Renal

Question 1

Name 2 chronic disease that are associated with kidney disease

Answer 1

DM
HTN

Question 2

Urine bacteria count that represents a UTI ____/Per mililiter

Answer 2

> 100,000 per militer

Question 3

Which will be cared for by LPN

1. 48 cystitis taking oral antibiotics
2. 64 kidney stones order for lithotripsy
3. 72 urinary incontence bladder training
4. 52 pyelonephritis severe flank pain

What is lithotripsy?
What is pyelonephritis?

Answer 3

1. 48 cystitis taking oral antibiotics

Lithotripsy
Utrasonic energy break up kidney stones, gallstones, or bezoars that are too large to pass through the urinary tract

pyelonephritis

Kidney infection

Question 4

66 male with UTI which can contribute

1. Wife had a UTI 1 month ago
2. Catherization 6 months ago
3. Kidney stone removal 1 year ago
4. Prostate diasese for 2 years

Answer 4

Prostate disease increases risk of UTI DUE TO URINARY RETENTION

the time frame for the others is too long ago

Question 5

Being admitted to rule out interstitial cystitis. What should the nurses plan of care for this patient include specific to this disease

1. Daily urine samples
2. Maintain accurate Is & Os
3. Obtain an admission urine sample to determine electrolyte levels
4. Teach patient about cytoscopy procedures.

What is interstitial cystitis?

Answer 5

Cytoscopy is needed to diagnose interstitial cystitis

Interstitial cystitis: chronic, painful bladder condition.

It’s often mistaken for a urinary tract infection (UTI), but there is no infection.

Question 6

Ciprofloxacin is prescribed for how long for:

Uncomplicated cystitis
Complicated cystitis
Uncomplicated pyelonephritis

Answer 6

Uncomplicated cystitis 3 days
Complicated cystitis 7 days
Uncomplicated pyelonephritis 10 - 14 days

Question 7

To prevent UTI which one is false

1. Drink 2 - 3 L fluid daily
2. Empty bladder regularly even if you don’t feel urge to go
3. Drinking cranberry juice will decrease the # of bacteria in bladder.
4. Bubble baths will reduce symptom flair ups

Answer 7

4. Bubble baths will reduce symptom flair ups

Avoid: bubble baths, nylons, and scented toilet tissue.

Cranberry juice reduces bacterias ability to cling to bladder by upto 80%

Question 8

For which patient will a bladder training program be appropriate

1. Functional incontence by mental status changes
2. Stress incontence due to weakened bladder neck support
3. Urge incontence and abnormal detrusor muscle contractions
4. Transient incontence related to loss of cognitive Function

Answer 8

3. Urge incontence and abnormal detrusor muscle contractions

Urge incontence can be trained to control bladder if patient is alert, aware, & able to resist urge to urinate by starting schedule for voiding, then increasing intervals.

Functional realt3d to mental status or loss of cognitive Function = No Bladder training ability

Stress incontence can be helped by pelvic floor Kegel exercises

Question 9

Match
Stress incontinence, Urge incontence, Functional incontinence, transient incontence.

Sudden need to urinate

Aware of the need to urinate, but for physical or mental reasons unable to get to a bathroom.

Inadequate closure of the bladder outlet by the urethral sphincter.

This type of incontence can happen from medication or infection

Answer 9

Urge incontence
Sudden need to urinate

Functional incontinence
Aware of the need to urinate, but for physical or mental reasons unable to get to a bathroom.

Stress incontinence
Inadequate closure of the bladder outlet by the urethral sphincter.

transient incontence
This type of incontence can happen from medication or infection

Question 10

Oxybutynin chloride 5mg 3x daily is taken for bladder incontence. What information should be included in health teaching SATA

1. This med is an anticholinergic that will help dry up secretion
2. Be sure to drink plenty of fluids when taking this medication
3. Notify HCP if dry mouth occurs
4. Take this medicine with food to prevent upset stomach

Answer 10

1. This med is an anticholinergic that will help dry up secretion
2. Be sure to drink plenty of fluids when taking this medication

Not
3. Notify HCP if dry mouth occurs
(Dry mouth will occur and it normal, drink plenty of fluids)
4. Take this medicine with food to prevent upset stomach
(Take between meal, food can interfere with absorption)

Question 11

Patient has reflex urinary incontence (urine leaks out without urge to go) which is an appropriate action for a new LPN

1. Teaching Credè method of bladder emptying
2. Demonstrate how to perform intermittent self-catheteruzation
3. Discuss when to report SE of bethanechol chloride to HCP
4. Reinforce importance of proper handwashing to prevent infection

What is Credè method?

