Nursing 2 Elimination
Which medication used to treat urinary incontinence strengthens the urinary sphincters and has anticholinergic action? A. Midorine B. Duloxetine C. Oxybutynin D. Mirabegron
B. Duloxetine Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that strengthens urinary sphincters and has anticholinergic action. Midorine is an alpha-adrenergic-agonist, which increases the contractile force of the urethral sphincter. Oxybutynin is an antispasmodic that causes bladder muscle relaxation. Mirabegron is a beta-3 blocker that relaxes the detrusor smooth muscle, which increases bladder capacity and urinary storage.
Which finding would the nurse expect in the urinalysis report of a client with diabetes insipidus? A. pH of urine: 9 B. Specific gravity of urine: 0.4 C. Red blood cells in urine: 6 hpf D. White blood cells in urine: 8 hpf
B. Specific gravity of urine: 0.4 The normal specific gravity of urine lies between 1.003 and 1.030. The specific gravity of urine of clients with diabetes insipidus is low due to the impaired functioning of antidiuretic hormone. The pH of normal urine ranges from 6.5 to 7.0. A pH higher than 8 indicates a urinary tract infection (UTI). Normal urine contains between 0 and 4 hpf of red blood cells (RBCs). A count greater than 4 hpf indicates tuberculosis, cystitis, neoplasm, and glomerulonephritis. In a normal urine sample, white blood cells (WBCs) lie in the range of 0 to 5 hpf. Any increase in the number of WBCs indicates a urinary tract inflammation.
After reviewing the urinalysis reports of a client with kidney dysfunction, the nurse suspects the presence of myoglobin. Which finding in the test reports supports the nurse's suspicion?
Red-colored urine in clients with kidney dysfunction indicates the presence of myoglobin. Brown-colored urine indicates increased bilirubin levels. Dark amber urine indicates concentrated urine. Very pale yellow urine indicates dilute urine
A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet. What is the rationale for the nurse's instruction?
Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen (BUN) and creatinine levels; these are the result of protein metabolism. There is no such substance in salt substitutes that interferes with the transfer of fluid across capillary membranes.
A client with mild diarrhea is diagnosed with a Clostridium difficile infection. Which is the first-line drug that would be used to treat this condition? A. Rifaximin B. Fidaxomicin C. Vancomycin D. Metronidazole
D. Metronidazole Metronidazole is the first line of treatment prescribed to clients with a Clostridium difficile infection. Rifaximin is used to treat traveler's diarrhea caused by Escherichia coli. Fidaxomicin is reserved for clients who are at risk for the relapse of or have recurrent Clostridium difficile infections. Vancomycin is preferred for serious Clostridium difficile infections.
The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. Which urinary finding should the nurse conclude needs to be reported to the primary healthcare provider? A. Acidic pH B. Glucose negative C. Bacteria negative D. Presence of large proteins
D. Presence of large proteins. The glomeruli are not permeable to large proteins such as albumin or red blood cells (RBCs), and it is abnormal if albumin or RBCs are identified in the urine; their presence should be reported. The urine can be acidic; normal pH is 4.0 to 8.0. Glucose and bacteria should be negative; these are normal findings.
What is a guaiac test?
A test to detect occult (hidden) blood in stool.
What is pyleonephritis?
Inflammation of nephron in kidney. Ascends from lower UTI (secondary) Most common cause is E. Coli
What is the effect of alcohol on urine production?
Inhibits the release of the antidiuretic hormone thus promotes urine production.
What are normal urine levels? (Specific gravity, pH, protein)
Normal urine specific gravity: 1.000 - 1.030 Average urine pH: 6 Normal urine protein: 0 - 0.8 mg/dL
What are the risk factors for nephrolithiasis?
Personal or family history, warm climate/ dehydration, immobility, excess dietary calcium, oxalate, and proteins, gout, hyperparathyroidism, stasis, repeated infections (more common in women)
What are the nursing considerations for ostomies?
Skin care Maintain diet and exercise Teach waste control Provide emotional support and encourage participation in care Sexuality and personal relationships Be familiar with supplies needed, proper use of equipment and warning signs of complications
A toddler with a repaired myelomeningocele has urinary incontinence and some flaccidity of the lower extremities. What should the nurse teach the parents?
