Point Questions 58&59
A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?
"Increase your carbohydrate intake."
A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client?
"This medication will relieve your pain."
A client presents at the clinic with complaints of urinary retention. What question should the nurse ask to obtain additional information about the client's complaint?
"When did you last urinate?"
The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of:
Disturbed body image
A patient who has been treated with uric acid for stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient?
Low-purine diet
The nurse has identified the nursing diagnosis of "risk for infection" in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk?
Maintain aseptic technique when administering dialysate.
The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patient's health education, what nutritional guidelines should the nurse provide?
Restrict protein intake as ordered
The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing ESKD?
A patient with diabetes mellitus and poorly controlled hypertension
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?
A GFR of 30-59 mL/min/1.73 m2 Correct
The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following?
Anemia
Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure?
Fluid volume excess
The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication?
with food
A 39-year-old client is being seen by a physician today because of symptoms indicating urinary tract infection. Especially in women, what is important education information in preventing urinary tract infections? Choose all correct options.
• Appropriate post-bowel movement hygiene • Appropriate bathing procedure
The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply.
• Dietary history • Family history of renal stones • Medication history
Mr. Billings is being seen as a client in the urology practice. He has a family history of polycystic kidney disease. Of the following assessment findings, which would you expect to find as you gather information and complete an assessment related to a polycystic kidney diagnosis? Select all that apply.
• Pain from retroperitoneal bleeding • Hypertension
Nicholas Pendergast, a 57-year-old professional athlete, has a lengthy history with chronic pyelonephritis. He is attending his annual physical and has become rather concerned with his potential for renal failure. How many clients with a history of chronic pyelonephritis require dialysis?
10% - 15%
The critical care nurse is monitoring the patient's urine output and drains following renal surgery. What should the nurse promptly report to the physician?
Absence of drain output
The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)?
Hyperkalemia
A 44-year-old client is in the hospital unit where you practice nursing. From the results of a series of diagnostic tests, she has been diagnosed with acute glomerulonephritis. What would you expect to find as a result of this condition?
Proteinuria
Which of the following is the hallmark of the diagnosis of nephrotic syndrome?
Proteinuria
A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms?
Pyridium
A patient informs the nurse that every time she sneezes or coughs, she urinates in her pants. What type of incontinence does the nurse recognize the patient is experiencing?
Stress incontinence
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
Tall, peaked T waves
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
Tea-colored urine
When teaching the patient how to perform self-catheterization, which of the following is important?
The catheterization should occur 4 to 6 hours and before bedtime.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
Urine output of 20 ml/hour
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
Urine output of 250 ml/24 hours
The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include:
WBC of 50
A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective?
cipro
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:
fatigue and weakness
A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patient's urine output hourly and notifies the physician when the hourly output is less than what?
30 mL
The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to help alleviate the symptoms?
Anticholinergic agents
The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize?
Assessment of the quantity of the patient's urine output
Ron Davidson, a 45-year-old editor, is a client on the rehab unit where you practice nursing. Ron was involved in an MVA which left him with paraplegia and he is working toward living at home with his wife. He is currently developing an individualized CIC schedule, as he prefers to not wear a leg bag. Which of the following is not a consequence to insufficient CIC?
Decreased urine production
A nurse is caring for a patient who is in the diuresis phase of AKI. The nurse should closely monitor the patient for what complication during this phase?
Dehydration
A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient?
Drink liberal amounts of fluids.
Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it?
Heart failure
The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?
Hematuria
A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)?
Hydrating with saline intravenously before the test
The nurse needs to assess the fluid volume status of a client with chronic glomerulonephritis. Which of the following methods should the nurse use to accurately assess the client's fluid volume status?
Weighing the client daily, at the same time, on the same scale, with similar clothing
The nurse is reviewing a patient's laboratory results. What findings does the nurse assess that are consistent with acute glomerulonephritis? (Select all that apply.)
• Red blood cells in the urine • Proteinuria • White cell casts in the urine
Which of the following is the most effective intravesical agent for recurrent bladder cancer?
Bacillus Calmette-Guérin (BCG)
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has?
Calcium
Ron Davidson, a 45-year-old editor, is a client on the rehab unit where you practice nursing. Ron was involved in an MVA, which left him with paraplegia, and he is working toward living at home with his wife. He is currently developing an individualized CIC schedule, as he prefers to not wear a leg bag. What is the maximum amount of urine he should allow to collect before catheterization?
350 mL
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia
A nurse is preparing a care plan for a client with Alzheimer's disease. The client is unable to communicate or feel the pain and discomfort associated with acute urinary retention. Which of the following nursing measures should be taken while caring for such a client? Choose all correct options.
• Measure fluid intake and output. • Palpate the abdomen to check for distended bladder.
Mr. Pike has just undergone a urinary diversion procedure and has been sent to your nursing unit. You are reviewing the physician's orders and the plan of care. What management issues related specifically to urinary diversion would you expect to see included? Choose all that apply.
