Med Surg (Week 4)
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?
"Avoid taking a blood pressure on the clients left arm."
A nurse is teaching a client who is preoperative for cystoscopy. Which of the following statements should the nurse make?
"Expect to have pink-tinged urine after this procedure."
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 furthur teaching?
"I prefer taking tub baths to showering."
Which action will the nurse anticipate taking for an otherwise healthy 50-yr-old who has just been diagnosed with stage 1 renal cell carcinoma? a. Prepare patient for a renal biopsy. b. Provide preoperative teaching about nephrectomy. c. Teach the patient about chemotherapy medications. d. Schedule for a follow-up appointment in 3 months.
B
Nursing staff on a hospital unit are reviewing rates of health care-associated infections (HAI) of the urinary tract. Which nursing action will be most helpful in decreasing the risk for urinary HAI in patients admitted to the hospital? a. Testing urine with a dipstick daily for nitrites b. Avoiding unnecessary urinary catheterizations c. Encouraging adequate oral fluid and nutritional intake d. Providing perineal hygiene to patients daily and as needed
B
The nurse caring for a patient after cystoscopy plans that the patient a. learns to request narcotics for pain. b. understands to expect blood-tinged urine. c. restricts activity to bed rest for 4 to 6 hours. d. remains NPO for 8 hours to prevent vomiting.
B
The nurse completing a physical assessment for a newly admitted patient is unable to feel either kidney on palpation. Which action should the nurse take? a. Obtain a urine specimen to check for hematuria. b. Document the information on the assessment form. c. Ask the patient about any history of recent sore throat. d. Ask the health care provider about scheduling a renal ultrasound.
B
Gerontologic Considerations
*Decrease in the size and weight of the kidneys between the age of 30-90 years of age. *Decrease blood supply due to atherosclerosis which leads to a decrease in the GFR. *Females have a loss of elasticaly and muscle support related to urethra, bladder vagina, and pelvic floor. *Older women are more at risk for bladder infections and incontinence. *Men will have issue with their prostate becoming enlarged which results in urinary flow issues (hesitation, retention, slow stream and bladder infections) *Older people with UTI will present with confusion.
Bladder
*The bladder detrusor muscle, composed of smooth muscle, distends during bladder filling and contracts during bladder emptying. *The ureterovesical sphincter prevents reflux or urine from the bladder to the ureter. *The total bladder capacity is between 600-1 L; normal adult urine output is 1500 mL/day. *Bladder is normally not palpable unless it is distended with urine.
UTI S/S:
-Dysuria -Hesitancy -Urgency -Suprapubic pain -Hematuria -Cloudy urine from sedimentation -Postvoid dribbling -Urinary retention or incomplete emptying -Urinary frequency -Incontinence -Abdominal or back pain -Old people will have cognitive changes
The nurse will plan to teach a 27-yr-old woman who smokes two packs of cigarettes daily about the increased risk for a.kidney stones. c. bladder infection. b. bladder cancer. d. interstitial cystitis.
B
To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating a. milk and cheese. c. spinach and chocolate. b. sardines and liver. d. legumes and dried fruit.
B
When assessing a patient with a urinary tract infection, indicate on the accompanying figure where the nurse will percuss to assess for possible pyelonephritis. a. 1 c. 3 b. 2 d.m4
B
When planning teaching for a patient with benign nephrosclerosis, the nurse should include instructions regarding a. preventing bleeding with anticoagulants. b. monitoring and recording blood pressure. c. obtaining and documenting daily weights. d.measuring daily intake and output volumes.
B
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 indicate an understanding of the information?
"I will feel the urge to urinate following this procedure."
A nurse is teaching a client who has a spinal cord injury to perform intermittent urinary self-catherization at home after discharge. Which of the following statements indicates that the client understnad the procedure?
"I will perform intermiitent sel-catherization every 2-3 hrs."
A nurse is providing teaching to a client who has a history of urinary tract infections. Which of the following client statements indicates the need for additional teaching?
"I will use a vaginal douche daily."
