Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08, Page 1 of 20, 3 Figure(s), 2 Table(s), 13 Box(es

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52: Renal System
PRACTICE QUESTIONS
1. A nurse has an order to obtain a sample for urinalysis from a client with an indwelling urinary catheter. The nurse would avoid which of the following, which could contaminate the specimen? 1. Obtaining the specimen from the urinary drainage bag 2. Clamping the tubing of the drainage bag 3. Aspirating a sample from the port on the tubing attached to the drainage bag 4. Wiping the port on the tubing with an alcohol swab before inserting the syringe Answer: 1 Rationale: A urine specimen is not taken from the urinary drainage bag. Urine undergoes chemical changes while sitting in the bag, and does not necessarily reflect current client status. In addition, it may become contaminated with bacteria from opening the system. Options 2, 3, and 4 are correct actions. Test-Taking Strategy: Note the key word, avoid. This word indicates a false response question and that you need to select the incorrect action. Recalling the basic principles of asepsis will direct you to option 1. Review this procedure if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: deWit, S. (2005). Fundamental concepts and skills for nursing. Philadelphia: W.B. Saunders, p. 533. 2. A nurse is caring for the client who has had a renal biopsy. Which intervention would the nurse avoid in the care of the client after this procedure? 1. Encouraging fluids to at least 3 L in the first 24 hours 2. Administering pain medication as prescribed 3. Testing serial urine samples with dipsticks for occult blood 4. Ambulating the client in the room and hall for short distances Answer: 4 Rationale: After renal biopsy, the nurse ensures that the client remain in bed for at least 24 hours. Vital signs and puncture site assessments are done frequently during this time. Encouraging fluids is done to reduce possible clot formation at the biopsy site. A Hematest is done on serial urine samples with urine dipsticks to evaluate bleeding. Analgesics are often needed to manage the renal colic pain that some clients feel after this procedure. Test-Taking Strategy: Begin to answer this question by recalling that pain and bleeding are potential concerns after this procedure. This will help eliminate options 2 and 3. From the remaining options, you need to recall that encouraging fluids will reduce clotting at the site, whereas ambulation could initiate or enhance bleeding at the biopsy site. Review care of the client following a renal biopsy if you had difficulty with this question. Level of Cognitive Ability: Application

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08, Page 2 of 20, 3 Figure(s), 2 Table(s), 13 Box(es)

Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby, p. 416. 3. A client with a diagnosis of cystitis has an indwelling urinary catheter and is being cared for by a nursing assistant. The nurse observes the nursing assistant care for the client and intervenes if the nursing assistant: 1. Uses soap and water to cleanse the perineal area 2. Keeps the urinary drainage bag below the level of the bladder 3. Uses the drainage tubing port to obtain urine samples 4. Lets the drainage tubing rest under the leg Answer: 4 Rationale: Proper care of an indwelling catheter is especially important to prevent prolonged infection or reinfection in the client with cystitis. The nurse and all caregivers must use strict aseptic technique when emptying the drainage bag or obtaining urine specimens. The perineal area is cleansed thoroughly using mild soap and water at least twice a day and following a bowel movement. The drainage bag is kept below the level of the bladder to prevent urine from being trapped in the bladder and, for the same reason, the drainage tubing is not placed under the client’s leg. The tubing must drain freely at all times. Test-Taking Strategy: Note the key word, intervenes. This word indicates a false response question and that you need to select the incorrect action. Eliminate option 1 first, because this is a basic standard of care for the client with an indwelling catheter. Option 3 is also consistent with principles of asepsis, and is eliminated next. From the remaining options, note that option 2 promotes drainage and option 4 could impede drainage. Review care of the client with an indwelling catheter if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Leadership/Management Reference: deWit, S. (2005). Fundamental concepts and skills for nursing. Philadelphia: W.B. Saunders, p. 550. 4. A nurse is assisting the client with cystitis with diet selection for an acid ash diet. The nurse encourages the client to eat which of the following foods? 1. Low-fat milk 2. Baked haddock 3. Garden peas 4. Apples Answer: 2 Rationale: Foods that are allowed on an acid ash diet include meat, fish, shellfish, cheese, eggs, poultry, grains, cranberries, prunes, plums, corn, lentils, and foods with high amounts of chlorine, phosphorus, and sulfur. Foods that not included are all milk and milk products (option 1); all other vegetables except corn and lentils (option 3); all fruits except cranberries, plums and

