Unit15

4. A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, "What can I do to help prevent these infections?" How should the nurse respond? a. "Test your urine daily for the presence of ketone bodies and proteins." b. "Use tampons rather than sanitary napkins during your menstrual period." c. "Drink more water and empty your bladder more frequently during the day." d. "Keep your hemoglobin A1c under 9% by keeping your blood sugar controlled."

ANS: C Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client's sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A1c of 9% is too high.

10. The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub? a. Registered nurse who just floated from the surgical unit b. Registered nurse who just floated from the dialysis unit c. Registered nurse who was assigned the same client yesterday d. Licensed practical nurse with 5 years' experience on this floor

ANS: C The client is exhibiting symptoms of pericarditis, which can occur with chronic kidney disease. Continuity of care is important to assess subtle differences in clients. Therefore, the registered nurse (RN) who was assigned to this client previously should again give care to this client. The float nurses would not be as knowledgeable about the unit and its clients. The licensed practical nurse may not have the education level of the RN to assess for pericarditis.

28. A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L Potassium 5 mEq/L Blood urea nitrogen (BUN) 44 mg/dL Serum creatinine 2.5 mg/dL What initial intervention would the nurse anticipate? a. Start hemodialysis immediately. b. Discuss the need for peritoneal dialysis. c. Increase the dose of immunosuppression. d. Return the client to surgery for exploration.

ANS: C The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute rejection of the transplanted kidney. The client does not need hemodialysis, peritoneal dialysis, or further surgery at this point.

3. A nurse reviews laboratory results for a client with glomerulonephritis. The client's glomerular filtration rate (GFR) is 40 mL/min as measured by a 24-hour creatinine clearance. How should the nurse interpret this finding? (Select all that apply.) a. Excessive GFR b. Normal GFR c. Reduced GFR d. Potential for fluid overload e. Potential for dehydration

ANS: C, D The GFR refers to the initial amount of urine that the kidneys filter from the blood. In the healthy adult, the normal GFR ranges between 100 and 120 mL/min, most of which is reabsorbed in the kidney tubules. A GFR of 40 mL/min is drastically reduced, with the client experiencing fluid retention and risks for hypertension and pulmonary edema as a result of excess vascular fluid.

A client is prescribed trimethoprim/sulfamethoxazole (Septra) for urinary tract infection (UTI). What does the nurse instruct the client about this therapy? Select all that apply. 1. Disclose any allergies to sulfa drugs before beginning therapy. 2. Wear sunscreen and protective clothing when out in the sun. 3. Monitor the pulse twice daily while taking this drug. 4. Drink a full glass of water with each dose of the drug. 5. Avoid taking the drug within 2 hours of taking an antacid.

1. Disclose any allergies to sulfa drugs before beginning therapy. 2. Wear sunscreen and protective clothing when out in the sun. 4. Drink a full glass of water with each dose of the drug. The nurse should ensure that the client does not have any allergies to sulfa drugs before beginning therapy, since allergies to sulfa drugs are common and may require changing the drug therapy. The client should wear sunscreen and protective clothing when out in the sun because sulfamethoxazole increases sensitivity to the sun and can lead to severe sunburns. The client must consume a full glass of water with each dose because the drug can form crystals that precipitate in the kidney tubules; drinking at least 3 L of fluids daily prevents this complication. The client taking fluoroquinolone is asked to monitor the pulse twice daily as this class of drugs induces serious cardiac dysrhythmias. Fluoroquinolone must not be taken within 2 hours of taking an antacid; antacids containing magnesium or aluminum interfere with drug absorption.

What nonsurgical methods does the nurse teach the client to manage stress incontinence? Select all that apply. 1. Reduce excess body weight. 2. Walk to strengthen pelvic muscles. 3. Perform Kegel exercises. 4. Use artificial sweeteners instead of sugar. 5. Practice vaginal cone therapy.

1. Reduce excess body weight. 3. Perform Kegel exercises. 5. Practice vaginal cone therapy. The client with stress incontinence should reduce excess weight because increased abdominal pressure aggravates stress incontinence. Kegel exercise therapy strengthens the muscles of the pelvic floor, and weighted vaginal cones are used to strengthen pelvic muscles and decrease stress incontinence. Walking is a good exercise; however, it does not help to increase pelvic strength. The client must avoid foods that irritate the bladder such as artificial sweeteners, alcohol, nicotine, citrus, and caffeine.

What clinical findings does the nurse attribute to the presence of kidney stones? Select all that apply. 1. Smoky urine 2. Odorless urine 3. Increased serum calcium 4. Increased serum phosphate 5. Urine pH of 6

1. Smoky urine 3. Increased serum calcium 4. Increased serum phosphate Smoky or rusty urine is common in clients with kidney stones, indicating hematuria. Increases in serum calcium and phosphate levels indicate that excess minerals are present and may contribute to stone formation. The urine generally has an odor, indicating infection. Normal urine is alkaline, with a pH between 5 and 6. If urine contains uric acid or cystine stones, it is highly acidic. If urine contains calcium phosphate and struvite stones, it is alkaline.

During assessment of a client, what finding does the nurse associate with the presence of kidney stones? 1. Oliguria 2. Flank pain 3. Dysuria 4. Flank pain extending to the scrotum

2. Flank pain The major manifestation of kidney stones is renal colic, which begins suddenly and is described as "unbearable." Flank pain indicates that the stone is in the kidney or the upper ureter. Oliguria, or scant urine output, indicates an obstruction at the bladder neck or urethra. Dysuria and frequency occur when the stone reaches the bladder and causes irritation. Flank pain extending to the scrotum suggests that the stones are in the ureters or bladder. The pain is most intense when the stone is moving or when the ureter is obstructed.

What complication may the nurse expect in an older client with an indwelling catheter for urinary continence? 1. Skin breakdown 2. Risk for infection 3. Damage to tissues 4. Urine retention

2. Risk for infection An indwelling catheter increases the risk for infection in a client. An indwelling catheter can help protect the skin and reduce the risk of skin breakdown caused by urinary incontinence. Applied devices, such as intravaginal pessaries for women and penile clamps for men, can cause tissue damage. An indwelling catheter completely drains the bladder, so the client does not have urinary retention.

A client is prescribed prophylactic immunotherapy with intravesical instillation of bacille Calmette-Guérin (BCG) to prevent recurrence of bladder tumor. What does the nurse inform the client about this therapy? 1. The procedure is done in an inpatient setting. 2. The BCG virus compound is allowed to dwell in the bladder for 2 hours. 3. Flush the toilet three times after use. 4. Dispose of clothing that comes in contact with urine in 24 hours.

2. The BCG virus compound is allowed to dwell in the bladder for 2 hours. The BCG virus compound is allowed to dwell in the bladder for 2 hours. Live virus will be excreted when the client urinates. The instillation procedure is done in an outpatient setting. The client must not share the toilet with other household members for 24 hours after instillation; the toilet must be flushed and cleaned with a solution of 10% liquid bleach. The client must wash all clothing that has come into contact with urine during the 24 hours after instillation separately with 10% liquid bleach.

The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? Select all that apply. 1. Cleanse the perineum from back to front after using the bathroom. 2. Try to take in 64 ounces of fluid each day. 3. Be sure to complete the full course of antibiotics. 4. If urine remains cloudy, call the clinic. 5. Expect some flank discomfort until the antibiotic has worked.

2. Try to take in 64 ounces of fluid each day. 3. Be sure to complete the full course of antibiotics. 4. If urine remains cloudy, call the clinic. Between 64 and 100 ounces (2-3 liters) of fluid should be taken daily to dilute bacteria and prevent infection. Not completing the course of antibiotics could suppress the bacteria, but would not destroy all bacteria, causing the infection to resurface. For persistent symptoms of infection, the client should contact the provider. The perineal area should be cleansed from front to back or "clean to dirty" to prevent infection. Cystitis produces suprapubic symptoms; flank pain occurs with infection or inflammation of the kidney.

What is the normal lab value for serum PHOSPHORUS?

2.4-4.1 mg/dL

What is the normal lab value for Urine Potassium?

25-100 mEq/L/day

A client is prescribed estrogen therapy for urinary incontinence. What does the nurse teach the client about this therapy? 1. Change positions slowly, especially in the mornings. 2. Report urine output that is significantly lower than fluid intake. 3. A thin application of cream is adequate. 4. Use hard candy to moisten the mouth.

3. A thin application of cream is adequate. Teach the client that a thin application of estrogen cream is all that is needed. The client taking tricyclic antidepressants must change positions slowly, especially in the mornings, because these drugs cause dizziness, orthostatic hypotension, and increase the risk for falls. The client taking antispasmodics or anticholinergics should report urine output that is significantly lower than fluid intake as these drugs cause urine retention. Dry mouth is another side effect of antispasmodics and anticholinergics; the client can use hard candy to moisten the mouth.

A client is ordered phenazopyridine (Prodium) to reduce bladder pain and burning on urination. What does the nurse teach the client about this drug regimen? 1. Report if the urine turns red. 2. Report blurred vision. 3. Take the drug with a meal. 4. Wear dark glasses in sunlight.

3. Take the drug with a meal. The client should take the drug with a meal to prevent gastrointestinal disturbances. The client need not report if the urine turns red or orange because this is an expected response to the drug. The client taking antispasmodics for relieving bladder spasms is asked to report blurred vision,which is a manifestation of toxicity. The client taking antispasmodics, not analgesics, is asked to wear dark glasses in sunlight as the drug dilates the pupil and increases eye sensitivity to light.

The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? 1. "For the best effect, perform all of your exercises while you are seated on the toilet." 2. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." 3. "Results should be visible to you within 72 hours." 4. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

4. "You know that you are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used. Pelvic muscle exercises can be performed anywhere and should be performed more often than 5 minutes twice daily. Noticeable results take several weeks.

The health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? 1. "It will act as an antibacterial drug." 2. "This drug will treat your infection, not the symptoms of it." 3. "You need to take the drug on an empty stomach." 4. "Your urine will turn red or orange while on the drug."

4. "Your urine will turn red or orange while on the drug." Phenazopyridine will turn the client's urine red or orange. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed, and care should be taken because it will stain undergarments. Phenazopyridine reduces bladder pain and burning by exerting a local analgesic/anesthetic effect on the mucosa of the urinary tract. It does treat the symptoms of bladder infection; it has no antibacterial action. Phenazopyridine should be taken with a meal or immediately after eating.

What clinical finding in a postmenopausal client with urethritis does the nurse attribute to low estrogen levels? 1. The urinalysis indicates pyuria. 2. The urethral culture is positive for bacteria. 3. The urinalysis indicates presence of bacteria. 4. A pelvic examination shows tissue changes.

4. A pelvic examination shows tissue changes. A pelvic examination of a postmenopausal client shows tissue changes due to low estrogen. The client with urethritis does not have pyuria or white blood cells (WBCs) in the urine. The urethral culture and urinalysis is usually negative for bacteria. These clients may have improvement in their urethral symptoms with the use of estrogen vaginal cream.

The nurse is caring for a client with cystitis. What does the nurse ask the client to include in the diet as part of nutritional therapy? 1. Carbonated beverages 2. Tomato products 3. Caffeine 4. Cranberry juice

4. Cranberry juice The client with cystitis should consume 50 mL of concentrated cranberry juice daily because it is known to decrease the ability of bacteria to adhere to the epithelial cells lining the urinary tract, decreasing the incidence of symptomatic urinary tract infections in some clients. Cranberry juice must be consumed for 3 to 4 weeks to be effective. Caffeine, carbonated beverages, and tomato products must be avoided to decrease bladder irritation during cystitis.

What procedure does the nurse expect the health care provider to prescribe for the removal of a large, impacted stone in a client's kidney? 1. Lithotripsy 2. Stenting 3. Pyelolithotomy 4. Nephrolithotomy

4. Nephrolithotomy Nephrolithotomy, an open surgical procedure, is often prescribed to remove a large, impacted stone in the kidney. This method is performed if all other procedures fail and there is a possible risk for a lasting injury to the ureter or kidney. Lithotripsy is the use of sound, laser, or dry shock waves to break stones into small fragments. Stenting is a minimally invasive procedure performed by placing a stent in the ureter by ureteroscopy. The stent dilates the ureter, enlarging the passageway for the stone or stone fragments. Pyelolithotomy is an open surgical procedure to remove stones in the kidney pelvis.

A client with diabetes has all of the following changes after a percutaneous nephrolithotomy procedure. Which change is most important for the nurse need to immediately report to the health care provider? A. Difficulty breathing and an oxygen saturation of 88% on 2 L of oxygen by nasal cannula B. A point-of-care blood glucose of 150 mg/dL and client report of thirst C. A decreased hematocrit by 1% (compared with preoperative values and hematuria D. An oral temperature of 38° C (101° F) and cloudiness of urine draining from the nephrostomy tube right after IV administration of a broad-spectrum antibiotic

A

The advanced-practice nurse is performing a digital rectal examination (DRE) and notes that the rectal sphincter contracts on digital insertion. How does the nurse interpret this finding? a. Nerve supply to the bladder is most likely intact. b. There is adequate strength in the pelvic floor. c. A rectocele is placing pressure on the bladder. d. Abnormal function for the bladder is unlikely.

A

An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? "Have you tried using the toilet at least every couple of hours?" "How does that make you feel?" "We can fix that." "That happens when we get older."

A By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control. The client has already stated how she feels; asking her again how she feels does not address her concern nor does it allow for nursing education. The nurse cannot assert that the problem can be fixed because this may be untrue. Suggesting that the problem occurs as we get older does not address the client's concern and does not provide for nursing education.

A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns? "Arise slowly and call for assistance when ambulating." "I must measure your intake and output." "We must save your urine because it is radioactive." "I must attach you to this cardiac monitor."

A Captopril can cause severe hypotension during and after the procedure, so the client should be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension. Intake and output measurement is not necessary after this procedure, unless it had been requested previously. A small amount of radionuclide is used in a renal scan; the urine is not radioactive, although the nurse should practice Standard Precautions, as always, and wear gloves. Cardiac monitoring is not needed, although the nurse should monitor for hypotension secondary to captopril.

Which urinary assessment information for a client indicates the potential need for increased fluids? Increased blood urea nitrogen Increased creatinine Pale-colored urine Decreased sodium

A Increased blood urea nitrogen can indicate dehydration. Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.

Which age-related change can cause nocturia? Decreased ability to concentrate urine Decreased production of antidiuretic hormone Increased production of erythropoietin Increased secretion of aldosterone

A Nocturia may result from decreased kidney-concentrating ability associated with aging. Increased production of antidiuretic hormone, decreased production of erythropoietin, and decreased secretion of aldosterone are age-related changes.

A client with these assessment data is preparing to undergo a computed tomography scan with contrast: Physical Assessment Diagnostic Findings Medications Flank pain BUN 54 mg/dL Captopril Dysuria Creatinine 2.4 mg/dL Metformin Bilateral knee pain Calcium 8.5 mg/dL Acetylcysteine Which medication does the nurse plan to administer before the procedure?] Acetylcysteine (Mucosil) Metformin (Glucophage) Captopril (Capoten) Acetaminophen (Tylenol)

A This client has kidney impairment demonstrated by increased creatinine. Acetylcysteine (an antioxidant) may be used to prevent contrast-induced nephrotoxic effects. Metformin is held at least 24 hours before procedures using contrast. Although captopril and acetaminophen may be administered with a sip of water with permission of the provider, this is not essential before the procedure.

10. After teaching a client with a history of renal calculi, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I should drink at least 3 liters of fluid every day. b. I will eliminate all dairy or sources of calcium from my diet. c. Aspirin and aspirin-containing products can lead to stones. d. The doctor can give me antibiotics at the first sign of a stone.

A Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the client is well hydrated the calcium will be excreted without issues. Dehydration increases the risk for supersaturation of calcium in the urine, which contributes to stone formation. The nurse should encourage the client to drink more fluids, not decrease calcium intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics neither prevent nor treat a stone.

6. A nurse cares for adult clients who experience urge incontinence. For which client should the nurse plan a habit training program? a. A 78-year-old female who is confused b. A 65-year-old male with diabetes mellitus c. A 52-year-old female with kidney failure d. A 47-year-old male with arthritis

A For a bladder training program to succeed in a client with urge incontinence, the client must be alert, aware, and able to resist the urge to urinate. Habit training will work best for a confused client. This includes going to the bathroom (or being assisted to the bathroom) at set times. The other clients may benefit from another type of bladder training.

5. After teaching a client who has stress incontinence, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will limit my total intake of fluids. b. I must avoid drinking alcoholic beverages. c. I must avoid drinking caffeinated beverages. d. I shall try to lose about 10% of my body weight.

A Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence.

16. A nurse obtains the health history of a client with a suspected diagnosis of bladder cancer. Which question should the nurse ask when determining this clients risk factors? a. Do you smoke cigarettes? b. Do you use any alcohol? c. Do you use recreational drugs? d. Do you take any prescription drugs?

A Smoking is known to be a factor that greatly increases the risk of bladder cancer. Alcohol use, recreational drug use, and prescription drug use (except medications that contain phenacetin) are not known to increase the risk of developing bladder cancer.

18. A nurse teaches a young female client who is prescribed amoxicillin (Amoxil) for a urinary tract infection. Which statement should the nurse include in this clients teaching? a. Use a second form of birth control while on this medication. b. You will experience increased menstrual bleeding while on this drug. c. You may experience an irregular heartbeat while on this drug. d. Watch for blood in your urine while taking this medication.

A The client should use a second form of birth control because penicillin seems to reduce the effectiveness of estrogen-containing contraceptives. She should not experience increased menstrual bleeding, an irregular heartbeat, or blood in her urine while taking the medication.

23. A nurse assesses a client who presents with renal calculi. Which question should the nurse ask? a. Do any of your family members have this problem? b. Do you drink any cranberry juice? c. Do you urinate after sexual intercourse? d. Do you experience burning with urination?

A There is a strong association between family history and stone formation and recurrence. Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask whether other family members have also had renal stones. The other questions do not refer to renal calculi but instead are questions that should be asked of a client with a urinary tract infection.

A young woman tells the nurse that she gets frequent UTIs that seem to follow sexual intercourse. Which questions would the nurse ask? (Select all that apply.) a. "Do you use a diaphragm or spermicides for contraception?" b. "Do you feel guilty or embarrassed about your sexual activities?" c. "Have you considered abstaining from intercourse?" d. "Do you and your partner(s) wash the perineal area before intercourse?" e. "Some positions cause more irritation during sex. Have you noticed this?"

A - "Do you use a diaphragm or spermicides for contraception?" D - "Do you and your partner(s) wash the perineal area before intercourse?" E - "Some positions cause more irritation during sex. Have you noticed this?"

The nurse is teaching a patient about self-care measures to prevent UTIs. Which daily fluid intake does the nurse recommend to the patient to prevent a bladder infection? a. 2 to 3 L of water b. 3 to 6 glasses of iced tea c. 4 to 6 cups of electrolyte fluid d. 3 to 4 glasses of juice

A - 2 to 3 L of water

Teaching intermittent self-catheterization for incontinence is appropriate for which patient? a. 25-year-old male patient with paraplegia b. 35-year-old female patient with stress incontinence c. 70-year-old patient who wears absorbent briefs d. 18-year-old patient with a severe head injury

A - 25-year-old male patient with paraplegia

Which patient is mostly likely to have mixed incontinence? a. 54-year-old woman who had four full-term pregnancies b. 52-year-old man who had a stroke with neurologic deficits c. 76-year-old man with benign prostatic hyperplasia d. 25-year-old woman who has a pelvic fracture

A - 54-year-old woman who had four full-term pregnancies

The nurse is caring for a patient with an indwelling catheter. What intervention does the nurse use to minimize catheter-related infections? a. Assess the patient daily to determine need for catheter. b. Irrigate the catheter daily with sterile solution to remove debris. c. Use sterile technique when opening system to obtain urine samples. d. Apply antiseptic solutions or antibiotic ointments to the perineal area.

