Learn Smart med/surg Renal and Urinary

Question 1

P. is 5th postop day from a non-related living donor kidney transplant and has gained 1kg of wt. WOTF also indicate kidney rejection?

a. BP 160/90
b. serum creatinine 0.8mg/dL
c. sodium 137 mg/dL
d. urinary output 100ml/hr

Answer 1

a. BP 160/90. Kidney rejections is accompanied by kidney failure. Bc the kidneys have a role in fluid and BP regulation, p’s experiencing rejection typically have hypertension.

Question 2

P. just had a transurethral resection of the prostate (TURP). WOTF should p. report to HCP?

a. pink-tinged urine
b. painful urination
c. stress incontinence
d. retrograde ejaculation

Answer 2

d. painful urination- the p should report any sign of UTI to the HCP (fever, frequency, dysuria). Pink-tinged urine is expected for 24-36 hr and urine can turn pink again with activity. Stress incontinence is expected (poor sphincter control). Retrograde ejaculation is also expected and p’s should be informed that a TURP can cause fertility problems.

Question 3

Caring for p w/ chronic renal failure. WOTF statements regarding nutrition is appropriate?

a. you should limit your fluid intake
b. you should eat a diet high in potassium
c. you should eat a diet high in phosphorus
d. you should eat a diet high in protein

Answer 3

a. you should limit fluid intake- p’s w/ CRF are on fluid restrictions to prevent overload. They should limit K+ and phosphorus in their diets bc the kidneys are no longer able to excrete it. They should eat a low protein diet to avoid an increase in serum BUN levels.

Question 4

Caring for p. that is receiving peritoneal dialysis, WOTF is a complication of this procedure?

a. constipation
b. metabolic acidosis
c. hypoglycemia
d. peritonitis

Answer 4

d. peritonitis- major complication and most commonly caused by connection site contamination. It is prevented by using sterile technique when caring for the PD catheter and when hooking up or clamping off dialysate bags. Diarrhea, metabolic alkalosis, and hyperglycemia (not constipation, acidosis and hypoglycemia) are other complications.

Question 5

Peritonitis S&S

Answer 5

cloudy dialysate outflow, fever, abdominal tenderness, abdominal pain, malaise, n/v

Question 6

Providing education for a p who has CRF. WOTF should p increase in her diet?

a. calcium
b. phosphorous
c. potassium
d. sodium

Answer 6

a. calcium- p’s with CRF have an abnormal calcium and phosphorus balance. Phosphorous is retained (hyperphosphatemia), and calcium levels decrease (hypocalcemia). PTH is released to increase the chronic low bld calcium levels - leading to calcium excretion from bones. Also, kidney cell damage reduces production of active Vit D causing less calcium to be absorbed through the GI tract.

Question 7

P. w/ renal tumor to undergo a renal biopsy. RN should?

a. instruct the p that there is NPO diet 8hr following procedure.
b. assess the p for a history of shellfish or iodine allergies
c. maintain bed rest for 4-12 hrs following proc
d. obtain a BUN and creatinine clearance prior to proc.

Answer 7

c. maintain the p on bed rest for 4-12 hours postop- a renal biopsy involves a skin biopsy through needle insertion into the lower lobe of the kidney. The test does not use contrast media. Pre-op CBC, bleeding times, PTT, platelet counts and crossmatch for blood transfusions collected. The pt. is NPO 8hr prior to the procedure.

Question 8

Teaching p about vasectomy procedure. WOTF indicates p understanding?

a. I should avoid having sex for at least 2 weeks after surgery.
b. I will no longer be capable of producing sperm
c. if I reverse the surgery, I will as fertile as before
d. I need to have two follow-up negative sperm counts

Answer 8

d. Sperm can remain viable in the vas deferens for up to 6 months; therefore, at least two follow up sperm counts are recommended to ensure the p is infertile. P’s can resume with sex activities 1 wk after proc., and fertility can decrease even with successful reanastomosis of the vas deferens.

Question 9

RN collecting a 24hr creatinine clearance and the p accidently discards a specimen. RN should?

a. continue the collection, noting the loss on the lab slip
b. add 1 hr to the collection time
c. discard the previously collected urine and start new collection
d. d/c the collection and draw a serum creatinine

Answer 9

c. The test results will not be valid if all of the urine voided in a 24 hr period is not collected. So if specimen is lost or contaminated, RN must start new collection

Question 10

P. undergoing extracorporeal shockwave lithotripsy (ESWL). WOTF findings should the nurse report?

a. an arrhythmia on the ECG
b. 300ml of pink-tinged urine
c. bruising on the affected flank area
d. gravel fragments in the urine

Answer 10

a. an arrhythmia on the ECG- ESWL is the use of sound or shock waves to break kidney stones into small fragments for excretion. Continuous ECG monitoring and fluoroscopic observation for stone destruction is maintained throughout the procedure. B/w 500-1500 shock waves are given in a 30-45 minute period and are delivered in synchrony with the R wave on the ECG to prevent dysrhythmias. All the other options are expected findings

Question 11

P suspected of having UTI and urine specimen is ordered. WOTF findings confirm an upper UTI involving the kidneys?

a. bacteria
b. WBCs
c. casts
d. ketones

Answer 11

c. casts are protein structures that are precipitated in the renal tubules. presence of these in the urine indicates a pathologic kidney condition. Bacteria and WBCs are present in the U/A of any p. with a UTI. Ketones are found in the urine with DKA and are not r/t a UTI.

