Urinary System: Med surge
A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The nurse appropriately asks which of the following questions first?
"Have you experienced any constipation recently?" (Reduced outflow from the dialysis catheter may be due to the catheter position, infection, or constipation. Constipation may contribute to a reduced outflow because peristalsis seems to aid in drainage.)
A nurse provides home care instructions to a client undergoing hemodialysis with regard to care of an arteriovenous (AV) fistula. Which statement by the client indicates an understanding of the instructions?
"I should check the fistula every day by feeling it for a vibration." (An AV fistula provides access to the client's bloodstream for the dialysis procedure. The client is instructed to monitor fistula patency daily by palpating for a vibration, known as a thrill. The client is instructed to avoid compressing the fistula with tight clothing or when sleeping and that blood pressure measurements and blood draws should not be performed on the arm with the fistula. The client also is instructed to assess the fistula for signs and symptoms of infection, including pain, redness, swelling, and excessive warmth.)
A client is scheduled for a myelogram, and the nurse provides a list of instructions to the client regarding preparation for the procedure. Which instructions should the nurse place on the list? Select all that apply.
1. Jewelry will need to be removed. 2. An informed consent will need to be signed. 4. The procedure will take approximately 45 minutes.
The nurse documents that the urine collected from a client diagnosed with early stage polycystic kidney disease is dilute and with a low-specific gravity. Based on this documentation, which specific gravity result was likely present?
1.000 (Specific gravity is a measure of the concentration of particles in the urine. A normal range of urine specific gravity is approximately 1.005 to 1.030. Early in polycystic kidney disease, the ability of the kidneys to concentrate urine decreases.)
Which of the following statements indicates an understanding of the necessary dietary modifications of a client diagnosed with chronic renal failure? Select all that apply.
2. "I should avoid eggs, and a bagel is preferable." 5. "I should consume approximately 40 g of protein daily."
A nurse is teaching a client regarding types of fluids that assist in prevention and treatment of urinary tract infections (UTIs). The nurse tells the client to consume which of the following fluids? Select all that apply.
3. Prune juice 4. Tomato juice 5. Cranberry juice (The client at risk for UTIs should be instructed to consume adequate amounts (2000 to 2500 mL/day) of fluids. Certain fluids can be used to acidify the urine to minimize the risk for development of UTI, such as prune juice, tomato juice, cranberry juice, and water. Dairy products and carbonated beverages should be avoided because they are alkylating agents)
An alkaline-ash diet is prescribed for a client with renal calculi. Which of the following diet menus does the nurse advise the client to select?
A spinach salad, milk, and a banana
A nurse has provided dietary instructions to a client with renal calculi who must learn to eat an alkaline-ash diet. The nurse determines that the client has properly understood the information presented if the client chooses which of the following selections from a diet menu?
A spinach salad, milk, and a banana (In an alkaline-ash diet, all fruits are allowed except cranberries, prunes, and plums.)
A client who suffered a crush injury to the leg has a highly positive urine myoglobin level. The nurse plans to monitor this particular client carefully for signs of:
Acute tubular necrosis (The normal urine myoglobin level is negative. After extensive muscle destruction or damage, myoglobin is released into the bloodstream, where it is cleared from the body by the kidneys. When a large amount of myoglobin is being cleared from the body, the renal tubules may become clogged with myoglobin, which causes acute tubular necrosis. This is one form of acute renal failure.)
A client with chronic renal failure has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now has mental cloudiness, dementia, and complaints of bone pain. The nurse interprets that these data are compatible with:
Aluminum intoxication (Aluminum intoxication may occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. This condition was formerly known as dialysis dementia. It may be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum.)
A client has just undergone renal biopsy. In planning care for this client, the nurse would avoid which intervention?
Ambulate in the room and hall for short distances.
A nurse is preparing the client who is scheduled for an intravenous pyelogram (IVP). The nurse would take which most important action before the test?
Ask about allergies to iodine or shellfish. (Some IVP dye is iodine based. It can cause allergic reactions manifested by itching, hives, rash, tight feeling in the throat, shortness of breath, and bronchospasm. Assessing for allergies is the priority. The dye is injected intravenously. The client may or may not receive premedication. Fluids are restricted before the procedure. The client is generally on nothing-by-mouth (NPO) status after midnight, and intravenous fluid rates may be slowed to allow better concentration of the dye in the kidneys.)
A male client has a history of urinary tract infections due to urinary retention. Which intervention should the nurse implement to decrease the risk of infection?
Assist the client to stand for voiding. (Most men are conditioned to urinate from a standing position, so a reasonable strategy is to assist the client to a standing position to increase the chance of emptying the bladder. This will decrease the risk of infection as the bladder empties more completely. Withholding fluids after 6:00 ᴘᴍ may improve client sleep but is harmful and is more likely to increase than decrease the risk of bladder infection. Thorough handwashing is always suitable for client teaching; however, bladder contamination from the client's hands is not the problem. Monitoring the temperature will not prevent infection but aids in the early detection of infection.)