A - Assess the patient daily to determine need for catheter.

The nurse is teaching a woman how to prevent UTIs. What information does the nurse include? a. Clean the perineal area from front to back. b. Always use a condom if spermicides are used for contraception. c. Obtain prescription for oral estrogen for vaginal dryness. d. Avoid urinary stasis by urinating every 6 to 8 hours.

A - Clean the perineal area from front to back.

Patients who have central nervous system lesions from stroke, multiple sclerosis, or parasacral spinal cord lesions may have which type of urinary incontinence? a. Detrusor hyperreflexia b. Mixed c. Stress d. Functional

A - Detrusor hyperreflexia

A patient is diagnosed with a urethral stricture. The nurse prepares the patient for which temporary treatment? a. Dilation of the urethra b. Antibiotic therapy c. Fluid restriction d. Urinary diversion

A - Dilation of the urethra

The nurse is counseling a patient with recurrent symptomatic UTIs about dietary therapy. What information does the nurse give to the patient? a. Drink 50 mL of concentrated cranberry juice every day. b. Low consumption of protein may prevent recurrent UTIs. c. Caffeine, carbonated beverages, and tomato products cause UTI. d. Cranberry tablets are more effective than juice or fluids.

A - Drink 50 mL of concentrated cranberry juice every day.

The urine output of a patient with a kidney stone has decreased from 40 mL/hr to 5 mL/hr. What is the nurse's priority action? a. Ensure IV access and notify the health care provider. b. Perform the Credé maneuver on the patient's bladder. c. Test the urine for ketone bodies. d. Document the finding and continue monitoring.

A - Ensure IV access and notify the health care provider.

The nurse is teaching self-care measures to a patient who had lithotripsy for kidney stones. What information does the nurse include? (Select all that apply.) a. Finish the entire prescription of antibiotics to prevent UTIs. b. Balance regular exercise with sleep and rest. c. Drink at least 3 L of fluid a day. d. Watch for and immediately report bruising after lithotripsy. e. Urine may be bloody for several days. f. Pain in the region of the kidneys or bladder is expected.

A - Finish the entire prescription of antibiotics to prevent UTIs. B - Balance regular exercise with sleep and rest. C - Drink at least 3 L of fluid a day. E - Urine may be bloody for several days.

A patient's recurrent cystitis appears to be related to sexual intercourse. The patient seems uncomfortable talking about the situation. What communication technique does the nurse use to assist the patient? a. Have a frank and sensitive discussion with the patient. b. Give the patient reading material with instructions to call with any questions. c. Call the patient's partner and invite the partner to discuss the problem. d. Talk about other topics until the patient feels more comfortable disclosing.

A - Have a frank and sensitive discussion with the patient.

A patient reports intense urgency, frequency, and bladder pain. Urinalysis results show white blood cells (WBCs) and red blood cells (RBCs) and urine culture results are negative for infection. How does the nurse interpret these findings? a. Interstitial cystitis b. Urethritis c. Bacteriuria d. Infectious cystitis

A - Interstitial cystitis

What does the nurse include in the care plan for a patient who had pyelolithotomy? (Select all that apply.) a. Monitor the amount of bleeding from incisions. b. Restrict fluids to prevent edema and fluid overload. c. Strain the urine to monitor the passage of stone fragments. d. Encourage fluids to avoid dehydration and supersaturation. e. Monitor changes in urine output. f. Administer antibiotics to eliminate or prevent infections.

A - Monitor the amount of bleeding from incisions. C - Strain the urine to monitor the passage of stone fragments. D - Encourage fluids to avoid dehydration and supersaturation. E - Monitor changes in urine output. F - Administer antibiotics to eliminate or prevent infections.

The home health nurse is assessing an older adult patient who refuses to leave the house to see friends or participate in usual activities. She reports taking a bath several times a day and becomes very upset when she has an incontinent episode. What is the priority problem for this patient? a. Negative self-image b. Stress urinary incontinence c. Social isolation d. Potential for skin breakdown

A - Negative self-image

Which task related to care of patients who have indwelling catheters can be delegated to unlicensed assistive personnel (UAP)? a. Perform daily catheter care by washing the perineum and proximal portion of the catheter with soap and water. b. Use sterile technique when inserting the urinary catheter or when opening the system to obtain urine samples. c. Determine whether use of condom catheters is appropriate for male patients and apply the devices accordingly. d. Keep urine collection bag in a place that is readily visible to the patient, so that the patient is reassured of kidney function.

A - Perform daily catheter care by washing the perineum and proximal portion of the catheter with soap and water.

The health care provider has recommended intermittent self-catheterization for a patient with long-term problems of incomplete bladder emptying. Which information does the nurse give the patient about the procedure? a. Perform proper handwashing and cleaning of the catheter to reduce the risk for infection. b. Use a large-lumen catheter and good lubrication for rapid emptying of the bladder. c. Catheterize yourself whenever the bladder gets distended. d. Use sterile technique, especially if catheterization is done by a family member.

A - Perform proper handwashing and cleaning of the catheter to reduce the risk for infection.

The nurse is reviewing a care plan for a patient who has functional incontinence. There is a note that containment is recommended, especially at night. What is the major concern with this approach? a. Skin integrity b. Cost of care and materials c. Self-esteem of the patient d. Fall risk

A - Skin integrity

A patient returns to the medical-surgical unit after having shock wave lithotripsy (SWL). What is an appropriate nursing intervention for the postprocedural care of this patient? a. Strain the urine to monitor the passage of stone fragments. b. Report bruising that occurs on the flank of the affected side. c. Continuously monitor electrocardiogram (ECG) for dysrhythmias. d. Apply a local anesthetic cream to the skin of the affected side.

A - Strain the urine to monitor the passage of stone fragments.

A middle-aged woman has urinary stress incontinence related to weak pelvic muscles. The patient is highly motivated to participate in self-care. Which interventions does the nurse include in the treatment plan? (Select all that apply.) a. Suggest keeping a detailed diary of urine leakage, activities, and foods eaten. b. Suggest wearing absorbent undergarments during the assessment process. c. Teach pelvic floor (Kegel) exercise therapy. d. Teach about vaginal cone therapy. e. Encourage drinking orange juice every day for 4 to 6 weeks. f. Refer to a nutritionist for diet therapy for weight reduction.

A - Suggest keeping a detailed diary of urine leakage, activities, and foods eaten. B - Suggest wearing absorbent undergarments during the assessment process. C - Teach pelvic floor (Kegel) exercise therapy. D - Teach about vaginal cone therapy. F - Refer to a nutritionist for diet therapy for weight reduction.

The nurse is designing a habit training bladder program for an older adult patient who is alert but mildly confused. What task associated with the training program is delegated to the UAP? a. Tell the patient it is time to go to the toilet and assist him to go on a regular schedule. b. Help the patient record the incidents of incontinence in a bladder diary. c. Change the patient's incontinence pants (or pad) every 4 hours. d. Gradually encourage independence and increase the intervals between voidings.

A - Tell the patient it is time to go to the toilet and assist him to go on a regular schedule.

For which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider? (Select all that apply.) Client with an allergy to shrimp Client with a history of asthma Client who requests morphine sulfate every 3 hours Client with a blood urea nitrogen of 62 mg/dL and a creatinine of 2.0 mg/dL Client who took metformin (Glucophage) 4 hours ago

A B D E The client who will be undergoing a CT scan with contrast should be asked about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. Contrast reactions have been reported to be as high as 15% in these clients. Clients with asthma have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. The risk for contrast-induced nephropathy is increased in clients who have pre-existing renal insufficiency (e.g., serum creatinine levels greater than 1.5 mg/dL or estimated glomerular filtration rate less than 45 mL/min). Metformin must be discontinued at least 24 hours before and for at least 48 hours after any study using contrast media because the life-threatening complication of lactic acidosis, although rare, could occur. There are no contraindications to undergo CT with contrast while taking morphine sulfate. CT with contrast may help to identify the underlying cause of pain.

The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed? a. I am thrilled that I can continue to eat fast food. b. I will cut out bacon with my eggs every morning. c. My cooking style will change by not adding salt. d. I will probably lose weight by cutting out potato chips.

A ~ Fast food restaurants usually serve food that is high in sodium. This statement indicates that more teaching needs to occur. The other statements show a correct understanding of the teaching.

A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best? a. Obtain daily weights of the client. b. Auscultate heart and breath sounds. c. Palpate the client's abdomen. d. Assess the client's diet history.

A ~ Furosemide (Lasix) is a loop diuretic that helps reduce fluid overload and hypertension in clients with early stages of CKD. One kilogram of weight equals about 1 liter of fluid retained in the client, so daily weights are necessary to monitor the response of the client to the medication. Heart and breath sounds should be assessed if there is fluid retention, as in heart failure. Palpation of the client's abdomen is not necessary, but the nurse should check for edema. The diet history of the client would be helpful to assess electrolyte replacement since potassium is lost with this diuretic, but this does not assess the effect of the medication.

A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH). Which finding is the cause of immediate action by the nurse? a. Blood pressure of 76/58 mm Hg b. Sodium level of 138 mEq/L c. Potassium level of 5.5 mEq/L d. Pulse rate of 90 beats/min

A ~ Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to maintain blood pressure. The specially trained nurse needs to monitor for ongoing fluid and electrolyte replacement. The sodium level is normal and the potassium level is slightly elevated, which could be normal findings for someone with acute kidney injury. A pulse rate of 90 beats/min is normal.

A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern? a. Albumin level of 2.5 g/dL b. Phosphorus level of 5 mg/dL c. Sodium level of 135 mmol/L d. Potassium level of 5.5 mmol/L

A ~ Protein restriction is necessary with chronic renal failure due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level (normal = 3.5-5.5) since this indicates that the protein in the diet is not enough for the client's metabolic needs. The electrolyte values are not related to the protein-restricted diet.

A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse? a. Discuss what the treatment regimen means to him. b. Refer the client to a mental health nurse practitioner. c. Reschedule the appointments to another date and time. d. Discuss the option of peritoneal dialysis.

A ~ The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options, assessment of the client's acceptance of the treatment should come first.

A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse? a. Place the client on a cardiac monitor immediately. b. Teach the client to limit high-potassium foods. c. Continue to monitor the client's intake and output. d. Ask to have the laboratory redraw the blood specimen.

A ~ The priority action by the nurse should be to check the cardiac status with a monitor. High potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.

A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this client's history? a. Have you been taking any aspirin, ibuprofen, or naproxen recently? b. Do you have anyone in your family with renal failure? c. Have you had a diet that is low in protein recently? d. Has a relative had a kidney transplant lately?

A ~ There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the client since both the serum creatinine and BUN are elevated, indicating some renal problems. A family history of renal failure and kidney transplantation would not be part of the questioning and could cause anxiety in the client. A diet high in protein could be a factor in an increased BUN.

A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best? a. Check the client's digoxin (Lanoxin) level. b. Administer an anti-nausea medication. c. Ask if the client is able to eat crackers. d. Get a referral to a gastrointestinal provider.

A ~ These signs and symptoms are indications of digoxin (Lanoxin) toxicity. The nurse should check the level of this medication. Administering antiemetics, asking if the client can eat, and obtaining a referral to a specialist all address the client's symptoms but do not lead to the cause of the symptoms.

A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority? a. Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c. Teach the client to drink 2 to 3 liters of water daily. d. Perform an electrocardiogram.

A ~ This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the client to drink 2 to 3 liters of water each day. An intravenous line may be ordered later, after the client's degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

7. A nurse teaches a client about self-care after experiencing a urinary calculus treated by lithotripsy. Which statements should the nurse include in this clients discharge teaching? (Select all that apply.) a. Finish the prescribed antibiotic even if you are feeling better. b. Drink at least 3 liters of fluid each day. c. The bruising on your back may take several weeks to resolve. d. Report any blood present in your urine. e. It is normal to experience pain and difficulty urinating.

A, B, C The client should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The client should drink at least 3 liters of fluid daily to dilute potential stone-forming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the client should expect bruising that may take several weeks to resolve. The client should also experience blood in the urine for several days. The client should report any pain, fever, chills, or difficulty with urination to the provider as these may signal the beginning of an infection or the formation of another stone.

The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (SATA) a. Man with prostate cancer b. Woman with blood clots in the urinary tract c. Client with ureterolithiasis d. Firefighter with severe burns e. Young woman with lupus

A, B, C ~ Urine flow obstruction, such as prostate cancer, blood clots in the urinary tract, and kidney stones (ureterolithiasis), causes post-renal AKI. Severe burns would be a pre-renal cause. Lupus would be an intrarenal cause for AKI.

1. A nurse assesses a client who has had two episodes of bacterial cystitis in the last 6 months. Which questions should the nurse ask? (Select all that apply.) a. How much water do you drink every day? b. Do you take estrogen replacement therapy? c. Does anyone in your family have a history of cystitis? d. Are you on steroids or other immune-suppressing drugs? e. Do you drink grapefruit juice or orange juice daily?

A, B, D Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent cystitis. Family history is usually insignificant, and cranberry juice, not grapefruit or orange juice, has been found to increase the acidic pH and reduce the risk for bacterial cystitis.

5. A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly paired with their clinical manifestation? (Select all that apply.) a. Stress incontinence Urine loss with physical exertion b. Urge incontinence Large amount of urine with each occurrence c. Functional incontinence Urine loss results from abnormal detrusor contractions d. Overflow incontinence Constant dribbling of urine e. Reflex incontinence Leakage of urine without lower urinary tract disorder

A, B, D Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising. Urge incontinence presents with an abrupt and strong urge to void and usually has a large amount of urine released with each occurrence. Overflow incontinence occurs with bladder distention and results in a constant dribbling of urine. Functional incontinence is the leakage of urine caused by factors other than a disorder of the lower urinary tract. Reflex incontinence results from abnormal detrusor contractions from a neurologic abnormality.

A client is undergoing hemodialysis. The client's blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (SATA) a. Adjust the rate of extracorporeal blood flow. b. Place the client in the Trendelenburg position. c. Stop the hemodialysis treatment. d. Administer a 250-mL bolus of normal saline. e. Contact the health care provider for orders.

A, B, D ~ Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Modest decreases in blood pressure, as is the case with this client, can be maintained with rate adjustment, Trendelenburg positioning, and a fluid bolus. If the blood pressure drops considerably after two boluses and cooling dialysate, the hemodialysis can be stopped and the health care provider contacted.

A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are accurate regarding PD? (SATA) a. You will not need vascular access to perform PD. b. There is less restriction of protein and fluids. c. You will have no risk for infection with PD. d. You have flexible scheduling for the exchanges. e. It takes less time than hemodialysis treatments.

A, B, D ~ PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is no need for vascular access. Protein is lost in the exchange, which allows for more protein and fluid in the diet. There is flexibility in the time for exchanges, but the treatment takes a longer period of time compared to hemodialysis. There still is risk for infection with PD, especially peritonitis.

Select the results (in italics) that are normal in a urinalysis. A. pH 6 B. Specific gravity 1.015 C. Protein small D. Sugar negative E. Nitrate small F. Leukocyte esterase positive G. Bilirubin negative

A, B, D, G Rationale: The abnormal values are indicative of a urinary tract infection. As a result of protein, nitrates, and leukoesterase in the urine, the nurse can expect the laboratory to analyze microscopic sediment including evaluating the sample for the presence of crystals, casts, WBCs, and RBCs.

6. A nurse teaches a client with a history of calcium phosphate urinary stones. Which statements should the nurse include in this clients dietary teaching? (Select all that apply.) a. Limit your intake of food high in animal protein. b. Read food labels to help minimize your sodium intake. c. Avoid spinach, black tea, and rhubarb. d. Drink white wine or beer instead of red wine. e. Reduce your intake of milk and other dairy products.

A, B, E Clients with calcium phosphate urinary stones should be taught to limit the intake of foods high in animal protein, sodium, and calcium. Clients with calcium oxalate stones should avoid spinach, black tea, and rhubarb. Clients with uric acid stones should avoid red wine.

8. A nurse teaches a female client who has stress incontinence. Which statements should the nurse include about pelvic muscle exercises? (Select all that apply.) a. When you start and stop your urine stream, you are using your pelvic muscles. b. Tighten your pelvic muscles for a slow count of 10 and then relax for a slow count of 10. c. Pelvic muscle exercises should only be performed sitting upright with your feet on the floor. d. After you have been doing these exercises for a couple days, your control of urine will improve. e. Like any other muscle in your body, you can make your pelvic muscles stronger by contracting them.

A, B, E The client should be taught that the muscles used to start and stop urination are pelvic muscles, and that pelvic muscles can be strengthened by contracting and relaxing them. The client should tighten pelvic muscles for a slow count of 10 and then relax the muscles for a slow count of 10, and perform this exercise 15 times while in lying-down, sitting-up, and standing positions. The client should begin to notice improvement in control of urine after several weeks of exercising the pelvic muscles.

A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client's spouse about the kidney-specific formulation for the enteral solution compared to standard formulas. What components should be discussed in the teaching plan? (SATA) a. Lower sodium b. Higher calcium c. Lower potassium d. Higher phosphorus e. Higher calories

A, C, E ~ Many clients with AKI are too ill to meet caloric goals and require tube feedings with kidney-specific formulas that are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formulas.

A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (SATA) a. Urine output of 100 mL in 4 hours b. Urine output of 500 mL in 12 hours c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg

A, C, E ~ The low urine output, sediment, and blood pressure should be reported to the provider. Postoperatively, the nurse should measure intake and output, check the characteristics of the urine, and report sediment, hematuria, and urine output of less than 0.5 mL/kg/hour for 3 to 4 hours. A urine output of 100 mL is low, but a urine output of 500 mL in 12 hours should be within normal limits. Perfusion to the kidneys is compromised with low blood pressure. The amber odorless urine is normal.

2. A nurse teaches a client about self-catheterization in the home setting. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. Wash your hands before and after self-catheterization. b. Use a large-lumen catheter for each catheterization. c. Use lubricant on the tip of the catheter before insertion. d. Self-catheterize at least twice a day or every 12 hours. e. Use sterile gloves and sterile technique for the procedure. f. Maintain a specific schedule for catheterization.

A, C, F The key points in self-catheterization include washing hands, using lubricants, and maintaining a regular schedule to avoid distention and retention of urine that leads to bacterial growth. A smaller rather than a larger lumen catheter is preferred. The client needs to catheterize more often than every 12 hours. Self-catheterization in the home is a clean procedure.

What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? Select all that apply. A. "Your urine will be strained after the procedure." B. "Be sure to finish all of your antibiotics." C. "Immediately call the health care provider if you notice bruising." D. "Remember to drink at least 3 liters of fluid a day to promote urine flow." E. "You will need to change the incisional dressing once a day."

A. "Your urine will be strained after the procedure." B. "Be sure to finish all of your antibiotics." D. "Remember to drink at least 3 liters of fluid a day to promote urine flow." After lithotripsy, urine is strained to monitor the passage of stone fragments. Clients must finish the entire antibiotic prescription to decrease the risk of developing a urinary tract infection. Drinking at least 3 L of fluid a day dilutes potential stone-forming crystals, prevents dehydration, and promotes urine flow. Bruising on the flank of the affected side is expected after lithotripsy as a result of the shock waves that break the stone into small fragments. The client must notify the health care provider if he or she develops pain, fever, chills, or difficulty with urination because these signs and symptoms may signal the beginning of an infection or the formation of another stone. There is no incision with extracorporeal shock wave lithotripsy. There may be a small incision when intracorporeal lithotripsy is performed.

8. A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH). Which finding is the cause of immediate action by the nurse? a. Blood pressure of 76/58 mm Hg b. Sodium level of 138 mEq/L c. Potassium level of 5.5 mEq/L d. Pulse rate of 90 beats/min

ANS: A Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to maintain blood pressure. The specially trained nurse needs to monitor for ongoing fluid and electrolyte replacement. The sodium level is normal and the potassium level is slightly elevated, which could be normal findings for someone with acute kidney injury. A pulse rate of 90 beats/min is normal.