Question 12

P. with dx of renal calculi is c/o severe rt flank pain and nausea. Priority nrs action?

a. relieve pain
b. push fluids
c. monitor I&O
d. strain urine

Answer 12

a. priority action is to relieve pain.

Question 13

RN caring for p with hx of cystitis. WOTF indicated need for further teaching?

a. I try to empty my bladder every 2-3 hours.
b. I drink 2-3 quarts of fluids a day
c. I prefer to take baths instead of showers
d. I use an oral contraceptive for birth control.

Answer 13

c. I prefer to take baths instead of showers. Women who have frequent UTIs are encouraged to take showers rather than baths (which is more likely to contaminate the urethra). A and b are appropriate prevention tactics. D has no correlation to UTIs

Question 14

P. receiving hemodialysis via a left arteriovenous fistula. WOTF is appropriate to include in self care teaching?

a. check the site hourly for patency
b. apply lotion to your arms
c. avoid tight clothing around your arms
d. sleep on the left side

Answer 14

c. tight clothing may decrease the bld flow and cause clotting. Also, patients are instructed to avoid carrying heavy objects with the extremity that has the fistula, and told not to lay on the side with the fistula. P’s are instructed to check the access site two times/day for adequate bld flow, and to avoid lotions to prevent infection

Question 15

P. receiving peritoneal dialysis, his dialysate output is less than the input, his abd is distended, and he is in pain. RN should?

a. infuse an additional amt of dialysate
b. give pain medication
c. change the p’s position
d. ask the p to ambulate

Answer 15

c. changing the p’s position may stimulate inflow or outflow of dialysate. having the p in a supine low-fowler’s position reduces abd pressure. P’s should not ambulate for 6hr following peritoneal dialysis

Question 16

P. with acute pyelonephritis. Appropriate response by RN regarding home care?

a. you should complete the entire cycle of antibiotic therapy.
b. you should maintain complete bed rest until S&S decrease.
c. you should drink 1 L of fluid/day
d. you should weigh yourself daily

Answer 16

a. Taking the full Rx of antibiotics decreases the chance of the recurring infection.
b. ambulation helps to prevent urine stasis and constipation
c. 2-3 L is recommended for p’s with pyelonephritis
d. daily weights are not indicated for txmt since retention is not expected

Question 17

RN educating p on postop cystoscopy expectations. WOTF should RN say?

a. it will be necessary to the keep the sutures clean
b. you will be placed in a dorsal recumbent position
c. expect to on bed rest for 24 hrs
d. pink-tinged urine and burning while urinating is expected

Answer 17

d. cystoscopy is a the direct visualization of the bladder to detect bladder trauma, urinary tract obstructions, or to remove bladder tumors. The test requires general anesthesia, NPO after midnight day before and bowel prep. Pink tinged urine and burning with urination is expected.

Question 18

P brought to the ER after a MVA. The RN suspects a ruptured bladder based on WOTF findings?

a. anuria
b. hematuria
c. pyuria
d. fever

Answer 18

b. hematuria, along with pelvic pain, and oliguria are key manifestations of a ruptured bladder. The most common cause of bladder trauma is puncture via bone fragments from a pelvic fracture.

Question 19

Caring for p receiving continuous ambulatory peritoneal dialysis. WOTF should be reported to HCP?

a. WBC count of 6000/mm3
b. K+ 3.0 mEq/L
c. frothy, pale yellow discharge
d. abdominal fullness

Answer 19

b. A low serum potassium level can occur as waste products and electrolytes are diffused into the dialysate and they can cause dysrhythmias. The wbc count, frothy/pale yellow drainage, and abdominal fullness are all expected with peritoneal dialysis

Question 20

RN assessing a p in the oliguric/anuric stage of ARF. Axmt reveals R 28/min, nausea, dull headache, palpitations, and malaise. WOTF is the priority?

a. administer an analgesic
b. check the latest electrolyte values
c. give an antiemetic
d. check O2 levels

Answer 20

b. The RN should check the electrolyte levels as these findings indicate hyperkalemia (which can be fatal).

Question 21

RN providing education about prostate health to a grp of ps. WOTF statements is correct regarding the prostatic specific antigen (PSA) test?

a. you should fast for 8 hrs prior to collection
b. yearly PSA screening should begin at age 40 for all men.
c. nml PSA values decrease as you get older
d. The test should not be performed for 48 hours following a digital rectal exam

Answer 21

d. digital examination prior to bld testing may lead to falsely elevated levels of PSA. PSA is a glycoprotein that is found only in the cytoplasm of the epithelial cells of the prostate. Fasting is not necessary prior to collection, yearly screening is recommended at age of 50, and PSA values increase with age.