The child will probably require a program of intermittent straight catheterization. Most children with spinal cord damage resulting from spina bifida can be managed successfully with a program of intermittent straight catheterization. An ileal bladder is not necessary because most of these children can be managed successfully with intermittent straight catheterization. An indwelling catheter is the least desirable approach because of the risk for recurrent urinary tract infection. Stating that the child will have to wear diapers for many years is inaccurate and may be devastating to the parents.
What does the nurse find in the laboratory report of a client who is suspected of having a urinary disorder and is on steroid therapy? A. Increased red blood cells count B. Increased sodium count C. Increased serum creatinine levels D. Increased blood urea nitrogen levels
D. Increased blood urea nitrogen levels Steroid therapy may be used to treat urinary disorders; however, it may cause the blood urea nitrogen (BUN) levels to elevate. Increased red blood cell count occurs in polycythemia. Increased sodium does not occur with steroid use. An increase in serum creatinine levels indicates kidney impairment.
What is an intravenous pyelogram?
A non-invasive imaging procedure that involves IV contrast dye injected to outline renal pelvis, ureters, bladder, & urethra.
What are the nursing interventions for paralytic ileus?
Ambulation. Privacy & time to eliminate. Nasogastric Tube (NPO). Warm pad to abdomen. Paralytic ileus is an accumulation of intestinal gas due to decreased or absent gastrointestinal motility and is characterized by absent bowel sounds.
Which client's urine specific gravity level is abnormal? A. 1.006 B. 1.012 C. 1.028 D. 1.041
D. 1.041 The normal specific gravity of urine lies between 1.005 and 1.030. A specific gravity value of 1.041 is higher than the normal range; therefore, it's abnormal. The specific gravity values of urine such as 1.006, 1.012, and 1.028 lie in the normal range.
What are the nursing interventions for a urinary tract infection?
Encourage fluid intake eight to ten 8 oz glasses of water dailyEncourage regular and complete emptying of the bladder with urgeTeach hand washing, proper wiping (front to back) and perineum careTeach signs/symptoms (odor, color, cloudiness, frequency)Teach risks associated with frequent intercourse, void before and afterEncourage taking antibiotics as ordered
What instructions would a nurse give to a client who has undergone a renal biopsy?
Lie on procedure side q 6-8 hr, then check hct and take it easy @ home. Check site for bruises/ blood and check I&O
What treatments and interventions are indicated for Renal Calculi: Calcium Oxalate
Reduce calcium and Oxalate food (Tea, almonds, cashews, chocolate, bean, rhubarb Acid Ash diet Meds: Allopurinol, pyridoxine (Vitamin B6) or magnesium oxide
What drug causes orange or rust colored urine?
Rifampin (Rifadin, Rimactane), an antibiotic often used to treat tuberculosis, can turn urine reddish orange — as can phenazopyridine (Pyridium), a drug that numbs urinary tract discomfort. Additionally, riboflavin, sulfasalazine, and warfarin or coumadin (in the absence of hematuria) may also cause orange urine.
What is mixed urinary incontinence?
Stress and urge symptoms combined: Stress incontinence is caused by increased intra-abdominal pressure, weak pelvic muscles and is characterized by urine leakage with coughing, laughing, sneezing. Urge incontinence is involuntary voiding related to an abrupt urge to void and is associated with UTI, caffeine, and alcohol.
Should you give an anti-diarrheal in acute or chronic?
give in chronic cases of diarrhea, not acute
A prescription for an isotonic enema is written for a 2-year-old child. What is the maximal amount of fluid the nurse should administer without a specific prescription from the healthcare provider?
255 - 360 ml. Unless prescribed, no more than 360 mL of solution should be administered to a young child because fluid and electrolyte balance in infants and children is easily disturbed. Between 100 and 150 mL may be prescribed for a small infant. Between 155 and 250 mL may be prescribed for an older or larger infant. Between 365 and 500 mL is too much for a toddler.
A client is admitted with renal calculi. Which clinical manifestations does a nurse expect the client to report? Select all that apply. A. Blood in the urine B. Irritability and twitching C.Dry, itchy skin and pyuria D. Frequency and urgency of urination E. Pain radiating from the kidney to a shoulder
A, D Blood in urine Frequency and urgency of urination
Which is a primary glomerular disease? A. Diabetic glomerulopathy B. Chronic glomerulonephritis C. Hemolytic-uremic syndrome D. Systemic lupus erythematosus (SLE)
B. Chronic glomerulonephritis Diabetic glomerulopathy, hemolytic-uremic syndrome, and systemic lupus erythematosus (SLE) are secondary glomerular diseases.
