LA #11 (Urinary) Chapters 47, 48, 49 Flashcards
After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take?
a.
Elevate the patient’s arm above the level of the heart.
b.
Report the patient’s symptoms to the health care provider.
c.
Remind the patient about the need to take a daily low-dose aspirin tablet.
d.
Educate the patient about the normal vascular response after AVG insertion.
B
The patient’s complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.
A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for
a.
vasodilation.
b.
poor skin turgor.
c.
bounding pulses.
d.
rapid respirations.
D
Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.
A patient with severe heart failure develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet the goal of
a.
replacing fluid volume.
b.
preventing hypertension.
c.
maintaining cardiac output.
d.
diluting nephrotoxic substances.
C
The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient’s heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.
A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV?
a.
Urine output
b.
Calcium level
c.
Cardiac rhythm
d.
Neurologic status
C
The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.
A patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which of these orders for the patient will the nurse question?
a.
NPO for 6 hours before IVP procedure
b.
Normal saline 500 mL IV before procedure
c.
Ibuprofen (Advil) 400 mg PO PRN for pain
d.
Dulcolax suppository 4 hours before IVP procedure
C
The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided. The suppository and NPO status are necessary to ensure adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure.
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse’s teaching about management of CKD has been effective?
a.
“I need to try to get more protein from dairy products.”
b.
“I will try to increase my intake of fruits and vegetables.”
c.
“I will measure my urinary output each day to help calculate the amount I can drink.”
d.
“I need to take the erythropoietin to boost my immune system and help prevent infection.”
C
The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.
Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?
a.
Blood pressure
b.
Phosphate level
c.
Neurologic status
d.
Creatinine clearance
B
Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.
Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess the
a.
blood urea nitrogen (BUN) and creatinine.
b.
blood glucose level.
c.
patient’s bowel sounds.
d.
level of consciousness (LOC).
C
Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse’s decision to give the medication.
The nurse has instructed a patient who is receiving hemodialysis about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful?
a.
Scrambled eggs, English muffin, and apple juice
b.
Oatmeal with cream, half a banana, and herbal tea
c.
Split-pea soup, whole-wheat toast, and nonfat milk
d.
Cheese sandwich, tomato soup, and cranberry juice
A
Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.
Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check the laboratory value for
a.
creatinine.
b.
potassium.
c.
total cholesterol.
d.
serum phosphate.
D
If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.
Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?
a.
Blood urea nitrogen (BUN) level
b.
Urine output
c.
Creatinine level
d.
Calculated glomerular filtration rate (GFR)
D
GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.
A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it
a.
is much less likely to clot.
b.
increases patient mobility.
c.
can accommodate larger needles.
d.
can be used sooner after surgery.
A
AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.
When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula?
a.
Check the fistula site for a bruit and thrill.
b.
Assess the rate and quality of the left radial pulse.
c.
Compare blood pressures in the left and right arms.
d.
Irrigate the fistula site with saline every 8 to 12 hours.
A
The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.
When a patient who has had progressive chronic kidney disease (CKD) for several years is started on hemodialysis, which information about diet will the nurse include in patient teaching?
a.
Increased calories are needed because glucose is lost during hemodialysis.
b.
Unlimited fluids are allowed since retained fluid is removed during dialysis.
c.
More protein will be allowed because of the removal of urea and creatinine by dialysis.
d.
Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.
C
Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.
Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?
a.
The patient slows the inflow rate when experiencing pain.
b.
The patient leaves the catheter exit site without a dressing.
c.
The patient plans 30 to 60 minutes for a dialysate exchange.
d.
The patient cleans the catheter while taking a bath every day.
D
Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.
When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation?
a.
The patient has metastatic lung cancer.
b.
The patient has poorly controlled type 1 diabetes.
c.
The patient has a history of chronic hepatitis C infection.
d.
The patient is infected with the human immunodeficiency virus.
A
Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.
The nurse is caring for a patient who had kidney transplantation several years ago. Which assessment finding may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid?
a.
Joint pain
b.
