Flashcards in Learn Smart med/surg Renal and Urinary Deck (21)
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
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.
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
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.
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
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.
Caring for p. that is receiving peritoneal dialysis, WOTF is a complication of this procedure?
b. metabolic acidosis
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.
cloudy dialysate outflow, fever, abdominal tenderness, abdominal pain, malaise, n/v
Providing education for a p who has CRF. WOTF should p increase in her diet?
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.
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.
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.
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
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.
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
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
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
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
P suspected of having UTI and urine specimen is ordered. WOTF findings confirm an upper UTI involving the kidneys?
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.
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
a. priority action is to relieve pain.
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.
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
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
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
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
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
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
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
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
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.
P brought to the ER after a MVA. The RN suspects a ruptured bladder based on WOTF findings?
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.
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
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
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
b. The RN should check the electrolyte levels as these findings indicate hyperkalemia (which can be fatal).