Urinary
In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which of the following physiologic processes are performed by the kidneys (select all that apply)? A Production of renin B Hemolysis of old red blood cells (RBCs) C Activation of vitamin D D Carbohydrate metabolism E Erythropoietin production
A, C, E In addition to urine formation, the kidneys activate vitamin D to maintain calcium levels, produce erythropoietin to stimulate RBC production, and release renin to maintain blood pressure. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are performed by the kidneys.
In preparing a patient for an intravenous pyelogram (IVP), the nurse would expect to: A administer a cathartic or enema. B assess patient for allergies to penicillin. C keep the patient NPO for 4 hours preprocedure. D advise the patient that a metallic taste may occur during procedure.
A Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity, keep the patient NPO for 8 hours preprocedure, and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.
Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which of the following measures should the nurse first recommend in an attempt to resolve the woman's incontinence? A Kegel exercises B Use of adult incontinence pads C Intermittent self-catheterization D Dietary changes including fluid restriction
A Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.
Which of the following statements by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure? A "It is essential that you maintain aseptic technique to prevent peritonitis." B "You will be allowed a more liberal protein diet once you complete CAPD." C "It is important for you to maintain a daily written record of blood pressure and weight." D "You will need to continue regular medical and nursing follow-up visits while performing CAPD."
A Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of preventing this from occurring. Although the other teaching statements are accurate, they do not have the potential for mortality as does the peritonitis, thus making that nursing action of highest priority.
A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. Which of the following teaching points should the nurse emphasize before the procedure? A "You might have pink-tinged urine and burning after your cystoscopy." B "You'll need to refrain from eating or drinking after midnight the day before the test." C "You'll require a urinary catheter inserted before the cystoscopy and it will be in place for a few days." D "The morning of the test, the nurse will ask you to drink some water that contains a contrast solution."
A Pink-tinged urine, burning, and frequency are common following a cystoscopy. The patient does not need to be NPO prior to the test and a contrast solution is unnecessary. A cystoscopy does not always necessitate catheterization before or after the procedure.
Which of the following nursing diagnoses is a priority in the care of a patient with renal calculi? A Acute pain B Deficient fluid volume C Risk for constipation D Risk for powerlessness
A Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.
A patient with a history of end-stage renal disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which of the following assessments should the nurse prioritize before, during, and after his treatment? A Level of consciousness B Blood pressure and fluid balance C Temperature, heart rate, and blood pressure D Assessment for signs and symptoms of infection
B Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the nature of procedure indicates a particular need to monitor patients' blood pressure and fluid balance.
Which of the following assessment findings is a consequence of the oliguric phase of acute kidney injury (AKI)? A Hypovolemia B Hyperkalemia C Hypernatremia D Thrombocytopenia
B In AKI the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.
Which of the following urinalysis results would the nurse recognize as an abnormal finding? A pH 6.0 B White blood cells (WBCs) 9/hpf C Amber yellow color D Specific gravity 1.025
B Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. Amber yellow is normal coloration, whereas a pH of 6.0 is average. Reference ranges for specific gravity are 1.003 to 1.030.
Which of the following nursing interventions is appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? A Help the patient cope with the rapid progression of the disease. B Suggest genetic counseling resources for the children of the patient. C Expect the patient to have polyuria and poor concentration ability of the kidneys. D Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.
B PKD is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.
A 70-year-old male patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. The nurse would document which of the following abnormal assessment findings? A Anuria B Dysuria C Oliguria D Enuresis
B Painful and difficult urination is characterized as dysuria. Anuria is an absence of urine production, whereas oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.
As a component of the head-to-toe assessment of a patient who has been recently transferred, the nurse is preparing to palpate the patient's kidneys. The nurse should position the patient: A Prone. B Supine. C Seated at the edge of the bed. D Standing, facing away from the nurse.
B To palpate the right kidney, the patient is positioned supine and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney.
The nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find which of the following as the "classic triad" of presenting symptoms occurring in patients with renal cancer? A Fever, chills, flank pain B Hematuria, flank pain, palpable mass C Hematuria, proteinuria, palpable mass D Flank pain, palpable abdominal mass, and proteinuria
B There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.
An elderly male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for which of the following factors that may dispose him to urinary tract infections (UTIs)? A High-purine diet B Sedentary lifestyle C Benign prostatic hyperplasia (BPH) D Recent use of broad-spectrum antibiotics
C BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi.
A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. Which of the following is an expected assessment finding for this patient during this early stage of recovery? A Hypokalemia B Hyponatremia C Large urine output D Leukocytosis with cloudy urine output
C Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.
When caring for a patient during the oliguric phase of acute kidney injury, which of the following would be an appropriate nursing intervention? A Weigh patient three times weekly. B Increase dietary sodium and potassium. C Provide a low-protein, high-carbohydrate diet. D Restrict fluids according to previous daily loss.
D Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention; hence, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 ml for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times a week.
The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. Which of the following is a priority nursing assessment in the care of this patient? A Assessment of pain and level of consciousness B Assessment of serum calcium and phosphorus levels C Blood pressure and assessment for orthostatic hypotension D Daily weights and measurement of the patient's abdominal girth
D Peripheral edema is characteristic of nephrotic syndrome and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the etiology of nephrotic syndrome.
The nurse preparing to administer a dose of PhosLo to a patient with chronic kidney disease would interpret that this medication should have a beneficial effect on which of the following laboratory values of the patient? A Sodium B Potassium C Magnesium D Phosphorus
D Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with chronic kidney disease.