and magnesium. such as liver. Williams basic nutrition and diet therapy (11th ed. it is necessary to know that foods such as meat. (2005). Foods that are low in purines include all fruits. Recalling that most fruits and vegetables are not included on the list may help you eliminate options 3 and 4. and sweetbreads. St. begin by examining the options and classifying the types of food sources they represent. Carrots 4. Test-Taking Strategy: To answer this question. Saunders. A client who has a history of gout is also diagnosed with urolithiasis. pp. Peckenpaugh. whereas options 1 and 4 represent foods that derive from animal sources. Other foods to avoid include herring. 406-407. sugars and sweets. Apples 3. Review this diet if you had difficulty with this question. Because purines are end products of protein metabolism. Milk Answer: 1 Rationale: Foods containing high amounts of purines should be avoided in the client with uric acid stones. coffee. p.B. and gravies. S. cheese. kidney. Nutrition essentials and diet therapy (9th ed. but milk and milk products are not. potassium. Medical-surgical nursing: Clinical management for positive outcomes (7th ed. meat extracts. 3 Figure(s). This includes limiting or avoiding organ meats. 2 Table(s). Review the foods that are high in purines if you had difficulty with this question. refined cereals. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal References: Nix. & Hawks. and foods containing high amounts of sodium. fish. brain. tea. consommés. many vegetables. sardines. heart. Philadelphia: W. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Black. calcium. chocolate. Philadelphia: W. . J. 3/e. 13 Box(es) prunes (option 4). and carbonated beverages. Liver 2. you would eliminate options 2 and 3 first. anchovies. The stones are determined to be of the uric acid type.). ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. The nurse tells the client to limit the intake of which food item? 1. J. To select between options 1 and 4. N. cheese. Options 2 and 3 represent foods that are grown.). Page 3 of 20. you would need to know that organ meats such as liver provide more protein than milk.Silvestri. From the remaining options.. 301. (2003).B. 885. 5. Louis: Mosby. This will direct you to option 1. eggs.). Saunders. p. milk. (2005). Test-Taking Strategy: This question is difficult to answer without specific knowledge of the types of foods that may be included in the acid ash diet. and eggs are included.

Gives specific cytological information about the lesion 4. 464-465. 3/e. Louis: Mosby. In formulating a response. Mosby’s diagnostic and laboratory test reference (6th ed. A male client has a tentative diagnosis of urethritis. & Pagana. Page 4 of 20. The nurse notifies the physician. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08.Silvestri. B. This will direct you to option 4. knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing. 8. knowing that which of the following are manifestations of the disorder? . 2 Table(s). Test-Taking Strategy: Use the process of elimination. St. 754-757. The nurse collects data from the client.. Answer: 4 Rationale: The presence of blood at the urinary meatus may indicate urethral trauma or disruption. 3. pp. The physician orders insertion of a Foley catheter. 3 Figure(s). Remember that with a biopsy the cells are examined under a microscope.). Use a smaller catheter. St. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Pagana. 7. Foundations of nursing (4th ed. Review the purpose of this test if you had difficulty with this question. Use extra povidone-iodine solution in cleansing the meatus. A nurse is caring for a client who has been diagnosed as having a kidney mass. that the client experienced a traumatic injury. T. Administer pain medication before inserting the catheter. 4. The nurse notes blood at the urinary meatus while preparing for the procedure. E. K. Notify the physician. A female client is admitted to the emergency room following a fall from a horse. The client asks the nurse the reason for a renal biopsy. Provides an outline of the renal vascular system 3. 13 Box(es) 6. The nurse should: 1. Review this procedure and the indications of urethral trauma if you had difficulty with this question. This examination then yields specific information about the type of neoplastic cell. Louis: Mosby. Determines if the mass is growing rapidly or slowly Answer: 3 Rationale: Renal biopsy is a definitive test that gives specific information about whether the lesion is benign or malignant. (2003). pp. Helps differentiate between a solid mass and a fluid-filled cyst 2.. when other tests such as computerized tomography (CT) and ultrasound are available. Test-Taking Strategy: Focus on the data in the question. 2. & Kockrow. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Christensen. An ultrasound discriminates between a fluid-filled cyst and a solid mass.). the nurse incorporates the knowledge that a renal biopsy: 1. (2003). Renal arteriography outlines the renal vascular system.

Knowing that most courses of antibiotic therapy generally extend from 7 to 10 days may help you eliminate option 3 next. 13 Box(es) 1. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. (2003). Dysuria and penile discharge Answer: 4 Rationale: Urethritis in the male client often results from chlamydial infection and is characterized by dysuria.Silvestri. 3. you would then eliminate the option with proteinuria. which is accompanied by a clear to mucopurulent discharge. 9. 3/e. 4. Begin to answer this question by eliminating options 1 and 2. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Linton. 2. p. and treated as necessary. J. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Renal References: Black. not the kidney. From the remaining options. Medication therapy should be continued for 2 weeks without interruption. Knowing that the problem originates in the urethra. Sexual partners during the last 12 months should be notified and treated. Hematuria and pyuria 3. 2 Table(s). which indicates a problem with kidney function. The infection can be prevented by the use of latex condoms. N.). Answer: 1 Rationale: The most serious complication of chlamydial infection is sterility. examined. & Maebius. Because this disorder often coexists with gonorrhea. The most serious complication of this infection is sterility.. & Hawks. Review the complications of this infection if you had difficulty with this question. Eliminate option 2 first.. diagnostic tests are done for both and include culture and rapid assays. A. Review the signs of urethritis if you had difficulty with this question. Dysuria and proteinuria 4. it is necessary to know either that sterility is a serious and permanent complication or that sexual partners within the last month should be notified and treated as needed. The male client with urethritis has dysuria and discharge from the penis. Test-Taking Strategy: Use the process of elimination. All sexual partners during the 30 days before diagnosis should be notified. Philadelphia: W. 769. A nurse is assisting in planning a teaching session with the female client diagnosed with urethritis caused by infection with chlamydia. Page 5 of 20. Medical-surgical nursing: Clinical management for . Test-Taking Strategy: Use the process of elimination.B. It is treated with doxycycline for 7 days or with azithromycin (Zithromax) as a single dose. J. 3 Figure(s). This leaves option 4 as the correct option. The nurse would plan to include which of the following points in the teaching session? 1. (2005). Saunders. The infection can be prevented by using spermicide to alter the pH in the perineal area. Urethritis is generally accompanied by dysuria in the male client. using principles of infection control. Hematuria and penile discharge 2. Introduction to medical-surgical nursing (3rd ed.