11. A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse? a. Discuss what the treatment regimen means to him. b. Refer the client to a mental health nurse practitioner. c. Reschedule the appointments to another date and time. d. Discuss the option of peritoneal dialysis.

ANS: A The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options, assessment of the client's acceptance of the treatment should come first.

6. A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse? a. Place the client on a cardiac monitor immediately. b. Teach the client to limit high-potassium foods. c. Continue to monitor the client's intake and output. d. Ask to have the laboratory redraw the blood specimen.

ANS: A The priority action by the nurse should be to check the cardiac status with a monitor. High potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not the best immediate action.

3. A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this client's history? a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?" b. "Do you have anyone in your family with renal failure?" c. "Have you had a diet that is low in protein recently?" d. "Has a relative had a kidney transplant lately?"

ANS: A There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the client since both the serum creatinine and BUN are elevated, indicating some renal problems. A family history of renal failure and kidney transplantation would not be part of the questioning and could cause anxiety in the client. A diet high in protein could be a factor in an increased BUN.

2. A marathon runner comes into the clinic and states "I have not urinated very much in the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority? a. Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c. Teach the client to drink 2 to 3 liters of water daily. d. Perform an electrocardiogram.

ANS: A This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the client to drink 2 to 3 liters of water each day. An intravenous line may be ordered later, after the client's degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

The client scheduled to have an intravenous urogram is a diabetic and taking the antidiabetic agent metformin. What should the nurse tell this client? A. "Call your diabetes doctor and tell him or her that you are having an intravenous urogram performed using dye." B. "Do not take your metformin the morning of the test because you are not going to be eating anything and could become hypoglycemic." C. "You must start on an antibiotic before this test because your risk of infection is greater as a result of your diabetes." D. "You must take your metformin immediately before the test is performed because the IV fluid and the dye contain a significant amount of sugar."

ANS: A Metformin can cause a lactic acidosis and renal impairment as an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established.

What would be the response if a person's nephrons were not able to filter normally due to scarring of the proximal convoluted tubule leading to inhibition of reabsorption? A. Increased urine output, fluid volume deficit B. Decreased urine output, fluid volume deficit C. Increased urine output, fluid volume overload D. Decreased urine output, fluid volume overload

ANS: A The nephrons filter about 120 mL/min. Most of this filtrate is reabsorbed in the proximal convoluted tubule. If the tubule were not able to reabsorb the fluid that has been filtered, urine output would greatly increase, leading to rapid and severe dehydration.

1. The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.) a. Man with prostate cancer b. Woman with blood clots in the urinary tract c. Client with ureterolithiasis d. Firefighter with severe burns e. Young woman with lupus

ANS: A, B, C Urine flow obstruction, such as prostate cancer, blood clots in the urinary tract, and kidney stones (ureterolithiasis), causes post-renal AKI. Severe burns would be a pre-renal cause. Lupus would be an intrarenal cause for AKI.

With a renal threshold for glucose of 220 mg/dL, what is the expected response when a client has a blood glucose level of 400 mg/dL? A. 400 mg/dL of excreted glucose in the urine B. 220 mg/dL of excreted glucose in the urine C. 180 mg/dL of glucose is excreted in the urine D. No excreted glucose in the urine

ANS: C Blood glucose is freely filtered at the glomerulus. Therefore, if a client has a blood sugar level of 400 mg/dl, the filtrate in the proximal convoluted tubule will have a glucose concentration of 400 mg/dL. With a renal threshold of 220 mg/dl, a total of 220 mg/dL of the 400 mg/dL will be reabsorbed back into the systemic circulation, and the final urine will have a glucose concentration of 180 mg/dL.

The client is going home after urography. Which instruction or precaution should the nurse teach this client? A. "Avoid direct contact with the urine for 24 hours until the radioisotope clears." B. "You are likely to experience some dribbling of urine for several weeks after this procedure." C. "Be sure to drink at least 3 L of fluids today to help eliminate the dye faster." D. "Your skin may become slightly yellow-tinged from the dye used in this procedure."

ANS: C Dyes used in urography are potentially nephrotoxic.

Confirmed by palpation and x-ray study, the client's right kidney is lower than the left kidney. What is the nurse's interpretation of this finding? A. The client has a problem involving the right kidney. B. The client has a problem involving the left kidney. C. The client has both kidneys in the normal position. D. The client is at increased risk for kidney impairment.

ANS: C Normally, the right kidney is positioned somewhat lower than the left kidney. This anatomic difference in otherwise symmetric organs is caused by liver displacement. The significance of this difference is that the right kidney is easier to palpate in an adult than is the left kidney.

The client has an elevated blood urea nitrogen (BUN) level and an increased ratio of blood urea nitrogen to creatinine. What is the nurse's interpretation of these laboratory results? A. The client probably has a urinary tract infection. B. The client may be overhydrated. C. The kidney may be hypoperfused. D. The kidney may be damaged.

ANS: C When dehydration or renal hypoperfusion exist, the BUN level rises more rapidly than the serum creatinine level, causing the ratio to be increased, even when no renal dysfunction is present.

5. A nurse teaches a client with polycystic kidney disease (PKD). Which statements should the nurse include in this client's discharge teaching? (Select all that apply.) a. "Take your blood pressure every morning." b. "Weigh yourself at the same time each day." c. "Adjust your diet to prevent diarrhea." d. "Contact your provider if you have visual disturbances." e. "Assess your urine for renal stones."

ANS: A, B, D A client who has PKD should measure and record his or her blood pressure and weight daily, limit salt intake, and adjust dietary selections to prevent constipation. The client should notify the provider if urine smells foul or has blood in it, as these are signs of a urinary tract infection or glomerular injury. The client should also notify the provider if visual disturbances are experienced, as this is a sign of a possible berry aneurysm, which is a complication of PKD. Diarrhea and renal stones are not manifestations or complications of PKD; therefore, teaching related to these concepts would be inappropriate.

6. A client is undergoing hemodialysis. The client's blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (Select all that apply.) a. Adjust the rate of extracorporeal blood flow. b. Place the client in the Trendelenburg position. c. Stop the hemodialysis treatment. d. Administer a 250-mL bolus of normal saline. e. Contact the health care provider for orders.

ANS: A, B, D Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Modest decreases in blood pressure, as is the case with this client, can be maintained with rate adjustment, Trendelenburg positioning, and a fluid bolus. If the blood pressure drops considerably after two boluses and cooling dialysate, the hemodialysis can be stopped and the health care provider contacted.

27. A client is recovering from a kidney transplant. The client's urine output was 1500 mL over the last 12-hour period since transplantation. What is the priority assessment by the nurse? a. Checking skin turgor b. Taking blood pressure c. Assessing lung sounds d. Weighing the client

ANS: B By taking blood pressure, the nurse is assessing for hypotension that could compromise perfusion to the new kidney. The nurse then should notify the provider immediately. Skin turgor, lung sounds, and weight could give information about the fluid status of the client, but they are not the priority assessment.

3. After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I will take a laxative every night before going to bed." b. "I must increase my intake of dietary fiber and fluids." c. "I shall only use salt when I am cooking my own food." d. "I'll eat white bread to minimize gastrointestinal gas."

ANS: B Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking plenty of water. Laxatives should be used cautiously. Clients with PKD should be on a restricted salt diet, which includes not cooking with salt. White bread has a low fiber count and would not be included in a high-fiber diet.

8. An emergency department nurse assesses a client with kidney trauma and notes that the client's abdomen is tender and distended and blood is visible at the urinary meatus. Which prescription should the nurse consult the provider about before implementation? a. Assessing vital signs every 15 minutes b. Inserting an indwelling urinary catheter c. Administering intravenous fluids at 125 mL/hr d. Typing and crossmatching for blood products

ANS: B Clients with blood at the urinary meatus should not have a urinary catheter inserted via the urethra before additional diagnostic studies are done. The urethra could be torn. The nurse should question the provider about the need for a catheter; if one is needed, the provider can insert a suprapubic catheter. The nurse should monitor the client's vital signs closely, send blood for type and crossmatch in case the client needs blood products, and administer intravenous fluids.

9. The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding? a. Woman with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c. Man with skin itching from head to toe d. Client with halitosis and stomatitis

ANS: B Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs. Hypertension is common in most clients with CKD, and skin itching increases with calcium-phosphate imbalances, another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.

13. After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I will take this medication with food and plenty of water." b. "I shall keep my appointment at the infusion center each week." c. "I'll limit my intake of green leafy vegetables while on this medication." d. "I must not take this medication if I have an infection or am feeling ill."

ANS: B Temsirolimus is administered as a weekly intravenous infusion. This medication blocks protein that is needed for cell division and therefore inhibits cell cycle progression. This medication is not taken orally, and clients do not need to follow a specific diet.

9. After teaching a client with hypertension secondary to renal disease, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I can prevent more damage to my kidneys by managing my blood pressure." b. "If I have increased urination at night, I need to drink less fluid during the day." c. "I need to see the registered dietitian to discuss limiting my protein intake." d. "It is important that I take my antihypertensive medications as directed."

ANS: B The client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions. These clients should be assessed thoroughly for potential dehydration. Increased nocturnal voiding can be decreased by consuming fluids earlier in the day. Blood pressure control is needed to slow the progression of renal dysfunction. When dietary protein is restricted, refer the client to the registered dietitian as needed.

4. A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this client's care? a. Edema and pain b. Electrolyte and fluid imbalance c. Cardiac and respiratory status d. Mental health status

ANS: B This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance is essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client's cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

The client is taking a medication for an endocrine problem that inhibits aldosterone secretion and release. To what complications of this therapy should the nurse be alert? A. Dehydration, hypokalemia B. Dehydration, hyperkalemia C. Overhydration, hyponatremia D. Overhydration, hypernatremia

ANS: B Aldosterone is a mineralocorticoid that increases the reabsorption of water and sodium in the kidney at the same time that it promotes excretion of potassium. Any drug or condition that disrupts aldosterone secretion or release increases the client's risk for excessive water loss and potassium reabsorption.

Which condition would trigger the release of antidiuretic hormone (ADH)? A. Plasma osmolarity decreased secondary to overhydration. B. Plasma osmolarity increased secondary to dehydration. C. Plasma volume decreased secondary to hemorrhage. D. Plasma volume increased with edema formation.

ANS: B Antidiuretic hormone is triggered by a rising ECF osmolarity, especially hypernatremia.

Which assessment maneuvers should the nurse perform first when assessing the renal system at the same time as the abdomen? A. Abdominal percussion B. Abdominal auscultation C. Abdominal palpation D. Renal palpation

ANS: B Auscultation precedes percussion and palpation because the nurse needs to auscultate for abdominal bruits before palpation or percussion of the abdominal and renal components of a physical assessment.

The female client's urinalysis shows all the following characteristics. Which should the nurse document as abnormal? A. pH 5.6 B. Ketone bodies present C. Specific gravity is 1.030 D. Two white blood cells per high-power field

ANS: B Ketone bodies are byproducts of incomplete metabolism of fatty acids. Normally, there are no ketones in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy.

Which of the following conditions are associated with oversecretion of rennin? A. Alzheimer's disease B. Hypertension C. Diabetes mellitus D. Diabetes insipidus

ANS: B Renin is secreted when special cells in the DCT, called the macula densa, sense changes in blood volume and pressure. When the macula densa cells sense that blood volume is low, blood pressure is low, or blood sodium levels are low, renin is secreted. Renin then converts angiotensinogen into angiotensin I. This leads to a series of reactions that cause the secretion of the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water, increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive renin secretion is a major cause of persistent hypertension.

The client's urine specific gravity is 1.018. What is the nurse's best action? A. Ask the client for a 24-hour recall of liquid intake. B. Document the finding as the only action. C. Obtain a specimen for culture. D. Notify the physician.

ANS: B This specific gravity is within the normal range for urine.

1. A nurse assesses a client who has a family history of polycystic kidney disease (PKD). For which clinical manifestations should the nurse assess? (Select all that apply.) a. Nocturia b. Flank pain c. Increased abdominal girth d. Dysuria e. Hematuria f. Diarrhea

ANS: B, C, E Clients with PKD experience abdominal distention that manifests as flank pain and increased abdominal girth. Bloody urine is also present with tissue damage secondary to PKD. Clients with PKD often experience constipation, but would not report nocturia or dysuria.

4. A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.) a. Clear drainage b. Bloody drainage at site c. Client reports headache d. Foul-smelling drainage e. Urine draining from site

ANS: B, D, E After a nephrostomy, the nurse should assess the client for complications and urgently notify the provider if drainage decreases or stops, drainage is cloudy or foul-smelling, the nephrostomy sites leaks blood or urine, or the client has back pain. Clear drainage is normal. A headache would be an unrelated finding.

23. A nurse is caring for a client who is scheduled for a dose of cefazolin and vitamins at this time. Hemodialysis for this client is also scheduled in 60 minutes. Which action by the nurse is best? a. Administer cefazolin since the level of the antibiotic must be maintained. b. Hold the vitamins but administer the cefazolin. c. Hold the cefazolin but administer the vitamins. d. Hold all medications since both cefazolin and vitamins are dialyzable.

ANS: D Both the cefazolin and the vitamins should be held until after the hemodialysis is completed because they would otherwise be removed by the dialysis process.

2. A nurse cares for a client with autosomal dominant polycystic kidney disease (ADPKD). The client asks, "Will my children develop this disease?" How should the nurse respond? a. "No genetic link is known, so your children are not at increased risk." b. "Your sons will develop this disease because it has a sex-linked gene." c. "Only if both you and your spouse are carriers of this disease." d. "Each of your children has a 50% risk of having ADPKD."

ANS: D Children whose parent has the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease. ADPKD is transmitted as an autosomal dominant trait and therefore is not gender specific. Both parents do not need to have this disorder.

10. A nurse cares for a client who is recovering after a nephrostomy tube was placed 6 hours ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour. Which action should the nurse take? a. Document the finding in the client's record. b. Evaluate the tube as working in the hand-off report. c. Clamp the tube in preparation for removing it. d. Assess the client's abdomen and vital signs.

ANS: D The nephrostomy tube should continue to have a consistent amount of drainage. If the drainage slows or stops, it may be obstructed. The nurse must notify the provider, but first should carefully assess the client's abdomen for pain and distention and check vital signs so that this information can be reported as well. The other interventions are not appropriate.

5. A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse's priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the client's pulse. d. Slow down the normal saline infusion.

ANS: D The nurse should assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter would evaluate the client's hemodynamic status, but this should not be the initial action by the nurse. Vital signs are also important after adjusting the intravenous infusion.

7. A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client's blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. Which action should the nurse take? a. Position the client to lay on the surgical incision. b. Measure the specific gravity of the client's urine. c. Administer intravenous pain medications. d. Assess the rate and quality of the client's pulse.

ANS: D The nurse should first fully assess the client for signs of volume depletion and shock, and then notify the provider. The radical nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Re-positioning the client, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.

A nurse observes that the client's left flank region is larger than the right flank region. What is the nurse's best action? A. Ask the client if he or she participates in contact sports and has been recently injured. B. Document the finding as the only action on the appropriate flowsheet. C. Apply a heating pad to the left flank after inspecting the site for signs of infection. D. Anticipate further diagnostic testing after sharing informing the physician of this finding

ANS: D Asymmetry of the flank or a unilateral protrusion may indicate an enlargement of a kidney. The enlargement may be benign or may be associated with a hydronephrosis or mass on the kidney.

Which change in renal or urinary functioning as a result of the normal aging process increases the older client's risk for infection? A. Decreased glomerular filtration B. Decreased filtrate reabsorption C. Weakened sphincter muscles D. Urinary retention

ANS: D Incomplete bladder emptying for whatever reason increases the client's risk for urinary tract infections as a result of urine stasis providing an excellent culture medium that promotes the growth of microorganisms.

The client reports the regular use of all the following medications. Which one alerts the nurse to the possibility of renal impairment when used consistently? A. Antacids B. Penicillin C. Antihistamine nasal sprays D. Nonsteroidal anti-inflammatory drug

ANS: D NSAIDs inhibit prostaglandin production and decrease blood flow to the nephrons. They can cause an interstitial nephritis and renal impairment.

The client is scheduled to have a renogram (kidney scan). She is concerned about discomfort during the procedure. What is the nurse's best response? A. "Before the test you will be given a sedative to reduce any pain." B. "A local anesthetic agent will be used, so you might feel a little pressure but no pain." C. "Although this test is very sensitive, there is no more discomfort than you would have with an ordinary x-ray." D. "The only pain associated with this procedure is a small needle stick when you are given the radioisotope

ANS: D The test involves an intravenous injection of the radioisotope and the subsequent recording of the emission by a scintillator.

Which laboratory test is the best indicator of kidney function? Blood urea nitrogen (BUN) Creatinine Aspartate aminotransferase (AST) Alkaline phosphatase

B Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best indicator of renal function. BUN may be affected by protein or fluid intake. AST and alkaline phosphatase are measures of hepatic function.

The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? Client who has just returned from having a kidney artery angioplasty Client with polycystic kidney disease who is having a kidney ultrasound Client who is going for a cystoscopy and cystourethroscopy Client with glomerulonephritis who is having a kidney biopsy

B Kidney ultrasounds are noninvasive procedures without complications; the LPN/LVN can provide this care. A kidney artery angioplasty is an invasive procedure that requires postprocedure monitoring for complications, especially hemorrhage; a registered nurse is needed. Cystoscopy and cystourethroscopy are procedures that are associated with potentially serious complications such as bleeding and infection. These clients should be assigned to RN staff members. Kidney biopsy is associated with potentially serious complications such as bleeding, and this client should be assigned to RN staff members.

The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first? Obtain blood urea nitrogen (BUN) and creatinine. Position the client supine. Administer pain medications. Check urine for hematuria.

B The client is positioned supine for several hours after a kidney biopsy to decrease the risk for hemorrhage. BUN and creatinine would be obtained before the procedure is performed. Only local discomfort should be noted around the procedure site; severe pain would indicate hematoma. Although pink urine may develop, the nurse should position the client to prevent bleeding first; the other actions are appropriate after this procedure, but do not need to be done immediately after the biopsy.

Which percussion technique does the nurse use to assess a client who reports flank pain? Place outstretched fingers over the flank area and percuss with the fingertips. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. Quickly tap the flank area with cupped hands.

B While the client assumes a sitting, side-lying, or supine position, the nurse forms one of the hands into a clenched fist. The other hand is placed flat over the costovertebral (CVA) angle of the client. Then, a firm thump is quickly delivered to the hand over the CVA area. Percussion is not appropriate for flank pain. Placing one hand palm up is not the correct technique. Percussion therapy, not assessment, involves tapping the flank area.

22. A nurse plans care for clients with urinary incontinence. Which client is correctly paired with the appropriate intervention? a. A 29-year-old client after a difficult vaginal delivery Habit training b. A 58-year-old postmenopausal client who is not taking estrogen therapy Electrical stimulation c. A 64-year-old female with Alzheimers-type senile dementia Bladder training d. A 77-year-old female who has difficulty ambulating Exercise therapy

B Exercise therapy and electrical stimulation are used for clients with stress incontinence related to childbirth or low levels of estrogen after menopause. Exercise therapy increases pelvic wall strength; it does not improve ambulation. Physical therapy and a bedside commode would be appropriate interventions for the client who has difficulty ambulating. Habit training is the type of bladder training that will be most effective with cognitively impaired clients. Bladder training can be used only with a client who is alert, aware, and able to resist the urge to urinate.

7. After delegating care to an unlicensed assistive personnel (UAP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the UAPs understanding. Which action indicates the UAP needs additional teaching? a. Toileting the client after breakfast b. Changing the clients incontinence brief when wet c. Encouraging the client to drink fluids d. Recording the clients incontinence episodes

B Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse should re-educate the UAP on the technique of habit training. The UAP should continue to toilet the client after meals, encourage the client to drink fluids, and record incontinent episodes.

