Renal and Urinary Med Surg ATI
A nurse is teaching a client who has acute pyelonephritis. Which of the following instructions should the nurse include in the teaching? A. "You should complete the entire cycle of antibiotic therapy." B. "You should maintain complete bed rest until manifestations decrease." C. "You should drink 1,000 mL of fluid per day." D. "You should avoid using NSAIDs for pain."
Correct Answer: A. "You should complete the entire cycle of antibiotic therapy." The client should take the full prescription of the antibiotic therapy to decrease the chance of regrowth of the causative organism.
A nurse is assessing a client who has acute kidney injury (AKI). According to the RIFLE classification system, which of the following findings indicates that the client has end-stage kidney disease? A. <0.5 mL/kg of urine output for 12 hr B. No urine output for 12 hr C. No urine output without renal replacement therapy for 4 to 12 weeks D. No urine output without renal replacement therapy for more than 3 months
Correct Answer: D. No urine output without renal replacement therapy for more than 3 months In the RIFLE classification, R stands for Risk, I stands for Injury, F stands for Failure, L stands for Loss, and E stands for End-stage kidney disease. No urine output without renal replacement therapy for more than 3 months indicates end-stage kidney disease.
A nurse is caring for an 8-year-old child who has acute glomerulonephritis. Which of the following findings should the nurse expect? A. Hypotension B. Stomatitis C. Bloody diarrhea D. Periorbital edema
Correct Answer: D. Periorbital edema Periorbital edema is an expected finding in a child who has glomerulonephritis.
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following adverse effects? A. Diarrhea B. Increased serum albumin C. Hypoglycemia D. Peritonitis
Correct Answer: D. Peritonitis Peritonitis is an adverse effect of peritoneal dialysis. Prevention requires using sterile technique and frequently assessing the catheter exit site. The nurse should obtain cultures of the dialysate outflow (effluent) if peritonitis is suspected.
A nurse is assessing a client who is 4 hr postoperative following a transurethral resection of the prostate and has an indwelling urinary catheter in place. Which of the following findings should the nurse expect? A. Blood-tinged urine in the drainage bag B. Catheter tubing coiled at the client's side C. Client report of severe bladder spams D. Urinary output of 20 mL/hr
Correct Answer: A. Blood-tinged urine in the drainage bag Blood-tinged urine in the drainage bag is an expected finding for the first 24 hours following surgery.
A nurse is providing dietary teaching a client who has late-stage chronic kidney disease (CKD). Which of the following nutrients should the nurse instruct the client to increase in her diet? A. Calcium B. Phosphorous C. Potassium D. Sodium
Correct Answer: A. Calcium A client who has CKD can develop hypocalcemia due to the reduced production of active vitamin D, which is needed for calcium absorption. The client should supplement dietary calcium.
A nurse is providing teaching to a client who has gout and urolithiasis. The client asks how to prevent future uric acid stones. Which of the following suggestions should the nurse provide? (Select all that apply.) A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine D. Decrease daily fluid intake E. Avoid citrus juices
Correct Answers: A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine The nurse should inform the client that allopurinol is an antigout medication that reduces uric acid, which helps prevent uric acid stone formation. Immobility is a risk factor for stone formation; therefore, the client should maintain a healthy lifestyle, including regular exercise. Purine increases the risk of uric acid stone formation; organ meats, poultry, fish, red wine, and gravy are high in purine.
A nurse is assessing a client who is 1 week postoperative following a living donor kidney transplant. Which of the following findings indicates the client is experiencing acute kidney rejection? A. Blood pressure 160/90 mmHg B. Creatinine 0.8 mg/dL C. Sodium 137 mg/dL D. Urinary output 100 mL/hr
Correct Answer: A. Blood pressure 160/90 mmHg Due to the kidneys' role in fluid and blood pressure regulation, a client who is experiencing rejection can have hypertension
A nurse is caring for a client who has acute renal failure. Which of the following assessments provides the most accurate measure of the client's fluid status? A. Daily weight B. Blood pressure C. Specific gravity D. Intake and output
Correct Answer: A. Daily weight According to the evidence-based priority-setting framework, daily weight provides important information about the client's fluid status. A gain or loss of 1 kg (2.2 lb) indicates a gain or loss of 1 L of fluid; therefore, weighing the client daily will provide the most accurate fluid status measurement.
