RN Medical Surgical: Renal and Urinary

A nurse is teaching a client about urinary tract infections. Which of the following manifestations should the nurse include? A) Weight gain B) back pain C) vaginal discharge D) Muscle cramps

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 doll 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 clients electrolyte values C) Measure the clients weight D) restrict the clients protein intake

B) check the clients electrolyte values The nurse should apply the urgent versus non-urgent 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, 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; therefore, this is the priority action.

A nurse is assessing a client who was brought to the emergency department following a motor vehicle crash. The nurse should recognize that which of the following findings is a manifestation of bladder trauma? A. Stress incontinence B. Hematuria C. Pyuria D. Fever

B. Hematuria Manifestations of bladder trauma include hematuria, or blood in the urine; blood at the urinary meatus; pelvic pain; and anuria, or the absence of urine.

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 6000/mm3 B. Potassium 3.0 mEq/L C. Clear, pale yellow drainage D. Report of abdominal fullness

B. Potassium 3.0 mEq/L A potassium level of 3.0 mEq/L is below the expected reference range and can cause dysrhythmias. The dialysis removes fluid, waste products, and electrolytes from the blood and can cause hypokalemia.

A nurse is providing teaching to a client who has a history of urinary tract infections. Which of the following statements should indicate to the nurse the need for additional teaching? A) " I will empty my bladder every four 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"

C) "I will use a vaginal douche daily" The client should avoid vaginal douches, bubble baths, and any substances that can increase the risk for UTIs. The client should use mild soap and water to wash the perineal area.

A nurse is teaching a client who is pre-operative for renal biopsy. Which of the following statements should the nurse make? A) you will be NPO for eight hours 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 for this procedure

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 hr following the procedure to reduce the risk for bleeding. The nurse can elevate the head of the bed.

A nurse is teaching a newly licensed nurse about caring for a client who has a new left arteriovenous fistula. Which of the following statements should the nurse make? A) Check the fistula site daily for a vibration B) Instruct the client to restrict movement of his left arm C) avoid taking blood pressure on the clients left arm D) instruct the client to sleep on his left side

C) avoid taking blood pressure on the clients left arm The nurse should avoid taking blood pressure measurements on the client's left arm, which can decrease blood flow and cause clotting.

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 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 clients position D) place the drainage bag above the clients abdomen

C) change the client's position The 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 reposition the client to facilitate the drainage of the solution from the peritoneal cavity.

A nurse is teaching a newly licensed nurse about collecting a 24 hour 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 avoided 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 hour period

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 providing dietary teaching to client who has late stage chronic kidney disease. Which of the following nutrients should the nurse instruct the client to decrease in her diet? A) calcium B) phosphorus C) potassium D) sodium

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 caring for a client who has a diagnosis of renal calculi and reports severe flank pain which of the following is a priority nursing action? A) Relieve the client's pain B) Encourage the client to increase fluid intake C) Monitor the client's I and O D) Strain the clients urine

A) Relieve the client's pain The nurse should apply the urgent versus non-urgent 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, 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 assessing a client who is one week post operative following a living donor kidney transplant. Which of the following findings should indicate to the nurse that 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

A. Blood pressure 160/90 MMHG Due to the kidney's role in fluid and blood pressure regulation, a client who is experiencing rejection can have hypertension.

A nurse is monitoring a client who is undergoing extracorporeal shockwave lithotripsy. 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

A. Dysrhythmias MY ANSWER The nurse should apply the ABC priority-setting framework. This framework 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 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 and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority-setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority-setting framework because 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 airway, breathing, circulation approach to client care, the nurse determines dysrhythmias are the priority finding.

A nurse is teaching a client who has chronic kidney disease. Which of the following instructions should the nurse include? A. Limit fluid intake B. Limit caloric intake C. A diet high in phosphorus D. Eat a diet high in protein

A. Limit fluid intake A client who has CKD should limit fluid intake to prevent hypervolemia, or excessive fluid overload.

A nurse is teaching a client who has acute pyelonephronitis. Which of the following instructions should the nurse include in the teaching? A. You should complete the entire cycle of antibiotics therapy B. You should maintain complete bed rest until manifestations decrease C. You should drink 1000 mL of fluid per day D. You should avoid using NSAIDs for pain

A. You should complete the entire cycle of antibiotics 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 providing teaching to a client who is pre-operative prior a transurethral resection of the prostate. which of the following statements includes 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

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 assessing a client who is post operative following a transurethral resection of the prostate. After the nurse discontinues the clients 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

D) decreased urine output A decrease in urine output after TURP indicates obstruction to urine flow by a clot or residual prostatic tissue and should be reported to the provider.

A nurse is teaching a client who is pre-operative for a cytoscopy. 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 hours after this procedure D) expect to have pink tinged urine after this procedure

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 teaching a client about the prostate specific antigen test. Which of the following statements should the nurse make? A) you should fast for eight hours after the PSA test B) annual PSA screening should begin at age 40 C) expected PSA values will decrease as you get older D) you should not ejaculate for 24 hours prior to the PSA test

D) you should not ejaculate for 24 hours prior to the PSA test PSA is a glycoprotein that is manufactured in the prostate and is used to screen for prostate cancer. Ejaculation within 24 hours prior to the test can cause falsely elevated levels of PSA.

A nurse is caring for a client who is receiving peritoneal dialysis the nurse should monitor client for which of the following adverse effects? A. Diarrhea B. Increased serum albumin C. Hypoglycemia D. Peritonitis

D. Peritonitis Peritonitis is an adverse effect of peritoneal dialysis. Prevention requires using sterile technique, and frequent assessment of the catheter exit site. The nurse should obtain cultures of the dialysate outflow, or effluent, if peritonitis is suspected.