Tachycardia
c.
Postural hypotension
d.
Increase in creatinine level
A
Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.
Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse?
a.
The blood glucose is 144 mg/dL.
b.
The patient’s blood pressure is 150/92.
c.
There is a nontender lump in the axilla.
d.
The patient has a round, moonlike face.
C
A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy. The elevated glucose, moon face, and hypertension are possible side effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy.
A patient with chronic kidney disease (CKD) brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required?
a.
Multivitamin with iron
b.
Milk of magnesia 30 mL
c.
Calcium phosphate (PhosLo)
d.
Acetaminophen (Tylenol) 650 mg
B
Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.
A patient with hypertension and stage 2 chronic kidney disease (CKD) is receiving captopril (Capoten). Before administration of the medication, the nurse will check the patient’s
a.
glucose.
b.
potassium.
c.
creatinine.
d.
phosphate.
B
Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values also would be monitored in patients with CKD but would not affect whether the captopril was given or not.
A new order for IV gentamicin (Garamycin) 60 mg BID is received for a patient with diabetes who has pneumonia. When evaluating for adverse effects of the medication, the nurse will plan to monitor the patient’s
a.
urine osmolality.
b.
serum potassium.
c.
blood glucose level.
d.
blood urea nitrogen (BUN) and creatinine.
D
When a patient at risk for chronic kidney disease (CKD) receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in determining the effect of the gentamicin.
Which of the following information obtained by the nurse who is caring for a patient with end-stage renal disease (ESRD) indicates the nurse should consult with the health care provider before giving the prescribed epoetin alfa (Procrit)?
a.
Creatinine 1.2 mg/dL
b.
Oxygen saturation 89%
c.
Hemoglobin level 13 g/dL
d.
Blood pressure 98/56 mm Hg
C
High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when EPO is administered to a target hemoglobin of >12 g/dL. Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider, but will not affect whether the medication is administered.
In a patient with acute kidney injury (AKI) who requires hemodialysis, a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which intervention will be included in the plan of care?
a.
Place the patient on bed rest.
b.
Start continuous pulse oximetry.
c.
Discontinue the retention catheter.
d.
Restrict the patient’s oral protein intake.
A
The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.
When the nurse is caring for a patient who has been admitted with a severe crushing injury after an industrial accident, which laboratory result will be most important to report to the health care provider?
a.
Serum creatinine level 2.1 mg/dL
b.
Serum potassium level 6.5 mEq/L
c.
White blood cell count 11,500/µL
d.
Blood urea nitrogen (BUN) 56 mg/dL
B
The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse also will report the other laboratory values, but abnormalities in these are not immediately life threatening.
A patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and an elevated blood urea nitrogen (BUN) and creatinine. Which of these prescribed therapies should the nurse implement first?
a.
Obtain renal ultrasound.
b.
Insert retention catheter.
c.
Infuse normal saline at 50 mL/hour.
d.
Draw blood for complete blood count.
B
The patient’s elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions also are appropriate, but should be implemented after the retention catheter.
Which information about a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration will be most important for the nurse to report to the health care provider?
a.
The blood urea nitrogen (BUN) level is 67 mg/dL.
b.
The creatinine level is 3.0 mg/dL.
c.
Urine output over an 8-hour period is 2500 mL.
d.
The glomerular filtration rate is <30 mL/min/1.73m2.
C
The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.
After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first?
a.
Document the QRS interval.
b.
Notify the patient’s health care provider.
c.
Look at the patient’s current blood urea nitrogen (BUN) and creatinine levels.
d.
Check the chart for the most recent blood potassium level.
D
The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient’s health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.
When caring for a dehydrated patient with acute kidney injury who is oliguric, anemic, and hyperkalemic, which of the following prescribed actions should the nurse take first?
a.
Insert a urinary retention catheter.
b.
Place the patient on a cardiac monitor.
c.
Administer epoetin alfa (Epogen, Procrit).
d.
Give sodium polystyrene sulfonate (Kayexalate).
