Urinary
The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia?
A Nocturia
A. Scrotal edema
B. Occasional constipation
C. Decreased force in the stream of urine.
D. 2200
What is D? Decreased force in the stream of urine.
Rationale: Decreased force in the stream of urine is the early sign of BPH. The stream later become weak and dribbling. The client then may develop hematuria, frequency urgency, urge incontinence and nocturne. If not treated, complete obstruction and urinary retention can occur.
A patient with chronic kidney disease experiences decreased erythropoietin levels. What complication, related to this finding, does the nurse anticipate when caring for this patient?
A. Anemia
B. Acidosis
C. Hyperkalemia
D. Hypocalcemia
What is A (anemia)?
Rationale: Erythropoeitin is secreted by the kidneys and stimulates RBC production. Erythropoeitin levels are often low in patients with CKD and ESRD and often require erythropoietin-stimulating agents.
A patient with cirrhosis of the liver has an albumin level of 2.5 g/dL. The nurse should plan care for this patient to address the patient's risk for developing:
A. Peripheral edema
B. Prolonged blood congestion
C. Jaundice of the skin
D. Vitamin A malabsorption
What is A (peripheral edema)?
Rationale: Albumin helps maintain oncotic pressure, so low levels can result in peripheral edema. Prolonged blood congestion is due to portal hypertension and jaundice is related to the liver's inability to conjugate bilirubin. Vitamin A is stored in hepatic cells, so while levels may be low--it's not related to albumin levels.
A patient with end stage renal disease is prescribed Sevelamer with meals. Which laboratory value indicates that this medication is effective?
A. Sodium 140 meq/L
B. Potassium 4.0 meq/L
C. Serum creatinine 2.0 mg/dL
D. Phosphorus 4.2 mg/dL
What is D (Phosphorus 4.2 mg/dL)?
Rationale: Sevelamer is given with meals to bind phosphorus. Therefore, a normal phosphorus level indicates that the medication is effective.
The nurse is educating a patient on a potassium-restricted diet. What food should the patient avoid due to having high levels of potassium?
A. Butter
B. Citrus fruit
C. Cooked white rice
D. Corn
What is B (citrus fruit)?
Rationale: Foods high in potassium include bananas, oranges, cantaloupe, honeydew, apricots, grapefruit, spinach, broccoli, and potatoes.
Which amount of urine output over an 24-hour period is associated with oliguria (select all that apply)?
A. 200 mL
B. 350 mL
C. 750 mL
D. 1000 mL
What is A and B (200 mL and 350 mL)?
Rationale: Oliguria is defined as less than 400 mL/day in adults.
Which laboratory value indicates renal impairment? A. Serum creatinine of 0.8 mg/dL
B. Blood urea nitrogen of 14 mg/dL
C. Creatinine clearance (estimated GFR) of 40 mL/min
D. Uric acid level of 6 mg/dL
What is C (Creatinine clearance (GFR) of 40 mL/min)?
Rationale: Creatinine clearance less than 60 mL/min indicates renal impairment. The BUN, creatinine, and uric acid levels are normal.
A. Assess for GI bleeding.
B. Withhold the lactulose.
C. Increase protein in the diet.
D. Monitor serum bilirubin levels.
What is A? Assess for GI bleeding.
Rationale: Client with cirrhosis can develop hepatic encephalopathy caused by increased ammonia level. Asterixis, a flapping tremor, is a characteristic symptom of increased ammonia levels. Bacterial action on increased protein in the bowel will increase ammonia levels and cause the encephalopathy to worsen. GI bleeding and protein consumed in the diet increase protein in the intestine and can elevate ammonia level. Lactulose is given to reduce ammonia formations in the intestine and should not be held since neurological symptoms are worsening. Bilirubin is associated with jaundice.
Long-term, chronic use of which medication class can lead to chronic kidney disease?
A. Beta-blockers
B. Insulin
C. Non-steroidal anti-inflammatory drugs (NSAIDs)
D. Loop diuretics
What is C (NSAIDs)?
Rationale: NSAIDs inhibit prostatglandins. In the kidney, prostaglandins promote vasodilation. Thus, NSAIDs decrease renal blood flow. The other options are not nephrotoxic.
The nurse is caring for a patient with dementia in a long-term care facility when the patient develops increased confusion and experiences a fall. What should the nurse suspect this patient may be experiencing?
A. Stroke
B. Fecal impaction
C. Myocaridal infarction
D. Urinary tract infection
What is D (urinary tract infection)?