3. A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in the last 6 months. The client asks, I never have urinary tract infections. Why is this happening now? How should the nurse respond? a. Your immune system becomes less effective as you age. b. Low estrogen levels can make the tissue more susceptible to infection. c. You should be more careful with your personal hygiene in this area. d. It is likely that you have an untreated sexually transmitted disease.

B Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes, predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this reason. Although immune function does decrease with aging and sexually transmitted diseases are a known cause of urethritis, the most likely reason in this client is low estrogen levels. Personal hygiene usually does not contribute to this disease process.

20. An emergency department nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question should the nurse ask first? a. Are you drinking plenty of water? b. What medications are you taking? c. Have you tried laxatives or enemas? d. Has this type of thing ever happened before?

B Some types of incontinence are treated with anticholinergic medications such as propantheline (Pro-Banthine). Anticholinergic side effects include dry mouth, constipation, and urinary retention. The nurse needs to assess the clients medication list to determine whether the client is taking an anticholinergic medication. If he or she is taking anticholinergics, the nurse should further assess the clients manifestations to determine if they are related to a simple side effect or an overdose. The other questions are not as helpful to understanding the current situation.

21. A nurse teaches a client who is starting urinary bladder training. Which statement should the nurse include in this clients teaching? a. Use the toilet when you first feel the urge, rather than at specific intervals. b. Try to consciously hold your urine until the scheduled toileting time. c. Initially try to use the toilet at least every half hour for the first 24 hours. d. The toileting interval can be increased once you have been continent for a week.

B The client should try to hold the urine consciously until the next scheduled toileting time. Toileting should occur at specific intervals during the training. The toileting interval should be no less than every hour. The interval can be increased once the client becomes comfortable with the interval.

24. A nurse assesses a male client who is recovering from a urologic procedure. Which assessment finding indicates an obstruction of urine flow? a. Severe pain b. Overflow incontinence c. Hypotension d. Blood-tinged urine

B The most common manifestation of urethral stricture after a urologic procedure is obstruction of urine flow. This rarely causes pain and has no impact on blood pressure. The client may experience overflow incontinence with the involuntary loss of urine when the bladder is distended. Blood in the urine is not a manifestation of the obstruction of urine flow.

12. A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the clients right lower back. Which action should the nurse take? a. Administer fresh-frozen plasma. b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results.

B The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh-frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level of intervention. Changing the clients position will not decrease bleeding.

A male college student comes to the clinic reporting burning or difficulty with urination and a discharge from the urethral meatus. Based on the patient's chief complaint, what is the most logical question for the nurse to ask about the patient's past medical history? a. "Do you have a history of a narrow urethra or a stricture?" b. "Could you have been exposed to a sexually transmitted disease (STD)?" c. "Do you have a history of kidney stones?" d. "Have you been drinking an adequate amount of fluids?"

B - "Could you have been exposed to a sexually transmitted disease (STD)?"

Which patient has the highest risk for developing a complicated UTI? a. 26-year-old woman who is sexually active, but not currently pregnant b. 22-year-old man who has a neurogenic bladder due to spinal cord injury c. 35-year-old woman who had three full-term pregnancies and a miscarriage d. 53-year-old woman who is having some menstrual irregularities

B - 22-year-old man who has a neurogenic bladder due to spinal cord injury

The nurse is teaching a patient with urge incontinence about dietary modifications. What is the best information the nurse gives to the patient about fluid intake? a. Drink at least 2000 mL per day unless contraindicated. b. Drink 120 mL every hour or 240 mL every 2 hours and limit fluids after dinner. c. Drink fluid freely in the morning hours, but limit intake before going to bed. d. Drinking water is especially good for bladder health.

B - Drink 120 mL every hour or 240 mL every 2 hours and limit fluids after dinner.

The nurse hears in report that the patient is being treated for a fungal UTI. In addition to performing routine care and assessments, the nurse is extra-vigilant for signs/symptoms of which systemic disorder that may underlie the fungal UTI? a. Chronic cardiac disease b. Immune system compromise c. Respiratory system dysfunction d. Connective tissue disorder

B - Immune system compromise

A patient with urinary incontinence is prescribed oxybutynin (Ditropan). What precautions or instructions does the nurse provide related to this therapy? a. Avoid aspirin or aspirin-containing products. b. Increase fluids and dietary fiber intake. c. Report any unusual vaginal bleeding. d. Change positions slowly, especially in the morning.

B - Increase fluids and dietary fiber intake.

The nursing student sees an order for a urinalysis for a patient with frequency, urgency, and dysuria. In order to collect the specimen, what does the student do? a. Use sterile technique to insert a small-diameter (6 Fr) catheter. b. Instruct the patient on how to collect a clean-catch specimen. c. Tell the patient to urinate approximately 10 mL into a specimen cup. d. Take the urine from a bedpan and transfer it into a specimen cup.

B - Instruct the patient on how to collect a clean-catch specimen.

A patient is admitted for an elective orthopedic surgical procedure. The patient also has a personal and family history for urolithiasis. Which circumstance creates the greatest risk for recurrent urolithiasis? a. Giving the patient milk with every meal tray b. Keeping the patient NPO for extended periods c. Giving the patient an opioid narcotic for pain d. Inserting an indwelling catheter for the procedure

B - Keeping the patient NPO for extended periods

Which clinical manifestation indicates to the nurse that interventions for the patient's renal colic are effective? a. Urine is pink-tinged. b. Patient reports that pain is relieved. c. Urine output is 50 mL/min. d. Bladder scan shows no residual urine.

B - Patient reports that pain is relieved.

Which patient with incontinence is most likely to benefit from a surgical intervention? a. Patient with vaginal atrophy and altered urethral competency b. Patient with reflex (overflow) incontinence caused by obstruction c. Patient with functional incontinence related to musculoskeletal weakness d. Patient with urge incontinence or overactive bladder

B - Patient with reflex (overflow) incontinence caused by obstruction

A patient received an antibiotic prescription several hours ago and has started the medication, but requests "some relief from the burning." What comfort measures does the nurse suggest to the patient? a. Take over-the-counter acetaminophen. b. Sit in a sitz bath and urinate into the warm water. c. Place a cold pack over the perineal area. d. Rest in a recumbent position with legs elevated.

B - Sit in a sitz bath and urinate into the warm water.

A patient has agreed to try a bladder training program. What is the priority nursing intervention in starting this therapy? a. Start a schedule for voiding (e.g., every 2-3 hours). b. Teach the patient how to be alert, aware, and able to resist the urge to urinate. c. Convince the patient that the bladder issues are controlling his/her lifestyle. d. Give a thorough explanation of the problem of stress incontinence.

B - Teach the patient how to be alert, aware, and able to resist the urge to urinate.

The employee health nurse is conducting a presentation for employees who work in a paint manufacturing plant. In order to protect against bladder cancer, the nurse advises that everyone who works with chemicals should do what? a. Shower with mild soap and rinse well before they come to work. b. Use personal protective equipment such as gloves and masks. c. Limit their exposure to chemicals and fumes at all times. d. Avoid hobbies such as furniture refinishing that further expose to chemicals.

B - Use personal protective equipment such as gloves and masks.

A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse? a. Warm the dialysate solution in a microwave before instillation. b. Take a sample of the effluent and send to the laboratory. c. Flush the tubing with normal saline to maintain patency of the catheter. d. Check the peritoneal catheter for kinking and curling.

B ~ An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse. Checking the catheter for obstruction is a viable option but will not treat the peritonitis.

A client is recovering from a kidney transplant. The client's urine output was 1500 mL over the last 12-hour period since transplantation. What is the priority assessment by the nurse? a. Checking skin turgor b. Taking blood pressure c. Assessing lung sounds d. Weighing the client

B ~ By taking blood pressure, the nurse is assessing for hypotension that could compromise perfusion to the new kidney. The nurse then should notify the provider immediately. Skin turgor, lung sounds, and weight could give information about the fluid status of the client, but they are not the priority assessment.

The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse? a. My sodium level changes by movement from the blood into the dialysate. b. Dialysis works by movement of wastes from lower to higher concentration. c. Extra fluid can be pulled from the blood by osmosis. d. The dialysate is similar to blood but without any toxins.

B ~ Dialysis works using the passive transfer of toxins by diffusion. Diffusion is the movement of molecules from an area of higher concentration to an area of lower concentration. The other statements show a correct understanding about hemodialysis.

The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the client's recent history? a. Pyelonephritis b. Myocardial infarction c. Bladder cancer d. Kidney stones

B ~ Pre-renal causes of AKI are related to a decrease in perfusion, such as with a myocardial infarction. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are post-renal causes of AKI related to urine flow obstruction.

A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this client's care? a. Edema and pain b. Electrolyte and fluid imbalance c. Cardiac and respiratory status d. Mental health status

B ~ This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance is essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client's cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (SATA) a. I can continue to take antacids to relieve heartburn. b. I need to ask for an antibiotic when scheduling a dental appointment. c. I'll need to check my blood sugar often to prevent hypoglycemia. d. The dose of my pain medication may have to be adjusted. e. I should watch for bleeding when taking my anticoagulants.

B, C, D, E ~ In discharge teaching, the nurse must emphasize that the client needs to have an antibiotic prophylactically before dental procedures to prevent infection. There may be a need for dose reduction in medications if the kidney is not excreting them properly (antacids with magnesium, antibiotics, antidiabetic drugs, insulin, opioids, and anticoagulants).

For which adverse drug effects does the nurse assess in a client who is hospitalized for an acute problem and is also prescribed an anticholinergic drug to manage incontinence? Select all that apply. A. Insomnia B. Blurred vision C. Constipation D. Dry mouth E. Loss of sphincter control F. Increased sweating G. Worsening mental function H. Hypotension

B, C, D, G

The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (SATA) a. I need to decrease sodium, cholesterol, and protein in my diet. b. My weight should be maintained at a body mass index of 30. c. Smoking should be stopped as soon as I possibly can. d. I can continue to take an aspirin every 4 to 8 hours for my pain. e. I really only need to drink a couple of glasses of water each day.

B, D, E ~ Weight should be maintained at a body mass index (BMI) of 22 to 25. A BMI of 30 indicates obesity. The use of nonsteroidal anti-inflammatory drugs such as aspirin should be limited to the lowest time at the lowest dose due to interference with kidney blood flow. The client should drink at least 2 liters of water daily. Diet adjustments should be made by restricting sodium, cholesterol, and protein. Smoking causes constriction of blood vessels and decreases kidney perfusion, so the client should stop smoking.

4. A nurse assesses a client with a fungal urinary tract infection (UTI). Which assessments should the nurse complete? (Select all that apply.) a. Palpate the kidneys and bladder. b. Assess the medical history and current medical problems. c. Perform a bladder scan to assess post-void residual. d. Inquire about recent travel to foreign countries. e. Obtain a current list of medications.

B, E Clients who are severely immunocompromised or who have diabetes mellitus are more prone to fungal UTIs. The nurse should assess for these factors by asking about medical history, current medical problems, and the current medication list. A physical examination and a post-void residual may be needed, but not until further information is obtained indicating that these examinations are necessary. Travel to foreign countries probably would not be important because, even if exposed, the client needs some degree of compromised immunity to develop a fungal UTI.

3. A nurse teaches clients about the difference between urge incontinence and stress incontinence. Which statements should the nurse include in this education? (Select all that apply.) a. Urge incontinence involves a post-void residual volume less than 50 mL. b. Stress incontinence occurs due to weak pelvic floor muscles. c. Stress incontinence usually occurs in people with dementia. d. Urge incontinence can be managed by increasing fluid intake. e. Urge incontinence occurs due to abnormal bladder contractions.

B, E Clients who suffer from stress incontinence have weak pelvic floor muscles or urethral sphincter and cannot tighten their urethra sufficiently to overcome the increased detrusor pressure. Stress incontinence is common after childbirth, when the pelvic muscles are stretched and weakened from pregnancy and delivery. Urge incontinence occurs in people who cannot suppress the contraction signal from the detrusor muscle. Abnormal detrusor contractions may be a result of neurologic abnormalities including dementia, or may occur with no known abnormality. Post-void residual is associated with reflex incontinence, not with urge incontinence or stress incontinence. Management of urge incontinence includes decreasing fluid intake, especially in the evening hours.

The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast: History and Physical Assessment Medications Diagnostic Findings Polycystic kidney disease Diabetes Hysterectomy Abdomen distended Negative edema Glyburide Metformin Synthroid BUN 26 mg/dL Creatinine 1.0 mg/dL HbA1c 6.9% Glucose 132 mg/dL Which intervention is essential for the nurse to perform? Obtain a thyroid-stimulating hormone (TSH) level. Report the blood urea nitrogen (BUN) and creatinine. Hold the metformin 24 hours before and on the day of the procedure. Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values.

C Before studies with contrast media are performed, the nurse must withhold metformin, which may cause lactic acidosis. The focus of this admission is the polycystic kidneys; a TSH level is not essential at this time. BUN and creatinine are normal. The glucose is only mildly elevated (if fasting), and the HbA1c is in an appropriate range.

The nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first? Administer heparin intravenously. Remove the urinary catheter. Notify the health care provider. Irrigate the catheter with sterile saline.

C Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. The nurse should monitor urine output and notify the health care provider of obvious blood clots or a decreased or absent urine output. Heparin will not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and should not be removed at this time. The Foley catheter may be irrigated with sterile saline, as ordered.

The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? "I must clean with the wipes and then urinate directly into the cup." "I will have to drink 2 liters of fluid before providing the sample." "I'll start to urinate in the toilet, stop, and then urinate into the cup." "It is best to provide the sample while I am bathing."

C To provide a clean-catch urine sample, the client should initiate voiding, then stop, then resume voiding into the container. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. Although cleaning with wipes before providing a clean-catch urine sample is proper procedure, a step is missing. It is not necessary to drink 2 liters of fluid before providing a clean-catch urine sample. Providing a clean-catch urine sample does not involve bathing.

9. A confused client with pneumonia is admitted with an indwelling catheter in place. During interdisciplinary rounds the following day, which question should the nurse ask the primary health care provider? a. Do you want daily weights on this client? b. Will the client be able to return home? c. Can we discontinue the indwelling catheter? d. Should we get another chest x-ray today?

C An indwelling catheter dramatically increases the risks of urinary tract infection and urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are medically needed. The nurse should inquire about removing the catheter. All other questions might be appropriate, but because of client safety, this question takes priority.

1. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis? a. A 36-year-old female who has never been pregnant b. A 42-year-old male who is prescribed cyclophosphamide c. A 58-year-old female who is not taking estrogen replacement d. A 77-year-old male with mild congestive heart failure

C Females at any age are more susceptible to cystitis than men because of the shorter urethra in women. Postmenopausal women who are not on hormone replacement therapy are at increased risk for bacterial cystitis because of changes in the cells of the urethra and vagina. The middle-aged woman who has never been pregnant would not have a risk potential as high as the older woman who is not using hormone replacement therapy.

4. After teaching a client with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I will not take this drug with food or milk. b. If I think I am pregnant, I will stop the drug. c. An orange color in my urine should not alarm me. d. I will drink two glasses of cranberry juice daily.

C Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients think they have blood in their urine when they see this. In addition, the urine can permanently stain clothing. Phenazopyridine is safe to take if the client is pregnant. There are no dietary restrictions or needs while taking this medication.

26. A nurse provides phone triage to a pregnant client. The client states, I am experiencing a burning pain when I urinate. How should the nurse respond? a. This means labor will start soon. Prepare to go to the hospital. b. You probably have a urinary tract infection. Drink more cranberry juice. c. Make an appointment with your provider to have your infection treated. d. Your pelvic wall is weakening. Pelvic muscle exercises should help.

C Pregnant clients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the client to make an appointment and have the infection treated. Burning pain when urinating does not indicate the start of labor or weakening of pelvic muscles.

A young female patient reports experiencing burning with urination. What question does the nurse ask to differentiate between a vaginal infection and a urinary infection? a. "Have you noticed any blood in the urine?" b. "Have you had recent sexual intercourse?" c. "Have you noticed any vaginal discharge?" d. "Have you had fever or chills?"

C - "Have you noticed any vaginal discharge?"

Which statement by a patient indicates effective coping with a Kock's pouch? a. "I don't have any discomfort, but the pouch frequently overflows." b. "My wife has been irrigating the pouch daily. She likes to do it." c. "I check the pouch every 2 to 3 hours depending on my fluid and diet." d. "I never undress in front of anyone anymore, but I guess that is okay."

C - "I check the pouch every 2 to 3 hours depending on my fluid and diet."

The nurse is evaluating outcome criteria for a patient being treated for urge incontinence. Which statement indicates the treatment has been successful? a. "I'm following the prescribed therapy, but I think surgery is my best choice." b. "I still lose a little urine when I sneeze, but I have been wearing a thin pad." c. "I had trouble at first, but now I go to the toilet every 3 hours." d. "I have been using the bladder compression technique and it works."

C - "I had trouble at first, but now I go to the toilet every 3 hours."

Which patient has the highest risk for bladder cancer? a. 60-year-old male patient with malnutrition secondary to chronic alcoholism and self- neglect b. 25-year-old male patient with type 1 diabetes mellitus, who is noncompliant with therapeutic regimen c. 60-year-old female patient who smokes two packs of cigarettes per day and works in a chemical factory d. 25-year-old female patient who has had three episodes of bacterial (Escherichia coli) cystitis in the past year.

C - 60-year-old female patient who smokes two packs of cigarettes per day and works in a chemical factory

The nurse is working in a long-term care facility. Which circumstance is cause for greatest concern, because the facility has a large number of residents who are developing UTIs? a. Residents are not drinking enough fluids with meals. b. Unlicensed personnel are not assisting with toileting in a timely fashion. c. A large percentage of residents have indwelling urinary catheters. d. Many residents have severe dementia and functional incontinence.

C - A large percentage of residents have indwelling urinary catheters.

An older adult patient with a cognitive impair-ment is living in an extended-care facility. The patient is incontinent, but as the family points out, "he will urinate in the toilet if somebody helps him." Which type of incontinence does the nurse suspect in this patient? a. Urge b. Overflow c. Functional d. Stress

C - Functional

The cystoscopy results for a patient include a small-capacity bladder, the presence of Hunner's ulcers, and small hemorrhages after bladder distention. How does the nurse interpret this report? a. Urosepsis b. Complicated cystitis c. Interstitial cystitis d. Urethritis

C - Interstitial cystitis

The nurse is caring for an obese older adult patient with dementia. The patient is alert and ambulatory, but has functional incontinence. Which nursing intervention is best for this patient? a. Help the patient to lose weight. b. Help the patient apply an estrogen cream. c. Offer assistance with toileting every 2 hours. d. Intermittently catheterize the patient.

C - Offer assistance with toileting every 2 hours.

A patient is diagnosed with urethral stricture. What findings does the nurse expect to see documented in the patient's chart for this condition? a. Pain on urination b. Pain on ejaculation c. Overflow incontinence d. Hematuria and pyuria

C - Overflow incontinence

The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching? a. I should leave the drainage bag above the level of my abdomen. b. I could flush the tubing with normal saline if the flow stops. c. I should take a stool softener every morning to avoid constipation. d. My diet should have low fiber in it to prevent any irritation.

C ~ Inflow and outflow problems of the dialysate are best controlled by preventing constipation. A daily stool softener is the best option for the client. The drainage bag should be below the level of the abdomen. Flushing the tubing will not help with the flow. A diet high in fiber will also help with a constipation problem.

A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time? a. Decreased calcium levels b. Increased phosphorus levels c. No adventitious sounds in the lungs d. Increased edema in the legs

C ~ The absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the client's body. Decreased calcium levels and increased phosphorus levels are common findings with CKD. Edema would indicate a fluid imbalance.

