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Following ureteroscopy, for the removal of ureteral calculus, a stent is temporarily left in place. The client asks what purpose the stent provides. Which is the correct response from the nurse?
- A. The stent is coated with an anti-infective to promote healing.
- B. The stent will catch any debris or blood clots left behind.
- C. The stent will provide easier passing of future stones.
- D. Inflammation from the stone can block the flow of urine.
Correct Answer: D
Rationale: Calculi can traumatize the lining of the ureters, resulting in inflammation and possible obstruction of urine flow. A stent is left behind to allow free-flowing urine until inflammatory process has resolved. Stents are not used for anti-infective properties or to catch debris or clots. Stents are not permanently placed for preventative measures.
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The client with chronic kidney disease is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?
- A. Azotemia
- B. Diminished erythropoietin production
- C. Impaired immunologic response
- D. Electrolyte imbalances
Correct Answer: B
Rationale: Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic kidney disease but not indicated with anemia.
A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead the nurse to support that the client is experiencing rejection?
- A. Hypertension
- B. Weight loss
- C. Polyuria
- D. Tenderness over transplant site
Correct Answer: D
Rationale: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the appropriate response by the nurse?
- A. Even a perfect match does not guarantee organ success.
- B. Immunosuppressive drugs guarantee organ success.
- C. The doctor may decide to delay the use of immunosuppressant drugs.
- D. Let's wait until after the surgery to discuss your treatment plan.
Correct Answer: A
Rationale: Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.
A child is brought into the clinic with symptoms of edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem?
- A. Sore throat 2 weeks ago
- B. Red blood cells in the urine
- C. Elevation of blood pressure
- D. Protein elevation in the urine
Correct Answer: A
Rationale: Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. Red blood cells and protein found in the urine and elevated blood pressure are symptoms associated with glomerulonephritis.
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client?
- A. Urine output of 35 to 40 ml/hour
- B. Pain of 3 out of 10, 1 hour after analgesic administration
- C. SpO2 at 90% with fine crackles in the lung bases
- D. Blood tinged drainage in Jackson-Pratt drainage tube
Correct Answer: C
Rationale: Altered Breathing Pattern and Ineffective Airway Clearance Risk are often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output are monitored to maintain a urine output of greater than 30 ml/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.