Answer 11

4. Reinforce importance of proper handwashing to prevent infection

Credè method is pressing bladder area (below belly button) to get urine out of bladder

Question 12

Urolithiasis and passing stone into lower urinary tract. What is the nursing priority

1. Pain
2. Infection
3. Injury
4. Anxiety

Answer 12

1. Pain

Excruciating pain can last from 24 - 35 hrs

Question 13

Which statement regarding lithotripsy is incorrect

1. Be sure to finish all your antibiotics even if you feel well.
2. Drink atleast 3L of fluid daily to prevent another stone.
3. Report any sign of bruising to your HCP immediately as this indicates bleeding
4. You can return to work in 2 days - 6 weeks depending on your HCP

Answer 13

3. Report any sign of bruising to your HCP immediately as this indicates bleeding

This statement is incorrect.
Bruising is to be expected after lithotripsy.

Other statements are true

Question 14

Is intermittent self-catheteruzation a clean or sterile procedure?

Answer 14

Self = clean

Nurse giving cathere = sterile

Question 15

Major risk for patient wearing briefs for incontence

1. Incontence-associated dermatitis
2. Skin breakdown
3. Infection
4. Fluid imbalance

Answer 15

2. Skin breakdown

Question 16

Renal cell carcinoma (adenocarcinoma of the kidney) is best treated how?

1. Nephrectomy
2. Radiation
3. Chemotherapy

Answer 16

Nephrectomy

Chemotherapy has little impact

Question 17

How to prevent renal trauma after an injury that required a left nephrectomy. SATA

1. Always wear a seat belt
2. Avoid contact sports
3. Practice safe walking habits
4. Wear protective clothing if you play contact sports
5. Caution with bicycle riding
6. Always avoid use of kidney damaging drugs

Answer 17

1. Always wear a seat belt
2. Avoid contact sports
3. Practice safe walking habits
4. Caution with bicycle riding

Not
4. Wear protective clothing if you play contact sports (Don’t play contact sports)
6. Always avoid use of kidney damaging drugs

Question 18

IV piggyback of gentamycin q12h. Priority for monitoring

1. Serum creatinine & BUN
2. Patient weight every AM
3. Is & Os
4. Temp

Answer 18

1. Serum creatinine & BUN

Gentamycin is highly Nephrotoxic

Monitor for elevation indicators of Nephrotoxicity

Question 19

Kidney failure patients can go through an Oliguria phase where boluses & diuretics don’t work (phase last from 8 - 15 days)

Then

Diuretics phase which last 2 - 6 weeks after onset of Oliguria phase. Upto 10L/ day of dilute urine.

Finally followed by recovery phase

During the diuretics phase it is important to monitor….

Answer 19

Electrolyte levels

Question 20

Acute kidney failure is to begin Continous Arteriovenous Hemofiltration(CAVH). What is the priority collaboration

1. Call charge nurse & arrange fir transfer to ICU
2. Develop teaching plan for patient that focuses on CAVH
3. Assist patient with morning bath & mouth care before transfer
4. Notify HCP that patients mean arterial pressure is 68 mm hg

Answer 20

1. Call charge nurse & arrange fir transfer to ICU

For critically ill who don’t tolerate rapids shifts of fluid and Electrolytes associated with hemodyalsis.

Mean arterial pressure >60 needed

Question 21

Dehydration secondary to deficient antidiuretic hormone. What specific gravity values supports this.

1. 1.010
   2.1.035
2. 1.020
3. 1.002

Answer 21

4. 1.002

Dehydration due to lack of ADH will have diluted urine specific gravity.

Normal urine specific gravity
1.003 - 1.030

1.002= diluted- 1.035 = concentrated

Question 22

78 is scheduled for intravenous pyelography test. What information would be stressed to about this procedure

1. After, monitor urine output, the contrast dyes increase risk for kidney failure
2. Purpose is to monitor kidney size
3. This procedure assess kidney function, no need to prep bowels
4. Keep patient NPO after until gag reflex returns

Answer 22

1. After, monitor urine output, the contrast dyes increase risk for kidney failure

Elderly & dehydrated at highest risk.
Try to schedule early AM to prevent dehydration

Question 23

What is the urine output that should be reported to HCP if it last more than 2 hrs.

Based on body weight

Answer 23

<0.5 mL/ kg/hr

Question 24

Chronic kidney diseases with hemodialysis. What caution would you give the UAP when taking their BP

Answer 24

Do it in the opposite arm to the access site