two kidneys are joined together across the midline of the body at the lower ends need to be separated
