MEDSURG CH 36/37 TB

The nurse is contributing to the plan of care for a patient who has chronic kidney disease. What possible effects of this condition should the nurse consider? (Select all that apply.) a. Anemia b. Cardiac dysrhythmias c. Peripheral neuropathy d. Increased bone density e. Anorexia, nausea, vomiting f. Increase in function of oil and sweat glands

A, B, C, E Chronic kidney disease can lead to anemia, cardiac dysrhythmias, peripheral neuropathy, and anorexia, nausea, and vomiting. D. F. Chronic kidney disease does not cause increases in bone density or in the function of oil and sweat glands.

The nurse is reinforcing teaching about the most serious side effect of peritoneal dialysis with a patient scheduled for the first treatment. Which side effect should the patient state that indicates correct understanding? a. Peritonitis. b. Paralytic ileus. c. Respiratory distress. d. Cramps in the abdomen.

ANS: A A major complication of peritoneal dialysis is peritonitis, which can be life threatening. The major cause of peritonitis is poor technique when connecting the bag of dialyzing solution to the peritoneal catheter. B. Paralytic ileus and respiratory distress are not associated with peritoneal dialysis. D. Abdominal cramps can occur with this type of dialysis however they are not the most serious side effect of this treatment.

A patient recovering from radiological studies of the renal system has a nursing diagnosis of Impaired Urinary Elimination. Which outcome indicates that the nursing interventions have been effective? a. Patient voids 35 mL/hour of clear urine. b. Patient voids 30 mL/hour of cloudy urine. c. Patient voids 10 mL/hour of reddish urine. d. Patient voids an average of 15 mL/hour of dark-colored urine.

ANS: A An expected outcome would be for the patient to maintain a urine output greater than 30 mL per hour in the post-procedure period. B. Cloudy urine could indicate an infection. C. Only 10 mL of red urine could indicate renal failure. D. Urine output should be at least 30 mL/hr.

A patient with pneumonia has a blood urea nitrogen (BUN) of 32 mg/dL and creatinine of 0.8 mg/dL. What should the nurse realize is the most probable explanation for this finding? a. The patient is dehydrated. b. The patient has septicemia. c. The patient is malnourished. d. The patient has kidney damage.

ANS: A BUN elevates with dehydration, because the loss of water makes the blood more concentrated. Creatinine levels are a very good indicator of kidney function. B. C. D. There is not enough information to determine if the patient is septic, malnourished, or has kidney damage.

The nurse is collecting data from a patient who has returned from a dialysis session. After dialysis, the nurse should anticipate which patient finding? a. Weight loss b. Hypertension c. Increased energy d. Distended neck veins

ANS: A Based upon the fluid pulled off during dialysis, weight will be lost. C. Following a treatment, the patient normally feels weak and fatigued. B. Hypotension may occur due to the fluid loss. D. Fluid and electrolyte levels drop rapidly, so there is no fluid overload.

The nurse needs to obtain a urine specimen from a female patient. What action should the nurse take when obtaining this specimen? a. Obtain the first voided urine of the day. b. Direct the patient to wash her perineum before collecting the urine specimen. c. Have the patient urinate into a bedpan, then pour the urine into the specimen container. d. Have the patient void, throw that urine away, and then collect another specimen at least 1 hour later.

ANS: A Direct the patient to wash her perineum before collecting the urine specimen to reduce contamination. A. If the specimen is for a routine urinalysis, the first morning voided urine is best to obtain however the type of specimen is not known. C. Pouring urine from a bedpan could cause the specimen to be contaminated. D. There is no need for the patient to provide a double specimen.

The nurse is caring for a patient who has a nephrostomy tube. What action should the nurse take to maintain the integrity of this device? a. Ensure tube is not kinked or clamped. b. Limit fluids to 1000 mL per 24 hours. c. Keep collection bag taped to abdomen. d. Remove and clean the tube once daily.

ANS: A For a nephrostomy tube, the nurse should ensure that it is draining adequately and is not kinked or clamped. B. Fluids do not need to be limited. C. The collection bag does not need to be taped to the abdomen. D. The tube is not to be removed and cleaned.

The nurse is making a visit to the home of a patient with functional incontinence. Which observation indicates that teaching about the disorder has been effective? a. Patient wearing sweat pants b. Patient drinking a cup of coffee c. Patient sitting with the legs elevated d. Patient restricting fluid intake after 6 pm. Multiple Response Identify one or more choices that best complete the statement or answer the question.

ANS: A If clothing is inhibiting timely voiding for the patient with functional incontinence, the patient should be instructed to wear clothing with Velcro fasteners or sweat pants. B. Coffee is a bladder irrigant and could precipitate voiding. C. Elevating the legs is not an action appropriate for functional incontinence. D. Restricting fluids after 6 pm is not an appropriate action for functional incontinence.

The nurse is collecting data for a patient with kidney disease. When reviewing a urinalysis report, which range should the nurse recognize as normal specific gravity of urine? a. 0.080 to 0.100 b. 1.002 to 1.035 c. 2.600 to 3.000 d. 4.612 to 5.030

ANS: B The usual range of specific gravity of urine is 1.002 to 1.035. A. C. D. These are not normal ranges for the urine specific gravity.

A patient with chronic kidney disease is very weak due to low hemoglobin. What should the nurse understand as the best explanation for the anemia? a. Secretion of erythropoietin by the diseased kidney is reduced. b. There is loss of red blood cells in the urine with kidney disease. c. Chronic hypertension associated with chronic kidney disease suppresses the bone marrow. d. Metabolic acidosis associated with chronic kidney disease increases red blood cell fragility.

ANS: A In chronic kidney disease secretion of erythropoietin by the diseased kidney is reduced. B. C. D. This patient is not experiencing anemia because of a loss of red blood cells, chronic hypertension, or metabolic acidosis.

The nurse is catheterizing a patient after voiding to determine the amount of residual urine in the bladder. What should the nurse consider as being the normal amount of urine within the bladder after urination? a. 50 mL b. 75 mL c. 100 mL d. 150 mL

ANS: A Normally, the bladder contains less than 50 mL after urination. B. C. D. These represent excessive amounts of residual urine after voiding.