A female client who has recurrent cystitis asks the nurse about preventing future episodes. For which of the following client statements should the nurse provide further teaching? A. "I drink at least 2 L of fluid per day." B. "I prefer taking tub baths to showering." C. "I urinate before and after sexual relations." D. "I wipe from front to back after urinating."
Correct Answer: B. "I prefer taking tub baths to showering." Cystitis is an inflammation of the bladder lining that commonly occurs with a urinary tract infection (UTI). Women who are at risk for UTIs should avoid tub baths because they increase the risk of infection. The nurse should recommend taking showers instead of tub baths.
A nurse is monitoring a client who is undergoing extracorporeal shockwave lithotripsy (ESWL). The nurse should identify that which of the following findings is the priority? A. Dysrhythmias B. Pink-tinged urine C. Bruising on the flank area D. Stone fragments in the urine
Correct Answer: A. Dysrhythmias The nurse should apply the ABC priority-setting framework, which emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these areas can indicate a threat to life and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear for oxygen exchange to occur. Breathing is the second-highest priority because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority because the delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. ESWL is the application of sound, laser, or dry shock wave energies to break a kidney stone into small pieces. The shock waves are initiated during the R wave of the ECG to prevent dysrhythmias. When using the ABC approach to client care, the nurse should determine that dysrhythmias are the priority finding.
A nurse is reviewing the laboratory results of a client who has end-stage renal disease and reports fatigue. The client's hemoglobin level is 8 g/dL. The nurse should expect a prescription for which of the following medications? A. Erythropoietin B. Erythromycin C. Filgrastim D. Calcitrio
Correct Answer: A. Erythropoietin Erythropoietin stimulates the production of RBCs and is used to treat anemia associated with chronic renal failure.
A nurse is reviewing the laboratory results of a client who has end-stage renal disease and reports fatigue. The client's hemoglobin level is 8 g/dL. The nurse should expect a prescription for which of the following medications? A. Erythropoietin B. Erythromycin C. Filgrastim D. Calcitriol
Correct Answer: A. Erythropoietin Erythropoietin stimulates the production of RBCs and is used to treat anemia associated with chronic renal failure
A nurse is teaching a client who has chronic kidney disease (CKD). Which of the following instructions should the nurse include? A. Limit fluid intake B. Limit caloric intake C. Eat a diet high in phosphorus D. Eat a diet high in protein
Correct Answer: A. Limit fluid intake A client who has CKD should limit fluid intake to prevent hypervolemia (excessive fluid overload).
A nurse is planning care for a client who had a stroke. The client has hemiplegia and occasional urinary incontinence. Which of the following actions should the nurse include in the client's plan of care? A. Offer the client a bedpan every 2 hr B. Limit the client's daily fluid intake until he is no longer incontinent C. Request a prescription for an indwelling urinary catheter from the client's provider D. Ambulate the client to the bathroom every 30 min
Correct Answer: A. Offer the client a bedpan every 2 hr Following a stroke, the client might have bladder incontinence due to confusion, impaired sensation in response to bladder fullness, and decreased sphincter control. The nurse should encourage and assist the client to void every 2 hours while awake to promote bladder control. By offering a bedpan, the nurse promotes client safety.
A nurse is checking the laboratory values of a client who has chronic kidney disease. The nurse should expect elevations in which of the following values? A. Potassium and magnesium B. Calcium and bicarbonate C. Hemoglobin and hematocrit D. Arterial pH and PaCO2
Correct Answer: A. Potassium and magnesium Clients who have chronic kidney disease have hyperkalemia, hyperphosphatemia, and hypermagnesemia as well as elevations in serum creatinine and blood urea nitrogen.
A nurse is teaching a client with chronic kidney disease about predialysis dietary recommendations. The nurse should recommending restricting the intake of which of the following nutrients? A. Protein B. Carbohydrates C. Calcium D. Monounsaturated fats
Correct Answer: A. Protein Dietary restrictions for clients who have chronic kidney disease vary based on the degree of kidney function; however, most clients need protein limitations. Predialysis protein restriction can help preserve some kidney function.
