TEST 1 - RENAL PROBLEMS 1
1. Which of the following symptoms do you expect to see in a patient
diagnosed with acute pyelonephritis?
1. Jaundice and flank pain
2. Costovertebral angle tenderness and chills
3. Burning sensation on urination
4. Polyuria and nocturia
2. You have a patient that might have a urinary tract infection (UTI).
Which statement by the patient suggests that a UTI is likely?
1. “I pee a lot.”
2. “It burns when I pee.”
3. “I go hours without the urge to pee.”
4. “My pee smells sweet.”
3. Which instructions do you include in the teaching care plan for a
patient with cystitis receiving phenazopyridine (Pyridium).
1. If the urine turns orange-red, call the doctor.
2. Take phenazopyridine just before urination to relieve
pain.
3. Once painful urination is relieved, discontinue prescribed
antibiotics.
4. After painful urination is relieved, stop taking
phenazopyridine.
4. Which patient is at greatest risk for developing a urinary tract infection
(UTI)?
1. A 35 y.o. woman with a fractured wrist
2. A 20 y.o. woman with asthma
3. A 50 y.o. postmenopausal woman
4. A 28 y.o. with angina
5. You have a patient that is receiving peritoneal dialysis. What should
you do when you notice the return fluid is slowly draining?
1. Check for kinks in the outflow tubing.
2. Raise the drainage bag above the level of the abdomen.
3. Place the patient in a reverse Trendelenburg position.
4. Ask the patient to cough.
6. What is the appropriate infusion time for the dialysate in your 38 y.o.
patient with chronic renal failure?
1. 15 minutes
2. 30 minutes
3. 1 hour
4. 2 to 3 hours
7. A 30 y.o. female patient is undergoing hemodialysis with an internal
arteriovenous fistula in place. What do you do to prevent complications
associated with this device?
1. Insert I.V. lines above the fistula.
2. Avoid taking blood pressures in the arm with the fistula.
3. Palpate pulses above the fistula.
4. Report a bruit or thrill over the fistula to the doctor.
8. Your patient becomes restless and tells you she has a headache and
feels nauseous during hemodialysis. Which complication do you
suspect?
1. Infection
2. Disequilibrium syndrome
3. Air embolus
4. Acute hemolysis
9.
Your patient is complaining of muscle cramps while undergoing
hemodialysis. Which intervention is effective in relieving muscle cramps?
1. Increase the rate of dialysis
2. Infuse normal saline solution
3. Administer a 5% dextrose solution
4. Encourage active ROM exercises
10. Your patient with chronic renal failure reports pruritus. Which
instruction should you include in this patient’s teaching plan?
1. Rub the skin vigorously with a towel
2. Take frequent baths
3. Apply alcohol-based emollients to the skin
4. Keep fingernails short and clean
11. Which intervention do you plan to include with a patient who has
renal calculi?
1. Maintain bed rest
2. Increase dietary purines
3. Restrict fluids
4. Strain all urine
12. An 18 y.o. student is admitted with dark urine, fever, and flank pain
and is diagnosed with acute glomerulonephritis. Which would most likely
be in this student’s health history?
1. Renal calculi
2. Renal trauma
3. Recent sore throat
4. Family history of acute glomerulonephritis
13. Which drug is indicated for pain related to acute renal calculi?
1. Narcotic analgesics
2. Nonsteroidal anti-inflammatory drugs (NSAIDS)
3. Muscle relaxants
4. Salicylates
14. Which of the following causes the majority of UTI’s in hospitalized
patients?
1. Lack of fluid intake
2. Inadequate perineal care
3. Invasive procedures
4. Immunosuppression
15. Clinical manifestations of acute glomerulonephritis include which of
the following?
