Quiz # 5
Textbook
Chapter 60:
Chapter 61:
Chapter 62:
Chapter 63:
ATI Book
Chapter 56:
Chapter 57:
Chapter 58:
Chapter 59:
Chapter 60:
Chapter 61:
Test bank
Quizlet
ATI book
ATI
Clean Catch
When doing a clean catch urine specimen, you’re going to take the lid off the sterile
container and place the cap on a table; keep the exposed area of the lid touching the table.
- Remember with a clean catch to make sure the patient urinates, stops, wipes, and then
urinates in the cup.
A nurse caring for patients in a long-term care facility is often required to collect urine
specimens from patients for laboratory testing. Which techniques for urine collection are
performed correctly? (Select all that apply).
A. The nurse catheterizes a patient to collect a sterile urine sample for routine urinalysis.
B. The nurse collects a clean-catch urine specimen in the morning from a patient and stores
it at room temperature until an afternoon pick-up.
C. The nurse collects a sterile urine specimen from the collection receptable of a patient’s
indwelling catheter.
D. The nurse collects about 3 mL of urine from a patient’s indwelling catheter to send for a
urine culture.
E. The nurse collects a urine specimen from a patient with a urinary division by
catheterizing the stoma
F. The nurse discards the first urine of the day when performing a 24-hour urine specimen
collection on a patient.
ANS: D, E, F
A nurse is reviewing the results of a client’s urinalysis. The findings indicate the urine is positive
for leukocyte esterase and nitrates. Which of the following actions should the nurse take?
A. Repeat the test early the next morning.
B. Start a 24-hr urine collection for creatinine clearance.
C. Obtain a clean-catch urine specimen for culture and sensitivity
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D. Insert an indwelling catheter urinary catheter to collect a urine specimen
ANS: C
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Bladder Scan
Bladder scan: for a female who has had a hysterectomy we will push the male button on
the bladder scanner.
***The nurse delegates completing a bladder scan to assistive personnel (AP). Which action by
the AP indicates that the nurse must provide additional instructions when delegating this task?
A. Selecting the female icon for all female patients and male icon for all male patients
B. Telling the client, “This test measures the amount of urine in your bladder.”
C. Applying ultrasound gel to the scanning head and removing it when finished
D. Taking at least two readings using the aiming icon to place the scanning head
ANS: A
The AP should use the female icon for women who have not had a hysterectomy. This allows the
scanner to subtract the volume of the uterus from readings. If a woman has had a hysterectomy,
the AP should choose the male icon. The AP should explain the procedure to the client, apply gel
to the scanning head and clean it after use, and take at least two readings.
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Patient should not have more than 350cc of urine in the bladder. If the patient gets more
than 1000mL of urine in the bladder the physician will order a foley or straight catheter.
While removing the urine you will clamp (for about 5 min) the catheter and assess the
patient to assess for hypovolemic shock since so much fluid volume is being removed.
The bladder can also go into spasms and cause bleeding. Once patient is stable, we will
unclamp and see how much more urine comes out. We will then document
characteristics, volume, how the pt tolerated the procedure
A nurse administered captopril to a client during a renal scan. Which of the following actions
should the nurse take?
A. Assess for hypertension
B. Limit the client’s fluid intake
C. Monitor for orthostatic hypotension
D. Encourage early ambulation
ANS: C
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Transurethral Resection of Prostate
If your pt has blood clots or bleeding from their urinary system; whether they have had a
procedure or not. You’re going to contact the provider. Unless it’s a TURP; pt coming
back from surgery with TURP will be expected to have some bleeding or some clots. If it
is not a TURP then there should not be any bleeding.
A nurse is assessing a client who is postoperative following a transurethral resection of the
prostate (TURP). After the nurse discontinues the client’s urinary catheter, which of the
following findings should the nurse report to the provider?
A. Pink-tinged urine
B. Report of burning upon urination
C. Stress incontinence
D. Decreased urine output
ANS: D
A nurse is assessing a client who is postoperative following a transurethral resection of the
prostate (TURP) and has continuous bladder irrigation. The nurse notes no drainage bag over 1
hr. Which of the following actions should the nurse take?
A. Instruct the client to attempt to void around the indwelling urinary catheter.
B. Increase the rate or irrigation fluid installation.
C. Irrigate the indwelling urinary catheter with a syringe
D. Prepare to administer a diuretic
ANS: C
***A nurse is caring for a client who has continuous bladder irrigation following a transurethral
resection of the prostate (TURP). Which of the following findings should the nurse report to the
provider?
A. Output equal to the instilled irrigant
B. Client report of bladder spasms
C. Viscous urinary output with clots
D. Client report of a strong urge to urinate.
ANS: C
CT Scan
- Patients going through CT scan with contrast, we want to make sure if it is not
contraindicated that we give the patient fluids because the dye from the scan is excreted
from the kidneys. If the patient does not drink enough fluids or the dye is not flushed out,
then the dye can damage the kidneys.
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If your patient had a scan with contrast, you must assess if they are allergic to shellfish or
iodine. Ask if they have a history of asthma because the dye can make it worse. We want
to check BUN and creatine levels (what are the acceptable ranges?)
We want to make sure the patient has not taken their Glucophage or their metformin
because the dye from the scan can interact with the Glucophage.