What is a neurogenic bladder?
Bladder dysfunction caused by an interruption of normal bladder nerve innervation. Person can't feel when bladder is full and must use catheter to void.
What is the effect of caffeine on urine production?
Caffeine is a diuretic and inhibits antidiuretic hormone thus increasing urine output.
What would urine specific gravity of 1.045 indicate?
Dehydration.
What is reflex urinary incontinence?
Involuntary loss of urine when bladder is full without urge. Caused by tissue damage from radiation, cystitis, radical pelvic surgery and may also be a result of damage to the nerves that normally warn the brain that the bladder is filling.
A nurse is assessing a client with a diagnosis of kidney failure for clinical indicators of metabolic acidosis. What should the nurse conclude is the reason metabolic acidosis develops with kidney failure? A. Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate B. Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention C. Inability of the renal tubules to reabsorb water to dilute the acid contents of blood D. Impaired glomerular filtration, causing retention of sodium and metabolic waste products
A. Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate. Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The rate of respirations increases in metabolic acidosis to compensate for a low pH. The fluid balance does not significantly alter the pH. The retention of sodium ions is related to fluid retention and edema rather than to acidosis.
A client with an invasive carcinoma of the bladder is receiving radiation to the lower abdomen in an attempt to shrink the tumor before surgery. What should the nurse do considering the side effects of radiation? A. Observe the feces for the presence of blood. B. Monitor the blood pressure for hypertension. C. Administer enemas to remove sloughing tissue. D. Provide a high-bulk diet to prevent constipation.
A. Observe the feces for the presence of blood. Radiation may damage the bowel mucosa, causing bleeding. Blood pressure changes are not expected during radiation therapy. Enemas are contraindicated with lower abdominal radiation because of the damaged intestinal mucosa. Diarrhea, not constipation, occurs with radiation that influences the intestine.
Which vascular component of the client's nephron delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta? A. Arcuate artery B. Efferent arteriole C. Afferent arteriole D. Interlobular artery
B. Efferent arteriole The efferent arteriole is the vascular component of the nephron that delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta. The arcuate artery is a curved artery of the renal system that surrounds the renal pyramids. The afferent arteriole is the vascular component of the nephron that delivers arterial blood from the branches of the renal artery into the glomerulus. The interlobular artery feeds the lobes of the kidney.
A client has undergone pelvic surgery and the nurse removes the catheter in a week according to instructions. In the follow up within several hours, which finding in the client indicates a need for reinsertion of catheter? A. Anuria B. Polyuria C. Retention D. Incontinence
C. Retention The inability of the client to urinate in spite of the bladder being filled with urine is called retention. Generally clients who have undergone pelvic surgery and have the catheter removed experience urinary retention. The catheter should be reinserted if the client is unable to void. Anuria is the drastic decrease in urine output to less than 100 mL in a day and is a sign of end-stage kidney disease or acute kidney injury. Polyuria is anticipated in a client who is diagnosed with diabetes mellitus or insipidus, and the client eliminates large volumes of urine at a time. Incontinence or the loss of ability over voluntarily control of urination is a sign of conditions such as neurogenic bladder or bladder infection.
What should a patient having lithotripsy be monitored for?
Cardiac arrhythmias
What treatments and interventions are indicated for renal calculi caused by uric acid?
Caused by dietary excess of purine or from gout. Meds: Allopurinol Alkaline ash diet Avoid high purine food ex. organ meats, gravies, red wine, sardine Fruits except cranberries, plums, prunes, and tomatoes. Milk, most vegetables, rhubarb, small amounts of beef, halibut,veal, trout, and salmon. Cherries help to reduce uric acid levels.
A client has glomerulonephritis. To prevent future attacks of glomerulonephritis, the nurse planning discharge teaching includes which instruction? A. "Restrict fluid intake." B. "Take showers instead of bubble baths." C. "Avoid situations that involve physical activity." D. "Seek early treatment for respiratory infections."
