Renal

Front 1

A 30 year old client has just been diagnosed with polycystic kidney disease. The nurse would expect to develop a plan of care based on which of the following nursing diagnoses?

Back 1

Infection related to obstructed urinary drainage.
Rationale: The client with polycystic disease would have the potential to develop renal failure, hypertension and urinary tract infections. Renal failure develops by age 60-70. Hypertension tract infections occur due to cysts obstructing urinary drainage.

Front 2

The client has been diagnosed with chronic glomerulonephritis. The nurse should teach the client that the disease may progress to:

Back 2

end stage renal disease.
Rationale: Chronic glomerulonephritis results from lupus nephritis, diabetic nephropathy and rapidly progressive glomerulonephritis. Glomeruli are destroyed and the signs of renal failure develop.

Front 3

In order to slow the progression of end stage renal disease in the client who has been diagnosed with glomerular disease the nurse would plan to administer:

Back 3

antihypertensives.
nonsteriodal anti-inflammatory drugs.
Rationale: Antihypertensives are administered to control systemic and renal hypertension. Non steroidal anti-inflammatory drugs reduce proteinuria. Hypertension inflammation and proteinuria lead to end stage renal disease.

Front 4

The physician suspects the client suffered renal artery trauma after a motor vehicle accident. In order to confirm the diagnosis the nurse would expect to prepare the client for which diagnostic test?

Back 4

Renal arteriography
Rationale: When renal artery trauma is suspected the nurse would prepare the client for renal arteriography. Magnetic resonance imaging is not usually performed for vessel trauma. Biopsy is used to obtain a tissue sample for cytology. A renal scan is used to determine the uptake of contrast material.

Front 5

The nurse caring for a patient who is experiencing renal cancer would include which priority nursing intervention after radical nephrectomy?

Back 5

Assessment of respiratory complications.
Rationale: After radical nephrectomy the patient must be assessed for respiratory complications, pain, infection and ability to cope. The priority intervention would be respiratory assessment. Pneumothorax is a common complication.

Front 6

A client who has experienced a burn injury over 40 percent of his body is at risk for acute tubular necrosis. In order to prevent renal failure in this client the nurse

Back 6

maintain blood pressure.
prevent infection.
maintain adequate fluid balance.
Rationale: Acute tubular necrosis results from burns and hypovolemia sepsis. The nurse should prevent ischemia by maintaining blood flow to the kidney and prevent hypotension and infection.

Front 7

When caring for a client with acute renal failure the nurse would plan which one of the following treatment goals for the client?

Back 7

Compensate for renal impairment by restoring fluid balance.
Rationale: The treatment goals for acute include: identifying and correcting underlying cause, preventing kidney damage, restoring urine output and kidney function and compensating for renal impairment.

Front 8

The nursing instructor is teaching the students about dialysis for the client with end stage renal disease. The nurse teaches the students that the client may experience hypotension, muscle cramping and cardiovascular disease when receiving __________.

Back 8

hemodialysis
Rationale: Hypotension, muscle cramps and death from cardiovascular disease are associated with hemodialysis and infection and increased triglyceride levels are associated with peritoneal dialysis.

Front 9

The nurse is caring for a client with acute renal failure. When providing the dietary instruction, the nurse would evaluate that the client has understood the instructions when the client states “I would avoid

Back 9

cereal with bananas and orange juice”.
Rationale: A client with renal failure should avoid foods high in potassium and sodium. Foods high in potassium include non salt seasoning mixes, potatoes, bananas, and orange juice.

Front 10

The client with chronic renal failure has a serum potassium of 6.6 mEq/L. The nurse should anticipate an order for:

Back 10

sodium polystyrene sulfonate (Kayexalate).
Rationale: The client with renal failure with a potassium level above 6.5 mEq/L is treated with sodium polystyrene sulfonate (Kayexalate SPS suspension). Sodium polystyrene exchanges sodium ions for potassium in the intestines. Fureosimide (Lasix) removes sodium and excess fluid. Aluminum hydroxide (Amphojel) is used to control hyperphosphatemia. Propranolol (Inderal) may control hypertension.

Front 11

A client with chronic renal failure has had an arteriovenous fistula created for hemodialysis. The nurse should assess this client for:

Back 11

a bruit and a thrill.
Rationale: The client needs to be assessed for a functional arteriovenous fistula by palpating a thrill and auscultating a bruit. Clients may have edema which is usually peripheral. A renal bruit indicates turbulent blood flow in the renal artery. A positive homan’s sign may indicate a deep vein thrombosis.