A client with diabetes mellitus type 2 has been well controlled with metformin. The client is
scheduled for magnetic resonance imaging (MRI) scan with contrast. What priority would the
nurse take at this time?
A. Teach the client about the purpose of the MRI.
B. Assess the client’s blood urea nitrogen and creatinine.
C. Tell the client to withhold metformin for 24 hours before the MRI.
D. Ask the client if he or she is taking antibiotics.
ANS: C
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be
nephrotoxic, and the client should not be exposed to two agents. Clients who have diabetes are
already at risk for renal damage
A nurse is preparing a client who has a brain tumor for computed tomography (CT). Which of
the following factors affects the manner in which the nurse will prepare the client for the scan?
A. No food or fluids consumed for 4 hr.
B. Difficulty recalling recent events
C. Development of hives when eating shrimp
D. Paresthesia in both hands
ANS: C
***A nurse is caring for a client who has type 2 diabetes mellitus and will have excretory
urography. Prior to the procedure, which of the following actions should the nurse take? (Select
all that apply).
A. Identify an allergy to seafood.
B. Withhold metformin for 24 hr.
C. Administer an enema.
D. Obtain a blood coagulation profile
E. Assess for asthma.
ANS: A, B, C, E.
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24-hour Urine
Your patient who is on a 24-hour urine. Start at a specific time and 24 hours it will end,
making sure to catch and document all urine during that 24-hour time.
The urine must be on ice, collect every drop, and document every drop and characteristic
of the urine.
The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has acute
kidney injury (AKI). The client’s 24-hour urinary output is 120 mL. How much fluid would the
client be allowed to have over the next 24 hours?
A. 380 mL
B. 500 mL
C. 620 mL
D. 750 mL
ANS: C
The general principle for fluid restriction for clients is that they may have a daily fluid intake of
500 mL plus the amount of their urinary output. In this case, 120 mL urinary output plus 500 mL
equals 620 mL fluid allowance.
A nurse is teaching a newly licensed nurse about collecting a 24-hour urine specimen for
creatinine clearance. Which of the following instructions should the nurse include?
A. Include the first voided specimen at the start of the collection period
B. Discard the last voided specimen at the end of the collection period.
C. Place signs in the bathroom as a reminder about the test in progress
D. Instruct the client to increase exercise during the 24-hour period.
ANS: C
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Incontinence
Why do we do Kegel exercises? Which incontinence is it connected to?
What are the differences between the different incontinence?
***The nurse teaches a client who has stress incontinence methods to regain more urinary
continence. Which health teaching is the most important for the nurse to include for this client?
A. What type of incontinence pads to use?
B. What types of liquids to drink and when?
C. Need to perform intermittent catheterizations.
D. How to do Kegel exercises to strengthen muscles?
ANS: D
The client who has stress incontinence needs to strengthen the muscles of the pelvic floor using
Kegel exercises. Catheterizations would not help with incontinence. Incontinence pads may need
to be used by this client but that is not the most important thing to teach, and it does not help the
client regain more control over his or her bladder.
After teaching a client who has stress incontinence, the nurse assesses the client’s understanding.
Which statement made by the client indicates a need for further teaching?
A. “I will limit my total intake of fluids.”
B. “I must avoid drinking alcoholic beverages.”
C. “I must avoid drinking caffeinated beverages.”
D. “I shall try to lose about 10% of my body weight.”
ANS: A
Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence or
cystitis. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated
beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing
incontinence.
After delegating care to assistive personnel (AP) for a client who is prescribed habit training to
manage incontinence, a nurse evaluates the AP’s understanding. Which action indicates that the
AP needs additional teaching?
A. Toileting the client after breakfast
B. Changing the client’s incontinence brief when wet
C. Encouraging the client to drink fluids
D. Recording the client’s incontinence episodes
ANS: B
Habit training is undermined using absorbent incontinence briefs or pads. The nurse should
reeducate the AP on the technique of habit training. The AP should continue to toilet the client
after meals, encourage the client to drink fluids, and record incontinent episodes.
A nurse plans care for a client with overflow incontinence. Which intervention does the nurse
include in this client’s plan of care to assist with elimination?
A. Stroke the medial aspect of the thigh.
B. Use intermittent catheterization.
C. Provide digital anal stimulation.
D. Use the Valsalva maneuver.
ANS: D
In patients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure,
such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if
to defecate), can initiate voiding. Stroking the medial aspect of the thigh or providing digital anal
stimulation requires the reflex arc to be intact to initiate elimination. Due to the high risk for
infection, intermittent catheterization should only be implemented when other interventions are
not successful.
A client asks the nurse why she has urinary incontinence. What risk factors would the nurse
recall in preparing to respond to the client’s question? (Select all that apply.)
A. Diuretic therapy
B. Anorexia nervosa
C. Stroke
D. Dementia
E. Arthritis
F. Parkinson disease
ANS: A, C, D, E, F
Drugs, such as diuretics, cause frequent voiding, often in large amounts. Diseases or disorders
that limit mobility, such as stroke, arthritis, and Parkinson disease, can prevent an individual
from getting to the bathroom in a timely manner. Mental/behavioral problems, such as dementia,
impair cognition and the ability to recognize when he or she needs to void.