• Observing for leakage of urine or stool from the anastomosis • Maintaining renal function • Assessing for signs and symptoms of peritonitis
A patient has a suprapubic catheter inserted postoperatively. What would be the advantages of the suprapubic catheter versus a urethral catheter? (Select all that apply.)
• The patient can void sooner than with a urethral catheter. • The suprapubic catheter allows for more mobility. • The suprapubic catheter permits measurement of residual urine without urethral instrumentation.
Tumors of the kidney are almost always cancerous. Renal cell carcinoma is the most common type of kidney cancer in adults. The cause of kidney tumors is unknown. Certain risk factors are known, which seem to be associated with a greater risk of developing renal cancer. Choose all of the following which are known risk factors.
• Tobacco use • Obesity • Age
The nurse is caring for a patient who has returned to the postsurgical suite after post-anesthetic recovery from a nephrectomy. The nurse's most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurse's best response?
Assess the patient for signs of bleeding and inform the physician.
The nurse is assisting in the preoperative planning for stoma placement in a patient scheduled for urinary diversion surgery. Where should the nurse plan for the stoma to be located?
Away From Skin Folds
Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis?
Azotemia
The nurse is caring for a patient with end-stage kidney disease in the hospital and smells a fetid odor from the patient's breath. What major manifestation of uremia will be present?
Hypocalcemia with bone changes
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
Impaired urinary elimination
The nurse understands acute dialysis is indicated in which of the following situations?
Impending pulmonary edema
Which type of voiding dysfunction is seen in patients diagnosed with Parkinson's disease?
Incontinence
Susan Morris is going to have a surgical procedure to improve urinary control. The physician has told her that the procedure is called a periurethral bulking. Ms. Morris has forgotten what the physician has told her about what type of procedure this is. What would you tell her?
It is the placement of small amounts of collagen in urethral walls to aid the closing pressure.
When assessing the impact of medications on the etiology of ARF, the nurse recognizes which of the following as the drug that is not nephrotoxic?
Penicillin
Which of the following medications may be ordered to relieve discomfort associated with a UTI?
Phenazopyridine (Pyridium)
The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function?
Serum creatinine of 1.5 mg/dL
The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?
Smoking cessation
A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the patient's chronic kidney disease is at what stage?
Stage 3
The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach?
Teach the patient to perform pelvic floor muscle exercises
Deborah Wheaten has been admitted for an outpatient cystoscopy because of a suspected interstitial cystitis. Which statement best describes the pathology of this disorder?
The bladder wall contains multiple pinpoint hemorrhagic areas that join and form larger hemorrhagic areas that may progress to fissuring and scarring of the bladder mucosa.
For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?
Limit Fluid Intake
Mr. Allen was hospitalized for treatment of large renal calculi that were causing obstruction to urine flow. He was taken to surgery for a nephrostomy tube placement. A nephrostomy tube, also called a pyelostomy tube, is a catheter inserted through the skin into the renal pelvis. Select the answer that is true about managing a nephrostomy tube.
Never clamp the nephrostomy tubing.
A client who has had a urinary diversion procedure is going to be discharged from your nursing unit. You are discussing care of the stoma and collection pouch. What information would you include? Select all that apply.
• Drain the continent urostomy four times a day or as directed by the physician. • Wash the urinary collection pouch thoroughly after changing. • When changing the adhesive wafer (to which the urostomy collection bag is attached), remove all remaining adhesive before applying a new wafer.
A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?
Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.
A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following?
Kayexalate
The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient?
Keep the dialysis supplies in a clean area, away from children and pets
The nurse is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone?
Ketoralac (Toradol)
The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output?
Less than 400 mL
Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys?
Oliguria
A patient is placed on hemodialysis for the first time. The patient complains of a headache with nausea and begins to vomit, and the nurse observes a decreased level of consciousness. What does the nurse determine has happened?
The patient is experiencing a cerebral fluid shift.
Ryan Zimmerman, an 18-year-old college freshman, is brought to the ED via squad. He is a victim of an MVA and is unconscious. In compliance with a physician order to insert an indwelling catheter, you place the catheter and note the drainage of a large amount of yellow urine with normal odor. Why will you clamp his catheter tubing?
To prevent bladder spasms
A patient taking an alpha-adrenergic medication for the treatment of hypertension is having a problem with incontinence. What does the nurse tell the patient?
When the medication is discontinued or changed, the incontinence will resolve
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?
White blood cell (WBC) count of 20,000/mm3
A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:
periorbital edema.
The nurse is caring for a patient following extensive abdominal surgery. The patient develops an infection that is treated with IV gentamicin. After 4 days of treatment, the patient develops oliguria, and laboratory results indicate azotemia. The patient is diagnosed with acute tubular necrosis and transferred to the ICU. The patient is hemodynamically stable. Which of the following dialysis methods would be most appropriate for the patient?
Hemodialysis
A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. Which of the following signs/symptoms is diagnostic for bladder cancer?
Painless, gross hematuria