A nurse has given instructions to the client with a cystocele about Kegel exercises. The nurse determines that the client has not fully understood the directions if the client states to:
Begin voiding and then stop the stream, holding residual urine for an hour. (Kegel exercises strengthen the perineal floor and are useful to prevent and manage cystocele, rectocele, and enterocele. There are several acceptable ways to perform Kegel exercises. These involve starting and stopping the flow of urine either once for up to 5 minutes, or several times during a single voiding for about 5 seconds. Because the muscles that control urination also are involved in defecation, these exercises also can be done once during defecation. Otherwise, they may be done by holding perineal muscles taut for up to 10 seconds several times a day, or for 5 minutes three or four times a day. Option 1 is not a correct method for performing Kegel exercises. Residual urine should not be held in the bladder for lengthy periods because it could promote urinary tract infection.)
A client is admitted to the surgical nursing unit following transurethral resection of the prostate (TURP) for benign prostatic hypertrophy. The client has a bladder irrigation infusing, and output is light cherry colored. The blood pressure is 134/82 mm Hg, the pulse is 84 beats per minute, and the client is afebrile with a respiratory rate of 18 breaths per minute. The licensed practical nurse (LPN) assisting in caring for the client collects assessment data 1 hour after admission to the nursing unit. The LPN notifies the registered nurse (RN) immediately if which of the following is noted on data collection?
Blood pressure of 102/50 mm Hg, pulse 110 beats per minute' (Frank bleeding, which is either arterial or venous, may occur during the first day after surgery. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The LPN would notify the RN, who would then contact the health care provider. Bladder spasms are expected to occur following surgery and are treated with medication. Some hematuria is usual for several days after surgery and is managed initially by increasing the flow rate of the bladder irrigation. A urinary output of 200 mL greater than intake is adequate.)
A nurse is caring for a hospitalized client following cystoscopy and is monitoring for signs of complications associated with the procedure. Which of the following, if noted in the first few hours following the procedure, indicates the need to notify the registered nurse?
Bloody urine with clots (The client may have clear, yellow, or pink-tinged urine after cystoscopy. Bloody urine with clots is always an abnormal finding and should be reported immediately.)
A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. The nurse monitors the client for signs of transurethral resection (TUR) syndrome, including:
Bradycardia and confusion (TUR syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.)
A nurse is encouraging a client, who is incontinent, to participate in recreational therapy. What nursing intervention would the nurse consider performing first?
Change the client's soiled disposable brief. (Basic physiological needs are a priority in administering nursing care.)
A nurse is assisting a client with cystitis to select foods that are appropriate for an acid-ash diet. The nurse encourages the client to eat which of the following foods?
Cheese (Foods that are allowed on an acid-ash diet include meat, fish, shellfish, cheese, eggs, poultry, grains, cranberries, prunes, plums, corn, lentils, and foods with high amounts of chlorine, phosphorus, and sulfur. Foods that are not included are milk and milk products such as ice cream, all vegetables except corn and lentils, all fruits except cranberries, plums, and prunes, and foods containing high amounts of sodium, potassium, calcium, and magnesium.)
A client's kidneys are retaining greater amounts of sodium. The nurse anticipates that the kidneys are also retaining greater amounts of:
Chloride and bicarbonate (Sodium is a cation. When sodium retention is increased, the kidney also has increased reabsorption of chloride and bicarbonate, which are anions.)
A nurse is monitoring an older client suspected of having a urinary tract infection (UTI) for signs of the infection. The nurse would be alert to the presence of:
Confusion (In an older client, the only symptom of a UTI may be something as vague as increasing mental confusion or frequent unexplained falls. Frequency and urgency may commonly occur in an older client, and fever can be associated with a variety of conditions.)
A client has epididymitis as a complication of urinary tract infection (UTI). The nurse is giving the client instructions to prevent a recurrence. The nurse determines that the client needs further instruction if the client states the intention to:
Continue to take antibiotics until all symptoms are gone. (The client who experiences epididymitis from UTI should increase intake of fluids to flush the urinary system. Because organisms can be forced into the vas deferens and epididymis from strain or pressure during voiding, the client should limit the force of the stream. Condom use can help prevent urethritis and epididymitis from sexually transmitted infections. Antibiotics are always taken until the full course of therapy is completed.)
A client who has a cold is seen in the emergency department with inability to void. Because the client has a history of benign prostatic hyperplasia (BPH), the nurse questions the client about use of which medication?
Decongestants (In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about use of these medications if presenting with urinary retention. Retention also can be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.)