***A nurse cares for clients with urinary incontinence. Which types of incontinence are correctly
paired with their description? (Select all that apply.)
A. Stress incontinence—urine loss with physical exertion
B. Urge incontinence—loss of urine upon feeling the need to void
C. Functional incontinence—urine loss results from abnormal detrusor contractions
D. Overflow incontinence—constant dribbling of urine
E. Reflex incontinence—leakage of urine without lower urinary tract disorder
ANS: A, B, D
Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising.
Urge incontinence presents with an abrupt and strong urge to void and usually has a large
amount of urine released with each occurrence. Overflow incontinence occurs with bladder
distention and results in a constant dribbling of urine. Functional incontinence is the leakage of
urine caused by factors other than a disorder of the lower urinary tract. Reflex incontinence
results from abnormal detrusor contractions from a neurologic abnormality.
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Patients on Medications
Your patients who are on certain medications (anti cholinergic) can dry out the patient;
dry eyes, dry mouth, constipation, increase intercranial pressure.
Patients that are on anticholinergics drugs and are being dried out we want to make sure
they are drinking enough, have something to moisturize their mouth, and we want to
make sure that they have an increase in fiber intake so they can eliminate their bowels
and not become constipated.
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Patient on antibiotics or with infection we want to make sure the patient takes all their
medication as prescribed. Take the full dose and finish all the medication. If the patient
forgot to take the medication in the morning that’s supposed to be take morning and
night; they cannot take two tabs at night
***The nurse assesses a client with a history of urinary incontinence who presents with extreme
dry mouth, constipation, and an inability to void. Which question would the nurse ask first?
A. “Are you drinking plenty of water?”
B. “What medications are you taking?”
C. “Have you tried laxatives or enemas?”
D. “Has this type of thing ever happened before?”
ANS: B
Some types of incontinence or other health problems are treated with anticholinergic
medications. Anticholinergic side effects include dry mouth, constipation, and urinary retention.
The nurse needs to assess the client’s medication list to determine whether the he or she is taking
an anticholinergic medication. The other questions are not as helpful to understanding the current
situation.
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Polycystic Kidney Disease (ATI pg. 395)
Patient with this disease, what does it look like and how does it feel. What happens to the
kidneys with this disease?
o Fluid filled cysts develop in the nephrons
If you take a cross section of the kidney it looks like its shriveled and bubbles throughout
the kidney which will create difficulty for the kidney to do what it is supposed to do. It
could be hereditary and caused by genetic mature (?). most common in Caucasian
patients.
A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding would
alert the nurse to immediately contact the primary health care provider?
A. Flank pain
B. Periorbital edema
C. Bloody and cloudy urine
D. Enlarged abdomen
ANS: B
Periorbital edema would not be a finding related to PKD and would be investigated further.
Flank pain and a distended or enlarged abdomen occur in PKD because the kidneys enlarge and
displace other organs. Urine can be bloody or cloudy because of cyst rupture or infection.
After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the
nurse assesses the client’s understanding. Which statement made by the client indicates a correct
understanding of the teaching?
A. “I will take a laxative every night before going to bed.”
B. “I must increase my intake of dietary fiber and fluids.”
C. “I shall only use salt when I am cooking my own food.”
D. “I’ll eat white bread to minimize gastrointestinal gas.”
ANS: B
Clients with PKD often have constipation, which can be managed with increased fiber, exercise,
and drinking plenty of water. Laxatives would be used cautiously. Clients with PKD would be on
a restricted salt diet, which includes not cooking with salt. White bread has a low-fiber count and
would not be included in a high-fiber diet.
A nurse assesses a client who has a family history of polycystic kidney disease (PKD). Which
assessment findings would the nurse expect? (Select all that apply.)
A. Nocturia
B. Flank pain
C. Increased abdominal girth
D. Dysuria
E. Hematuria
F. Diarrhea
ANS: B, C, E
Clients with PKD experience abdominal distention that manifests as flank pain and increased
abdominal girth. Bloody urine is also present with tissue damage secondary to PKD. Clients with
PKD often experience constipation but would not report nocturia or dysuria.
A nurse teaches a client with polycystic kidney disease (PKD). Which statements would the
nurse include in this client’s discharge teaching? (Select all that apply.)
A. “Take your blood pressure every morning.”
B. “Weigh yourself at the same time each day.”
C. “Adjust your diet to prevent diarrhea.”
D. “Contact your provider if you have visual disturbances.”
E. “Assess your urine for renal stones.”
ANS: A, B, D
A client who has PKD would measure and record his or her blood pressure and weight daily,
limit salt intake, and adjust dietary selections to prevent constipation. The client should notify the
primary health care provider if urine smells foul or has blood in it, as these are signs of a urinary
tract infection or glomerular injury. The client should also notify the provider if visual
disturbances are experienced, as this is a sign of a possible berry aneurysm, which is a
complication of PKD. Diarrhea and renal stones are not manifestations or complications of PKD;
therefore, teaching related to these concepts would be inappropriate.
Autosomal dominate polycystic kidney disease
Chronic kidney disease (pg. 393 ATI)
- Stages
The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the
nurse assess first upon initial rounding?