A nurse is caring for a client who has a diagnosis of renal calculi and reports severe flank pain. Which of the following is the priority nursing action? A. Relieve the client's pain B. Encourage the client to increase fluid intake C. Monitor the client's intake and output (I&O) D. Strain the client's urine
Correct Answer: A. Relieve the client's pain Using the urgent versus non-urgent priority-setting framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which finding is the most urgent. The pain associated with renal calculi is severe and can lead to shock; therefore, this is the priority action.
A nurse is caring for a client who is receiving intermittent peritoneal dialysis. The nurse observes that the peritoneal fluid is not adequately draining. Which of the following actions should the nurse take? A. Turn the client from side to side B. Elevate the height of the dialysate bag C. Lower the head of the client's bed D. Advance the catheter approximately 2.5 cm (1 in) further
Correct Answer: A. Turn the client from side to side The nurse should assist the client in turning from side to side to facilitate the removal of peritoneal drainage. This action helps ensure there are no kinks in the tubing or an air lock in the peritoneal catheter.
A nurse is assessing a client who has urolithiasis and reports pain in his thigh. This finding indicates the stone is in which of the following structures? A. Ureter B. Bladder C. Renal pelvis D. Renal tubules
Correct Answer: A. Ureter When stones are in the ureters, pain radiates to the genitalia and to the thighs.
A nurse is providing teaching to a young adult client who has a history of calcium oxalate renal calculi. Which of the following instructions should the nurse include? A. "Drink fruit punch or juice with every meal." B. "Consume 1,000 mg of dietary calcium daily." C. "Take 1 g of a vitamin C supplement daily." D. "Increase your daily bran intake."
Correct Answer: B. "Consume 1,000 mg of dietary calcium daily." Clients who are prone to the development of calcium oxalate stones should consume the recommended daily allowance for calcium for their age. The RDA for calcium for adults ages 19 to 50 is 1,000 mg daily. Calcium should be obtained from dietary sources rather than supplements that can promote the development of renal calculi.
A nurse is teaching a female client who has pyelonephritis about the disorder. Which of the following pieces of information should the nurse include to help the client prevent a recurrence? A. "Douche after vaginal intercourse." B. "Wipe from front to back after defecation." C. "Avoid foods that are high in phosphate." D. "Add yogurt to your diet regularly."
Correct Answer: B. "Wipe from front to back after defecation." Pyelonephritis is a bacterial infection of the kidney and renal pelvis. The nurse should instruct the client about the importance of wiping from front to back following fecal elimination to avoid introducing bacteria into the urinary tract, which can ultimately cause pyelonephritis.
A nurse is teaching a client about urinary tract infections (UTIs). Which of the following manifestations should the nurse include? A. Weight gain B. Back pain C. Vaginal discharge D. Muscle cramps
Correct Answer: B. Back pain Back pain and flank pain are manifestations of a UTI. Other manifestations include frequency, urgency, and cloudy, foul-smelling urine.
A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney injury. The client reports diarrhea, a dull headache, palpitations, and muscle tingling and weakness. Which of the following actions should the nurse take first? A. Administer an analgesic to the client B. Check the client's electrolyte values C. Measure the client's weight D. Restrict the client's protein intake
Correct Answer: B. Check the client's electrolyte values The nurse should apply the urgent versus nonurgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which finding is the most urgent. The nurse should check the client's most recent potassium value because these findings are manifestations of hyperkalemia, which can lead to cardiac dysrhythmias.
A nurse is caring for a client who has acute glomerulonephritis and a prescription for furosemide. The nurse should monitor the client for which of the following therapeutic effects of this medication? A. Hypotension B. Diuresis C. Increased blood glucose level D. Weight gain
Correct Answer: B. Diuresis The nurse should identify that furosemide is a high-ceiling loop diuretic indicated for the treatment of clients who have severe renal impairment such as acute glomerulonephritis. Furosemide blocks the reabsorption of sodium and chloride, thereby preventing the reabsorption of water. Diuresis is a therapeutic response to the administration of furosemide.
