RN renal NCLEX prep
The nurse is caring for a client with multiple renal calculi. Which nursing interventions should be included in the plan of care? Select all that apply.
1. Administer analgesics at regularly scheduled intervals. 2. encourage fluid intake of up to 3 L/day 5. Strain all urine for the presence of stones
Place the nursing actins for performing a renal system physical assessment in the correct order. All options must be used.
1. Advise client to empty the bladder completely. 4. Observe skin and contour of abdomen and lower back 2. Auscultate the renal arteries in right and left upper quadrants. 5. Percuss and palpate both the right and left kidneys. 3. Document the assessment of renal system function
The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient outflow. What actions should the nurse perform initially? select all that apply.
1. Assess for abdominal distention and constipation 3. examine the catheter for kinds and obstructions 5. place the client in a side-lying position.
The nurse is caring for a client who received extracorporeal shock wave lithotripsy with ureteral stent placement for treatment of a kidney stone. Which discharge instructions provided by the nurse are appropriate? Select all that apply.
1. Contact your health care provider if you develop a fever or chills. 3. Increase your fluid intake to help flush out the kidney stone fragments. 4. It is common to have some blood in the urine up to 24 hours after this procedure. 5. You may develop some bruising on your back or on the side of your abdomen.
The nurse reinforces teaching about self-management strategies for a client with urge incontinence. Which of the following indicate that teaching has been effective? Select all that apply.
1. I am going to join a walking program to lose excess weight. 2. I may have dry mouth as a side effect from the oxybutynin. 4. I should perform Kegel exercises several times daily 5. I will void every 2 hours until I am having fewer accidents
The nurse assesses a client receiving peritoneal dialysis. Which assessment findings are most important for the nurse to report to the health care provider? Select all that apply
1. cloudy outflow. 2. low-grade fever 5. tachycardia
The nurse gathers a health history from a 58- year-old male client with acute urinary retention. Which of the following questions should the nurse ask to aid in assessing for benign prostatic hyperplasia? Select all that apply.
1. do you feel the need to urinate again immediately after urinating? 2. do you have to strain to begin your stream of urine? 4. how often do you wake at night with the urge to urinate? 5. is your stream of urine weak of intermittent?
The nurse caring for multiple clients who underwent renal system diagnostic testing should report which post-procedure finding to the health care provider?
150 mL residual urine on bladder scan
The emergency department nurse cares for 5 clients. Which of the clients below are at risk for developing metabolic acidosis? select all that apply.
2. 36-year-old client with food poisoning and severe diarrhea for the past 3 days. 4 75-year-old client with pyelonephritis and hypotension 5. 82-year-old client due for hemodialysis with clotted arteriovenous shunt
The nurse assesses a client diagnosed with chronic kidney disease who had an internal arteriovenous fistula performed on the left arm yesterday. Which assessment finding would require immediate follow-up?
A bruit cannot be auscultated over the fistula site
The nurse is caring for a client with overflow urinary incontinence related to diabetic neuropathy. Which of the following interventions are appropriate? Select all that apply.
2. encourage the client to bear down while attempting to void. 3. inspect the perineal area for evidence of skin breakdown 4. measure postvoid residual volumes as prescribed. 5. tell the client to wait 30 seconds after voiding and then attempt to void again.
A sexually active female client has had 3 urinary tract infections (UTIs) in 12 months. Which instructions should the nurse include in teaching the client how to prevent UTI recurrence? select all that apply.
2. increase daily intake of fluids 5. void immediately after intercourse 6. wear underwear with a cotton crotch
The charge nurse is making rounds and should immediately intervene when making which observation?
A nursing assistant is hanging a urinary drainage bag on the back of a wheelchair when transporting a client.
A client diagnosed with end-stage renal disease comes to the dialysis clinic for treatment. Which actions should the nurse take to prepare the client for hemodialysis? Select all that apply.
3. Check the client's medical records to determine the last post-dialysis weight 4. Obtain a set of client vital signs and the client's current weight. 5. Palpate the fistula in the client's arm for a thrill and auscultate for a bruit.
A client with chronic kidney disease has a subcutaneous arteriovenous fistula (AVF) placed in the nondominant left wrist for hemodialysis. Which of the following statements indicate the client understands how to care for the fistula properly? Select all that apply.
3. I will squeeze a small sponge with my left hand several times a day 4.v I will touch the site and feel for a vibration several times a day. 5. I will try not to sleep on my left arm.