A. Client with a blood pressure of 158/90 mm Hg
B. Client with Kussmaul respirations
C. Client with skin itching from head to toe
D. Client with halitosis and stomatitis
ANS: B
Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of
CKD. The client is increasing the rate and depth of breathing to excrete carbon dioxide through
the lungs to lower serum pH. Hypertension is common in most patients with CKD, and skin
itching increases with calcium–phosphate imbalances and elevations of nitrogenous wastes,
another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in
the common findings of halitosis and stomatitis.
A client with chronic kidney disease (CKD) is refusing to take his medication and has missed
two hemodialysis appointments. What is the best initial action for the nurse?
A. Discuss what the treatment regimen means to the client.
B. Refer the client to a mental health nurse practitioner.
C. Reschedule the appointments to another date and time.
D. Discuss the option of peritoneal dialysis.
ANS: A
The initial action for the nurse is to assess anxiety, coping styles, and the client’s acceptance of
the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling
hemodialysis appointments may help, and referral to a mental health practitioner and the p
A client is taking furosemide 40 mg/day for management of early chronic kidney disease (CKD).
To assess the therapeutic effect of the medication, what action of the nurse is best?
A. Obtain daily weights of the client.
B. Auscultate heart and breath sounds.
C. Palpate the client’s abdomen.
D. Assess the client’s diet history.
ANS: A
Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in patients with
early stages of CKD. One kilogram of weight equals about 1 L of fluid retained in the client, so
daily weights are necessary to monitor the response of the client to the medication. Heart and
breath sounds would be assessed if there is fluid retention, as in heart failure. Palpation of the
client’s abdomen is not necessary, but the nurse would check for edema. The diet history of the
client would be helpful to assess electrolyte replacement since potassium is lost with this
diuretic, but this does not assess the effectiveness of the medication
A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient has
a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of
most concern to the nurse?
A. Albumin level of 2.5 g/dL (3.63 mcmol/L)
B. Phosphorus level of 5 mg/dL (1.62 mmol/L)
C. Sodium level of 135 mEq/L (135 mmol/L)
D. Potassium level of 5.5 mEq/L (5.5 mmol/L)
ANS: A
Protein restriction is necessary with CKD due to the buildup of waste products from protein
breakdown. The nurse would be concerned with the low albumin level since this indicates that
the protein in the diet is not enough for the client’s metabolic needs. The electrolyte values are
not related to the protein-restricted diet
The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction
needed in the diet to prevent edema and hypertension. Which statement by the client indicates
that more teaching is needed?
A. “I will probably lose weight by cutting out potato chips.”
B. “I will cut out bacon with my eggs every morning.”
C. “My cooking style will change by not adding salt.”
D. “I am thrilled that I can continue to eat fast food.”
ANS: D
Fast-food restaurants usually serve food that is high in sodium. This statement indicates that
more teaching needs to occur. The other statements show a correct understanding of the teaching
A client is placed on fluid restriction because of chronic kidney disease (CKD). Which
assessment finding would alert the nurse that the client’s fluid balance is stable at this time?
A. Decreased calcium levels
B. Increased phosphorus levels
C. No adventitious sounds in the lungs
D. Increased edema in the legs
ANS: C
The absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid
overload and fluid balance in the client’s body. Decreased calcium levels and increased
phosphorus levels are common findings with CKD. Edema would indicate a fluid imbalance.
The nurse administers epoetin alfa to a client who has chronic kidney disease (CKD). Which
laboratory test value would the nurse monitor to determine this drug’s effectiveness?
A. Potassium
B. Sodium
C. Renin
D. Hemoglobin
ANS: D
The purpose of giving epoetin alfa to a client with CKD is to manage anemia by stimulating the
bone marrow to produce more red blood cells. Therefore, monitoring the client’s hemoglobin,
hematocrit, and red blood cell count would indicate if the drug was effective
A client with chronic kidney disease (CKD) has an elevated serum phosphorus level. What drug
would the nurse anticipate being prescribed for this client?
A. Calcium acetate
B. Doxycyline
C. Magnesium sulfate
D. Lisinopril
ANS: A
The client with CKD often has a high phosphorus level which tends to lower the calcium level in
an inverse relationship and causes osteodystrophy. To prevent this bone disease, the client needs
to take a drug that can bind with phosphorus for elimination via the GI tract. When phosphorus is
lowered to within normal limits, normal calcium levels may be restored.
The nurse is caring for a client with a new diagnosis of chronic kidney disease. Which priority
complications would the nurse anticipate? (Select all that apply.)
A. Dehydration
B. Anemia
C. Hypertension
D. Dysrhythmias
E. Heart failure
ANS: B, C, D, E
The client who has CKD has fluid overload and electrolyte imbalances, especially hyperkalemia,
that can cause hypertension, heart failure, and dysrhythmias. Anemia results because
erythropoietin production by the kidneys is decreased.
A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney
disease (CKD). Which statements made by the client indicate a correct understanding of the
teaching? (Select all that apply.)
