Test 3

The oncologist has told the patient that he or she has a benign tumor in the liver. The patient asks the nurse, "What is the main difference between benign and malignant tumors?" Which answer by the nurse is correct? "Malignant tumors usually are encapsulated." "Malignant tumors have a rare recurrence rate." "Benign tumors do not invade and spread to other organs." "Malignant tumors require less nutrients for their cells than benign

"Benign tumors do not invade and spread to other organs." The ability of malignant tumor cells to invade and metastasize is the major difference between benign and malignant neoplasms. Benign tumors usually are encapsulated; metastasis is absent, and recurrence is rare. Malignant tumors rarely are encapsulated, are capable of metastasis, and are capable of recurring. p. 253

When conducting a health history interview for a patient diagnosed with renal calculi, which question is appropriate when assessing the cognitive-perceptual pattern? "Do you experience urinary frequency?" "Do you experience pain in your genitalia?" "Do you have a family history of renal calculi?" "Do you experience colicky pain in your abdomen?" "Do you take purine-rich foods like sardines or sweet bread?"

"Do you experience pain in your genitalia?" "Do you experience colicky pain in your abdomen?" While assessing the effect of renal calculi on a patient's cognitive-perceptual pattern, the appropriate question to ask is if the patient has experienced any pain in his or her genitalia or any colicky pain in his or her abdomen or flank. Interviewing the patient about urinary frequency will determine the patient's elimination pattern. Inquiring about the patient's family history of renal calculi will determine health perception and health management. Asking the patient about his or her dietary intake of purine-rich food will determine the patient's nutritional-metabolic pattern. p. 1080

A patient with breast cancer experiences a 3-kilogram weight loss over the course of a week. The nurse is evaluating the patient after teaching necessary interventions to reduce the risk of malnutrition. Which statement made by the patient indicates effective learning? "I can use packages of instant breakfast." "I can add cheese to sandwiches or snacks." "I can take low-calorie foods throughout the day." "I can supplement puddings and cereals with Ensure." "I can use raw milk when preparing milkshakes and sauces."

"I can use packages of instant breakfast." "I can add cheese to sandwiches or snacks." "I can supplement puddings and cereals with Ensure." A cancer patient who has lost 3 kilograms in a week is at a high risk of malnutrition. Instant breakfast packages can be sprinkled over puddings and sausages because they contain protein. Cheese contains protein and calories, which are essential for a patient suffering from weight loss. Ensure is a commercial nutritional supplement that provides adequate protein and fat for the patient. Low-calorie foods can further cause weight loss in the patient. Raw milk may contain bacteria, which would place the patient at a high risk of infection. p. 276

The nurse is explaining the use of romiplostim [Nplate] to treat idiopathic thrombocytopenic purpura (ITP). Which patient statement indicates understanding of the nurse's explanation? "I will have my white blood cell count evaluated in 1 month." "I'll call my healthcare provider if I notice any swelling in my legs." "I'll let my healthcare provider know if I have any pain in my joints." "I shouldn't take this medication with food because that prevents absorption of the drug."

"I'll let my healthcare provider know if I have any pain in my joints." Arthralgia (pain in the joints) is a common adverse effect of treatment with romiplostim and should be reported. Peripheral edema is not a side effect of this medication. Platelet counts, not white blood cell counts, should be evaluated. The drug is administered subcutaneously, not orally; therefore, there is no interference by food. p. 662-Lehne

A cancer patient wants to know what the word nadir means. What is the nurse's best response? "It is the patient's tolerance to the chemotherapy's bone marrow suppressant effect." "It is the time it takes the bone marrow to completely recover from a dose of chemotherapy." "It is the maximum dose for a chemotherapy drug in reference to bone marrow suppression effects." "It is the average number of days it takes for chemotherapy to decrease the neutrophil count to its lowest level."

"It is the average number of days it takes for chemotherapy to decrease the neutrophil count to its lowest level." Neutropenia begins to develop a few days after dosing, and the lowest neutrophil count, called the nadir, occurs between days 10 and 14. Nadir does not mean the patient's tolerance, the time it takes the bone marrow to recover, or the maximum dose. p. 1214-Lehne

A patient who is undergoing a diagnostic workup for cancer expresses anxiety about the results. Which is the best nursing response? "It is probably nothing." "Let's discuss that later." "Everyone feels that way." "Let's talk about your concerns."

"Let's talk about your concerns." During the diagnostic workup of cancer, it is common for patients to be anxious. The nurse should actively listen to all concerns expressed. The nurse should not use communication patterns that may hinder exploration of feelings and meanings. "It is probably nothing" may indicate that the nurse is giving false reassurances. "Let's discuss that later" may mean that the nurse is delaying the discussion, and "Everyone feels this way" means that the nurse is generalizing the patient's concern. By using these strategies, the nurse may deny patients the opportunity to share the meaning of their experience. pp. 255-256

Oliguric phase AKI -Urinary Output -how many days after injury does it occur? -how many days does it last? -urinalysis results -fluid volume changes

-UO< 400 mL/day -1-7 days -10-14 days -may show casts, RBCs, WBCs -hypovolemia can exacerbate, with decreased UO, fluid retention occurs

A patient with lung cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." What is the best response by the nurse? "Would you like for me to call your spiritual advisor so you can talk about your feelings?" "Perhaps you are depressed about your illness; I will speak to the health care provider about getting some medications for you." "None of us knows when we are going to die. Is this a particularly difficult day?" "What are your feelings about being so sick and thinking you may die soon?"

"What are your feelings about being so sick and thinking you may die soon?" The best response to psychosocial questions is to acknowledge the patient's feelings and explore his or her concerns. "What are your feelings about being so sick and thinking you may die soon?" does both and is a helpful response that encourages further communication between patient and nurse. Calling the spiritual advisor is permissible; however, this does not increase communication and rapport between the patient and the nurse. The patient is expressing feelings; medication is not indicated for this. Ignoring the patient's feelings is not therapeutic communication. pp. 280-281

A patient is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which question is most important for the nurse to ask the patient? "Have you recently had strep throat?" "Do you have susceptibility to allergies?" "How much fluid do you drink in a day?" "Have you had any contact with anyone who has measles?"

'Have you recently had strep throat?" Glomerulonephritis is an inflammatory process, usually resulting from antibodies reacting with group A hemolytic streptococcal antigens, the organism responsible for strep throat. Allergies, fluid intake, and measles exposure are not germane to the diagnosis of acute glomerulonephritis. p. 1074

Hemoglobin normal levels

(low end for females) 11.7-17.3 (high end for males)

Hematocrit normal levels

(low end for females) 35%-50% (high end for males)

Histologic classifications of cancer

-stages Stage 0: cancer in situ Stage I: tumor limited to the tissue of origin; localized tumor growth Stage II: limited local spread Stage III: extensive local and regional spread Stage IV: metastasis -grades Grade 1 represents the most well-differentiated or lowest grade (most like the original cells), and grade 5 represents the most poorly differentiated (unlike the original cells) or highest grade. -TNM Primary Tumor (T) T0: No evidence of primary tumor Tis: Carcinoma in situ T1-4:Ascending degrees of increase in tumor size and involvement Tx: Tumor cannot be measured or found Regional Lymph Nodes (N) N0: No evidence of disease in lymph nodes N1-4:Ascending degrees of nodal involvement Nx: Regional lymph nodes unable to be assessed clinically Distant Metastases (M) M0: No evidence of distant metastases M1-4: Ascending degrees of metastatic involvement, including distant nodes Mx: Cannot be determined

Normal Urine Output

0.5 mL/kg/hr

Creatinine normal range

0.6-1.3

Cystoscopy

Cystoscopic lithotripsy uses an ultrasonic lithotrite to pulverize a renal stone. Complications associated with these cystoscopic procedures include hemorrhage, retained stone fragments, and infection.

WBC normal range

4-11

During irrigation, no more than _____ of sterile saline solution should be instilled at once to prevent renal damage.