UTI Diagnostic Studies
**Dipstick Urinalysis to look for 1) Nitrites which indicate the presents of bacteiuria. 2) WBC's and leukocytes indicating PYURIA -CULTURE to determine what is growing if the patient has bacteriuria, recurring UTI's or if the UTI is not responsive to therapy -Clean catch via midstream is preferred. How it is collected. -If the midstream cannot be collected, then collection from a cath is needed (red robbin) straight cath. -If obsruction is suspected, then imaging is needed ultrasound or CT
A patient who had surgery for the creation of an ileal conduit 3 days ago will not look at the stoma and requests that only the ostomy nurse specialist does the stoma care. The nurse identifies a nursing diagnosis of a. anxiety related to effects of the procedure on lifestyle. b. disturbed body image related to change in function. c. readiness for enhanced coping related to need for information. d. self-care deficit (toileting) related to denial of altered body function.
B
Urinary System
*Urine is formed in the kidneys, drains through the ureters to be stored in the bladder, and then passes out of the body through the uretera. *Kidneys are the principal organs of the urinary system *Kidneys primary functions are to. 1)Maintain acid-base balance 2)Excrete end products of body mechanism. 3)Control fluid and electrolyte balance. 4)Excrete bacterial toxins, water-soluble medications, and medication metabolites 5)Secrete renin to regulate the blood pressure. 6)Makes erythropoiein (hormone produced primarily by the kidneys plays a key role in the production of red blood cells) 7)Synthesize vitamin D for calcium absorption and regulation of the parathyroid hormones.
Glomerulonephritis
-An inflammation of the glomerular capillaries that can be acute or chronic and can lead to ESRD Causes: *Kidney infections *Drug toxicity *Immunological reactions *Hypertension *Poststreptococcal Glomerulonephritis is the most common
Interstitial Cystitis Treatment
-Avoid triggers and irritate the bladder like -Avoid alcohol, caffeine, citrus foods, chocolate, curries, food with vinegar and spicy food. -Take medications as prescribed OTC supplements -Decrease Stress -Tricyclic antidepressants like amitriptyline will help with burning and frequency.
Interventions (Cystitis)
-Before administering prescribed antibiotics, obtain a urine specimen for culture and sensitivity, if prescribed, to identify bacterial growth. -Encourage the client to increase fluids intake, especially if the client is taking a sulfonamide; sulfonamides can form crystals in concentration of urine. -Administer prescribed medications, which may include analgesics, antiseptics, antispasmodics, antibiotics, and antimicrobials. -Use sterile technique when inserting a urinary catheter. -Provide meticulous perineal care for the client with and indwelling catheter. -Discourage caffeine products such as coffee, tea, and cola.
Manifestation of Glomerulonephritis
-Generalized body edema -Dysuria -Oliguria -Fatigue -Hypertension -Reddish-brown or smoky which indicate bleeding in the upper urinary tract
Diagnosis
-Hx and PA -Throat culture to identify possible streptococcus infection -Renal biopsy can confirm the dx's -Erythrocyte sedimentation rate (ESR) (elevated indicating active inflammatory response) -White blood cell count (elevated indicating inflammation and presence of active strep infection) -X-Ray (KUB) or renal ultrasound to determine if there are structural abnormalities.
Urethritis
-Inflammation of the urethra commonly associated with a sexually transmitted infection (STI); may occur with cystitis. -In men, urethritis most often is caused by gonorrhea or chlamydial infection. -In women, urethritis most often is cause by feminine hygiene sprays, perfumed toilet paper or sanitary napkins, spermicidal jelly, UTI, or changes in the vaginal mucosal lining. Assessment: Pain or burning on urination, frequency and urgency, males may have clear to mucopurulent discharge from the penis, females may have lower abdominal discomfort. Treatment: Encourage fluid intake, prepare the client for testing to determine whether an STI is present. Health promotion relate to protection, avoid, irritates listed above.
Interstitial Cystitis (Don't Mix it up)
-Interstitial Cystitis is not caused by a bacteria and is not treated with ABT. -Chronic, painful inflammatory disease of the bladder. -Symptoms of urgency, frequency, and pain in the bladder and/or pelvis -Cause of IC/PBS is unknown
Interventions
-Monitor vital signs, especially for elevated temperature -Encourage fluid intake to reduce fever and prevent dehydration. -Monitor intake and output (ensure that output is a minimum of 1500 mL/24 hour) -Monitor weight -Provide warm, moist compresses to the flank area to help relieve pain. -Administer analgesics, antipyretics, antibiotics, urinary antiseptics, and antiemetics as prescribed.
A nurse is providing teaching to a client who has gout and urolithiasis. The client asks how to prevent future uric acid stones. Which of the following suggestions should the nurse provide? (Select all that apply.)