A. “I can continue to take antacids to relieve heartburn.”
B. “I need to ask for an antibiotic when scheduling a dental appointment.”
C. “I’ll need to check my blood sugar often to prevent hypoglycemia.”
D. “The dose of my pain medication may have to be adjusted.”
E. “I should watch for bleeding when taking my anticoagulants.”
ANS: B, C, D, E
In discharge teaching, the nurse must emphasize that the client needs to have an antibiotic
prophylactically before dental procedures to prevent infection. There may be a need for dose
reduction in medications if the kidney is not excreting them properly (antacids with magnesium,
antibiotics, antidiabetic drugs, insulin, opioids, and anticoagulants).
A nurse is planning care for a client who has Stage 4 chronic kidney disease. Which of the
following actions should the nurse include in the plan of care? (Select all that apply).
A. Assess for jugular vein distention
B. Provide frequent mouth rinses
C. Auscultate for a pleural friction rub
D. Provide a high-sodium diet.
E. Monitor for dysrhythmias.
ANS: A, B, C, E
A nurse is reviewing client laboratory data. Which of the following findings is expected for a
client who has stage 4 chronic kidney disease?
A. BUN 15 mg/dL
B. GFR 20 mL/min
C. Blood creatinine 1.1 mg/dL
D. Blood K 5.0 mEq/L
ANS: B
Kidney Stones
We want to make sure when our patient has a history of kidney stones what other
diagnoses are an indicator of this?
A nurse cares for a client who has kidney stones from gout ricemia. Which medication does the
nurse anticipate administering?
A. Phenazopyridine
B. Doxycycline
C. Tolterodine
D. Allopurinol
ANS: D
Stones caused by hyperuricemia caused by gout or other reason respond to allopurinol.
Phenazopyridine is given to clients with urinary tract infections. Doxycycline is an antibiotic.
Tolterodine is an anticholinergic with smooth muscle-relaxant properties.
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A nurse is completing the admission assessment of a client who has renal calculi. Which of the
following findings should the nurse expect?
A. Bradycardia.
B. Diaphoresis (sweating)
C. Nocturia
D. Bradypnea
ANS: B
A nurse is reviewing discharge instructions with a client who has spontaneous passage of a
calcium phosphate renal calculus. Which of the following instructions should the nurse include
in the teaching (Select all that apply)?
A. Limit intake of food high in animal protein (contains calcium)
B. Reduce sodium intake
C. Strain urine for 48 hr.
D. Report burning with urination to the provider
E. Increase fluid intake to 3 L/day
ANS: A, B, D, E
A nurse is teaching a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL).
Which of the following statements by the client indicates understanding of the teaching?
A. I will be fully awake during the procedure
B. Lithotripsy will reduce my chances of having stones in the future
C. I will report any bruising that occurs to my doctor
D. Straining my urine following the procedure is important
ANS: Dselect
A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter.
Which of the following assessment findings is the priority for the nurse to report to the provider?
A. Flank pain that radiates to the lower abdomen
B. Client report of nausea
C. Absent urine output for 1 hr.
D. Blood WBC count 15,000/mm^3
ANS: C
A nurse is completing discharge instructions with a client who has spontaneously passed a
calcium oxalate calculus. To decrease the change of reoccurrence, the nurse should instruct the
client to avoid which of the following foods? (Select all that apply).
A. Red meat
B. Black tea
C. Cheese
D. Whole grain
E. Spinach
ANS: B, E
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Acute Kidney Injury
Make sure to know with your patients with ADK AKI that your patient has acute kidney
infection or acute kidney disease; what kind of trauma would cause that?
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A patient that may have been in a car accident, football or baseball players, patient’s
recovering from the flu, patient on high level of antibiotics might have a kidney injury.
The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which
condition would the nurse expect to find in the patient’s recent history?
A. Pyelonephritis
B. Dehydration
C. Bladder cancer
D. Kidney stones
ANS: B
Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have
prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney
damage. Bladder cancer and kidney stones are postrenal causes of AKI related to urine flow
obstruction.
A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is
the major concern of the nurse regarding this patient’s care?
A. Edema and pain
B. Cardiac and respiratory status
C. Electrolyte and fluid imbalance
D. Mental health status
ANS: C
This client may have an inflammatory cause of AKI with proteins entering the glomerulus and
holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential.
Edema and pain are not usually a problem with fluid loss. There could be changes in the client’s
cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.
A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary
health care provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain
perfusion. The client starts to develop shortness of breath. What is the nurse’s priority action?
A. Calculate the mean arterial pressure (MAP).
B. Ask for insertion of a pulmonary artery catheter.
C. Take the client’s pulse.
D. Decrease the rate of the IV infusion.
ANS: D
The nurse would assess that the client could be developing fluid overload and respiratory distress
and slow down the normal saline infusion. The calculation of the MAP also reflects perfusion.
The insertion of a pulmonary artery catheter would evaluate the client’s hemodynamic status, but
this would not be the initial or priority action by the nurse. Vital signs are also important after
adjusting the intravenous infusion.
The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse
consider to be at risk for postrenal acute kidney injury (AKI)? (Select all that apply.)
A. Client with prostate cancer
B. Client with blood clots in the urinary tract
C. Client with ureterolithiasis
D. Client with severe burns
E. Client with lupus
ANS: A, B, C
Urine flow obstruction, such as prostate cancer, blood clots in the urinary tract, and kidney
stones (ureterolithiasis), causes postrenal AKI. Severe burns would be a prerenal cause. Lupus
would be an intrarenal cause for AKI.