A client is scheduled for intravenous pyelography (IVP). Before the test, the priority nursing action would be to:
Determine a history of allergies. (An iodine-based dye may be used during the IVP and can cause allergic reactions such as itching, hives, rash, tight feeling in the throat, shortness of breath, and bronchospasm.)
A nurse notes that a client's urinalysis report contains a notation of positive red blood cells (RBCs). The nurse interprets that this finding is unrelated to which of the following items that is part of the client's medical record?
Diabetes mellitus (Hematuria can be caused by trauma to the kidney, such as with blunt trauma to the lower posterior trunk or flank. Kidney stones can cause hematuria as they scrape the endothelial lining of the urinary system. Anticoagulant therapy can cause hematuria as a side effect. Diabetes mellitus does not cause hematuria, although it can lead to renal failure from prerenal causes.)
A male client has a tentative diagnosis of urethritis. The nurse collects data from the client, knowing that which of the following are manifestations of the disorder?
Dysuria and penile discharge (Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge.)
A nurse is reviewing the client's record and notes that the health care provider has documented that the client has a renal disorder. On review of the laboratory results, the nurse would most likely expect to note which of the following?
Elevated blood urea nitrogen (BUN) level (BUN testing is a frequently used laboratory test to determine renal function. The BUN level starts to rise when the glomerular filtration rate falls below 40% to 60%. A decreased hemoglobin and RBC count may be noted if bleeding from the urinary tract occurs or if erythropoietic function by the kidney is impaired. An increased WBC is most likely to be noted in renal disease.)
A client has an arteriovenous (AV) shunt in place for hemodialysis. The nurse would take which priority precaution, knowing that bleeding is a potential complication?
Ensure that small clamps are attached to the AV shunt dressing. (An AV shunt is a cannula with two ends that are tunneled subcutaneously into an artery and a vein. An AV shunt is a less common form of access site but carries a risk for bleeding when it is used. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be observed at least every 4 hours. Once per shift is insufficient. Checking for blood results, bruit, and thrill all apply to the care of this client but do not focus on bleeding.)
A client newly diagnosed with renal failure will be receiving peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is appropriate?
Explain that the pain will subside after the first few exchanges. (Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, it disappears after a week or two. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.)
A nurse is providing instructions to the client regarding the complications of peritoneal dialysis. The nurse instructs the client that which manifestation is likely associated with the onset of peritonitis?
Fever (The signs of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output. )
A nurse is caring for a client with epididymitis. The nurse anticipates noting which of the following findings on data collection?
Fever, nausea and vomiting, and painful scrotal edema (Typical signs and symptoms of epididymitis include scrotal pain and edema, which are often accompanied by fever, nausea and vomiting, and chills. It is most often caused by infection, although sometimes it can be caused by trauma.)
The spouse of a client with acute renal failure secondary to heart failure asks the nurse how this could happen. The nurse plans to base a response in part on the fact that the kidneys:
Generally require and receive about 20% to 25% of the resting cardiac output (The kidneys normally receive about 20% to 25% of the cardiac output and require adequate perfusion to function properly. With significant or prolonged decrease in blood supply, the kidneys can fail. Heart failure is referred to as a prerenal cause of kidney failure because the insult occurs outside the renal system)
A nurse is caring for the client with epididymitis. The nurse understands that which treatment modality could increase swelling in the affected area?
Heating pad (Common interventions used in the treatment of epididymitis include bedrest, elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics. A heating pad would not be used because direct application of heat could increase blood flow to the area and increase the swelling.)
A nurse is collecting data on a newly admitted client with a diagnosis of bladder cancer. While collecting data on this client the nurse would most likely expect to note:
Hematuria (Gross, painless hematuria is most frequently the first manifestation of bladder cancer. As the disease progresses, the client may experience burning, frequency, and urgency.)
The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of:
Hyperglycemia (An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. )
A nurse is told by an older woman that she has begun to be incontinent of urine at night and now drinks no fluids after 6:00 ᴘᴍ. The nurse's response should be guided by the knowledge that:
Incontinence at any age deserves urological attention. (Urinary incontinence requires evaluation as to the cause so that appropriate treatment can be begun.)
A nurse is providing dietary instructions to a client with renal calculi, and the laboratory analysis has revealed that the calculus is composed of uric acid. The nurse tells the client that it would be helpful to:
Increase intake of legumes in the diet. (Dietary instructions to the client with a uric acid type kidney stone include increasing legumes, green vegetables, and fruits (except prunes, grapes, cranberries, and citrus fruits) to increase the alkalinity of the urine. The client should also be instructed to decrease purine sources such as organ meats, gravies, red wines, goose, venison, and seafood.)
A nurse is inserting an indwelling urinary catheter into a male client. As the catheter is inserted into the urethra, urine begins to flow into the tubing. At this point, the nurse:
Inserts the catheter 2.5 to 5 cm and inflates the balloon (The catheter's balloon is behind the opening at the insertion tip. The catheter is inserted 2.5 to 5 cm after urine begins to flow to provide sufficient space to inflate the balloon. Inserting the catheter the extra distance will ensure that the balloon is inflated inside the bladder and not in the urethra, which could produce trauma.)