D. "Seek early treatment for respiratory infections." A common cause of glomerulonephritis is a streptococcal infection. This infection initiates an antibody formation that damages the glomeruli. Any fluid restriction is moderated as the client improves; fluid is allowed to prevent urinary stasis. The alkalinity of bubble baths is linked to urinary tract infections, not glomerulonephritis. Moderate activity is helpful in preventing urinary stasis, which can precipitate urinary infection.
Which complications does the nurse expect in the client with a renal disorder who has a blood urea nitrogen (BUN)/creatinine ratio of 28? Select all that apply. A. Malnutrition B. Hepatic damage C. Kidney impairment D. Fluid volume deficit E. Obstructive uropathy
D. Fluid volume deficit E. Obstructive uropathy The normal range of blood urea nitrogen (BUN)/creatinine ratio is 6 to 25. The BUN/creatinine ratio of 28 is a higher value than the normal; the client may have complications like fluid volume deficit and obstructive uropathy. A decrease in BUN levels indicates malnutrition and severe hepatic damage. Increased serum creatinine levels indicate kidney impairment.
A client is admitted to the hospital with a diagnosis of cancer of the liver with ascites and is scheduled for a paracentesis. Which nursing intervention is appropriate to include in the client's plan of care? A. Cleansing the intestinal tract B. Marking the anesthetic insertion site C. Discussing the operating room set-up D. Having the client void before the procedure
D. Having the client void before the procedure. Because the trocar is inserted below the umbilicus, having the client void decreases the danger of puncturing the bladder. Cleansing the intestinal tract is not necessary because the gastrointestinal tract is not involved in a paracentesis. The primary healthcare provider, not the nurse, uses a local anesthetic to block pain during the insertion of the aspirating needle; marking the site usually is not done. A paracentesis usually is performed in a treatment room or at the client's bedside, not in the operating room.
A health care provider prescribes cholestyramine, an anion exchange resin, to treat a client's persistent diarrhea. What vitamin does the nurse anticipate may become deficient because cholestyramine reduces the absorption of fat?
Vitamin A. Cholestyramine is a fat-binding agent; it binds with and interferes with all the fat-soluble vitamins (A, D, E, and K). Thiamine is not a fat-soluble vitamin and is unaffected. Riboflavin is not a fat-soluble vitamin and is unaffected. Vitamin B 6 is not a fat-soluble vitamin and is unaffected.
Monitoring vital signs, particularly the blood pressure and the rate and quality of the pulse, is essential in detecting physiologic adaptations in a preschool child with nephrotic syndrome. Which clinical manifestation should the nurse be able to detect from these vital signs? A. Heart failure B. Hypovolemia C. Pulmonary embolus D. Increased serum potassium
B. Hypovolemia The shift of fluid from the intravascular to the interstitial compartment predisposes the child to hypovolemia; a weak, thready pulse and hypotension are signs of impending shock. Heart failure is usually not a complication of nephrotic syndrome; however, it is a major complication of glomerulonephritis. The development of a pulmonary embolus is not a complication of nephrotic syndrome. Chest pain and dyspnea are signs of a pulmonary embolus. Hypokalemia, not hyperkalemia, occurs. Tubular reabsorption of sodium is increased to replenish the vascular volume; therefore potassium is excreted.
The laboratory values of a client with renal calculi reveal a serum calcium within expected limits and an elevated serum purine. How should the nurse interpret these findings about the stone's composition? A. It contains cystine. B. It contains uric acid. C. It contains calcium oxalate. D. It contains magnesium ammonium phosphate.
B. It contains uric acid. Purines are precursors of uric acid, which crystallizes. Cystine stones are caused by a rare hereditary defect resulting in defective absorption of cysteine in the gastrointestinal tract and kidneys (inborn error of cystine metabolism). Serum purine will not be elevated if the stone is composed of calcium oxalate. A struvite stone sometimes is called a magnesium ammonium phosphate stone and is precipitated by recurrent urinary tract infections.
The older adult client with a weakened urinary sphincter is at risk for which condition? A. Bladder distention B. Skin irritation C. Tendency to fall or trip over objects D. Urinary retention
B. Skin irritation The weakening of the urinary sphincter results in involuntary dribbling of urine, which increases the risk of skin irritation and infections. Therefore maintaining thorough hygiene in the perineum area reduces the chance of occurrence of infection or skin rash. The nurse should observe for signs of bladder distention in clients who have a tendency to retain urine. Keeping a bedside light at night is an intervention to prevent night falls in clients who have nocturia. A weakened urinary sphincter will cause loss of urine.