B
Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output, but does not correct the cause of the renal failure.
Which nursing action for a patient who has arrived for a scheduled hemodialysis session is most appropriate for the RN to delegate to a dialysis technician?
a.
Educate patient about fluid restrictions.
b.
Check blood pressure before starting dialysis.
c.
Assess for reasons for increase in predialysis weight.
d.
Determine the ultrafiltration rate for the hemodialysis.
B
Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of the appropriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN.
The RN observes an LPN/LVN carrying out all of the following actions while caring for a patient with stage 2 chronic kidney disease. Which action requires the RN to intervene?
a.
The LPN/LVN administers erythropoietin subcutaneously.
b.
The LPN/LVN assists the patient to ambulate in the hallway.
c.
The LPN/LVN gives the iron supplement and phosphate binder with lunch.
d.
The LPN/LVN carries a tray containing low-protein foods into the patient’s room.
C
Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency.
The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which information should be reported immediately to the health care provider?
a.
The patient has an outflow volume of 1800 mL.
b.
The patient’s peritoneal effluent appears cloudy.
c.
The patient has abdominal pain during the inflow phase.
d.
The patient complains of feeling bloated after the inflow.
B
Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.
Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider?
a.
The urine output is 900 to 1100 mL/hr.
b.
The blood urea nitrogen (BUN) and creatinine levels are elevated.
c.
The patient’s central venous pressure (CVP) is decreased.
d.
The patient has level 8 (on a 10-point scale) incisional pain.
C
The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.
A patient in the oliguric phase of acute renal failure has a 24-hour fluid output of 150 mL emesis and 250 mL urine. The nurse plans a fluid replacement for the following day of ___ mL.
a.
400
b.
800
c.
1000
d.
1400
C
Usually fluid replacement should be based on the patient’s measured output plus 600 mL/day for insensible losses.
During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first?
a.
Slow down the rate of dialysis.
b.
Obtain blood to check the blood urea nitrogen (BUN) level.
c.
Check the patient’s blood pressure.
d.
Give prescribed PRN antiemetic drugs.
C
The patient’s complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions also may be appropriate, based on the blood pressure obtained.
Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation?
a.
Heart rate
b.
Blood urea nitrogen (BUN) level
c.
Urine output
d.
Creatinine clearance
C
Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.
A patient complains of leg cramps during hemodialysis. The nurse should first
a.
reposition the patient.
b.
massage the patient’s legs.
c.
give acetaminophen (Tylenol).
d.
infuse a bolus of normal saline.
D
Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.
Which of the following assessment findings would the nurse expect in the patient with a lower urinary tract infection (UTI)?
a.
Flank pain
b.
Dysuria
c.
Oliguria
d.
Nausea
B
Pain with urination is a common symptom of a lower UTI. Urinary output does not decrease, but frequency may be experienced.
What is one of the most important ways to prevent the development of acute post-streptococcal glomerulonephritis?
a.
Control of blood pressure with exercise
b.
Early diagnosis and treatment of sore throat
c.
Ensuring complete bladder emptying when the patient voids
d.
Daily intake of high-potency multivitamins
B
One of the most important ways to prevent the development of acute post-streptococcal glomerulonephritis is to encourage early diagnosis and treatment of sore throats and skin lesions.
The nurse determines that instruction regarding prevention of future UTIs for a patient with cystitis has been effective when the patient gives which of the following responses?
a.
“I will limit my fluid intake to 1000 mL/day to prevent symptoms of frequency and urgency.”
b.
“I will increase my fluid intake and empty my bladder every 2 to 4 hours during waking hours.”
c.
“I should use an antiseptic vaginal deodorant spray twice a day to reduce the bacterial growth in the perineal area.”
d.
“I will wash my perineal area with soap and water after each bowel movement and before and after sexual intercourse.”
B
Voiding every 2 to 4 hours is recommended to prevent UTIs.
To relieve the symptoms of a lower UTI for which the patient is taking prescribed antibiotics, the nurse suggests that the patient use the over-the-counter urinary analgesic of phenazopyridine (Pyridium), but should give the patient which of the following cautions?
a.
