URS 315 EXAM CORRECT DEFINED ANSWERS 2025

NURS 315 EXAM CORRECT DEFINED ANSWERS 2025 What is glomerular filtration rate (GFR) and its normal range? Which diagnostic test can be used to measure GFR? - -- Glomerular Filtration Rate: The amount of blood filtered by the glomeruli in a given time. Most reliable indicator of kidney function - Normal Range: 70-135ml/min (125 mL/min) - GFR can be lower in older adults - Diagnostic Test Used to measure GFR: 24-hour urine collection, based on creatinine levels Bicarbonate normal range and changes when kidney function is impaired - -Normal Range: 22-26 mEq/L Changes: Most patients in renal failure have metabolic acidosis and low serum HCO3 − levels. BUN normal range and changes when kidney function is impaired - -Normal Range: 10 20 mg/dL Changes: Nonrenal factors may ↑ BUN BUN/Creatinine normal range and changes when kidney function is impaired - -Normal Range: 12:1-20:1 Changes: Increased ratio may be due to conditions that ↓ blood flow to kidneys Calcium normal range and changes when kidney function is impaired - -Normal Range: 9.0-10.5mg/dL Changes: Lower Creatinine normal range and changes when kidney function is impaired - -Normal: Males 0.6-1.2mg/dL/Females 0.5-1.1mg/dL Changes: Phosphorus normal range and changes when kidney function is impaired - -Normal Range: 3.5-4.5 mg/dL Changes: Phosphorus balance is inversely related to Ca2+ balance. In kidney disease, phosphorus levels are high Potassium normal range and changes when kidney function is impaired - -Normal Range: 3.5-5.0 mEq/L Changes: High K+ levels 6 mEq/L can lead to muscle weakness and dysrhythmias. NUR 315 NUR 315 Sodium normal range and changes when kidney function is impaired - -Normal Range: 136-145mEq/L Changes: Lowers Uric Acid normal range and changes when kidney function is impaired - -Normal Range: Male 4.0-8.5 mg/dL / Female 2.7-7.3 mg/dL Changes: Values depend on renal function, rate of purine metabolism, and diet intake of food rich in purines. Phosphate normal range and changes when kidney function is impaired - -Normal Range: 3-4.5 Changes: Higher because of indirect relationship with calcium What are the normal findings in urinalysis? - -- Bilirubin: None - Casts: None - Color: Amber yellow - Culture for organisms: No organisms in bladder 10 to the 4 organisms/mL result of normal urethral flora - Glucose: None - Ketones: None - Odor: Aromatic - Osmolality: 50-1200 mOsm - pH: 4.6-8.0 (6.o is average) - Protein: Random protein: 0-trace / 24h protein: 50-80mg/day - RBCs: 0-4/hpf - Specific gravity: 1.005-1.030 - WBCs: 0-5/hpf (elevated in UTI) Who are at the risk of development of urinary tract infection (UTI)? - -Hospitalized individuals with catheters, females - specifically those going through menopause, pregnant women, people with suppressed immune systems, Age (older adults), dehydration/malnutrition Pyelonephritis - -Upper tract; kidney, implies inflammation (usually caused by an infection) of the renal parenchyma and collecting system Cystitis - -Lower tract; inflammation of the bladder Urethritis - -Lower tract; inflammation of the urethra Upper Tract symptoms - -fever, chills, and flank pain NUR 315 NUR 315 Lower Tract symptoms - -Dysuria, frequency (voiding more than every 2 hours), urgency, and suprapubic discomfort or pressure. The urine may have grossly visible blood (hematuria) or sediment, giving it a cloudy appearance What are the characteristics of UTI symptoms among older patients? - -- Asymptomatic - typically mental status changes How would you instruct patients when they take antibiotics and over-the-counter medicines for UTIs? - -- Take full course of antibiotics - even if symptoms are gone continue to take it - Use over the counter (OTC) to relieve discomfort - Pyridium (inform patient that urine color may be orange), Urised (inform patient that urine color may be greenish/blueish) How would you promote the prevention of UTI in community and hospital settings? - ADD How would you teaching patient about preventing UTIs? - -1. Take all antibiotics as prescribed. Symptoms may improve after 1-2 days of therapy, but organisms may still be present. 2. Practice appropriate hygiene, including: • Carefully clean the perineal region by separating the labia in females, or in males pulling back the foreskin if present when cleansing. • Wipe from front to back after urinating. • Cleanse with warm soapy water after each bowel movement. 3. Empty the bladder before and after sexual intercourse. 4. Void regularly, about every 3-4 hours during the day. 5. Maintain adequate fluid intake. 