A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube
feedings. The nurse is teaching the client’s spouse about the renal-specific formulation for the
enteral solution compared to standard formulas. What components would be discussed in the
teaching plan? (Select all that apply.)
A. Lower sodium
B. Higher calcium
C. Lower potassium
D. Higher phosphorus
E. Higher calories
ANS: A, C, E
Many clients with AKI are too ill to meet caloric goals and require tube feedings with renalspecific formulas that are lower in sodium, potassium, and phosphorus, and higher in calories
than are standard formulas.
A nurse is planning care for a client who has prerenal acute kidney injury (AKI) following
abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hr, and BP is 92/58 mm
Hg. The nurse should expect which of the following interventions?
A. Prepare the client for a CT scan with contrast dye.
B. Plan to administer nitroprusside
C. Prepare to administer a fluid challenge
D. Plan to position the client to Trendelenburg
ANS: C
A nurse is planning care for a client who has a postrenal AKI due to metastatic cancer. The client
has a blood creatinine of 5 mg/dL. Which of the following interventions should the nurse include
in the plan? (Select all that apply).
A. Provide a high-protein diet
B. Assess the urine for blood
C. Monitor the intermittent anuria
D. Weight the client once per week
E. Provide NSAIDS for pain
ANS: A, B, C
A nurse is assessing a client who has prerenal AKI. Which of the following findings should the
nurse expect? (Select all that apply).
A. Reduced BUN
B. Elevated cardiac enzymes
C. Reduced urine output
D. Elevated blood creatinine
E. Elevated blood calcium
ANS: C, D
Transplant
- Patients that have had a transplant those patients will be on medications for the rest of
their lives. We want to make sure that they are not going into fluid overload. Check and
make sure their lungs are clear and that there is no edema and that their temperature is
good, and their blood pressure is normal. How will the BUN and creatinine look?
- We want to make sure the patient is taking all their meds to prevent rejection. Check their
vital signs often because we want to make sure this patient does not acquire any type of
infection.
A nurse reviews the laboratory values of a client who returned from kidney transplantation 12
hours ago: Sodium 136 mEq/L (135 mmol/L) Potassium 5 mEq/L (5 mmol/L) Blood urea
nitrogen (BUN) 44 mg/dL (15.7 mmol/L) Serum creatinine 2.5 mg/dL (221 mcmol/L) What
initial intervention would the nurse anticipate?
A. Start hemodialysis immediately.
B. Discuss the need for peritoneal dialysis.
C. Increase the dose of immunosuppression.
D. Return the client to surgery for exploration.
ANS: C
The client may need a higher dose of immunosuppressive medication as evidenced by the
elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute
rejection of the transplanted kidney. The client does not need hemodialysis, peritoneal dialysis,
or further surgery at this point.
A nurse is teaching a client who had a kidney transplant surgery about immunosuppressive
medications. Which of the following adverse effects of these medications should the nurse
include in the teaching?
A. Increased urinary output
B. Increased susceptibility to infection
C. Increased hair loss
D. Increased risk of autoimmune disorders.
ANS: B
A nurse is assessing a client who has end-stage kidney disease. Which of the following findings
should the nurse expect? (Select all that apply)
A. Anuria
B. Marked azotemia
C. Crackles in lungs
D. Increased calcium level
E. Proteinuria
ANS: A, B, C, E
A nurse is planning postoperative care for a client following a kidney transplant. Which of the
following actions should the nurse include? (Select all that apply).
A. Obtain daily weights
B. Assess dressings for bloody drainage
C. Replace hourly urine output with IV fluids
D. Expect oliguria in the first 4 hr.
E. Monitor blood electrolytes
ANS: A, B, C, E
A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk
factors of surgery. Which of the following findings increase the client’s risk of surgery? (Select
all that apply).
A. Age older than 70 years
B. BMI of 41
C. Administering NPH insulin each morning
D. Past medical history of lymphoma
E. BP of 120/70
ANS: A, B, C, D
A nurse is teaching a client who is scheduled for a kidney transplant about organ rejection.
Which of the following statements should the nurse include? (Select all that apply).
A. Expect an immediate removal of the donor kidney for a hyperacute rejection
B. You might need to begin dialysis to monitor your kidney function for a hyperacute
rejection
C. A fever is a manifestation of an acute rejection
D. Fluid retention is a manifestation of an acute rejection
E. Your provider will increase your immunosuppressive medications for a chronic rejection
ANS: A, C, D
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Dialysis (she said make sure to go through ATI)
We have two types of dialysis, peritoneal is where the catheter is in the peritoneum and
the fluid will drain by gravity or pump. We want to make sure this stays a sterile
procedure. If the patient is going home on this dialysis, we need to teach the patient how
to keep it sterile and the ss to look out for. If the patient develops a fever or ss of sepsis
they need to call their physician and we must tell the patient to look at the color and
consistency of the urine and watch the amount of dialysate that goes in and how much
comes out. Watch for peritonitis.