A nurse is reviewing the laboratory values for a 3-year-old client with nephrotic syndrome. The nurse interprets the results to most clearly reflect which physiologic process related to nephrotic syndrome? Click on the exhibit button for additional information. Laboratory results: Serum albumin 2.0 g/dL (20 g/L) Serum total cholesterol 275 mg/dL (7.1 mmol/L) Urinalysis, protein 3+
Glomerular injury
The nurse is caring for a 68-year-old male client following a laparoscopic cholecystectomy 8 hours ago. The client has not urinated since surgery. Which would be the most appropriate initial intervention?
Help the client out of bed.
The nurse is administering medications to a client experiencing heart palpitations who is scheduled to receive a dose of furosemide. Based on the client's laboratory results, what is the nurse's priority action? Click on the exhibit button for additional information.
Hold the furosemide.
When a client diagnosed with acute urinary retention is emergently catheterized, the nurse should initially assess for which priority manifestation that may occur as a result of the catheterization?
Hypotension
The nurse is providing discharge instructions to a client receiving oxybutynin for overactive bladder. Which client statement indicates that further teaching is required?
I am looking forward to our summer vacation at the beach.
A client suffering from bladder prolapse and subsequent stress urinary incontinence has discussed treatment options with the health care provider (HCP). The nurse evaluates that the client understands support pessary use when the client makes which statement?
I can remain sexually active while my pessary is in place.
The nurse is performing discharge teaching on nutritional therapy for a client with chronic kidney disease. Which statement indicates that further teaching is needed?
I can use salt substitute because I am required to restrict both sodium and potassium in my daily diet.
The nurse assesses a client with benign prostatic hyperplasia. Which client statement requires further assessment?
I have a burning sensation when I urinate Clients with BPH have increased risk for UTI due to incomplete bladder emptying and urine retention
The nurse provides post-procedure teaching for a female client who had a cystoscopy as an outpatient. Which client statement indicates the need for additional instruction?
I should expect to see blood clots in my urine for up to 24 hours.
A client has been given instructions about collecting a urine specimen to test creatinine clearance. The client indicates correct understanding of the specimen collection procedure by making which statement?
I will need to collect all my urine in a container for 24 hours.
The nurse is caring for a 7-year-old client diagnosed with nephrotic syndrome who will be discharged soon. Which statement by the parent indicates the need for further teaching?
I'll organize playdates to keep my child's spirits up during relapses
Which nursing intervention is the highest priority when teaching a 38-year-old female client newly diagnosed with stress incontinence?
Importance of voiding every 2 hours
The nurse is admitting a 4-year-old diagnosed with Wilms tumor. The child is scheduled for a right nephrectomy in the morning. Which action is a priority in the preoperative care plan?
Instructions not to palpate the abdomen Wilms tumor is discovered when caregivers note an unusual bulging/swelling on one side of a child's abdomen. The abdomen should not be palpated until after the diagnosis is suspected or confirmed as this can disrupt the tumor and cause dissemination of tumor cells.
A 65-year-old client with end-stage renal renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7/5 mEq/L (7.5 mmol/L) and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia.
Intravenous calcium gluconate The priority in treatment of hyperkalemia with ECG changes (eg, peaked T waves) is administration of intravenous calcium gluconate to prevent life-threatening dysrhythmias. Once calcium gluconate is administered, prescriptions to correct serum potassium (eg, intravenous regular insulin with dextrose, sodium polystyrene sulfonate, hemodialysis) may be implemented.
A client had a percutaneous nephrolithotripsy 3 hours ago to remove left renal calculi. Since then, the indwelling urethral catheter has drained 125 mL of urine and the nephrostomy tube has drained 0 mL. The clinet now reports left flank pain radiating to the left groin along with severe nausea. What is the appropriate nursing intervention.
Irrigate the nephrostomy tube with sterile normal saline as prescribed.
The nurse cares for a client scheduled for a percutaneous left kidney biopsy as an outpatient. which intervention should the nurse include in the client's post-procedure care plan?
Monitor vital signs every 15 minutes for the first hour.
The nurse caring for a 72-year-old client with a history of renal calculi and diabetes mellitus who was admitted for acute pyelonephritis. The nurse assesses shaking chills, temperature of 101.2 F, and flank pain. Which of the following is the priority nursing intervention?
Obtain blood and urine cultures.