-Take allopurinol as prescribed -Exercise several times a week -Limit intake of foods high in purine
UTI Treatment
-Uncomplicated UTI could equal a short course of ABT 3 days. -Complicated may need 7-14 days -Meds of choice for uncomplicated -Antibiotic : TMP/SMX AKA co-trimoxazole, Nitrofurantoin -Co-Trimoxazole is inexpensice but not effective with e.coli. -UTI's caused by fungal infections will be treated with Diflucan remember patient with creatine clearance below 30 ml/min should not take diflucan -Painful urination=the need for urinary analgesic known as pyridium will turn the urine orange red. -Fluid intake will vary take the patients weight in pounds and divide by 2 that is the amount of H20 unless contraindicated.
Diagnostic Tests
-Urinalysis: (What is normal specific gravity? WBC? What if I see nitrates?) -Urine Diagnostic Studies. (What is creatinine clearance? How do you collect a 24 hr urine) -Blood studies urinary system (What if you say a BUN of 30 mEq/L, what does it mean?) (What if you say a BUN of 5 mEq/L. What does it mean?) -Diagnostic Studies Urinary System
Exemplar
-Urinary tract infection -Cystitis -Pyelonephritis -Glomerulonephritis -Interstitial Cystitis -Renal Stones -RAAS
Treatment
-Weight daily -Monitor intake and output -Monitor the patient for pruritus -Bed rest is maintained to decrease metabolic demands -Monitor electrolytes, BUN and creatine -Restricting sodium and fluid intake and diuretics can decrease edema -Antihypertensive meds might be needed. -If the BUN is increased the patient might be on protein restricted diet but will vary depending on how much protein is in the urine. -If strept infection is still ongoing the patient will need ABT.
Assessment (Cystitis)
1) Frequency and urgency 2) Suprapubic pain 3) Voiding in small amounts 4) Inability to void 5) Incomplete emptying of the bladder Diagnosis is done to exclude other causes urinalysis will not have bacteria.
A young adult male patient seen at the primary care clinic complains of feeling continued fullness after voiding and a split, spraying urine stream. The nurse will ask about a history of a. recent kidney trauma. c. recurrent bladder infection. b. gonococcal urethritis. d. benign prostatic hyperplasia.
B
A nurse is assessing a client who is receiving continous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider?
3.0 Potassium
A 76-yr-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider should the nurse implement first? a. Insert a urinary retention catheter. b. Draw blood for a serum creatinine level. c. Schedule an intravenous pyelogram (IVP). d. Administer lorazepam (Ativan) 0.5 mg PO
A
A female patient being admitted with pneumonia has a history of the neurogenic bladder as a result of a spinal cord injury. Which action will the nurse plan to take first? a. Ask about the usual urinary pattern and any measures used for bladder control. b. Assist the patient to the toilet at scheduled times to help ensure bladder emptying. c. Check the patient for urinary incontinence every 2 hours to maintain skin integrity. d. Use intermittent catheterization on a regular schedule to avoid the risk of infection.
A
A patient in the urology clinic is diagnosed with monilial urethritis. Which action will the nurse include in the plan of care? a. Teach the patient about the use of antifungal medications. b. Tell the patient to avoid tub baths until the symptoms resolve. c. Instruct the patient to refer recent sexual partners for treatment. d. Teach the patient to avoid nonsteroidal antiinflammatory drugs (NSAIDs).
A
A patient is admitted to the emergency department with possible renal trauma after an automobile accident. Which prescribed intervention will the nurse implement first? a. Check blood pressure and heart rate. b. Administer morphine sulfate 4 mg IV. c. Transport to radiology for an intravenous pyelogram. d. Insert a urethral catheter and obtain a urine specimen.
A
A patient is unable to void after having an open-loop resection and fulguration of the bladder. Which nursing action should be implemented? a. Assist the patient to soak in a 15-minute sitz bath. b. Restrict oral fluids to equal previous urine volume. c. Insert a straight urethral catheter and drain the bladder. d. Teach the patient how to do isometric perineal exercises.
A
A patient who has elevated blood urea nitrogen (BUN) and serum creatinine levels is scheduled for a renal arteriogram. Which bowel preparation order would the nurse question for this patient? a. Fleet enema c. Senna/docusate (Senokot-S) b. Tap-water enema d. Bisacodyl (Dulcolax) tablets
A
A patient with a history of polycystic kidney disease is admitted to the surgical unit after having shoulder surgery. Which of the routine postoperative orders is most important for the nurse to discuss with the health care provider? a. Give ketorolac 10 mg PO PRN for pain. b. Infuse 5% dextrose in normal saline at 75 mL/hr. c. Order regular diet after patient is awake and alert. d. Draw blood urea nitrogen (BUN) and creatinine in 2 hours.