Use doxycycline prophylactically to prevent symptoms of chlamydia. Saunders. Philadelphia: W. N. needs further reinforcement. & Maebius. A client with chlamydial infection has received instructions on self-care and prevention of further infection. Test-Taking Strategy: Note the key words. and following universal precautions is the only measure that needs to be used. N. because antibiotics are not used intermittently at random for prophylaxis of this infection. The nurse tells the assistant that: 1.B. p.Silvestri. 10. 2. & Maebius. If this question was difficult. Page 6 of 20. Linton. Also. note that option 3 is the umbrella (global) option. Answer: 3 Rationale: Chlamydia is a sexually transmitted disease. 1131. 4. 11. Introduction to medical-surgical nursing (3rd ed.). The risk of reinfection can be reduced by limiting the number of sexual partners. . 13 Box(es) positive outcomes (7th ed. Enteric precautions should be instituted for the client. 139. Test-Taking Strategy: A basic knowledge of infection control and disease transmission guides you to select option 3 as correct. The nurse determines that the client needs further reinforcement if the client states that he or she will: 1. 996. A. 2 Table(s). because the disease is transmitted sexually. Options 1 and 2 are the most obviously correct and are therefore eliminated as possible answers to the question. (2003). From the remaining options. Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Linton. Gloves and mask should be used when in the client’s room. 3. Use latex condoms to prevent disease transmission.).B. 3. Saunders.). Philadelphia: W. It requires no special precautions. p. In some instances. follow-up culture is requested in 4 to 7 days to confirm a cure. These words indicate a false response question and that you need to select the incorrect client statement. Return to the clinic as requested for follow-up culture in 1 week. The nursing assistant assigned to the client asks the nurse what measures are necessary to prevent contraction of the infection during care. recalling the basic principles of antibiotic therapy allows you to eliminate option 4. Level of Cognitive Ability: Application Client Needs: Safe. Introduction to medical-surgical nursing (3rd ed. and by the use of condoms. A male client who is hospitalized is diagnosed with urethritis caused by chlamydial infection. and is frequently called non-gonococcal urethritis in the male client. 2. Standard precautions are sufficient. Reduce the chance of reinfection by limiting the number of sexual partners. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08.B. p. A. Saunders.. 3/e. because the disease is highly contagious. Philadelphia: W. Answer: 4 Rationale: Antibiotics are not taken prophylactically to prevent acquisition of urethritis from chlamydia. 4. Review the client teaching points related to this infection if you had difficulty with this question. (2003). review transmission of this disorder and standard precautions.. Caregivers cannot acquire the disease during administration of care. Contact isolation should be initiated. 3 Figure(s).

Test-Taking Strategy: Use the process of elimination. you can eliminate options 3 and 4 because they do not contain fever as part of the option. Sitz bath 4. From the remaining options.B. analgesics and antibiotics. (2003). groin pain. Introduction to medical-surgical nursing (3rd ed. Philadelphia: W. 13. Scrotal elevation 3. which are often accompanied by fever. Test-Taking Strategy: Note the key word. 3/e. p. Eliminate options 1 and 2. Diarrhea. and painful scrotal edema 3. Fever. A nurse is caring for a client with epididymitis. and chills. 13 Box(es) Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Evaluation Content Area: Adult Health/Renal Reference: Linton. because they are obviously the most helpful in the care of the client. Therefore. Philadelphia: W. elevation of the scrotum. Review the signs of this infection if you had difficulty with this question. groin pain. With this in mind. A. Page 7 of 20. A sitz bath uses a lower temperature and the heat is moist and . The nurse anticipates noting which of the following findings on data collection? 1. & Maebius. and ecchymosis 2. p. and scrotal edema with ecchymosis Answer: 2 Rationale: Typical signs and symptoms of epididymitis include scrotal pain and edema.. Use of heating pad Answer: 4 Rationale: Common interventions used in the treatment of epididymitis include bed rest. Introduction to medical-surgical nursing (3rd ed.B. avoid. A nurse is caring for the client with epididymitis. (2003). 998. Saunders. Bed rest 2. 3 Figure(s). 2 Table(s). It needs to be correctly distinguished from testicular torsion. 12. The nurse would avoid using which of the following treatment modalities in the care of the client? 1. A. A heating pad would not be used because direct application of heat could increase blood flow to the area and increase the swelling. 978.. directs you to option 2. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. diarrhea. although sometimes it can be caused by trauma. Any disorder which ends in itis results from inflammation or infection. nausea and vomiting. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Linton. Saunders.). recalling that ecchymosis results from bleeding. and scrotal edema 4. It is most often caused by infection. sitz baths. Fever.). ice packs. Nausea. N. N. an expected finding would be elevated temperature. & Maebius. Note that both remaining options address the application of heat to the client. vomiting.Silvestri. which is not part of this clinical picture. nausea and vomiting.