Front 12

The client with end stage renal disease has received a kidney transplant. The client asks “Why do I need to take cyclosporine (sandimmune)?” The nurse’s best response is:

Back 12

It will help prevent rejection of the kidney by suppressing your immune system.”
Rationale: Unless a kidney is received from an identical twin the body will produce antibodies and the body will begin to reject the kidney. Immunosuppressants suppress the immune system and the inflammatory response.

Front 13

The client has just returned from hemodialysis. It is essential for the nurse to evaluate the client for:

Back 13

signs of disequilibrium syndrome.
Rationale: Dialysis can cause disequilibrium syndrome if fluid is withdrawn too quickly. The nurse should assess for headache, nausea, vomiting, change in level of consciousness and hypertension. Dialysis pulls off fluid and potassium.

Front 14

The nurse should instruct the client who is performing peritoneal dialysis to remain in which one of the following positions?

Back 14

Semi-Fowler’s
Rationale: Respiratory distress due to increase pressure from the dialyslate may occur unless the client remains in semi Fowler’s or Fowler’s position. Lateral, supine or dorsal recumbent may increase the risk of respiratory distress.

Front 15

In the client experiencing acute renal failure the nurse should evaluate which laboratory diagnostic tests to assess renal function?

Back 15

Blood urea nitrogen

Creatinine
Rationale: Serum blood urea nitrogen, creatinine, electrolytes and complete blood count. Blood urea nitrogen and creatinine evaluate renal function. Electrolytes will provide information on hyponatremia and hyperkalemia. Complete blood count will indicate the degree of anemia in a renal client.

Front 16

A client diagnosed with pyelonephritis asks the nurse “What is the disease?” The nurse’s best response “Pyelonephritis is an:

Back 16

inflammation of the kidney and renal pelvis.”
Rationale: Pyelonephritis is an inflammation of the kidney and renal pelvis. Prostatis is an inflammation of the prostate gland. Urethritis is an inflammation of the urethra. Cystitis is an inflammation of the bladder.

Front 17

The nurse is planning to teach the client about the signs and symptoms of a urinary tract infection. The nurse should include:

Back 17

dysuria.
foul smelling cloudy urine.
urgency.
Rationale:Signs and symptoms of urinary tract infections include dysuria, frequency, urgency, foul odor, pyuria, hematuria and pain in the suprapubic area.

Front 18

A male client is complaining of urinary frequency, dysuria, pain, fever and chills for the third time in 9 months. The nurse should expect which diagnostic test to be ordered since this is the third infection in 9 months?

Back 18

Intravenous pyelography
Rationale: An intravenous pyelograph evaluates the structure and excretory function of the kidneys, ureter and bladder for abnornalies such as vesicoureteral refex in people who have frequent infections. Urine culture and sensitivity is appropriate but repetitive infections may indicate an underlying problem. Flat plate and CT scan of abdomen will only evaluate structures of the kidneys, ureter and bladder.

Front 19

The client with a history of recurrent urinary tract infections due to renal calculi is to undergo extra corpeal shock wave lithotripsy. Post procedure, the nurse will need to evaluate the client for:

Back 19

bleeding.
Rationale: Signs of infection, bleeding and decreased urine output may all be signs of complications from extracorpeal shock wave lithotripsy. Incontinence may be due to an overflow or urinary stress related disorder.

Front 20

The nurse is developing a teaching plan for the sexually active woman for preventing urinary tract infections. The nurse should instruct the client to

Back 20

wear cotton briefs.
void before and after intercourse.
increase fluids to 2.5 quarts per day.
Rationale: In order to prevent urinary tract infections a client should be taught to drink 2.0 to 2.5 quarts of fluid per day, empty the bladder every 3 to 4 hours, cleanse from front to back after voiding or defecating, void before and after intercourse, avoid bubble baths and hygiene sprays and douches, wear cotton briefs and consume cranberry juice and ascorbic acid.

Front 21

A client with a history of urinary tract infection should be instructed by the nurse to avoid:

Back 21

tea and coffee.
Rationale: A client with urinary tract infections should be instructed to avoid caffeine, citrus juices, artificial sweeteners as these substances irritate the bladder and can increase urgency and spasms.