A
After change-of-shift report, which patient should the nurse assess first? a. Patient with a urethral stricture who has not voided for 12 hours b. Patient who has cloudy urine after orthotopic bladder reconstruction c. Patient with polycystic kidney disease whose blood pressure is 186/98 mm Hg d. Patient who voided bright red urine immediately after returning from lithotripsy
A
The nurse is caring for a hospitalized patient with a decreased glomerular filtration rate who is scheduled for an intravenous pyelogram (IVP). Which action will be included in the plan of care? a. Monitor the urine output after the procedure. b. Assist with monitored anesthesia care (MAC). c. Give oral contrast solution before the procedure. d. Insert a large size urinary catheter before the IVP.
A
The nurse is caring for a patient who has had an ileal conduit for several years. Which nursing action could be delegated to unlicensed assistive personnel (UAP)? a. Change the ostomy appliance. b. Choose the appropriate ostomy bag. c. Monitor the appearance of the stoma. d. Assess for possible urinary tract infection (UTI).
A
What glomerular filtration rate (GFR) would the nurse estimate for a 30-yr-old patient with a creatinine clearance result of 60 mL/min? a.60 mL/min c. 120 mL/min b. 90 mL/min d. 180 mL/min
A
Which medication is taken at home by a patient with the decreased renal function will be of most concern to the nurse? a. ibuprofen (Motrin) c. folic acid (vitamin B9) b. warfarin (Coumadin) d. penicillin (Bicillin C-R)
A
Which nursing action is of highest priority for a patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain? a. Administer prescribed analgesics. b. Monitor temperature every 4 hours. c. Encourage increased oral fluid intake. d. Give antiemetics as needed for nausea.
A
How will the nurse assess for flank tenderness in a patient with suspected pyelonephritis? a. Palpate along both sides of the lumbar vertebral column. b. Strike a flat hand covering the costovertebral angle (CVA). c. Push fingers upward into the two lowest intercostal spaces. d. Percuss between the iliac crest and ribs at the midaxillary line.
B
Upper UTI Pyelonephritis E. coli is the most common causative bacterial organism
Acute pyelonephritis: -Acute pyelonephritis often occurs after bacterial contamination of the urethra or following an invasive procedure of the urinary tract. -Most common cause is bacteria e.coli or klebsiella. -It can progress to bacteremia or chronic pyelonephritis ASSESSMENT: a) fever and chills b)tachycardia and tachypnea c) nausea/vomiting malaise d) flank pain on the affected side Can also include s/s from LUTIs as well e) Dysuria h) Frequency and urgency
A 46-yr-old female patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole for 3 days. Which action will the nurse plan to take? a. Remind the patient about the need to drink 1000 mL of fluids daily. b. Obtain a midstream urine specimen for culture and sensitivity testing. c. Suggest that the patient use acetaminophen (Tylenol) to relieve symptoms. d. Teach the patient to take the prescribed trimethoprim and sulfamethoxazole for 3 more days.
B
A 48-yr-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma from a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon? a. Blood pressure is 102/58. b. Urine output is 20 mL/hr for 2 hours. c. Incisional pain level is reported as 9/10. d. Crackles are heard at bilateral lung bases.
B
A 56-yr-old female patient is admitted to the hospital with new-onset nephrotic syndrome. Which assessment data will the nurse expect? a. Poor skin turgor c. Elevated urine ketones b. Recent weight gain d. Decreased blood pressure
B
A 58-yr-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. Which patient problem is present based on these findings? a. Activity intolerance c. Disturbed body image b. Excess fluid volume d. Altered nutrition: less than required
B
A 79-yr-old patient has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care? a. Limit fluid intake to no more than 1000 mL/day. b. Leave a light on in the bathroom during the night. c. Ask the patient to use a urinal so that urine can be measured. d. Pad the patient's bed to accommodate overflow incontinence.