The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub? a. Registered nurse who just floated from the surgical unit b. Registered nurse who just floated from the dialysis unit c. Registered nurse who was assigned the same client yesterday d. Licensed practical nurse with 5 years experience on this floor

C ~ The client is exhibiting symptoms of pericarditis, which can occur with chronic kidney disease. Continuity of care is important to assess subtle differences in clients. Therefore, the registered nurse (RN) who was assigned to this client previously should again give care to this client. The float nurses would not be as knowledgeable about the unit and its clients. The licensed practical nurse may not have the education level of the RN to assess for pericarditis.

A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L Potassium 5 mEq/L Blood urea nitrogen (BUN) 44 mg/dL Serum creatinine 2.5 mg/dL What initial intervention would the nurse anticipate? a. Start hemodialysis immediately. b. Discuss the need for peritoneal dialysis. c. Increase the dose of immunosuppression. d. Return the client to surgery for exploration.

C ~ The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute rejection of the transplanted kidney. The client does not need hemodialysis, peritoneal dialysis, or further surgery at this point.

The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? a. Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c. Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left arm

C ~ The nurse should not use the arm with the AV fistula for intravenous infusion, blood pressure readings, or venipuncture. Compression and infection can result in the loss of the AV fistula. The AV fistula should be monitored by auscultating or palpating the access site. Checking the distal pulse would be an appropriate assessment.

A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema? a. Maintaining oxygen saturation of 89% b. Minimal crackles and wheezes in lung sounds c. Maintaining a balanced intake and output d. Limited shortness of breath upon exertion

C ~ With an optimal fluid balance, the client will be more able to eject blood from the left ventricle without increased pressure in the left ventricle and pulmonary vessels. Other ideal goals are oxygen saturations greater than 92%, no auscultated crackles or wheezes, and no demonstrated shortness of breath.

A 25-year-old sexually active female client diagnosed with cystitis tells the nurse that she doesn't understand why she has these infections yearly because she tries to avoid them by drinking very little at work so she doesn't have to use the "dirty" public toilet. Which suggestions or actions by the nurse are most likely to help this client reduce her risk for cystitis? Select all that apply. A. Reinforce her choice to avoid using a public toilet. B. Teach her to shower immediately after having sexual intercourse. C. Suggest that she drink at least 2-3 L of fluid throughout the day. D. Urge her to change her method of birth control from oral contraceptives to a barrier method. E. Instruct her to always wipe her perineum from front to back after each toilet use. F. Reinforce that she should complete the entire course of antibiotics as prescribed. G. Instruct her to empty her bladder immediately before having intercourse.

C, E, F, G

The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day? Client with chronic kidney disease Client with heart failure Client with complete bowel obstruction Client with hyperparathyroidism

D A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones; this client should remain hydrated. A client with chronic kidney disease should not consume 2 to 3 liters of water because the kidneys are not functioning properly, and this could lead to fluid retention. People with heart failure typically have fluid volume excess. A client with complete bowel obstruction may experience vomiting and should be NPO.

Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter? Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. Remove the existing catheter and obtain a sample during the process of inserting a new Foley. Use a sterile syringe to withdraw urine from the urine collection bag. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.

D Clamping the tubing, attaching a syringe to the specimen, and withdrawing at least 5 mL of urine is the correct technique for obtaining a sterile urine specimen from the client with a Foley catheter. Disconnecting the Foley catheter from the drainage tube and collecting urine directly from the Foley increases the risk for microbe exposure. A Foley catheter should not be removed to get a urine sample. Microbes may be in the urine collection bag from standing urine, so using a sterile syringe to withdraw urine from the urine collection bag is not the proper technique to obtain a urine sample.

A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the provider visited the client the day before. What action does the nurse take? Asks the client to sign the informed consent Cancels the procedure Asks the client's spouse to sign the form Notifies the department and the provider

D The client may be asked to sign the consent form in the department; notifying both the provider and the department ensures communication across the continuum of care, with less likelihood of omission of information. The provider gives the client a complete description of and reasons for the procedure and explains complications; the nurse reinforces this information. The procedure should not be cancelled without an attempt to correct the situation. The client has not received sedation, so nothing suggests that the client is not competent to consent.

One of the nurse's roles is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? Children's terms that are easily understood Slang words and terms that are heard "socially" Technical and medical terminology Words that the client uses

D The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client. The use of children's terms is demeaning to adult clients. The use of slang terms is unprofessional. Technical terms should not be used because the client may not know what they mean.

8. A nurse plans care for a client with overflow incontinence. Which intervention should the nurse include in this clients plan of care to assist with elimination? a. Stroke the medial aspect of the thigh. b. Use intermittent catheterization. c. Provide digital anal stimulation. d. Use the Valsalva maneuver.

D In clients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure, such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh or providing digital anal stimulation requires the reflex arc to be intact to initiate elimination. Due to the high risk for infection, intermittent catheterization should only be implemented when other interventions are not successful.

11. A nurse cares for a client who has kidney stones from secondary hyperoxaluria. Which medication should the nurse anticipate administering? a. Phenazopyridine (Pyridium) b. Propantheline (Pro-Banthine) c. Tolterodine (Detrol LA) d. Allopurinol (Zyloprim)

D Stones caused by secondary hyperoxaluria respond to allopurinol (Zyloprim). Phenazopyridine is given to clients with urinary tract infections. Propantheline is an anticholinergic. Tolterodine is an anticholinergic with smooth muscle relaxant properties.

14. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for bladder cancer? a. A 25-year-old female with a history of sexually transmitted diseases b. A 42-year-old male who has worked in a lumber yard for 10 years c. A 55-year-old female who has had numerous episodes of bacterial cystitis d. An 86-year-old male with a 50pack-year cigarette smoking history

D The greatest risk factor for bladder cancer is a long history of tobacco use. The other factors would not necessarily contribute to the development of this specific type of cancer.

The nurse is performing an assessment on a patient with probable stress incontinence. Which assessment technique does the nurse use to validate stress incontinence? a. Assess the abdomen to estimate bladder fullness. b. Check for residual urine using a portable ultrasound. c. Catheterize the patient immediately after voiding. d. Ask the patient to cough while wearing a perineal pad.

D - Ask the patient to cough while wearing a perineal pad.

The nurse is caring for a patient with functional incontinence. The UAP reports that "the linens have been changed four times within the past 6 hours, but the patient refuses to wear a diaper." What does the nurse do next? a. Thank the UAP for the hard work and advise to continue to change the linens. b. Call the health care provider to obtain an order for an indwelling catheter. c. Instruct the UAP to stop using the word "diaper" and instead use "incontinence pants." d. Assess the patient for any new urinary problems and ask about toileting preferences.

D - Assess the patient for any new urinary problems and ask about toileting preferences.

A patient is returning from the postanesthesia care unit after surgery for bladder cancer resulting in a cutaneous ureterostomy. Where does the nurse expect the stoma to be located? a. On the perineum b. At the beltline c. On the posterior flank d. In the midabdominal area

D - In the midabdominal area

A patient has been started on oxybutynin (Ditropan) for urinary incontinence. What is the major action of this medication? a. Increases blood flow to the urethra b. Blocks acetylcholine receptors c. Causes slight numbing of the bladder d. Relaxes bladder muscles

D - Relaxes bladder muscles

A patient with a history of kidney stones presents with severe flank pain, nausea, vomiting, pallor, and diaphoresis. He reports freely passing urine, but it is bloody. The priority for nursing care is to monitor for which patient problem? a. Possible dehydration b. Impaired tissue perfusion c. Impaired urinary elimination d. Severe pain

D - Severe pain

A patient repots the loss of small amounts of urine during coughing, sneezing, jogging, or lifting. Which type of incontinence do these symptoms describe? a. Urge b. Overflow c. Functional d. Stress

D - Stress

Which urine characteristic suggests that the patient is drinking a sufficient amount of fluid? a. Urine pH is between 6 to 6.5. b. Urine has a high specific gravity. c. Urine has a faint ammonia odor. d. Urine is a pale yellow color.

D - Urine is a pale yellow color.

A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the client's nose and around the intravenous catheter. What action by the nurse is the priority? a. Hold pressure over the client's nose for 10 minutes. b. Take the client's pulse, blood pressure, and temperature. c. Assess for a bruit or thrill over the arteriovenous fistula. d. Prepare protamine sulfate for administration.

D ~ Heparin is used with hemodialysis treatments. The bleeding alerts the nurse that too much anticoagulant is in the client's system and protamine sulfate should be administered. Pressure, taking vital signs, and assessing for a bruit or thrill are not as important as medication administration.

A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurses priority action? a. Calculate the mean arterial pressure (MAP). b. Ask for insertion of a pulmonary artery catheter. c. Take the client's pulse. d. Slow down the normal saline infusion.

D ~ The nurse should assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter would evaluate the client's hemodynamic status, but this should not be the initial action by the nurse. Vital signs are also important after adjusting the intravenous infusion.

The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? A. "I am so relieved that I can continue eating my fried fish meals every week." B. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." C. "My wife will be happy to know that I can keep enjoying her liver and onions recipe." D. "I will no longer be able to have red wine with my dinner."

D. "I will no longer be able to have red wine with my dinner." Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client should decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming. Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stone consists of calcium oxalate.

Define the "L" in the RIFLE classification system.

OUTCOME LOSS STAGE = Persistent acute kidney injury (AKI) requiring renal replacement therapy for >4 wks

Impairment in the thirst mechanisms associated with aging makes an older adult patient more vulnerable to which disorder? a. Hypernatremia b. Hypocalcemia c. Hyperkalemia d. Hypoglycemia

a

Limiting fluid intake would have what effect on urine? a. Increases the concentration of urine b. Makes the urine less irritating c. Decreases the risk for urine infection d. decreases the pH of urine

a

A nurse teaches a client about self-management after experiencing a urinary calculus treated by lithotripsy. Which statements would the nurse include in this client's discharge teaching? (Select all that apply.) "Finish the prescribed antibiotic even if you are feeling better." "Drink at least 3 L of fluid each day." "The bruising on your back may take several weeks to resolve." "Report any blood present in your urine." "It is normal to experience pain and difficulty urinating."

a, b, c

The nurse is caring for a client who is diagnosed with urinary tract infection (UTI). What common urinary signs and symptoms does the nurse expect? (Select all that apply.) a. Dysuria b. Frequency c. Burning d. Fever e. Chills f. Hematuria

a, b, c, f

A nurse assesses a client who has had two episodes of bacterial cystitis in the last 6 months. Which question(s) would the nurse ask? (Select all that apply.) "How much water do you drink every day?" "Do you take estrogen replacement therapy?" "Does anyone in your family have a history of cystitis?" "Are you on steroids or other immune-suppressing drugs?" "Do you drink grapefruit juice or orange juice daily?"

a, b, d

A nurse assesses a client with nephrotic syndrome. Which assessment findings would the nurse expect? (Select all that apply.) Proteinuria Hypoalbuminemia Dehydration Lipiduria Dysuria Costovertebral angle (CVA) tenderness

a, b, d

A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly paired with their description? (Select all that apply.) Stress incontinence—urine loss with physical exertion Urge incontinence—loss of urine upon feeling the need to void Functional incontinence—urine loss results from abnormal detrusor contractions Overflow incontinence—constant dribbling of urine Reflex incontinence—leakage of urine without lower urinary tract disorder

a, b, d

A nurse teaches a client with polycystic kidney disease (PKD). Which statements would the nurse include in this client's discharge teaching? (Select all that apply.) "Take your blood pressure every morning." "Weigh yourself at the same time each day." "Adjust your diet to prevent diarrhea." "Contact your provider if you have visual disturbances." "Assess your urine for renal stones."

a, b, d

The nurse is reviewing the results of a client's urinalysis. The client has a diagnosis of acute glomerulonephritis. Which urine findings would the nurse expect? (Select all that apply.) Presence of protein Presence of red blood cells Presence of white blood cells Acidic urine Dilute urine

a, c, d

A client asks the nurse why she has urinary incontinence. What risk factors would the nurse recall in preparing to respond to the client's question? (Select all that apply.) Diuretic therapy Anorexia nervosa Stroke Dementia Arthritis Parkinson disease

a, c, d, e, f

The nurse is planning health teaching for a client starting mirabegron for urinary incontinence. What health teaching would the nurse include? (Select all that apply.) "Monitor blood tests carefully if you are prescribed warfarin." "Avoid crowds and individuals with infection." "Report any fever to your primary health care provider." "Take your blood pressure frequently at home." "Report palpitations or chest soreness that may occur."

a, d

18. A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best? a. Check the client's digoxin (Lanoxin) level. b. Administer an anti-nausea medication. c. Ask if the client is able to eat crackers. d. Get a referral to a gastrointestinal provider.

a. Check the client's digoxin (Lanoxin) level.

A patient has undergone a kidney biopsy. In the immediate postprocedural period, the nurse notifies the health care provider about which findings? (SATA) a. Hematuria with blood clots b. Localized pain at the site c. "Tamponade effect" d. Decreasing urine output e. Flank pain f. Decreasing blood pressure

adef

The nurse is assessing a client with acute pyelonephritis. What assessment findings would the nurse expect? (Select all that apply.) Fever Chills Tachycardia Tachypnea Flank or back pain Fatigue

all of these

A nurse assesses a client who is recovering from extracorporeal shock-wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client's right lower back. What action would the nurse take? Administer fresh-frozen plasma. Apply an ice pack to the site. Place the client in the prone position. Obtain serum coagulation test results.

b

A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding would alert the nurse to immediately contact the primary health care provider? Flank pain Periorbital edema Bloody and cloudy urine Enlarged abdomen

b

A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in the last 6 months. The client asks, "I never have urinary tract infections. Why is this happening now?" How would the nurse respond? "Your immune system becomes less effective as you age." "Low estrogen levels can make the tissue more susceptible to infection." "You should be more careful with your personal hygiene in this area." "It is likely that you have an untreated sexually transmitted disease."

b

A nurse reviews the laboratory findings of a client with a urinary tract infection (bacterial cystitis). The laboratory report notes a "shift to the left" in the client's white blood cell count. What action would the nurse take? Request that the laboratory perform a differential analysis on the white blood cells. Notify the primary health care provider and start an intravenous line for parenteral antibiotics. Ask assistive personnel (AP) to strain the client's urine for renal calculi. Assess the client for a potential allergic reaction and anaphylactic shock.

b

A patient had a renal scan. What is included in the postprocedural care for this patient? a. Administer laxatives to cleanse the bowel b. Encourage oral fluids to assist excretion of isotope c. Administer captopril (Capoten) to increase blood flow d. Insert a urinary catheter to measure urine output

b

A patient has sustained a minor kidney injury. Which structure must remain functional in order to form urine from blood? a. Medulla b. Nephron C. calyx d. capsule

b

After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? "I will take a laxative every night before going to bed." "I must increase my intake of dietary fiber and fluids." "I shall only use salt when I am cooking my own food." "I'll eat white bread to minimize gastrointestinal gas."

b

During the day, the nursing student is measuring urine output and observing for urine characteristics in a patient. Which abnormal finding is the most urgent, which must be reported to the supervising nurse? a. Specific gravity is decreased b. Output is decreased c. pH is decreased d. Color has changed

b

In which circumstance is the regulatory role of aldosterone most important in order for the person to maintain homeostasis? a. person is having pain related to a kidney stone b. person has been hiking in the desert for several hours c. person experiences stress incontinence when coughing d. person experiences a burning sensation during urination

b

Ketones in the urine may indicate which occurrence or process? a. Increased glomerular membrane permeability b. Chronic kidney infection c. Body's use of fat for cellular energy d. Urianry tract infection

b

The health care provider informs the nurse that there is a change in orders because the patient has a decrease in creatine clearance rate. what change does the nurse anticipate? a. fluid restriction b. reduction of drug dosage c. limitation on activity level d. modification of diet

b

The nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question would the nurse ask first? "Are you drinking plenty of water?" "What medications are you taking?" "Have you tried laxatives or enemas?" "Has this type of thing ever happened before?"

b

The nurse is caring for a patient with dehydration. Which laboratory test results does the nurse anticipate to see for this patient? a. BUN and creatinine ratio stay the same b. BUN rises faster than creatinine level c. Creatinine rises faster than BUN d. BUN and creatinine have a direct relationship

b

The nurse is interviewing a 35-year-old women who needs evaluation for a potential kidney problem. The woman reports she has been pregant twice and has two healthy children. what would the nurse ask about health problems that occurred during pregnancy? a. "How much weight did you gain during the preganncy? b. "Were you treated for gestational diabetes?" c. "Did both of your pregnancies go to full-term? d. "Did you have a urinary catheter inserted during labor?"

b

The nurse is performing an assessment of the renal system. What is the first step in the assessment process? a. Percuss the lower abdomen; continue toward the umbilicus b. Observe the flank region for asymmetry or discoloration c. Listen for a bruit over each renal artery d. Lightly palpate the abdomen in all quadreants

b

The nurse is taking a history on a 55-year-old patient who denies any serious chronic health problems Which sudden onset sign/symptoms suggests possible kidney disease in this patient? a. Weakness b. Hypertension c. Confusion d. Dysrhythmia

b

The nurse is teaching a patient scheduled for an ultrasonography. What preprocedural instruction does the nurse give the patient? a. void just before the test begins b. drink water to fill the bladder c. stop routine medications d have nothing to eat or drink after midnight

b

The nurse reads in the assessment note made by the advanced-practice nurse that the "left kidney cannot be palpated." How does the nurse interpret this notation? a. The left kidney is smaller than normal, which indicates CKD b. The left kidney is normally deeper and often cannot be palpated c. The palpation of kidneys should be repeated by another provider d. The patient is too obese for this type of examination

b

The nurse sees that an older patient has a blood osmolarity of 303 mOsm/L. Which additional assessment will the nurse make before notifying the health care provider about the laboratory results? a. Patients mental stauts b. Signs of dehydration c. Patients temeprature d. Odor of the urine

b

The nurse tells the patient that the health care provider recommends a fluid intake of at least 2 liters per day. The nurse then asks the patient to report on fluid intake over the past 24 hours to assess typical intake. The patient reports 15 ounces of coffee and 10 ounces of juice for breakfast; 10 ounces of skim milk for a midmorning snack, 12 ounces of protein shake for lunch, 1/2 liter of sports drink in the afternoon and 3 ounces of wine for dinner. After calculating the 24-hour fluid intake, what does the nurse tell the patient? a. Fluid consumptions should be increased by at least 2 more servings b. Fluid consumption is meeting the 2 liters/day recommendation c. Fluid consumption exceeds recommendation, therefore eliminate the wine d. Fluid consumption only includes liquids such as water, juice, or milk

b

Vitamin D is converted to its active form in the kidney. If this function fails, which electrolyte imbalance will occur? a. Hyperkalemia b. Hypocalcemia c. Hypernatremia d. Hypoglycemia

b

What is an advantage of a renal scan compared to a CT scan for diagnosing the perfusion, function, and structure of the kidneys? a. renal scan is more readily tolerated by elderly patients and small children b. Renal scan is preferred if the patient is allergic to iodine or has impaired kidney function c. renal scans are more likely to detect pathologic changes that CT scans do not detect d. renal scan requires less pre- and postprocedural care than CT scan

b

When patients have problems with kidneys or urinary tract, what is the most common symptoms that prompts them to seek medical attention? a. Change in the frequency or amount of urinartion b. Pain in flank or abdomen or pain when urinating c. Noticing a change in the color or odor of the urine d. Exposure to a nephrotoxic substance

b

Which ethnic group has the highest risk for kidney failure and needs special attention for patient teaching related to hypertension and sodium intake? a. caucasian American b. African Americans c. asian americans d Native Americans

b

Which hormone is released from the posterior pituitary and makes the distal convoluted tubule and the collecting duct permeable to water to maximize reabsorption and produce concentrated urine? a. Aldosterone b. Vasopressin c. Bradykinins d. Natriuretic

b

Which patient is most likely to exceed the renal threshold if there is noncompliance with the prescribed therapeutic regimen? a. Has recurrent kidney stone formation b. has type 2 diabetes mellitus c. has functional urinary incontinence d. has biliary obstruction

b

Which personal action is most likely to cause the kidenys to produce and release erythropoietin? a. person moves to a low desert area where the humidity is very low b. person moves to a high-altitude area where atmospehric oxygen is low c. Person drinks an excessive amount of fluid that resutls in fluid overload d. person eats a large high-protein meal after a rigourous exercise workout

b

what is the average urine output of a healthy adult for a 24-hour period? a. 500 to 1000 mL per day b. 1500 to 2000 mL per day c. 3000 to 5000 mL per day d. 5000 to 7000 mL per day

b

A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings would alert the nurse to urgently contact the primary health care provider? (Select all that apply.) Clear drainage Bloody drainage at site Patient reports headache Foul-smelling drainage Urine draining from site

b, d, e

20. The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse? a. "My sodium level changes by movement from the blood into the dialysate." b. "Dialysis works by movement of wastes from lower to higher concentration." c. "Extra fluid can be pulled from the blood by osmosis." d. "The dialysate is similar to blood but without any toxins."

b. "Dialysis works by movement of wastes from lower to higher concentration."

