Targeted M-S Renal and Urinary Flashcards
ID= 6520857
Pword= 53E7255T72
A newly licensed nurse and nurse preceptor are caring for a p who has just had an arteriovenous shunt placed in her left arm. WOTF actions by the newly licensed nurse requires intervention?
a. auscultating for bruits in the shunt q4h
b. elevating the shunted arm on pillows postoperatively
c. mxing BP in the shunted arm q4h
d. palpating distal pulses of the shunted arm
c. mxing the BP in the shunted arm is CI’d bc repeated compression can result in the loss of vascular access.
D/C teaching for CKD. WOTF ind. p understands?
a. I will consume foods high in protein
b. I will decrease my intake of foods high in phosphorous
c. I will limit my intake of foods high in calcium
d. I will add salt to the foods I consume
b. decreasing phosphorous intake is appropriate bc CKD causes retention of phosphorous.
Assessing a p who has CKD and has completed her third peritoneal dialysis txmt. WOTF should be reported?
a. greater outflow of dialysate than inflow
b. weight loss
c. cloudy dialysate effluent
d. report of pain during inflow
c. cloudy dialysate effluent- this is the earliest sign of peritonitis. Pain with initial PD txmts is common. Greater outflow is expected since it contains the excess F&E and nitrogen based waste products diffused out of the blood.
Performing admission axmt of a p who has acute glomerulonephritis. RN should expect?
a. low bp
b. polyuria
c. dark-colored urine
d. wt loss
c. dark-colored urine is an expected finding as glomerular damage/infection leads to hematuria, proteinuria, decreased GFR, edema and hypertension. P’s describe their urine as cola or rust colored. Other S&S= dysuria, oliguria, fatigue, lack of energy, anorexia, n/v (if uremia occurs).
Planning care for a p who has acute glomerulonephritis. RN should plan to?
a. weight the p daily
b. encourage the p to drink 2-3 L/day
c. instruct p to ambulate q2h
d. obtain the p’s serum blood glucose
a. weighing the patient daily will detect fluid retention, a common problem for patients with glomerulonephritis. Bc of this, p’s are placed on fluid restrictions. These ps have fatigue/loss of energy so they should be encouraged to rest.
RN is discussing hemodialysis with a newly licensed nurse. The nurse should ID that hemodialysis is CI’d for which p?
a. p who can’t receive anticoagulants
b. p who is unable to ambulate
c. p who is immunocompromised
d. p who is allergic to iodine
a. pts undergoing hemodialysis require anticoagulant therapy during HD treatments in order to prevent clots from forming within the dialyzer or the blood tubing.
Caring for a p following extracorporeal shock wave lithotripsy (ESWL) for the txmt of kidney stones. RN should?
a. mon the p’s urine for ketones
b. provide the p with an increased animal protein diet
c. limit the p’s fluid intake to 1.5L/day
d. Strain all of the p’s urine
d. straining all of the p’s urine is appropriate to monitor the passage of stone fragments. Ketones are only present in the urine with DKA. The p’s animal protein diet should be decreased and fluid intake should be 2-3 L/day to prevent further stone formation
Reviewing lab reports of p w/ acute kidney injury (AKI). WOTF should RN expect? (MM)
a. BUN 30 mg/dL
b. urine output of 40mL in past 3 hr
c. K+ 3.6 mEq/L
d. serum calcium 9.8 mg/dL
e. hct 30%
a/b/e. An elevated BUN is expected as nitrogenous wastes build up in the blood (azotemia) bc of decreased glomerular function and activation of Renin-angiotensin-aldosterone pathway. For these same reasons oliguria occurs. Hgb/hct are decreased bc of fluid retention
nurse is preparing a teaching plan for a male p who has a continent internal ileal reservoir following bladder cancer surgery. WOTF statements appropriate?
a. this should not affect your ability to have sex
b. you should empty your new bladder when it feels full
c. you will need to avoid foods that produce gas
d. you must insert a catheter through your stoma to drain the urine
d. a continent internal ileal reservoir diverts urine into a surgically created pouch or pocket that functions as a bladder. The stoma is continent and the patient removes urine by regular self-catheterizations. The p will not have sensation to detect when the bladder is full and the surgery causes impotence. C is not relevant
Rn caring for p who has AKI. WOTF labs should be reported?
a. K+ 5.0 mEq/L
b. Ca 9.0
c. Serum creatinine 4.0 mg/dL
d. serum amylase 84 IU/L
C. creatinine lvl of 4.0 mg/dL is abnormally high. All other values are WNL
P. with CRF has BUN 196, Na 152, and K 7.3. RN should?
a. initiate an IV infusion of 0.9% NaCl
b. give oral spironolactone
c. infuse regular insulin in D10W
d. administer furosemide
c. infusing regular insulin in D10W will help move K+ into cells and out of the ECF
Performing admit axmt on p with CKD. Expect?
a. tachypnea
b. hypotension
c. exophthalmos
d. insomnia
a. tachypnea is expected as the respiratory system attempts to compensate for retained hydrogen ions (acids). The kidneys cannot excrete excessive hydrogen ions due to low amounts of bicarbonate. The build of h-ions leads to metabolic acidosis, thus, CO2 is blown off.
P. received hemodialysis, wotf place the p at risk for seizures?
a. hypokalemia
b. rapid increase of catecholamines
c. rapid decrease in fluids
d. hypercalcemia
c. a rapid decrease in fluids (and the associated decrease in BUN levels) can cause Dialysis disequilibrium syndrome. The change in urea levels lead to cerebral edema and IICP, resulting in neurologic symptoms- headache, n/v, restlessness, decreased loc, seizures, coma and death.
P. just had kidney transplant, WOTF indicates delayed functioning of the transplanted kidney?
a. BP 110/58
b. incisional tenderness
c. pink and bloody urine
d. urine output 30 mL/2hr
d. urine output of 30 mL/2 hr indicates oliguria, lack of urine formation indicates delayed kidney functioning. All other options are typical postop findings for a kidney transplant