A client undergoes transurethral resection of the prostate for benign prostatic hyperplasia. The client has a 3-way Foley catheter with continuous bladder irrigation. Which assessment is the best indication that the bladder irrigation flow rate is productive?
Output urine is light pink in color.
A nurse is caring for a client 2 days after surgical creation of an arteriovenous fistula in the forearm. Which finding should the nurse report immediately to the health care provider?
Pale skin of the hand of the arm with the arteriovenous fistula.
A client taking morphine sulfate for acute pain has not voided in 6 hours. The nurse suspects the client has developed urinary retention. What is the priority nursing intervention?
Palpate the client's suprapubic area.
The nurse assesses a pediatric client who was diagnosed with diarrhea caused by Escherichia coli. The nurse is most concerned with which finding?
Petechiae noted on the trunk Hemolytic uremic syndrome is a life-threatening complication of escherichia coli diarrhea. clinical features include anemia (pallor), low platelets (petechiae and purpura), and acute injury (low urine output).
A client who was discharged following a prostatectomy performed 6 days ago calls the clinic and reports passing some small blood clots and experiencing a decreased urinary stream. What is the nurse's best response?
Please come to the clinic to be evaluated by the health care provider.
A client with a chronic kidney disease has blood laboratory values as shown in the exhibit. The nurse administers sodium polystyrene sulfonate by mouth per the health care provider's prescription. The nurse evaluates that the therapy is effective when which value is noted on the follow-up results? Click on the exhibit button for additional information. Creatinine: 4.5 Potassium 5.9 Calcium 6.3 Phosphorus 5.2
Potassium 4.9 mEq/L (4.9 mmol/L)
The nurse is caring for a client with an ileal conduit. While assisting the client in removing the external pouch, the nurse observes that the stoma appears bluish grey. What is the nurse's best action?
Report the findings to the health care provider (HCP) immediately. The stoma should be pink to brick-red and moist. Suspected impaired perfusion is considered a surgical emergency and should be reported immediately.
A client is receiving IV sodium bicarbonate for acute metabolic acidosis. Which of these laboratory values would best indicate that the sodium bicarbonate has been effective?
Serum pH 7.39, HCO3 -24 mEq/L (24 mmol/L), potassium 3.8 mEq/L (3.9 mmol/L)
The nurse evaluates the results of laboratory tests completed on a client admitted for a non-healing wound. Which of the following values would be a priority for the nurse?
Serum sodium 153 mEq/L
A client has a serum potassium level of 2.8 mEq/L, and the health care provider (HCP) prescribes intravenous (IV) potassium chloride (KCL). The nurse administers 10 mEq KCL/100 mL 5% dextrose in water at 100 mL/hr through the client's peripheral IV line using an infusion pump. Shortly after initiation of the infusion, the client reports feeling burning and discomfort at the IV site. What is the nurse's priority intervention.
Slow the rate of the KCL infusion.
A client with chronic heart failure is being discharged home on furosemide and sustained-release potassium chloride tablets. Which instructions related to the potassium supplement should the nurse give to the client?
Take it with a full glass of water and stay sitting upright afterward.
The nurse is preparing to administer a sodium polystyrene sulfonate retention enema. Which explanation by the nurse best describes the purpose of this type of enema?
The enema assists the large intestines in removing excess potassium from the body.
Which health history information would be most important for the nurse to obtain when assessing a client with suspected bladder cancer who reports painless hematuria?
Tobacco use
The nurse prepares to instill dialysate for a client receiving peritoneal dialysis. Which nursing action is the priority?
Using sterile technique when spiking and attaching the bag of dialysate.
After reviewing the urinalysis report data on a client, which question is most appropriate for the nurse to ask? click on the exhibit button for additional information Color: amber Specific gravity: 1.031 Red blood cells: none White blood cells: Rare Protein: none Glucose: absent
What has your fluid intake been for the last 24 hours?
A client with advanced kidney disease has serum potassium of 7.1 mEq/L (7.1 mmol/L) and creatinine of 4.5 mg/dL (398 mmol/L). What is the priority prescribed intervention?
Administer IV 50% dextrose and regular insulin Administration of IV 50% dextrose and regular insulin rapidly corrects an elevated serum potassium level by shifting potassium intracellularly. if the client has ECG changes from hyperkalemia, calcium gluconate should be given first to stabilize cardiac muscle.
A client with chronic kidney disease has blood laboratory results as shown in the exhibit. What is the best afternoon snack to provide to this client?