5. A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.) a. "I can continue to take antacids to relieve heartburn." b. "I need to ask for an antibiotic when scheduling a dental appointment." c. "I'll need to check my blood sugar often to prevent hypoglycemia." d. "The dose of my pain medication may have to be adjusted." e. "I should watch for bleeding when taking my anticoagulants."

b. "I need to ask for an antibiotic when scheduling a dental appointment." c. "I'll need to check my blood sugar often to prevent hypoglycemia." d. "The dose of my pain medication may have to be adjusted." e. "I should watch for bleeding when taking my anticoagulants."

4. The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (Select all that apply.) a. "I need to decrease sodium, cholesterol, and protein in my diet." b. "My weight should be maintained at a body mass index of 30." c. "Smoking should be stopped as soon as I possibly can." d. "I can continue to take an aspirin every 4 to 8 hours for my pain." e. "I really only need to drink a couple of glasses of water each day."

b. "My weight should be maintained at a body mass index of 30." d. "I can continue to take an aspirin every 4 to 8 hours for my pain." e. "I really only need to drink a couple of glasses of water each day."

The nurse is assessing a patient with a chronic kidney problem. The nurse notes that the patient has pedal edema and periorbital edema. What additional assessments will the nurse make to assess for fluid overload? (SATA) a. Obtain a urine specimen b. Compare current blood pressure to baseline c. Measure the residual urine with a bladder scanner d. Weigh the patient and compare to baseline e. Auscultate lung fields to determine if fluid is present

bde

A 24-hour urine specimen is required from a patient. Which strategy is best to ensure that all the urine is collected for the full 24-hour period? a. Instruct the UAP to collect all the urine b. Put a bedpan or commode next to the bed as a reminder c. Place a sign in the bathroom reminding everyone to save urine d. Verbally remind the patient about the test

c

A client with pneumonia and dementia is admitted with an indwelling urinary catheter in place. During interprofessional rounds the following day, which question would the nurse ask the primary health care provider? "Do you want daily weights on this client?" "Will the client be able to return home?" "May we discontinue the indwelling catheter?" "Should we get another chest x-ray today?"

c

A nurse cares for a client who has pyelonephritis. The client states, "I am embarrassed to talk about my symptoms." How would the nurse respond? "I am a professional. Your symptoms will be kept in confidence." "I understand. Elimination is a private topic and shouldn't be discussed." "Take your time. It is okay to use words that are familiar to you." "You seem anxious. Would you like a nurse of the same gender to care for you?"

c

A nurse cares for a middle-age female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, "What can I do to help prevent these infections?" How would the nurse respond? "Test your urine daily for the presence of ketone bodies and proteins." "Use tampons rather than sanitary napkins during your menstrual period." "Drink more water and empty your bladder more frequently during the day." "Keep your hemoglobin A1C under 9% by keeping your blood sugar controlled."

c

A nurse teaches a client who is starting urinary bladder training. Which statement would the nurse include in this client's teaching? "Use the toilet when you first feel the urge, rather than at specific intervals." "Initially try to use the toilet at least every half hour for the first 24 hours." "Try to consciously hold your urine until the scheduled toileting time." "The toileting interval can be increased once you have been continent for a week."

c

A patient has a urinalysis ordered. When is the best time for the nurse to collect the specimen? a. In the evening b. After a meal c. In the morning d. After a fluid bolus

c

After teaching a client with bacterial cystitis who is prescribed phenazopyridine, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? "I will not take this drug with food or milk." "I will have my partners tested for STIs." "An orange color in my urine should not alarm me." "I will drink two glasses of cranberry juice daily."

c

In addition to kidney disease, which patient condition causes the BUN to rise above the noraml range? a. Anemia b. Asthama c. Infection d. Malnutrtion

c

Several patients are scheduled for testing to diagnose potential kidney problems. Which test requires a patient to have a urinary catheter inserted before the test? a. Urine stream testing b. Computed tomography c. Cystography d. Renal scan

c

The community health nurse is talking to a group of African-American adults about renal health. The nurse encourages the participants to have which type of yearly examination to screen for kidney problems a. Kidney ultrasound b. Serum creatinine and blood urea nitrogen c. Urinalysis and microalbuminuria d. 24-hour urine collection

c

The nurse is determining whether a patient has a history of hypertension because of the potential for kidney problems. Which question is best to elicit this information? a. "Do you have high blood pressure?" b. "Do you take any blood pressure medications?" c. "Have you ever been told that your blood pressure was high?" d. "When was the last time you had your blood pressure checked"

c

The nurse is taking a nutritional history on a patient. The patient states, "I really don't drink as much water as I should." What is the nurses best response? a. "We should probably all drink more water than we do." b. "Its an easy thing to forget; just try to remember to drink more." c. "What would encourage you to drink the recommneded 2 literes per day?" d. "Id like you to read this brochure about kidney health and fluids."

c

What does an increase in the ratio of BUN to serum creatinine indicate? a. Highly suggestive of kidney dysfunction b. definitive for kidney infection c. Suggests kidney factors causing an elevation in BUN d. Suggests nonkidney factors causing an elevation in serum creatinine

c

Which patients narrative describes the symptoms of dysuria? a. "I have to pee all the time." b. "I have to wait before the pee starts." c. "It burns when I pee." d. "It feels like I am going to pee in my pants."

c

19. The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8° F (37.6° C). What is the most appropriate action by the nurse? a. Administer fluid to increase blood pressure. b. Check the white blood cell count. c. Monitor the client's temperature. d. Connect the client to an electrocardiographic (ECG) monitor.

c. Monitor the client's temperature.

17. A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time? a. Decreased calcium levels b. Increased phosphorus levels c. No adventitious sounds in the lungs d. Increased edema in the legs

c. No adventitious sounds in the lungs

A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client's blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. What action would the nurse take? Position the client to lay on the surgical incision. Measure the specific gravity of the client's urine. Administer intravenous pain medications. Assess the rate and quality of the client's pulse.

d

A patient appears very uncomfortable with the nurses questions about urinary functions and patterns. what is the best technique for the nurse to use to elixit relevant information and decrease the patients discomfort ? a. Defere the questions until a later time b. Direct the questions toward a family member c. Use anatomic or medical terminology d. Use the patients own terminology

d

A patient reports flank pain and tenderness. What technique does the nurse use to assess for costovertebral angle tenderness? a. Percuss the nontender flank and assess for rebound b. Thump the CVA area with the flat surface of the hand c. Thump the CVA area with a clenched fist d. Place one palm over the CVA area, thump with other fist

d

14. A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)? a. Antibiotic b. Histamine blocker c. Bronchodilator d. Angiotensin-converting enzyme (ACE) inhibitor

d. Angiotensin-converting enzyme (ACE) inhibitor

22. A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the client's nose and around the intravenous catheter. What action by the nurse is the priority? a. Hold pressure over the client's nose for 10 minutes. b. Take the client's pulse, blood pressure, and temperature. c. Assess for a bruit or thrill over the arteriovenous fistula. d. Prepare protamine sulfate for administration.

d. Prepare protamine sulfate for administration

What is the normal lab value for Serum Creatinine?

0.6-1.2 mg/dL

The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply. 1. Dysuria 2. Enuresis 3. Frequency 4. Nocturia 5. Urgency 6. Polyuria

1. Dysuria 3. Frequency 4. Nocturia 5. Urgency Dysuria (painful urination), nocturia (frequent urinating at night), urgency (having the urge to urinate quickly), and frequency are symptoms of UTI. Enuresis (bed-wetting) and polyuria (increased amounts of urine production) are not signs of a UTI.

What method of emptying the bladder is helpful for a client with a large cystocele? 1. Splinting 2. Credé method 3. Double-voiding 4. Valsalva maneuver

1. Splinting The client with a large cystocele or prolapse of the bladder into the vagina may use splinting to reduce renal urinary incontinence. This is achieved by inserting fingers into the vagina and lifting the cystocele to urinate. The client using the Credé method presses over the bladder area to increase pressure. The client may also trigger nerve stimulation by tugging at the pubic hair or massaging the genital area. In the double-voiding technique, the client empties the bladder once and then attempts a second voiding within a few minutes. The Valsalva maneuver is a breathing technique that increases chest and abdominal pressure. Increased pressure is directed toward the bladder during exhalation.

What is the normal lab value for urine Specific Gravity?

1.01-1.03

The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? 1. "A small-lumen catheter will help prevent injury to my urethra." 2. "I will use a new, sterile catheter each time I do the procedure." 3. "My family members can be taught to help me if I need it." 4. "Proper handwashing before I start the procedure is very important."

2. "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating. The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization and is a principle that should be stressed.

The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? 1. 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) 2. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours 3. 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy 4. 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

2. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention. The 26-year-old admitted with urosepsis and slight fever, the 32-year-old scheduled for cystoscopy, and the 40-year-old with noninfectious urethritis are not at immediate risk for complications or deterioration.

The nurse is caring for a client who has pyuria. What does the urinalysis reveal in this client? 1. Kidney stones. 2. White blood cells in the urine. 3. Red blood cells in the urine. 4. Heavy bacteria in the urine.

2. White blood cells in the urine. Urinalysis showing pyuria means that the client has white blood cells in the urine without a large number of bacteria.

The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? 1. "I must avoid drinking carbonated beverages." 2. "I need to douche vaginally once a week." 3. "I should drink 2½ liters of fluid every day." 4. "I will not drink fluids after 8 pm each evening."

3. "I should drink 2½ liters of fluid every day." Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis. Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8 pm would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late-night fluid intake to 120 mL.

A 53-year-old postmenopausal woman reports "leaking urine" when she laughs, and is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? 1. "They can relieve your anxiety associated with incontinence." 2. "They help your bladder to empty." 3. "They may be used to improve urethral resistance." 4. "They decrease your bladder's tone."

3. "They may be used to improve urethral resistance." Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance. Relieving anxiety has not been shown to improve stress incontinence. No drugs have been shown to promote bladder emptying, and this is not usually the problem with stress incontinence. Emptying the bladder is accomplished by the individual, or if that is not possible, by using a catheter. Decreasing bladder tone would not be a desired outcome for a woman with incontinence.

A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? 1. Bladder training 2. Credé method 3. Habit training 4. Kegel exercises

3. Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis. Bladder training, the Credé method, and learning Kegel exercises require that the client be alert, cooperative, and able to assist with his or her own training.

The certified Wound, Ostomy, and Continence Nurse (CWOCN) or enterostomal therapist (ET) teaches a client who has had a cystectomy about which care principles for the client's postdischarge activities? 1. Nutritional and dietary care 2. Respiratory care 3. Stoma and pouch care 4. Wiping from front to back (asepsis)

3. Stoma and pouch care The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms. The registered dietitian (RD) teaches the cystectomy client about nutritional care. The respiratory therapist teaches the cystectomy client about respiratory care. The client with a cystectomy does not require instruction about front-to-back wiping.

What is the normal lab value for serum ALBUMIN?

3.5-5.5 g/dL

What is the normal Osmolality of Urine?

300-900 mOsm/kg

The nurse is teaching a client who is scheduled for a neobladder and a Kock's pouch. Which client statement indicates a correct understanding of these procedures? 1 . "If I restrict my oral intake of fluids, the adjustment will be easier." 2. "I must go to the restroom more often because my urine will be excreted through my anus." 3. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." 4. "I will have to drain my pouch with a catheter."

4. "I will have to drain my pouch with a catheter." For the client with a neobladder and a Kock's pouch, urine is collected in a pouch and is drained with the use of a catheter. Fluids should not be restricted. A neobladder does not require the use of an ostomy bag.

Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN? 1. 42-year-old with painless hematuria who needs an admission assessment 2. 46-year-old scheduled for cystectomy who needs help in selecting a stoma site 3. 48-year-old receiving intravesical chemotherapy for bladder cancer 4. 55-year-old with incontinence who has intermittent catheterization prescribed

4. 55-year-old with incontinence who has intermittent catheterization prescribed Insertion of catheters is within the education and legal scope of practice for LPN/LVNs. Admission assessments and intravesical chemotherapy should be done by an RN. Preoperative preparation for cystectomy and stoma site selection should be done by an RN and either a Certified Wound, Ostomy, and Continence Nurse (CWOCN) or an enterostomal therapy (ET) nurse.

What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)? 1. Limit fluid intake. 2. Increase caffeine consumption. 3. Limit sugar intake. 4. Drink about 3 liters of fluid daily.

4. Drink about 3 liters of fluid daily. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs. Fluids flush the system and should not be limited. Increased caffeine intake and limiting sugar intake will not prevent UTIs.

In what location would the nurse expect to find infection in a client with acute pyelonephritis? 1. Urethra 2. Urinary bladder 3. Prostate gland 4. Kidneys

4. Kidneys Acute pyelonephritis is a kidney infection. Urinary tract infections are described by their location in the tract. Urethritis is an acute infection in the urethra, cystitis in the bladder, and prostatitis in the prostate gland.

A client reports experiencing involuntary loss and constant dribbling of urine due to an enlarged prostate. How does the nurse document this incontinence? 1. Stress incontinence 2. Urge incontinence 3. Reflex incontinence 4. Overflow incontinence

4. Overflow incontinence This client's condition is known as overflow incontinence. The urethra in the client is obstructed due to the enlarged prostate; the urethra fails to relax sufficiently to allow urine to flow, resulting in incomplete bladder emptying or complete urinary retention. Loss of urine following physical exertion, cough, or sneeze is documented as stress incontinence. Stress incontinence occurs due to intrinsic sphincter deficiency or acquired anatomic damage to the urethral sphincter. The client with urge incontinence experiences an involuntary loss of urine with a strong desire to urinate. The client with reflex incontinence has a post-void residual less than 50 mL.

What is the normal lab value for Urine pH?

4.8-7.5

What is the normal lab value for Urine Sodium?

40-220 mEq/day

A client in the intensive care unit with acute kidney injury (AKI) must maintain a mean arterial pressure (MAP) of 65 mm Hg to promote kidney perfusion. What is the client's MAP if the blood pressure is 98/50 mm Hg? (Record your answer using a whole number.) _____ mm Hg

66 mmHg (sytolic + diastolic + diastolic)/3= MAP

What is the normal lab value for Urine Protein?

<100 mg/dL

What is the normal lab value for Urine RBCs?

<4 RBC/HPF

13. A nurse cares for a client admitted from a nursing home after several recent falls. What prescription should the nurse complete first? a. Obtain urine sample for culture and sensitivity. b. Administer intravenous antibiotics. c. Encourage protein intake and additional fluids. d. Consult physical therapy for gait training.

A Although all interventions are or might be important, obtaining a urine sample for urinalysis takes priority. Often urinary tract infection (UTI) symptoms in older adults are atypical, and a UTI may present with new onset of confusion or falling. The urine sample should be obtained before starting antibiotics. Dietary requirements and gait training should be implemented after obtaining the urine sample.

A patient reports symptoms indicating a UTI. Results from which diagnostic test will verify a UTI? a. Urinalysis to test for leukocyte esterase and nitrate b. Urinalysis for glucose and red blood cells c. Urinalysis to test for ketones and protein d. Urinalysis for pH and specific gravity

A - Urinalysis to test for leukocyte esterase and nitrate

1. An emergency department nurse cares for a client who is severely dehydrated and is prescribed 3 L of intravenous fluid over 6 hours. At what rate (mL/hr) should the nurse set the intravenous pump to infuse the fluids? (Record your answer using a whole number.) ____ mL/hr

ANS: 500 mL/hr Because IV pumps deliver in units of milliliters per hour, the pump would have to be set at 500 mL/hr to deliver 3 L (3000 mL) over 6 hours. 6x = 3000 x = 500

1. A client in the intensive care unit with acute kidney injury (AKI) must maintain a mean arterial pressure (MAP) of 65 mm Hg to promote kidney perfusion. What is the client's MAP if the blood pressure is 98/50 mm Hg? (Record your answer using a whole number.) _____ mm Hg

ANS: 66 mm Hg 98+(2*50) / 3 = MAP

5. A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should the nurse recognize as a positive response to the prescribed treatment? a. The client has lost 11 pounds in the past 10 days. b. The client's urine specific gravity is 1.048. c. No blood is observed in the client's urine. d. The client's blood pressure is 152/88 mm Hg.

ANS: A Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of 152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.

The client scheduled for intravenous urography informs the nurse of the following allergies. Which one should the nurse report to the physician immediately? A. Seafood B. Penicillin C. Bee stings D. Red food dye

ANS: A Clients with seafood allergies often have severe allergic reactions to the standard dyes used during intravenous urography.

2. A nurse assesses a client with nephrotic syndrome. For which clinical manifestations should the nurse assess? (Select all that apply.) a. Proteinuria b. Hypoalbuminemia c. Dehydration d. Lipiduria e. Dysuria f. Costovertebral angle (CVA) tenderness

ANS: A, B, D Nephrotic syndrome is caused by glomerular damage and is characterized by proteinuria (protein level higher than 3.5 g/24 hr), hypoalbuminemia, edema, and lipiduria. Fluid overload leading to edema and hypertension is common with nephrotic syndrome; dehydration does not occur. Dysuria is present with cystitis. CVA tenderness is present with inflammatory changes in the kidney.

7. A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are accurate regarding PD? (Select all that apply.) a. "You will not need vascular access to perform PD." b. "There is less restriction of protein and fluids." c. "You will have no risk for infection with PD." d. "You have flexible scheduling for the exchanges." e. "It takes less time than hemodialysis treatments."

ANS: A, B, D PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is no need for vascular access. Protein is lost in the exchange, which allows for more protein and fluid in the diet. There is flexibility in the time for exchanges, but the treatment takes a longer period of time compared to hemodialysis. There still is risk for infection with PD, especially peritonitis.

3. A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client's spouse about the kidney-specific formulation for the enteral solution compared to standard formulas. What components should be discussed in the teaching plan? (Select all that apply.) a. Lower sodium b. Higher calcium c. Lower potassium d. Higher phosphorus e. Higher calories

ANS: A, C, E Many clients with AKI are too ill to meet caloric goals and require tube feedings with kidney-specific formulas that are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formulas.

2. A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.) a. Urine output of 100 mL in 4 hours b. Urine output of 500 mL in 12 hours c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg

ANS: A, C, E The low urine output, sediment, and blood pressure should be reported to the provider. Postoperatively, the nurse should measure intake and output, check the characteristics of the urine, and report sediment, hematuria, and urine output of less than 0.5 mL/kg/hour for 3 to 4 hours. A urine output of 100 mL is low, but a urine output of 500 mL in 12 hours should be within normal limits. Perfusion to the kidneys is compromised with low blood pressure. The amber odorless urine is normal.

12. A nurse provides health screening for a community health center with a large population of African-American clients. Which priority assessment should the nurse include when working with this population? a. Measure height and weight. b. Assess blood pressure. c. Observe for any signs of abuse. d. Ask about medications.

