ATI Elimination/ Urinary. All Questions with Rationale Answers. 2022/2023

A nurse is caring for a client with recurrent kidney stones. The provider order several diagnostic studies, including intravenous pyelogram (IVP), urine culture and sensitivity, and strain all urine. The nurse needs to i ...

A nurse is caring for a client with recurrent kidney stones. The provider order several diagnostic studies, including intravenous pyelogram (IVP), urine culture and sensitivity, and strain all urine. The nurse needs to inquire further if the client states which of the following? - ✔✔-"I never eat shellfish because they give me hives." Rationale: Getting hives after eating shellfish is a likely indication of an allergy. The contrast medium used for IVP dye is typically an iodine or shellfish derivative. A client with sensitivity to iodine or shellfish may have an anaphylactic reaction after the contrast material is injected. A nurse is caring for a client who is receiving hemodialisis via the left arteriovenous fistula for management of chronic renal disease. Which of the following teaching points should the nurse reinforce? - ✔✔-Avoid tight clothing around the access site. Rationale: Tight clothing may decrease the blood flow and cause clotting. A nurse is caring for a client with chronic renal failure. Which of the following client statements indicates an understanding of the dietary needs for lifestyle management of this disease? - ✔✔-"I will limit my fluid intake." Rationale: The client who has chronic renal failure needs to avoid hypovolemia, or fluid overload , by following the fluid restriction each daily. Protein restriction will also be necessary to avoid elevating the serum BUN levels. A nurse is caring for a client who was brought to the emergency room following an accident. The nurse suspects a ruptured bladder.Which of the following is consistent with this diagnosis? - ✔✔-Hematuria Rationale: The cheif manifestation of a ruptured bladder are hematuria (blood in the urine), pelvic pain, and oliguria (low urine output). A nurse is caring for a client who just had a transurethral resection of the prostate (TURP). Which of the following should the nurse remind the client to report to the provider? - ✔✔-Painful urination Rationale:The client should notify the provider of any signs of urinary tract infection, such as fever, urinary frequency, or painful urination. A nurse is caring for a client who is to undergo a cystoscopy. When reinforcing teaching to the client on post-procedure expectations, which of the following should the nurse state? - ✔✔-"Pink tinged urine and burning while urinating can be expected." Rationale: Cystoscopy is a direct look inside the clients bladder through a small camera that is inserted through the urethra. It is a common test used to look for causes to bleeding in the urine and other bladder problems. Following the procedure, pink tinged urine and burning on urination is to be expected. A nurse is caring for a client with a history of cystitis. Which of the following statements indicates a need for further education? - ✔✔-"I prefer to take baths instead of showers." Rationale: Women who have frequent uti's are encouraged to take showers instead of baths. A tub bath is more likely to cause irritation and contamination of the urethra; therefor, leading to frequent uti's. A nurse is caring for a client with chronic kidney disease. The nurse anticipates that the provider will prescribe a diet that has which of the following restrictions? - ✔✔-Protein Rationale: Chronic kidney disease is irreversible loss of kidney ability to excrete waste, concentrate urine, and conserve electrolytes. A diet low in protein supplies only essential amino acids reducing the amount of metabolic waste products and may help to preserve a degree of kidney function. A nurse is reinforcing teachings to a client scheduled for a vasectomy about the procedure. Which of the following client statements indicates an understanding of the procedure? - ✔✔-"I need to have a two follow-up negative sperm count." Rationale: Contraceptive measures need to be used until after sperm analysis are negative. Sperm can remain viable for up to 6month in the vas deferens. A nurse is caring for a client who has a diagnosis of renal calculi. Which of the following is a priority nursing action? - ✔✔-Relieve Pain Rationale: The pain associated with renal calculi is severe and should be addressed immediately. A nurse is caring for a client who is suspected of having a UTI. The provider prescribes a urine specimen. Which of the following findings should confirm to the nurse that an upper UTI involving the kidney is present? - ✔✔-Casts Rationale: Casts are protein structures that are precipitated in the renal tubules. Presence