This preparation contains methylene blue, which turns the urine blue or green.
b.
This preparation must be taken with food to prevent gastrointestinal irritation.
c.
This preparation causes the urine to turn reddish orange and can stain underclothing.
d.
This preparation frequently causes allergic reactions and should be stopped if a rash occurs.
C
Patients should be taught that phenazopyridine will colour the urine deep orange and stain underclothing.
A 34-year-old patient with diabetes mellitus is hospitalized with fever, anorexia, and confusion. The physician suspects acute pyelonephritis when the urinalysis reveals bacteriuria. Which of the following is an appropriate collaborative problem identified by the nurse for this patient?
a.
Potential complication: urosepsis
b.
Potential complication: hydronephrosis
c.
Potential complication: acute kidney injury
d.
Potential complication: chronic pyelonephritis
A
Infection can easily spread from the kidney to the circulation, causing urosepsis.
A 72-year-old man has benign prostatic hypertrophy, which has contributed to repeated bouts of cystitis. He is now admitted to the hospital with chills, fever, and nausea and vomiting. A urinalysis is positive for bacteria, red blood cells, and white blood cells. The nurse suspects the presence of an upper UTI when assessment of the patient reveals which of the following findings?
a.
Suprapubic pain
b.
Foul-smelling urine
c.
A distended bladder
d.
Costovertebral angle (CVA) tenderness
D
CVA tenderness is characteristic of pyelonephritis.
After teaching a patient with interstitial cystitis about management of the condition, the nurse determines that further instruction is needed when the patient makes which of the following comments?
a.
“I will avoid eating citrus products and aged cheese.”
b.
“I should take a high-potency multivitamin daily.”
c.
“I should report the development of bladder pain or odorous urine.”
d.
“I can use the dietary supplement calcium glycerophosphate (Prelief) to control my symptoms.”
B
High-potency multivitamins may irritate the bladder and increase symptoms.
When admitting a patient with acute glomerulonephritis, the nurse inquires about which of the following?
a.
History of high blood pressure
b.
Frequency of UTIs
c.
Recent sore throat and fever
d.
Family history of kidney disease
C
Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat, so it is appropriate for the nurse to ask about recent sore throat and fever.
The nurse establishes a nursing diagnosis of excess fluid volume related to decreased glomerular filtration rate in a patient with acute post-streptococcal glomerulonephritis. Which of the following clinical data support this nursing diagnosis?
a.
Proteinuria
b.
Elevated blood urea nitrogen
c.
Periorbital edema
d.
Hematuria with smoky urine
C
Resolution of the excess fluid volume is best evaluated by changes in edema.
A patient with nephrotic syndrome develops flank pain. The nurse will anticipate treatment with which of the following?
a.
Antibiotics
b.
Antihypertensives
c.
Anticoagulants
d.
Corticosteroids
C
Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is needed.
One week after using an over-the-counter nonsteroidal anti-inflammatory drug to treat aches resulting from a fall, a patient noticed the development of progressive edema throughout his body. Diagnostic studies confirmed a diagnosis of nephrotic syndrome. When teaching the patient about his condition, the nurse uses the knowledge that the edema results from which of the following changes?
a.
Increased serum oncotic pressure exerted by dyslipidemia
b.
Loss of protein through the kidney, resulting in a fall in plasma colloid osmotic pressure
c.
Loss of albumin in the urine, creating an osmotic diuresis and low tissue hydrostatic pressure
d.
Fluid retention caused by decreased glomerular filtration rate through kidneys damaged by trauma
B
The increased glomerular membrane permeability found in nephrotic syndrome is responsible for the massive excretion of protein in the urine. This results in decreased serum protein and subsequent edema formation and low tissue hydrostatic pressure.
Which of the following actions will assist the nurse in evaluating the effectiveness of treatment for the patient with nephrotic syndrome?
a.
Monitoring the blood pressure every 4 hours
b.
Measuring the abdominal girth daily
c.
