NUR 2502 Multidimensional Care III - Rasmussen - MDC III - Exam 1

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(50 Qs - 6 SATA; 2 Dose Calc)

A 70-year-old woman with chronic kidney disease and a history of type 2 diabetes had

surgery two weeks ago to place a vascular graft access for hemodialysis. Which

precaution will the nurse follow to ensure the function of the AV graft?

A. Insert an IV and run saline at 10 mL/hr.

B. Keep the patient's arm elevated on two pillows.

C. Monitor blood pressure and radial pulses in both arms.

D. Check for a bruit and thrill by auscultation and palpation over the site.

S/S: Urolithiasis and Pyelonephritis

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- ▪ Flank pain

▪ Fever

▪ N/V

▪ Difficulty urinating

▪ Elevated WBC

Since the s/s of urolithiasis and pyelonephritis are so similar, how you diagnose the

difference?

- ▪ Pyelonephritis is the result of *repeated upper UTIs* in patients with anatomy

abnormalities of the urinary tract

- ▪ Imaging, like a CT scan

The nurse is caring for four patients. Which patient does the nurse identify as at highest

risk for acute pyelonephritis?

A. 19-year-old male with spinal cord injury

B. 27-year-old female with urinary reflux

C. 37-year-old male with HIV infection

D. 44-year-old female with urinary tract stones

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A 35-year-old patient is admitted to the ED with fever, chills, and severe right flank pain.

His heart rate is 112/min and respiratory rate is 32/min. He was recently treated for a

urinary tract infection. Assessment reveals tenderness of the right costovertebral angle

(CVA).

What diagnosis does the nurse expect?

- Acute pyelonephritis

________ occurs suddenly and result from an infection (often *streptococcal*) within the

body often caused by streptococcal infections that originate in the upper respiratory tract,

middle ear, and strep throat.

- Acute glomerulonephritis

The nurse is caring for a patient with polycystic kidney disease. Which assessment finding

requires immediate nursing intervention?

A. Temperature of 99° F

B. Blood pressure of 170/90

C. Heart rate of 100 beats/min

D. Urine output less than 30 cc/hr

S/S: Acute Glomerulonephritis

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- ▪ Fatigue

▪ Anergia

▪ *Hematuria*

▪ *Proteinuria*

▪ Nocturia

▪ *Decreased urination*

▪ Altered urinary elimination

▪ *Painful urination

▪ Weight loss

▪ N/V

▪ Dyspnea

▪ Edema lower extremities

▪ *Elevated BP*

▪ Jugular vein distention

▪ Anemia from reduced production of erythropoietin

▪ Hypercholesterolemia

▪ *"cardiac complications"*

Risk Factors: Polycystic Kidney Disease

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- *Genetics*

▪ Autosomal dominant, which usually appears between the ages of 30 to 50

▪ Autosomal recessive, which has a childhood onset and progresses rapidly to endstage kidney disease.

S/S: Polycystic Kidney Disease

- ▪ *Pain - first symptom*

▪ *CVA tenderness*

▪ Constipation

▪ Cyst bleeding

▪ Changes in urine color or frequency

▪ Hypertension

▪ Headaches

▪ Abdominal distention and pain

▪ Dysuria

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