Download CHA 2 Exam 3 | Comprehensive Questions and Answers Latest Updated 2025/2026 With 100% Veri and more Exams Nursing in PDF only on Docsity!
CHA 2 Exam 3 | Comprehensive Questions and Answers Latest Updated 2025/2026 With 100% Verified Solutions When obtaining a health history from a 22-year-old female client who has new-onset urinary incontinence, which findings or factors does the nurse consider significant? (65-1) a. chemical exposure in the workplace b. a burning sensation occurring on urination c. urinating 10 times daily although fluid intake remains unchanged d. a recent change in the client's oral contraceptive prescription e. a new inability to hold urine (urgency) f. a stinky odor from urine - B, C, E, F YELLOW BOX - Ensure that the patient who is prescribed metformin does not receive the drug after a procedure requiring IV contrast material until adequate kidney function has been determined. Which client being managed for dehydration does the nurse consider at greatest risk for possible reduced kidney function? (65-2) a. an 80 year old man who has benign prostatic hyperplasia b. a 62 year old woman with a known allergy to contrast media c. a 48 year old woman with established urinary incontinence d. a 45 year old man receiving oral and IV fluid therapy - a. which symptom(s) in a client during the first 12 hours after a kidney biopsy indicates to the nurse a possible complication from the procedure? (65-4) a. the client experiences nausea and vomiting after drinking juice b. the biopsy site is tender to light palpation. c. the abdomen is distended, and the client reports abdominal discomfort d. the heart rate is 118, blood pressure 108/50, and peripheral pulses are thready - d. nursing interventions for kidney stones focus on.. - comfort and preventing infection and urinary obstruction
A 70 year-old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? (66-5) a. a five-pack year history of smoking 45 years ago b. difficulty starting and stopping the urine stream c. a 30-year occupation as a long-distance truck driver d. a recent colon cancer diagnosis in his 72-year-old brother - c. Which question does the nurse ask the client who has urinary tract infection to assess the risk for possible pyelonephritis? (67-1) a. what drugs do you take for asthma b. how long have you had diabetes? c. how much fluid do you drink daily? d. do you take your antihypertension drugs at night or in the morning? - b. GREEN BOX - The less common symptoms of acute GN are more likely to occur in older adults. circulatory congestion and pulmonary edema often are present causing acute GN to be easily confused with new onset of acute exacerbation of heart failure. ask any older adult with symptoms of circulatory overload mimicking heart failure about urine elimination patterns and determine whether the problem may be related to acute GN When assessing a client with acute glomerulonephritis, which question about self-management will the nurse ask to determine whether the client is currently following best practices to slow the progression of kidney damage? (67-2) a. have you increased your protein intake to promote healing of the damaged nephrons? b. do you avoid contact sports while you are taking cyclosporine? c. how are you evaluating the amount of daily fluid you drink? d. have you contacted anyone from our dialysis support services? - c. YELLOW BOX - after nephrostomy, monitor the patient to recognize indications of complications (i.e., decreased or absent drainage, cloudy or foul-smelling drainage, leakage of blood or urine from the nephrostomy site, back pain). If any indications are present, respond by notifying the surgeon immediately.
YELLOW BOX - monitor the patient to recognize hypotension. If hypotension or excessive diuresis is present, respond by notifying the nephrology health care provider because hypotension reduces perfusion and oxygen to the new kidney, threatening graft survival A 70-year-old client asks the nurse if she needs a pap smear. her last pap smear was 3 years ago, and it was normal. What is the correct nursing response? (69-1) a. yes you need a pap test this year b. you aren't due for another pap test until next year c. a pap smear is not needed unless you are sexually active d. you may not need an annual pap smear after 65 years of age - d. A client has undergone a breast biopsy. Which postprocedure symptoms will the nurse teach the client to report immediately to the primary health care provider? (69-2) a. tenderness around biopsy site b. numbness around biopsy site c. heavy bleeding from biopsy site d. slight edema near biopsy site - c. The nurse is caring for these clients. Which client does the nurse recognize as having the highest risk for development of breast cancer? (70-1) a. 55 year-old male with gynecomastia and obesity b. 60 year-old female whose father died from colon cancer c. 65 year-old male whose mother had ovarian cancer d. 75 year-old female who was treated for breast cancer 5 years ago - D YELLOW BOX - Teach women undergoing brachytherapy fro breast cancer that radiation is contained in the temporary implant. The risk for others to be exposed to radiation is very small. Body fluids and items contacted by patients with brachytherapy are not radioactive. However, during the time that the radiation is delivered, it is recommended that visitors, including pregnant women and children, be limited normal hematocrit - 34%-50%
