Renal and Urinary System: Saunders NCLEX Review

Renal and Urinary System: Saunders NCLEX Review

ScienceMedicineEmergency Medicine mr235088 Save NCLEX Questions for Renal Disorder...40 terms mdunlap5920Preview Renal NCLEX Questions 30 terms lilnurseangelPreview Saunders NCLEX Renal* 143 terms Astra-dutchie Preview Fluid a 33 terms Ale A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply.

• Place the client on a cardiac monitor.
• Notify the health care provider (HCP).
• Put the client on NPO (nothing by mouth) status except for ice chips.
• Review the client's medications to determine if any contain or retain potassium.
• Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

1, 2, 4

Rationale: The normal potassium level is 3.5-5.0 mEq/L(3.5- 5.0 mmol/L). A potassium level of 7.0 is elevated. The client with hyperkalemia is at risk of developing cardiac dysrhyth- mias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the HCP and also review medications to determine if any contain potassium or are potassium retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly.A client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious and the nurse suspects air embolism. What are the priority nursing actions? Select all that apply.

• Administer oxygen to the client.
• Continue dialysis at a slower rate after checking the lines for air.
• Notify the health care provider (HCP) and Rapid Response Team.
• Stop dialysis, and turn the client on the left side with head lower than feet.
• Bolus the client with 500 mL of normal saline to break up the air embolus.

1, 3, 4

Rationale: If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, position the client so the air embolus is in the right side of the heart, notify the HCP and Rapid Response Team, and administer oxygen as needed. Slowing the dialysis treatment or giving an intravenous bolus will not correct the air embolism or prevent complications.

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition?

• Pyelonephritis
• Glomerulonephritis
• Trauma to the bladder or abdomen
• Renal cancer in the client's family

3 Rationale: Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematu- ria.Glomerulonephritis and pyelonephritis would be accom- panied by fever and are thus not applicable to the client described in this question.Renal cancer would not cause pain that is felt in the low abdomen; rather, the pain would be in the flank area.The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? Select all that apply.

• Hemodialysis
• Peritoneal dialysis
• Kidney transplant
• Bilateral nephrectomy
• Intense immunosuppression therapy

1, 3, 4

Rationale: Polycystic kidney disease is a genetic familial dis- ease in which the kidneys enlarge with cysts that rupture and scar the kidney, eventually resulting in end-stage renal disease. Treatment options include hemodialysis or kidney transplant. Clients usually undergo bilateral nephrectomy to remove the large, painful, cyst-filled kidneys. Peritoneal dialysis is not a treatment option due to the infected cysts. The condition does not respond to immunosuppression.A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action?

• Notify the HCP before performing the catheterization.
• Use a small-sized catheter and an anesthetic gel as a lubricant.
• Administer parenteral pain medication before inserting the catheter.
• Clean the meatus with soap and water before opening the catheterization kit.

1 Rationale: The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing. The other options include performing the catheterization pro- cedure and therefore are incorrect.

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent?

• Palpation of a thrill over the fistula
• Presence of a radial pulse in the left wrist
• Visualization of enlarged blood vessels at the fistula site
• Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand

1 Rationale: The nurse assesses the patency of the fistula by pal- pating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Enlarged visible blood vessels at the fistula site are a normal observation but are not indicative of fistula patency. Although the presence of a radial pulse in the left wrist and capillary refill less than 3 seconds in the nail beds of the fingers on the left hand indicate adequate circulation to the hand, they do not assess fistula patency.A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder?

• Hematuria and pyuria
• Dysuria and proteinuria
• Hematuria and urgency
• Dysuria and penile discharge

4 Rationale: Urethritis in the male client often results from chla- mydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays. Hema- turia is not associated with urethritis. Proteinuria is associated with kidney dysfunction.The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination?

• Fever, diarrhea, groin pain, and ecchymosis
• Nausea, painful scrotal edema, and ecchymosis
• Fever, nausea, vomiting, and painful scrotal edema
• Diarrhea, groin pain, testicular torsion, and scrotal edema

3 Rationale: Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection, although sometimes it can be caused by trauma. The remaining options do not present all of the accurate manifestations.

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder?

• Soft and swollen prostate gland
• Swollen, and boggy prostate gland
• Tender and edematous prostate gland
• Tender, indurated prostate gland that is warm to the touch

4 Rationale: The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated.Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection, which often accompany the disorder.The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia?

• Nocturia
• Scrotal edema
• Occasional constipation
• Decreased force in the stream of urine

4 Rationale: Decreased force in the stream of urine is an early symptom of benign prostatic hyperplasia. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and noc- turia. If untreated, complete obstruction and urinary retention can occur. Constipation or scrotal edema is not associated with benign prostatic hyperplasia.The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply.

• Check the level of the drainage bag.
• Reposition the client to his or her side.
• Contact the health care provider (HCP).
• Place the client in good body alignment.
• Check the peritoneal dialysis system for kinks
• Increase the flow rate of the peritoneal dialysis solution.

1, 2, 4, 5

Rationale: If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the HCP. Increasing the flow rate should not be done and also is not associated with the amount of outflow solution.