Rationale: Older adults often do not have the major clinical manifestations of infection due to changes associated with aging and often only present with altered mental status.
The nurse is assessing the laboratory findings of a hospitalized patient with a urinary tract infection. Which finding is most concerning?
A. Left shift in the white blood cell (WBC) differential
B. Serum white blood cell count of 15,000/mm3
C. Presence of red blood cells in the urine
D. Presence of white blood cells in the urine
What is A (Left shift in the white blood cell (WBC) differential)?
Rationale: A left shift indicates an increase in immature neutrophils usually related to infection. Immature neutrophils can't perform phagocytosis. This finding usually indicates a severe infection. Options B, C, and D are expected findings.
The nurse is caring for a 73-year-old man patient with a history of benign prostatic hyperplasia and symptoms of a possible urinary tract infection. Which diagnostic finding would support this diagnosis?
A. White blood cell count is 7500 cells/µL.
B. Prostate specific antigen level of 5.0 ng/mL.
C. Glucose, protein, and ketones are present in the urine
D. Nitrites and leukocyte esterase are present in the urine.
What is D (Nitrites and leukocyte esterase are present in the urine)?
Rationales: Nitrites are common with UTIs caused by gram negative bacteria (the bacteria convert urinary nitrates to nitrites). Leukocyte esterase is an enzyme produced by WBCs. The WBC count is normal and PSA levels help to screen for prostate cancer. Urinary glucose indicates hyperglycemia, urinary protein indicates renal injury, and ketones indicate diabetic ketoacidosis or severe malnutrition.
Which criterion is most critical in determining protein intake for the patient with advanced cirrhosis?
A. Protein/albumin level
B. Ammonia level
C. Weight loss
D. Muscle tone
What is B (ammonia level)?
Rationale: Ammonia is a by-product of protein metabolism and is also created by bacteria in the colon. Normally, the liver converts ammonia to urea and it's then excreted by the kidneys. This is why ammonia can be elevated with liver impairment. Ammonia crosses the blood-brain barrier causing neurologic impairments. Therefore, patients with cirrhosis and elevated ammonia levels need to restrict their dietary protein.
The nurse in the dialysis clinic is reviewing the home medications of a patient with end stage renal disease. Which medication reported by the patient indicates that patient teaching is required?
A. Ferrous sulfate
B. Acetaminophen
C. Magnesium hydroxide
D. Sevelamer
What is C (Magnesium hydroxide)?
Rationale: Magnesium is renally excreted, so magnesium-containing medications should be avoided in patients receiving dialysis. Ferrous sulfate (iron) is often used due to anemia. Acetaminophen is hepatotoxic, not nephrotoxic. Sevelamer is used to decrease serum phosphorus associated with renal impairment.
The RN has just received change-of-shift report. Which of the assigned patients will be assessed first?
A. A patient with chronic renal failure who was just admitted with shortness of breath
B. A patient with renal insufficiency who is scheduled to have an AV fistula inserted
C. A patient with acute kidney injury whose blood urea nitrogen and creatinine are increasing
D. A patient receiving peritoneal dialysis who is due for an exchange
What is A (A patient with chronic renal failure who was just admitted with shortness of breath)?
Rationale: While all of the patients have immediate needs, the patient recently admitted with shortness of breath takes priority. Given the diagnosis of chronic renal failure, the patient could be experiencing pulmonary edema and should be assessed first.
A patient is admitted to the medical unit with acute kidney injury caused by urinary retention secondary to benign prostatic hypertrophy. Which of these provider orders should the nurse implement first?
A. Place patient on a protein-restricted diet.
B. Insert a 16-Fr Foley retention catheter.
C. Collect a 24-hour urine specimen for creatinine clearance.
D. Give furosemide (Lasix) 80 mg IV.
What is B (Insert a 16-Fr Foley retention catheter)?
Rationale: The urethral obstruction has caused postrenal acute kidney injury. Therefore, treating the urinary retention is the priority. Options A and C may be needed depending on the degree of renal insufficiency but is not the priority. Option D could cause bladder rupture since there is urinary retention.
Which intervention can be used to decrease the risk of contrast-induced nephropathy in a patient with chronic kidney disease undergoing a computed tomography scan with intravenous contrast?
A. Administer sodium bicarbonate after the procedure
B. Hydrate with intravenous 0.9% sodium chloride before the procedure
C. Administer oral N-acetylcysteine after the procedure
D. Perform dialysis before the procedure.
What is B (hydrate with intravenous 0.9% sodium chloride before the procedure)?
