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Renal Review Flashcards

Terms in this set (43)

When caring for a patient who has just returned from a cystoscopy, it is most important for the nurse to observe for...
Bright red urine
A 78-year-old woman is at her annual checkup with her health care provider. She seems very embarrassed about asking if it's normal to "leak" urine when coughing or laughing, especially at her age. She has given birth to five children.

What is the nurse's best response to this question?
"Involuntary loss of urine or incontinence is not a normal consequence of childbirth or aging."
Later in the visit, the patient asks what could have caused her stress incontinence. What is the nurse's most accurate reply?
"It may be due to weakening of the bladder neck support that is associated with childbirth."
Before going home, the patient asks what can be done to fix her problem with urine leaking. Which teaching points should the nurse be sure to include? (Select all that apply.)
- First, keep a diary of episodes of incontinence.
- Collection devices can be used during treatment.
- Kegel exercises can help strengthen the muscles that prevent urine leakage.
- You may want to avoid caffeine and other bladder irritants.
The patient says that she vaguely recalls advice from her OB/GYN about Kegel exercises, but does not recall how to perform them.
1) How should the nurse describe this procedure?
Kegel exercises help strengthen the pelvic floor muscles. These muscles support the bladder, rectum, small intestine, and uterus and can help prevent urinary incontinence. To perform Kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if you're lifting the marble. Try it for three seconds at a time, then relax for a count of three.
2) How many repetitions of Kegel exercises should be recommended that the patient perform?
The patient should try to perform 3 sets of Kegels per day with 10-15 repetitions a set
The patient says that a friend mentioned taking antidepressant drugs when she had a similar problem, (with stress incontinence) and asks if this could help herself. What is the nurse's best response?
"Tricyclic antidepressants such as imipramine have been helpful in relieving urinary incontinence."
A 21-year-old male reports burning and difficulty with urination. What priority question would obtain information about the patient's chief complaint?
"Are you sexually active?"
Which patient is at greatest risk of developing a kidney stone?
Overweight Caucasian male
Once an indwelling urinary catheter is placed, how long before bacterial colonization begins?
48 hours
Which statement about sulfonamide therapy is true?
Clients on sulfonamide therapy need to increase their fluid intake.
The nurse identifies the patient with the greatest risk for a urinary tract infection as a...
72-year-old woman hospitalized with a stroke who has a urinary catheter because of urinary incontinence.
Clients taking methenamine (Urex) for urinary tract infections are counseled to drink cranberry juice in order to...
Lower the pH of the urine
Which statement by the client indicates that MORE TEACHING on nitrofurantoin (Macrodantin) therapy is needed?
"I will not take this medication at bedtime because it causes insomnia."
A client with a urinary tract infection is complaining of pain with urination. The nurse would anticipate the client's receiving...
PhenazopyRIDine (PyRIDium)
(think RID of the pain :D)
Which of the following medications is indicated in the treatment of hypotonic or atonic bladder? (damage to stretch receptors - reduced awareness of being full)
Bethanechol (Urecholine)
(Stim bladder to empty urine retention)
To evaluate the effectiveness of treatment for the patient with nephrotic syndrome, the nurse assesses...
The abdominal girth daily.
A client has been diagnosed with a lower
urinary tract infection, or cystitis, caused by
the gram-negative microorganism E. coli.
1) What other bacteria commonly cause cystitis?
Yeast, Saprophyticus, Proteus species, Klebsiella species, Enterococcus faecalis, Enterobacteriaceae, Staphylococcus saprophyticus in young women and S saprophyticus in older women (oof)
2) What symptoms are common with cystitis?
- strong, persistent urge to urinate
- burning sensation when urinating
- passing frequent, small amounts of urine
- cloudy urine
- urine that appears red, bright pink or cola-colored (bloody urine)
- strong-smelling urine
- pelvic pain
- fever
- pain when urinating
- confusion or altered mental status can be a symptom in older patients.
A client with a lower urinary tract infection has been prescribed Nitrofurantoin (Macrodantin). What side effects/adverse reactions would the nurse teach the
client to expect? (Select all that apply)
- Brown, discolored urine
- umm she didnt list anything else even though its SATA... but I said anxiety also?? (DM me if I'm wrong please :D)
A client entering the medical clinic has been
diagnosed with an overactive bladder. Which
medication would the nurse expect to be ordered?
Tolterodine tartrate (Detrol)
(think "toilet rate" maybe) (Detrol = Pee-trol - control of pee)