normal albumin - 3.5- normal urine protein - 0-0. normal calcium - 8.5-10. Normal magnesium levels - 1.5-2. normal phosphate levels - 2.5-4. normal WBC - 5000- normal hemoglobin - 12- normal BUN - 7- normal creatinine - 0.7-1. Normal eGFR - > urethral meatus located on the ventral undersurface or perineum. The farther from normal location, the more serious and difficult to repair. - Hypospadias urethral meatus located on the dorsal aspect of the penis proximal to the glans - Epispadias painful, persistent erection r/t venous outflow obstruction. Can lead to penile necrosis and urinary tract obstruction. - Priapism
- inflammation of the testicle. -Caused by spread of bladder or urethral infection or by trauma. -Can lead to sterility of untreated - Epididymitis treatment of epididymitis - bedrest, scrotal support, antibiotics, surgical drainage (I & D) if abscess. treatment of testicular cancer - orchiectomy (removal of the testicle and spermatic cord - the contralateral testicle is spared, therefore erectile and reproduction function is rarely affected by surgery) +/- chemo or radiation (which can affect reproductive function) -Patient can preserve sperm in sperm bank. common characteristics of malignant breast lump - Fixed, hard, irregularly shaped, nontender descent of the uterus into the vagina - uterine prolapse symptoms of uterine prolapse - sensation of bearing down, dyspareunia, urinary symptoms, backache, constipation, urinary incontinence, hemorrhoids treatment of uterine prolapse - Kegel exercises, surgical repair of support structures, hysterectomy, pessary protrusion of part of the bladder into the anterior vagina - cystocele symptoms of cystocele - pressure or fullness in the vagina, urinary symptoms treatment of cystocele - anterior colporrhaphy
protrusion of anterior rectal wall into posterior vagina - rectocele symptoms of rectocele - bowel symptoms (constipation), pressure, dyspareunia. treatment of rectocele - surgical repair - posterior colporrhaphy dilation of the cervix & scraping uterine lining for abnormal bleeding - Dilation & Curettage (D & C) scarring of uterine lining for heavy bleeding after cancer has been ruled out - endometrial ablation removal a fibroid tumor (noncancerous growth in the uterine muscle) - myomectomy removal of uterus; may be abdominal (open) or vaginal with laparascopic assistance - hysterectomy removal of uterus and cervix - complete hysterectomy absence or suppression of menstruation - amenorrhea bleeding between periods - metrorrhagia increase in amount or duration of bleeding - menorrhagia long interval between periods - oligomenorrhea excessive irregular menses - menometorrhagia mild pain noted at ovulation - mittleschmerz
blood in urine - hematuria protein in urine - proteinuria Burning with urination - dysuria common signs that someone has a renal disorder - -frequency, urgency, retention, lower abd. pain, dysuria, blood in urine, flank pain, back pain, N/V, chills, fever, HTN voiding process requires - -neuro function -bladder -sphincters high protein levels in urine indicate... - something wrong with the nephrons stimulates bone marrow to produce RBCs - erythropoietin activated in kidneys to help the body absorb calcium - vitamin D helps reabsorb sodium and conserve water in the body - aldosterone released when blood pressure is low - renin patients with renal disorders can have... - -osteoporosis (loss of calcium) -fluid imbalances (HR/BP) -acidosis -hypo/hypertension
Amount of blood filtered by glomeruli in a given time - EGFR who is at risk for cystitis - pregnant, elderly, men with increased prostate size urinary anesthetic that turns urine orange - pyridium inflammatory disorder affecting the renal pelvis and functional portion of the kidney tissue (cortex) - pyelonephritis -infection develops in patchy areas with WBC infiltration and inflammation -kidney becomes grossly edematous and abscess may form - acute pyelonephritis occurs with recurrent bouts of acute pyelonephritis also associated with nonbacterial infections, metabolic, chemical, and immunological processes. - chronic pyelonephritis symptoms of acute pyelonephritis - -chills -fever -N/V -tachycardia/tachypnea -flank pain -CVA TENDERNESS -LBP -dysuria -frequency -confusion in elderly symptoms of chronic pyelonephritis - -Hyperkalemia
-VS Q4 HRS
