Med-Surg: Renal and Urinary
A nurse is assessing a client who is 1 week postoperative following a living donor kidney transplant. Which of the following findings indicates the client is experiencing acute kidney rejection? A. Blood pressure 160/90 mmHg B. Creatinine 0.8 mg/dL C. Sodium 137 mg/dL D. Urinary output 100 mL/hr
A. Blood pressure 160/90 mmHg Due to the kidneys' role in fluid and blood pressure regulation, a client who is experiencing rejection can have hypertension. - B: Manifestations of acute kidney rejection can include an increase in serum creatinine. This finding is within the expected reference range. - C: Manifestations of acute kidney rejection can include an increase in sodium. This finding is within the expected reference range. - D: Manifestations of acute kidney rejection can include decreased urine output, anuria, oliguria (<30 mL/hr), and weight gain.
A nurse is teaching a client who has chronic kidney disease (CKD). Which of the following instructions should the nurse include? A. Limit fluid intake B. Limit caloric intake C. Eat a diet high in phosphorus D. Eat a diet high in protein
A. Limit fluid intake A client who has CKD should limit fluid intake to prevent hypervolemia (excessive fluid overload). - B: A client who has CKD should increase caloric intake so that the body can use protein for protein synthesis instead of energy consumption. Using protein for energy can lead to a negative nitrogen balance and malnutrition. - C: A client who has CKD should limit phosphorus intake because the kidneys are unable to excrete it. - D: A client who has CKD should not eat excessive protein to prevent the build-up of protein waste products and uremia.
A nurse is checking the laboratory values of a client who has chronic kidney disease. The nurse should expect elevations in which of the following values? A. Potassium and magnesium B. Calcium and bicarbonate C. Hemoglobin and hematocrit D. Arterial pH and PaCO2
A. Potassium and magnesium Clients who have chronic kidney disease have hyperkalemia, hyperphosphatemia, and hypermagnesemia as well as elevations in serum creatinine and blood urea nitrogen. - B: Serum levels of calcium and bicarbonate decrease in clients who have chronic kidney disease. - C: Hemoglobin and hematocrit decrease in clients who have chronic kidney disease. - D: Arterial pH decreases or remains at expected levels, and PaCO2 decreases in clients who have chronic kidney disease.
A nurse is reviewing the laboratory report of a client who has chronic kidney disease (CKD). The nurse finds the following lab test results: potassium 6.8, calcium 7.4, hemoglobin 10.2, and phosphate 4.8. Which finding is the priority for the nurse to report to the provider? A. Hypocalcemia B. Hyperkalemia C. Anemia D. Hypoalbuminemia
B. Hyperkalemia Hyperkalemia, which can cause life-threatening cardiac dysrhythmias, is the priority for the nurse to report to the provider. - A: Hypocalcemia is an expected finding with CKD; therefore, another finding is the priority for the nurse to report to the provider. The decreased calcium level would require reporting if the client developed muscle spasms or twitching. - C: Anemia is an expected finding with CKD; therefore, another finding is priority for the nurse to report to the provider
A female client who has recurrent cystitis asks the nurse about preventing future episodes. For which of the following client statements should the nurse provide further teaching? A. I drink at least 2 L of fluid per day B. I prefer taking tub baths to showering C. I urinate before and after sexual relations D. I wipe from front to back after urinating
B. I prefer taking tub baths to showering Cystitis is an inflammation of the bladder lining that commonly occurs with a UTI. Women who are at risk for UTIs should avoid tub baths because they increase the risk of infection. The nurse should recommend taking showers instead of baths.
A nurse is preparing an in-service program about the stages of acute kidney injury (AKI). Which of the following pieces of information should the nurse include about pre renal azotemia? A. Prerenal azotemia begins prior to the onset of symptoms B. Interference with renal perfusion causes pre renal azotemia C. Prerenal azotemia is irreversible, even in the early stages D. Infections and tumors cause pre renal azotemia
B. Interference with renal perfusion causes pre renal azotemia Prerenal azotemia results from interference with renal perfusion, such as from heart failure or hypovolemic shock. - A: Clients who have prerenal azotemia typically have tachycardia, lethargy, reduced urine output, and other manifestations. - C: In early stages, reversal of prerenal azotemia is possible with correction of hypovolemia and improvement in blood pressure and cardiac output. - D: Infections and ingested toxins cause infrarenal AKI, not prerenal azotemia.