6. Avoid vaginal douches and harsh soaps, bubble baths, powders, and sprays in the perineal area. 7. Report to the HCP symptoms or signs of recurrent UTI (e.g., fever, cloudy urine, pain on urination, urgency, frequency). Glomerulonephritis - -Immunologic processes result in inflammation of the glomeruli. NOT an infection. Bowman's capsule doesn't work What medical history will help you to identify the risk of glomerulonephritis? - -Recent respiratory or throat infection What are the clinical manifestations of glomerulonephritis? - -Hematuria, proteinuria, periorbital and peripheral edema, hypertension, flank pain How to modify fluid intake, diet, and activity level for patient with APSGN? - -- Fluid intake: restrict sodium and fluid intake, diuretics NUR 315 NUR 315 - Diet: Low protein diet, kidney is unable to filter it out - can give antihypertensive medications and antibiotics if strep infection is still indicated - Activity Level: REST, allow kidneys and immune system to take a break Nephrotic Syndrome - -Glomerulus is excessively permeable to plasma protein - lots of protein is lost What are the clinical manifestations for nephrotic syndrome? - -Severe proteinuria (3.5g/day), Hypoalbuminemia (normal is 3.5-5), Peripheral edema, hypo-/hypertension, hyperlipidemia (liver produces more protein which also produces more cholesterol, more than 200), infections, hypercoagulation How would you modify patient's fluid intake and diet to treat the symptoms of nephrotic syndrome? - -- Fluid Intake: Low sodium, diuretics - Diet: Moderate/increase protein diet How would you monitor for edema for renal patients? - -- Daily weight, I and O, abdominal girth - If treatment for nephrotic syndrome is working, edema should be better with these monitoring techniques What are the major risk factors for the development of Urinary Tract Calculi? - -Climate • Warm climates that cause increased fluid loss, low urine volume, and increased urine solute concentration Diet • Excess amounts of tea or fruit juices that increase urinary oxalate level • Large intake of diet proteins that increases uric acid excretion • Large intake of salt, low calcium intake • Low fluid intake that increases urine concentration Genetic Factors • Family history of stone formation, cystinuria, gout, or renal acidosis Lifestyle • Immobility • Obesity • Sedentary occupation Metabolic • Abnormalities that result in increased urine pH, calcium, oxalate, or uric acid levels, or low citrate Calcium Oxalate stone treatment - -Increase hydration. Reduce oxalate intake (spinach, beets, potatoes), animal protein, and sodium. Increase intake of calcium, fruits, and vegetables. Give thiazide diuretics. Give potassium citrate to maintain alkaline urine. Avoid vitamin C and calcium supplements. NUR 315 NUR 315 Uric Acid stone treatment - -Increase hydration. Reduce urinary concentration of uric acid. Alkalinize urine with potassium citrate. Consider allopurinol. Reduce purine intake (meats and seafood) What are the major clinical symptoms and their complications for Urinary Tract Calculi? - -- Manifestations: severe abdominal or flank pain, hematuria, fever - Complications: UTI (infection), Acute urinary retention What are the major interventions and nursing care principles for Urinary Tract Calculi? - -- Noncontrast CT/KUB - Intravenous pyelogram (IVP) - Pain control (PRIORITY) - opioids - Monitor urinary elimination - Control infection Intravenous pyelogram (IVP) - -NPO, check iodine and shellfish allergy and assess kidney function first, normal reaction to dye - flushed face, salty taste Post cystoscopy - --Used for stones in the bladder o Cystoscope is interested into the bladder and crushes the stone § Complications: · Expect burning, pink tinges (not red!) urine, and frequency · May need continuous bladder irrigation to prevent clots · Watch for bleeding and infection What complications do you need to watch for during post-op period? - -- Complications: bleeding, injury, and infection What post of teaching do you give? - -- Strain urine through gauze to collect stone o Identifies the type of stones to help educate patient on dietary restrictions and treatment plan in the future. Encourage fluid (3L/day) and encourage ambulation What are the major clinical manifestations of PKD? - -- Enlarged kidney, hypertension, hematuria, pain, multisystem involvement What educational information would you provide to a patient who has been diagnosed as Polycystic kidney disease (PKD)? - -- Educate patient to have their children come to the hospital to have the counseling and screening for PKD because it is a genetic condition - Also educate about pain management and monitor for hypertension/bleeding/pain/infection and other clinical manifestations - Educate about avoiding activities that can cause a risk for injury to then kidney (prevent rupture) NUR 315 NUR 315 What the risk factors for bladder cancer? - -Males, most common at age 60-70, smoking, Exposure to: dyes, rubber, leather, ink, paint, chronic renal calculi, UTI What are the characteristics of the symptoms for bladder cancer? - -Painless gross hematuria (blood is easily seen), dysuria, freq, urgency Intravesical Therapy - -- BCG is placed in the bladder for 1-2 hours acting as chemotherapy or immunotherapy for bladder cancer o First, the patient must void, then a catheter is placed, and the medication is inserted into the bladder o The patient must change position every 15 minutes, so the medication is washed over each part of the bladder o This therapy is done once a week for 6-12 weeks o Patient may develop flu like symptoms Urinary Incontinence Treatment - -- Functional incontinence: Modifying environment - Overflow: straight cath - Reflex: Treat underlying cause, pelvic floor exercises, anticholinergics - Stress: Kegal exercises - Urge: Ditropan (anticholinergic), bladder training What is your first action when you identify patient has acute urinary retention? - Catheter insertion Indwelling Catheter Uses - -o Relieve urinary retention caused by lower urinary