B
A female patient with a suspected urinary tract infection (UTI) is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen, the nurse will a. have the patient empty the bladder completely; then obtain the next urine specimen that the patient is able to void. b. teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup. c. insert a short sterile "mini" catheter attached to a collecting container into the urethra and bladder to obtain the specimen. d. clean the area around the meatus with a povidone-iodine (Betadine) swab and then have the patient void into a sterile container
B
A patient gives the admitting nurse health information before a scheduled intravenous pyelogram (IVP). Which item requires the nurse to intervene before the procedure? a. The patient has not had food or drink for 8 hours. b. The patient lists allergies to shellfish and penicillin. c. The patient complains of costovertebral angle (CVA) tenderness. d. The patient used a bisacodyl (Dulcolax) tablet the previous night.
B
A patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider? a. Urinary urgency c. Intermittent hematuria b. Left-sided flank pain d. Burning with urination
B
Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider? a. Complaint of flank pain c. Cloudy and foul-smelling urine b. Blood pressure 90/48 mm Hg d. Temperature 100.1° F (57.8° C)
B
Which nursing action is essential for a patient immediately after a renal biopsy? a. Insert a urinary catheter and test urine for microscopic hematuria. b. Apply a pressure dressing and keep the patient on the affected side. c. Check blood glucose to assess for hyperglycemia or hypoglycemia. d. Monitor blood urea nitrogen (BUN) and creatinine to assess renal function.
B
A patient has been diagnosed with urinary tract calculi that are high in uric acid. Which foods will the nurse teach the patient to avoid (Select all that apply)? a. Milk b. Liver c. Spinach d. Chicken e. Cabbage f. Chocolate
B,D
A nurse is teaching a client about urinary tract infections (UTIs). Which of the following manifestations should the nurse include?
Back pain
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?
Blood pressure 160/90 mmHg
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?
Blood tinged urine in the drainage bag.
A 28-yr-old male patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time? a. Complications of renal transplantation b. Methods for treating severe chronic pain c. Options to consider for genetic counseling d. Differences between hemodialysis and peritoneal dialysis
C
A 68-yr-old female patient admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action should be included in the plan of care? a. Restrict fluids between meals and after the evening meal. b. Insert an indwelling catheter until the symptoms have resolved. c. Assist the patient to the bathroom every 2 hours during the day. d. Apply absorbent adult incontinence diapers and pads over the bed linens.
C
A 68-yr-old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching? a. Application of ostomy appliances b. Barrier products for skin protection c. Catheterization technique and schedule d. Analgesic use before emptying the pouch
C
A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take? a. Notify the patient's health care provider. b. Teach correct midstream urine collection. c. Ask the patient about current medications. d. Question the patient about urinary tract infection (UTI) risk factors.
C
A patient admitted to the hospital with pneumonia has a history of functional urinary incontinence. Which nursing action will be included in the plan of care? a. Demonstrate the use of the Credé maneuver. b. Teach exercises to strengthen the pelvic floor. c. Place a bedside commode close to the patient's bed. d. Use an ultrasound scanner to check postvoiding residuals.
C
A patient had a cystectomy with an ileal conduit yesterday. Which new assessment data is most important for the nurse to communicate to the health care provider? a. Cloudy appearing urine c. Heart rate 102 beats/minute b. Hypotonic bowel sounds d. Continuous stoma drainage
C
A patient passing bloody urine is scheduled for a cystoscopy with a cystogram. Which description of the procedure by the nurse is accurate? a. "Your doctor will place a catheter into an artery in your groin and inject a dye to visualize the blood supply to the kidneys." b. "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney." c. "Your doctor will insert a lighted tube in the bladder through your urethra, inspect the bladder, and instill dye that will outline your bladder on x-ray." d. "Your doctor will inject a radioactive solution into a vein in your arm, then the distribution of the isotope in your kidneys and bladder will be visible."
C
After ureterolithotomy, a patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care? a. Provide teaching about home care for both catheters. b. Apply continuous steady tension to the ureteral catheter. c. Call the health care provider if the ureteral catheter output drops suddenly. d. Clamp the ureteral catheter off when output from the urethral catheter stops.
C
Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes for the first 4 hours. Which nursing action is most appropriate? a. Monitor the patient's intake and output overnight. b. Have the patient drink small amounts of fluid frequently. c. Use an ultrasound scanner to check the postvoiding residual volume. d. Reassure the patient that this is normal after anesthesia for rectal surgery.
C
The home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying. Which patient statement indicates that the teaching has been effective? a. "I will buy seven new catheters weekly and use a new one every day." b. "I will use a sterile catheter and gloves for each time I self-catheterize." c. "I will clean the catheter carefully before and after each catheterization." d. "I will take prophylactic antibiotics to prevent any urinary tract infections.