St. it is necessary to know that the force of stream should be limited to prevent backflow into the epididymis. The nurse is giving the client instructions to prevent a recurrence. 3. 539. Because organisms can be forced into the vas deferens and epididymis from strain or pressure during voiding. Knowing that direct heat may increase inflammation with tissue that is already at risk will guide you to option 4 as the item to avoid. 3/e. E. the client may limit the force of the stream. Condom use can help prevent urethritis and epididymitis from sexually transmitted diseases. & Kockrow. 2 Table(s). this option can be eliminated first. Urge incontinence 2. Urinary retention . 13 Box(es) soothing. p. Louis: Mosby. p..Silvestri. 2. and that condoms are helpful in preventing this disorder from occurring as a complication of a sexually transmitted disease. needs further instruction. the nurse asks the client about the presence of which early symptom? 1. 14. Review care of the client with epididymitis if you had difficulty with this question. Continue to take antibiotics until all symptoms are gone. (2003). To determine if the client is currently experiencing exacerbation of BPH. B. From the remaining options. 15. A client has epididymitis as a complication of urinary tract infection. 539. Because option 1 is consistent with good practices in the prevention of UTI. (2003).). These words indicate a false response question and that you need to select the incorrect client statement. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. but must be taken until the full course of therapy is completed. Use condoms to eliminate risk from chlamydia and gonorrhea. St. & Kockrow. Decreased force of the stream of urine 4. E. A nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. Remember that antibiotics are not stopped when symptoms subside. B. Review care of the client with epididymitis if you had difficulty with this question. 3 Figure(s). Test-Taking Strategy: Note the key words. 4. Nocturia 3. Answer: 2 Rationale: The client who experiences epididymitis from urinary tract infection (UTI) should increase intake of fluids to flush the urinary system. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Christensen. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Evaluation Content Area: Adult Health/Renal Reference: Christensen. Page 8 of 20. Adult health nursing (4th ed. Limit the force of the stream during voiding. Adult health nursing (4th ed. Drink increased amounts of fluids..). Antibiotics are always taken until the full course of therapy is completed. Louis: Mosby. The nurse determines that the client needs further instruction if the client states to: 1.

17.Silvestri.). Saunders. therefore.. Test-Taking Strategy: Note the key words. because antibiotics should have no effect at all on voiding. 978. (2003). bed rest.). Antibiotics 3. p. medications that could exacerbate or contribute to urinary retention in the client with BPH. episodes of urinary retention can be triggered by certain medications. Diuretics should help voiding. The stream later becomes weak and dribbling. such as alcoholic beverages. and nocturia. Saunders.B. eliminate option 1. complete obstruction and urinary retention can occur. From the remaining options. Test-Taking Strategy: Use the process of elimination and focus on the issue. From the remaining options. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Linton. becoming chilled. Philadelphia: W. such as decongestants. The nurse determines that the client needs further instruction if the client states that he or she will perform which of the following as part of these exercises? 1. Review the signs of benign prostatic hypertrophy if you had difficulty with this question. Diuretics 2. A. This will guide you to option 4. antitussives have no effect on urinary retention. and taking alcoholic beverages. Philadelphia: W. Decongestants Answer: 4 Rationale: In the client with BPH. N. 3/e. Retention can also be precipitated by other factors. Introduction to medical-surgical nursing (3rd ed. N. A client who had a prostatectomy has learned perineal exercises to gain control of the urinary sphincter. early symptom. urge incontinence.. & Maebius. focusing on the key words and recalling the pathophysiology related to BPH will direct you to option 3. p. eliminate option 2. (2003). Because the client has a history of benign prostatic hyperplasia (BPH). anticholinergics. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Linton. Page 9 of 20. Review the causes of urinary retention in the client with BPH if you had difficulty with this question. A client who has a cold is seen in the emergency room with inability to void. 3 Figure(s). the nurse questions the client about use of which medication? 1. A. 16. & Maebius. Introduction to medical-surgical nursing (3rd ed.B. Antitussives 4. Option 4 identifies the most severe of symptom and therefore is eliminated first. The client may then develop hematuria. Also. The client should be questioned about use of these medications if presenting with urinary retention. If untreated. 13 Box(es) Answer: 3 Rationale: Decreased force in the stream of urine is an early sign of BPH. frequency. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. urgency. Tightening the muscles as if trying to prevent urination . 978. recall that medications that contain anticholinergics may cause urinary retention. 2 Table(s). and antidepressants. infection. Next.