ANS: B All interventions are important for the visiting nurse to accomplish. However, African Americans have a high rate of hypertension leading to end-stage renal disease. Each encounter that the nurse has with an African-American client provides a chance to detect hypertension and treat it. If the client is already on antihypertensive medication, assessing blood pressure monitors therapy.

24. A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse? a. Warm the dialysate solution in a microwave before instillation. b. Take a sample of the effluent and send to the laboratory. c. Flush the tubing with normal saline to maintain patency of the catheter. d. Check the peritoneal catheter for kinking and curling.

ANS: B An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse. Checking the catheter for obstruction is a viable option but will not treat the peritonitis.

6. After teaching a client with nephrotic syndrome and a normal glomerular filtration, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the nutritional therapy for this condition? a. "I must decrease my intake of fat." b. "I will increase my intake of protein." c. "A decreased intake of carbohydrates will be required." d. "An increased intake of vitamin C is necessary."

ANS: B In nephrotic syndrome, the renal loss of protein is significant, leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss should be matched by increased intake of protein. The client would not need to adjust fat, carbohydrates, or vitamins based on this disorder.

1. A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding should alert the nurse to immediately contact the health care provider? a. Flank pain b. Periorbital edema c. Bloody and cloudy urine d. Enlarged abdomen

ANS: B Periorbital edema would not be a finding related to PKD and should be investigated further. Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge and displace other organs. Urine can be bloody or cloudy as a result of cyst rupture or infection.

1. The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the client's recent history? a. Pyelonephritis b. Myocardial infarction c. Bladder cancer d. Kidney stones

ANS: B Pre-renal causes of AKI are related to a decrease in perfusion, such as with a myocardial infarction. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are post-renal causes of AKI related to urine flow obstruction.

Which of the following muscle actions results in voluntary urination? A. Detrusor contraction, external sphincter contraction B. Detrusor contraction, external sphincter relaxation C. Detrusor relaxation, external sphincter contraction D. Detrusor relaxation, external sphincter relaxation

ANS: B Voiding becomes a voluntary act as a result of learned responses controlled by the cerebral cortex that cause contraction of the bladder detrusor muscle and simultaneous relaxation of the external urethral sphincter muscle.

14. A nurse cares for a client who has pyelonephritis. The client states, "I am embarrassed to talk about my symptoms." How should the nurse respond? a. "I am a professional. Your symptoms will be kept in confidence." b. "I understand. Elimination is a private topic and shouldn't be discussed." c. "Take your time. It is okay to use words that are familiar to you." d. "You seem anxious. Would you like a nurse of the same gender to care for you?"

ANS: C Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse should encourage the client to use language that is familiar to the client. The nurse should not make promises that cannot be kept, like keeping the client's symptoms confidential. The nurse must assess the client and cannot take the time to stop the discussion or find another nurse to complete the assessment.

25. The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching? a. "I should leave the drainage bag above the level of my abdomen." b. "I could flush the tubing with normal saline if the flow stops." c. "I should take a stool softener every morning to avoid constipation." d. "My diet should have low fiber in it to prevent any irritation."

ANS: C Inflow and outflow problems of the dialysate are best controlled by preventing constipation. A daily stool softener is the best option for the client. The drainage bag should be below the level of the abdomen. Flushing the tubing will not help with the flow. A diet high in fiber will also help with a constipation problem.

Two hours after a closed percutaneous kidney biopsy, the client reports a dramatic increase in pain. What is the nurse's best first action? A. Reposition the client on the operative side. B. Administer prescribed opioid analgesic. C. Assess pulse rate and blood pressure. D. Check the Foley catheter for kinks.

ANS: C An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of internal hemorrhage.

6. What is the result of stimulation of erythropoietin production in the kidney tissue? A. Increased blood flow to the kidney B. Inhibition of vitamin D and loss of bone density C. Increased bone marrow production of red blood cells D. Inhibition of the active transport of sodium, leading to hyponatremi

ANS: C Erythropoietin is produced in the kidney and released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell (RBC) production in the bone marrow.

11. A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma. Which statement should the nurse include in this client's teaching? a. "Since you only have one kidney, a salt and fluid restriction is required." b. "Your therapy will include hemodialysis while you recover." c. "Medication will be prescribed to control your high blood pressure." d. "You need to avoid participating in contact sports like football."

ANS: D Clients with one kidney need to avoid contact sports because the kidneys are easily injured. The client will not be required to restrict salt and fluids, end up on dialysis, or have new hypertension because of the nephrectomy.

7. A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse? a. Use the catheter for the next laboratory blood draw. b. Monitor the central venous pressure through this line. c. Access the line for the next intravenous medication. d. Place a heparin or heparin/saline dwell after hemodialysis.

ANS: D The central line should have a heparin or heparin/saline dwell after hemodialysis treatment. The central line catheter used for dialysis should not be used for blood sampling, monitoring central venous pressures, or giving drugs or fluids.

Based on the nurses knowledge of the normal function of the kidney, which large particles are not found in the urine because they are too large to filter through the glomerular capillary walls? (SATA) a. Blood cells b. Albumin c. Other proteins d. Electrolytes e. Water

Abc

2. A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a shift to the left in a clients white blood cell count. Which action should the nurse take? a. Request that the laboratory perform a differential analysis on the white blood cells. b. Notify the provider and start an intravenous line for parenteral antibiotics. c. Collaborate with the unlicensed assistive personnel (UAP) to strain the clients urine for renal calculi. d. Assess the client for a potential allergic reaction and anaphylactic shock.

B An increase in band cells creates a shift to the left. A left shift most commonly occurs with urosepsis and is seen rarely with uncomplicated urinary tract infections. The nurse will be administering antibiotics, most likely via IV, so he or she should notify the provider and prepare to give the antibiotics. The shift to the left is part of a differential white blood cell count. The nurse would not need to strain urine for stones. Allergic reactions are associated with elevated eosinophil cells, not band cells.

For a patient who needs an indwelling catheter for at least 2 weeks, which intervention would help reduce the bacterial colonization along the catheter? a. Secure the catheter to the female patient's thigh. b. Consider the use of a coated catheter. c. Wash the urine bag and outflow tube every day. d. Apply antiseptic ointment to the catheter tubing.

B - Consider the use of a coated catheter.

Which group has the highest prevalence of urinary tract infections (UTIs)? a. Young men b. Older women c. Older men d. School-aged girls

B - Older women

A patient has been performing Kegel exercises for 2 months. How does the nurse know whether the exercises are working? a. Incontinence is still present, but the patient states that it is less. b. The patient is able to stop the urinary stream. c. There are no complaints of urgency from the patient. d. The patient is using absorbent undergarments for protection.

B - The patient is able to stop the urinary stream.

The nurse is reviewing the laboratory results for an older adult patient with an indwelling catheter. The urine culture is pending, but the urinalysis shows greater than 105 colony-forming units, and the differential WBC count shows a "left shift." How does the nurse interpret these findings? a. Interstitial cystitis b. Urosepsis c. Complicated cystitis d. Radiation-induced cystitis

B - Urosepsis

The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding? a. Woman with a blood pressure of 158/90 mm Hg b. Client with Kussmaul respirations c. Man with skin itching from head to toe d. Client with halitosis and stomatitis

B ~ Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs. Hypertension is common in most clients with CKD, and skin itching increases with calcium-phosphate imbalances, another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.

A 70-year-old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? A. A five-pack year history of smoking 45 years ago B. Difficulty starting and stopping the urine stream C. A 30-year occupation as a long-distance truck driver D. A recent colon cancer diagnosis in his 72-year-old brother

C

Which instruction does the nurse give a client who needs a clean-catch urine specimen? "Save all urine for 24 hours." "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." "Do not touch the inside of the container." "You will receive an isotope injection, then I will collect your urine."

C A clean-catch specimen is used to obtain urine for culture and sensitivity of organisms present; contamination by the client's hands will render the specimen invalid and alter results. Saving urine for 24 hours is not necessary for a midstream clean-catch urine specimen. After cleaning, the client should initiate voiding into the commode, then stop and resume voiding into the container. Only 1 ounce (30 mL) is needed; the remainder of the urine may be discarded into the commode. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. A clean-catch specimen for culture does not require an injection of isotope, simply cleansing of the perineum.

Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation? Pink-tinged urine Urinary frequency Temperature of 100.8° F Lethargy

C Fever, chills, or an elevated white blood cell count after cystoscopy suggest infection after an invasive procedure; the provider must be notified immediately. Pink-tinged urine is expected after a cystoscopy; gross hematuria would require notification of the surgeon. Frequency may be noted as a result of irritation of the bladder. If sedation or anesthesia was used, lethargy is an expected effect.

When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first? Give lispro (Humalog) insulin, 12 units subcutaneously. Request a breakfast tray for the client. Infuse 0.45% normal saline at 125 mL/hr. Administer captopril (Capoten).

C Fluids are needed because the dye used in a CT scan with contrast has an osmotic effect, causing dehydration and potential kidney failure. Lispro is not administered until the breakfast tray arrives. A breakfast tray will be requested, but preventing complications of the procedure is done first. Because the client may be hypovolemic, the nurse should monitor blood pressure and administer IV fluids before deciding whether administration of captopril is appropriate.

A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? Increased oral fluids IV fluids Privacy Health history forms

C The nurse should provide privacy, assistance, and voiding stimulants, such as warm water over the perineum, as needed, for the client with urinary problems. Increased oral fluids and IV fluids would exacerbate the client's problem. Obtaining a health history is not the priority for this client's care.

15. A nurse assesses a client with bladder cancer who is recovering from a complete cystectomy with ileal conduit. Which assessment finding should alert the nurse to urgently contact the health care provider? a. The ileostomy is draining blood-tinged urine. b. There is serous sanguineous drainage present on the surgical dressing. c. The ileostomy stoma is pale and cyanotic in appearance. d. Oxygen saturations are 92% on room air.

C A pale or cyanotic stoma indicates impaired circulation to the stoma and must be treated to prevent necrosis. Blood-tinged urine and serous sanguineous drainage are expected after this type of surgery. Oxygen saturation of 92% on room air is at the low limit of normal.

25. A nurse cares for a client with urinary incontinence. The client states, I am so embarrassed. My bladder leaks like a young childs bladder. How should the nurse respond? a. I understand how you feel. I would be mortified. b. Incontinence pads will minimize leaks in public. c. I can teach you strategies to help control your incontinence. d. More women experience incontinence than you might think.

C The nurse should accept and acknowledge the clients concerns, and assist the client to learn techniques that will allow control of urinary incontinence. The nurse should not diminish the clients concerns with the use of pads or stating statistics about the occurrence of incontinence.

When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? Abdominal girth Presence of urinary infection History of hysterectomy Hematuria

C The scanner must be in the scan mode for female clients to ensure the scanner subtracts the volume of the uterus from the measurement, or in the scan mode for male clients for women who have undergone a hysterectomy. The nurse performs this procedure in response to distention or pressure in the bladder; girth is not a factor. This procedure detects urine retained in the bladder, not infection. The presence of retained urine in the bladder is assessed, regardless of hematuria.

Which dietary changes does the nurse suggest to a patient with urge incontinence? a. Limit fluid intake to no more than 2 L/day. b. Peel all fruit before consuming. c. Avoid alcohol and caffeine. d. Avoid smoked or salted food

C - Avoid alcohol and caffeine.

The nurse is caring for a patient who has an indwelling catheter and subsequently developed a UTI. The patient has been receiving antibiotics for several days, but develops hypotension, a rapid pulse, and confusion. The nurse suspects urosepsis and alerts the health care provider. Which diagnostic test is the provider most likely to order to confirm urosepsis? a. Culture of the drainage bag b. Culture of the catheter tip c. Blood culture d. Repeat urinalysis

C - Blood culture

The home health nurse reads in the patient's chart that the patient has asymptomatic bacterial urinary tract infection (ABUTI). Which intervention will the nurse perform? a. Obtain an order for urinalysis and urine culture and sensitivity. b. Check the patient's medication list for appropriate antibiotic order. c. Closely monitor for conditions that cause progression to acute infection. d. Ask the patient when the ABUTI first started and when it was diagnosed.

C - Closely monitor for conditions that cause progression to acute infection.

Several patients at the clinic have just been diagnosed with UTIs. Which patients may need longer antibiotic treatment (7 to 21 days) or different agents than the typical first-line medi- cations? (Select all that apply.) a. Postmenopausal patient b. Patient with urethritis c. Diabetic patient d. Immunosuppressed patient e. Pregnant patient

C - Diabetic patient D -Immunosuppressed patient E - Pregnant patient

A patient is diagnosed with a fungal UTI. Which drug does the nurse anticipate the patient will be treated with? a. Trimethoprim/sulfamethoxazole (Bactrim) b. Ciprofloxacin (Cipro) c. Fluconazole (Diflucan) d. Amoxicillin (Amoxil)

C - Fluconazole (Diflucan)

The nurse is talking to a 68-year-old male patient who has lifestyle choices and occupational exposure that put him at high risk for bladder cancer. The nurse is most concerned about which urinary characteristic? a. Frequency b. Nocturia c. Painless hematuria d. Incontinence

C - Painless hematuria

The nurse is caring for an older adult patient with urinary incontinence. The patient is alert and oriented, but refuses to use the call bell and has fallen several times while trying to get to the bathroom. What is the nurse's priority concern for this patient? a. Managing noncompliance b. Accurately measuring urinary output c. Providing fall prevention measures d. Managing urinary incontinence

C - Providing fall prevention measures

A patient reports severe flank pain. The report indicates that urine is turbid, malodorous, and rust-colored; RBCs, WBCs, and bacteria are present; and microscopic analysis shows crystals. What does this data suggest? a. Pyuria and cystitis b. Staghorn calculus with infection c. Urolithiasis and infection d. Dysuria and urinary retention

C - Urolithiasis and infection

The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8 F (37.6C). What is the most appropriate action by the nurse? a. Administer fluid to increase blood pressure. b. Check the white blood cell count. c. Monitor the client's temperature. d. Connect the client to an electrocardiographic (ECG) monitor.

C ~ During hemodialysis, the dialysate is warmed to increase diffusion and prevent hypothermia. The client's temperature could reflect the temperature of the dialysate. There is no indication to check the white blood cell count or connect the client to an ECG monitor. The other vital signs are within normal limits.

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? a. pH b. Osmolality c. Creatinine d. Protein level

C ~ The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.

For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter? A. 35-year-old woman who was admitted with a splenic laceration and femur fracture (closed repair completed) following a car crash B. 48-year-old man who has established paraplegia and is admitted for pneumonia C. 61-year-old woman who is admitted following a fall at home and has new-onset dysrhythmia D. 74-year-old man who has lung cancer with brain metastasis and is being transitioned to hospice for end-of-life care

D

When planning an assessment of the urethra, what does the nurse do first? Examine the meatus. Note any unusual discharge. Record the presence of abnormalities. Don gloves.

D Before examination begins, body fluid precautions (gloves) must be implemented first. Examining the meatus, noting unusual discharge, or recording the presence of abnormalities are things that the nurse should do after putting on gloves.

A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? Maintaining bedrest Medicating for pain Monitoring for hematuria Promoting fluid intake

D The nurse should ensure adequate hydration by urging the client to take oral fluid or by giving IV fluids. Hydration reduces the risk for kidney damage. Bedrest is not indicated for the client who has undergone a CT scan with contrast dye. CT with contrast dye is not a painful procedure, so pain medication is not indicated. The client who has undergone CT with contrast dye is not at risk for hematuria.

19. A nurse teaches a client with functional urinary incontinence. Which statement should the nurse include in this clients teaching? a. You must clean around your catheter daily with soap and water. b. Wash the vaginal weights with a 10% bleach solution after each use. c. Operations to repair your bladder are available, and you can consider these. d. Buy slacks with elastic waistbands that are easy to pull down.

D Functional urinary incontinence occurs as the result of problems not related to the clients bladder, such as trouble ambulating or difficulty accessing the toilet. One goal is that the client will be able to manage his or her clothing independently. Elastic waistband slacks that are easy to pull down can help the client get on the toilet in time to void. The other instructions do not relate to functional urinary incontinence.

17. A nurse cares for a client who is scheduled for the surgical creation of an ileal conduit. The client states, I am anxious about having an ileal conduit. What is it like to have this drainage tube? How should the nurse respond? a. I will ask the provider to prescribe you an antianxiety medication. b. Would you like to discuss the procedure with your doctor once more? c. I think it would be nice to not have to worry about finding a bathroom. d. Would you like to speak with someone who has an ileal conduit?

D The goal for the client who is scheduled to undergo a procedure such as an ileal conduit is to have a positive self-image and a positive attitude about his or her body. Discussing the procedure candidly with someone who has undergone the same procedure will foster such feelings, especially when the current client has an opportunity to ask questions and voice concerns to someone with first-hand knowledge. Medications for anxiety will not promote a positive self-image and a positive attitude, nor will discussing the procedure once more with the physician or hearing the nurses opinion.

The nurse is teaching a man about how to prevent UTIs. What information does the nurse include? a. "Have a minimal fluid intake of 5 L daily, unless contraindicated." b. "Empty your bladder before and after sexual intercourse." c. "Make sure that spermicides are used with condoms." d. "Gently wash the genital area before intercourse."

D - "Gently wash the genital area before intercourse."

A patient has had a bladder suspension and a suprapubic catheter is in place. The patient wants to know how long the catheter will remain in place. What is the nurse's best response? a. "Typically it remains for 24 hours postoperatively." b. "It will be removed at your first clinic visit." c. "When you can void on your own, it will be removed." d. "It will be removed when you can void and residual urine is less than 50 mL."

D - "It will be removed when you can void and residual urine is less than 50 mL."

Which patient should not be advised to take cranberry juice? a. 26-year-old pregnant woman with a history of uncomplicated UTI b. 23-year-old man with history of recurrent kidney stones c. 65-year-old man with urinary retention secondary to enlarged prostate d. 33-year-old woman with dysuria associated with interstitial cystitis

D - 33-year-old woman with dysuria associated with interstitial cystitis

The nurse is teaching a patient a behavioral intervention for bladder compression. In order to correctly perform the Credé method, what does the nurse teach the patient to do? a. Insert the fingers into the vagina and gently push against the vaginal wall. b. Breathe in deeply and direct the pressure towards the bladder during exhalation. c. Empty the bladder, wait a few minutes, and attempt a second bladder emptying. d. Apply firm and steady pressure over the bladder area with the palm of the hand.

D - Apply firm and steady pressure over the bladder area with the palm of the hand.

What role does drug therapy have as an intervention for reflex (overflow) urinary incontinence? a. Captopril (Capoten) is given to lower urine cystine levels. b. Levofloxacin (Levaquin) is given to prevent UTIs with this type of incontinence. c. Midorine (ProAmatine) is given to increase the contractile force of the bladder. d. Bethanechol chloride (Urecholine) may be used short-term after surgery.

D - Bethanechol chloride (Urecholine) may be used short-term after surgery.

A patient has UTI symptoms but there are no bacteria in the urine. The health care provider suspects interstitial cystitis. The nurse prepares patient teaching material for which diagnostic test? a. Urography b. Abdominal sonography c. Computed tomography (CT) d. Cystoscopy

D - Cystoscopy

A patient comes to the clinic and reports severe flank pain, bladder distention, and nausea and vomiting with increasingly smaller amounts of urine with frank blood. The patient states, "I have kidney stones and I just need a prescription for pain medication." What is the nurse's priority concern? a. Controlling the patient's pain b. Checking the quantity of blood in the urine c. Flushing the kidneys with oral fluids d. Determining if there is an obstruction

D - Determining if there is an obstruction

A patient has had surgery for bladder cancer. To prevent recurrence of superficial bladder cancer, the nurse anticipates that the health care provider is likely to recommend which treatment? a. No treatment is needed for this benign condition. b. Intravesical instillation of single-agent chemotherapy. c. Radiation therapy to the bladder, ureters, and urethra. d. Intravesical instillation of bacille Calmette- Guérin.