A nurse reviews the history of a client who is hospitalized with a diagnosis of urinary calculi and identifies that which factor may have contributed to the development of the calculi? A. Increased fluid intake B. Urine specific gravity of 1.017 C. Jogging 3 miles (4.8 km) a day D. History of hyperparathyroidism
D. History of hyperparathyroidism Hyperparathyroidism results in high serum calcium levels; as the blood is filtered through the nephron, precipitates of calcium may form calculi. Increased fluid intake will discourage stone formation by preventing stagnation of urine. A urine specific gravity of 1.017 is within the expected range of 1.010 to 1.030 and will not increase the risk of developing urinary calculi. A jogging schedule of 3 miles (4.8 km) daily reduces the risk of developing urinary calculi; activity improves glomerular filtration and inhibits calcium from leaving the bone.
What are the adverse effects of Allopurinol?
Drowsiness, maculopapular, bone marrow depression. Report unusual bleeding or rash.
What is enuresis?
Involuntary bed wetting specific to childhood age. Nocturnal enuresis (nighttime bedwetting) "Primary" if bladder training never achieved "Secondary" if established then lost
Renal failure causes, symptoms, diagnostics.
Kidney no longer functions. Diabetes and hypertension are #1 causes. Disease is progressive and irreversible. Proteinuria is 1st indicator- will screw up electrolytes. Symptoms: proteinuria, electrolyte changes, output changes, polyuria, nocturia, oliguria, anuria, UA with protein, casts, pyuria, RBCs
The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled into the peritoneal cavity. Which information will the nurse share with the client? A. Because it forces potassium back into the cells, thereby decreasing serum levels B. Because it adds extra warmth to the body because metabolic processes are disturbed C. Because it helps prevent cardiac dysrhythmias by speeding up removal of excess potassium D. Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels
D. Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels. Encouraging the removal of serum urea by preventing constriction of peritoneal blood vessels promotes vasodilation so that urea, a large-molecular substance, is shifted from the body into the dialyzing solution. Heat does not affect the shift of potassium into the cells. The removal of metabolic wastes is affected in kidney failure, not the metabolic processes. Heating dialysis solution does not affect cardiac dysrhythmias.
While performing diagnostic tests on a client with a urinary tract infection, the nurse documents the urine creatinine value as 0.9 mg/dL and serum creatinine level as 1.0 mg/dL. The volume of urine collected is 100 mL/min. What is the creatinine clearance of the client? Record your answer using a whole number.
90 Creatinine clearance (CrCl) is a diagnostic test used to assess the filtration capacity of the kidney. Creatinine clearance by the kidney approximates the glomerular filtration rate. Creatinine is a waste product of protein breakdown. The Cockcroft-Gault formula for estimating creatinine clearance (CrCl) should be used routinely as a simple means to provide a reliable approximation of residual renal function in all patients with CKD. The formulas are as follows: CrCl (male) = ([140-age] × weight in kg)/(serum creatinine × 72) CrCl (female) = CrCl (male) × 0.85
A client with kidney dysfunction is about to undergo renal testing using a contrast medium. Which nursing interventions should be conducted before the procedure to ensure the client's safety? Select all that apply. A. Assessing the client for a history of cirrhosis B. Asking the client if he or she has a known shellfish allergy C. Assessing the client for a history of lactic acidosis D. Assessing the client's hydration status by checking blood pressure and respiratory rate E. Asking the client to discontinue metformin 12 hours before the procedure
A, B, D A. Assessing the client for a history of cirrhosis B. Asking the client if he or she has a known shellfish allergy D. Assessing the client's hydration status by checking blood pressure and respiratory rate. While interviewing a client who is about to undergo kidney procedure using a contrast medium, the nurse should assess for a history of cirrhosis. Clients with cirrhosis have an increased chance of developing kidney failure after the procedure. The nurse should confirm any known shellfish allergies because contrast dye administered during the study may cause nephrotoxicity. It is not necessary to check the client for a history of lactic acidosis when ensuring the client's safety for renal testing. If the client had lactic acidosis currently, then this would be a significant factor when ensuring the client's safety for renal testing. The nurse should also assess the client's hydration status by checking blood pressure and respiratory rate. The nurse should ask the client to discontinue metformin 24 hours before the procedure to prevent lactic acidosis.