1. Chills and flank pain
2. Oliguria and generalized edema
3. Hematuria and proteinuria
4. Dysuria and hypotension
16. You expect a patient in the oliguric phase of renal failure to have a 24
hour urine output less than:
1. 200ml
2. 400ml
3. 800ml
4. 1000ml
17. The most common early sign of kidney disease is:
1. Sodium retention
2. Elevated BUN level
3. Development of metabolic acidosis
4. Inability to dilute or concentrate urine
18. A patient is experiencing which type of incontinence if she
experiences leaking urine when she coughs, sneezes, or lifts heavy
objects?
1. Overflow
2. Reflex
3. Stress
4. Urge
19. Immediately post-op after a prostatectomy, which complications
requires priority assessment of your patient?
1. Pneumonia
2. Hemorrhage
3. Urine retention
4. Deep vein thrombosis
20. The most indicative test for prostate cancer is:
1. A thorough digital rectal examination
2. Magnetic resonance imaging (MRI)
3. Excretory urography
4. Prostate-specific antigen
21. A 22 y.o. patient with diabetic nephropathy says, “I have two kidneys
and I’m still young. If I stick to my insulin schedule, I don’t have to worry
about kidney damage, right?” Which of the following statements is the
best response?
1. “You have little to worry about as long as your kidneys
keep making urine.”
2. “You should talk to your doctor because statistics show
that you’re being unrealistic.”
3. “You would be correct if your diabetes could be managed
with insulin.”
4. “Even with insulin, kidney damage is still a concern.”
22. A patient diagnosed with sepsis from a UTI is being discharged.
What do you plan to include in her discharge teaching?
1. Take cool baths
2. Avoid tampon use
3. Avoid sexual activity
4. Drink 8 to 10 eight-oz glasses of water daily
23. You’re planning your medication teaching for your patient with a UTI
prescribed phenazopyridine (Pyridium). What do you include?
1. “Your urine might turn bright orange.”
2. “You need to take this antibiotic for 7 days.”
3. “Take this drug between meals and at bedtime.”
4. “Don’t take this drug if you’re allergic to penicillin.”
24. Which finding leads you to suspect acute glomerulonephritis in your
32 y.o. patient?
1. Dysuria, frequency, and urgency
2. Back pain, nausea, and vomiting
3. Hypertension, oliguria, and fatigue
4. Fever, chills, and right upper quadrant pain radiating to
the back
25. What is the priority nursing diagnosis with your patient diagnosed
with end-stage renal disease?
1. Activity intolerance
2. Fluid volume excess
3. Knowledge deficit
4. Pain
26. A patient with ESRD has an arteriovenous fistula in the left arm for
hemodialysis. Which intervention do you include in his plan of care?
1. Apply pressure to the needle site upon discontinuing
hemodialysis
2. Keep the ehad of the bed elevated 45 degrees
3. Place the left arm on an arm board for at least 30
minutes
4. Keep the left arm dry
27. Your 60 y.o. patient with pyelonephritis and possible septicemia has
had five UTIs over the past two years. She is fatigued from lack of sleep,
has lost weight, and urinates frequently even in the night. Her labs show:
sodium, 154 mEq/L; osmolarity 340 mOsm/L; glucose, 127 mg/dl; and
potassium, 3.9 mEq/L. Which nursing diagnosis is priority?
1. Fluid volume deficit related to osmotic diuresis induced
by hyponatremia
2. Fluid volume deficit related to inability to conserve water
3. Altered nutrition: Less than body requirements related to
hypermetabolic state
4. Altered nutrition: Less than body requirements related to
catabolic effects of insulin deficiency
28. Which sign indicated the second phase of acute renal failure?
1. Daily doubling of urine output (4 to 5 L/day)
2. Urine output less than 400 ml/day
3. Urine output less than 100 ml/day
4. Stabilization of renal function
29. Your patient had surgery to form an arteriovenous fistula for
hemodialysis. Which information is important for providing care for the
patient?
1. The patient shouldn’t feel pain during initiation of dialysis
2. The patient feels best immediately after the dialysis
treatment
3. Using a stethoscope for auscultating the fistula is
contraindicated
4. Taking a blood pressure reading on the affected arm can
cause clotting of the fistula
30.