A patient hourly urine output is recorded. Which output rates should be brought to the attention of the registered nurse (RN) immediately? a. 15 mL/hr b. 40 mL/hr c. 60 mL/hr d. 80 mL/hr

ANS: A The minimum urine output should be 30 mL/hr, so 15 mL/hr should be reported. B. C. D. These rates are adequate and do not need to be reported.

The nurse is caring for a patient who has renal calculi. Which action is essential for the nurse to take? a. Strain all urine. b. Limit fluids at night. c. Record blood pressure. d. Obtain a sterile urine specimen.

ANS: A The nurse should ensure that all urine is strained to detect passage of stones. B. This patient does not need to have fluids limited at night. C. Blood pressure does not need to be measured. D. A sterile urine specimen is not needed.

The nurse learns that a patient has a urine pH of 7.9. What question should the nurse ask the patient after learning of this laboratory value? a. Are you a vegetarian? b. Are you lactose intolerant? c. How much protein do you eat each day? d. How much acetaminophen do you take each day?

ANS: A The pH range of urine is 4.6 to 8.0, with an average of 6.0. Diet has the greatest influence on urine pH. A vegetarian diet results in more alkaline urine. B. Lactose does not influence urine pH. C. A high-protein diet results in more acidic urine. D. Acetaminophen use does not influence urine pH.

The nurse is reinforcing teaching provided to a patient about risk factors for the development of bladder cancer. What risk factor should the patient state that indicates understanding of this teaching? a. Smoking b. Hyperlipidemia c. Diet high in calcium d. Recurrent UTIs

ANS: A There is a strong correlation between cigarette smoking and bladder cancer. B. C. D. Hyperlipidemia, high calcium diet, and recurrent UTIs are not identified as risk factors for the development of bladder cancer.

A female patient is embarrassed because of not being able to walk to the bathroom in time before become incontinent of urine. Which type of incontinence should the nurse plan care for this patient? a. Urge b. Total c. Stress d. Functional

ANS: A Urge incontinence is the involuntary loss of urine associated with an abrupt and strong desire to void. The patient typically reports being unable to make it to the bathroom in time. B. Total incontinence is a continuous and unpredictable loss of urine. It usually results from surgery, trauma, or a malformation of the ureter. C. Stress incontinence is the involuntary loss of less than 50 mL of urine associated with increasing abdominal pressure during coughing, sneezing, laughing, or other physical activities. D. Functional incontinence is the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation.

The nurse is reviewing a patients history and physical report. What term should the nurse recognize is being used to describe waste products building up in the blood? a. Uremia b. Septicemia c. Nitrosemia d. Proteinemia

ANS: A Waste products (blood urea nitrogen [BUN], creatinine, etc.) building up in the blood is called uremia. B. Septicemia is a bacterial infection in the blood. C. D. These terms do not describe waste products building up in the blood.

The nurse is collecting data from a patient with a vascular access graft in the right arm for dialysis. What should the nurse do when assessing this patient? (Select all that apply.) a. Auscultate for a bruit over the site. b. Palpate for a thrill in the right arm. c. Observe the tubing for bright red blood. d. Feel for a brachial pulse on the affected arm. e. Redress the arm daily, keeping the site sterile at all times.

ANS: A, B Arteriovenous grafts are checked for patency by palpating for a thrill (a tremor) and auscultating for a bruit (swishing sound) at the site of the graft or fistula. C. The graft is under the skin so there is no tubing. D. The distal radial pulse should be checked. E. There is no dressing over the site.

The nurse is collecting data for a patient who has suspected kidney disease. What health problems should the nurse consider as being associated with a high urine specific gravity? (Select all that apply.) a. Nephrosis b. Dehydration c. Heart failure d. Diabetes mellitus e. Diabetes insipidus f. Fluid volume excess

ANS: A, B, C, D A high specific gravity may occur from diabetes mellitus and high sugar concentrations in the urine, nephrosis, congestive heart failure, and dehydration. E. F. Specific gravity measurements are most likely lower in diabetes insipidus and fluid volume excess.

patient with a UTI is concerned about the expectation to void every three hours. What should the nurse explain to the patient about voiding this frequently? (Select all that apply.) a. Empties the bladder b. Reduces urine stasis c. Prevents reinfection d. Cleanses the perineum e. Lowers bacterial counts

ANS: A, B, C, E Encourage voiding every 3 hours to empty the bladder, lower bacterial counts, reduce stasis, and prevent reinfection. D. Voiding every 3 hours for a UTI is not done to cleanse the perineum.

The nurse is participating in care planning for a patient with urge incontinence. What should the nurse recommend be included in this patients plan of care? (Select all that apply.) a. Void every 2 hours. b. Practice relaxation breathing. c. Use urge inhibition techniques. d. Reduce fluid intake for several hours before sleep. e. Gradually increase length of time between voidings.

ANS: A, B, C, E For urge incontinence, the nurse should teach the patient to void at frequent intervals (every 2 hours) and then gradually increase the length of time between voidings. The nurse also should teach urge inhibition techniques (distraction), such as relaxation breathing. D. Reducing fluid intake is not an appropriate action to help treat urge incontinence.

The nurse is caring for a patient with an indwelling catheter. What should the nurse include in this patients routine care? (Select all that apply.) a. Encourage fluid intake. b. Maintain a closed system. c. Secure the catheter to the patients leg. d. Clamp the catheter for 1 hour each shift. e. Remove the catheter as soon as possible. f. Use sterile technique when emptying the drainage bag.

ANS: A, B, C, E Routine care should include encourage fluid intake, maintain a closed system, secure the catheter to the patients leg, and remove the catheter as soon as possible. F. Aseptic technique should be used when emptying the drainage bag. D. The catheter should not routinely be clamped.