A nurse is conducting dietary teaching with a client who has a history of renal calculi. Which of the following instructions should the nurse include in the teaching? A. Consume foods containing vitamin C B. Drink 3.8 L (4 qt) of water throughout the day C. Suggest almonds as a snack D. Limit sodium intake to 3 g per day
Correct Answer: B. Drink 3.8 L (4 qt) of water throughout the day The nurse should instruct the client to drink 3.8 L of water per day to keep urine diluted and decrease the risk of kidney stone formation.
A nurse is providing dietary teaching to a client who has chronic renal failure. Which of the following food choices by the client indicates an understanding of the teaching? A. Canned soup B. Grilled fish C. Pastrami D. Peanut butte
Correct Answer: B. Grilled fish Protein choices, such as fresh fish or poultry, can minimize the risk of worsening chronic renal failure.
A nurse is assessing a client who was brought to the emergency department following a motor-vehicle crash. Which of the following findings is a manifestation of bladder trauma? A. Stress incontinence B. Hematuria C. Pyuria D. Fever
Correct Answer: B. Hematuria Manifestations of bladder trauma include hematuria, blood at the urinary meatus, pelvic pain, and anuria.
A nurse is reviewing the laboratory report of a client who has chronic kidney disease (CKD). The nurse finds the following laboratory test results: potassium 6.8 mEq/L, calcium 7.4 mg/dL, hemoglobin 10.2 g/dL, and phosphate 4.8 mg/dL. Which finding is the priority for the nurse to report to the provider? A. Hypocalcemia B. Hyperkalemia C. Anemia D. Hypoalbuminemia
Correct Answer: B. Hyperkalemia The nurse should apply the urgent versus nonurgent priority-setting framework when caring for this client. Using this framework, the nurse should consider urgent needs the priority need because they pose more of a threat to the client. The nurse may also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which finding is the most urgent. Hyperkalemia, which can cause lifethreatening cardiac dysrhythmias, is the priority for the nurse to report to the provider.
A nurse is caring for a client who has chronic glomerulonephritis with oliguria. For which of the following electrolyte imbalances should the nurse monitor? A. Hypercalcemia B. Hyperkalemia C. Hypomagnesemia D. Hypophosphatemia
Correct Answer: B. Hyperkalemia Oliguria resulting from chronic glomerulonephritis causes potassium retention, leading to levels above the expected reference range of 3.5 to 5 mEq/L. Other electrolyte imbalances common with this disorder affect sodium and phosphorus levels. Chronic glomerulonephritis eventually leads to end-stage kidney disease.
A nurse is preparing an in-service program about the stages of acute kidney injury (AKI). Which of the following pieces of information should the nurse include about prerenal azotemia? A. Prerenal azotemia begins prior to the onset of symptoms. B. Interference with renal perfusion causes prerenal azotemia. C. Prerenal azotemia is irreversible, even in the early stages. D. Infections and tumors cause prerenal azotemia.
Correct Answer: B. Interference with renal perfusion causes prerenal azotemia. Prerenal azotemia results from interference with renal perfusion, such as from heart failure or hypovolemic shock.
A nurse is assessing a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider? A. WBC 6,000/mm^3 B. Potassium 3.0 mEq/L C. Clear, pale yellow drainage D. Report of abdominal fullness
Correct Answer: B. Potassium 3.0 mEq/L A potassium level of 3.0 mEq/L is below the expected reference range and can cause dysrhythmias. Dialysis removes fluid, waste products, and electrolytes from the blood and can cause hypokalemia.
A nurse is reviewing laboratory findings of an adolescent who has acute renal failure. Which of the following findings should the nurse expect? A. Hypokalemia B. Hypercalcemia C. Decreased plasma creatinine level D. Metabolic acidosis
Correct Answer: D. Metabolic acidosis Metabolic acidosis is an expected finding for clients who have acute renal failure.