A nurse is assessing a client who is receiving hemodialysis for the first time. Which of the following findings indicates that the client is developing dialysis disequilibrium syndrome (DDS)? A. Elevated BUN B. Bradycardia C. Headache D. Temperature 39.2c (102.5f)
C. Headache DDS is a CNS disorder that can develop in clients who are new to dialysis due to the rapid removal of solutes and changes in the blood pH. Clients beginning hemodialysis are at greatest risk, particularly if their BUN is above 175. - DDS causes headaches, nausea, vomiting, a decreased level of consciousness, seizures, and restlessness. - When the condition is severe, clients progress to confusion, seizures, coma, and death. - A: An elevated BUN increases the client's risk of developing DDS; however, it is not a manifestation of this complication - B: A loss of body fluid activates the body's compensatory mechanisms. In this case, the rapid decrease in fluid volume after dialysis causes the heart to try to compensate by increasing the heart rate. Therefore, the client would have tachycardia, not bradycardia. - D: An elevated temperature indicates a possible infection, which is a common risk for clients undergoing dialysis, not DDS.
A nurse is teaching a client who is preoperative for a cystoscopy. Which of the following statements should the nurse make? A. You will need to keep the sutures clean after this procedure B. You will be placed on your left side for this procedure C. Expect to be on bed rest for 24 hr after this procedure D. Expect to have pink-tinged urine after this procedure
D. Expect to have pink-tinged urine after this procedure A cystoscopy is a procedure in which a scope is inserted into the urethra to diagnose or treat bladder problems. Following the procedure, pink-tinged urine is expected. - A: There are no surgical incisions made during a cystoscopy; therefore, no sutures are used. - B: The client will be placed in a lithotomy position. This position provides exposure of the genitalia and facilitates insertion of the cystoscope. - C: A client can undergo a cystoscopy as an outpatient. Bed rest for 24 hours is not indicated.
A nurse is teaching a client who has a spinal cord injury to perform intermittent urinary self-catheterization at home after discharge. Which of the following statements indicates that the client understands the procedure? A. I'll drink less water so I don't have to catheterize myself too often B. I must use sterile technique for each of the catheterizations C. I should stop the catheterization when I have removed 150 mL of urine D. I will perform intermittent self-catheterization every 2 to 3 hours
D. I will perform intermittent self-catheterization every 2 to 3 hours The client might initially require self-catheterization every 2 to 3 hours, with the frequency eventually increasing to every 4 to 6 hours. A longer interval can result in bladder distention and an increased risk of urinary tract infections. - A: The client can self-catheterize as often as needed and should drink at least 2 to 2.5 L of fluid to make sure a sufficient amount of urine is produced to flush the bladder adequately. - B: A client performing intermittent self-catheterization at home uses clean (not sterile) technique. Evidence-based practice indicates that clients using clean technique in their own home are at no greater risk of infection because they have acclimated to the bacterial environment of their home. - C: The client should empty the bladder completely with each catheterization, as urine that remains for long periods of time in the bladder increases the client's risk of a urinary tract infection.
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following adverse effects? A. Diarrhea B. Increased serum albumin C. Hypoglycemia D. Peritonitis
D. Peritonitis Peritonitis is an adverse effect of peritoneal dialysis. Prevention requires using sterile technique and frequently assessing the catheter exit site. The nurse should obtain cultures of the dialysate outflow (effluent) if peritonitis is suspected.