of the these in the urine indicates a pathologic condition of the kidney. A nurse is collecting a 24hr creatinine clearance. During the collection, the client accidentally discards a specimen. Which of the following is an appropriate nursing action? - ✔✔-Discard the previous collection and start the collection again. Rationale: All urine voided in a 24hr must be collected, or the test results will not be accurate. A nurse is caring for a client who has under-gone a non-related living donor kidney transplant. On the 5th postoperative day, the nurse notes that the client has gained 1kg of body weight since the previous day. The nurse suspects rejection. Which of the following would also be seen in a client experiencing rejection? - ✔✔-Blood Pressure of 160/90mm/Hg Rationale: If the client is having kidney rejection, that will be accompanied by kidney failure. Consequently, due to the kidneys role in fluid and blood pressure regulation, the client experiencing rejection will typically be hypertensive. A nurse is caring for a client who has chronic renal failure. Which of the following should the nurse remind the client to increase in her diet? - ✔✔-Calcium The client should supplement calcium in to her diet because the kidneys are unable to activate calcium through the gastrointestinal track. A nurse is reinforcing education on prostate health to a client. Which of the following statements is an appropriate statement for the nurse to make regarding a PSA test. - ✔✔-The PSA should not be given within 48hrs of a rectal exam. Rationale: PSA is a glycoprotein that is found only in cytoplasm of the epithelial cells of the prostate. A nurse is caring for a client receiving peritoneal dialysis. The nurse notes that the client's dialysate output is less than the input, the abdomen is distended, and the client is reporting pain. Which of the following is an appropriate nursing action? - ✔✔-Change the client's position. Rationale: Dialysate solution is infused through the catheter in the abdominal wall into the peritoneal space. If the client appears to be retaining the dialysate solution, the client should change positions to facilitate the drainage of the solution from the peritoneal cavity. A nurse is caring for a client with suspected acute renal failure who is to undergo a renal biopsy. Which of the following positions should the nurse assist the client into? - ✔✔-The client is positioned prone with a pillow elevating the abdomen. A renal biopsy is the insertion of a needle into the kidney just below the twelfth rib to obtain diagnostic specimens. A nurse is caring for a client receiving peritoneal dialysis. Which of the following is a complication of this procedure? - ✔✔-Infection Rationale: The danger of peritonitis requires a sterile techniques, closed sterile instillation and drainage systems, and frequent cultures of peritoneal drainage. A nurse is caring for a client with acute pyelonephritis. Which of the following is an appropriate response by the nurse regarding home care. - ✔✔-You should complete the entire cycle of antibiotic therapy. Rationale: It is important that the client take the full prescription of antibiotic therapy to decrease the chance of regrowth of the causative organism. A nurse is caring for a younger adult client who sustained massive damage to the bladder. An emergency cystectomy and ileal conduit was performed. After viewing the appliance for the first time, the client tells the nurse, "Well, I guess my sex life is over now." The most therapeutic response from the nurse would be which of the following? - ✔✔-Lets talk about why you feel that way. Rationale: In the therapeutic response the nurse acknowledges the client's feelings first and offer's to discuss the client's concerns. The nurse knows that ostomates live full, active and happy lives (including sexual expression) with ileal conduits and external appliances ABG's - ✔✔-Blood gas measurements are used to evaluate a person's lung function and acid/base balance. BG Element Normal Value Range pH 7.4 7.35 to 7.45 Pa02 90mmHg 80 to 100 mmHg Sa02 93 to 100% PaC02 40mmHg 35 to 45 mmHg HC03 24mEq/L 22 to 26mEq/L Metabolic acidosis is characterized by a lower pH and decreased HCO3-, causing the blood to be too acidic for proper metabolic/kidney function. Causes include diabetes, shock, and renal failure Specific gravity - ✔✔-Norm: 1.005 - 1.030 urine pH - ✔✔-Norm: 4.5 - 8 BUN ( blood urea nitrogen) - ✔✔-Norm: 5-20 ↑20 BUN levels suggest impaired kidney function. Cholesterol (total) - ✔✔-Desirable: A cholesterol below 200 mg/dL High risk: A cholesterol ↑ or equal to 240 mg/dL Glucose - ✔✔-From 70 to 99 mg/dL Normal fasting glucose From 100 to 125 mg/dL Prediabetes 126 mg/dL Diabetes Glycosylated Hemoglobin (HgbA1C) - ✔✔-A