Philadelphia: W. Test-Taking Strategy: Note the key words. (2003). 18. Other reactions include personality changes. An acceptable exercise is tightening the abdominal. N. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08.Silvestri. pp. Page 10 of 20. A. needs further instruction.).B. Performing the Valsalva maneuver Answer: 4 Rationale: The Valsalva maneuver is avoided following prostatectomy. Saunders. These words indicate a false response question and that you need to select the incorrect client statement. Note that the type of movement in the exercises described in options 1. (2005). Focusing on the client’s statement will direct you to option 3. & Maebius. withdrawal. and 3 are all muscle tightening types of movements. Medical-surgical nursing: Clinical management for positive outcomes (7th ed. 3/e. the Valsalva maneuver in option 4 involves bearing down or pushing types of movements.). The individual client’s response may vary depending on the client’s personality and support systems. as if trying to prevent urination. 1025-1026. 3 Figure(s). Review the purpose of perineal exercises if you had difficulty with this question. and perineal muscles. gluteal.B. Introduction to medical-surgical nursing (3rd ed. Anger 4. A nurse is working with the client newly diagnosed with chronic renal failure to set up a schedule for hemodialysis. Review the psychosocial aspects of care for the client with CRF if you had difficulty with this question. emotional lability. J. Philadelphia: W. Level of Cognitive Ability: Analysis Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal . Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Renal References: Black. 2. Test-Taking Strategy: Use the process of elimination. and may include anger. and depression. The client has not projected blame on the nurse nor does the client statement reflect withdrawal or depression. Linton. p. Saunders. 982. The client in this question is exhibiting anger.. Another acceptable exercise is tightening the rectal sphincter while relaxing the abdominal muscles. On the other hand. 2 Table(s). because it increases the risk of bleeding in the postoperative period. Depression 3. 13 Box(es) 2. The client states. “This is impossible! How can I even think about leading a normal life again if this is what I’m going to have to do?” The nurse determines that the client is exhibiting: 1. & Hawks. this prevents the Valsalva maneuver from occurring. J. Contracting the abdominal. Withdrawal 2. gluteal and perineal muscles 3.. Projection Answer: 3 Rationale: Psychosocial reactions to chronic renal failure and hemodialysis are varied. Tightening the rectal sphincter while relaxing abdominal muscles 4.

Knowing that the client is at risk for disequilibrium syndrome. tachycardia. causing brain swelling and onset of symptoms.. Philadelphia: W.). Note the relation between the medication name in the question and option 2. vomiting. & Maebius. nausea. Saunders. the nurse monitors the client during dialysis for: 1. & Maebius. and generalized weakness 4. 2 Table(s). Introduction to medical-surgical nursing (3rd ed. the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. and twitching Answer: 4 Rationale: Disequilibrium syndrome is characterized by headache. N. Hypertension. and is prevented by dialyzing for shorter times or at reduced blood flow rates. 13 Box(es) Reference: Linton. Phosphate overdose 2. dementia. The client now presents with mental cloudiness. and hypothermia 3. Test-Taking Strategy: Use the process of elimination. and complaints of bone pain. mental confusion. 3/e. Review the signs of aluminum intoxication if you had . This condition was formerly known as dialysis dementia. irritability. deteriorating level of consciousness. dementia. It is caused by rapid removal of solutes from the body during hemodialysis. pp. Restlessness. A client newly diagnosed with chronic renal failure has recently begun hemodialysis. Folic acid deficiency Answer: 2 Rationale: Aluminum intoxication may occur when there is accumulation of aluminum. p. bradycardia. As a result. (2003). 20. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Linton.B. N. 19. 3 Figure(s). It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum. Introduction to medical-surgical nursing (3rd ed. and fever 2. Headache. and bone pain from infiltration of the bone with aluminum. Noting the relation between the words “disequilibrium syndrome” and the signs in option 4 will direct you to this option. which make aluminum available to be dialyzed from the body.B. A. Philadelphia: W. including aluminum hydroxide as a phosphate-binding agent. Test-Taking Strategy: Use the process of elimination. It may be treated with aluminum-chelating agents. water goes into cerebral cells because of the osmotic gradient. an ingredient in many phosphate-binding antacids. Hypotension. Aluminum intoxication 3. The client is receiving the usual combination of medications for the disease. It most often occurs in clients who are new to dialysis. Saunders. Advancing uremia 4. Page 11 of 20. Review this syndrome if you had difficulty with this question. At the same time. twitching and possible seizure activity. 788-789. decreasing level of consciousness.Silvestri.). 784. It results in mental cloudiness. A. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. The nurse interprets that this data is compatible with: 1. A client with chronic renal failure has been on dialysis for 3 years. (2003)..

Louis: Mosby. 2 Table(s). Warmth. would the nurse identify as a risk factor for this pyelonephritis? 1. 958. Options 3 and 4 are not characteristics of steal syndrome. Coronary artery disease 3. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula.B. presence of urinary stones. Which disorder.B. which is caused by tissue ischemia. The nurse monitors this client for which manifestation of this disorder? 1. redness. Edema and purplish discoloration of the left arm 4. Saunders. This will direct you to the correct option. L.. Philadelphia: W. Medical-surgical nursing: Clinical management for positive outcomes (7th ed. A nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. From the remaining options. p. Review these signs if you had difficulty with this question. 3 Figure(s). Hypoglycemia 2.. & Hawks. pallor.. p. and indwelling or frequent urinary catheterization. & Hawks.Silvestri. St. Review these . E. and pain in the left hand 2. and pain would more likely characterize a problem with infection. Medical-surgical nursing: Clinical management for positive outcomes (7th ed. Eliminate options 1 and 4 first as least likely being associated as risk factors.). A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. structural abnormalities of the urinary tract. (2005). Recalling that arterial steal syndrome results from vascular insufficiency will direct you to option 2. Test-Taking Strategy: Use the process of elimination. redness. Warmth. chronic renal calculi. Page 12 of 20. pp. and pain in the left hand 3. Aching pain. Diabetes mellitus 4. Pallor. diminished pulse.). & Salerno. chronic cystitis. hypertension. J. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Black. 13 Box(es) difficulty with this question. Test-Taking Strategy: Use the process of elimination. if noted on the client’s record. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal References: Black. McKenry. Philadelphia: W. J. (2003).). Orthostatic hypotension Answer: 3 Rationale: Risk factors associated with pyelonephritis include diabetes mellitus. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. 22. and edema of the left arm Answer: 2 Rationale: Arterial steal syndrome results from vascular insufficiency after creation of a fistula. Saunders. 21. J. 2097-2098. (2005). remember that diabetes mellitus can cause renal complications. J. 213. 3/e. Mosby’s pharmacology in nursing (21st ed.