A nurse is preparing a 24-hr urine specimen for a client who is suspected to have pheochromocytoma. Which of the following laboratory tests from the 24-hr urine specimen should the nurse use to determine the client's condition? A. Creatinine clearance B. Vanillylmandelic acid (VMA) C. 17-hydroxycorticosteroids (17- OHCS) D. Protein
Correct Answer: B. Vanillylmandelic acid (VMA) The VMA test is used to determine if the client has pheochromocytoma, which measures the level of catecholamine metabolites in a 24-hour urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines epinephrine and norepinephrine, which are hormones that regulate blood pressure and heart rate.
A nurse is preparing a client who is scheduled for an intravenous pyelogram (IVP). Which of the following findings should the nurse report to the provider? A. Allergy to egg products B. Vomiting and diarrhea for the last 6 hr C. Serum potassium of 3.6 mEq/L D. Serum creatinine of 1.2 mg/dL
Correct Answer: B. Vomiting and diarrhea for the last 6 hr Vomiting and diarrhea for 6 hours deplete the client's fluid volume, which results in dehydration that can cause renal failure following a procedure that uses contrast dye. Therefore, the nurse should notify the provider.
A nurse is providing teaching to a client who has a history of urinary tract infections (UTIs). Which of the following client statements indicates the need for additional teaching? A. "I will empty my bladder every 4 hours." B. "I will drink 2 L of fluids per day." C. "I will use a vaginal douche daily." D. "I will wear cotton underwear."
Correct Answer: C. "I will use a vaginal douche daily." The client should avoid vaginal douches, bubble baths, and any substances that can increase the risk of UTIs. The client should use mild soap and water to wash the perineal area.
A nurse is providing teaching to a client who is preoperative for a renal biopsy. Which of the following statements should the nurse make? A. "You will be NPO for 8 hr following the procedure." B. "An allergy to shellfish is a contraindication to this procedure." C. "You will need to be on bed rest following the procedure." D. "A creatinine clearance is needed prior to the procedure."
Correct Answer: C. "You will need to be on bed rest following the procedure." A renal biopsy involves a tissue biopsy through needle insertion into the lower lobe of the kidney. The client should maintain bed rest in a supine position with a back roll for support for 2 to 24 hours following the procedure to reduce the risk of bleeding. The nurse can elevate the head of the bed.
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that the client's dialysate output is less than the input and that his abdomen is distended. Which of the following actions should the nurse take? A. Insert an indwelling urinary catheter B. Administer pain medication to the client C. Change the client's position D. Place the drainage bag above the client's abdomen
Correct Answer: C. Change the client's position This client is retaining the dialysate solution after the dwell time. The nurse should ensure that the clamp is open and the tubing is not kinked and should reposition the client to facilitate the drainage of the solution from the peritoneal cavity.
A nurse is caring for a client who had a nephrostomy tube inserted 8 hours ago. Which of the following actions should the nurse include in the client's plan of care? A. Flush the nephrostomy tube every 4 hours with sterile water. B. Clamp the nephrostomy tube intermittently to establish continence. C. Check the skin at the nephrostomy site for irritation from urine leakage. D. Monitor for and report any bloodtinged drainage to the provider immediately.
Correct Answer: C. Check the skin at the nephrostomy site for irritation from urine leakage. The nurse should monitor the client for complications (e.g. bleeding, hematuria, fistula formation, infection), impairment of skin integrity (e.g. inflammation, infection, bleeding, urine leakage, irritation), and tube obstruction. The nurse should use the aseptic technique for dressing changes and encourage oral intake but should never clamp or irrigate the nephrostomy tube without a specific prescription to do so.
A nurse is caring for a client who is producing large amounts of urine. The nurse should document this finding as which of the following? A. Retention B. Oliguria C. Diuresis D. Dysuria
Correct Answer: C. Diuresis Diuresis or polyuria is the excretion of a high volume of urine. This condition has many causes, including metabolic and hormonal imbalances and diuretic therapy for treating renal, cardiovascular, and pulmonary disorders.
A nurse is assessing a client who is receiving hemodialysis for the first time. Which of the following findings indicates that the client is developing dialysis disequilibrium syndrome (DDS)? A. Elevated BUN B. Bradycardia C. Headache D. Temperature 39.2°C (102.5°F)
Correct Answer: C. Headache DDS is a CNS disorder that can develop in clients who are new to dialysis due to the rapid removal of solutes and changes in the blood pH. Clients beginning hemodialysis are at greatest risk, particularly if their BUN is above 175. DDS causes headaches, nausea, vomiting, a decreased level of consciousness, seizures, and restlessness. When the condition is severe, clients progress to confusion, seizures, coma, and death.