C
The nurse determines that further instruction is needed for a patient with interstitial cystitis when the patient says which of the following? a. "I should stop having coffee and orange juice for breakfast." b. "I will buy calcium glycerophosphate (Prelief) at the pharmacy." c. "I will start taking high potency multiple vitamins every morning." d. "I should call the doctor about increased bladder pain or foul urine."
C
The nurse observes unlicensed assistive personnel (UAP) taking the following actions when caring for a patient with a urethral catheter. Which action requires that the nurse intervene? a. Taping the catheter to the skin on the patient's upper inner thigh b. Cleaning around the patient's urinary meatus with soap and water c. Disconnecting the catheter from the drainage tube to obtain a specimen d. Using an alcohol-based gel hand cleaner before performing catheter care
C
The nurse teaches an adult patient to prevent the recurrence of renal calculi by a. using a filter to strain all urine. b. avoiding dietary sources of calcium. c. drinking 2000 to 3000 mL of fluid each day. d. choosing diuretic fluids such as coffee and tea.
C
The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with a. antibiotics. c. anticoagulants. b. antifungals. d. antihypertensives.
C
To determine possible causes, the nurse will ask a patient admitted with acute glomerulonephritis about a. recent bladder infection. c. recent sore throat and fever. b. history of kidney stones. d. history of high blood pressure.
C
When a patient's urine dipstick test indicates a small amount of protein, the nurse's next action should be to a. send a urine specimen to the laboratory to test for ketones. b.obtain a clean-catch urine for culture and sensitivity testing. c.inquire about which medications the patient is currently taking. d.ask the patient about any family history of chronic renal failure.
C
When preparing a female patient with bladder cancer for intravesical chemotherapy, the nurse will teach about a. premedicating to prevent nausea. b. obtaining wigs and scarves to wear. c. emptying the bladder before the medication. d. maintaining oral care during the treatments.
C
Which information about a patient with Goodpasture syndrome requires the most rapid action by the nurse? a. Blood urea nitrogen level is 70 mg/dL. b. Urine output over the last 2 hours is 30 mL. c. Audible crackles bilaterally over the posterior chest to the midscapular level. d. Elevated level of antiglomerular basement membrane (anti-GBM) antibodies.
C
Which information from a patient who had a transurethral resection with fulguration for bladder cancer 3 days ago is most important to report to the health care provider? a. The patient is voiding every 4 hours. b. The patient is using opioids for pain. c. The patient has seen clots in the urine. d. The patient is anxious about the cancer.
C
Which information from a patient's urinalysis requires that the nurse notify the health care provider? a. pH 6.2 c. WBC 20 to 26/hpf b. Trace protein d. Specific gravity 1.021
C
Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine? a. Take phenazopyridine for at least 7 days. b. Phenazopyridine may cause photosensitivity c. Phenazopyridine may change the urine color d. Take phenazopyridine before sexual intercourse.
C
A nurse is providing dietary teaching 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?
Calcium
A nurse is caring for a client who is receiving peiotoneal 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?
Change the clients position.
A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney injury. The client reports diarrhea, a dull headache, palpitations, and muscle tingling and weakness. Which of the following actions should the nurse take first?
Check the clients electrolyte values.
A nurse is caring for a client who has a nephrostomy tube inserted 8 hours ago. Which of the following actions should the nurse include in the clients plan of care?
Check the skin at the nephrostomy site for irrigation from urine leakage.
Upper UTI Pyelonephritis E. coli is the most common causative bacterial organism
Chronic pyelonephritis: -Chronic pyelonephritis most commonly occurs following chronic urinary flow obstruction with reflux -Cause the ureter to become fibrotic and narrowed by strictures *Frequency diagnosed incidentally when a client is being evaluated for hypertension
A nurse is assessing a client who is receiving peritoneal dialysis. Which of the following findings should the nurse report to the provider immediately?
Cloudy effluent
A nurse is providing teaching to a young adult client who has a history of calcium oxalate renal calculi. Which of the following instructions should the nurse include?
Consume 1,000 mg of dietary calcium daily
A young adult who is employed as a hairdresser and has a 15 pack-year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for a. renal failure. c. pyelonephritis. b. kidney stones. d. bladder cancer.