5 mL

A patient with liver cancer requires considerable assistance and frequent medical care. The nurse would give this patient which Karnofsky Performance Scale score? 90 80 50 20

50 A patient who requires considerable assistance and frequent medical care would score a 50 on the Karnofsky Performance Scale. A 90 represents the ability to carry on normal activity with minor signs or symptoms of disease; a score of 80 indicates the ability to carry on normal activity with effort and signs and symptoms of the disease; and patients scoring a 20 are very sick, requiring hospitalized supportive treatment. p. 1217-Lehne

BUN normal range

6-20

A maintenance dose of epoetin alfa [Epogen] is ordered for a patient undergoing dialysis for chronic renal failure. The nurse should anticipate administering which dosage of epoetin alfa [Epogen]? 40,000 units subQ weekly 75 units/kg IV 3 times/week 100 units/kg IV 3 times/week 150 units/kg subQ 3 times/week

75 units/kg IV 3 times/week For dialysis patients, the median maintenance dosage of epoetin alfa is 75 units/kg 3 times a week by IV bolus. The initial dosage for dialysis patients is 50 to 100 units/kg 3 times a week by IV bolus until the target hemoglobin has been achieved. For patients receiving cancer chemotherapy, a once weekly (40,000 units subQ) or thrice weekly (150 units/kg subQ) schedule may be maintained. p. 658

The patient was told that he or she would have intraperitoneal chemotherapy. The patient asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? It is delivered via an Ommaya reservoir and extension catheter. It is instilled in the bladder via a urinary catheter and retained for one to three hours. A Silastic catheter will be placed percutaneously into the peritoneal cavity for chemotherapy administration. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

A Silastic catheter will be placed percutaneously into the peritoneal cavity for chemotherapy administration. Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter, and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump. p. 261

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? A bland, low-fiber diet A high-protein, high-calorie diet A diet high in fresh fruits and vegetables A diet emphasizing whole and organic foods

A bland, low-fiber diet Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea. p. 266

The nurse is administering epoetin alfa [Procrit] to a patient receiving chemotherapy. Which adverse effect is a potential risk with this drug? Bone pain Hypotension Easy bruising Accelerated tumor progression

Accelerated tumor progression Epoetin alfa has been shown to accelerate tumor progression and shorten life in some patients with cancer. This is more common when the hemoglobin level rises above 12 gm/dL. Other adverse effects associated with epoetin alfa include hypertension, cardiovascular events, and deep vein thrombosis when the drug is used preoperatively. Bone pain is associated with filgrastim. p. 657-Lehne

The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? Morphine sulfate Ibuprofen Ondansetron Acetaminophen

Acetaminophen Acetaminophen is administered before therapy and every four hours after to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon, which frequently is used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms such as headache, fever, chills, and myalgias. p. 273

The nurse is caring for a 49-year-old woman who had surgery one day ago for removal of a suspected malignant breast mass. The patient is awaiting the pathology report. She is tearful and says that she is afraid to die. Which of these is the most effective nursing intervention at this time? Actively listen and allow her to talk about her fears. Teach the patient about the seven warning signs of cancer. Discuss the need to make changes in an unhealthy lifestyle. Remind the patient that there is probably nothing to worry about.

Actively listen and allow her to talk about her fears. While patients are waiting for the results of diagnostic studies, be available to actively listen to their concerns. It is not an appropriate time to teach about the warning signs of cancer, or to provide patient teaching regarding lifestyle changes. Do not provide false reassurances by telling her there is nothing to worry about. pp. 279-280

Which nursing diagnosis is a priority in the care of a patient with renal calculi? Acute pain Risk for constipation Deficient fluid volume Risk for powerlessness

Acute Pain Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care. p. 1081

________________________________________ is indicated on x-rays by transverse lines of rarefaction at the ends of the metaphysis of long bones.

Acute lymphocytic leukemia

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? Increase intake of liquids at mealtime to stimulate the appetite. Serve three large meals per day plus snacks between each meal. Avoid the use of liquid protein supplements to encourage eating at mealtime. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. The nurse can increase the nutritional density of foods by adding items high in protein or calories (such as peanut butter, skim milk powder, cheese, or honey) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are tolerated best. Supplements can be helpful. p. 276

A patient is receiving filgrastim. Which assessment finding indicates that the medication has been effective? A decrease in platelets A decrease in stomatitis An increase in red blood cells An increase in white blood cells

An increase in white blood cells Filgrastim increases the production of white blood cells (especially neutrophils) in the bone marrow. The desired patient outcome is that the patient will not contract an infection. Filgrastim does not affect platelets, stomatitis, or red blood cells. p. 1215-Lehne

The nurse caring for a patient undergoing chemotherapy finds that the patient has a low white blood cell (WBC) count. Which is an appropriate intervention? Request that the chemotherapy dose be reduced. Monitor the respiratory rate of the patient. Allow the patient to visit with family and friends. Administer white blood cell growth factors.

Administer white blood cell growth factors Chemotherapy may suppress the proliferation of bone marrow, resulting in neutropenia, or low white blood cell counts. Low WBC count makes the patient prone to developing infections; therefore, the nurse should consult the health care provider and get WBC growth factors administered. In addition, the nurse should monitor the temperature of the patient because it can indicate fever. The number of visitors should be limited to prevent risk of infection. The chemotherapy dose need not be reduced, because neutropenia is a common side effect. Respiratory rate is routinely monitored, but in this case it is not directly related to the patient's WBC. p. 265

When administering anticancer drugs, the nurse should identify which interventions as effective in minimizing renal injury from hyperuricemia? Administration of fluids Administration of rasburicase [Elitek] Premedication with ondansetron [Zofran] Premedication with dexamethasone [Decadron] Prophylactic administration of allopurinol [Zyloprim]

Administration of fluids Administration of rasburicase [Elitek] Prophylactic administration of allopurinol [Zyloprim] Administration of fluids, administration of rasburicase [Elitek], and prophylactic administration of allopurinol [Zyloprim] have been found to be effective in minimizing renal injury from hyperurecemia when anticancer drugs are administered. Premedication with dexamethasone [Decadron] and ondansetron [Zofran] has been found to be effective in reducing the occurrence of nausea and vomiting associated with anticancer drug therapy. p. 1216-Lehne

Which adverse effects will the nurse monitor for in a patient receiving chemotherapy? Alopecia Stomatitis Neutropenia Hypertension Urinary retention

Alopecia Stomatitis Neutropenia Bone marrow suppression (leukopenia, neutropenia, thrombocytopenia, and anemia), stomatitis, and alopecia are common adverse reactions to antineoplastic drugs. Urinary retention and hypertension are not expected side effects. pp. 1214-1216-Lehne

Which diagnosis does the nurse expect in a patient who presents with hematuria, progressive uremia, and sensorineural deafness? Alport syndrome Nephrotic syndrome Goodpasture syndrome Polycystic kidney disease (PKD)

Alport syndrome Hematuria, progressive uremia, and sensorineural deafness are clinical manifestations of Alport syndrome. The clinical manifestations of nephrotic syndrome include peripheral edema, massive proteinuria, hypertension, and hyperlipidemia. Clinical manifestations of Goodpasture syndrome include primary symptoms such as cough, rhonchi, crackles, and mild shortness of breath. Clinical manifestations of PKD are hematuria, hypertension, and a feeling of heaviness in the abdomen. p. 1083

Normal uric acid levels

Female: 2.3-6.6 Male: 4.4-7.6

Postrenal etiology

Avoid bladder/kidney carcinogens Prevent/Treat urinary calculi

Intrarenal etiology

Avoid exposure to nephrotoxins -Gentamicin, amphotericin B, contrast dye, chemicals Treat UTIs

Which dietary restriction does a nurse teach the patient with uric acid stones to avoid further complications? Avoid cheese Avoid herring Avoid spinach Avoid sardines Avoid dried fruits

Avoid herring Avoid sardines Herring and sardines are rich in purines that produce uric acid as the waste product and result in the formation of uric acid-related renal calculi. Cheese is highly rich in calcium and should be avoided by a patient with calcium phosphate stones. Spinach should be avoided to reduce calcium oxalate stone formation. Dried fruits are also avoided as to prevent the formation of calcium phosphate stones.

A patient who is undergoing a course of outpatient chemotherapy reports feeling lonely and isolated and expresses the desire to resume normal activities, such as socialization with friends. Which precaution should the nurse recommend when allowing the patient to resume these activities? Avoiding crowds Drinking only bottled water Refraining from eating outside the home Using the bathroom at home, not in public places

Avoiding crowds The nurse needs to teach the patient measures that will protect against infection, such as maintaining adequate nutrition and fluid intake and avoiding crowds, people with infections, and others who have been recently vaccinated with live or attenuated vaccines. Drinking bottled water, eating only at home, and using the bathroom only at home are unnecessary precautions. p. 266

Which medication does the nurse expect to be beneficial for a patient who smokes one pack of cigarettes each day and has a history of cough, crackles, and hematuria? Colestipol Azathioprine Floxuridine Acetohydroxamic acid

Azathioprine Cough, crackles, and hematuria are clinical manifestations of Goodpasture syndrome, which is found in smokers. Azathioprine is used in the management of Goodpasture syndrome. Colestipol is used in the treatment of hyperlipidemia, which is a clinical manifestation of nephrotic syndrome. FUDR is used for treating renal cancers. Acetohydroxamic acid is used in the treatment of renal calculi. p. 1074

An __________________________ requires harvesting the stem cells from the patient, and transfusing it back to the patient after myeloablative therapy.

autologous stem cell transplant

A nurse is teaching a group of nursing students about cancer cell proliferation. Which are the tissues in the human body where cell proliferation is rapid? Bone marrow Cartilage Myocardium Hair follicles Epithelial lining of the GI tract

Bone marrow Hair follicles Epithelial lining of the GI tract The tissues in the human body that proliferate very rapidly include bone marrow, hair follicles, and epithelial lining of the gastrointestinal (GI) tract. The rapid rate of proliferation of these tissues makes them susceptible to developing cancers. Cartilage and myocardial cells do not proliferate or proliferate very slowly. Therefore, these cells are less prone to developing cancers. p. 249

The nurse is caring for a patient undergoing cancer chemotherapy who presents with rash, bone pain, hypertension, and pedal edema. Which symptom is most likely an adverse reaction to the filgrastim [Neupogen] the patient is receiving? Rash Headache Bone pain Swelling in feet