A nurse is caring for a client who has manifestations of acute tubular necrosis (ATN) following a kidney transplantation. Which of the following interventions should the nurse anticipate for this client? (Select all that apply.) A. Hemodialysis B. Biopsy C. Immunosuppression D. Balloon angioplasty E. Surgical repair
A, B, C A. Hemodialysis B. Biopsy C. Immunosuppression - Clients who develop ATN after transplantation surgery might need dialysis until they have an adequate urine output and their BUN and creatinine levels stabilize - Because the development of ATN after transplantation surgery mimics the symptoms of rejection of the transplanted kidney, clients have to undergo a biopsy to determine the correct diagnosis - Immunosuppressive medication therapy is essential after kidney transplantation to protect the new kidney - D: Balloon angioplasty corrects renal artery stenosis, which is a potential complication of kidney transplantation - E: Surgery corrects several other complications of kidney transplantation such as graft rupture
A nurse is assessing a client who is 4 hr postoperative following a transurethral resection of the prostate and has an indwelling urinary catheter in place. Which of the following findings should the nurse expect? A. Blood-tinged urine in the drainage bag B. Catheter tubing coiled at the client's side C. Client report of severe bladder spasms D. Urinary output of 20 mL/hr
A. Blood-tinged urine in the drainage bag Blood-tinged urine in the drainage bag is an expected finding for the first 24 hours following surgery. - B: The catheter tubing should be free from kinks and coiling. The nurse should ensure the tubing is below the level of the bladder and allows urinary outflow. - C: Severe bladder spasms might indicate an obstruction and should be reported to the provider. - D: Urinary output of < 30 mL/hr can indicate hypovolemia or renal complications; therefore, the nurse should notify the provider.
A nurse is providing dietary teaching to a client who has late-stage chronic kidney disease (CKD). Which of the following nutrients should the nurse instruct the client to increase in her diet? A. Calcium B. Phosphorus C. Potassium D. Sodium
A. Calcium A client who has CKD can develop hypocalcemia due to the reduced production of active vitamin D, which is needed for calcium absorption. The client should supplement dietary calcium. - B: A client who has CKD can develop hyperphosphatemia because excretion of phosphorus by the kidneys is reduced - C: A client who has CKD can develop hyperkalemia because excretion of potassium by the kidneys is reduced - D: A client who has CKD can develop hypernatremia because excretion of sodium by the kidneys is reduced
A nurse is assessing a client who has urolithiasis and reports pain in his thigh. This finding indicates the stone is in which of the following structures? A. Ureter B. Bladder C. Renal pelvis D. Renal tubules
A. Ureter When stones are in the ureters, pain radiates to the genitalia and to the thighs - B: Stones in the bladder produce manifestations of irritation that resemble a urinary tract infection. They can also cause pain in the vulva and scrotal areas. - C: The renal pelvis is part of the kidney. Stones in the kidneys cause pain in the costovertebral region. - D: The renal tubules are within the nephron, which is a part of the kidney. Stones in the kidneys cause flank pain.
A nurse is teaching a client who has acute pyelonephritis. Which of the following instructions should the nurse include in the teaching? A. You should complete the entire cycle of antibiotic therapy B. You should maintain complete bed rest until manifestations decrease C. You should drink 1,000 mL of fluid per day D. You should avoid using NSAIDs for pain
A. You should complete the entire cycle of antibiotic therapy The client should take the full prescription of the antibiotic therapy to decrease the chance of regrowth of the causative organism. - B: The client should balance rest and activity and does not require complete bed rest. Ambulation can prevent complications of bed rest such as constipation and urinary stasis. - C: A client who has acute pyelonephritis should drink at least 2,000 mL per day, unless otherwise contraindicated. - D: A client who has acute pyelonephritis can take NSAIDs as needed for pain, unless otherwise contraindicated.
A nurse is caring for a client who has chronic glomerulonephritis with oliguria. For which of the following electrolyte imbalances should the nurse monitor? A. Hypercalcemia B. Hyperkalemia C. Hypomagnesemia D. Hypophosphatemia
B. Hyperkalemia Oliguria resulting from chronic glomerulonephritis causes potassium retention, leading to levels above the expected reference range of 3.5-5.0. Other electrolyte imbalances common with this disorder affect sodium and phosphorus levels. Chronic glomerulonephritis eventually leads to end-stage kidney disease.
A nurse is preparing a client who is scheduled for an intravenous pyelogram (IVP). Which of the following findings should the nurse report to the provider? A. Allergy to egg products B. Vomiting and diarrhea for the last 6 hr C. Serum potassium of 3.6 mEq/L D. Serum creatinine of 1.2 mg/dL
B. Vomiting and diarrhea for the last 6 hr Vomiting and diarrhea for 6 hours deplete the client's fluid volume, which results in dehydration that can cause renal failure following a procedure that uses contrast dye. Therefore, the nurse should notify the provider. - A: A client who is allergic to shellfish, iodine, or contrast agents is at risk for an allergic reaction to an IVP. An allergy to eggs is associated with allergic reactions to immunizations. - C & D: These are within the expected reference ranges.