During discharge teaching, a client with an ileal conduit asks how frequently the urine pouch should be emptied. Which reply by the nurse is best? A. "To prevent leakage and pulling of the pouch from the skin, it should be emptied every few hours." B. "To prevent skin irritation, it should be emptied every hour if any urine has collected in the bag." C. "To reduce the risk of infection, the system should be opened as little as possible; two times a day is adequate." D. "To reduce the cost of drainage pouches, it should be emptied once the system is switched to a bedside collection bag."
A. "To prevent leakage and pulling of the pouch from the skin, it should be emptied every few hours." The weight of a full bag can pull the appliance from the skin and cause leakage; it should be emptied approximately every 2 to 3 hours or when half full. Emptying the collection bag every hour is too often; it should be emptied when it is half full. With proper technique, draining the pouch should not put the individual at risk for infection. The collection bag would be too full if emptied only twice a day. A drainage pouch will always be in place with an ileal conduit [1] [2] and urine emptied every few hours.
What treatments and interventions are indicated for Renal Calculi: Calcium phosphate?
Acid Ash diet Decrease intake of oxalate or phosphate Meds: phosphates, thiazide diuretics, allopurinol
A client who recently had a myocardial infarction is admitted to the cardiac care unit. How can the nurse best determine the effectiveness of the client's ventricular contractions? A. Observing anxiety levels B. Monitoring urinary output hourly C. Evaluating cardiac enzyme results D. Assessing breath sounds frequently
B. Monitoring urinary output hourly. A decreased urinary output reflects a decreased cardiac output; immediate action is indicated if urinary output decreases. Although anxiety may occur, the priority is to monitor urinary output, which reflects cardiac effectiveness. Cardiac enzyme results do not reflect effectiveness of cardiac contractions; they reflect tissue damage. Although the presence of crackles (rales) will indicate pulmonary edema, it will not determine the effectiveness of ventricular contractions.
Which laboratory finding is suggestive of mild kidney disease in male clients? A. Serum creatinine - 0.9 mg/dL B. Urinary albumin - 24 mg/mmol C. Blood urea nitrogen (BUN) - 18 mg/dL D. Blood urea nitrogen (BUN)/creatinine ratio - 23
B. Urinary albumin - 24 mg/mmol Increased levels of albumin in the urine indicate mild or moderate kidney disease. The normal levels of albumin in the urine range between 2.0 and 20 mg/mmol in men and between 2.8 and 28 mg/mmol in women. An albumin level of 24 mg/mmol is higher than the normal range for men. Therefore a urinary albumin of 24 mg/mmol suggests mild kidney failure. The normal levels of serum creatinine range between 0.6-1.2 mg/dL in men and between 0.5-1.1 mg/dL in women. Therefore a serum creatinine value of 0.9 mg/dL is normal. Blood urea nitrogen (BUN) in the range of 10-20 mg/dL is normal. Therefore a BUN value of 18 mg/dL is a normal finding. The normal range of a BUN/creatinine ratio is between 6 and 25. Therefore a BUN/creatinine ratio of 23 is a normal value.
A client is to have hemodialysis. What must the nurse do before this treatment? A. Obtain a urine specimen to evaluate kidney function. B. Weigh the client to establish a baseline for later comparison. C. Administer medications that are scheduled to be given within the next hour. D. Explain that the peritoneum serves as a semipermeable membrane to remove wastes.
B. Weigh the client to establish a baseline. A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.
The laboratory report of a client reveals increased levels of atrial natriuretic peptide. Which other finding does the nurse anticipate to find in the client? A. Decreased urine output B. Increased concentration of urine C. Increased sodium excretion in urine D. Decreased glomerular filtration rate
C. Increased sodium excretion in urine Atrial natriuretic peptide is secreted by the myocyte cells in the right atrium. Atrial natriuretic peptide acts on the kidneys and causes an increase in the excretion of sodium by inhibiting aldosterone. Atrial natriuretic peptide increases urine output.