Bone pain Bone pain occurs in about 25% of patients receiving filgrastim. Rash, headache, and pedal swelling are not adverse effects associated with filgrastim. p. 659-Lehne

Epoetin (Epogen)

hematopoietic IV or subQ used to treat anemia in CKD, chemotherapy-induced anemia, replaces erythrocytes SE: thromboembolism, HTN

The nurse should identify which class of anticancer drugs as used most often in the treatment of patients? Targeted drugs Cytotoxic drugs Immunomodulating agents Biologic response modifiers

Cytotoxic drugs Of the four major classes of anticancer drugs, the cytotoxic agents are used most often. Targeted drugs, immunomodulating agents, and biologic response modifiers are used less often than cytotoxic agents. p. 1206-Lehne

A ___________ is a part of the continuous renal replacement therapy (CRRT), which removes nonprotein solutes and plasma water.

hemofilter

Aldesleukin (Interleukin-2)

immunostimulant used in advanced renal carcinoma, melanoma administered IV on a ICU unit, monitored closely for severe adverse effects SE: dyspnea, flu like symptoms, hypotension (capillary leak syndrome)

RRT in AKI

intermittent hemodialysis is RRT of choice, PD not frequently used

IVP

intravenous pyelogram x-ray with contrast

Protein intake in CKD

CKD stage 1-4: normal, avoid high protein Normal for HD patient Increased for PD patient Monitor serum albumin, prealbumin, ferritin

Multiple myeloma: CMs, complications, nursing management

CMs -develops insidiously -skeletal pain #1 manifestation -hypercalcemia which may cause polyuria, anorexia, confusion, seizures, coma Complications -hyperuricemia, hypercalcemia, pathological fractures,

Neutropenia: CMs, acute care, pt. & caregiver teaching,

CMs -infection, low grade fever, minor complaints may be signs of infection acute care -blood cultures, neutropenic precautions, (1) determining the cause of the neutropenia, (2) identifying the offending organisms if an infection has developed, (3) instituting antibiotic therapy, (4) administering hematopoietic growth factors, and (5) implementing protective environmental practices pt. & caregiver teaching -table 31-24 -wash hands frequently, take temp, avoid crowds, avoid possibly undercooked food, hygiene daily, soft toothbrush 4x daily, do not garden or clean up after pets

Polycystic kidney disease CMs, nursing & IP management

CMs -latent for many years, typically involves both kidneys, HTN, hematuria, feeling of heaciness, urinary calculi, chronic constant, severe pain, palpable kidneys nursing & IP management -genetic disorder: genetic counseling -prevent infections of urinary tract, nephrectomy, dialysis, kidney transplant, diet modification, fluid restriction, drugs (antihypertensives)

Acute pyelonephritis CMs & Acute Care

CMs -vary from mild fatigue to the sudden onset of chills; fever; vomiting; malaise; flank pain; and the LUTS characteristic of cystitis, including dysuria, urgency, and frequency. Costovertebral tenderness to percussion (costovertebral angle [CVA] pain) is typically present on the affected side. Acute Care -The patient with mild symptoms may be treated as an outpatient with antibiotics for 14 to 21 days (see Table 46-7). Parenteral antibiotics are often given initially in the hospital to rapidly establish high serum and urinary drug levels. When initial treatment resolves acute symptoms and the patient is able to tolerate oral fluids and drugs, the person may be discharged on a regimen of oral antibiotics for an additional 14 to 21 days. Symptoms and signs typically improve or resolve within 48 to 72 hours after starting therapy.

Stage II bladder cancer

Cancer has invaded the bladder wall but is still confined to bladder.

Stage III bladder cancer

Cancer has spread through the bladder wall to surrounding tissue. It may also have spread to the prostate in men or the uterus or vagina in women.

Stage IV bladder cancer

Cancer has spread to the lymph nodes and other organs, such as lungs, bones, or liver.

Stage I bladder cancer

Cancer is in the inner lining of the bladder but has not invaded the bladder muscle wall.

Thrombocytopenia: causes of acquired, CMs, acute care, pt. & caregiver teaching

Causes -herbal preparations, drugs that advance platelet destruction, inherited disorders (Wiskott-Aldrich syndrome), autoimmune destruction CMs -bleeding, epistaxis, gingival bleeding, petechia, purpura, superficial ecchymoses, anemia, hemorrhage Acute care -removal or treatment of the underlying cause or disorder is sometimes sufficient -avoid aspirin, other medications that affect platelet function pt & caregiver teaching -table 31-16

A nurse is caring for a patient who is suspected to have a kidney disorder. The laboratory findings indicate decreased serum albumin, decreased total serum protein, and elevated cholesterol. Which medication does the nurse expect will be prescribed to the patient? Tamsulosin Doxorubicin 5-fluorouracil Cyclophosphamide

Cyclophosphamide Decreased levels of serum albumin and serum protein and elevated serum cholesterol indicate that the patient has nephrotic syndrome. Cyclophosphamide is used to treat nephrotic syndrome. Tamsulosin is used to facilitate the passage of stones. Doxorubicin is used in the treatment of invasive bladder cancer. 5-fluorouracil is used in the chemotherapeutic treatment of metastatic cancer. p. 1075

NSAID can cause damage in the ____________

kidney

Nephrotic Syndrome causes, CMs, nursing & IP management

Causes -primary: diseases that are in the kidney, neoplasms, allergens, -extrarenal: drugs (penicillamine, NSAIDS, captopril, heroin) , SLE< DM, infection (strep, syphilis, hepatitis, HIV, malaria) CMs -calcium and skeletal abnormalities (hypocalcemia) -hypercoagulability- renal vein, PE in 40% -peripheral edema, massive proteinuria, hypertension, hyperlipidemia, and hypoalbuminemia (ascites & anasarca). -decreased serum albumin, decreased total serum protein, and elevated serum cholesterol -later: triglycerides increased, fatty casts in urine Nursing & IP management -corticosteroids, cyclophosphamide, diabetes management, diuretics, fluid restriction, cautious use of ACE inhibitors, NSAIDs, lipid-lowering agents, anticoagulants if thrombosis present -low sodium, moderate protein diet, avoid malnourishment from proteinuria by providing small frequent meals in pleasant setting

Glomerulonephritis causes, CMs, nursing & IP management

Causes -strep, immune disorders, diabetic nephropathy, HTN, illicit drug use CMs -acute: generalized body edema, hypertension, oliguria, hematuria with a smoky or rusty appearance, and proteinuria -chronic: insidious onset, proteinurea, hematuria, slow development of uremia, urinalysis shows RBcs, WBCs, and casts Nursing & IP management -acute: rest, fluid restriction, diuretics, antihypertensives, low-protein, low-sodium diet -chronic: supportive ans symptomatic, progressing to chronic kidney disease

The laboratory report reveals that the cells from the patient's tumor biopsy are Grade II. What should the nurse know about this histologic grading? Cells are abnormal and moderately differentiated. Cells are very abnormal and poorly differentiated. Cells are immature, primitive, and undifferentiated. Cells differ slightly from normal cells and are well differentiated.

Cells are abnormal and moderately differentiated. Grade II cells are more abnormal than Grade I and moderately differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine. Grade I cells differ slightly from normal cells and are well differentiated. p. 254

________________________________________ is characterized by low RBC count, Hgb and Hct.

Chronic myelogenous leukemia

AKI goals

Completely recover without any loss of kidney function Maintain normal fluid and electrolyte balance Have decreased anxiety Comply with and understand the need for careful follow-up care

differentiating between UTI & pyelonephritis

Costoveterbral-angle pain (flank pain) present in pyelonephritis, not UTI

Stage 1 CKD

kidney damage with normal or increased GFR (> or equal to 90)

What patient care is necessary for peritoneal dialysis to prevent peritonitis?

Ensure tubing is connected in a sterile manner, monitor for manifestations: abdominal pain, cloudy peritoneal effluent, diarrhea, vomiting, abd. distention, hyperactive bowel sounds

Mineral Bone disorder physiology

less Vit. D activated → ↓GI Ca⁺⁺ absorption ↓serum Ca⁺⁺ stimulates parathyroid glands to secrete parathyroid hormone which causes bones to release Ca⁺⁺ & phosphate hyperphosphatemia & hypercalcemia

Oliguria

less than 400 mL output per day

The nurse is caring for a patient with anemia related to chronic renal failure. Which agent might be used to treat the anemia? Epoetin alfa [Procrit] Filgrastim [Neupogen] Oprelvekin [Neumega] Sargramostim [Leukine]

Epoetin alfa Epoetin alfa is used to increase red blood cell counts in patients with anemia from several causes including chronic renal failure. Filgrastim is used to elevate neutrophil counts in cancer patients and for the treatment of severe chronic neutropenia. Sargramostim is used to accelerate recovery from bone marrow transplantation. Oprelvekin is given to stimulate platelet production during chemotherapy. pp. 655-656-Lehne

A ______________ is used to fix the catheter in place in peritoneal dialysis.