A female client is admitted to the emergency department following a fall from a horse. The health care provider (HCP) prescribes the insertion of an indwelling urinary catheter. The nurse notes blood at the urinary meatus while preparing for the procedure. The nurse should:
Notify the health care provider. (The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing.)
A nurse is assisting a client who is new to a low-potassium diet to select food items from the menu. Which of the following food items is lowest in potassium and would be recommended to the client who is on this dietary restriction?
Lima beans (Cantaloupe, spinach, and strawberries are high-potassium foods. Lima beans contain potassium but in lower amounts than options 2, 3, and 4.)
A client is seen in the health care clinic and acute pyelonephritis is suspected. The nurse reviews the client's record and would expect to note which associated signs and symptoms documented?
Nausea and vomiting (Typical manifestations of acute pyelonephritis include high fever, chills, nausea, vomiting, flank pain on the affected side with costovertebral angle tenderness, general weakness, and headache. The client often exhibits the typical signs and symptoms of cystitis, with production of urine that is foul smelling and cloudy or bloody and that has an increased white blood cell (WBC) count.)
A client hospitalized with urolithiasis has a sudden significant decrease in urine output. The nurse would immediately:
Notify the registered nurse. (A sudden significant decrease in urine output, to either oliguria or anuria, represents obstruction of the urinary tract, usually at the bladder neck or urethra. This represents a medical emergency, requiring prompt treatment to preserve kidney function. In this instance, the nurse would notify the registered nurse, who would call the health care provider to report the findings immediately. There are no data in the question to indicate that a Foley catheter is present. Obtaining a urine-specific gravity will not relieve the obstruction. Telling the client to increase fluid intake is incorrect. Additionally, if an obstruction is present, increasing fluids can cause hydronephrosis.)
A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse monitors this client for which manifestation of this disorder?
Pallor, diminished pulse, and pain in the left hand (Arterial steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula, which is caused by tissue ischemia)
A nurse is assisting in planning a diet for a client with acute renal failure (ARF). The nurse plans to restrict which of the following dietary components from this client's diet?
Potassium (In the client with renal failure, potassium intake must be restricted as much as possible (30 to 50 mEq/day). The primary mechanism of potassium removal during ARF is dialysis.)
A male client who is hospitalized is diagnosed with urethritis caused by chlamydial infection. The nursing assistant assigned to the client asks the nurse what measures are necessary to prevent a contraction of the infection during care. The nurse tells the assistant that:
Standard precautions are sufficient, because the infection is transmitted sexually. (Chlamydia is a sexually transmitted infection and is frequently called "non-gonococcal urethritis" in the male client. It requires no special precautions. Caregivers cannot acquire the disease during administration of care, and following standard precautions is the only measure that needs to be used.)
A nurse is assigned to care for a client who has just returned to the nursing unit following a renal biopsy. The nurse plans to do which of the following to properly care for this client for the remainder of the shift?
Test the urine for occult blood. (Following renal biopsy, serial urine samples are tested for occult blood. The nurse encourages fluid intake to reduce possible clot formation at the biopsy site. Opioid analgesics are often used to manage the renal colic pain that some clients feel after this procedure. The nurse ensures that the client remains in bed for at least 24 hours. The nurse also frequently checks the client's vital signs and puncture site.)
A young female client with acute pyelonephritis is scheduled for a voiding cystourethrogram. The nurse determines that this client would likely benefit from increased support and teaching about the procedure because:
The client must void while the micturition process is filmed. (Having to void in the presence of others can be very embarrassing for clients and actually may interfere with the client's ability to void. The nurse teaches the client about the procedure to try to minimize stress from lack of preparation and gives the client encouragement and emotional support. Screens may be used in the radiology department to try to provide an element of privacy during this procedure.)
The use of peritoneal dialysis for the treatment of chronic renal failure would be contraindicated for which of the following clients? #2
The client with chronic obstructive pulmonary disease (COPD) (Peritoneal dialysis requires instillation of approximately 2 L of a dialysate solution into the peritoneal space. This solution remains in the peritoneal space for a prescribed amount of time, usually from 4 to 10 hours. This is known as the "dwell time." Although this fluid remains in the peritoneal space, it causes upward displacement of the diaphragm, resulting in decreased lung expansion. A client with COPD would be at high risk for developing respiratory distress if the respiratory system were to be further compromised by the instillation of the dialysate solution and the resulting upward displacement of the diaphragm.)
A nurse is assisting in planning a teaching session with a female client diagnosed with urethritis caused by infection with chlamydia. The nurse would plan to include which of the following points in the teaching session?