The nurse is reinforcing teaching provided to a patient with chronic kidney disease who is receiving hemodialysis three times a week at a hemodialysis center. Which statements should be included? (Select all that apply.) a. You may feel weak and fatigued after the treatment. b. You may not be able to eat before the treatment session. c. You will need to be weighed before and after the session. d. Your medication schedule will be the same on dialysis days. e. Report any numbness, swelling, redness, or drainage from the dialysis access site. f. You may experience some bleeding from the puncture site or a nosebleed. Report it if it doesnt stop within a few minutes.

ANS: A, B, C, E, F Sessions cause fatigue and the need to rest. Eating may not be possible for some patients as digestion of food causes blood diversion to the gastrointestinal (GI) tract which can drop blood pressure as fluid is removed during dialysis. Weight must be monitored to determine effect of treatment. Side effects must be reported at the access site and if bleeding from the heparin occurs. D. Medications such as hypertensives may need to be held before dialysis.

The nurse is monitoring a patient with chronic kidney disease. Which findings should the nurse realize indicates fluid overload? (Select all that apply.) a. Periorbital edema b. Crackles in the lungs c. Postural hypotension d. Increased blood pressure e. Decreased pulse pressure f. Auditory wheezes on inspiration

ANS: A, B, D Neck vein distention, periorbital edema, hypertension and crackles in the lungs are symptoms of fluid overload. C. E. F. Postural hypotension, decreased pulse pressure, and auditory wheezes on inspiration are not manifestations of fluid overload.

While collecting data, the nurse suspects that a patient is experiencing renal calculi. What did the nurse assess to come to this conclusion? (Select all that apply.) a. Nausea b. Flank pain c. Fever and chills d. Costovertebral tenderness e. Pain radiating to the genitalia

ANS: A, B, D, E Symptoms of renal calculi include excruciating flank pain and renal colic. When a stone is lodged in the ureter, it is common to have pain radiate down to the genitalia. The pain results when the stone prevents urine from draining. The patient also may have costovertebral tenderness. Some people develop nausea because of the proximity of the gastrointestinal structures. C. Fever and chills are not manifestations of renal calculi.

The nurse is caring for a patient with an elevated uric acid level. Which health problems should the nurse consider as potentially causing this patients elevation? (Select all that apply.) a. Leukemia b. Steroid use c. Malnutrition d. Kidney disease e. Use of thiazide diuretics f. Gastrointestinal bleeding

ANS: A, C, D, E An elevated uric acid level can be caused by kidney disease, malnutrition, leukemia, and use of thiazide diuretics. B. F. Elevated uric acid levels are not associated with steroid use or gastrointestinal bleeding.

The nurse notes it is time to administer prescribed gentamicin (Garamycin) for a patient with acute kidney injury and suspected streptococcal pneumonia. Which action should the nurse take at this time? (Select all that apply.) a. Hold medication. b. Administer drug as ordered. c. Administer half of the prescribed dose. d. Consult physician about medication order. e. Flush the tubing with heparin before infusing.

ANS: A, D The medication should be held until the physician can be consulted about the medication order, as this is a nephrotoxic agent and the patient already has renal damage. Another agent will likely be ordered. B. The medication should not be provided as ordered. C. The nurse cannot alter the prescribed dose of the medication. E. The tubing does not need to be flushed with heparin before administering this medication.

The nurse is reinforcing teaching provided to a patient with polycystic kidney disease. Which patient statements indicate a correct understanding of the teaching? (Select all that apply.) a. It is a hereditary disease. b. It affects women more than men. c. Symptoms appear in early childhood. d. Genetic counseling is appropriate for individuals with this diagnosis. e. There is no effective treatment to stop the progression of the disease. f. It is characterized by the formation of multiple grapelike cysts in the kidney.

ANS: A, D, E, F Polycystic kidney disease is a hereditary disorder that can result in kidney disease. Because this is a hereditary disorder, genetic counseling is appropriate. There is no treatment to stop the progression of polycystic kidney disease. Polycystic kidney disease is characterized by formation of multiple cysts in the kidney that can eventually replace normal kidney structures. B. The disease affects men and women equally. C. The patient generally first shows signs of the disease in adulthood.

The nurse is reinforcing teaching provided to a patient about caring for a new fistula in the left arm for dialysis. Which patient statements indicates correct understanding? (Select all that apply.) a. Do not sleep on my arm. b. Keep my arm elevated at all times. c. Keep a firm bandage on my arm. d. Wear loose clothing on my left arm. e. Avoid carrying heavy things with my left arm. f. Do not allow blood pressures to be taken on my left arm.

ANS: A, D, E, F The fistula must be protected from clotting. This would be done by not sleeping on the arm, wearing loose clothing, avoiding carrying heavy items with the arm, and not permitting blood pressure to be assessed on the arm. B. C. The arm does not need to be elevated or have a firm bandage applied.

A patient is being evaluated for renal dialysis. What creatinine clearance value should the nurse realize this patient must have to live without needing dialysis treatments? a. 5 mL b. 10 mL c. 20 mL d. 50 mL

ANS: B A minimum creatinine clearance of 10 mL per minute is needed to live without dialysis. A. The patient would need dialysis for this value. C. D. The patient can live without dialysis with these values however they are not the minimum value to live without dialysis.

A patient is scheduled for an intravenous pyelogram (IVP). What care should the nurse provide before the patient has this procedure? a. IV antibiotics b. Opioid pain medication c. Enema evening before the test d. Bedrest for 16 hours before the test

ANS: C For an IVP, enemas may be given the evening before the test to empty the colon. A. B. D. The patient does not need antibiotics, opioid medication, or bedrest before the procedure.

The nurse is collecting data from a patient with kidney disease. Which adventitious lung sound should the nurse recognize as being caused by fluid overload? a. Stridor b. Crackles c. Wheezes d. Pleural friction rub

ANS: B Assessment of vital signs, lung sounds, edema, daily weights, and intake and output can provide valuable data related to urinary function. Fluid retention in the lungs is manifested as crackles, which are popping sounds heard on inspiration and sometimes on expiration. C. Wheezes might be heard however do not necessarily indicate fluid overload. A. D. Stridor and pleural friction rub are not heard in fluid overload.