non-diabetic person will have an A1c result ↓ than 5.7% Diabetes: A1c level is 6.5% or higher Increased risk of developing diabetes in the future: A1c of 5.7% to 6.4% Hematocrit Male: Female: - ✔✔-Hematocrit is often performed as part of a CBC, results from other components are taken into consideration. A rise or drop in the hematocrit must be interpreted in conjunction with other parameters, such as RBC count, hemoglobin, reticulocyte count and/or red blood cell indices. Men: 40%-55% Women:36%-46% Cause ↑ Kidney tumor Cause ↓ Kidney failure platelets - ✔✔-Norm: 150,000 and 450,000 platelets per microlite ↓ 150,000 thrombocytopenia ↑ 450,000 thrombocytosis potassium - ✔✔-Norm: 3.5-5.5 mmol/L ↑ potassium levels: Acute or chronic kidney failure, Addison's disease, Diabetes ↓Decreased potassium levels: diarrhea & vomiting, Hyperaldosteronism, complication of acetaminophen overdose, In diabetes, the potassium level may fall after someone takes insulin, potassium-wasting diuretics Sodium - ✔✔-Norm: 135-145 mEq/L ↑ Sodium level hypernatremia: dehydration, Cushing syndrome, or diabetes insipidus. ↓sodium levels hyponatremia: edema, Addison's disease, diarrhea, diuretic administration, kidney disease, nephrotic syndrome, WBC - ✔✔-5,000-10,000 Creatinine - ✔✔-Male 0.9 - 1.3 mg/dL Female 0.6 - 1.1 mg/dL ↓creatinine levels: Typically no concern ↑ Creatinine level: glomerulonephritis, pyelonephritis, acute tubular necrosis, Prostate disease, kidney stone, urinary tract obstruction, complication w/diabetes PT (prothrombin time) - ✔✔-Norm: 10 to 13.5 seconds ↑ than 14seconds: liver disease, vitamin K deficiency, anticoagulation drug (warfarin) therapy, severe liver disease A prolonged PT means that the blood is taking too long to form a clot. PTT - ✔✔-Norm: 25 to 35 seconds longer than 35 sec. indicates- Disseminated intravascular coagulation, Hemophilia A or B, Liver disease, Malabsorption, Vitamin K deficiency, Von Willebrand's disease APTT - ✔✔-Norm: 25-35seconds Prolonged APTT + Prolonged PT= Vitamin K deficiency, Liver disease, thrombolytic therapy, Heparin, Warfarin, Coumadin INR - ✔✔-Norm: 0.8 to 1.2 Diuretic's Definition: Nursing interventions : - ✔✔-Definition: Drugs that act to increase the flow of urine. Purpose is to increase net loss of water. To do this they act on the kidney to increase excretion of sodium. Nursing Interventions Diet I&O Urine output Respond to BP Electrolytes Take pulse Ischemic episodes or TIAs Complications: CVA, CAD, CHR, CRF Loop Diuretics - ✔✔-Block reabsorption of sodium, chloride and water into the loop of Henle, these are most effective. Side effects: dehydration, hypokalemia, ototoxicity do not take w/aminoglycosides Types: Furosemide (Lasix), bmetanide (Bumex), ethacrynic asid (Edecrin), torsemide (Demadex) Thiazide Diuretics - ✔✔-Block the reabsorption of sodium and chloride and increases the excretion of K+ and water in the early distal tubule Most frequently prescribed Side effects similar to Loop but less Types: Hydrochlorothiazide (Microzide), bendroflumethiazide and nadolol (Corzide), metolazone (Zarozolyn), chlorthalidone (Hygroton), indapamide (Lozol), methyclothiazide (Enduron) Potassium-Sparing Diuretics - ✔✔-Blocks the reabsorption of sodium and reduce the secretion of potassium in the late distal tubule and collecting ducts Less side effects Weak diuretic effect Spironolactone (Aldactone), amiloride (Midamor), eperenone (Inspra), triamterene (Dyrenium) Osmotic Diuretics - ✔✔-Osmotic force to pull water into the nephron to increase the excretion of nearly all electrolytes in the proximal tubule and the loop of Henle Has very specific applications, can worsen edema Decreases cerebral edema Mannitol (Osmitrol), urea (Ureaphil), glycerin Carbonic Anhydrase Inhibitors - ✔✔-Inhibits carbonic anhydrase: an enzyme that affects acid-base Also has indications for use as an anticonvulsant and treating motion sickness Not commonly used: weak diuretic, can contribute to metabolic acidosis Acetazolamide (Diamox), methazolamide (Neptazane) Combination Drugs - ✔✔-Common to combine two or more drugs when treating HTN and fluid retention disorders. May give 2 separate meds or a single tablet combination Example: Aldactazide: hydrochlorothiazide and sironolactone Laxatives: - ✔✔-Chemicals that act to promote the evacuation of the bowel sub classified based on mechanism of action Stimulant Laxatives: - ✔✔-Irritant to intestine - promote peristalsis and evacuation within 6-10 hours (orally) or within 60-90 min (rectally) Ex-lax, Peri-colace, Dulcolax (also softens stool) Saline Laxatives: - ✔✔-Hypertonic compounds - draw water into intestine from surrounding tissue May cause dehydration & electrolyte imbalance. Works within 1-3 hours Magnesium Citrate - used bowel prep