The nurse wears gloves to maintain standard precautions. Remember. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Linton. the nurse would most likely expect to note which of the following? 1. 426. except to wear gloves if coming in contact with the client’s urine. & Kockrow. 23. p. Philadelphia: W.). 24. N. most likely expect to note. 2. 3/e. Place the client on radiation precautions for 18 hours. option 1 is the most likely laboratory finding. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Christensen. B. Limit contact with the client for 20 minutes per hour. and 3 are unnecessary measures. Saunders.B. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. Decreased red blood cell (RBC) count 4. Save all urine in a radiation-safe container for 18 hours. Eliminate option 4 first because it is not associated with the renal system. Decreased hemoglobin V 3.). Focus on the client’s diagnosis and note the key words. 783. Louis: Mosby. 2 Table(s). Test-Taking Strategy: Use the process of elimination. E. The BUN level starts to rise when the glomerular filtration rate falls below 40% to 60%. the BUN level is a frequently used laboratory test to determine renal function. & Maebius. Review the laboratory tests to determine renal function if you had difficulty with this question. (2003). Elevated blood urea nitrogen (BUN) level 2. Adult health nursing (4th ed. (2003).Silvestri. 3.. A decreased hemoglobin and RBC count may be noted if bleeding from the urinary tract occurs or if erythropoietic function by the kidney is impaired.. Answer: 4 Rationale: There are no specific precautions following a renal scan. A nurse is reviewing the client’s record and notes that the physician has documented that the client has a renal disorder. Options 1. 13 Box(es) risk factors if you had difficulty with this question. An increased WBC is most likely to be noted in renal disease. Decreased white blood cell (WBC)count Answer: 1 Rationale: BUN testing is a frequently used laboratory test to determine renal function. No special precautions required. 4. St. Page 13 of 20. Although options 2 and 3 may be noted in some renal disorders. Recalling that there is generally no danger . Test-Taking Strategy: Use the process of elimination. 2. Which of the following would the nurse include in the plan of care for a client following a renal scan? 1. p. A. On review of the laboratory results. 3 Figure(s). Introduction to medical-surgical nursing (3rd ed.

Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Chernecky. 3 Figure(s). The nurse interprets this complaint and further monitors the client for: 1. There are no data to support the presence of renal colic. Before the test. and 4 address implementation. Normal. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Chernecky. Signs of infection would not appear immediately following a biopsy. Level of Cognitive Ability: Application Client Needs: Safe. and gross or microscopic hematuria would also indicate bleeding. a decreasing hematocrit.Silvestri.B. Focusing on the data in the question will assist in eliminating options 3 and 4. rash. Determine a history of allergies. 3/e. 25. Philadelphia: W. A client is scheduled for intravenous pyelography (IVP). 3. 2. Philadelphia: W. Answer: 3 Rationale: The iodine-based dye used during the IVP can cause allergic reactions such as itching. Review this test if you had difficulty with this question. the priority nursing action would be to: 1. p. (2004). 13 Box(es) from the small amount of radioactive material used in this procedure will direct you to option 4. shortness of breath. C.. (2004). Option 3 is the only option that addresses data collection. B. B. & Berger. the client complains of pain at the biopsy site. expected pain Answer: 1 Rationale: If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen. Infection 3. Following a renal biopsy.). Test-Taking Strategy: Use the process of elimination. 2. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. priority. Review the complications following renal biopsy if you had difficulty with this question. . tight feeling in the throat. 964-965. and bronchospasm. Laboratory tests and diagnostic procedures (4th ed. pp. Saunders. Page 14 of 20. Laboratory tests and diagnostic procedures (4th ed. Pain of this nature is not normal. Assessing for allergies is the priority. Review this procedure if you had difficulty with this question. Hypotension. Test-Taking Strategy: Note the key word.B. Options 1. Administer an oral preparation of radiopaque dye. Recalling that signs of infection may not appear immediately following biopsy will assist in directing you to option 1 from the remaining options. hives. and use the nursing process as a guide. Saunders. Bleeding 2. 26. which radiates to the front of the abdomen. 2 Table(s). C. 4. Administer a sedative..). Renal colic 4. 696. & Berger. Restrict fluids. bleeding should be suspected.