The nurse is collecting data from a patient with suspected cancer of the bladder. What finding should the nurse recognize as the most common symptom of cancer of the bladder? a. Pain b. Hematuria c. Urine retention d. Burning on urination

ANS: B Cancer of the bladder usually causes painless hematuria. A. C. D. Pain, urine retention, and burning on urination are not the most common symptoms of bladder cancer.

The nurse is caring for a patient who is scheduled for a cystoscopy (C&P) with basket extraction of a stone. What is the most important postoperative care for the nurse to provide? a. Limiting fluid intake b. Measuring urine output c. Monitoring daily weights d. Observing for acute kidney injury

ANS: B Care following a C&P includes measuring urine to make sure the patient has not developed urinary retention from swelling of the urinary meatus. A. Fluids should be encouraged. C. Daily weights is not necessary for this procedure. D. The patient is not at risk for developing an acute kidney injury.

A patients urinalysis results are: white blood cells (WBC) 100+/hpf; red blood cells (RBC) 4/hpf; bacteria, moderate amount; nitrite, positive; specific gravity, 1.025; urine, cloudy. What should the nurse recognize these findings indicate? a. Dehydration b. Urinary tract infection c. Contamination from menstruation d. Contamination of the specimen from bacteria on the perineum

ANS: B Elevated WBCs, bacteria, nitrites, and cloudy urine indicate an infection. A. C. D. These findings do not indicate dehydration, contamination from menstruation, or bacterial contamination of the specimen.

The nurse is caring for a male patient with functional incontinence. What action should the nurse take to help prevent incontinence? a. Teach the patient how to do Kegel exercises. b. Ensure that the patient has ready access to the urinal. c. Teach the patient to increase the time between voiding. d. Give the patient cranberry juice to keep the urine acidic.

ANS: B Functional incontinence is the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation, so ensuring access to a urinal is important. A. Kegel exercises are helpful with stress or urge incontinence. C. Prolonging the time between voiding is helpful for urge incontinence. D. Cranberry juice does not affect continence.

A patient with glomerulonephritis asks, How could I have gotten this? How should the nurse respond? a. Has anyone in your family had glomerulonephritis? b. Have you had a sore throat or skin infection recently? c. Glomerulonephritis almost always follows a bladder infection. d. Glomerulonephritis often results from having unprotected sex.

ANS: B Glomerulonephritis can be caused by a variety of factors but is most commonly associated with a group A beta-hemolytic streptococcus infection following a streptococcal infection of the throat or skin. A. Glomerulonephritis is not contracted from another person. C. D. Glomerulonephritis is not caused by a bladder infection or having unprotected sex.

The nurse is caring for a patient recovering from a renal biopsy. For which complication should the nurse monitor the patient during the 24 hours after the procedure? a. Polyuria b. Bleeding c. Infection d. Urinary obstruction

ANS: B Grossly bloody urine, falling blood pressure, and rising pulse are signs of bleeding and are reported immediately. A. C. D. Polyuria, infection, and urinary obstruction are not complications typically associated with a renal biopsy.

The nurse is caring for a patient with a kidney infection. When providing prescribed medications, the nurse should recall that which structure is the capillary network in each nephron? a. Corpuscles b. Glomerulus c. Renal tubules d. Bowmans capsule

ANS: B The glomerulus is a capillary network that arises from an afferent arteriole and empties into an efferent arteriole. A. C. D. These structures are not the capillary network with a nephron.

The nurse is contributing to the plan of care for a patient who is having an intravenous pyelogram (IVP) done to diagnose possible bladder cancer. Which intervention should the nurse recommend be included for the patient after the procedure? a. Document heart rhythm. b. Monitor creatinine level. c. Monitor arterial blood gases (ABGs). d. Review thyroid-stimulating hormone (TSH) and T4 levels.

ANS: B The nurse should monitor creatinine levels to observe for renal damage after the IVP due to the dye that is used. A. C. D. Heart rhythm, arterial blood gases, and thyroid hormone levels do not need to be monitored after an IVP.

The nurse is caring for a patient with kidney disease. How should the nurse end a 24-hour urine test at the end of the 24 hours? a. The final voiding before 24 hours is discarded. b. The patient voids at the end of 24 hours, adding it to the collection container. c. One hundred milliliters of collected urine is placed into a specimen cup and sent to the laboratory. d. The patient voids, and the first and last specimens from 24 hours are sent to the laboratory.

ANS: B The patient is in a prone position, usually with a sandbag under the abdomen, and the biopsy is taken through the flank area. A. C. D. These positions are not appropriate when obtaining a renal biopsy.

The nurse is helping to prepare a patient for a renal biopsy. In which position should the nurse help the patient assume? a. Sims b. Prone c. Supine d. Fowlers

ANS: B The patient is in a prone position, usually with a sandbag under the abdomen, and the biopsy is taken through the flank area. A. C. D. These positions are not appropriate when obtaining a renal biopsy.

During an assessment, the nurse notes that a patient has crystals deposited on the skin. What should this finding indicate to the nurse? a. Gout b. Uremic frost c. Poor hygiene d. Metabolic alkalosis

ANS: B The presence of crystals on the skin is called uremic frost and is a late sign of waste products building up in the blood (uremia). When the waste products are not filtered by the kidneys or with treatment, they can come out through the skin and look like a coating of frost in the winter. A. C. D. Crystal deposits on the skin do not indicate gout, poor hygiene, or metabolic alkalosis.

The nurse is reviewing normal kidney function with a patient experiencing an acute kidney injury. Which hormones should the nurse include that affect kidney function? (Select all that apply.) a. Estrogen b. Aldosterone c. Parathyroid hormone d. Antidiuretic hormone (ADH) e. Atrial natriuretic hormone (ANH) f. Thyroid-stimulating hormone (TSH)

ANS: B, C, D, E Hormones that affect kidney function include aldosterone, which promotes reabsorption of sodium ions from the filtrate to the blood and excretion of potassium ions into the filtrate; ADH, which promotes reabsorption of water from the filtrate to the blood; ANH, which decreases reabsorption of sodium ions, which remain in the filtrate; and parathyroid hormone, which promotes reabsorption of calcium ions from the filtrate to the blood and excretion of phosphate ions into the filtrate. A. F. Estrogen and TSH do not affect renal function.