Measuring daily dietary protein intake
d.
Checking the urine of each voiding for protein
B
It is important to assess the edema by weighing the patient daily, accurately recording intake and output, and measuring abdominal girth or extremity size. Comparing this information daily provides the nurse with a tool for assessing the effectiveness of treatment.
The nurse notes that the results of an intravenous pyelogram indicate a left hydroureter and hydronephrosis in a female patient who was hospitalized with a markedly distended bladder. A catheterization for residual urine obtained 1650 mL. What does the nurse understand about these findings that are characteristic of a urinary tract obstruction?
a.
They are located at the bladder neck.
b.
They are caused by ureteral calculi.
c.
They are situated at the ureteropelvic junction.
d.
They are caused by a ureteral stricture.
A
When obstruction occurs at the level of the bladder neck or prostate, significant bladder changes can occur and are characteristic of a urinary tract obstruction.
A patient with a history of renal calculi is hospitalized with gross hematuria and severe colicky left flank pain that radiates to his left testicle. In planning care for the patient, the nurse gives the highest priority to which of the following nursing diagnoses?
a.
Acute pain related to irritation of stone
b.
Deficient fluid volume related to inadequate intake
c.
Risk for infection related to urinary system damage
d.
Altered health maintenance related to lack of knowledge about prevention of stones
A
Although all the diagnoses are appropriate, the initial nursing actions should focus on relief of the acute pain.
The nurse instructs a patient seen in the outpatient clinic with symptoms of renal calculi to strain all urine for which of the following primary purposes?
a.
To validate the diagnosis of kidney stones
b.
To obtain a stone for analysis of composition
c.
To determine when a stone has passed from the system
d.
To determine the extent of damage to the urinary system
B
Patients should strain their urine to obtain a stone. The patient saves the stone for analysis of the stone composition, which will help in determining treatment.
A patient with a confirmed renal calculus in the proximal left ureter undergoes extracorporeal shock wave lithotripsy, which successfully shatters the stone. After the lithotripsy, the nurse encourages fluids to 3000 mL/day and knows that the interventions for the patient have been effective based on which of the following findings?
a.
Free flow of urine is present.
b.
Adequate fluid balance is maintained.
c.
The patient verbalizes a decrease in pain.
d.
There is no indication of UTI.
A
Because lithotripsy breaks the stone into fine sand, which could cause obstruction, it is important to monitor the urinary output to ensure it is flowing freely.
The composition of a patient’s renal calculi is identified as uric acid. To prevent recurrence of stones, what should the nurse teach the patient to avoid?
a.
Milk and dairy products
b.
Legumes and dried fruits
c.
Spinach, chocolate, and tomatoes
d.
Organ meats and fish with fine bones
D
Organ meats and fish such as sardines increase purine levels and uric acid.
To prevent the recurrence of renal calculi, what should the nurse teach the patient to do?
a.
Avoid all sources of dietary calcium.
b.
Drink fluids such as cranberry juice and colas, which will acidify the urine.
c.
Maintain fluid intake at 3000 mL a day, especially when physically active.
d.
Empty the bladder every 2 to 4 hours to prevent urinary stasis and precipitation of urates.
C
A fluid intake of 3000 mL daily is recommended to help flush out minerals before stones can form.
In planning teaching for a patient with nephrosclerosis, what should the nurse include instructions about?
a.
Monitoring of daily intake and output amounts
b.
Maintenance of fluid restriction at 1000 mL/day
c.
Techniques of monitoring and recording blood pressure
d.
Prevention and detection of bleeding from anticoagulation therapy
C
Hypertension is the major symptom of nephrosclerosis; therefore, the patient should be able to monitor and record his or her blood pressure.
The nurse advises genetic counselling for the children of which of the following patients?
a.
A patient with interstitial cystitis
b.
A patient with horseshoe kidney
c.
A patient with polycystic kidney disease
d.
A patient with Goodpasture syndrome
C
The adult form of polycystic kidney disease is an autosomal dominant disorder; therefore, genetic counselling is warranted.