-cysts form and grow within the tubular epithelium of kidney -the cysts fill with fluid and enlarge the kidney -blood vessels are compressed, leading to destruction of renal tissue and kidney failure - Polycystic kidney disease signs and symptoms of polycystic kidney disease - -abdominal or flank pain (from cyst rupture) -hematuria -nocturia -hypertension -constipation -at risk for hyperkalemia and hyponatremia Treatment of polycystic kidney disease - - PAIN MANAGEMENT (avoid aspirin/NSAIDs) -Sodium and fluid management -I & O -treat constipation -Control hypertension -MONITOR SODIUM: sodium wasting in end stage! -prevent and treat UTI's (prone to infection) -Nephrectomy -Treatment of renal failure (dialysis/transplant) -A clinical condition caused by a number of diseases -Disease is characterized by: proteinuria, hypoalbuminemia, and edema -Increased glomerular membrane permeability develops -Kidney function decreases - Nephrotic Syndrome
Causes of nephrotic syndrome - Renal lesions from: -Lupus -Diabetes -Chronic interstitial nephritis -Cancer -Bacterial infections -Medications -Kidney function decreases due to the insults of inflammations and other diseases -Increased glomerular membrane permeability develops with loss of protein from the kidneys; with less protein in vascular system, fluid leaks into tissues - nephrotic syndrome signs and symptoms of nephrotic syndrome - -Hypoalbuminemia (levels below 3) -Proteinuria -Peripheral Edema -Frothy urine -ascites -Hyperlipidemia -altered immune response -decreased calcium -increased clotting factors Nursing care for nephrotic syndrome - -physical exam Q4hrs -temperature Q4hrs -skin care -assess edema -reposition Q2hrs -small frequent meals (ascites) -prevent infection
severe impairment or total loss of renal function - renal failure rapid decline in kidney function - acute kidney injury hallmark of renal failure - decreased GFR eGFR 60-89 - stage 2 eGFR 30-59 - Stage 3 eGFR 15-29 - stage 4 eGFR less than 15 - stage 5 signs and symptoms of chronic kidney disease affect every body system due to... - uremia causes of chronic kidney disease - -HTN -Diabetes -Meds -Infection -Glomerulonephritis -Polycystic kidney disease Labs in chronic kidney disease - -decreased hemoglobin/hct -hyperkalemia -hypocalcemia -hyperphosphatemia -Increased BUN and Creatinine -Decreased eGFR
what is given for cardiac arrhythmias due to hyperkalemia in chronic kidney disease - -Kayexelate Treatment of chronic kidney disease - -Treat HTN -Avoid cardiac arrhythmias -Restrict phosphates (give calcium) -Diuretics -Insulin/glucose therapy -Supplement calcium and Vit. D -If anemia: folic acid/iron/epogen diet for chronic kidney disease - -low protein -low na -low k -low phosphorus -fluid restriction functional unit of the kidney - nephron serum creatine of or greater puts the patient at risk for AKI if given contrast dye - 1.5 or greater high specific gravity indicates - concentrated urine from dehydration/decreased kidney blood flow or excess vasopressin low specific gravity indicates - dilute urine from high fluid intake, diuretics, DI measure of eGFR and kidney function (can be determined using 24 hr urine collection) - creatinine clearance
determination of compatibility between tissues to be used in grafts and transplants. Each person's cells have a unique genetically controlled complex or "self" marker. - tissue typing types of patients that cannot be organ donors - Severe, current infections Actively spreading cancer (except primary brain cancer which doesn't metastasize) The general belief is to consider all persons potential organ donors The UNOS and our local Organ Procurement Organization (UW-Health) state: "Anyone can be a donor, regardless of age. At the time of your death, the appropriate medical professionals will determine the medical suitability for organ donation.") donation from a living donor requirements - a. Must have the same blood type b. Tissue typing done if blood types match c. Two types: i. Related ii. Unrelated donation after death requirements - a. Blood typing and tissue typing also done b. Two types: i. Cardiac Death ii. Brain Death tests to determine brain death - 1.Oculocephalic reflex ("Doll's Eyes)
- Oculovestibular reflex ("Ice Caloric Testing")
- Apnea testing
confirmatory tests of brain death - 1. Cerebral blood flow study (to determine absence of cerebral blood flow)
- EEG
- Transcranial Doppler ultrasonography Nursing Care of the Potential Donor - Early recognition of potential donors Participation in discussion of organ donation as an option (State law requires all patients/families be asked about organ donation) Advocate for family to ensure that the patient's wishes are followed Provide psychological support for loved ones. Provide information for informed consent. (Despite the patient signing the driver's license, family must give consent for organ donation.) Provide hemodynamic stability: administer fluids Administer vasopressors as needed to maintain cardiac output and maintain adequate kidney function. Prevention of infection Initiate diagnostic testing for determining donor organ function Maintain contact with the donor coordinator Triple drug therapy used for transplants - a.Corticosteroids (prednisone) (inhibits inflammation, cytokine production and T cell activation)