The nursing home administrator for a skilled nursing facility is concerned because a large number of older residents are developing UTIs. What should the staff nurse explain about the development of UTIs in this population? (Select all that apply.) a. Overuse of antibiotics b. Diminished immune function c. Enlarged prostate in older men d. Presence of neurogenic bladder e. Decline in estrogen in older women

ANS: B, C, D, E Older adults have an increased incidence of UTIs due to diminished immune function and neurogenic bladder which fails to completely empty. Older men are predisposed to infection because an enlarged prostate obstructs urine flow. In older women, the decline in estrogen can also contribute to the risk of UTI. A. Overuse of antibiotics is not identified as a reason for UTI development in older patients.

The nurse is contributing to the plan of care for a patient with chronic kidney disease. The nurse has recognized a growing body of evidence related to restricting protein intake. Which evidence should the nurse use to develop the plan of care? (Select all that apply.) a. Protein requirements should be based on ideal body weight. b. Increased protein is recommended for patients on hemodialysis. c. Protein calorie malnutrition should be avoided for patients on hemodialysis. d. Optimum nutritional status should be maintained for all patients with kidney disease. e. All patients with renal compromise should limit protein intake to less than 0.5 g/kg/day. f. Protein energy malnutrition is a predictor of mortality and morbidity for patients on dialysis.

ANS: B, C, D, F Protein energy malnutrition is a predictor for morbidity and mortality in patients on dialysis. For patients receiving hemodialysis, increased protein is recommended. It is advisable to avoid protein calorie malnutrition with patients on hemodialysis. Optimum nutritional status should be maintained for all patients with kidney disease. E. A protein-controlled diet is recommended or patients with kidney disease. A. Protein requirements are based on actual weight of the patient and not ideal body weight.

The nurse is contributing to a staff education program about the risks of smoking and conditions related to smoking. Which statements by a staff member indicate correct understanding of the teaching? (Select all that apply.) a. Kidney stones b. Kidney cancer c. Bladder cancer d. Hydronephrosis e. Diabetic nephropathy f. UTI

ANS: B, C, E Smoking is a risk factor for kidney cancer. There is a strong correlation between cigarette smoking and bladder cancer. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. A. D. F. No correlation between UTIs, kidney stones, or hydronephrosis and cigarette smoking has been established.

The nurse is caring for a patient with an indwelling urinary catheter. Which instructions should the nurse provide to help prevent development of a urinary tract infection? (Select all that apply.) a. Limit fluid intake to decrease the flow of urine. b. Position the tubing to allow free flow of the urine. c. Use aseptic technique when emptying the drainage bag. d. Wash the perineum with an antibacterial soap every 8 hours. e. Keep the catheter securely taped to prevent catheter movement. f. Empty the urinary bag every 4 hours to prevent stagnation of urine.

ANS: B, C, E The nurse should instruct to position the tubing to allow free flow of urine, use aseptic technique when emptying the drainage bag, and keep the catheter securely taped or fastened to the leg. A. Fluids should be encouraged. D. The perineum should be washed daily and prn. F. The drainage bag does not need to be emptied every 4 hours.

The nurse is reinforcing teaching provided to a patient with a history of calcium oxalate kidney stones. The nurse recognizes that teaching has been effective if the patient avoids which foods? (Select all that apply.) a. Bread b. Cocoa c. Lettuce d. Spinach e. Chicken f. Instant coffee

ANS: B, D, F A low oxalate diet restricts foods such as beets, rhubarb, spinach, cocoa, and instant coffee. A. C. E. Bread, lettuce, and chicken do not need to be restricted on this diet.

The nurse is collecting data for a patient with kidney disease. Which information should the nurse identify as being normal urinalysis findings? (Select all that apply.) a. pH 3.5 b. Amber color c. Small amount of nitrite d. Red blood cells of 8/hpf e. Specific gravity of 1.010 f. Small quantities of enzymes

ANS: B, E, F Straw to amber color, specific gravity 1.002 to 1.028, small quantities of enzymes, and hormones would all indicate a normal analysis finding. A. Normal pH is 4.6 to 8. D. Red blood cells should be 0 to 4/hpf. C. Nitrite is negative.

The nurse is to obtain orthostatic blood pressure measurements for a patient on dialysis for end-stage renal disease. What should the nurse do when measuring this patients blood pressure? a. Take blood pressure before and after dialysis treatments. b. Check blood pressure every minute three times for four readings. c. Obtain blood pressure while the patient is lying, sitting, and standing. d. Monitor blood pressure before and after an antihypertensive medication is given.

ANS: C A drop in blood pressure accompanied by a rise in pulse rate as the patient rises to sitting or standing positions is called orthostatic or postural hypotension and may indicate fluid deficit. The nurse will check blood pressure while the patient is lying, sitting, and standing. A. B. D. These do not describe the correct approach to measure orthostatic blood pressure measurements.

The nurse contributes to the plan of care for a patient with edema. Which action should the nurse take as the best indicator of this patients fluid volume status? a. Vital signs b. Skin turgor c. Daily weight d. Intake and output

ANS: C Daily weight is the single best indicator of fluid balance in the body. A. B. D. Vital signs, skin turgor, and intake and output are not the best indicators of fluid balance in the body.

A patient has a glomerular filtration rate of 20 mL/min. For which stage of renal failure should the nurse plan care for this patient? a. Mild b. Slight c. Severe d. Moderate Multiple Response Identify one or more choices that best complete the statement or answer the question.

ANS: C In severe renal failure the glomerular filtration rate is between 15 to 29 mL/min. A. In mild failure the rate is 60 to 89 mL/min. B. In slight failure the rate is greater than or equal to 90 mL/min. D. In moderate failure, the rate is 30 to 59 mL/min.

