Flashcards in Targeted M-S Renal and Urinary Deck (30)
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
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 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?
b. rapid increase of catecholamines
c. rapid decrease in fluids
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
Reviewing EMR of 4 ps. WOTF is a rf for chronic pyelonephritis?
a. Parkinson's disease
b. diabetes mellitus
d. Gallbladder disease
b. Chronic pyelonephritis often occurs in ps with DM r/t reduced bladder tone and reflux of urine
WOTF p's should the nurse plan to mon for signs of nephrotoxicity?
a. p receiving gentamicin for txmt of a wound infection
b. p receiving digoxin for CHF
c. p receiving methylprednisolone for txmt of asthma
d. p receiving propranolol for HTN
a. p's receiving gentamicin can experience acute tubular necrosis. Digoxin, methylprednisolone and propranolol are not nephrotoxic
Teaching for CKD. WOTF indicates p understands?
a. I will mon my BP on the same day each week
b. I will take milk of magnesia if I'm constipated
c. I will weigh myself each morning
d. I will use a salt substitute in my diet
c. daily weights are important to mon for fluid retention. Weigh p's at same time each day, wearing the same clothing, after voiding. Ps should also take their BP qday. MOM contains magnesium and sodium, which the patient should avoid. Salt substitutes contain potassium and should also be avoided (ps cannot excrete electrolytes)
Caring for p the night before a scheduled IV urography. WOTF is nurse's priority intervention?
a. inform the p about dietary limitations
b. place the informed consent document in the ps record
c. give a bowel prep to the p
d. determine if p has allergy to iodine or shellfish
d. IV urography uses contrast media or dye to highlight urinary structures including the kidneys, ureters, and bladder. Xray images are taken as the dye is excreted to yield information r/t kidney/bladder size , any obstructions, and adequate rates of excretion. Bowel prep is given early on the day before the proc.
WOTF axmts is the priority for a p who is postop for a nephrectomy?
a. bowel sounds
b. WBC count
c. Pain level
d. BP is the priority axmt. The greatest risk for this p is acute adrenal insufficiency resulting from removal or damage to the adrenal gland during the procedure. This would cause hypotension, low UOP (oliguria), and changes in LOC.
WOTF actions should the RN plan to take for p scheduled to undergo extracorporeal shock wave lithotripsy (ESWL) for urolithiasis?
a. place p in a semi-fowler's position
b. assist with intubating the p
c. begin a 24hr urine collection postop
d. apply electrodes for cardiac monitoring
d. Continuous ECG monitoring is required for ESWL bc the shock waves are given in synchronicity to the R wave to prevent dysrhythmias. The p should be supine during the proc, does not need to be intubated as only moderate sedation is required, and the urine is strained, not collected, postoperatively.
Kidney transplant 2 days ago and taking cyclosporine. WOTF is correct regarding education?
a. you may exp. hair loss due to the medication
b. you will need to continue taking this med to protect your new kidneys
c. use an OTC anti-inflammatory med for aches and pains
d. you will be at an increased risk for infection if you stop taking this med
b. the p will need to take cyclosporine (an anti-rejection drug) qday following the proc to prevent transplant rejection. A SE of this med is hirsutism, not hair loss. The use of NSAIDS can compound renal damage, thus, should be avoided in these ps. Also, ps taking these medications are at an increased risk for infections, stopping the med will increase rejection risk
P c/o urinary urgency and dysuria. WOTF also indicate a UTI?
a. vag discharge
d. elevated creatine kinase-MB
b. pyuria- the presence of pus and WBCs in the urine indicates a UTI
Teaching for reducing dietary K+ intake in a p with CKD. WOTF selections is appropriate?
a. 1 cup cubed cantaloupe
b. 1 cup boiled spinach
c. one baked potato
d. one large apple
d. one large apple- this is the choice that is lowest in K+
Teaching for patient with urge urinary incontinence?
a. sit on the toilet with water running q4h
b. set an interval for toileting based on previous voiding pattern
c. response immediately to the urge to void.
d. self-catheterize daily following a regular voiding
b. setting intervals for toileting based on previous voiding patterns is the initial step for a bladder training program in ps with this type of incontinence.
Instructions for a p w/ a new dx of acute pyelonephritis?
a. drink up to 1500 mL of fluid/day
b. avoid the use of NSAIDs for pain
c. mon peripheral blood glucose levels 2 times/day
d. increase dietary protein intake
b. ps should be told be avoid NSAIDs as they can cause further damage to the kidneys. Likewise, ps should be told to drink 2-3 L/day and decrease their protein intake.
P. w/ nephrotic syndrome has been taking prednisone for 3 days. WOTF AEs should RN mon for?
a. sore throat
b. frequent stools
a. a sore throat indicates an infection, which can be r/t corticosteroid use as these drugs suppress the immune system
P just had hemodialysis 1 hr ago. WOTF should the RN assess first?
a. serum K+
b. body weight
c. serum creatinine
d. vital signs
d. vital signs- priorities= ABCs
P c/o costovertebral angle tenderness, N/V. Which lab value should RN report?
a. WBC 15000/mm3
b. BUN 15
c. Urine spec grav 1.020
d. urine pH 5.5
a. the WBC is high, meaning infection. all other values are WNL