Rationale: Contrast-induced nephropathy a form of intrarenal acute kidney injury; renal perfusion is decreased for up to 20 hours following contrast administration. Hydration therapy is the major way to prevent this complication. Options A and C are sometimes used before contrast administration as well with fluid administration. Option D would not prevent this complication.
Which information given by a 70-year-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C?
A. The patient had a blood transfusion in 2005.
B. The patient used IV drugs about 20 years ago.
C. The patient frequently eats in fast-food restaurants.
D. The patient traveled to a country with poor sanitation.
What is B (The patient used IV drugs about 20 years ago)?
Rationale: Risk factors for hepatitis C include blood transfusions prior to 1992, IV drug use, tattoos, etc. Hepatitis A is transmitted by the fecal-oral route (options C and D).
Which finding indicates to the nurse that lactulose is effective for a 72-year-old man who has advanced cirrhosis?
A. The patient is alert and oriented.
B. The patient denies nausea or anorexia.
C. The patient's bilirubin level decreases.
D. The patient has at least one stool daily.
What is A (The patient is alert and oriented)?
Rationale: Lactulose is given for hepatic encephalopathy (HE) related to elevated serum ammonia levels. HE causes decreased level of consciousness and other neuro changes, so this is the best way to assess the medication's effectiveness. While increased bowel movements are an expected effect of the drug, assessing mental status is a better indicator of the drug's effectiveness.
A patient with cirrhosis had a paracentesis performed. Which assessment finding after the procedure should be immediately reported to the physician?
A. Nausea and anorexia
B. Fatigue and dark-orange urine
C. Respirations 20/min and dry mouth
D. Rigid abdomen and low urine output
What is D (rigid abdomen and low urine output)?
Rationale: One complication of paracentesis is bladder perforation. To prevent this, patients are instructed to empty their bladder before the procedure. The other findings are common with cirrhosis.
Which is the nurse's highest priority for meeting the needs of a patient who presents with a 3-day history of vomiting and diarrhea, blood pressure of 85/60 mm Hg, and heart rate of 105 beats/min?
A. Finding the source of infection
B. Preventing nutritional deficit
C. Replacement of fluid loss
D. Relief of nausea
What is C (replacement of fluid loss)?
Rationale: This history combined with the clinical findings indicates a fluid volume deficit, so the fluids are the priority. While options B and D are appropriate, reestablishing adequate circulating volume is more important. These findings may or may not be due to infection.
Which statement by the patient with diabetic nephropathy indicates a need for further education about their disease?
A. ''Diabetes is the leading cause of renal failure.''
B. "I need less insulin, so I am getting better.''
C. "I may need to reduce my insulin.''
D. ''I should call my provider if the urine dipstick shows protein.''
What is B ("I need less insulin, so I am getting better.")?
Rationale: Insulin is excreted in urine, so people with renal impairment often require lower dosage due to the increased risk of hypoglycemia.
Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective?
A. Increased serum albumin level
B. Decreased indirect bilirubin level
C. Improved alertness and orientation
D. Fewer episodes of bleeding varices
What is D (Fewer episodes of bleeding varices)?
Rationale: TIPS is used to reroute blood around the liver due to portal hypertension. Decreasing portal pressure decreases the risk of GI bleeding. Some people develop hepatic encephalopathy as a side effect of the procedure which would cause decreased mental status. Albumin and bilirubin levels would not be affected by TIPS.
A. Constipation
B. Hyperkalemia
C. irregular pulse
D. dysuria
What is B? Spironolactone is a potassium sparring diuretic; therefore, client should be monitor closely for hyperkalemia. Other adverse effects are abdominal cramping, diarrhea, and rash. Constipation and dysuria are not common adverse effect of spironolactone. An irregular pulse is not an adverse effect of this medication but could develop if serum potassium levels are not closely monitored.
When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis?
A. Impaired skin integrity related to edema, ascites, and pruritus
B. Imbalanced nutrition: less than body requirements related to anorexia
C. Excess fluid volume related to portal hypertension and hyperaldosteronism
D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume
What is D (Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume)?
Rationale: While all of the nursing problems are important, ineffective breathing pattern is the highest priority. The pressure on the diaphragm is likely due to ascites and can be treated with diuretics, albumin infusion, paracentesis, and therapeutic positioning.