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Flashcards in Genitourinary Disorders Deck (173)
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The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question
would be most important for the nurse to ask during the admission interview?
1. “Have you recently traveled outside the United States?”
2. “Did you recently begin a vigorous exercise program?”
3. “Is there a chance you have been exposed to a virus?”
4. “What over-the-counter medications do you take regularly?”

4. Medications such as nonsteroidal antiinflammatory drugs (NSAIDs) and some
herbal remedies are nephrotoxic; therefore,
asking about medications is appropriate.


The client is diagnosed with ARF. Which laboratory values are most significant for diagnosing
1. BUN and creatinine.
2. WBC and hemoglobin.
3. Potassium and sodium.
4. Bilirubin and ammonia level.

1. Blood urea nitrogen (BUN) levels reflect
the balance between the production and
excretion of urea from the kidneys. Creatinine is a byproduct of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the
laboratory value most significant in diagnosing renal failure.


The client is diagnosed with rule out ARF. Which condition would predispose the client
to developing pre-renal failure?
1. Diabetes mellitus.
2. Hypotension.
3. Aminoglycosides.
4. Benign prostatic hypertrophy.

2. Hypotension, which causes a decreased
blood supply to the kidney, is one of the
most common causes of pre-renal failure
(before the kidney).


The client is diagnosed with ARF. Which signs/symptoms would indicate to the nurse
that the client is in the recovery period? Select all that apply.
1. Increased alertness and no seizure activity.
2. Increase in hemoglobin and hematocrit.
3. Denial of nausea and vomiting.
4. Decreased urine-specific gravity.
5. Increased serum creatinine level.

1. Renal failure affects almost every system
in the body. Neurologically the client may
have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client would be alert and not have seizures.
2. In renal failure, levels of erythropoietin are
decreased, leading to anemia. An increase
in hemoglobin and hematocrit indicates the
client is in the recovery period.
3. Nausea, vomiting, and diarrhea are common in the client with ARF; therefore, an
absence of these indicates the client is in
the recovery period.


The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which
collaborative treatment would the nurse anticipate for the client?
1. Administer a phosphate binder.
2. Type and cross-match for whole blood.
3. Assess the client for leg cramps.
4. Prepare the client for dialysis.

4. Normal potassium level is 3.5–5.5 mEq/L.
A level of a 6.8 mEq/L is life threatening
and could lead to cardiac dysrhythmias.
Therefore, the client may be dialyzed to
decrease the potassium level quickly. This
would be done with an order from a healthcare
provider, so it is a collaborative intervention.


The nurse is developing a plan of care for a client diagnosed with ARF. Which statement
would be an appropriate outcome for the client?
1. Monitor intake and output every shift.
2. Decrease of pain by 3 levels on a 1–10 scale.
3. Electrolytes are within normal limits.
4. Administer enemas to decrease hyperkalemia.

3. Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore the desired client
outcome would be that all the electrolytes
are within normal limits.


The client diagnosed with ARF is admitted to the intensive care department and placed
on a therapeutic diet. Which diet would be most appropriate for the client?
1. A high-potassium and low-calcium diet.
2. A low-fat and low-cholesterol diet.
3. A high-carbohydrate and restricted-protein diet.
4. A regular diet with six (6) small feedings a day.

3. Carbohydrates are increased to provide for
the client’s caloric intake and protein is restricted to minimize protein breakdown
and to prevent accumulation of toxic end


The client diagnosed with ARF is placed on bed rest. The client asks the nurse, “Why
do I have to stay in bed, I don’t feel that bad.” Which scientific rationale would support the nurse’s response?
1. Bed rest helps increase the blood return to the renal circulation.
2. Bed rest reduces the metabolic rate during the acute stage.
3. Bed rest decreases the workload of the left side of the heart.
4. Bed rest aids in reduction of peripheral and sacral edema.

2. Bed rest reduces exertion and the metabolic
rate, thereby reducing catabolism and
subsequent release of potassium and accumulation of endogenous waste products
(urea and creatinine).


The nurse and unlicensed nursing assistant are caring for clients on a medical floor.
Which nursing task would be most appropriate for the nurse to delegate?
1. Collect a clean voided midstream urine specimen.
2. Evaluate the client’s 8-hour intake and output.
3. Assist in checking a unit of blood prior to hanging.
4. Administer a cation-exchange resin enema.

1. The assistant can collect specimens. Collecting a midstream urine specimen requires
the client to clean the perineal area,
to urinate a little, and then collect the rest
of the urine output in a sterile container.


The client is admitted to the emergency department after a gunshot wound to the
abdomen. Which nursing intervention would the nurse implement first to prevent
1. Administer normal saline IV.
2. Take vital signs.
3. Place client on telemetry.
4. Assess abdominal dressing.

1. Preventing and treating shock with blood
and fluid replacement will prevent acute
renal failure from hypoperfusion of the
kidneys. Significant blood loss would be expected in the client with a gunshot wound.