Dacron cuff

The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. What are priority nursing assessments in the care of this patient? Assessment of pain and level of consciousness Assessment of serum calcium and phosphorus levels Blood pressure and assessment for orthostatic hypotension Daily weights and measurement of the patient's abdominal girth

Daily weights and measurement of the patient's abdominal girth Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weight, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the diagnosis of nephrotic syndrome. p. 1075

OTC drugs to avoid in CKD

Decongestants, Antihistamines NSAIDs, acetaminophen aluminum- and magnesium-based laxatives and antacids

A patient with cancer who is neutropenic is hospitalized. Which action by the nursing assistant requires the supervising nurse to intervene? Maintaining isolation protocol for the patient Assisting the patient in basic hygiene as needed Delivering a fresh fruit basket to the patient's room Obtaining the patient's temperature at frequent intervals

Delivering a fresh fruit basket to the patient's room When working with hospitalized patients who are neutropenic, every precaution must be taken to prevent nosocomial infection. Patients should be given an isolation room and monitored frequently for fever. Certain foods, such as salads and fresh fruit, contain a great deal of pathogenic bacteria and must be avoided. p. 1214-Lehne

The nurse is caring for a patient undergoing chemotherapy for breast cancer. Which should the nurse recognize as the rationale for using more than one chemotherapy drug simultaneously? Drug resistance occurs less frequently. Normal cell repopulation is not necessary. The intervals between dosages are shorter. The effect occurs during the mitotic phase of the cell cycle.

Drug resistance occurs less frequently. Multiagent chemotherapy can suppress drug resistance, which is acquired through random mutational events. The probability of a cell undergoing the single mutation needed for resistance to one agent is greater than that of the cell undergoing two or more mutations and developing resistance to a combination of agents. Normal cell repopulation is needed for most chemotherapeutic agents, regardless of whether they are used alone or in combination. The intervals between dosages also depend on normal cell recovery. Combination therapy uses agents that are targeted to all phases of the cell cycle, not just the mitotic phase. p. 1212-Lehne

The nurse is attending to a patient with obstructing urinary calculi. The patient is treated with tamsulosin to help ease passage of the stones. In addition, opioids are administered to relieve colic pain. What actions should the nurse perform to ensure treatment effectiveness and patient safety? Restrict fluid intake. Advise complete bed rest. Encourage the patient to move. Strain all urine voided by the patient. Avoid letting the patient ambulate unattended.

Encourage the patient to move. Strain all urine voided by the patient. Avoid letting the patient ambulate unattended. Encouraging the patient to move helps promote the movement of the stone from the upper to the lower urinary tract, resulting in the passage of stones. The nurse should also strain all urine voided by the patient using gauze or a urine strainer to ensure that any spontaneously passed stones are retrieved. To ensure safety, the patient is not left to walk unattended while experiencing acute renal colic, particularly when opioid analgesics are being given. Restricting fluid intake does not help; instead increasing fluid helps to dilute the urine and eases the spontaneous passage of stones. Bed rest is advised only if ordered, during which the patient should be moved every two hours. p. 1081

Prerenal etiology

Ensure adequate intravascular volume & CO -Force fluids -Loop diuretics (furosemide)

The nurse should review which baseline data before starting epoetin alfa [Epogen] therapy in a patient with chronic renal failure (CRF)? Ferritin level Blood glucose level Temperature trends Blood pressure trends Hemoglobin and hematocrit

Ferritin level Blood pressure trends Hemoglobin and hematocrit Baseline data that should be collected and evaluated before initiation of epoetin alfa [Epogen] include blood pressure, blood chemistry (blood urea nitrogen [BUN], uric acid, creatinine, phosphorous, potassium), degree of transferrin saturation, ferritin concentration, and hemoglobin and hematocrit. The ferritin concentration should be at least 100 ng/mL for epoetin alfa therapy to be effective. In patients with CRF, epoetin alfa is associated with a rise in blood pressure. Knowledge of baseline blood pressures is essential to determine whether changes are occurring. Baseline hemoglobin/hematocrit levels serve as a measure of comparison for determining the effectiveness of therapy. It is not essential to know the temperature trends or blood glucose level before starting therapy. pp. 655-658-Lehne

A patient with nonmyeloid cancer is receiving oprelvekin [Neumega]. Which symptom(s), if observed in this patient, would prompt the nurse to notify the provider of an adverse reaction to the oprelvekin [Neumega]? . Hypertension Fluid retention Atrial fibrillation Anaphylactic reactions Accelerated tumor progression

Fluid retention Atrial fibrillation Anaphylactic reactions The primary adverse effects associated with oprelvekin are fluid retention, cardiac dysrhythmias (tachycardia, atrial fibrillation, and atrial flutter), and severe allergic reactions. Hypertension and accelerated tumor progression are associated with epoetin alfa. p. 661-Lehne

A nurse finds that the patient undergoing radiotherapy has developed erythema and desquamation. Which measure should the nurse include when teaching the patient about skin care in the radiation treatment area? Wear fabrics such as wool and corduroy to prevent exposure to cold. Use perfumes and cosmetics on the treatment area as desired. Gently cleanse the skin using a mild soap, tepid water, and a soft cloth. Allow brief periods of direct exposure to sunlight for good bone health.

Gently cleanse the skin using a mild soap, tepid water, and a soft cloth. The skin should be gently cleansed using a mild soap, tepid water, and a soft cloth. Fabrics such as wool and corduroy should not be worn, because they can traumatize the skin. Chemicals like perfumes, cosmetics, and powders should not be used on the treatment area, because they are harsh on skin and can increase the irritation of the skin. The skin should not be exposed to direct sunlight. Protective clothing should be worn, if exposure to sun is expected. p. 270

A patient is diagnosed with calcium oxalate urinary tract calculi. What actions should the nurse perform to manage this patient? Give calcium lactate. Reduce sodium intake. Reduce dietary oxalate. Reduce dietary purines. Give α-penicillamine and tiopronin.

Give calcium lactate Reduce sodium intake Reduce dietary oxalate Give calcium lactate, because it helps to precipitate oxalate in the gastrointestinal tract. Reduce daily sodium intake, because sodium can cause fluid retention and reduce the outflow of urine. Reduce dietary oxalate, because the urinary calculi diagnosed are calcium oxalate. A reduction in dietary purines is advised in cases of uric acid calculi. Give α-penicillamine and tiopronin in the case of cystine stones, which are caused by a rare hereditary defect resulting in an inborn error of cystine metabolism. p. 1078

Anemia treatment, side effects

Hematopoietics -epoetin alfa (Epogen), darbepoeitin alfa -SE: thromboembolism, HTN Iron Supplements -SE: GI irritation, constipation -pt. teaching: take between meals, do not give w/ calcium Folic Acid Supplement

A patient has undergone a lithotripsy procedure. When preparing this patient for the postoperative period, what does the nurse inform this patient to expect after the procedure? Hematuria can be observed. A ureteral stent will be placed. There will be no pain. The ureteral stent is removed within two weeks. An open surgical procedure will be performed.

Hematuria can be observed A ureteral stent will be placed The ureteral stent is removed within two weeks Hematuria is common after lithotripsy procedures and during the initial postoperative period. In addition, the urine may appear bright red (hematuria). A ureteral stent will be placed after the procedure to facilitate passage of shattered stone particles and prevent sand buildup within the ureter, which might lead to obstruction. The ureteral stent is removed within two weeks, after the stone particles have possibly passed out. The patient may complain of moderate to severe colicky pain during the postoperative period. Surgery may be required only if a stone is large or positioned in the mid or distal ureter. Surgery may also be considered for patients with complications like pain, infection, and obstruction. p. 1079

A patient is being treated with radioactive iodine ( 131I) for thyroid cancer. With which major source of contamination from this patient should the nurse take precautions? Urine Feces Blood Sputum

Urine Urine is the major source of contamination with this form of radioactive treatment. The nurse must be careful in handling bedpans, urinals, and linens and apply standard radiation precautions of time, distance, and shielding. Feces, blood, and sputum tend to contain lower levels of radiation contamination, but they should also be handled with the use of standard precautions. p. 264

A nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find what clinical manifestations as the "classic triad" occurring in patients with renal cancer? Fever, chills, flank pain Hematuria, flank pain, palpable mass Hematuria, proteinuria, palpable mass Flank pain, palpable abdominal mass, and proteinuria

Hematuria, flank pain, palpable mass There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease. Fever, chills, and proteinuria are not signs of renal carcinoma. p. 1084

A patient with multiple myeloma is prescribed bisphosphonate and hydration therapy. Which complication is being treated by these medications? Hypercalcemia Third space syndrome Spinal cord compression Superior vena cava syndrome

Hypercalcemia Bisphosphonate and hydration therapy are prescribed to treat hypercalcemia in a patient with multiple myeloma. Bisphosphonate and diuretics will not provide effective treatment for patients with third space syndrome, spinal cord compression, or superior vena cava syndrome. p. 278

When examining a patient with glomerulonephritis, which clinical characteristics is the nurse likely to find? Hypertension Nausea and vomiting Dysuria, fever, and chills Generalized body edema Hematuria and smoky urine

Hypertension Generalized body edema Hematuria and smoky urine Hypertension can result from increased extracellular fluid volume due to decreased glomerular filtration. Generalized body edema is observed due to fluid retention, which occurs as a result of decreased glomerular filtration; initially, periorbital edema is noted, but later it progresses to involve the total body as ascites or peripheral edema in the legs. Hematuria and smoky urine can be observed due to bleeding in the upper urinary tract. Nausea and vomiting are commonly caused by pain associated with urinary tract infections and calculi. Dysuria, fever, and chills are noted in urinary tract infections and calculi. p. 1074