A patient with bladder cancer undergoes a cystectomy with formation of an ileal conduit. During the patient's first postoperative day, the nurse plans to...
Empty the drainage bag every 2 to 3 hours and measure the urinary output
A 35-year-old patient is admitted to the ED with fever, chills, and severe right flank pain. His heart rate is 112/min and respiration rate is 32/min. He was recently treated for a urinary tract infection. Assessment reveals tenderness of the right costovertebral angle (CVA).
1) What diagnosis does the nurse expect?
Possible relapse of UTI; development of kidney infection; or possible kidney stones
2) What laboratory tests does the nurse anticipate?
- CBC and Metabolic panel blood labs should be drawn to assess the patients creatinine, BUN, and GFR levels.
- A urinalysis should be taken to assess for clarity, color, protein, specific gravity, and any bacteria or blood in the urine.
- Some sort of imaging should be done such as an X-ray, MRI, or CT scan to evaluate for and possibly rule out kidney stones.
The patient is diagnosed with possible acute pyelonephritis and is admitted to the acute medical unit.
What is the nurse's priority concern on admission?
Acute pain
Which orders and interventions should be implemented for the priority patient problem on admission to the unit? (Select all that apply.)
- Administer analgesics as ordered.
- Assess patient pain level often.
- Administer nitrofurantoin (Macrodantin) 50 mg with meals and at bedtime.
- Encourage 2 to 3 L of fluid intake per day.
Which imaging test would the nurse expect to be ordered for this patient (with acute pyelonephritis)?
IV urography
(radiological procedure used to visualize abnormalities of the urinary system, including the kidneys, ureters, and bladder -- xray dye injected into arm vein, flows through and outlines renal system structures for xray imaging)
Two days later during morning assessment, the patient expresses embarrassment about his illness. He says that he did not take all of the antibiotics prescribed to treat his UTI 2 weeks ago.
What is the nurse's best response?
"Can you tell me more about why you didn't take all of your antibiotics?"
The older adult patient with acute glomerulonephritis is often misdiagnosed with...
Congestive heart failure
Which assessment parameter requires IMMEDIATE attention in a patient with polycystic kidney disease?
Hypertension
What percentage of patients with end-stage kidney disease treated by dialysis or kidney transplant have diabetes mellitus?
44% hade diabetes mellitus
When implementing care for the patient on peritoneal dialysis, the nurse recognizes that dietary needs include an INCREASED amount of...
Protein
When teaching a patient with chronic kidney disease about prevention of complications, the nurse instructs the patient to...
Weigh daily and report a gain of greater than 4 pounds. (think urine retention)
Six days following a deceased donor kidney transplant, the patient develops a temperature of 101.2° F (38.5° C), tenderness at the transplant site, and oliguria. The nurse recognizes that these findings indicate....
Acute rejection, which is not uncommon and is usually reversible.
A 68-year-old woman has chronic kidney disease and a history of type 2 diabetes. Two weeks ago, she had surgery to place a vascular graft access for hemodialysis.
Which precaution will the nurse follow to ensure the function of the AV graft?
Check for a BRUIT (abnormal; murmur) by auscultation AND a THRILL (vibrations on skin over turbulence indicating a murmur) by palpation over the site.
The patient is to have hemodialysis this morning.
Which drug should be HELD unTIL AFTER the dialysis treatment?
Atenolol (Tenormin)
(beta-blocker lowering BP, HR, and strain on heart)
After dialysis, the patient's daughter asks why the dialysis nurses weighs her mother before and after the dialysis treatment.
What is the nurse's best response?
"It estimates the amount of fluid and sodium your mother is retaining and how much is taken off during dialysis."
After dialysis, which instruction should the nurse provide to the student nurse who is helping to provide care for the patient?
Expect the patient's temperature to be higher after dialysis.
As the patient is preparing to discharge, the patient should be taught to RESTRICT which elements in her diet? (Select all that apply.)
- Potassium
- Phosphorus
- Protein
(3 P's !! its all about the Pee)
Which clinical data requires IMMEDIATE nursing intervention to PREVENT progression of acute kidney injury?
Urine specific gravity of 1.001
Use of the alpha-adrenergic blocker prazosin (Minipress) is CONTRAINDICATED for clients with....
Renal disease
A patient with end-stage kidney disease (ESKD) has this serum laboratory analysis:
K+ 5.9 mEq/L
Na+ 152 mEq/L
Creatinine 6.2 mg/dL
BUN 60 mg/dL
What would the priority intervention be?
Assess the heart rate and rhythm
True or False = Patients with diabetes who also have chronic kidney disease require LESS insulin to treat hyperglycemia than a patient with diabetes who does NOT have chronic kidney disease.
Trueeee
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