A nurse is assessing a client who is postoperative following a transurethral resection of the prostate (TURP) and has continuous bladder irrigation. The nurse notes no drainage in the client's urinary drainage bag over 1 hr. Which of the following actions should the nurse take? A. Instruct the client to attempt to void around the indwelling urinary catheter B. Increase the rate of irrigation fluid instillation C. Irrigate the indwelling urinary catheter with a syringe D. Prepare to administer a diuretic
Correct Answer: C. Irrigate the indwelling urinary catheter with a syringe No drainage in the urinary drainage bag indicates an obstruction. The nurse should gently irrigate the indwelling urinary catheter as prescribed to clear the obstruction and allow urine and irrigating fluid to drain.
A nurse is caring for an adolescent who has end-stage renal disease and is scheduled for peritoneal dialysis. Which of the following actions should the nurse take? A. Position the adolescent supine during the procedure B. Have the adolescent drink 240 mL (8 oz) of fluid prior to the procedure C. Obtain the adolescent's weight prior to the procedure D. Monitor the adolescent's vital signs every 4 hours during the procedure
Correct Answer: C. Obtain the adolescent's weight prior to the procedure The nurse should obtain a baseline weight prior to the initiation of the procedure and again following the procedure.
A nurse is teaching a newly licensed nurse about collecting a 24-hr urine specimen for creatinine clearance. Which of the following instructions should the nurse include? A. Include the first voided specimen at the start of the collection period B. Discard the last voided specimen at the end of the collection period C. Place signs in the bathroom as a reminder about the test in progress D. Instruct the client to increase exercise during the 24-hr period
Correct Answer: C. Place signs in the bathroom as a reminder about the test in progress The nurse should place signs in the bathroom and alert family members of the test in progress so that everyone saves the specimens appropriately throughout the test.
A nurse is reviewing laboratory reports for a client who has Clostridium difficile infection and is receiving vancomycin. Which of the following results should the nurse report to the provider before administering the next dose? A. Hematocrit 46% B. Serum glucose 110 mg/dL C. Serum creatinine 2.5 mg/dL D. Serum potassium 4.8 mEq/L
Correct Answer: C. Serum creatinine 2.5 mg/dL Vancomycin is nephrotoxic and can result in renal failure, which is indicated by elevated levels of creatinine above the expected reference range of 0.5 to 1.3 mg/dL. The nurse should report this laboratory value to the provider prior to administering any further doses of the medication.
A nurse is reviewing the laboratory values for a 6-month-old infant who has acute renal failure. Which of the following findings should the nurse expect? A. BUN 5 mg/dL B. Creatinine 0.2 mg/dL C. Sodium 125 mEq/L D. Potassium 4.2 mEq/L
Correct Answer: C. Sodium 125 mEq/L The nurse should expect an infant with acute renal failure to have hyponatremia. A sodium level of 125 mEq/L is below the expected reference range for an infant.
A nurse is caring for a client who has just returned from the surgical suite following a right nephrectomy. Which of the following indicates that the client is meeting a successful short-term goal following this procedure? A. The client requests pain medication upon arrival from surgery. B. A chest X-ray shows consolidation in the right lower lobe. C. Urinary output is 35 to 50 mL/hr consistently. D. The client has slight abdominal distention.
Correct Answer: C. Urinary output is 35 to 50 mL/hr consistently. Following a nephrectomy, the client should have a urine output of at least 30 mL/hr consistently. A lower output indicates inadequate blood flow to the remaining kidney.
A nurse is caring for a client who has continuous bladder irrigation following a transurethral resection of the prostate (TURP). Which of the following findings should the nurse report to the provider? A. Output equal to the instilled irrigant B. Client report of bladder spasms C. Viscous urinary output with clots D. Client report of a strong urge to urinate
Correct Answer: C. Viscous urinary output with clots The nurse should report urine output that is bright red with clots or urine that resembles ketchup to the provider because this is an indication of arterial bleeding.