The most serious complication of this infection is sterility. (The most serious complication of chlamydial infection is sterility. The infection can be prevented by the use of latex condoms. It may be treated with doxycycline or with azithromycin (Zithromax). All sexual partners during the 30 days before diagnosis should be notified, examined, and treated as necessary.)
A client has received instructions on self-management of peritoneal dialysis. The nurse determines that the client needs further instruction if the client states to:
Use a strong adhesive tape to anchor the catheter dressing. (The client is at risk for impairment of skin integrity resulting from the presence of the catheter, exposure to moisture, and irritation from tape and cleansing solutions. The client should be instructed to use paper or non-allergenic tape to prevent skin irritation and breakdown. It is proper procedure for the client to use aseptic technique and to self-monitor vital signs and weight on a daily basis.)
A nurse is working with a client newly diagnosed with chronic renal failure (CRF) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting:
Anger (Psychosocial reactions to CRF and hemodialysis are varied and may include anger. Other reactions include personality changes, emotional lability, withdrawal, and depression. The individual client's response may vary depending on the client's personality and support systems. The client in this question is exhibiting anger. The client has not projected blame on the nurse, and the client's statement does not reflect withdrawal or depression.)
A client with acute glomerulonephritis had a urinalysis sent to the laboratory. The report reveals that there is hematuria and proteinuria in the urine. The nurse interprets that these results are:
Consistent with glomerulonephritis (Gross hematuria and proteinuria are the cardinal signs of glomerulonephritis. The urine may be small in volume, dark or smoky from the hematuria, and foamy from the proteinuria. Concurrent serum studies would reveal elevated blood urea nitrogen, creatinine, C-reactive protein level, and antistreptolysin-O titer.)
The client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which of the following medications?
Decongestants (In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if he or she has urinary retention. Retention also can be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.)
Which of the following would the nurse include in the plan of care for a client following a renal scan?
No special precautions, except to wear gloves if coming into contact with the client's urine.
The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication:
On return from dialysis (Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and from having the medication removed from the bloodstream by dialysis.)
A nurse is urging a client to cough and deep breathe after a nephrectomy. The client tells the nurse, "That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is likely a result of:
Pain that is intensified because the location of the incision is near the diaphragm (After nephrectomy, the client may be in considerable pain. This is due to the size of the incision and its location near the diaphragm, which makes coughing and deep breathing so uncomfortable. For this reason, opioids are used liberally and may be most effective when provided as patient-controlled analgesia or through epidural analgesia)
A client is diagnosed with polycystic kidney disease, and the nurse provides information to the client about the treatment plan. The nurse determines that the client needs additional information if the client states that which of the following is a component of the treatment plan?
Sodium restriction Individuals with polycystic kidney disease seem to waste rather than retain sodium. Thus, they need increased sodium and water intake. Aggressive control of hypertension is essential. Genetic counseling is advisable because of the hereditary nature of the disease.
After a renal biopsy, the client complains of pain at the biopsy site, which radiates to the front of the abdomen. Based on this complaint, the nurse further monitors the client for:
Bleeding (If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding should be suspected.)
A client who had a prostatectomy has learned perineal exercises to gain control of the urinary sphincter. The nurse determines that the client needs further instruction if the client states that he or she will perform which of the following as part of these exercises?
1. Perform the Valsalva maneuver. (The Valsalva maneuver is avoided following prostatectomy because it increases the risk of bleeding in the postoperative period. An acceptable exercise is tightening the abdominal, gluteal, and perineal muscles, as if trying to prevent urination. Another acceptable exercise is tightening the rectal sphincter while relaxing the abdominal muscles; this prevents the Valsalva maneuver from occurring.)
A nurse is caring for a client who had a renal biopsy. Which interventions would the nurse include in the plan of care for the client after this procedure? Select all that apply.
2. Administering pain medication as prescribed 3. Monitoring vital signs and the puncture site frequently 4. Testing serial urine samples with dipsticks for occult blood (After renal biopsy, the nurse ensures that the client remains in bed for at least 24 hours. Vital signs and puncture site assessments are done frequently during this time. Encouraging fluids is done to reduce possible clot formation in the kidney and urinary tract. A Hematest is done on serial urine samples with urine dipsticks to evaluate bleeding. Analgesics are often needed to manage the renal colic pain that some clients feel after this procedure.)
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply.
2. Check the level of the drainage bag. 3. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. (If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and the peritoneal dialysis system is also checked for kinks or twisting, and the clamps on the system are checked to ensure that they are open. There is no reason to contact the HCP. Increasing the flow rate is an inappropriate action and is unassociated with the amount of outflow solution.)
A nurse has a prescription to collect a 24-hour urine specimen from a client. The nurse should avoid which of the following errors in technique while completing this procedure?
