Nokea
After receiving change-of-shift report, which of the following patients should the nurse assess first?
- A. A patient with nephrotic syndrome with massive edema and ascites
- B. A patient with stage 3 chronic kidney disease with complaints of fatigue
- C. A patient with stage 4 chronic kidney disease with complaints of dysuria
- D. A patient with urolithiasis who needs teaching about preventing recurrence
Correct Answer: A
Rationale: The patient with nephrotic syndrome with massive edema and ascites is at risk for complications such as respiratory distress or infection due to fluid overload, making this the priority for assessment. Fatigue and dysuria in chronic kidney disease and teaching needs for urolithiasis are less urgent.
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The nurse is caring for a patient whose renal calculus is analyzed as being very high in uric acid. To prevent recurrence of stones, which of the following foods should the nurse teach the patient to avoid eating?
- A. Milk and dairy products
- B. Legumes and dried fruits
- C. Organ meats and sardines
- D. Spinach, chocolate, and tea
Correct Answer: C
Rationale: Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.
The nurse is caring for a young adult female patient who is diagnosed with polycystic kidney disease. Which of the following information should the nurse include in teaching at this time?
- A. Importance of genetic counselling
- B. Complications of renal transplantation
- C. Methods for treating persistent and severe pain
- D. Differences between hemodialysis and peritoneal dialysis
Correct Answer: A
Rationale: Because a young female patient may be considering having children, the nurse should include information about genetic counselling when teaching the patient. The well-managed patient will not need to choose between hemodialysis and peritoneal dialysis or know about the effects of transplantation for many years. There is no indication that the patient has persistent pain.
The nurse is assessing a male patient with symptoms of a feeling of incomplete bladder emptying and a split, spraying urine stream. Which of the following conditions should the nurse question the patient about when taking a health history?
- A. Bladder infection
- B. Recent kidney trauma
- C. Gonococcal urethritis
- D. Benign prostatic hyperplasia
Correct Answer: C
Rationale: The patient's clinical manifestations are consistent with urethral strictures, a possible complication of gonococcal urethritis. These symptoms are not consistent with benign prostatic hyperplasia, kidney trauma, or bladder infection.
The nurse is preparing a patient with bladder cancer for intravesical chemotherapy. Which of the following information should the nurse teach the patient about in preparation for the treatment?
- A. Premedicating to prevent nausea
- B. Where to obtain wigs and scarves
- C. The importance of oral care during treatment
- D. The need to empty the bladder before treatment
Correct Answer: D
Rationale: Intravesical chemotherapy is the instillation of the agent directly into the bladder, therefore the patient needs to have an empty bladder before the instillation of the chemotherapy. Systemic adverse effects are not experienced with intravesical chemotherapy.
The nurse is obtaining the health history for a patient who smokes two packs of cigarettes daily. Which of the following conditions should the nurse include in the teaching plan that the patient is at an increased risk for developing?
- A. Kidney stones
- B. Bladder cancer
- C. Bladder infection
- D. Interstitial cystitis
Correct Answer: B
Rationale: Cigarette smoking is a risk factor for bladder cancer. The patient's risk for developing interstitial cystitis, urinary tract infection (UTI), or kidney stones will not be reduced by quitting smoking.