When assessing a patient who complains of a feeling of incomplete bladder emptying and a split, spraying urine stream, what history should the nurse ask about more specifically?
a.
Renal calculi
b.
Kidney trauma
c.
Bladder infection
d.
Gonococcal urethritis
D
The patient’s clinical manifestations are consistent with urethral strictures, a possible complication of gonococcal urethritis.
The physician suspects transitional-cell bladder cancer in a 69-year-old patient who has gross hematuria and history of a 9-kg weight loss during the last 3 months, and schedules diagnostic testing. When obtaining a nursing history from the patient, the nurse identifies a significant risk factor for bladder cancer when the patient reports which of the following histories?
a.
Chronic cystitis
b.
Cigarette smoking
c.
High caffeine intake
d.
Use of artificial sweeteners
B
Cigarette smoking is a risk factor for bladder cancer.
To promote muscle relaxation and induce voiding after the patient has undergone an open loop resection and fulguration of the bladder, what is an appropriate intervention for the nurse to use?
a.
Sitz baths four times per day
b.
Encouraging fluids to 3000 mL/day
c.
Isometric exercises of the perineal muscles every 2 hours
d.
Application of warm compresses to the suprapubic area four times per day
A
Sitz baths will relax the perineal muscles and promote voiding.
A 78-year-old woman is admitted to the hospital with dehydration and electrolyte imbalance. She is confused and incontinent of urine on admission. In developing a plan of care for the patient, what is an appropriate nursing intervention for the patient’s incontinence?
a.
Insert an in-dwelling catheter.
b.
Apply absorbent incontinence pads.
c.
Restrict fluids after the evening meal.
d.
Assist the patient to the bathroom every 2 hours.
D
In older or confused patients, incontinence may be avoided by using scheduled toileting times.
After her bath, a 62-year-old woman asks the nurse for a perineal pad, saying that she uses them because sometimes she leaks urine when she laughs or coughs. Which of the following interventions is most appropriate to include in a teaching plan to assist the patient with this problem?
a.
Performance of Kegel exercises
b.
Performance of Credé manoeuvre
c.
Use of bladder neck support devices
d.
Establishment of a pattern of urinating every 3 hours
A
Exercises to strengthen the pelvic floor muscles, such as Kegel exercises, will help reduce stress incontinence.
Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes. Which nursing action is most appropriate?
a.
Use an ultrasound scanner to check for residual urine after voiding.
b.
Have the patient take small amounts of fluid frequently throughout the day.
c.
Reassure the patient that this is normal after rectal surgery because of the anaesthesia.
d.
Monitor the patient’s intake and output over the next few hours.
A
An ultrasound scanner can be used to check for residual urine after the patient voids because the patient’s history and clinical manifestations are consistent with overflow.
What is the most common type of urinary tract calculi?
a.
Uric acid
b.
Cystine
c.
Calcium oxalate
d.
Struvite
C
Calcium oxalate is the most common urinary stone with an incidence of 30% to 40%.
A patient with a neurogenic bladder is to be taught intermittent catheterization for bladder emptying. What should the nurse teach the patient to do?
a.
Use a clean procedure with a new catheter each day.
b.
Use a new, sterile catheter and sterile gloves and procedure for each catheterization.
c.
Request prophylactic antibiotics if clean, rather than sterile, technique is going to be used.
d.
Wash and rinse the catheter and the hands with soap and water before and after each catheterization.
D
Patients who are at home can use a clean technique for intermittent self-catheterization and change the catheter every 7 days.
To prevent the incidence of UTIs in a catheterized patient, which of the following actions should the nurse implement?
a.
Irrigate the catheter with an antiseptic solution.
b.
Apply an antiseptic solution to the perineum daily.
c.
Perform perineal cleansing with mild soap and water twice daily and as needed.
d.
Apply an antibiotic ointment around the catheter at the urinary meatus at least twice a day.
C
Perineal care (two times per day and when necessary) should include cleaning of the meatus–catheter junction with soap and water.