A client has been admitted with a urinary tract infection. The nurse receives a urine culture and sensitivity report that reveals the client has vancomycin-resistant enterococcus (VRE). After notifying the primary healthcare provider, which action should the nurse take to decrease the risk of transmission to others? A. Insert a Foley catheter. B. Initiate droplet precautions. C. Move the client to a private room. D. Use a high-efficiency particulate air (HEPA) respirator when entering the room.
C. Move the client to a private room. Clients with VRE should be moved to a private room to decrease transmission to others. VRE has been identified in the urine, not respiratory secretions. Contact isolation should be implemented. A Foley catheter should not be inserted because it will predispose the client to develop an additional infection. A HEPA respirator is not required when entering the room.
The client diagnosed with a fistula between the bowel and urinary bladder reports passing air and bubbles during urination. What does the nurse anticipate the client's condition to be? A. Nocturia B. Oliguria C. Pneumaturia D. Stress incontinence
C. Pneumaturia The occurrence of gas along with urination is called pneumaturia and could result from the formation of a fistula between the bowel and urinary bladder. Frequent urination during the night is called nocturia and is associated with conditions such as heart failure and diabetes mellitus. In medical conditions such as severe dehydration and shock, the urine output is reduced to 100 to 400 mL/day and this is termed oliguria. Weak sphincter control, urinary retention, and estrogen deficiency are some causes for stress incontinence or involuntary urination during increased pressure situations.
A nurse is teaching about the function of the loop of Henle. Which function should the nurse include? A. Secretion of ammonia in the descending limb B. Secretion of hydrogen in the descending limb C. Reabsorption of sodium in the ascending limb D. Reabsorption of water in the ascending limb
C. Reabsorption of sodium in the ascending limb Happens as a response to serum levels of sodium in the body. Ammonia is secreted from the distal tubule. The secretion of hydrogen occurs in the proximal and distal tubules of the nephron. Reabsorption of water is carried out in the descending limb of the loop of Henle.
A nurse is reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which new prescription will the nurse question? A. Oral psyllium B. Oral potassium supplement C. Parenteral half normal saline D. Parenteral albumin
D. Parenteral albumin. Albumin is hypertonic and will draw additional fluid from the tissues into the intravascular space. Oral psyllium will absorb the watery diarrhea, giving more bulk to the stool. An oral potassium supplement is appropriate because diarrhea causes potassium loss. Parenteral half-normal saline is a hypotonic solution, which can correct dehydration.
Which urinalysis finding indicates a urinary tract infection? A. Presence of crystals B. Presence of bilirubin C. Presence of ketones D. Presence of leukoesterase
D. Presence of leukoesterase Leukoesterases are released by white blood cells as a response to an infection or inflammation. Therefore, the presence of this chemical in urine indicates a urinary tract infection. The presence of crystals in the urine indicates that the specimen had been allowed to stand. Presence of bilirubin in the urine indicates anorexia nervosa, diabetic ketoacidosis, and prolonged fasting. The presence of ketones indicates diabetic ketoacidosis.
What is urinary retention and what are some of the causes?
Inability to empty the bladder (even when full). Obstruction, Inflammation, Neurologic problems. Medications including antihistamines, anticholinergics, antidepressants. Anxiety
What are the symptoms of nephrolithiasis?
Depends on site of stone formation. Kidney/pelvis: few symptoms, dull achy flank pain. Bladder: few symptoms, dull suprapubic pain, hematuria. Ureter: renal colic (severe flank pain), nausea, vomiting, pale cool clammy skin, hematuria, fever, chills { pain may refer to groin, entire flank, or back}
What is the effect of fever on urine production?
Fever results in fluid loss through diaphoresis causing kidneys to retain water thus decreasing urine output
A mother reports feeding her infant immediately before arriving in the emergency department. After completing the assessment, the nurse reports which finding immediately to the primary healthcare provider because it likely indicates pyloric stenosis?
Peristaltic waves that traverse the epigastrium. Left-to-right peristalsis is noted as the stomach tries to force the feeding into the duodenum. Bowel activity is minimal, because little of the feeding passes through the pyloric sphincter; thus there are no loud bowel sounds. Sudden diarrhea is rare, because little of the feeding passes through the pyloric sphincter into the intestinal tract. Projectile vomiting, not regurgitation, is a classic manifestation of pyloric stenosis.