D - Intravesical instillation of bacille Calmette- Guérin.

A patient is considering vaginal cone therapy, but is a little hesitant because she does not understand how it works. What does the nurse tell her about how vaginal cone therapy improves incontinence? a. It mechanically obstructs urine loss from the urethra. b. It repositions the bladder to reduce compression. c. It increases the normal flora of the perineum. d. It strengthens pelvic floor muscles.

D - It strengthens pelvic floor muscles.

The health care provider verbally informs the nurse that the patient needs a fluoroquinolone antibiotic to treat a UTI. The pharmacy delivers gabapentin (Neurontin). What should the nurse do first? a. Administer the medication as ordered. b. Call the pharmacist and ask for a read back of the order. c. Call the health care provider for clarification of the order. d. Look at the written order to clarify the name of the medication.

D - Look at the written order to clarify the name of the medication.

The nurse is caring for a patient with urolithiasis. Which medication is likely to be given in the acute phase to relieve the patient's severe pain? a. Ketorolac (Toradol) b. Oxybutynin chloride (Ditropan) c. Propantheline bromide (Pro-Banthine) d. Morphine sulfate (Astramorph)

D - Morphine sulfate (Astramorph)

In which patient circumstance would the nurse question the order for the insertion of an indwelling catheter? a. Patient is critically ill and at risk for hypovolemic shock. b. Patient has urinary retention with beginnings of hydronephrosis. c. Patient was in a car accident and has a possible spinal cord injury. d. Patient has functional incontinence related to Alzheimer's disease.

D - Patient has functional incontinence related to Alzheimer's disease.

A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)? a. Antibiotic b. Histamine blocker c. Bronchodilator d. Angiotensin-converting enzyme (ACE) inhibitor

D ~ ACE inhibitors stop the conversion of angiotensin I to the vasoconstrictor angiotensin II. This category of medication also blocks bradykinin and prostaglandin, increases renin, and decreases aldosterone, which promotes vasodilation and perfusion to the kidney. Antibiotics fight infection, histamine blockers decrease inflammation, and bronchodilators increase the size of the bronchi; none of these medications helps slow the progression of CKD in clients with hypertension.

A nurse is caring for a client who is scheduled for a dose of cefazolin and vitamins at this time. Hemodialysis for this client is also scheduled in 60 minutes. Which action by the nurse is best? a. Administer cefazolin since the level of the antibiotic must be maintained. b. Hold the vitamins but administer the cefazolin. c. Hold the cefazolin but administer the vitamins. d. Hold all medications since both cefazolin and vitamins are dialyzable.

D ~ Both the cefazolin and the vitamins should be held until after the hemodialysis is completed because they would otherwise be removed by the dialysis process.

A client with chronic kidney disease states, "I feel chained to the hemodialysis machine." What is the nurse's best response to the client's statement? a. That feeling will gradually go away as you get used to the treatment. b. You probably need to see a psychiatrist to see if you are depressed. c. Do you need help from social services to discuss financial aid? d. Tell me more about your feelings regarding hemodialysis treatment.

D ~ The nurse needs to explore the client's feelings in order to help the client cope and enter a phase of acceptance or resignation. It is common for clients to be discouraged because of the dependency of the treatment, especially during the first year. Referrals to a mental health provider or social services are possibilities, but only after exploring the client's feelings first. Telling the client his or her feelings will go away is dismissive of the client's concerns.

Define the "E" in the RIFLE classification system.

END-STAGE KIDNEY DISEASE = requiring dialysis >3 mos

Define the "F" in the RIFLE classification system.

FAILURE STAGE = Serum Creatinine increased by 3.0 or GFR decrease by >75% (or UO <0.3 mL/kg/hr X 24hrs) (or anuria X 12hrs)

Define the "I" in the RIFLE classification system.

INJURY STAGE = Serum Creatinine increased by 2.0 or GFR decrease by >50% (or UO <0.5 mL/kg/hr X 12hrs)

When caring for a client with uremia, the nurse assesses for which symptom? Tenderness at the costovertebral angle (CVA) Cyanosis of the skin Nausea and vomiting Correct Insomnia

Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue. CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.

What are the normal Creatinine Clearance values?

Men 107-139 mL/min Women 87-107 mL/min

What is the normal Glomerular Filtration Rate (GFR)?

Men 130 mL/min/1.73m2 Women 120 mL/min/1.73m2

Define the "R" in the RIFLE classification system.

RISK STAGE = Serum Creatinine increased by 1.5 or GFR decrease > 25% (or UO < 0.5mL/kg/hr X 6hrs)

What is the normal Urine Glucose lab value?

ZERO

What is the normal lab value for Urine Nitrates?

ZERO

A nurse assesses a client who presents with renal calculi. Which question would the nurse ask? "Do any of your family members have this problem?" "Do you drink any cranberry juice?" "Do you urinate after sexual intercourse?" "Do you experience burning with urination?"

a

A nurse evaluates a client with acute glomerulonephritis (GN). Which assessment finding would the nurse recognize as a positive response to the prescribed treatment? The client lost 11 lb (5 kg) in the past 10 days. The client's urine specific gravity is 1.048. No blood is observed in the client's urine. The client's blood pressure is 152/88 mm Hg.

a

A nurse obtains the health history of a client with a suspected diagnosis of bladder cancer. Which question would the nurse ask when determining this client's risk factors? "Do you smoke cigarettes?" "Do you use any alcohol?" "Do you use recreational drugs?" "Do you take any prescription drugs?"

a

A nurse teaches a young female client who is prescribed cephalexin for a urinary tract infection. Which statement would the nurse include in this client's teaching? "Use a second form of birth control while on this medication." "You will experience increased menstrual bleeding while on this drug." "You may experience an irregular heartbeat while on this drug." "Watch for blood in your urine while taking this medication."

a

A patient had a cystoscopy. After the procedure, what does the nurse expect to see in this patient? a. Pink-tinged urine b. Blood urine c. Very dilute urine d. Decreased urine output

a

A patient is scheduled for a CT with iodinated contrast medium. Which medication is discontinued 24 hours before the procedure and for at least 48 hours until kidney function has been reevaluated? a. Glucophage (Metformin) b. Morphine (MS Contin) c. Furosemide (Lasix) d. Oral acetylcysteine (Mucomyst)

a

After teaching a client who has stress incontinence, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? "I will limit my total intake of fluids." "I must avoid drinking alcoholic beverages." "I must avoid drinking caffeinated beverages." "I shall try to lose about 10% of my body weight."

a

After teaching a client with a history of renal calculi, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? "I should drink at least 3 L of fluid every day." "I will eliminate all dairy or sources of calcium from my diet." "Aspirin and aspirin-containing products can lead to stones." "The doctor can give me antibiotics at the first sign of a stone."

a

Mastering voluntary micturtition is a normal developmental task for which person? a. a healthy 20-month-old toddler b. a 56-year-old women with stress incontinence c. a healthy 8-year-old child d. a 25-year-old with a spinal cord injury

a

The nurse hears in report that the patient is having renal colic pain. Whne performing the physical assessment of this patient during a severe pain episode, what additional sign/symptoms may the nurse expect to observe? a. Diaphoresis b. Redness over the flank c. Jaundice d. Bruit in the renal artery

a

The nurse is assessing a patient for bladder distention. What technique does the nurse use? a. Gently palpate for the outline of the bladder, percuss the lower abdomen, continue toward the umbilicus until dull sounds are no longer produced b. gently palpate for the outline of the bladder, auscultate for sounds in the lower abdomen c. Place one hand under the back and palpate with the other hand over the bladder, percuss the lower abdomen until tympanic sounds are no longer produced. d. Use the hand to depress the bladder as the patient takes a deep breath, then percuss

a

The nurse is reviewing the results of a patient ultrasound of the kidney. The report reveals an enlarged kidney which suggests which possible problem? a. Polycystic kidney b. Kdienyinfection c. Renal carcinoma d. Chronic kidney disease

a

The nurse performs a dipstick urine test for a patient being evaluated for kidney problems. Glucose is present in the urine. How does the nurse interpret this result? a. Blood glucose level is greater than 220 mg/dL b. The kidneys are failing to filter any glucose c. The patient is at risk for hypoglycemia d. The renal threshold has not been exceeded

a

What does the BUN test measure? a. Kidney excretion of urea nitrogen b. Urine osmolality c. Creatinine clearance d. Urine utput

a

Which patient is most likely to have a decreased calcium level? a. Patients with kidney disease b. Patients with cystitis c. Patients with a Foley catheter d. Patients with urinary retention

a

Which patient is most likely to produce urine with a specific gravity of less than 1.005? a. Takes diuretic medication everyday b. Has dehydration secondary to vomiting c. Is hypovolemic due to blood loss d. Has syndrome of inappropriate antidiuretic horome

a

Which renal change associated with aging does the nurse expect an older adult patient to report a. Nocturanl polyuria b. Micturition c. Hematuria d. Dysuria

a

Which urine characteristic listed on a urinalysis report arouses the nurses suspicion of a problem in the urinary tract? a. Cloudiness b. Straw color c. Ammonia odor d. One cast per high-powered field

a

an elderly patient has been in bed for several days after a fall. The nurse encourages ambulation to stimulate the movemnt of urine through the ureter by what phenomenon? a. Peristalsis b. Gravity c. Pelvic pressure d. Back flow

a

the nurse is talking to a group of older women about changes in the urinary system related to aging. what symptoms is likely to be the common concern for this group? a. Incontinence b. Hematuria c. Retention d. Dysuria

a

After treating several young women for urinary tract infections (UTIs), the college nurse plans an educational offering on reducing the risk of getting a UTI. What information does the nurse include? (Select all that apply.) Void before and after each act of intercourse. Consider changing to spermicide from birth control pills. Do not douche or use scented feminine products. Wear loose-fitting nylon panties. Wipe or clean the perineum from front to back.

a, e

16. The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed? a. "I am thrilled that I can continue to eat fast food." b. "I will cut out bacon with my eggs every morning." c. "My cooking style will change by not adding salt." d. "I will probably lose weight by cutting out potato chips."

a. "I am thrilled that I can continue to eat fast food."

15. A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern? a. Albumin level of 2.5 g/dL b. Phosphorus level of 5 mg/dL c. Sodium level of 135 mmol/L d. Potassium level of 5.5 mmol/L

a. Albumin level of 2.5 g/dL

12. A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best? a. Obtain daily weights of the client. b. Auscultate heart and breath sounds. c. Palpate the client's abdomen. d. Assess the client's diet history.

a. Obtain daily weights of the client.

the nurse is taking a history on a patient with a change in urinary patterns. in additon to medical and surgical history, what does the nurse ask the patient about to complete the assessment? (SATA) a. Occupation exposure to toxins b. Use of illicit substances, such as cocaine c. Financial resources for payment of treatments d. Likelihood of complying with treatment recommendations e. Recent travel to geographic regions that pose infectious disease risks

abe

A patient has undergone a kidney biopsy. what does the nurse monitor for in the patient related to this procedure? a. Nephrotoxicity b. Hemorrhage c. Urinary retention d. Hypertension

b

A patient is diagnosed with renal artery stenosis. Which sound does the nurse expect to hear by auscultation when a bruit is present in a renal artery? a. Quiet, pulsating sound b. Swishing sound c. Faint wheezing d. NO sound at all

b

A patient returns to the unit after a renal scan. Which instruction about the patient urine does the nurse give to the UAP caring for the patient? a. It is radioactive, so it should be handled with special biohazard precautions b. It does not place anyone at risk because of the small amount of radioactive material c. its radioactivity is dangerous only to those who are pregnant d. it is potentially dangerous if allowed to sit for prolonged periods in the command

b

After delegating care to assistive personnel (AP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the AP's understanding. Which action indicates that the AP needs additional teaching? Toileting the client after breakfast Changing the client's incontinence brief when wet Encouraging the client to drink fluids Recording the client's incontinence episodes

b

After teaching a client with hypertension secondary to renal disease, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? "I can prevent more damage to my kidneys by managing my blood pressure." "If I have increased urination at night, I need to drink less fluid during the day." "I need to see the registered dietitian to discuss limiting my protein intake." "It is important that I take my antihypertensive medications as directed."

b

After teaching a client with nephrotic syndrome and a normal glomerular filtration, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the diet therapy for this condition? "I must decrease my intake of fat." "I will increase my intake of protein." "A decreased intake of carbohydrates will be required." "An increased intake of vitamin C is necessary."

b

An older adult male patient has a history of an enlarged prostate. the patient is most liekly to report which symptoms associated with this condition? a. Inability to sense the urge to void b. Difficulty starting the urine stream c. Excreting large amounts of very dilute urine d. Burning sensation when urinating

b

Damage to which renal structure or tissues can change the acutal production of urine? a. kidney parenchyma b. convulted tubules c. calyces d. ureters

b

The nurse is preparing to assess a female patients urethra prior to the insertion of a Foley catheter. In addition to gloves, which equipment does the nurse obtain to perform the initial assessment? a. Glass slide b. Good light source c. Speculum d. Cotton ball

b

Which test is the best indicator of kidney function? a Urine osmolarity b. serum creatinine c. Urine pH d. BUN

b

the nurse is caring for a paitent who sustained major injuries in an automobile accident. Which blood pressure will result in compromised kidney function, in particualr the glomerular filtration rate (GFR)? a. 150/70 mm Hg b. 70/40 mm Hg c. 80/60 mm Hg d. 140/80 mm Hg

b

A nurse assesses a client who has a family history of polycystic kidney disease (PKD). Which assessment findings would the nurse expect? (Select all that apply.) Nocturia Flank pain Increased abdominal girth Dysuria Hematuria Diarrhea

b, c, e

The nurse and nutritionist are evaluating the diet and nutritional therapies for a patient with kidney problems. BUN levels for this patient are tracked because of the direct relationship to the intake and metabolism of which substance? a. Lipids b. Carbohydrates c. Protein d. Fluids

c

The nurse assesses a client who has possible bladder cancer. What common assessment finding associated with this type of cancer would the nurse expect? Urinary retention Urinary incontinence Painless hematuria Difficulty urinating

c

The nurse is caring for a client who has chronic pyelonephritis. What assessment finding would the nurse expect? Fever Flank pain Hypertension Nausea and vomiting

c

The nurse is caring for a client with urinary incontinence. The client states, "I am so embarrassed. My bladder leaks like a young child's bladder." How would the nurse respond? "I understand how you feel. I would be mortified." "Incontinence pads will minimize leaks in public." "I can teach you strategies to help control your incontinence." "More people experience incontinence than you might think."

c

The nurse is planning the care for several patients who are undergoing diagnostic testing. Which patient is likely to need the most time for postprocedural care? a will have a kidney, ureter, and bladder x-ray b. Needs a kidney ultrasound c. Will have a cystoscopy d. Needs urine for culture and sensitivity

c

Which diagnostic test incorpartes contrast dye, but does not place a patient at risk for nephrotoxicity? a. renal scan b. Renal angiogrpahy c. Voiding cystourethrogram d. Computed tomography

c

21. The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe? a. Palpating the access site for a bruit or thrill b. Using the right arm for a blood pressure reading c. Administering intravenous fluids through the AV fistula d. Checking distal pulses in the left arm

c. Administering intravenous fluids through the AV fistula

13. A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema? a. Maintaining oxygen saturation of 89% b. Minimal crackles and wheezes in lung sounds c. Maintaining a balanced intake and output d. Limited shortness of breath upon exertion

c. Maintaining a balanced intake and output

A healthy 34-year-old male with no physical complaints has a BUN of 26 mg/dL. Which questions would the nurse ask to identify nonrenal factors that could be contributing to this laboratory result? (SATA) a. "Did you drink a lot of extra fluid before the blood sample was drawn?" b. "Have you been on a severe protein- or calorie-restricted diet?" c. "Are you taking or have you recently taken any steroid medications?" d. "Have you recently experienced any physical or emotional stress?" e. "Have you noticed any blood in the stool or have you vomited any blood?"

cde

A healthy female patient has no physical symptoms, but urinalysis results reveal a protein level of >0.8 mg/dL and a white blood cell count of 4 per high-powered field. What question would the nurse ask the patient in order to assist the health care provider to correctly interpreting the urinalysis results? a. "Have you ever been treated for a urinary tract infection?" b. "Do you have a family history of cardiac or biliary disease?" c. "Are you sexually active and if so, do you use condoms?" d. "Have you recently performed any strenuous exercise?"

d

A nurse cares for a client who has kidney stones from gout ricemia. Which medication does the nurse anticipate administering? a. Phenazopyridine b. Doxycyline c. Tolterodine d. Allopurinol

d

A nurse plans care for a client with overflow incontinence. Which intervention does the nurse include in this client's plan of care to assist with elimination? Stroke the medial aspect of the thigh. Use intermittent catheterization. Provide digital anal stimulation. Use the Valsalva maneuver.

d

A nurse teaches a client with functional urinary incontinence. Which statement would the nurse include in this client's teaching? "You must clean around your catheter daily with soap and water." "You will need to be on your drug therapy for life." "Operations to repair your bladder are available, and you can consider these." "You might want to get pants with elastic waistbands."

d

A patient is scheduled for retrograde urethrography. Postprocedural care is similar to postprocedural care given for which test? a. Ultrasonography b. Computed tomography c. Renal angiogram d. Cystoscopy

d

A patient with chronic kidney disease (CKD) devleops anorexia nausea and vomiting, muscle cramping, and purritus. How does the nurse interepret these findings? a. Oliguria b. Azotemia c. Anuria d. Uremia

d

The nurse is admitting a client who has acute glomerulonephritis caused by beta streptococcus. What drug therapy would the nurse expect to be prescribed for this client? a. Antihypertensives b. Antilipidemics c. Antidepressants d. Antibiotics

d

The nurse is assisting an inexperienced health care provider to assess a patient who has an aneurysm. The nurse would intervene if the provider performed which action? a. Inspected the flank for bruising or redness b. listened for a bruit over the renal artery c. Auscultated the abdomen for bowel sounds d. Palapated deeply to locate masses or tenderness

d

The nurse teaches a client who has stress incontinence methods to regain more urinary continence. Which health teaching is the most important for the nurse to include for this client? a. What type of incontinence pads to use? b. What types of liquids to drink and when? c. Need to perform intermittent catheterizations. d. How to do Kegel exercises to strengthen muscles?

d

Which abnormal finding would be associated with chronic kidney disease? a. Hematuria b. Pus in the urine c. Blood at the urethral meatus d. Decreased urine specific gravity

d

Which event is most likely to trigger renin production? a. patient particpiates in strenuous exercise b. Patient becomes anxious and nervous. c. Patient has urge to urinate during the night d. patient sustains significant blood loss

d

Which hematologic disorder is most likely to occur if the hormonal function of the kidneys is not working properly? a. Leukemia b. Thrombocyopenia c. Neutrpenia d. Anemia

d

Which over-the-counter product used by a patient does the nurse further explore for potential impact on kideny function? a. Mouthwash with alcohol b. Fiber supplement c. Vitamin C d. Acetaminophen

d

26. A client with chronic kidney disease states, "I feel chained to the hemodialysis machine." What is the nurse's best response to the client's statement? a. "That feeling will gradually go away as you get used to the treatment." b. "You probably need to see a psychiatrist to see if you are depressed." c. "Do you need help from social services to discuss financial aid?" d. "Tell me more about your feelings regarding hemodialysis treatment."

d. "Tell me more about your feelings regarding hemodialysis treatment."

Place the steps of using a bedside bladder scanner in the correct order a. Select the male or female icon the bladder scanner b. Aim the scan head towards the expected location of the bladder c. Place the probe midline bout 1.5 inches above the pubic bone d. explain the purpose and what sensations to expect e. Place the ultrasound probe with gel right above the symphysis pubis f. press and release the scan button

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