The unlicensed nursing assistant tells the nurse that the client with ARF has a white
layer on top of the skin that looks like crystals. Which intervention should the nurse
1. Have the assistant apply a moisture barrier cream to the skin.
2. Instruct the nursing assistant to bathe the client in cool water.
3. Tell the nursing assistant not to turn the client in this condition.
4. Explain that this is normal and do not do anything to the client.

2. These crystals are uremic frost resulting
from irritating toxins deposited in the
client’s tissues. Bathing in cool water will
remove the crystals, promote client comfort,
and decrease the itching that occurs
from uremic frost.


The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level?
1. Erythropoietin.
2. Calcium gluconate.
3. Regular insulin.
4. Osmotic diuretic.

3. Regular insulin, along with glucose, will
drive potassium into the cells, thereby
lowering serum potassium levels temporarily.


The client diagnosed with end-stage renal disease (ESRD) is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client?
1. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH.
2. A shortened life span of red blood cells because of damage secondary to dialysis
treatments. This, in turn, leads to metabolic acidosis.
3. The kidney cannot excrete increased levels of acid because the kidneys cannot
excrete ammonia or cannot reabsorb sodium bicarbonate.
4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.

3. This is the correct scientific rationale for
metabolic acidosis occurring in the client
with ESRD.


The nurse in the dialysis center is initiating the morning dialysis run. Which client
should the nurse assess first?
1. The client who has hemoglobin of 9.8 mg/dL and hematocrit of 30%.
2. The client who does not have a palpable thrill or auscultated bruit.
3. The client who is complaining of being exhausted and is sleeping.
4. The client who did not take antihypertensive medication this morning.

2. This client’s dialysis access is compromised
and should be assessed first.


The male client in ESRD has received the initial dose of erythropoietin, a biologic
response modifier, 1 week ago. Which complaint by the client would indicate the need to notify the health-care provider?
1. The client complains of flulike symptoms.
2. The client complains of being tired all the time.
3. The client reports an elevation in his blood pressure.
4. The client reports discomfort in his legs and back.

3. After the initial administration of erythropoietin, a client’s antihypertensive medications may need to be adjusted. Therefore, this complaint requires notification of the HCP. Erythropoietin therapy is contraindicated in clients with hypertension that cannot be controlled.


The nurse is developing a nursing care plan for the client diagnosed with ESRD.
Which nursing problem would have priority for the client?
1. Low self-esteem.
2. Knowledge deficit.
3. Activity intolerance.
4. Excess fluid volume.

4. Excess fluid volume is priority because of
the stress placed on the heart and vessels,
which could lead to heart failure, pulmonary
edema, and death.


The client with ESRD is placed on a fluid restriction of 1500 milliliters per day. On
the 7 A.M. to 7 P.M. shift the client drank an eight (8)-ounce cup of coffee, 4 ounces of
juice, 12 ounces of tea, and 2 ounces of water with medications. What amount of fluid
can the 7 P.M. to 7 A.M. nurse give to the client? _____________

Answer: 720 mL. The nurse must add up how many milliliters of fluid the client drank on the 7 A.M. to 7 P.M. shift and then subtract that number from 1500 mL to determine how much fluid the client can receive on the 7 P.M. to 7 A.M. shift. One
(1) ounce is equal to 30 mL. The client drank 26 ounces (8 4 12 2) of fluid, or 780 mL (26
30) of fluid. Therefore, the client can have 720 mL (1500 - 780) of fluid on the 7 P.M. to 7 A.M. shift.


The client diagnosed with ESRD has a new arteriovenous fistula in the left forearm.
Which intervention should the nurse implement?
1. Teach the client to carry heavy objects with the right arm.
2. Perform all laboratory blood tests on the left arm.
3. Instruct the client to lie on the left arm during the night.
4. Discuss the importance of not performing any hand exercises.

1. Carrying heavy objects in the left arm could
cause the fistula to clot by putting undue
stress on the site, so the client should carry
objects in the right arm.


The male client diagnosed with ESRD secondary to diabetes has been receiving dialysis for 12 years. The client is notified that he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis
treatments. Which response would be most therapeutic?
1. “You cannot just quit your dialysis. This is not an option.”
2. “Are you angry at not being on the list, so you want to quit dialysis?”
3. “I will call your nephrologist right now so you can talk to the HCP.”
4. “Make your funeral arrangements because you are going to die.”

2. Reflecting the client’s feelings and restating
them are therapeutic responses that the
nurse should use when addressing the
client’s issues.


The nurse is discussing kidney transplants with clients at a dialysis center. Which
population is less likely to participate in organ donation?
1. Caucasian.
2. African American.
3. Asian.
4. Hispanic.

2. The African American culture believes that
the body must be kept intact after death,
and organ donation is rare among African
Americans. This is also why a client of
African American descent will be on a
transplant waiting list longer than people
of other races. This is because of tissuetyping compatibility.