A patient is suspected to have acute glomerulonephritis. The nurse is evaluating the causes and risk factors for glomerulonephritis in this patient. Which patient factors would the nurse anticipate contributed to acute glomerulonephritis? Hypertension Chlamydial infection Streptococcal throat infection Human immunodeficiency virus (HIV) Neurogenic hypersensitivity of the lower urinary tract

Hypertension Streptococcal throat infection Human immunodeficiency virus (HIV) Hypertension can cause scarring and nephrosclerosis, which can lead to glomerulonephritis. Streptococcal throat infection can lead to acute poststreptococcal glomerulonephritis (APSGN), which is a common type and develops 5 to 21 days after an infection of the tonsils or pharynx by nephrotoxic strains of group A β-hemolytic streptococci. Viruses, such as HIV, can trigger glomerulonephritis. Chlamydial infection causes urethritis, which is an inflammation of the urethra. Neurogenic hypersensitivity of the lower urinary tract is the cause of interstitial cystitis or painful bladder syndrome. pp. 1073-1074

A patient has glomerulonephritis. The nurse recalls that which common complications of the disorder tend to recur frequently? Fever and edema Urinary tract infections Hypertension and edema Upper respiratory infections

Hypertension and edema Hypertension and edema, along with headaches and oliguria, are common complications of glomerulonephritis and tend to recur. Fever, UTI, and upper respiratory infections are not primarily associated with glomerulonephritis. p. 1074

A patient with cancer is receiving massive doses of chemotherapeutic agents. The nurse reviews the patient's laboratory results to assess for which findings that suggest the development of tumor lysis syndrome (TLS)? Hypokalemia Hyponatremia Hypercalcemia Hyperuricemia Hyperphosphatemia

Hyperuricemia Hyperphosphatemia Tumor lysis syndrome is a metabolic change that occurs whenever a tumor sensitive to chemotherapy is subjected to chemotherapeutic agents. It is characterized by hyperuricemia and hyperphosphatemia. Hyperkalemia is associated with tumor lysis syndrome, but not hypokalemia. Tumor lysis syndrome is not associated with hyponatremia. In tumor lysis syndrome there is hypocalcemia, but not hypercalcemia. p. 278

Vincristine

IV only, vesicant vinca alkaloid, blocks mitosis during metaphase used in lymphomas, leukemia, bladder cancer S/E: neurotoxicity, alopecia,

A nurse is describing the characteristics of neoplastic cells to a patient. Which information will the nurse include in the teaching session? Immortality Noninvasive growth Persistent proliferation Formation of metastases Progressively shorter telomeres

Immortality Persistent Proliferation Formation of metasteses Cancer cells have immortality, persistent proliferation, and the ability to metastasize. They also have invasive growth and preserve or extend telomere length. pp. 1207, 1208-Lehne

Stage 2 CKD

Kidney damage with mildly lower GFR (60-89)

Stage 5 CKD

Kidney failure, GFR<15, indicates renal replacement therapy (dialysis if uremia present and patient desires)

Filgrastim (Neupogen)

Leukopoietic works in bone marrow to increase neutrophils used in patients undergoing myelosupressive chemotherapy, bone marrow transplantation

The nurse anticipates that which procedure will be prescribed as a therapeutic medical intervention for renal calculi? Myelogram Lithotripsy Renal sonogram Intravenous pyelogram

Lithotripsy Lithotripsy (also known as extracorporeal shock wave) is a noninvasive therapeutic treatment in which high-energy shock waves are used to crush or pulverize renal calculi in the renal pelvis, ureter, and bladder. Once crushed into smaller particles, the calculi can be more easily eliminated from the genitourinary tract with the aid of increased fluids and pain medication. The myelogram is a neurologic diagnostic procedure most commonly used for spinal issues. The renal sonogram and intravenous pyelography are diagnostic tools for renal problems, but they are not medical interventions. p. 1079

A patient is diagnosed with acute poststreptococcal glomerulonephritis. On examination, the nurse finds that the patient is hypertensive and has edema and increased blood urea nitrogen (BUN) levels. What type of diet should the nurse plan for this patient? Low-protein diet Low-sodium diet Fluid-restricted diet Nonvegetarian diet Increased fruit juices

Low-protein diet Low-sodium diet Fluid-restricted diet A low-protein diet should be maintained. An elevation in BUN is evidence of an increase in nitrogenous wastes in the patient. A low-sodium diet is necessary to control the patient's edema; this edema is due to decreased glomerular filtration. A fluid-restricted diet will also help control fluid retention, because the patient has edema. A nonvegetarian diet is not advisable, because it is rich in protein; the patient has elevated BUN levels and a low-protein diet should be maintained. Increased fruit juices should be avoided, because the increased fluid intake and additional sodium may exacerbate edema and fluid retention. p. 1074

Stage 3 CKD

Moderately lowered GFR (30-59)

A patient with ovarian cancer is receiving radiation therapy. A nurse finds that the patient has developed anemia as a side effect of radiation therapy. How should the nurse manage anemia in the patient? Monitor hemoglobin and hematocrit levels. Monitor WBC count, especially neutrophils. Administer iron supplements and erythropoietin. Promote foods that increase hemoglobin levels. Teach the patient to avoid large crowds and people with infections.

Monitor hemoglobin and hematocrit levels.. Administer iron supplements and erythropoietin. Promote foods that increase hemoglobin levels.

The nurse is reviewing the laboratory reports of a patient with cancer and anticipates that the patient is at an increased risk for infection. Which finding supports this conclusion? Anemia Neutropenia Hyperkalemia Hyponatremia

Neutropenia Neutropenia, or a decreased white blood cell count, indicates that the patient at risk for infection. Anemia is a complication associated with chemotherapy; anemia does not indicate that the patient has infection. Hyperkalemia and hyponatremia also do not indicate infection. p. 277

Lymphomas: non-Hodgkin's vs. Hodgkin's,

Non-hodgkin's -B lymphocytes (85%), T lymphocytes (15%), disseminated, b symptoms in 40%, extranodal involvement common Hodgkins -B lymphocytes, localized to regional, B symptoms common, extranodal involvement, onset typically insidious

Kidney Cancer nursing & IP management, nephrectomy

Nursing & IP management -prevention: quitting smoking, maintaining healthy weight, BP control, avoid exposure to toxins -partial or radical nephrectomy, ablation, radiation, chemo, biologic & targeted therapy Nephrectomy -partial or radical -must have one working kidney to maintain normal renal function -postop: output q1-2h, daily weights, cough, turn, deep breathe, IS q2h, pain management, restrict oral intake until bowel sounds present

A patient is diagnosed with constriction of the pericardium by a tumor. Which treatment plan would be beneficial to the patient? Oxygen therapy Vasopressor therapy Corticosteroid therapy Decompressive laminectomy Indwelling pericardial catheter

Oxygen therapy Vasopressor therapy Indwelling pericardial catheter A patient with a constriction of the pericardium by a tumor will have cardiac tamponade, which is characterized by shortness of breath, tachycardia, excess perspiration, and reduced consciousness. Oxygen therapy is used to improve oxygenation. Vasopressor therapy is used to improve cardiac output. Indwelling pericardial catheters can reduce constriction and pain caused by the tumor. Corticosteroid therapy and decompressive laminectomy will help to reduce spinal cord compression caused by a tumor but not by cardiac tamponade. p. 278

Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? Help the patient cope with the rapid progression of the disease. Suggest genetic counseling resources for the children of the patient. Expect the patient to have polyuria and poor concentration ability of the kidneys. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

PKD is one of the most common genetic diseases and genetic counseling should be suggested. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD. pp. 1082-1083

Which characteristic of cancer cells can be described as "unresponsiveness to feedback mechanisms that control cellular growth in healthy tissue?" Invasive growth Telomerase activity Persistent proliferation Formation of metastases

Persistent proliferation Persistent proliferation is a characteristic of malignancy in which cells are able to continue multiplying under conditions that would suppress further growth and division of normal cells. Metastases arise when malignant cells form in areas distant from the site of origin to form new cancers. Invasive growth describes a condition in which malignant cells are free of constraints that inhibit invasion to adjacent tissue. Telomerase is an enzyme, and its activity allows for infinite cellular divisions in cancer cells. This activity is rarely expressed in normal cells. p. 1207

The ____________________________ is present in 90 to 95 percent of patients with chronic myelogenous leukemia.

Philadelphia chromosome

The nurse reviews laboratory reports of a patient with kidney tumor and finds that the patient's serum calcium levels are 12 mg/dL. Which symptoms would the nurse find in the patient? Polyuria Nocturia Anorexia Hypotension Muscle weakness Low central venous pressure

Polyuria Nocturia Anorexia Muscle weakness A patient with a kidney tumor has serum calcium levels of 12 mg/dL; this indicates that the patient has hypercalcemia. The patient may experience polyuria, nocturia, anorexia, and muscle weakness as a result. A patient with third space syndrome will have septic shock; this condition may result in hypotension and low central venous pressure. p. 279

A patient with lung cancer develops headaches, facial edema, periorbital edema, and distention of the veins in the head, neck, and chest. The nurse expects that what will be included in the patient's treatment plan? Prepare the patient for radiation therapy. Administer a narcotic and reassure the patient. Administer a diuretic agent and reassure the patient. Inform the patient that chemotherapy may be required. Inform the patient that the symptoms are due to obstruction of the bronchus.