A nurse is teaching a client who is preoperative for a cystoscopy. Which of the following statements should the nurse make? A. "You will need to keep the sutures clean after this procedure." B. "You will be placed on your left side for this procedure." C. "Expect to be on bed rest for 24 hr after this procedure." D. "Expect to have pink-tinged urine after this procedure."
Correct Answer: D. "Expect to have pink-tinged urine after this procedure." A cystoscopy is a procedure in which a scope is inserted into the urethra to diagnose or treat bladder problems. Following the procedure, pink-tinged urine is expected.
A nurse is providing teaching to a client who is preoperative prior to a transurethral resection of the prostate (TURP). Which of the following client statements indicates an understanding of the information? A. "I will not need to have a urinary catheter following this procedure." B. "I will expect my urine to be cloudy after having this procedure." C. "At least I won't have leakage of urine after having this procedure." D. "I will feel the urge to urinate following this procedure."
Correct Answer: D. "I will feel the urge to urinate following this procedure." After a TURP, the client will feel the urge to urinate. The nurse should reassure him that he will receive analgesics to help relieve this discomfort.
A nurse is teaching a client who has a spinal cord injury to perform intermittent urinary self-catheterization at home after discharge. Which of the following statements indicates that the client understands the procedure? A. "I'll drink less water so I don't have to catheterize myself too often." B. "I must use sterile technique for each of the catheterizations." C. "I should stop the catheterization when I have removed 150 mL of urine." D. "I will perform intermittent self-catheterization every 2 to 3 hr."
Correct Answer: D. "I will perform intermittent self-catheterization every 2 to 3 hr." The client might initially require self-catheterization every 2 to 3 hours, with the frequency eventually increasing to every 4 to 6 hours. A longer interval can result in bladder distention and an increased risk of urinary tract infections.
A nurse is assessing a client who is receiving peritoneal dialysis. Which of the following findings should the nurse report to the provider immediately? A. Difficulty draining the effluent B. Redness at the access site C. Fluid flowing from the catheter site D. Cloudy effluent
Correct Answer: D. Cloudy effluent A cloudy or opaque effluent indicates the client is at high risk for peritonitis, a bacterial infection of the peritoneum. Therefore, this is the priority finding for the nurse to report to the provider.
A nurse is assessing a client who is postoperative following a transurethral resection of the prostate (TURP). After the nurse discontinues the client's urinary catheter, which of the following findings should the nurse report to the provider? A. Pink-tinged urine B. Report of burning upon urination C. Stress incontinence D. Decreased urine output
Correct Answer: D. Decreased urine output A decrease in urine output after TURP indicates an obstruction to urine flow by a clot or residual prostatic tissue and should be reported to the provider.
A nurse is reviewing the laboratory findings of a client who has chronic kidney disease. The client reports significant persistent nausea and muscle weakness. Which of the following findings should the nurse expect? A. Hypernatremia B. Hypomagnesemia C. Hypercalcemia D. Hyperkalemia
Correct Answer: D. Hyperkalemia A client who has chronic kidney disease can have hyperkalemia, which is a potassium level greater than 5.0 mEq/L. The expected reference range for potassium is 3.5 to 5.0 mEq/L. Other manifestations of hyperkalemia can include palpitations, dysrhythmias, nausea, and muscle weakness.
A nurse is caring for a client who has manifestations of acute tubular necrosis (ATN) following a kidney transplantation. Which of the following interventions should the nurse anticipate for this client? (Select all that apply.) A. Hemodialysis B. Biopsy C. Immunosuppression D. Balloon angioplasty E. Surgical repair
Correct Answers: A. Hemodialysis B. Biopsy C. Immunosuppression Clients who develop ATN after transplantation surgery might need dialysis until they have an adequate urine output and their BUN and creatinine levels stabilize. Because the development of ATN after transplantation surgery mimics the symptoms of rejection of the transplanted kidney, clients have to undergo a biopsy to determine the correct diagnosis. Immunosuppressive medication therapy is essential after kidney transplantation to protect the new kidney.