The client receiving dialysis is complaining of being dizzy and light-headed. Which
action should the nurse implement first?
1. Place the client in the Trendelenburg position.
2. Turn off the dialysis machine immediately.
3. Bolus the client with 500 mL of normal saline.
4. Notify the health-care provider as soon as possible.

1. The nurse should place the client’s chair
with the head lower than the body, which
will shunt blood to the brain; this is the
Trendelenburg position.


The nurse caring for a client diagnosed with ESRD writes a client problem of “noncompliance of dietary restrictions.” Which intervention should be included in the plan of care?
1. Teach the client the proper diet to eat while undergoing dialysis.
2. Refer the client and significant other to the dietician.
3. Explain the importance of eating the proper foods.
4. Determine the reason for the client not adhering to the diet.

4. Noncompliance is a choice the client has a
right to make, but the nurse should determine
the reason for the noncompliance and
then take appropriate actions based on the
client’s rationale. For example, if the client
has financial difficulties, the nurse may
suggest how the client can afford the
proper foods along with medications, or
the nurse may be able to refer the client to
a social worker.


The client diagnosed with ESRD is receiving peritoneal dialysis. Which assessment
data warrant immediate intervention by the nurse?
1. Inability to auscultate a bruit over the fistula.
2. The client’s abdomen is soft, is nontender, and has bowel sounds.
3. The dialysate being removed from the client’s abdomen is clear.
4. The dialysate instilled into the client was 1500 mL and that removed was 1500 mL.

4. Because the client is in ESRD, fluid must be
removed from the body so the output should be more than the amount instilled.
These assessment data require intervention
by the nurse.


The client receiving hemodialysis is being discharged home from the dialysis center.
Which instruction should the nurse teach the client?
1. Notify the HCP if oral temperature is 102F or greater.
2. Apply ice to the access site if it starts bleeding at home.
3. Keep fingernails short and try not to scratch the skin.
4. Encourage significant other to make decisions for the client.

3. Uremic frost, which results when the skin
attempts to take over the function of the
kidneys, causes itching, which can lead to
scratching that results in a break in the skin.


The client is admitted to a nursing unit from a long-term care facility with a hematocrit
of 56% and a serum sodium level of 152 mEq/L. Which condition would be a
cause for these findings?
1. Overhydration.
2. Anemia.
3. Dehydration.
4. Renal failure.

3. Dehydration results in concentrated serum
that causes lab values to increase because
the blood has normal constituents but not
enough volume to dilute the values to
within normal range or possibly lower.


The client who has undergone an exploratory laparotomy and subsequent removal of a large intestinal tumor has a nasogastric tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should be reported to the HCP?
1. The pump keeps sounding an alarm that the high pressure has been reached.
2. Intake is 1800 mL, NGT output is 550 mL, and Foley output 950 mL.
3. On auscultation, crackles and rales in all lung fields are noted.
4. Client has negative pedal edema and an increasing level of consciousness.

3. Crackles and rales in all lung fields indicate
that the body is not able to process the
amounts of fluids being infused. This
should be brought to the HCP’s attention.


The client diagnosed with diabetes insipidus weighed 180 pounds when the daily
weight was taken yesterday. This morning’s weight is 175.6 pounds. One liter of fluid
weighs approximately 2.2 pounds. How much fluid has the client lost? ______

2000 mL has been lost. First, determine how
many pounds the client has lost:
180 - 175.6 = 4.4 pounds lost
Then, based on the fact that 1 liter of fluid weighs 2.2 pounds, determine how many liters of fluid have been lost.
4.4 ÷ 2.2 = 2 liters lost. Then, because the question asks for the answer in
milliliters convert 2 liters into milliliters.
2 x 1000= 2000 mL


The nurse writes the nursing problem of “fluid volume excess” (FVE). Which intervention should be included in the plan of care?
1. Change the IV fluid from 0.9% NS to D5W.
2. Restrict the client’s sodium in the diet.
3. Monitor blood glucose levels.
4. Prepare the client for hemodialysis.

2. Fluid volume excess refers to an isotonic
expansion of the extracellular fluid by an
abnormal expansion of water and sodium.
Therefore sodium is restricted to allow the
body to excrete the extra volume.


The client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented?
1. Encourage fluids orally.
2. Administer 10% saline solution IVPB.
3. Administer antidiuretic hormone intranasally.
4. Place on seizure precautions.

4. Clients with sodium levels less than 120
mEq/L are at risk for seizures as a complication.
The lower the sodium level, the greater the risk of a seizure.


The telemetry monitor technician notifies the nurse of the morning telemetry readings.
Which client should the nurse assess first?
1. The client in normal sinus rhythm with a peaked T wave.
2. The client diagnosed with atrial fibrillation with a rate of 100.
3. The client diagnosed with a myocardial infarction who has occasional PVC.
4. The client with a first-degree AV block and a rate of 92.

1. A client with a peaked wave could be
experiencing hyperkalemia. Changes in
potassium levels can initiate cardiac
dysrhythmias and instability.