Apple slices with caramel dip The diet for a client with chronic kidney disease may need to be restricted in fluids, sodium, potassium, and phosphorus. Dairy products (eg, milk, yogurt) and certain fruits (eg, bananas, oranges, coconuts, watermelons, and avocados) contain high potassium levels. Dairy products are also high in phosphorus.
The nurse prepares to administer a prescribed dose of sodium polystyrene sulfonate to a client with hyperkalemia. Which action by the nurse is most important prior to administering the dose?
Assessing the client's abdomen and reviewing the medical record for frequency of stools.
The nurse is preparing to administer morning medications to a client with type 2 diabetes mellitus and end-stage renal disease who is scheduled for dialysis today. Which medication should the nurse hold for clarification prior to administration? Click the exhibit button for more information.
Atenolol Unless otherwise indicated by the health care provider, antihypertensives and other blood pressure-lowering medications, antibiotics, digoxin, and water-soluble vitamins (B, C, and folic acid) should be held prior to dialysis.
A nurse is caring for a child with acute glomerulonephritis. Frequent monitoring of which of the following is a priority?
Blood pressure
The health care provider is starting an elderly client on terazosin to treat benign prostatic hyperplasia (BPH). Which information should be included when teaching this client about the new medication?
Change positions slowly when going from lying to standing.
A client underwent a transurethral resection of the prostate (TURP) today and has a 3-way Foley urinary catheter and continuous bladder irrigation (CBI). The clients reports lower abdominal pain rated as an 8 on a scale of 0-10. What action should the nurse carry out first?
Check amount and characteristics of urine output.
A client suffering from chronic kidney disease is scheduled to receive recombinant human erythropoietin and iron sucrose. The client's hemoglobin is 9.7 g/dL (97 g/L) and hematocrit is 29% (0.29). What is the appropriate nursing action?
Check blood pressure prior to administering the erythropoietin.
The nurse has assessed 4 children. Which finding requires immediate follow-up with the health care provider?
Child who had a surgical repair of hypospadias earlier today with no urinary output in the past two hours.
A client has a follow-up checkup in the urology clinic. Six months ago, the client started taking tolterodine. What data collected from the client should the nurse report to the health care provider?
Client excitedly reports being able to go an entire work day without having to urinate.
A clinic nurse receives messages on 4 clients. Which client should the nurse call back first?
Client with chronic kidney disease reporting nausea, vomiting, and headache.
The nurse is caring for a 78-year-old client with a urinary tract infection (UTI). Which assessment finding would be most concerning and require immediate follow-up by the nurse?
Confusion
A client returns to the unit after receiving hemodialysis for the first time. The client vomits once, reports headache, and appears restless and disoriented. What is the priority intervention?
Contact the health care provider Dialysis disequilibrium syndrome is a potentially life-threatening condition associated with cerebral edema. Characteristic neurologic manifestations include nausea and vomiting, headache, restlessness, change in mentation, and seizure activity. If DDS is suspected, the health care provider should be contacted immediately and dialysis should be stopped.
The nurse assesses a client during the dwell time of a peritoneal dialysis cycle. Which assessment would require immediate intervention?
Crackles present in the left and right lung bases Clients receiving peritoneal dialysis should be monitored carefully for signs and symptoms of respiratory compromise, including difficulty breathing, rapid respirations, and crackles.
The evening shift nurse reviews the preoperative checklist and latest serum laboratory value for an elderly client with a ruptured diverticulum who is scheduled for surgery in the early morning. Which laboratory value is most important for the nurse to report to the health care provider?
Creatinine level 2.5 mg/dL (221 mmol/L)
A client diagnosed with acute glomerulonephritis has pitting edema in both lower extremities, blood pressure of 170/80 mm Hg, and proteinuria. When developing a plan of care for this client, the nurse should include which most accurate indicator of fluid loss or gain?
Daily weight measurements.
The health care provider prescribes phenazopyridine hydrochloride for a client with a urinary tract infection. What would the office nurse teach the client to expect while taking this medication?
Discoloration of urine.
The nurse is conducting a pain assessment on a client with dysuria. Which pain description is most likely associated with pyelonephritis?
Dull flank pain; extending toward the umbilicus
A nurse is preparing an educational presentation on herbal supplements for the local community center. Saw palmetto is one herbal medicine being discussed. Which audience participants would find this information beneficial?
Elderly clients with benign prostatic hyperplasia.