Ask the client to void, save the specimen, and note the start time. (Because the 24-hour urine test is a timed quantitative determination, the test must be started with an empty bladder. Therefore the first urine is discarded. Fifteen minutes prior to the end of the collection time, the client should be asked to void, and this specimen is added to the collection. The urine collection should be refrigerated or placed on ice to prevent changes in urine.)
A client arrives at the ambulatory care clinic with low abdominal pain. A routine urine specimen reveals hematuria. The client does not have a fever. The nurse should next ask the client about a history of which of the following?
Blow or trauma to the bladder or abdomen ( Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever because they are infections. Renal cancer would cause pain in the flank area, not the low abdomen.)
A nurse must ambulate a client who has a nephrostomy tube attached to a drainage bag. The nurse plans to do this most safely and effectively by:
Changing the drainage bag to a leg collection bag (The safest approach to protect the integrity and safety of the nephrostomy tube with a mobile client is to attach the tube to a leg collection bag. This allows for greater freedom of movement while alleviating worry over accidental disconnection or dislodgement. The other options do not present the most safe and effective methods to ensure the integrity of the tube.)
A nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. To determine if the client is currently experiencing exacerbation of BPH, the nurse asks the client about the presence of which early symptom?
Decreased force in the stream of urine (Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client may then develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.)
A client has been diagnosed with pyelonephritis. The nurse interprets that which of the following health problems has placed the client at risk for this disorder?
Diabetes mellitus (Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.)
A nurse is collecting data from a male client with epididymitis. The nurse would expect to note which of the following signs and symptoms of this problem?
Fever, nausea and vomiting, and painful scrotal edema (Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. It most often is caused by infection, although sometimes it can be caused by trauma. Diarrhea and ecchymosis are not associated with this disorder.)
A nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the nurse the reason for a renal biopsy, when other tests such as computed tomography (CT) and ultrasound are available. In formulating a response, the nurse incorporates the knowledge that a renal biopsy:
Gives specific cytological information about the lesion (Renal biopsy is a definitive test that gives specific information about whether the lesion is benign or malignant. An ultrasound discriminates between a fluid-filled cyst and a solid mass. Renal arteriography outlines the renal vascular system.)
A client newly diagnosed with chronic renal failure has recently begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse monitors the client during dialysis for:
Headache, deteriorating level of consciousness, and twitching (Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea and vomiting, twitching, and possible seizure activity. It is caused by rapid removal of solutes from the body during hemodialysis)
Which of the following conditions places the client at risk for developing acute postrenal failure?
Hydronephrosis (Postrenal failure is caused by an obstruction in the urinary tract, anywhere from the tubules to the urethral meatus. Some causes of obstruction include calculi, tumors, prostatic hypertrophy, or strictures, which impede the normal flow of urine. This causes the renal pelvis and calices to become distended (hydronephrosis). Urine production continues, and the urine becomes trapped because of the obstruction. The accumulating urine exerts pressure on the renal pelvis, and this pressure can destroy the nephrons in the kidney. This type of renal failure is called, "postrenal." Dehydration places the client at risk for acute prerenal failure because the kidneys are not being perfused. Other causes of prerenal failure include shock, decreased cardiac output, and hypotension. Rhabdomyolysis and glomerulonephritis place the client at risk for intrarenal failure.)
A nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that the drainage from the outflow catheter is cloudy. The nurse notifies the registered nurse and plans to take which action?
Obtain a culture and sensitivity of the drainage. (When the drainage becomes cloudy, peritonitis is suspected. A culture and sensitivity is obtained, and broad-spectrum antibiotics are added to the dialysis solution as prescribed pending culture and sensitivity results. The dialysis solution may also be heparinized to prevent catheter occlusion. Some clients must switch to hemodialysis if peritonitis is severe or recurring, but the nurse does not make this decision. The peritoneal dialysis is not stopped)
A nurse is admitting a client to the nursing unit who has returned from the post-anesthesia care unit following prostatectomy. The client has a three-way Foley catheter with continuous bladder irrigation. The nurse would maintain the flow rate of the continuous bladder infusion to maintain a urine output that is:
Pale yellow or slightly pink (Bladder irrigant is not infused at a preset rate, but rather it is increased or decreased to maintain urine that is clear or pale yellow or that has just a slight pink tinge. The infusion rate should be increased if the drainage is red or if clots are seen. Correspondingly, the rate can be slowed slightly if the returns are as clear as water.)
A client with acute glomerulonephritis is admitted to the nursing unit. The nurse should plan to do which of the following immediately on admission?
Remove the water pitcher from the bedside. (The client with acute glomerulonephritis commonly experiences fluid volume excess and fatigue. Interventions include fluid restriction and ongoing monitoring of weight, intake, and output. It is unnecessary to monitor the temperature as frequently as every 2 hours. The client is placed on bedrest or at least encouraged to rest because increased activity levels are correlated directly with proteinuria and hematuria. The diet is high in calories but low in protein.)