Prepare the patient for radiation therapy. Inform the patient that chemotherapy may be required. A lung cancer patient who presents with headaches, facial edema, periorbital edema, and distension of veins of the head, neck, and chest is indicative of superior vena cava syndrome. Management of this condition involves treating the patient with localized radiation therapy. If the cancer is sensitive to drugs, then the patient may also be treated with chemotherapy. Superior vena cava syndrome is a medical emergency, hence, just administering a pain killer and diuretic will only provide symptomatic relief without any effect on disease progression. Superior vena cava syndrome is due to obstruction of the superior vena cava and not the bronchus. p. 277

Which treatment does the nurse expect for a patient who presents with hematuria, flank pain, and a palpable mass in the abdomen? Ileal conduit Marsupialization Radical nephrectomy Cystoscopic lithotripsy Radiofrequency ablation

Radial nephrectomy Radiofrequency ablation Hematuria, flank pain, and palpable mass in the abdomen are common clinical manifestations of renal cancer. Radical nephrectomy involves removal of a kidney, the adrenal gland, and part of the ureter. Radiofrequency ablation involves destroying a tumor by using heat from radiofrequency. Ileal conduit is a surgical urinary diversion used to treat painful bladder syndrome. Marsupialization is a creation of a permanent opening of a diverticular sac in the vagina. Cystoscopic lithotripsy uses an ultrasonic lithotrite to pulverize a renal stone. p. 1084

Which diagnostic study can be used to diagnose suspected metastases due to renal tumors? Ultrasound Computed tomography (CT) Radionuclide isotope scanning Magnetic resonance imaging (MRI)

Radionuclide isotope scanning Radionuclide isotope scanning is used to detect metastases when cancer spreads from one part of the body to another. Ultrasound examination is a diagnostic procedure and has the ability to differentiate solid mass tumors and cysts. CT is used in the diagnosis and detection of small kidney tumors. MRI is used to detect renal tumors. p. 1084

When caring for a patient undergoing chemotherapy, which nursing measures should the nurse take to manage fatigue in the patient? Reassure the patient that fatigue is a common side effect. Pace activities in accordance with energy level. Encourage strenuous exercise to build strength. Encourage the patient to be active even when tired. Maintain usual lifestyle patterns as much as possible.

Reassure the patient that fatigue is a common side effect. Pace activities in accordance with energy level. Maintain usual lifestyle patterns as much as possible. Fatigue is common during cancer treatment, and the patient can be helped to manage it. The nurse should reassure the patient that fatigue is a side effect of treatment that may subside once the treatment is over. Energy-conserving strategies should be adopted, and the patient should pace activities in accordance with his or her energy level, resting when necessary. The patient should maintain usual lifestyle patterns as much as possible and avoid strenuous exercise, instead doing mild or moderate exercise, if possible. p. 265

Allopurinol (Zyloprim)

Reduces uric acid blood levels used for hyperuricemia secondary to chemo, leukemia, gout, kidney calculi S/E: rash or fever(sign of serious adverse reaction), GI reactions, metallic taste, cataracts w/ prolonged use

Which is the most beneficial diagnostic tool to diagnose the condition of a patient admitted with fibromuscular hyperplasia who is suspected of having partial occlusion of one of the renal arteries? Renal ultrasound Renal arteriogram Computed tomography (CT) Magnetic resonance imaging (MRI)

Renal arteriogram Partial occlusion of one of the renal arteries indicates renal stenosis, which is caused by fibromuscular hyperplasia. A renal arteriogram is the most beneficial diagnostic tool to diagnose renal stenosis. Renal ultrasound, CT, and MRI are also used to diagnose renal stenosis but are considered to be of secondary importance. p. 1082

The nurse is providing care for a patient who underwent kidney transplantation surgery two days ago. An appropriate roommate to cohort with the postoperative patient is the patient with a diagnosis of: Hepatitis C Renal calculi Osteomyelitis Bronchial pneumonia

Renal calculi A patient who has had a kidney transplant will be undergoing immunosuppressive therapy and ideally should be in a private room. However, if a roommate is necessary, someone with renal calculi would be least likely to possess an infectious organism that could be spread to the immunocompromised transplant patient. A patient with hepatitis C, osteomyelitis, or bronchial pneumonia is not an appropriate roommate because of the risk of infection. p. 1079

The nurse is caring for a cancer patient and finds that the patient has tumor lysis syndrome. Which other condition should the nurse check for? Renal failure Cardiac arrest Venous thrombosis Rheumatoid arthritis

Renal failure Tumor lysis syndrome occurs when large numbers of neoplastic cells are killed rapidly due to chemotherapy. This cellular destruction is characterized by a rapid development of hyperuricemia and hyperphosphatemia, and can lead to acute renal failure. Cardiac arrest and rheumatoid arthritis are not common complications with tumor lysis syndrome. Venous thrombosis would occur with a patient who has a tumor in the superior vena cava. p. 278

When teaching a patient about the ways to manage nephrotic syndrome, which instructions should the nurse include? Restrict dietary salt intake. Increase daily water intake. Consume calorie-rich and heavy meals. Clean edematous skin carefully. Avoid exposure to infected persons.

Restrict dietary salt intake Clean edematous skin carefully Avoid exposure to infected persons Restriction of dietary salt intake is necessary to control edema caused by fluid retention. Clean edematous skin carefully, because the fluid retention means that any trauma to the skin should be avoided. Because the patient with nephrotic syndrome is susceptible to infections, the patient should avoid exposure to persons with known infections. Increased daily water intake is not recommended due to fluid retention; a fluid-restricted diet is advised. Patients with nephrotic syndrome are usually anorexic and can become malnourished from the excessive loss of protein in the urine. Small, frequent meals in a pleasant setting should be encouraged for better dietary intake. pp. 1075-1076

RIFLE

Risk Injury Failure Loss End-stage kidney disease

Skin cancer: risk factors, compare basal cell carcinoma, squamous cell carcinoma, and melanoma

Risk factors -sun exposure, fair skin, family history, tar exposure, systemic arsenicals, living near equator, Basal cell carcinoma -locally invasive malignancy arising from epidermal basal cells -most common skin cancer, least deadly Squamous Cell Carcinoma -malignant neoplasm of keratinizing epidermal cells -can be highly aggressive, has the potential to metastasize, and may lead to death if not treated early and correctly Melanoma -tumor arising in melanocytes, which are the cells producing melanin -causes majority of skin cancer deaths, can metastasize to any organ

The nurse should recognize that a high tissue growth fraction allows chemotherapeutic medications to be more toxic to tissues in which phases of the cell cycle? S G 1 G 0 M G 2

S G 1 M G 2 Active phases of the cell cycle in which mitotic division are carried out are G 1, S, G 2, and M. Cells that enter G 0 become mitotically dormant (resting) and are not active participants in the cell cycle. Cytotoxic agents are more active against proliferating cells than they are against cells in G 0. The ratio of proliferating cells to G 0 cells is called the growth fraction . A tissue with a large percentage of proliferating cells and few cells in G 0 has a high growth fraction. pp. 1208-1209

Which treatment strategy is most effective for treating bone pain? Samarium-153 Antiseizure drugs Acetaminophen Antidepressant drugs

Samarium-153 Samarium-153 is a radiopharmaceutical that diffuses bone pain effectively. Antiseizure medications are used to treat neuropathic pain. Acetaminophen is a nonsteroidal antiinflammatory drug that reduces visceral pain. Antidepressant drugs are used in adjuvant therapy and are effective for neuropathic pain. p. 279

Which are immune diseases that cause glomerulonephritis? Scleroderma Diabetic nephropathy Goodpasture syndrome Wegener's granulomatosis Systemic lupus erythematosus (SLE)

Scleroderma Goodpasture syndrome Systemic lupus erythematous (SLE) Scleroderma, Goodpasture syndrome, and SLE are immune diseases that cause glomerulonephritis. Diabetic nephropathy results in scarring of glomeruli. Wegener's granulomatosis is a form of vasculitis that causes glomerulonephritis. p. 1073

Stage 4 CKD

Severe lowered GFR (15-29)

Fluid balance management CKD

Sodium - 2-4 g/day Fluid restriction HD 600 mL + previous day urine output

The nurse prepares to discharge a patient who has a renal calculus. What is the most important instruction for the nurse to include in the patient's teaching? Maintain bed rest. Continue a clear-liquid diet. Strain all urine at home for stones. Perform relaxation exercises to ease pain.