Front 22

The client is experiencing urolithiasis composed of Struvite. The nurse would teach the client that the cause of these stones is:

Back 22

bacteria.
Rationale: Most kidney stones are composed of calcium, others are from uric acid. Cystine stones are from a genetic defect whereas struvite stones originate from bacteria.

Front 23

A client has been diagnosed with renal obstruction due to calculi. The nurse should evaluate the client for the complication of:

Back 23

hydronephosis.
Rationale: The client who has a urinary tract obstruction can develop hydronephrosis which is distention of the renal pelvis, calyces and ureter because the kidneys continue to produce urine behind the obstruction.

Front 24

A client has just been diagnosed with bladder cancer. The nurse should develop a plan of care which includes:

Back 24

smoking cessation classes.
Rationale: Smoking is a risk factor for bladder cancer. The client should be encouraged to participate in a smoking cessation program.

Front 25

The most appropriate nursing diagnosis one day for the client who has had a radical cystectomy and urinary diversion for the nurse to develop a plan of care for is:

Back 25

disturbed body image.
Rationale: The client’s body image may be affected by a radical cystectomy and a urinary diversion. In the majority of people an abdominal stoma is present and the sexual organs are removed. Infections do not develop immediately. The client should be home in 2-3 days.

Front 26

The nurse is caring for a client with an ileal conduit. The nurse should assess for which complication that the client is most at risk for?

Back 26

Skin breakdown
Rationale: A client who has an ieal conduit should be assessed for peristomal skin breakdown. The client is not at risk for electrolyte disturbance, adrenal insufficiency or diarrhea.

Front 27

A client with a nuerogenic bladder is taking oxybutynin (Ditropan). The nurse would evaluate the client for which adverse effects?

Back 27

Dry mouth, blurred vision
Rationale: Anticholinergic drugs relax the detrusor muscle and contract the internal sphincter. The adverse effects include: dry mouth, blurred vision and constipation.

Front 28

The nurse should instruct the client with stress or urge urinary incontinence to:

Back 28

perform kegel exercises.

keep a voiding log.
Rationale: The client with stress or urge urinary incontinence should be instructed to perform pelvic floor exercises, bladder training programs. The client should be instructed to keep a voiding log. Wearing disposable briefs is not dignified for a client, restricting fluids can lead to calculi.

Front 29

A client has had surgery and a continent ileal conduit (Kock’s Pouch) created. The nurse must instruct the client to:

Back 29

self catheterize the stoma every 2 to 4 hours.
Rationale: A client with a continent ileal conduit the client must be able to perform self catheterization every four hours. Fluids should not be restricted. Ileocystoplasty will permit client to use the valsalva maneuver to void.

Front 30

The nurse would conclude that the education goals of a client with stress incontinence have been met when the client:

Back 30

returns to previous level of activity.
remains dry between voidings.
maintains a bladder voiding program every three hours.
Rationale: A client with stress incontinence demonstrates successful achievement of goals when the client remains dry between voiding, demonstrates increased muscle strength, has intact perineal skin integrity, can function socially and continues voiding program every 3-4 hours. Restricting fluids can lead to stone formation or infection.

Front 31

A client reports to the ambulatory clinic with complaints of blood in the urine. The nurse completes a data collection on the client. Which of the following questions by the nurse should be included? Select all that apply.

Back 31

“Are you taking any types of anticoagulant medications at this time?”
“Do you notice any pain or burning during urination?”
“Do you have any fever or chills?”
Rationale: The use of anticoagulant medications could cause bleeding in the urinary system. Pain, burning, fever, and chills are all signs and symptoms of infection in the urinary system. Excessive protein in the diet is not considered problematic for the urinary system.

Front 32

A client reports to the Emergency Room with complaints of urinary dysfunction. The nurse completes a physical assessment and would suspect kidney disease based on the following findings:

Back 32

systolic bruits heard over the renal arteries.
Rationale: If systolic bruits are heard over the renal arteries, this is indicative of renal artery stenosis. The skin and mucous membranes should be red/pink. Pallor of the skin and mucous membranes may indicate kidney disease with resultant anemia. T he abdomen should be concave and symmetric. Assymetric kidneys may indicate a hernia or mass. When palpating the kidneys, they should be equal in size and firm. Soft kidneys is an indication of chronic renal disease and unequal kidney size may indicate hydronephrosis.