D
Does the nurse determine that instruction regarding prevention of future urinary tract infections (UTIs) has been effective for a 22-yr-old female patient with cystitis when the patient states which of the following? a. "I can use vaginal antiseptic sprays to reduce bacteria." b. "I will drink a quart of water or other fluids every day." c. "I will wash with soap and water before sexual intercourse." d. "I will empty my bladder every 3 to 4 hours during the day."
D
The nurse assessing the urinary system of a 45-yr-old patient would use palpation to a. determine kidney function. c. check for ureteral peristalsis. b. identify renal artery bruits. d. assess for bladder distention.
D
To assess whether there is any improvement in a patient's dysuria, which question will the nurse ask? a."Do you have to urinate at night?" b."Do you have blood in your urine?" c."Do you have to urinate frequently?" d."Do you have pain when you urinate?"
D
A 55-yr-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is most appropriate to include in the care plan? a. Assist the patient to the bathroom q3hr. b. Place a commode at the patient's bedside. c. Demonstrate how to perform the Credé maneuver. d. Teach the patient how to perform Kegel exercises.
D
A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is scheduled for a creatinine clearance test. Which item will the nurse need to obtain? a. Urinary catheter c. Cleansing towelettes b. Sterile specimen cup d. Large urine container
D
When working in the urology/nephrology clinic, which patient could the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Patient who is scheduled for a renal biopsy after a recent kidney transplant b. Patient who will need monitoring for several hours after a renal arteriogram c. Patient who requires teaching about possible post-cystoscopy complications d. Patient who will have catheterization to check for residual urine after voiding
D
Which assessment data reported by a patient is consistent with a lower urinary tract infection (UTI)? a. Low urine output c. Nausea and vomiting b. Bilateral flank pain d. Burning on urination
D
Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy? a. Blood in urine c. Left flank discomfort b. Left flank bruising d. Decreased urine output
D
Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)? a. Bladder distention c. Suprapubic discomfort b. Foul-smelling urine d. Costovertebral tenderness
D
Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective? a. The patient denies pain with voiding. b. The urine dipstick is negative for nitrites. c. The antistreptolysin-O (ASO) titer has decreased. d. The periorbital and peripheral edema are resolved.
D
Which statement by a patient who had a cystoscopy the previous day should be reported immediately to the health care provider? a. "My urine looks pink." c. "My sleep was restless." b. "My IV site is bruised." d. "My temperature is 101."
D
A nurse is assessing a client who is postoperative following a transurethral resection of the prostate (TURP). After the nurse discontinues the clients urinary cather, which of the following findings should the nurse report to the provider?
Decreased urine output
A nurse is conducting dietary teaching with a client who has a history of renal calculi. Which of the following instuctions should the nurse, include in the teaching?
Drink 3.8 L (4 qt) of water throughout the day.
A nurse is monitoring a client who is undergoing extracorporeal shockwave lithotripst (ESWL). The nurse should identify that which of the following findings is the priority.
Dysrhythmias
Urinary Tract Infection
Infections that affect the urinary tract.. Second most common bacterial disease and the most common bacterial infection in women -Escherichia coli is the most common pathogen causing a UTI. -Indwelling catheter is responsible for the second most common pathogen CANDIDA ALBICANS -Uncomplicated UTI's usually involve the bladder. -Complicated UTI's involves structural or functional problem in the urinary tract at high risk for pyelonephritis, urosepsis, and renal damage. -Antibiotic resistance UTI's can also be in the complicated UTI category.
A nurse is providing dietary teaching to a client who has chronic renal failure. Which of the following food choices by the client indicates an understanding of the teaching?
Grilled fish
A nurse is assessing a client who is receiving hemodialyis for the first time. Which of the following findings indicates that the client is developing dialysis disequilibrium syndrome (DDS)?
Headache
A nurse is assessing a client who has brought ot the emergency department following a motor vehicle crash. Which of the following findings is a manifestation of bladder trauma?
Hematuria-blood in urine
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)
Hemodialysis Biopsy Immunosuppression
A nurse is caring for a client who has chronic glomerulonephritis with oliguria. For which of the following electrolyte imbalances should the nurse monitor?
Hyperkalemia
A nurse is reviewing the labratory findings of a client who has chronic kidney disease. The client reports significant presistent nausea and muscle weakness. Which of the following findings should the nurse expect?
Hyperkalemia
A nurse is reviewing the labratory report of a client who has chronic kidney disease (CKD). The nurse finds the following labratory test results: potassium 6.8 mEq/L, calcium 7.6 mg/dl, hemoglobin 10.2 g/dl, and phosphate 4.8 mg/dl. Which finding is the prioriy for te nurse to report to the provider.
