Kristina Beers is a 32-year-old woman who recently visited her primary care physician a couple days ago for an uncomplicated urinary tract infection (UTI) and obtained a prescription for azithromycin. She reports that she has finished 3 of the 7 days of treatment. 

QuestionKristina Beers is a 32-year-old woman who recently visited her primary care physician a couple days ago for an uncomplicated urinary tract infection (UTI) and obtained a prescription for azithromycin. She reports that she has finished 3 of the 7 days of treatment.  Match the following urinary assessment findings with their descriptions.__5_ a. Enuresis _6__ b. Polyuria __1_ c. Hematuria__10_ d. Nocturia_9__ e. Anuria_7__ f. Hesitancy_8__ g. Dysuria_4__ h. Oliguria__3_ i. Retention_2__ j. Urgency  She reports that she received the following information from her physician’s office: Return in 1 week for another urinalysis; Report increases in frequency, urgency, or burning on urination; Call immediately if fever or chills experienced; Complete all prescribed meds as ordered What client teaching is critical for the nurse to provide to prevent recurrence of another urinary tract infection? (Select all that apply)”Drink 8 ounces of high fructose cranberry juice daily.””Empty your bladder before and after sexual intercourse.””Clean your perineum from front to back when you go to the bathroom.””If you take a bubble bath, limit the amount of time you are in the tub to 10 minutes.””Don’t hold your urine when you feel like you have to go to the bathroom.””Drink a maximum of 2 liters of water or other nonalcoholic beverages per day.” Ms. Beers now presents to the hospital with reports of fatigue and dehydration. She is being admitted to the medical floor with AKI from dehydration. While taking her history, she reports that she was diagnosed with type 1 diabetes mellitus (DM) and has been insulin-dependent since the age of 10. Your initial assessment reveals a pale, thin, slightly drowsy woman. Her skin is warm and dry to the touch with poor skin turgor and mucous membranes are dry. Her vital signs include blood pressure 140/88 mm Hg, heart rate 116, respiratory rate 18, SpO2 96%, and temp 100.9 degrees. She tells you she has been nauseated for 2 days so she has not been eating or drinking. She also reports not having to void very often. She reports severe diarrhea. Laboratory results are pending.  Shortly after admission to the unit the provider places the following orders: insert and maintain indwelling foley catheter, send urine for urinalysis with culture, perform chlorhexidine care around indwelling urinary catheter every 8 hours, continuous cardiac monitoring, vancomycin 1g IVPB stat, renal ultrasound to rule out obstruction, monitor vital signs every 4 hours, apply oxygen to keep SpO2 > 94%, strict intake and output, consult pharmacist for antibiotic dosing. After obtaining the necessary supplies, use the following table to place the steps the nurse would take to insert an indwelling foley catheter in the correct order. You will insert the appropriate letter in the right column to coincide with the correct step in the left column.  Step Action1. __J__ A. Inflate the balloon to keep the catheter in place and secure the catheter with nonallergenic tape or leg securing device. 2. __E__ B. Lubricate 1 to 2 inches of the catheter tip and attach prefilled syringe to the injection port.3. __I__ C. Prepare sterile field and apply sterile gloves.4. __C__ D. With dominant hand, insert the catheter until urine appears then insert the catheter an additional 1 to 2 inches. 5. ___H_ E. With clean gloves, thoroughly clean and dry the perineal area.6. __F__ F. With your dominant hand, sterilely cleanse the urinary/vaginal area with cotton balls soaked in anti-septic solution from front to back. 7. __B__ G. Hang the collection drainage bag below the level of the bladder.8. __D__ H. Use your nondominant hand to hold the labia open and expose the urethral meatus.9. __A__ I. Remove gloves and perform hand hygiene.10. _G___ J. Place patient in dorsal recumbent position and place a waterproof pad under patient’s buttocks. Which provider order should the nurse perform first? Administer 1 gram vancomycin IV stat.Call ultrasound department to perform routine renal ultrasound. Perform chlorhexidine care around indwelling urinary catheter.Obtain urine sample for urinalysis and culture & sensitivity.  Which action is most correct for obtaining a sterile urine specimen from an indwelling foley catheter?Obtain specimen with a sterile cup from the point farthest from the client, the collection bag. Collect all urine in a container for a 24-hour period and send the container to lab. Obtain specimen with a syringe from the point closest to the client, the injection port.Disconnect tubing and drain urine into a sterile specimen cup before replacing tubing.  