p.Silvestri. Frequency 3. P. (2003). 757. Eliminate options 2. and 4 because they are common signs of a urinary tract infection. frequency. A.). 3/e. Frequency Answer: 1 Rationale: Gross. Fever 2. Review the clinical manifestations of UTI that occur in the older client if you had difficulty with this question. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. Eliminate options 2 and 4 because they may commonly occur in an older client. & Perry. 783. Note the client’s age in the question. K. Louis: Mosby. Mosby’s diagnostic and laboratory test reference (6th ed. Confusion 4. Hematuria 2. Review the specific manifestations associated with bladder cancer if you had difficulty with this question. Frequency and urgency may commonly occur in an older client and fever can be associated with a variety of conditions. and urgency. the only symptom of a UTI may be something a vague as increasing mental confusion or frequent unexplained falls. Page 15 of 20. A nurse is monitoring an 88-year-old woman suspected of having a urinary tract infection (UTI) for signs of the infection. Louis: Mosby. (2005) Fundamentals of nursing (6th ed. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity . 13 Box(es) Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Pagana. Burning 3. because fever can be associated with a variety of conditions. Urgency 4. St.). p. As the disease progresses the client may experience dysuria. & Pagana. St. a manifestation of bladder cancer. Test-Taking Strategy: Use the process of elimination and focus on the issue.. T. Urgency Answer: 3 Rationale: In an older client. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Potter. Eliminate option 1 next. 3 Figure(s). A nurse is performing an admission assessment on a client with a diagnosis of bladder cancer. 2 Table(s). painless hematuria is most frequently the first manifestation of bladder cancer. 28. Which of the following would alert the nurse to the possibility of the presence of a UTI? 1. Test-Taking Strategy: Use the process of elimination. 27. Which of the following would the nurse most likely expect to note on data collection of this client? 1. 3..

confusion. increase fluid intake. Exercise as much as possible to stimulate circulation. & Neighbors. 29. J. Decreased urinary output and bladder spasms 4. A client with prostatitis secondary to kidney infection has received instructions on management of the condition at home and prevention of recurrence. 1836. 30. Stop antibiotic therapy when pain subsides. A. Increased urinary output and anemia Answer: 1 Rationale: TUR syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. (2003). (2003). Keep fluid intake to a minimum to decrease the need to void. p.. & Maebius.). From the remaining options.). 13 Box(es) Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Linton. Knowledge of either of these concepts will direct you to option 4. Monahan..Silvestri. Option 1 is also eliminated. M. 3 Figure(s). Medicalsurgical nursing: Health and illness perspectives (7th ed. Bradycardia and confusion 2. The nurse determines that the client understood the instructions if the client has verbalized that he or she will: 1. Saunders.B. Test-Taking Strategy: Use the process of elimination. muscle twitching. Eliminate option 3 first. J. 778. The nurse monitors the client for signs of transurethral resection syndrome. 3. Sands. Louis: Mosby. because stopping medication therapy before the end of the course is contraindicated. W. . 3/e. bradycardia. Recalling that increased intracranial pressure is the concern will direct you to option 1.. F. and nausea and vomiting. Page 16 of 20. 2. disorientation. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure. and use sitz baths for comfort. Answer: 4 Rationale: Treatment of prostatitis includes medication with antibiotics. Marek. Review the measures to prevent prostatitis if you had difficulty with this question. because fluid intake should be increased. Introduction to medical-surgical nursing (3rd ed. visual disturbances. it is necessary to understand that sitz baths provide comfort and that rest is helpful in the healing process. Test-Taking Strategy: Knowledge regarding TUR syndrome is required to answer this question. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. Which of the following data would indicate the onset of this syndrome? 1. The client is also taught to rest.. p. Use warm sitz baths and analgesics to increase comfort. analgesics. Tachycardia and diarrhea 3. Philadelphia: W. 2 Table(s). 4. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Phipps. Antimicrobial therapy is always continued until the prescription is completely finished. and stool softeners. St.. Review this disorder if you had difficulty with this question. A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. N.

Although the presence of a radial pulse in the left wrist and capillary refill less than 3 seconds in the nail beds of the fingers on the left hand are normal findings. Stop the dialysis. D. 4. Explain that the pain will subside after the first few exchanges. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Renal Reference: Ignatavicius. it disappears after a week or two. Which action by the nurse is appropriate? 1. 2. Absence of a bruit on auscultation of the fistula 2. Review the complications associated with peritoneal dialysis and the .). 2. S. Answer: 3 Rationale: Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation. (2004). From the remaining options. St. 3/e... and the infusion should not be slowed or stopped. 32. A client newly diagnosed with renal failure will be receiving peritoneal dialysis. 1443. Slow the infusion. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. Medical-surgical nursing: Assessment and management of clinical problems (6th ed.Silvestri. S. they do not assess fistula patency.. Palpation of a thrill over the fistula 3. During the infusion of the dialysate. & Workman. Philadelphia: W. Eliminate options 3 and 4 first because they are similar and assess for adequate circulation in the distal portion of the extremity (not the fistula). Heitkemper. Louis: Mosby. M. Saunders. Decrease the amount to be infused. & Dirksen. (2006). however. p. the client complains of abdominal pain. and 4 because they are similar actions. The presence of a thrill and bruit indicate patency of the fistula. M. Medical-surgical nursing: Critical thinking for collaborative care (5th ed. Review the expected findings when assessing an arteriovenous fistula if you had difficulty with this question. focusing on the issue (patency) and noting the word “absence” in option 1 will assist in eliminating this option. Page 17 of 20. 3 Figure(s). 31. 1754. 2 Table(s). 13 Box(es) Level of Cognitive Ability: Analysis Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Evaluation Content Area: Adult Health/Renal Reference: Lewis. A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure.B. 3. The infusion amount should not be decreased. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand Answer: 2 Rationale: The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. Test-Taking Strategy: Use the process of elimination. p.). Test-Taking Strategy: Use the process of elimination. Which finding indicates that the fistula is patent? 1. Presence of a radial pulse in the left wrist 4. Eliminate options 1.