Strain all urine at home for stones. The renal calculus could pass after the patient is discharged and be expelled in the urine. Laboratory analysis of the stone reveals the exact contents and will guide further treatment. Bed rest is not recommended or necessary. A clear-liquid diet may not be necessary if the patient can tolerate the usual diet. Having the patient perform relaxation exercises to ease pain is secondary in importance to straining the urine. p. 1081

Acute glomerulonephritis is associated with which microorganism

Strep- causes permeability change which causes proteinuria, edema, oliguria (small amt's of urine), hematuria w/ smoky or rusty color, HTN

A nurse is caring for a patient with metastatic breast cancer. The nurse finds that the patient has developed facial and periorbital edema, and has distention of veins of the face, neck, and chest. What condition do these findings indicate to the nurse? Spinal cord compression Third space syndrome Superior vena cava syndrome Tumor lysis syndrome

Superior vena cava syndrome Superior vena cava syndrome (SVCS) is an obstructive emergency. There can be many causes, including lung cancer, metastatic breast cancer, and non-Hodgkin's lymphoma. In these instances, SVCS results due to the obstruction of the superior vena cava by a tumor or thrombosis. Spinal cord compression is also an obstructive emergency caused by a malignant tumor in the epidural space of the spinal cord. It can be caused by breast, lung, prostate, GI, and renal tumors and melanomas. Third space syndrome is an obstructive emergency caused by the shifting of fluid from the vascular space to the interstitial space. It may occur due to extensive surgical procedures, biologic therapy, or septic shock. Tumor lysis syndrome is a metabolic emergency caused by rapid release of intracellular components in response to chemotherapy. p. 277

Which statements regarding treatment modalities for cancer should the nurse identify as true? Irradiation is the treatment of choice for leukemias. Surgery is the most common treatment for solid cancers. Drug therapy is the treatment of choice for disseminated cancers. Drug therapy is not effective in treating a patient with cancer who has had surgery. Drug therapy is effective as an adjunct therapy in treating a patient who has had irradiation.

Surgery is the most common treatment for solid cancers. Drug therapy is the treatment of choice for disseminated cancers. Drug therapy is effective as an adjunct therapy in treating a patient who has had irradiation. Surgery is the most common treatment for solid cancers, drug therapy is the treatment of choice for disseminated cancers, and drug therapy plays an important role as an adjunct to surgery and irradiation. Drug therapy is the treatment of choice for disseminated cancers such as leukemias. Drug therapy is effective in treating a patient with cancer who has had surgery. p. 1206-Lehne

_______________________ involves obtaining stem cells from one identical twin and infusing them into the other.

Syngeneic transplantation

Which underlying cause does the nurse expect in a patient who presents with hematuria, red blood cell casts, and proteinuria? Hodgkin's lymphoma Obstructive uropathies Focal glomerulonephritis Systemic lupus erythematosus (SLE) Acute poststreptococcal glomerulonephritis (APSGN)

Systemic lupus erythematosus (SLE) Acute poststreptococcal glomerulonephritis (APSGN) Hematuria, red blood cell casts, and proteinuria are clinical manifestations of rapidly progressive glomerulonephritis (RPGN). SLE and APSGN are underlying causes of RPGN. Hodgkin's lymphoma is a form of neoplasm that causes nephrotic syndrome. Obstructive uropathies cause polycystic kidney disease (PKD). Focal glomerulonephritis is a primary glomerular disease that results in nephrotic syndrome. p. 1074

vascular access hemodialysis

Temporary catheters Arteriovenous (AV) fistulas Grafts nursing management: -Monitor for patency -Keep patent -Prevent infection

The nurse is reviewing the role of the immune system in cancer development. Which of these statements explains the primary protective role of the immune system related to malignant cells? Immune cells bind with free antigen released by malignant cells. Immune cells produce blocking factors that immobilize cancer cells. The immune system produces antibodies that attack the cancer cells. The immune system provides surveillance for cells with tumor-associated antigens (TAAs).

The immune system provides surveillance for cells with tumor-associated antigens (TAAs). It is believed that one of the functions of the immune system is to respond to TAAs, which are altered cell-surface antigens that occur on a cancer cell as a result of malignant transformation. This immune function is known as immunologic surveillance. Immune cells do not bind with free antigens released by malignant cells, nor do they produce blocking factors that immobilize cancer cells. The immune system does not produce antibodies to attack cancer cells. pp. 252-253

Which finding indicates a positive outcome from treatment with filgrastim [Neupogen]? Bone pain is eliminated. The cancer goes into remission. The neutrophil count increases. The red blood cell count increases.

The neutrophil count increases. Filgrastim is a granulocyte colony-stimulating factor that is used to promote neutrophil recovery in cancer patients after myelosuppressive chemotherapy or bone marrow transplantation. It also is used to treat severe chronic neutropenia. Bone pain is a side effect of the drug. The drug is not a treatment for the cancer itself. Red blood cells are not increased. p. 659

The nurse is reviewing the medical record of a patient who has been newly diagnosed with testicular cancer. When considering the goal of curing cancer, the treatment is based on which of these principles? Surgery will be the single most effective treatment. Therapy will include a combination of treatment modalities. The risk for recurrent disease is lowest after treatment completion. Chemotherapy most often is tried as the initial treatment for most cancers.

Therapy will include a combination of treatment modalities. When cure is the goal, treatment is expected to have the greatest chance of disease eradication. Curative cancer therapy differs according to the particular cancer being treated and may involve local therapies (i.e., surgery or radiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy). In general, the risk for recurrent disease is highest after treatment completion, and gradually decreases the longer the patient remains disease free following treatment. Chemotherapy is not always the initial treatment for cancer. p. 257

A cancer patient is receiving a combination of cancer drugs. How should the nurse interpret this finding? The patient is terminal. The patient has an infection. This activates P-glycoprotein. This prevents drug resistance.

This prevents drug resistance. Drug resistance occurs less frequently with multiple-drug therapy than with single-drug therapy. One mechanism of resistance—cellular production of a drug transport molecule known as P-glycoprotein—can confer multiple drug resistance upon cells; activation of P-glycoprotein would make drug resistance worse. The nurse would not conclude that the patient is terminal or has an infection when combination chemotherapy is used. p. 1212-Lehne

Why would a nurse administer epidural analgesia to a patient with cancer? To increase urine production To minimize the use of opioid drugs To increase the effectiveness of furosemide To minimize the risk of false calcium levels

To minimize the use of opioid drugs Epidural analgesia minimizes the use of opioids in patients with cancer to relieve pain. Hydration therapy increases urine production and reduces the risk of hyperurecimia. Furosemide is not dependent on analgesic drugs. Low albumin levels in the blood cause false calcium levels; these levels will not be reduced by epidural analgesia. p. 279

Hyperkalemia treatment

To remove excess potassium: kayexalate (don't give to pt.'s with ileus, will lead to bowel necrosis) To shift potassium temporarily: IV insulin (IV glucose to prevent hypoglycemia) To prevent ventricular lethal rhythms: IV 10% calcium gluconate

A patient has undergone a lithotripsy procedure and is at risk of obstruction of the ureter by edema. Which catheter should be used for preventing obstruction of the ureter? Urethral catheter Suprapubic catheter Ureteral catheter Nephrostomy catheter

Ureteral catheter A ureteral catheter is used after surgery to splint the ureters and to prevent them from being obstructed. Urethral catheters are the most commonly used catheters. The urethral catheter is inserted through the external meatus, to the urethra, past the internal sphincter, and into the bladder. A suprapubic catheter is placed while the patient is under general anesthesia. A nephrostomy catheter is inserted on a temporary basis to preserve renal function when the ureter is completely obstructed. p. 1094

What are factors that increase urinary stasis?

Urinary retention Renal impairment Urinary tract calculi

A patient from a long-term care facility is admitted to the medical unit with pyelonephritis. What is a common cause of pyelonephritis for patients residing in long-term care facilities? Urinary tract catheterization Fever Gram-negative bacilli Urethral trauma from childbearing

Urinary tract catheterization For residents of long-term care facilities, urinary tract catheterization is a common cause of pyelonephritis. Fever is a symptom of pyelonephritis, but does not cause it. Gram-negative bacilli cause urinary tract infections, not pyelonephritis. Urethral trauma from childbearing can cause urethral diverticula, not pyelonephritis. p. 1069

The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving prescriptions, what should the nurse do? Keep the patient on bed rest Use 5 mL of sterile saline to irrigate Use 30 mL of water to gently irrigate Have the patient turn from side to side

Use 5 mL of sterlie saline to irrigate With a nephrostomy tube, if the tube is occluded and irrigation is prescribed, the nurse should use 5 mL or less of sterile saline to irrigate it gently. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency. p. 1094

The nurse is caring for a patient who has mild thrombocytopenia after chemotherapy. Which action should the nurse take? Administer a colony-stimulating factor. Take the pulse before and after activity. Obtain blood cultures and then begin antibiotic therapy. Use minimal cuff inflation when taking the blood pressure.