The pharmacy sends 1 gram Vancomycin in 250 mL of Normal Saline. Micromedex states that this can be administered at 1250 mg/hr. How many mL/hr will the nurse set the IV pump at? (Round to the whole number) *must show your work for full credit. _________ mL/hr313 mL/hr  How would the nurse describe a renal ultrasound to a client?This test is an invasive procedure where the doctors will insert a needle into your kidney and obtain a small sample for exam. This test will use gel on your lower back and sides to obtain information about structure and blood flow of your kidneys from sound waves.This test requires the injection of dye into your bladder and will obtain 3D images that tell us about the kidneys and urinary tract. This test will obtain pictures that tell us about anatomy of your urinary tract and will require you to lie still on a hard board for a couple minutes. What intervention(s) would the nurse implement to prevent infection from an indwelling urinary catheter? (Select all that apply)Begin IV antibiotic therapy for any client with an indwelling catheter.Empty collection bag every 8 hours with a clean container. Irrigate the catheter with sterile saline once a shift. Keep collection bag below the level of the bladder at all times.Maintain urinary catheter until discharge.Provide perineal care with antiseptic cleaning solution every 4 hours. Secure catheter to prevent excessive catheter movement. What medication would the nurse suggest to the provider to treat only the symptoms of discomfort from a urinary tract infection? Amoxicillin.Ciprofloxacin. Sulfamethoxazole.Phenazopyridine. What client education is critical for the nurse to provide about side effects of the above medication to decrease client anxiety? Monitor your heart rate and report any irregular beats to your provider. Notify your provider if you experience vision changes or dizziness. This medication may cause the color of your urine to change to red or orange. Use another form of birth control while you are this medication.  Match the following conditions and characteristics with their associated etiologies (causes) of acute kidney injury (answers will be used more than once). pre-renal, intra-renal, post-renal___ a. Renal stones ___ b. Mechanical outflow obstruction___ c. Bladder cancer___ d. Acute glomerulonephritis ___ e. Nephrotoxic medications ___ f. Hypovolemia___ g. Tubular obstruction by myoglobin___ h. Decreased cardiac output___ i. Prostate cancer___ j. Renal vascular obstruction Ms. Beer’s laboratory results have come back. Sodium  144 mEq/LPotassium 6.7 mEq/LChloride 98 mEq/LBicarbonate 27 mEq/LBUN 52 mg/dLCreatinine 5.2 mg/dLGlucose  268 mg/dLPhosphorous  5.9 mg/dLABGs pH 7.23; PaCO2 39 mm Hg; HCO3 17 mm Hg; PaO2 81 Based on the laboratory results above, what action takes priority? Administer client’s home dose of insulin glargine.Obtain order for and place client on telemetry. Apply 2 L of oxygen via binasal cannula.Consult with dietitian for nutritional education. The provider orders the following: sevelamer 600 mg PO TID with meals and sodium polystyrene 60g PO now. Recheck electrolytes in 4 hours.  When explaining the action of sevelamer to the client, the nurse would say that this medication:helps remove extra phosphorous by preventing absorption with food.increases vitamins and minerals that are lost during hemodialysis.stimulates the kidneys to begin making erythropoietin.will help prevent clotting on days the client has hemodialysis.  After the nurse has administered sodium polystyrene, which assessment data would indicate that the medication has had the desired effect?Difficulty passing bowel movements. Subjective reports of decreased fatigue levels. Next serum potassium level has decreased to 5.3 mEq/L.Urinary output increases to 400 mL in the next 8 hours. Clients with kidney disease may obtain dialysis through hemodialysis or peritoneal dialysis. The healthcare provider determines Ms. Beers will need hemodialysis and places a hemodialysis catheter through the subclavian vein.  Which intervention(s) would the nurse implement to prevent a central line associated blood stream infection? (Select all that apply)Use sterile technique during insertion of central line.Perform hand hygiene prior to accessing the central line. Change dressing on central line once a month. Daily bathing with chlorhexidine solution. Clean needleless system connections vigorously once every 24 hours. Use of alcohol as skin disinfectant prior to insertion.  Indicate whether the following characteristics are associated with peritoneal dialysis (PD) or hemodialysis (HD). ___ a. Lowers serum triglycerides ___ b. Risk of hypotension during treatment___ c. More protein loss___ d. Requires vascular access___ e. Increased risk of abdominal infection___ f.  Requires fewer dietary restrictions___ g. Increased hyperlipidemia ___ h. Portable system Ms. Beers admission CBC yields the following results:  WBC 10,600/mm3RBC 3.2 million/mm3Hgb 9.1 g/dLHct 31.3%Platelets 333,000 mm3 Why do clients with kidney disease develop anemia? There is an increased destruction of blood cells due to chronic conditions causing anemia. The bone marrow has been damaged, which has led to decreased production of red blood cells. The kidneys are unable to produce erythropoietin, which is necessary for red blood cell production. The process of hemodialysis removes blood and volume from the client, thus causing anemia.  