Question 1

The nurse is aware that as a person ages there is a loss of the __________mechanism of the kidney due to a decrease in blood supply to the kidneys and loss of nephrons.

Accepted Answer

The filtering mechanism is most affected with aging.By the age of 70,the filtering mechanism is only 50% as efficient as at 40 years of age.

Question 2

A home health patient with end-stage renal disease (ESRD)has a nursing diagnosis of powerlessness related to life-altering disease.Which nursing intervention would be most helpful?

Accepted Answer

Listen to the patient and allow time for discussion about concerns and the plan of care to return some sense of control.End-of-life discussions are premature.

Question 3

The nurse notes the amount and color of the urine the patient with urolithiasis has voided.While using Standard Precautions,what should be the nurse's next action?

Accepted Answer

All urine should be strained.Because stones may be any size,even the smallest speck must be saved for assessment by the laboratory.

Question 4

It is 2 days after a 42-year-old male patient's urinary diversion surgery.He continues to be critical of the hospital and the nursing care,even though the staff has spent time explaining the care to him.What is the most likely explanation for his behavior?

Accepted Answer

Persons with altered body image may react to the loss of self-esteem by behaving in a critical or derogatory manner.

Question 5

As the body breaks down protein,nitrogen wastes are broken down into urea,ammonia,and:

Accepted Answer

As proteins break down,nitrogenous wastes-urea,ammonia,and creatinine-are produced.

Question 6

As the nurse and the dietitian review a female patient's diet plan with her,she shouts that with her diabetes and now the kidney failure,there is just nothing she can eat.She says she might as well eat what she wants,because there is nothing she can do to help herself.Based on the patient's response,which nursing diagnosis does the nurse identify?

Accepted Answer

Ineffective coping due to the feeling of powerlessness against the multiorgan failure may result in aggressive or infantile behavior.

Question 7

What should the nurse encourage,barring any other contraindication,when teaching a patient how to decrease the chance of further problems with urolithiasis?

Accepted Answer

Fluid intake should be encouraged to at least 2000 mL of fluid in 24 hours,unless contraindicated.

Question 8

The patient is scheduled for a transurethral resection of the prostate.During preoperative teaching,what should the nurse emphasize about what the patient can expect after the procedure?

Accepted Answer

The patient and family need to know that hematuria is expected after prostatic surgery.

Question 9

Because the kidneys are located in proximity to the vertebrae and are protected by the ribs,their location in documentation is referred to as:

Accepted Answer

The kidneys lie behind the parietal peritoneum (retroperitoneal).

Question 10

A patient,age 69,is admitted to the hospital with gross hematuria and history of a 20-lb weight loss during the last 3 months.The physician suspects renal cancer.In obtaining a nursing history from this patient,the nurse recognizes which of the following as a significant risk factor for renal cancer?

Accepted Answer

Risk factors include smoking;familial incidence;and preexisting renal disorders,such as adult polycystic kidney disease and renal cystic disease secondary to renal failure.

Question 11

What is the hormone from the posterior pituitary gland that influences the amount of water that is eliminated with the urine?

Accepted Answer

ADH causes the cells of the distal convoluted tubules to increase their rate of water reabsorption.

Question 12

The patient is on postoperative day 1 after having undergone a TURP procedure.He has continuous bladder irrigation (CBI).Actual urine output during continuous bladder irrigation is calculated by:

Accepted Answer

To determine urine output,the nurse will subtract the amount of irrigation fluid used with the Foley catheter output to calculate urine output.

Question 13

The patient with nephrosis complains about the need for bed rest.How would the nurse explain the benefit of bed rest?

Accepted Answer

It is believed that the recumbent position helps initiate diuresis.

Question 14

A patient who is receiving continuous bladder irrigation following a transurethral resection of the prostate (TURP)complains of "spasm-like" pain over his lower abdomen.What should the initial intervention be by the nurse?

Accepted Answer

The patient who has a TURP may have continuous closed bladder irrigation or intermittent irrigation to prevent occlusion of the catheter with blood clots,which would cause bladder spasms.

Question 15

A 56-year-old patient with cancer of the bladder is recovering from a cystectomy with an ileal conduit.What is an important aspect in nursing interventions of the patient with an ileal conduit?

Accepted Answer

Care of the patient with an ileal conduit is a nursing challenge because of the continual drainage of urine through the stoma.Complications of this procedure are wound infection,dehiscence,and urinary leakage.The patient is urged to drink adequate fluids to flush the conduit.

Question 16

A male patient,age 71,has benign prostatic hypertrophy.He is recovering from a trans-urethral prostatic resection.The physician orders removal of the indwelling catheter 2 days after the TURP procedure.What might the patient experience after the catheter is removed?

Accepted Answer

The patient is informed that initially he may experience frequency and voiding small amounts with some dribbling.There should be no hematuria or clots after 2 days.

Question 17

When the home health patient is started on dialysis,the home health nurse refers the patient to a community support group that assists with the adjustments necessary to living with dialysis.Which group offers this service?

Accepted Answer

The American Association of Kidney Patients offer support to the patient and family as they adapt to living with dialysis.

Question 18

What should the nurse instruct the patient to do before obtaining the urine specimen for a urine culture?

Accepted Answer

Urine cultures are dependent on a clean-catch or catheterized specimen.

Question 19

The nurse assessing a patient who is taking furosemide (Lasix)finds an irregular pulse.This is likely a sign of:

Accepted Answer

The loop diuretic prototype,furosemide (Lasix),affects electrolytes and causes hypokalemia;
the deficiency of the electrolyte can cause arrhythmias and muscle weakness.

Question 20

What portion of the nephron is involved with filtration?

Accepted Answer

Filtration of water and blood products occurs in the glomerulus of the Bowman capsule.

Quiz 10: Care of the Patient with a Urinary Disorder