Then there is hemodialysis where they can have an AV (arterial venous) fistula in the
upper arm. Here you will feel the thrill and hear the bruit. Or they can have a venous
catheter in their chest area. This we flush with large amounts of heparin. We do not
bother them. For hemodialysis there are two types of schedules: Mon, Wed, & Fri or
Tues, Thurs, & Sat. whether they are in the hospital or outpatient where there are clinics
the patient can go to. Make sure the patient is sent with all their meds and food tray so
they can eat while they are on dialysis. The nurse will have a long dialysis needle that
will go through the arm into the fistula to clean and make sure the dialysis fluids all get
through.
Patients on dialysis can only have a certain about of protein, calcium, and/or magnesium.
They are not on a regular diet; they are on a renal diet. With this diet comes certain
restrictions.
A client with chronic kidney disease (CKD) is refusing to take his medication and has missed
two hemodialysis appointments. What is the best initial action for the nurse?
A. Discuss what the treatment regimen means to the client.
B. Refer the client to a mental health nurse practitioner.
C. Reschedule the appointments to another date and time.
D. Discuss the option of peritoneal dialysis.
ANS: A
The initial action for the nurse is to assess anxiety, coping styles, and the client’s acceptance of
the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling
hemodialysis appointments may help, and referral to a mental health practitioner and the
possibility of peritoneal dialysis are all viable options, assessment of the client’s acceptance of
the treatment would come first.
A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient has
a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of
most concern to the nurse?
A. Albumin level of 2.5 g/dL (3.63 mcmol/L)
B. Phosphorus level of 5 mg/dL (1.62 mmol/L)
C. Sodium level of 135 mEq/L (135 mmol/L)
D. Potassium level of 5.5 mEq/L (5.5 mmol/L)
ANS: A
Protein restriction is necessary with CKD due to the buildup of waste products from protein
breakdown. The nurse would be concerned with the low albumin level since this indicates that
the protein in the diet is not enough for the client’s metabolic needs. The electrolyte values are
not related to the protein-restricted diet.
The charge nurse is orienting a new nurse about care for an assigned client with an arteriovenous
(AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be
considered unsafe?
A. Palpating the access site for a bruit or thrill
B. Using the right arm for a blood pressure reading
C. Administering intravenous fluids through the AV fistula
D. Checking distal pulses in the left arm
ANS: C
The nurse would not use the arm with the AV fistula for intravenous infusion, blood pressure
readings, or venipuncture. Compression and infection can result in the loss of the AV fistula. The
AV fistula would be monitored by auscultating or palpating the access site. Checking the distal
pulse would be an appropriate assessment.
A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent.
What is the priority action by the nurse?
A. Warm the dialysate solution in a microwave before instillation.
B. Obtain a sample of the effluent and send to the laboratory.
C. Flush the tubing with normal saline to maintain patency of the catheter.
D. Check the peritoneal catheter for kinking and curling.
ANS: B
An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need
to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic.
Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse.
Checking the catheter for obstruction is a viable option but will not treat the peritonitis.
A client is undergoing hemodialysis. The client’s blood pressure at the beginning of the
procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions would the nurse
perform to maintain blood pressure? (Select all that apply.)
A. Adjust the rate of extracorporeal blood flow.
B. Place the patient in the Trendelenburg position.
C. Stop the hemodialysis treatment.
D. Administer a 250-mL bolus of normal saline.
E. Contact the primary health care provider.
ANS: A, B, D
Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the
warmed dialysate. Modest decreases in blood pressure, as is the case with this client, can be
maintained with rate adjustment, Trendelenburg positioning, and a fluid bolus. If the blood
pressure drops considerably after two boluses and cooling dialysate, the hemodialysis can be
stopped, and the primary health care provider contacted.
A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the
advantages of this treatment with the nurse. Which statements by the nurse are correct regarding
PD? (Select all that apply.)
A. “You will not need vascular access to perform PD.”
B. “There is less restriction of protein and fluids.”
C. “You will have no risk for infection with PD.”
D. “You have flexible scheduling for the exchanges.”
E. “It takes less time than hemodialysis treatments.”
ANS: A, B, D
PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is no
need for vascular access. Protein is lost in the exchange, which allows for more protein and fluid
in the diet. There is flexibility in the time for exchanges, but the treatment takes a longer period
compared to hemodialysis. There still is risk for infection with PD, especially peritonitis
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the
client for which of the following adverse effects?
A. Diarrhea
B. Increased serum albumin
C. Hypoglycemia
D. Peritonitis
ANS: D
A nurse is assessing a client who is receiving continuous ambulatory peritoneal dialysis. Which
of the following findings should the nurse report to the provider?
A. WBC 6,000/mm^3
B. Potassium 3.0 mEq/L
C. Clear, pale-yellow drainage
D. Report of abdominal fullness
ANS: B
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse notes that the
client’s dialysate output is less than the input and that his abdomen is distended. Which of the
following actions should the nurse take?
A. Insert an indwelling urinary catheter
B. Administer pain medication to the client.
C. Change the client’s position
D. Place the drainage bag above the client’s abdomen.
ANS: C
A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which
of the following information should the nurse include in the teaching?
A. Hemodialysis restores kidney function
B. Hemodialysis replaces hormonal function of the renal system.
C. Hemodialysis allows an unrestricted diet
D. Hemodialysis returns a balance to blood electrolytes
ANS: D
A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury. Which of
the following actions should the nurse take? (Select all that apply).