Front 33

A hospitalized client is suspected of having a neurogenic bladder. When considering the plan of care for this client, which of the following tests can the nurse anticipate being ordered for this client?

Back 33

Cystogram
Rationale: A Cystogram is used to visualize the bladder wall and urethra. Small renal calculi can be removed from the ureter, bladder, and urethra during this procedure and tissue biopsy can be performed. Choledochescopy, colposcopy, and colonoscopy will not provide information needed to assess the urinary system.

Front 34

A client reports to the Emergency Room with complaints of dysuria, nocturia, and hematuria. The physician orders labs for this client. Upon review of the lab reports, the nurse would know kidney disease was possible based on the following results: ______________ .

Back 34

Blood Urea Nitrogen of 45
Rationale: An elevated Blood Urea Nitrogen is an indication of a prerenal disorder. The other lab values are within normal range.

Front 35

A hospitalized client is to undergo a renal arteriogram. The nurse completes pre-operative teaching with the client. The nurse knows the client understands the procedure based on the following statements.

Back 35

“I will have to take a laxative or enema to clean out my bowel the night before the test.”
Rationale: The test requires the client to be NPO for 8-12 hours prior to the test. Medications will be held, especially anticoagulants, prior to the procedure. The client will have restricted activity for a day following this procedure. The client will receive a laxative or cleansing enema the night before to facilitate visualization.

Front 36

A client arrives at an ambulatory clinic complaining of urinary dysfunction. The nurse is completing a history and physical. Included in this information should be:

Back 36

lifestyle.
diet.
cigarette smoking.
work history, including exposure to toxic chemicals.
Rationale: All of these categories are important to investigate when collecting data concerning the urinary tract. Many contain exposures that can alter the urinary system function.

Front 37

A client is being admitted to your Medical-Surgical Unit with Pylonephritis and Dehydration. The nurse is assessing the client and completing the admission database. During the health assessment interview, the nurse inquires about family members with health problems relating to the urinary system. The client becomes concerned about the line of questioning and asks the nurse to explain why this information is needed. The nurses best response is:

Back 37

“If we know your family background, it may help us better diagnose and treat your condition.”
Rationale: Family history can uncover valuable information and help a physician decide on a plan of care. The family history is part of an admission database that is required to be completed by the nurse, but that is not the BEST response to this question. Genetic counseling is not within the nursing scope of practice. Urinary disease is not always a hereditary link.

Front 38

The nurse is completing a physical assessment on a client admitted with complaints of urinary dysfunction. Upon assessment of the abdomen, the nurse notes that the abdomen is distended and asymmetrical. Which action by the nurse should be performed next?

Back 38

Palpate the bladder
Rationale: When finding an abnormal assessment, the nurse will want to first complete the assessment. In this particular situation, palpating the bladder would give the nurse additional information to then report to the physician. Anchoring a foley catheter is not to be completed without a physician order. Performing a bladder percussion is a role of the physician or advanced nurse practitioner.

Front 39

A client is admitted to your facility with a possible urinary tract infection. A nursing database has been collected. The nurse notifies the physician of the client’s condition and the findings from the assessment. The physician gives the nurse telephone orders which includes a urine culture. Which statement by the nurse is correct in regards to teaching a client how to obtain a urine culture

Back 39

“You will need to notify me as soon as you collect the specimen so that I can transport it in a timely manner to the lab for testing.”
Rationale: A urine culture must be transported to the lab immediately after collecting or stored in a refrigerator unit until testing begins or bacteria will begin to grow and a false reading will occur. To collect a urine culture, the labia and foreskin must be separated or retracted prior to cleansing. The labia do not need to remain separated during the urination process. To collect a specimen correctly, the client needs to void a small amount in the toilet and then void the remainder of the urine into the specimen cup.

Front 40

An 82 year old client enters the Emergency Room complaining of having “difficulty with their bladder”. The nurse gathers data concerning their urinary system. As the nurse begins to process this information, it is correct for the nurse to recognize that:

Back 40

as we age, larger amounts of residual urine is present after voiding.
Rationale: As we age, urinary retention, frequency, urgency, and nocturia does become more common. Urinary incontinence is not a normal outcome of aging. However, as we age, larger amounts of residual urine is left in our bladder after voiding.