A patient with glomerulonephritis develops acute kidney injury. Which form of kidney injury should the nurse realize has occurred with this patient? a. Prerenal b. Postrenal c. Intrarenal d. Suprabladder

ANS: C Intrarenal kidney injury occurs when there is damage to the nephrons inside the kidney. Causes are ischemia, reduced blood flow, toxins, infectious processes leading to glomerulonephritis, trauma to the kidney, allergic reactions to radiograph dyes, and severe muscle injury. A. B. This patients kidney injury is not caused by a pre- or postrenal injury. D. Suprabladder is not a type of kidney injury.

The nurse is reinforcing teaching provided to a patient with chronic kidney disease. Which patient statement indicates the need for further teaching? a. I do not use salt substitute. b. My fluid intake is restricted. c. As long as I dont eat protein, Ill be okay. d. Since Im on dialysis, I cannot eat just anything I want.

ANS: C Protein may be restricted when the patients kidneys are failing but increased if dialysis is started. A. B. D. These statements indicate that teaching has been effective.

The nurse is reviewing a urinalysis report. What should the nurse recognize as the normal average pH of urine? a. 2 b. 4.2 c. 6 d. 7.4

ANS: C The pH range of urine is 4.6 to 8, with an average of 6. A. B. D. These values are not considered the normal average pH of urine.

The nurse is instructing a patient on the use of Kegel exercises. How many times a day should the nurse recommend that these exercises be performed? a. 10 to 20 b. 15 to 30 c. 30 to 80 d. 85 to 100

ANS: C The patient should be advised to perform these exercises 30 to 80 times per day. A. B. D. The exercises need to be done more than 30 times a day however not as much as 85 to 100 times a day.

The nurse is caring for a patient with chronic kidney disease. Which data collection technique is the best one for the nurse to use to determine this patients fluid volume status? a. Vital signs b. Skin turgor c. Daily weight d. Intake and output

ANS: C The patient should have daily weights monitored, at the same time every day. Weight change is the best estimation of fluid balance. A. B. D. Vital signs, skin turgor, and intake and output are not the best measurements to indicate fluid balance.

The nurse is reinforcing teaching provided to a patient about antibiotics prescribed for a UTI. Which patient statement indicates teaching has been effective? a. I will take the antibiotics until my urine is no longer cloudy. b. I will take the antibiotics whenever I feel discomfort from urinating. c. I will take the antibiotics until they are gone regardless of symptoms. d. I will take the antibiotics until my temperature has been normal for 3 days.

ANS: C The patient should take the prescribed medication for a UTI until all medication has been taken. A. B. D. These statements indicate that teaching has not been effective.

The nurse is reinforcing 24-hour fluid intake teaching for a patient to prevent further UTIs. Which amount should the patient state that indicates that teaching has been effective? a. 1000 mL. b. 1500 mL. c. 3000 mL. d. 5000 mL.

ANS: C To prevent UTIs, the patient should be encouraged to drink up to 3000 mL of fluid a day if there are no fluid restrictions from the physician. A. B. Less than 2 liters of fluid per day is not sufficient to prevent the onset of a UTI. D. There is no need for the patient to ingest 5 liters of fluid per day.

A patient hospitalized for orthopedic surgery had a urinary catheter inserted. The patient later develops a urinary tract infection (UTI) and asks the nurse what caused it. What is the appropriate response by the nurse? a. There was a change in the pH of your urine. b. You probably did not void frequently enough. c. Bacteria probably ascended the catheter, causing the infection. d. There are always bacteria on your perineum that enter your urine.

ANS: C UTIs are almost always caused by an ascending infection, starting at the external urinary meatus and progressing toward the bladder and kidneys. Instrumentation, or having instruments or tubes inserted into the urinary meatus, is a predisposing cause. A. B. D. Change in urinary pH, infrequent voiding, and presence of bacteria are not predisposing causes for UTIs.

The nurse is contributes to the plan of care for an older patient. What should the nurse recognize as normal signs of aging within the renal system? (Select all that apply.) a. Bladder size increases b. Urethral changes position c. Number of nephrons decreases d. Detrusor muscle tone decreases e. Glomerular filtration rate increases

ANS: C, D With age, the number of nephrons in the kidneys decreases, often to half the original number by age 70 or 80. E. The GFR also decreases; this is in part a consequence of arteriosclerosis and diminished renal blood flow. A. The urinary bladder decreases in size. D. The tone of the detrusor muscle decreases. B. The urethra does not change position with aging.

41. While participating in the creation of a teaching plan, the nurse suggests that a patient ingest cranberry juice every day to reduce the risk of developing a UTI. What information did the nurse use to make this suggestion? (Select all that apply.) a. The fiber in cranberries reduces the amount of sediment in the urine. b. Cranberries facilitate the removal of fluid from the interstitial spaces. c. Compounds in cranberries inhibit the adherence of E. coli to the urogenital mucosa. d. Cranberries reduce the incidence of UTIs in patients after renal transplants. e. Cranberries contain a substance that prevents bacteria from sticking on the walls of the bladder.

ANS: C, D, E In a systematic review of studies that compared the use of cranberries containing products to prevent UTI with placebo or nonplacebo controls, it was found that cranberry containing products are associated with a protective effect against UTIs. Cranberries contain a substance that can prevent bacteria from sticking on the walls of the bladder. Other compounds found in cranberries inhibit the adherence of E coli to the urogenital mucosa. It was also found that cranberries are effective in reducing the annual number of UTI episodes by 63.9% in clients after renal transplantation. A. Cranberries do not reduce the amount of sediment in urine. B. It is not known if cranberries facilitate the removal of fluid from the interstitial spaces.

The nurse is reviewing data for a patient with acute kidney injury. Which diagnostic test results should the nurse recognize that indicate kidney injury? (Select all that apply.) a. Hematocrit 20% b. Uric acid 8 ng/dL c. Serum creatinine 4.2 mg/dL d. Blood urea nitrogen 40 mg/100 mL e. Urine output of 100 mL in 24 hours f. Fixed urine specific gravity of 1.010

ANS: C, E, F A serum creatinine level above 1.5 mg/dL means there is kidney dysfunction. The higher the creatinine level, the more impaired the kidney function. A fixed urine specific gravity is also indicative of renal compromise and impending failure. Normal urinary output is 1000 to 2000 mL per 24 hours. Individuals with acute kidney injury experience oliguria (reduced output). A. B. D. These test results are not consistent with a renal injury.