Use minimal cuff inflation when taking the blood pressure. Thrombocytopenia, a reduction in circulating platelets, increases the risk for bleeding. Routine procedures such as blood pressure readings should be performed with care and only as needed, because overinflation of the cuff may cause bruising. Taking the pulse before and after activity may be done to assess a patient's response to anemia. Administering a colony-stimulating factor and obtaining blood cultures are appropriate nursing actions for a patient with neutropenia. p. 1215-Lehne

Sodium polystyrene sulfonate (Kayexalate)

Used in treatment of hyperkalemia absorbs potassium PO or rectal administration

Pyuria

WBC in the urine

A patient has a history of calcium phosphate renal calculi. The nurse provides teaching about recommended food choices. The patient says, "So I need to eat foods low in calcium like yogurt, oranges, chicken, cranberry juice, spinach, eggs..." Which of the patient's food choices, indicate that further instruction is required? Eggs Yogurt Oranges Chicken Spinach Cranberry juice

Yogurt Spinach Milk and milk products are the richest sources of calcium. Dark-green leafy vegetables are also high in calcium. The choice of yogurt and spinach demonstrates that the patient lacks knowledge about a calcium-restricted diet. Oranges, chicken, cranberry juice, and eggs do not contain high levels of calcium and are therefore not restricted from the patient's diet. p. 1080

Absolute neutrophil count normal range

above 1000

Hypercellular bone marrow with lymphoblasts indicates ________________________________________.

acute lymphocytic leukemia

An _________________________ involves obtaining stem cells from a donor who is human leukocyte antigen (HLA) matched to the patient. It can be a family member or a donor from a bone marrow registry.

allogeneic transplantation

Hydroxyurea

anticancer agent Used in chronic myelogenous leukemia, squamous cell carcinoma, relieves symptoms of sickle cell anemia SE: bone marrow supression, N/V, dysuria

A _______________ returns blood from the dialyzer back to the patient.

blue catheter lumen

Sevelamer (Renagel)

calcium free Phosphate binder for patients on renal dialysis cost much more than calcium based phosphate binder but eliminates risk of hypercalcemia also binds with bile salts in intestine to decrease synthesis of cholesterol

renal arteriogram

catheter is inserted into the femoral artery and passed up the aorta to the level of the renal arteries. Contrast media is injected to outline the renal blood supply Partial occlusion of one of the renal arteries indicates renal stenosis, which is caused by fibromuscular hyperplasia. A renal arteriogram is the most beneficial diagnostic tool to diagnose renal stenosis.

AKI causes, CMs, phases (staging?), hyperkalemia management, nursing management

causes -prerenal: severe dehydration, HF, decreased cardiac output -intrarenal: prolonged ischemia, nephrotoxins, hemoglobin, myoglobin, acute tubular necrosis (most common) -postrenal: mechanic obstruction, BPH, prostate cancer, calculi, trauma, extrarenal tumors CMs -affects the whole body: urinary, cardiovascular, respiratory, GI, hematologic, neurologic, and metabolic deficits phases -oliguric: oliguria, occurs 1-7 days after injury, last about 10-14 days, urinalysis may show WBCs, casts, RBCs, specific gravity fixed at 1.010 & urine osmolality at about 300, hypovolemia, hypotension, metabolic acidosis, hyponatremia, hyperkalemia, leukocytosis, BUN & creatinine elevated, asterixis -diuretic: urine output is typically 1-3L caused by osmotic diuresis, hypovolemia, hypotension. Monitor for hyponatremia, hypokalemia, and dehydration, may last 1-3 weeks. -recovery: begins when GFR increases, kidney functions may take up to 12 months to stabilize completely hyperkalemia management -monitor ECG got peaked T waves, widening of QRS complex, and ST segment depression -dietary restriction of K+ -To remove excess potassium: kayexalate (don't give to pt.'s with ileus, will lead to bowel necrosis) -To shift potassium temporarily: IV insulin (IV glucose to prevent hypoglycemia) -To prevent ventricular lethal rhythms: IV 10% calcium gluconate -hemodialysis if severe or other therapies not effective nursing management -treat precipitating cause, fluid restriction (600 mL plus 24-hr fluid loss), adequate protein intake, potassium, phosphate, and sodium restriction, manage hyperkalemia, phosphate binding agents, enteral/parenteral nutrition, dialysis &/or CRRT is necessary

chronic glomerulonephritis will lead to ________ _________ ________

chronic renal failure

CKD compare to AKI, CMs, nursing management & interprofessional care, dietary restrictions, patient and caregiver teaching

compare to AKI -onset gradual, most common cause diabetic nephropathy, progressive & irreversible, primary cause of death cardiovascular disease -diagnostic criteria: GFR <60 for >3 mo &/or kidney damage > 3 mo nursing management & IP care -correct extracellular fluid volume overload or deficit, nutritional therapy, erythropoietin, calcium supplements, phosphate binders, antihypertensives, ACE inhibitors or ARBs, treat hyperlipidemia, hyperkalemia, adjust drug dosage to renal function, RRT dietary restrictions -Table 47-10, 47-11 pt. & caregiver teaching -diet, drugs, follow-up care, avoid OTC drugs like NSAIDs, aluminum & magnesium-based laxatives and antacids. daily weights and BPs, Phosphate binders should be taken with meals, Calcium supplements prescribed to treat hypocalcemia directly should be taken on an empty stomach (but not at the same time as iron supplements), Iron supplements should be taken between meals.

Biopsy purpose

determine grade of abnormal cells Grade I-IV

Most specific indicator of UTI in urinalysis

nitrates also check for casts, RBC, WBC

Anuria

no urine output in 24 hours

KUB

nonconstrast spiral CT (kidneys, ureters, bladders) used most commonly in patients with renal colic

Bladder Cancer nursing & IP management, transurethral resection, radical cystectomy, intravesical chemo

nursing & IP management -determine grade and stage, intravesical chemo, transuretheral resection of the bladder tumor (TURBT), segmental cystectomy, radical cystectomy, radiatiation and chemo, transurethral resection -used for superficial lesions -A wire loop inserted through the cystoscope is used to cauterize (with electric current or laser) and kill the cancer cells. radical cystectomy: urinary diversions -involves removal of bladder, prostate, and seminal vesicles (men) bladder, ureter, cervix, urethra, ovaries (women) -types of diversions: -incontinent (to the skin) most common is ileal conduit -disadvantages: visible stoma and need for external collection device -continent (intraabdominal reservoir): Kock, Mainz, Indiana, and Florida pouches -disadvantages: need to self catheterize q4-6h intravesical chemo -usually initiated at weekly intervals for 6 to 12 weeks -instilled directly into the patient's bladder and retained for about 2 hours (must be empty before, change position q15 min after) -irritative voiding symptoms and hemorrhagic cystitis occur after

Oncologic emergencies

obstructive emergencies, superior vena cava syndrome, spinal cord compression, third space syndrome

analgesic medication for UTI

phenazopyradine (pyridium) S/E: red or orange urine, this is ok

Doxorubicin (Adriamycin)

potent chemo, used in severe bladder cancer, lymphomas, S/E: cardiotoxicity (acute & delayed), N/V, neutropenia, thrombocytopenia, anemia

Sickle cell anemia: prevention of sickling episodes, CMs of sickling, complications

prevention -prevent hypoxia, deoxygenation, educate pt. to wash hands to avoid infection, avoid high altitudes, & blood loss CM -pallor (check mucous membrane in dark skinned pts), grayish cast, jaundice, gallstones, pain, fever, swelling, tenderness, tachypnea, hypertension, N/V Complications -infection, acute chest syndrome (pneumonia, tissue infarction, fat embolism), chronic leg ulcers, priapism (persistent penile erection)

what will urinalysis show in glomerulonephritis?

protein

A _________________________ is used to withdraw blood from the patient and send it to the dialyzer for purification.

red catheter lumen

Urinary tract calculi risk factors, CMs, management, nursing management

risk factors -increased levels of calcium, oxaluric acid (tea & fruit juices), uric acid (dietary protein), or citric acid in urine, dehydration, family history, sedentary lifestyle CMs -severe pain with sudden onset in the flank area, back, or lower abdomen (called renal colic), kidney stone dance -N/V, dull CVP if obstruction at calyx or UPJ -may be in mild shock, testicular pain, labial pain, groin pain, UTI manifestations management -treat pain (opioids), infection, and/or obstruction, tamsulosin or terazosin, identify risk factors -struvite stones: infection control, antibiotics, acetohydroxamic acid -endurologic, lithotropsy, or open surgical stone removal (>7cm, bacteriuria or symptomatic infection, impairing renal function, causing persistent pain, nausea, paralytic ileus, cannot be treat medically, pt. only has one kidney) nursing management -avoid high purine, calcium, or oxalate content, drink adequate fluid

Ondansetron (Zofran)

serotonin receptor agonist, antiemetic used in prophylactic treatment of N/V in cancer pt's S/E: QT interval prolongation, dizziness, diarrhea

Causative agents of glomerulonephritis

streptococcus staphylococcus

Leukemia: types, CMs

types (table 31-25) -acute myelogenous: onset abrupt & dramatic, uncontrolled proliferation of myeloblasts, hyperplasia of bone marrow -acute lymphocytic: most common in children, lymphocytes proliferate in bone marrow, CNS manifestations -chronic myelogenous: excessive development of mature neoplastic granulocytes in bone marrow, move into peripheral blood and infiltrate liver and spleen -chronic lymphocytic: chronic fatigue, anorexia, splenomegaly, lymphadenopathy, hepatomegaly, fever, night sweats, weight loss, fatigue, frequent infections

Tumor angiogenesis

when a tumor creates it's own blood supply