A. Review the medications the client currently takes
B. Assess the AV fistula for bruit
C. Calculate the client’s hourly urine output.
D. Measure the client’s weight
E. Check the blood electrolytes
F. Use the access site area for venipuncture.
ANS: A, B, D, E
A nurse is planning post procedure care for a patient who received hemodialysis. Which of the
following interventions should the nurse include in the plan of care? (Select all that apply).
A. Check BUN and creatinine
B. Administer medications the nurse withheld prior to dialysis
C. Observe for findings of hypovolemia
D. Assess the access site for bleeding
E. Evaluate blood pressure on the arm with AV access.
ANS: A, B, C, D
A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the
following actions should the nurse take? (Select all that apply).
A. Monitor blood glucose levels
B. Report cloudy dialysate return
C. Warm the dialysate in a microwave oven
D. Assess for shortness of breath
E. Check the access site dressing for wetness
F. Maintain medical asepsis when accessing the catheter insertion site.
ANS: A, B, D, E
Pyelonephritis
- Chronic cases may have had some spinal injuries.
- Risk factors include chronic diabetes and hypertension. Can happen in patient’s 65 yrs. or
older or patients with bladder tumors.
The nurse is caring for a client who has chronic pyelonephritis. What assessment finding would
the nurse expect?
A. Fever
B. Flank pain
C. Hypertension
D. Nausea and vomiting
ANS: C
The client who has chronic pyelonephritis has renal damage and therefore has hypertension. The
other assessment findings commonly occur in clients with acute pyelonephritis.
A nurse cares for a middle-age female client with diabetes mellitus who is being treated for the
third episode of acute pyelonephritis in the past year. The client asks, “What can I do to help
prevent these infections?” How would the nurse respond?
A. “Test your urine daily for the presence of ketone bodies and proteins.”
B. “Use tampons rather than sanitary napkins during your menstrual period.”
C. “Drink more water and empty your bladder more frequently during the day.”
D. “Keep your hemoglobin A1C under 9% by keeping your blood sugar controlled.”
ANS: C
Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons.
Chronically elevated blood glucose levels spill glucose into the urine, changing the pH, and
providing a favorable climate for bacterial growth. The neuropathy associated with diabetes
reduces bladder tone and reduces the client’s sensation of bladder fullness. Thus, even with large
amounts of urine, the client voids less frequently, allowing stasis and overgrowth of
microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis
and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis.
A hemoglobin A1C of 9% is too high.
A nurse cares for a client who has pyelonephritis. The client states, “I am embarrassed to talk
about my symptoms.” How would the nurse respond?
A. “I am a professional. Your symptoms will be kept in confidence.”
B. “I understand. Elimination is a private topic and shouldn’t be discussed.”
C. “Take your time. It is okay to use words that are familiar to you.”
D. “You seem anxious. Would you like a nurse of the same gender to care for you?”
ANS: C
Clients may be uncomfortable discussing issues related to elimination and the genitourinary area.
The nurse would encourage the client to use language that is familiar to the client.
The nurse is assessing a client with acute pyelonephritis. What assessment findings would the
nurse expect? (Select all that apply.)
A. Fever
B. Chills
C. Tachycardia
D. Tachypnea
E. Flank or back pain
F. Fatigue
ANS: A, B, C, D, E, F
All of these assessment findings commonly occur in clients who have acute pyelonephritis
because this health problem is a kidney infection.
A nurse is planning care for a client who has chronic pyelonephritic. Which of the following
actions should the nurse plan to take? (Select all that apply).
A. Provide a referral for nutrition counseling
B. Encourage daily fluid intake of 1 L
C. Palpate the costovertebral angle.
D. Monitor urinary output
E. Administer antibiotics
ANS: A, C, D, E
A nurse is caring for several clients. Which of the following clients are at risk for developing
pyelonephritis? (Select all that apply).
A. A client who is at 32 weeks’ gestation
B. A client who has kidney calculi
C. A client who has a urine pH of 4.2
D. A client who has a neurogenic bladder
E. A client who has DM
ANS: A, B, D, E
Glomerulonephritis
The nurse is admitting a client who has acute glomerulonephritis caused by beta streptococcus.
What drug therapy would the nurse expect to be prescribed for this client?
A. Antihypertensives
B. Antilipidemics
C. Antidepressants
D. Antibiotics
ANS: D
Beta streptococcus is a bacterium that can cause acute glomerulonephritis, so antibiotic therapy
is indicated.
A nurse evaluates a client with acute glomerulonephritis (GN). Which assessment finding would
the nurse recognize as a positive response to the prescribed treatment?
A. The client lost 11 lb (5 kg) in the past 10 days.
B. The client’s urine specific gravity is 1.048.
C. No blood is observed in the client’s urine.
D. The client’s blood pressure is 152/88 mm Hg.
ANS: A
Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating
that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is
high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of
152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.
The nurse is reviewing the results of a client’s urinalysis. The client has a diagnosis of acute
glomerulonephritis. Which urine findings would the nurse expect? (Select all that apply.)
A. Presence of protein
B. Presence of red blood cells
C. Presence of white blood cells
D. Acidic urine
E. Dilute urine
ANS: A, C, D
The nurse would expect all these findings except that the urine is usually concentrated with a
high specific gravity.