Page 1894 - Saunders Comprehensive Review For NCLEX-RN

Integrated Process: Nursing Process—Implementation
Content Area: Adult Health: Renal and Urinary
Health Problem: Adult Health: Renal and Urinary: Chronic kidney disease
Priority Concepts: Clinical Judgment; Intracranial Regulation
Reference: Ignatavicius, Workman, Rebar (2018), p. 1417.

656. Answer: 4, 5

Rationale: Urolithiasis is the condition that occurs when a stone forms in the
urinary system. Hydronephrosis develops when the stone has blocked the ureter
and urine backs up and dilates and damages the kidney. Priority treatment is to
allow the urine to drain and relieve the obstruction in the ureter. This is
accomplished by placement of a percutaneous nephrostomy tube to drain urine from
the kidney and placement of a ureteral stent to keep the ureter open. Peritoneal
dialysis is not needed, since the kidney is functioning. Stone analysis will be done
later when the stone has been retrieved and analyzed. Opioid analgesics are
necessary for pain relief but do not treat the obstruction.
Test-Taking Strategy: Focus on the subject, treatment to relieve the obstruction.
Think about what each option will accomplish. Eliminate the options that do not
address the obstruction.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Analysis
Content Area: Adult Health: Renal and Urinary
Health Problem: Adult Health: Renal and Urinary: Obstructive problems
Priority Concepts: Clinical Judgment; Elimination
Reference: Ignatavicius, Workman, Rebar (2018), pp. 1361, 1382-1383.

657. 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. Diabetic clients may require extra insulin when receiving
peritoneal dialysis. Peritonitis is a risk associated with breaks in aseptic technique.
Hyperphosphatemia is an electrolyte imbalance that occurs with renal dysfunction.
Disequilibrium syndrome is a complication associated with hemodialysis.
Test-Taking Strategy: Focus on the subject, a complication associated with an
extended dwell time. Noting the client’s diagnosis and recalling that the dialysate
solution contains glucose will direct you to the correct option.
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health: Renal and Urinary
Health Problem: Adult Health: Renal and Urinary: Chronic kidney disease
Priority Concepts: Elimination; Glucose Regulation
Reference: Ignatavicius, Workman, Rebar (2018), p. 1421.

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