Ms. Beers receives hemodialysis and, after a few treatments, reports feeling better. Over the next 24 hours, Ms. Beers nausea subsides, and she is able to eat normally. What information would need to be included when teaching about nutritional requirements for a client with kidney disease who is on hemodialysis? “Limit the amount of … (Select all that apply)carbohydrates in your diet by limiting breads.”phosphorous in your diet by limiting intake of fish.”potassium in your diet by limiting bananas and oranges.”sodium in your diet by limiting processed and canned foods.”sugar in your diet by limiting intake of sweets.”vitamins and minerals in your diet.” Due to her hyperkalemia, which specific foods would the nurse teach the client to avoid? Broccoli, dried fruits, dairy products, whole grains.Deli meats, canned or processed foods, bagged chips.Eggs, fresh apples, boiled carrots, white bread.Peanuts, legumes, fortified grains, spinach.  Which classes of medications should be held prior to hemodialysis because they can cause serious side effects leading to decreased perfusion?Phosphorous binders.Multivitamins.Antihypertensives.Gastric acid Inhibitors.  What would the nurse teach the client to do at home to prevent complications from chronic kidney disease? (Select all that apply)”Because of dialysis, you no longer have to take your blood pressure medications.””Depending on the amount of urine you produce, you may need to limit fluid intake.””It may help if you become part of a support group in order to learn coping mechanisms and express your feelings.” “On days you receive your dialysis, you don’t need to limit the types of foods you eat.””You should weigh yourself every day and keep a log for your physician.” Due to her chronic conditions and lack of renal function improvement, the nephrologist decides to have an AV fistula placed surgically.  In one sentence, briefly describe what an AV fistula is.    Match the characteristics with the type of vascular access sites (answers may be used more than once).  1- External vascular catheter 2-Av fistula 3-Av graft___ a. 2 to 4 months requires for healing___ b. Least likely to thrombose (clot)___ c. Most prone to infection due to site___ d. May lead to distal ischemia__ Usually used for temporary access for continuous renal replacement therapy You receive care for the client after she has had the AV fistula placed in her left arm.  A bruit can be assessed by palpating the AV fistula whereas a thrill should be auscultated. TRUE or FALSE (choose one)   What physical findings are expected when assessing Ms. Beers AV fistula? Difficulty performing passive range of motion.Presence of a thrill and bruit.Numbness and pain in fingers. Pallor and difficulty palpating radial pulse. As you continue the assessment, you notice that unlicensed assistive personnel (UAP) is taking Ms. Beers blood pressure.  The UAP places the blood pressure cuff on her left arm. What is the correct response by the nurse?Instruct the UAP to take the blood pressure below the level of the fistula for more accurate results. Have the UAP continue as you continue the physical assessment by auscultating lung sounds. Praise the UAP for obtaining vital signs in a timely manner.Stop the UAP and instruct them that the blood pressure should be taken on the other arm. The following day, Ms. Beers is discharged feeling much better and with a good understanding of her dietary restrictions. Her iron stores have been evaluated and found to be low.  Her physician has instructed her to resume her preadmission medications and has added ferrous sulfate elixir 5mL PO TID, multivitamin 1 tablet PO daily, and epoetin alfa 75 units/kg to be given every MWF SQ.  When explaining the action of epoetin alfa to the client, the nurse would say that this medication:helps remove extra phosphorous by preventing absorption with food.increases vitamins and minerals that are lost during hemodialysis.stimulates the bone marrow to begin making red blood cells. will help prevent clotting on days the client has hemodialysis.  The pharmacy has a multi-dose vial of epoetin alfa available for the client to take home. The client weighs 143 lbs. How many units of epoetin alfa will the client receive? (Round to the nearest whole number) *must show your work for full credit. __________ units  The concentration of this medication is 5000 units/0.5 mL. How many mL would the nurse teach the client to draw up? (Round to the nearest hundredth) *must show your work for full credit. __________ mL    What information would the nurse teach the client about ferrous sulfate elixir? “Limit your fluid intake while taking this medication because it can cause fluid retention.””Monitor your blood sugar while on this medication because it can cause decreases in these values.””Report black, tarry stools to your provider because this may indicate a bleeding problem.””Take a stool softener while on this medication because it can cause constipation.” Ms. Beers is trying to plan her work schedule around dialysis. Ms. Beers asks the nurse, “how often will I have to go and how long does it take?” What is the nurse’s best response?”If you are compliant with the diet and fluid restrictions, you will spend less time in dialysis each week.””If you gain a large amount of fluid weight, a longer treatment time may be necessary to prevent severe side effects.””Most people require multiple three- to four-hour sessions of dialysis, usually three times per week.””It will vary between individuals; you will have to call your dialysis clinic for specific instructions.”___Health ScienceScienceNursingNURS DDDShare Question