Hyperkalemia.
A nurse is preparing an in-service program about the stage of acute kidney injury (AKI). Which of the following pieces of information should the nurse include about prerenal azotemia?
Interference with renal perfusion causes prerenal azotemia.
A nurse is assesing a client who is postoperative following a transurethral resections of the prostate (TURP) and has continous bladder irrigation. The nurse notes no drainage in the clients urinary drainage bag over 1 hour, which of the following actions should the nurse take?
Irrigate the indwelling urinary catheter with a syringe.
Cystitis LUTI's
Is an inflammation of the bladder from and infection Causes: Allergens or irritants, such as soaps, spray, bubble bath, perfumed sanitary napkins *Bladder distenion *Calculus *Hormonal changes, influencing alterations in vaginal flora *Indwelling urinary catheters *Invasive urinary tract procedures *Loss of bactericidal properities of prostatic secretions in the male. *Microorganisms *Poor fitting vaginal diaphragms *Sexual intercourse *Synthetic underwear and pantyhose *Urinary stasis *Use of spermicides *Wet bathing suits
A nurse is teaching a client who has chronic kidney disease (CKD). Which of the following instructions should the nurse include?
Limit fluid intake
A nurse is assessing a client who has acute kidney injury (aki). According to the RIFLE classification system, which of the following findings indicate that the client hs end-stage kidney disease
No urine output without renal replacement therapy for more than 3 months.
A nurse is planning care for a client who had a stroke. The client has hemiplegia and occasional urinary incontinence. Which of the following actions should the nurse include in the clients plan of care?
Offer the client a bedpan every 2 hr.
A nurse is caring for a client who is receiving periotoneal dialysis. The nurse should monitor the client for which of the following adverse effects?
Peritonitis
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?
Place signs in the bathroom as a reminder about the test in progress
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?
Potassium and magnesium
A nurse is teaching a client with chronic kidney disease about predialysis dietary recommendations. The nurse should recommending restricting the intake of which of the following nutrients?
Protein
Urinary Tract Calculi
Purine: HIGH: sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweet breaks. Calcium: Milk, cheese, ice cream , beans, fish with fine bones, sardines, kippers, herring, salmon, dried fruit, nut, olvaltine, chocolate, cocoa. Oxalate: Dark roughage, spinach, rhybarb, asparagus, cabbage, beets, nuts, celery, parsley, instant coffee
A nurse is caring for a client who has a diagnosis of renal calculi and reports severe flank pain. Which of the following is the priority nursing action?
Relieve the clients pain
Cystitis
The most common causative organisms are escherichia coli and enterobacter -Cystitis is more common in women because women have a shorter urethra than men and the urethra in the woman is located in the rectum -Sexually active and pregnant women are most vulnerable to cystitis.
Urinary System
The upper tract: -Kidneys -Ureter The lower tract: -Bladder -Urethra
A nurse is caring for a client who is receiving intermittent peritoneal dialysis. The nurse observes that the peritoneal fluid is not adequately draining. Which of the following actions should the nurse take?
Turn the client from side to side.
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?
Ureter
A nurse is caring for a client who has just returned from the surgical suite following a right nephrectomy. Which of the following indicates that the client is meeting a successful short-term goal following this procedure
Urinary output is 35-50 ml/hr consistently
A nurse is caring for a client who has continous bladder irrigation following a transurethral resection of the prostate (TURP). Which of the following findings should the nurse report to the provider?
Viscous urinary output with clots.
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?
Vomiting and diarrhea for the last 6 hr.
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?
Wipe from front to back after defecation.
A nurse is teaching a client who has acute pyelonephritis. Which of the following instructions should the nurse include in the teaching?
You should complete the entire cycle of antibiotic therapy.
A nurse is providing teaching to a client who is preoperative for a renal biopsy. Which of the following statements should the nurse make?
You will need to be on bed rest following the procedure.
RAAS
renin-angiotensin-aldosterone system -Goal of RAAS: Increase BP w/ angiotension II 1) Blood pressure drops 2) Sympathetic nervous system stimulates 3) Kidneys juxtaglomerular cells release renin 5) creates angiotensin I 6) ACE (angiotensin converting enzyme) -Found in surface lung & kidney endothelium ) Converts Angiotensin I to Angiotensin II *Constrict vessels and increase blood volume.