S. Louis: Mosby. Test-Taking Strategy: Use the process of elimination. Review the complications associated with peritoneal dialysis if you had difficulty with this question. These words indicate a false response question and that you need to select the incorrect client statement. they need an increased sodium and water intake.). Heitkemper. 3/e. 33. Test-Taking Strategy: Note the key words.. A client is diagnosed with polycystic kidney disease and the nurse provides information to the client about the treatment plan.Silvestri. Antihypertensive medications 3.. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Adult Health/Renal Reference: Lewis.B. Page 18 of 20. Medical-surgical nursing: Assessment and management of clinical problems (6th ed. p. Infection 2. Sodium restriction 2. St.). The nurse determines that the client needs additional information if the client states that which of the following is a component of the treatment plan? 1. M. and 4 are not associated with dwell time. 2 Table(s). Options 1. M. Increased water intake 4. & Workman. Disequilibrium syndrome Answer: 2 Rationale: An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. (2004). 13 Box(es) appropriate nursing actions. S. Recalling that sodium is wasted in polycystic kidney disease will direct you to option 1. D. Noting the client’s diagnosis and recalling that the dialysate solution contains glucose will direct you to option 2. needs additional information. 1758. & Dirksen. Genetic counseling is advisable because of the hereditary nature of the disease. 3 Figure(s).. The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. Medical-surgical nursing: Critical thinking for collaborative care (5th ed. Thus. Hyperglycemia 3. 1232. Aggressive control of hypertension is essential. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Fluid overload 4. 34. Review the manifestations associated with this disease if you had difficulty with this question. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. p. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Ignatavicius. Philadelphia: W. Saunders. (2006). The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of: 1. Genetic counseling Answer: 1 Rationale: Individuals with polycystic kidney disease seem to waste rather than retain sodium. . 3. if you had difficulty with this question.

13 Box(es) Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Adult Health/Renal Reference: Phipps. & Neighbors. Marek. 1204. Monahan. ____Check the level of the drainage bag. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Renal References: Lewis. Medicalsurgical nursing: Health and illness perspectives (7th ed. Monahan. M. 2 Table(s).. J. Medical-surgical nursing: Assessment and management of clinical problems (6th ed. The nurse is monitoring a client receiving peritoneal dialysis and nurse notes that a client’s outflow is less than the inflow. F. The day after dialysis Answer: 3 Rationale: Antihypertensive medications such as enalapril are given to the client following hemodialysis. 3 Figure(s).).. Because hypotension is much more likely to occur in this circumstance... There is no rationale for waiting a full day to resume the medication. ____Check the peritoneal dialysis system for kinks. J.. Test-Taking Strategy: Use the process of elimination. Eliminate option 4 because this action would lead to ineffective blood pressure control. M.. Marek. This would lead to ineffective control of the blood pressure. eliminate options 1 and 2. (2004). Phipps.. M. On return from dialysis 4. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08.. F. 35. Just prior to dialysis 2. (2003). ____Reposition the client to his or her side. Begin to answer this question by thinking about the effects of an antihypertensive medication on the blood pressure when fluid is being removed from the body. J. Louis: Mosby. Page 19 of 20. S. p. This prevents the client from becoming hypotensive during dialysis and from having the medication removed from the bloodstream by dialysis. Review preprocedure hemodialysis measures if you had difficulty with this question. (2003). Louis: Mosby.). <AQ>36. St. W. Heitkemper. Check the peritoneal dialysis system for kinks. J. ____Contact the physician. 766. Medical-surgical nursing: Health and illness perspectives (7th ed. St. & Neighbors. Select the actions that the nurse should take. Answers: Check the level of the drainage bag. S. Louis: Mosby. ____Place the client in a high-Fowler’s position. 1222.). During dialysis 3. & Dirksen. p.. The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). . Sands. W. The nurse should plan to administer this medication: 1.. St. Sands. 3/e. p.Silvestri.

increased intra-abdominal pressure also contributes to leakage at the peritoneal dialysis catheter site. Rationale: If outflow drainage is inadequate. if you had difficulty with this question. 13 Box(es) Reposition the client to his or her side. D. Saunders.Silvestri.B. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. There is no reason to contact the physician. 3 Figure(s). 1759.). M. . 2 Table(s). the nurse attempts to stimulate outflow by changing the client’s position. Medical-surgical nursing: Critical thinking for collaborative care (5th ed. p. The drainage bag needs to be lower than the client’s abdomen to enhance gravity drainage. The connecting tubing and the peritoneal dialysis system is also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. & Workman. ISBN 1-1460-0052-6 Chapter 052 (edited file)—"Renal System" 10/14/08. (2006). 3/e. This will assist in determining the correct interventions. Philadelphia: W. Test-Taking Strategy: Use the principles related to gravity flow and preventing obstruction to flow to answer this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Renal Reference: Ignatavicius. Review the nursing interventions related to insufficient flow of dialysate. Page 20 of 20.. A low-Fowler’s position reduces intra-abdominal pressure.

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