A patient is recovering from a renal arteriogram. What actions should the nurse take when caring for this patient? (Select all that apply.) a. Check vital signs twice daily. b. Raise the head of the bed to 90 degrees. c. Check distal pulses in leg every 30 to 60 minutes. d. Encourage the patient to ambulate as soon as possible. e. A pressure dressing and sandbag used to apply pressure. f. Implement bedrest for 12 hours, and instruct the patient not to bend leg.

ANS: C, E, F Patient care following angiography includes bedrest for up to 12 hours to prevent bleeding at the injection site. Pressure dressing is applied, and a sandbag is used to apply pressure. Distal pulses in the leg are checked every 30 to 60 minutes. B. D. The patient is instructed not to bend the leg, and the head of the bed is not raised more than 45 degrees. A. Vital signs, dressing, and pulses in the affected extremity are monitored frequently.

A patient with chronic kidney disease has a serum potassium level of 6 mEq/L. Which action should the nurse take? (Select all that apply.) a. Obtain consent for hemodialysis. b. Administer the patient an antacid. c. Place the patient on a cardiac monitor. d. Give the patient a glass of orange juice. e. Repeat laboratory test of electrolyte levels. f. Inform RN to notify physician.

ANS: C, F As the kidneys lose their ability to excrete electrolytes, such as sodium, potassium, and magnesium, these substances accumulate at high levels in the blood and may cause life-threatening dysrhythmias. Notify the RN and physician for treatment orders, and place the patient on a cardiac monitor to detect dysrhythmias. A. The patient may or may not need dialyzed at this time. B. An antacid will not help reduce the potassium level. D. Orange juice has potassium and would be contraindicated for the patient at this time. E. The physician needs to prescribe repeat laboratory tests for the patient.

The nurse is reviewing the results of a patients urinalysis. Which components should the nurse identify as being abnormal in urine? (Select all that apply.) a. Urea b. Water c. Protein d. Ammonia e. Hormones f. Red blood cells

ANS: C, F Persistent proteinuria is seen with renal disease from damage to the glomerulus. Intermittent protein in the urine can result from strenuous exercise, dehydration, or fever. Protein in the urine is a significant sign of renal problems. Blood in the urine may be caused by infection, stones, cancer, renal disease, or trauma. A. B. D. E. These components are considered normal within urine.

A patient who has diabetic nephropathy asks the nurse, Why am I using smaller doses of insulin than I used to? What would be the best explanation by the nurse? a. Insulin is now more potent than it used to be. b. It would be best if you spoke with your physician about this. c. You have probably decreased the amount of food you are eating. d. Your kidneys are no longer breaking down the insulin as much as before.

ANS: D As renal function decreases, the patient needs smaller doses of insulin because the kidney normally degrades insulin. A. Insulin is not more potent than it used to be. B. The nurse can explain why the dosage of insulin has changed. C. There is no evidence that the patient has changed the amount of food being ingested.

The nurse is caring for an unstable patient with acute kidney injury. What therapy should the nurse expect to be ordered? a. Hemodialysis b. Urinary catheter c. Peritoneal dialysis d. Continuous renal replacement therapy (CRRT)

ANS: D Continuous renal replacement therapy (CRRT) is used to remove fluid and solutes in a con-trolled, continuous manner in unstable patients with AKI. Unstable patients may not be able to tolerate the rapid fluid shifts that occur in hemodialysis, so CRRT provides an alternative therapy that results in less dramatic fluid shifting. A. C. The patient is not stable enough for hemodialysis or peritoneal dialysis. B. A urinary catheter may or may not be indicated for this patient.

A patient is diagnosed with end-stage kidney disease. The nurse realizes that what percentage of functioning nephrons have been lost in this patient? a. 25% b. 50% c. 75% d. 90%

ANS: D End-stage renal disease (ESRD) occurs when 90% of the nephrons are lost. A. Renal disease is not diagnosed when 25% of functioning nephrons are lost. B. In the early, or silent stage (decreased renal reserve), the patient is usually without symptoms, even though up to 50% of nephron function may have been lost. C. The renal insufficiency stage occurs when the patient has lost 75% of nephron function and some signs of mild kidney disease are present.

A patient who is on hemodialysis for chronic kidney disease is prescribed sevelamer hydrochloride (Renagel) with meals. What explanation should be provided to the patient as the primary reason the medication is being given? a. To prevent metabolic acidosis b. To prevent gastrointestinal ulcer formation c. To relieve gastric irritation from excess acid production d. To prevent damage to bones from high phosphorus levels

ANS: D Hyperphosphatemia, a phosphorous level above 5 mg/dL, is associated with a low calcium level. These imbalances cause the bones to release calcium, causing patients to be prone to fractures. Sevelamer hydrochloride (Renagel) is a medication that binds with the phosphates in the stool and be eliminated. A. B. C. This medication does not prevent metabolic acidosis, gastrointestinal ulcer formation, or relieve gastric irritation.

The nurse determines that a patients urine output is normal. How many mL of urine did the patient void within the last 24 hours? a. 150 to 400 mL b. 250 to 500 mL c. 750 to 1000 mL d. 1000 to 2000 mL

ANS: D Normal urinary output is 1000 to 2000 mL per 24 hours. A. B. C. These volumes represent inadequate amounts of urine output for 24 hours.

The nurse is caring for a patient who has an acute kidney injury. Which diagnostic test result should the nurse identify as most supporting this diagnosis? a. Hematocrit 20% (normal 38% to 47%) b. Uric acid 8 ng/dL (normal 2.5 to 5.5 ng/dL) c. 24-hour creatinine clearance 5 mL/min (normal 100 mL/min) d. Blood urea nitrogen 20 mg/100 mL (normal 8 to 25 mg/100 mL)

ANS: D Of the tests listed a normal 24-hour creatinine clearance of 100 mL/min is the most accurate test for renal function. A value less than 100 mL/min indicates kidney disease. A. B. Hematocrit and uric acid levels are not used to diagnose kidney disease. D. Blood urea nitrogen test is also used to detect kidney disease however the value is within normal limits.