A nurse is teaching a female client who has pyelonephritis about the disorder. Which of the following pieces of information should the nurse include to help the client prevent a recurrence? A. Douche after vaginal intercourse B. Wipe from front to back after defecation C. Avoid foods that are high in phosphate D. Add yogurt to your diet regularly
B. Wipe from front to back after defecation Pyelonephritis is a bacterial infection of the kidney and renal pelvis. The nurse should instruct the client about the importance of wiping from front to back following fecal elimination to avoid introducing bacteria into the urinary tract, which can ultimately cause pyelonephritis. - A: Most providers discourage routine douching. This measure does not prevent renal infection. - C: Avoiding an excessive intake of phosphate can help prevent some types of kidney stones, but it does not prevent renal infection. - D: Eating yogurt with active cultures can help prevent genital tract infections, but it does not prevent renal infection.
A nurse is teaching a newly licensed nurse about caring for a client who has a new left arteriovenous fistula. Which of the following statements should the nurse make? A. Check the fistula site daily for a vibration B. Instruct the client to restrict movement of his left arm C. Avoid taking blood pressure on the client's left arm D. Instruct the client to sleep on his left side
C. Avoid taking blood pressure on the client's left arm The nurse should avoid taking blood pressure measurements on the client's left arm, as this can decrease blood flow and cause clotting. - A: The nurse should assess the client every 4 hours for blood flow - B: The client should perform range-of-motion exercises of the left arm - D: Sleeping on top of the extremity with the access site can impair blood flow and cause possible clotting
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that the client's dialysate output is less than the input and that his abdomen is distended. Which of the following actions should the nurse take? A. Insert an indwelling urinary catheter B. Administer pain medication to the client C. Change the client's position D. Place the drainage bag above the client's abdomen
C. Change the client's position The client is retaining the dialysate solution after the dwell time. The nurse should ensure that the clamp is open and the tubing is not kinked and should reposition the client to facilitate the drainage of the solution from the peritoneal cavity. - A: An indwelling urinary catheter will not relieve the client's discomfort - B: Pain medication will not correct the cause of the client's discomfort - D: The nurse should position the drainage bag lower than the client's abdomen to promote gravity drainage
A nurse is caring for a client who had a nephrostomy tube inserted 8 hours ago. Which of the following actions should the nurse include in the client's plan of care? A. Flush the nephrostomy tube every 4 hours with sterile water B. Clamp the nephrostomy tube intermittently to establish continence C. Check the skin at the nephrostomy site for irritation from urine leakage D. Monitor for and report any blood-tinged drainage to the provider immediately
C. Check the skin at the nephrostomy site for irritation from urine leakage The nurse should monitor the client for complications (e.g. bleeding, hematuria, fistula formation, infection), impairment of skin integrity (e.g. inflammation, infection, bleeding, urine leakage, irritation), and tube obstruction. - The nurse should use the aseptic technique for dressing changes and encourage oral intake but should never clamp or irrigate the nephrostomy tube without a specific prescription to do so. - A: Routine irrigation of a nephrostomy tube is unnecessary; however, the nurse should notify the provider if the drainage stops, becomes cloudy, or has a foul odor. - B: The nephrostomy tube relieves urine outflow obstruction; therefore, the nurse should never clamp it. - D: The nurse should expect blood-tinged urine drainage for 12 to 24 hours following tube insertion.
A nurse is teaching a newly licensed nurse about collecting a 24-hr urine specimen for creatinine clearance. Which of the following instructions should the nurse include? A. Include the first voided specimen at the start of the collection period B. Discard the last voided specimen at the end of the collection period C. Place signs in the bathroom as a reminder about the test in progress D. Instruct the client to increase exercise during the 24-hr period
C. Place signs in the bathroom as a reminder about the test in progress The nurse should place signs in the bathroom and alert family members of the test in progress so that everyone saves the specimens appropriately throughout the test. - A: The nurse should have the client void first thing in the morning, discard the specimen, and collect all subsequent specimens for 24 hours. - B: The nurse should include the last voided specimen at the end of the collection period. - D: The nurse should instruct the client to avoid vigorous exercise, meat, tea, and coffee during the 24-hr period.