A client complains of leaking urine whenever she sneezes, coughs, or laughs. The nurse recognizes that this report is consistent with which type of incontinence?
Stress (Stress incontinence is caused by coughing, laughing, and other activities that increase intra-abdominal pressure. Reflex incontinence, sometimes called "overflow incontinence," is a loss of urine that is uncontrollable and occurs at predictable intervals. Functional incontinence is also involuntary and occurs often in clients with cognitive deficits, although the urinary and nervous systems are intact. Urge incontinence occurs following the sensation of an urgent need to void.)
The use of peritoneal dialysis for the treatment of chronic renal failure would be contraindicated for which of the following clients?
The client with severe emphysema (Peritoneal dialysis requires the instillation of approximately 2 L of a dialysate solution into the peritoneal space. This solution remains in the peritoneal space for a prescribed amount of time, usually from 4 to 10 hours. This is known as the "dwell time." While this fluid remains in the peritoneal space, it causes upward displacement of the diaphragm, resulting in decreased lung expansion. A client with severe emphysema would be at high risk for developing respiratory distress if the respiratory system were to be further compromised by the instillation of the dialysate solution and the resulting upward displacement of the diaphragm.)
A client with chlamydial infection has received instructions on self-care and prevention of further infection. The nurse determines that the client needs additional instructions if the client states that he or she will:
Use doxycycline prophylactically to prevent symptoms of chlamydia. (Antibiotics are not taken prophylactically to prevent acquisition of urethritis from chlamydia. The risk of reinfection can be reduced by limiting the number of sexual partners and by the use of condoms. In some instances, follow-up culture is requested in 4 to 7 days to confirm a cure.)
A client with prostatitis resulting from kidney infection has received instructions on management of the condition at home and prevention of recurrence. The nurse determines that the client understood the instructions if the client has verbalized that he will:
Use warm sitz baths and analgesics to increase comfort. (Treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. The client is also taught to rest, increase fluid intake, and use sitz baths for comfort.)
A client with new-onset renal failure is having a first hemodialysis treatment. The nurse is especially careful to monitor the client for which of the following on return from the dialysis treatment?
Headache, decreasing level of consciousness, and seizures (Disequilibrium syndrome occurs most often in clients who are new to dialysis. It is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. It results from rapid removal of solutes from the body during hemodialysis, with a higher residual concentration gradient in the brain because of the blood-brain barrier. Water goes into cerebral cells because of the osmotic gradient, causing brain swelling and the onset of symptoms. It is prevented by dialyzing for shorter times or at reduced blood flow rates.)
A nurse is assigned to care for a client who has returned to the nursing unit following a left nephrectomy. The nurse places the highest priority on monitoring which of the following?
Hourly urine output (Following a nephrectomy, it is imperative to measure the urine output hourly. This is done to monitor the function of the remaining kidney and to detect renal failure early if it occurs. The client may also experience significant pain after this surgery, which could affect the client's ability to reposition, cough, and deep breathe. Therefore the next most important measurements are vital signs (including oxygen saturation), pain level, and bed mobility. Clear liquids are not given until the client has bowel sounds, which are not referred to in this question.)
The client with diabetes mellitus receiving peritoneal dialysis asks the nurse why it is important to leave the dialysate infused only for a specific amount of time. The nurse responds that not adhering to the dwell time can increase the risk of the client experiencing:
Hyperglycemia (Dialysate contains glucose, which helps remove fluids through an osmotic gradient. An extended dwell time increases the risk of hyperglycemia in diabetic clients as a result of the absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin during peritoneal dialysis)
A nurse is admitting a client with chronic renal failure (CRF) to the nursing unit. The nurse monitors the client for which frequent cardiovascular sign that occurs in CRF?
Hypertension (Hypertension is the most common cardiovascular finding in the client with CRF. It is a result of a number of mechanisms, including volume overload, renin-angiotensin system stimulation, vasoconstriction from sympathetic stimulation, and absence of prostaglandins. Hypertension may also be the cause of the renal failure. It is an important item to assess because hypertension can lead to heart failure in the CRF client because of increased cardiac workload in conjunction with fluid overload.)
A client has undergone a transurethral resection of the prostate (TURP) a few hours ago to treat symptoms of benign prostatic hypertrophy. The nurse notes bright red blood and clots in the urinary catheter drainage bag. What is the nurse's initial action?
Increase the flow rate of the continuous bladder irrigation. (Increasing the flow rate of the continuous bladder irrigation usually controls bleeding and clot formation, and this should be the nurse's first action. If this is ineffective, then notification of the surgeon is appropriate. Removing fluid from the retention bulb actually would increase the bleeding, because traction is applied to the surgical site to reduce bleeding. Removal of the catheter is inappropriate and would likely cause more bleeding to occur.)