tract obstruction, paralysis, or inability to void o Bladder decompression preoperatively and operatively for lower abdominal or pelvic surgery o Facilitate surgical repair of urethra and surrounding structures o Splinting of ureters or urethra to promote healing after surgery or other trauma in area o Accurate measurement of urine output o Contamination of stage III or IV pressure injuries with urine that has impeded healing, despite appropriate personal care for the incontinence o Terminal illness or severe impairment, which makes positioning or clothing changes uncomfortable, or which is associated with intractable pain Incontinent Urinary Diversion - -Ileal conduit o Cut a segment of the ileum and one side is... Continent Urinary Diversion - -Kock pouch, Indiana pound o Part of the bowel is made into.. Orthotopic Bladder Reconstruction - -Neobladder o Fake bladder made out of bowels and attaches to ureters NUR 315 NUR 315 o Patient is able to urinate out of their urethra Ileal Conduit - -- Requires patient to wear appliance over the stoma to collect urine. Teach how to change bag, how to control odors (a little bit of vinegar), how to take care of the skin around the stoma, o After the surgery: Patency of the ileal conduit - monitor urine output and color of stoma Kock pouch and Indiana pouch - -patient needs to self-catheterize the stoma to drain the reservoir at 4- to 6- hour intervals Neobladder - -patient empties the neobladder by relaxing the external sphincter and bearing down or by intermittent self-catheterization because they have no desire to void Pre-op and Post-op care for urinary diversion - -- Pre-op: assess readiness to learn - Post-op: o Prevent surgical complications o Prevent injury to stoma (stoma should be pink or red), instruct altered elimination pattern, skin care, maintain urine output by high fluid intake o Address physiological needs: body image o Discharge instruction: symptoms of infection and obstruction, care of ostomy (secretions around is normal, odor, crust around stoma), appliances o Never clamp tubing, always make sure the catheter is not obstructed or kinked Main points in pt teaching on self-care of urostomy bag - -1. Keep pouch in place for 3-4 days. May need changed more or less often as needed. 2. Change pouch when fluid intake has been restricted for several hours. 3. Sit or stand in front of mirror. 4. Can moisten edge of faceplate with warm water or adhesive solvent and gently remove. 5. Use warm water and a washcloth to clear the skin around the stoma. Use soap to remove any adhesive solvent. 6. Dry skin and inspect. 7. Place wick (rolled-up 4 × 4-inch pad) over stoma to keep skin free of urine. 8. Place pouch over stoma. Family History Assessment - -Ask the patient and caregiver about any inherited traits since they may contribute to the surgical outcome. These can include hypertension, sudden cardiac death, MI, etc. The patient may have a similar predisposition or condition o Obtain information about the patients family history of adverse reactions to or problems with anesthesia (ex: malignant hyperthermia) NUR 315 NUR 315 Medications assessment - -Antidepressants effecting anesthesia, coumadin, aspirin, can effect bleeding What might need to be held?? Herbal Assessment - -Garlic, ginger - can effect blood thinning Allergies Assessment - -Latex; ask about what happens when exposed and make sure its an allergy o If you find out a patient is allergic to latex notify OR and surgeon immediately Medical Conditions Assessment - -o Cardiovascular: Dysarthria, Congenital heart disease, clots/DVT (higher cholesterol = higher risks), bleeding (takes blood thinner previously increases risk) o Respiratory: Listen for crackles, if patient has crackles further assess the patient and then contact the doctor with evidence of why the patient may have crackles in lungs o Neurologic: Loss of consciousness, Increased Intracranial Pressure - need to watch for older adults because they are more at risk for delirium after surgery. Check and compare baseline assessments o Genitourinary: Kidneys, watch the labs (intake and output), test women for pregnancy o Hepatic: Alcohol use, albumin level (malnutrition) o Integumentary: Color (circulation), Skin breakdown (pressure ulcers) o Musculoskeletal: Anything that interferes with positioning of the patient (osteoporosis, arthritis, low ROM, etc) o Endocrine: Check glucose levels and follow hospital protocol about whether or not patients with diabetes will receive insulin or not before surgery o Immune system: Patient on antibiotics CANNOT go to surgery -Assess for smoking history, obesity, etc. What things could effect the surgery?? NPO timeframes - -- Clear liquids (e.g., water, clear tea, black coffee, carbonated beverages, fruit juice without pulp): 2 Hours - Breast milk: 4 hours - Nonhuman milk, including infant formula: 6 hours - Light meal (e.g., toast and clear liquids): 6 hours - Regular meal (may include fried or fatty food, meat): 8 hours or more Informed consent - -An active, shared decision-making process between the HCP and the recipient of care. What information does the nurse need to verify when obtaining consent from the patient? - -· There must be adequate disclosure of everything about the treatment · Patient must have a clear understanding (no more