A nurse is caring for a client who has continuous bladder irrigation following a transurethral resection of the prostate (TURP). Which of the following findings should the nurse report to the provider? A. Output equal to the instilled irrigant B. Client report of bladder spasms C. Viscous urinary output with clots D. Client report of a strong urge to urinate
C. Viscous urinary output with clots The nurse should report urine output that is bright red with clots or urine that resembles ketchup to the provider because this is an indication of arterial bleeding. - A, B, & D: These are expected findings.
A nurse is providing teaching to a client who is preoperative for a renal biopsy. Which of the following statements should the nurse make? A. You will be NPO for 8 hr following the procedure B. An allergy to shellfish is a contraindication to this procedure C. You will need to be on bed rest following the procedure D. A creatinine clearance is needed prior to the procedure
C. You will need to be on bed rest following the procedure A renal biopsy involves a tissue biopsy through needle insertion into the lower lobe of the kidney. The client should maintain bed rest in a supine position with a back roll for support for 2 to 24 hours following the procedure to reduce the risk of bleeding. The nurse can elevate the head of the bed. - A: The client will be NPO 4 to 8 hours prior to the procedure; however, food and fluids can resume following the procedure. - B: An allergy to shellfish is not a contraindication to this procedure because contrast media is not used - D: Because of the risk for post-procedural bleeding, preliminary lab tests include coagulation studies such as platelet count and prothrombin time. Tests for anemia are also done to evaluate whether a pre-procedural blood transfusion is needed. Creatinine clearance is not required.
A nurse is reviewing the laboratory findings of a client who has chronic kidney disease. The client reports significant persistent nausea and muscle weakness. Which of the following findings should the nurse expect? A. Hypernatremia B. Hypomagnesemia C. Hypercalcemia D. Hyperkalemia
D. Hyperkalemia A client who has chronic kidney disease can have hyperkalemia, which is a potassium level greater than 5.0 mEq/L. (3.5-5.0 is normal) - Other manifestations of hyperkalemia can include palpitations, dysrhythmias, nausea, and muscle weakness - A: Hypernatremia is indicated by a sodium level greater than 145 mEq/L (135-145 is normal). S/S of hypernatremia include dry mucous membranes, agitation, thirst, hyperreflexia, and convulsions. It is not associated with chronic kidney disease. - B: Hypomagnesemia is indicated by a magnesium level below 1.3 mEq/L (1.3-2.1 is normal). Hypomagnesemia is present in clients who have hyperthyroidism or diabetes and in clients who are pregnant. It is not associated with chronic kidney disease. - C: Hypercalcemia is indicated by a calcium level greater than 10.5 mEq/L (9.0-10.5 is normal). Hypercalcemia is present with some cancers. It is not associated with chronic kidney disease.
A nurse is providing teaching to a client who is preoperative prior to a transurethral resection of the prostate (TURP). Which of the following client statements indicates an understanding of the information? A. I will not need to have a urinary catheter following this procedure B. I will expect my urine to be cloudy after having this procedure C. At least I won't have leakage of urine after having this procedure D. I will feel the urge to urinate following this procedure
D. I will feel the urge to urinate following this procedure After a TURP, the client will feel the urge to urinate. The nurse should reassure him that he will receive analgesics to help relieve this discomfort. - A: The client will require an indwelling urinary catheter following a TURP to monitor urine output and bleeding. - B: Cloudy urine can be a manifestation of retrograde ejaculation or infection. The client should report cloudy urine to the provider. - C: The client might have temporary dribbling and leakage of urine following a TURP. The nurse should reassure the client that these manifestations will resolve.
A nurse is assessing a client who has acute kidney injury (AKI). According to the RIFLE classification system, which of the following findings indicates that the client has end-stage kidney disease? A. <0.5 mL/kg of urine output for 12 hr B. No urine output for 12 hr C. No urine output without renal replacement therapy for 4 to 12 weeks D. No urine output without renal replacement therapy for more than 3 months
D. No urine output without renal replacement therapy for more than 3 months In the RIFLE classification, R stands for risk, I stands for injury, F stands for failure, L stands for loss and E stands for end-stage kidney disease. - No urine output without renal replacement therapy for more than 3 months indicates end-stage kidney disease - A: According to the RIFLE classification, this indicates injury - B: According to the RIFLE classification, this indicates failure - C: According to the RIFLE classification, this indicates loss