The nurse is reinforcing teaching provided to a patient about risk factors for prerenal injury. Which risk factor should the patient state that indicates understanding of this teaching? a. Kidney stones. b. Enlarged prostate. c. Exposure to nephrotoxins agents. d. Use of nonsteroidal anti-inflammatory drugs.

ANS: D Prerenal injury causes include decreased blood pressure from dehydration, blood loss, shock, trauma to or blockage in the arteries to the kidneys, and NSAIDs and cyclooxygenase-2 inhibitors, which impair the autoregulatory responses of the kidney by blocking prostaglandin, which is necessary for renal perfusion. A. B. Kidney stones and enlarged prostate are risk factors for a postrenal injury. C. Nephrotoxic agents are risk factors for an intrarenal injury.

The nurse is reviewing the history and physical of a patient who has an infection. What term should the nurse realize describes an infection of the kidneys? a. Cystitis b. Hepatitis c. Urethritis d. Pyelonephritis

ANS: D Pyelonephritis is infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys. A. Cystitis is inflammation and infection of the bladder wall. B. Hepatitis is inflammation and infection of the liver. C. Urethritis is inflammation of the urethra.

A patient has a glomerular filtration rate of 55%. What should this value indicate to the nurse? a. This is a normal value. b. The patient is in renal failure. c. The patient needs to be on a fluid restriction. d. The patients other tests will be in the normal range.

ANS: D Renal function test values may be within the normal range until the glomerular filtration rate is less than 50% of normal. A. This value is not normal. B. This value does not indicate that the patient is in renal failure. C. There is no reason to place this patient on fluid restriction.

The nurse is collecting data from a patient with stress incontinence. Which finding should the nurse document? a. The patient is unable to tell when there is the need to urinate. b. The patient is unable to hold urine when under emotional stress. c. The patient is unable to reach the bathroom and urinates in underwear. d. The patient loses small amounts of urine when he or she coughs or sneezes.

ANS: D Stress incontinence is the involuntary loss of less than 50 mL of urine associated with increasing abdominal pressure during coughing, sneezing, laughing, or other physical activities. A. B. C. These statements do not describe stress incontinence.

The nurse is caring for a patient with an acidbase imbalance from kidney disease. How should the nurse explain the role of the kidneys to maintain acidbase balance in the body to the patient? a. Promoting retention of proteins b. Promoting excretion of carbon dioxide c. Conserving or excreting potassium ions d. Conserving or excreting bicarbonate ions

ANS: D The kidneys regulate the acidbase balance of the blood by the excretion or conservation of ions such as hydrogen or bicarbonate. A. Promoting retention of proteins will not maintain acidbase balance. B. C. Excretion of carbon dioxide or conserving or excreting potassium does not contribute to maintaining acidbase balance in the body.

The nurse is reviewing the anatomy of the kidney with a patient scheduled for renal surgery. What should the nurse explain as being the structural and functional unit of the kidney? a. Cortex b. Medulla c. Pyramid d. Nephron

ANS: D The nephron is the structural and functional unit of the kidney. Urine is formed in the approximately 1 million nephrons in each kidney. A. B. C. Cortex, medulla, and pyramid are different parts of the kidney.

A 19-year-old patient reports flank pain and scanty urination. The nurse notices periorbital edema, and the urinalysis reveals white blood cells, red blood cells, albumin, and casts. What question would be most important for the nurse to include in data collection? a. Is your vision blurred? b. Are you sexually active? c. Have you had any gastrointestinal problems lately? d. Have you had a strep infection of the throat or skin recently?

ANS: D The patient has symptoms of glomerulonephritis, which can be caused by a variety of factors but is most commonly associated with a group. A beta-hemolytic streptococcus infection following a streptococcal infection of the throat or skin. A. B. C. Asking about blurred vision, sexual activity, and gastrointestinal problems would not be appropriate for this patients health problem.

The nurse notes that the urine from a patient with an ileal conduit has mucus strands. What action should the nurse take? a. Notify the physician. b. Send a urine sample to the laboratory for culture. c. Ask the patient about a history of UTIs. d. Nothing, as the nurse understands that this is a normal finding.

ANS: D The urine from an ileal conduit contains mucus because it comes through the ileum, which normally secretes mucus. A. B. C. There is no need to notify the physician, send a specimen for culture, or ask the patient about a history of UTIs.

A 32-year-old female patient is diagnosed with uncomplicated cystitis. Which medications should the nurse expect to be prescribed for this patient? (Select all that apply.) a. Ciprofloxacin (Cipro) b. Aztreonam (Azactam) c. Decadron (Solu-Medrol) d. Nitrofurantoin (Macrodantin) e. Sulfamethoxazole and trimethoprim (Bactrim, Septra)

ANS: D, E Treatment of uncomplicated cystitis is most often a combination of sulfa medication, such as sulfamethoxazole and trimethoprim (Bactrim, Septra), or nitrofurantoin (Macrodantin). A. Complicated cystitis is often treated with ciprofloxacin (Cipro). B. Aztreonam (Azactam) may be used to treat UTIs. C. Decadron (Solu-Medrol) is a steroid and is not used to treat cystitis.

The nurse reviews the process to obtain a midstream urine specimen for culture and sensitivity with a female patient. Which patient statements indicate understanding of this process? (Select all that apply.) a. A 24-hour urine specimen is needed. b. A second-voided specimen is preferred. c. I should wash from the back to the front. d. The labia should be kept separated while voiding. e. When urine starts to flow, collect it in the clean container provided. f. The genitalia should be thoroughly cleaned with the towelettes provided.

ANS: D, F Female patients should be told to separate the labia with one hand and keep it separated while washing with provided towelettes and collecting the specimen to decrease the risk of contamination of the specimen. B. The first morning specimen is best, but collection can occur at any time. E. The container must be sterile for a culture. A. A 24-hour specimen is not needed. C. Women should wash from the front to the back.