The nurse has given dietary instructions to a client diagnosed with acute glomerulonephritis. The nurse determines that the client understands the information presented if the client states the intention to do which of the following?
Limit protein intake. (The diet for the client with acute glomerulonephritis is generally high in calories and low in protein. This diet inhibits protein catabolism and allows the kidneys to rest. In acute glomerulonephritis it is important to protect the kidneys while they are recovering their function. Sodium also may be limited depending on the amount of edema present. No specific recommendations are made for fiber, potassium, or magnesium food types.)
A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?
Palpation of a thrill over the fistula (The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicates patency of the fistula)
A client with acute renal failure (ARF) has been treated with sodium polystyrene sulfonate (Kayexalate) by mouth. The nurse evaluates this therapy as effective if which of the following values is noted on follow-up laboratory testing?
Potassium, 4.9 mEq/L (Of all the electrolyte imbalances that accompany renal failure, hyperkalemia is the most dangerous because it can lead to cardiac dysrhythmias and death. If the potassium level rises too high, sodium polystyrene sulfonate may be given to cause excretion of potassium through the gastrointestinal tract. Each of the electrolyte levels noted in the question falls within the normal reference range for that electrolyte. The potassium level is measured following administration of this medication to note the extent of its effectiveness.)
A long-term care nurse notes that a female client has leaking of urine when sneezing, coughing, or laughing. The nurse reports that this client has which of the following types of incontinence?
Stress incontinence (Stress incontinence is caused by coughing, laughing, and other activities that increase intra-abdominal pressure. Reflex incontinence, sometimes called overflow incontinence, is a loss of urine that is uncontrollable and occurs at somewhat predictable intervals. Functional incontinence is also involuntary and occurs often in clients with cognitive deficits, although the urinary and nervous systems are intact. Urge incontinence occurs following the sensation of an urgent need to void.)
A nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, would the nurse identify as a risk factor for this disorder?
Diabetes mellitus (Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.)
A nurse is assessing a client with suspected acute renal failure. Which of the following findings would support a diagnosis of acute intrarenal failure?
Urine analysis positive for casts and cellular debris (Acute tubular necrosis is responsible for 90% of acute intrarenal renal failure cases, and, in these cases, the tubular epithelium is destroyed. The debris from the destruction of the epithelial cells can be detected in the urinalysis of a client with acute intrarenal failure. The BUN-to-creatinine ratio is normally 10:1. When the BUN-to-creatinine ratio is greater than 20:1, it generally indicates acute prerenal failure. Option 4 has a BUN-to-creatinine ratio of 40:1, indicating acute prerenal renal failure. However, if the client were to have an elevated BUN and creatinine levels, but the ratio remains 10:1, this generally indicates intrarenal failure. A urine output of 30 mL/hr is an adequate urine output, and this does not indicate that the client has acute renal failure. Ureteral calculi places the client at risk for postrenal failure.)
A nurse is assigned to care for a client who has just returned to the nursing unit after having hemodialysis for the first time. The nurse monitors the client carefully for which signs and symptoms of disequilibrium syndrome?
Vomiting and headaches (A complication that can occur during early dialysis is disequilibrium syndrome. This syndrome results from a high osmotic gradient in the brain following the rapid removal of fluid that can occur during hemodialysis. Because solutes are not removed as quickly from the cerebrospinal fluid (CSF) and brain, fluid from the circulation shifts into the brain, causing cerebral edema. The client may exhibit nausea and vomiting, confusion, headaches, restlessness, twitching, muscle cramps, and seizures.)
A female client has a prescription for a clean-catch urine culture. After providing a sterile specimen cup to the client, the nurse would give which instruction so that the specimen is collected properly?
Cleanse the labia using cleansing towels, begin to void into toilet, and then collect the specimen. (The client should cleanse the labia, begin to void, and then "catch" the sample midstream. Proper cleansing and voiding techniques are necessary so that the specimen does not become contaminated from external sources.)
A client diagnosed with chronic renal failure is being treated at home with continuous ambulatory peritoneal dialysis. The client notes that there is a decrease in the catheter outflow following the prescribed 6-hour dwell time and calls the nurse to report this occurrence. The nurse should instruct the client to take which action?
Ambulate in the home. (The most common causes of decreased outflow of dialysate in peritoneal dialysis are displacement and obstruction of the catheter. Obstruction may be a result of malposition, adherence of the catheter tip to internal organs, constipation, or infection. The client with decreased catheter outflow should first attempt to displace the catheter tip from internal organs by changing positions or walking. This may be a simple solution to the problem. If the client has been constipated, treatment of the constipation would be necessary. The health care provider need not be notified immediately, unless the client is exhibiting signs of infection or if attempts to noninvasively clear the obstruction are not effective. Straight catheterization of the bladder will not alleviate this problem, and the client should never instill any type of medication into the catheter besides the medications contained in the dialysate solution.)