A patient with diabetes mellitus and renal failure begins
hemodialysis. Which diet is best on days between dialysis treatments?
1. Low-protein diet with unlimited amounts of water
2. Low-protein diet with a prescribed amount of water
3. No protein in the diet and use of a salt substitute
4. No restrictions
31. After the first hemodialysis treatment, your patient develops a
headache, hypertension, restlessness, mental confusion, nausea, and
vomiting. Which condition is indicated?
1. Disequilibrium syndrome
2. Respiratory distress
3. Hypervolemia
4. Peritonitis
32. Which action is most important during bladder training in a patient
with a neurogenic bladder?
1. Encourage the use of an indwelling urinary catheter
2. Set up specific times to empty the bladder
3. Encourage Kegel exercises
4. Force fluids
33. A patient with diabetes has had many renal calculi over the past 20
years and now has chronic renal failure. Which substance must be
reduced in this patient’s diet?
1. Carbohydrates
2. Fats
3. Protein
4. Vitamin C
34. What is the best way to check for patency of the arteriovenous
fistula for hemodialysis?
1. Pinch the fistula and note the speed of filling on release
2. Use a needle and syringe to aspirate blood from the
fistula
3. Check for capillary refill of the nail beds on that extremity
4. Palpate the fistula throughout its length to assess for a
thrill
35. You have a paraplegic patient with renal calculi. Which factor
contributes to the development of calculi?
1. Increased calcium loss from the bones
2. Decreased kidney function
3. Decreased calcium intake
4. High fluid intake
36. What is the most important nursing diagnosis for a patient in
end-stage renal disease?
1. Risk for injury
2. Fluid volume excess
3. Altered nutrition: less than body requirements
4. Activity intolerance
37. Frequent PVCs are noted on the cardiac monitor of a patient with
end-stage renal disease. The priority intervention is:
1. Call the doctor immediately
2. Give the patient IV lidocaine (Xylocaine)
3. Prepare to defibrillate the patient
4. Check the patient’s latest potassium level
38. A patient who received a kidney transplant returns for a follow-up
visit to the outpatient clinic and reports a lump in her breast. Transplant
recipients are:
1. At increased risk for cancer due to immunosuppression
caused by cyclosporine (Neoral)
2. Consumed with fear after the life-threatening experience
of having a transplant
3. At increased risk for tumors because of the kidney
transplant
4. At decreased risk for cancer, so the lump is most likely
benign
39. You’re developing a care plan with the nursing diagnosis risk for
infection for your patient that received a kidney transplant. A goal for this
patient is to:
1. Remain afebrile and have negative cultures
2. Resume normal fluid intake within 2 to 3 days
3. Resume the patient’s normal job within 2 to 3 weeks
4. Try to discontinue cyclosporine (Neoral) as quickly as
possible
40. You suspect kidney transplant rejection when the patient shows
which symptoms?
1. Pain in the incision, general malaise, and hypotension
2. Pain in the incision, general malaise, and depression
3. Fever, weight gain, and diminished urine output
4. Diminished urine output and hypotension
41. Your patient returns from the operating room after abdominal aortic
aneurysm repair. Which symptom is a sign of acute renal failure?
1. Anuria
2. Diarrhea
3. Oliguria
4. Vomiting
42. Which cause of hypertension is the most common in acute renal
failure?
1. Pulmonary edema
2. Hypervolemia
3. Hypovolemia
4. Anemia
43. A patient returns from surgery with an indwelling urinary catheter in
place and empty. Six hours later, the volume is 120ml. The drainage
system has no obstructions. Which intervention has priority?
1. Give a 500ml bolus of isotonic saline
2. Evaluate the patient’s circulation and vital signs
3. Flush the urinary catheter with sterile water or saline
4. Place the patient in the shock position, and notify the
surgeon
44. You’re preparing for urinary catheterization of a trauma patient and
you observe bleeding at the urethral meatus. Which action has priority?
1. Irrigate and clean the meatus before catheterization
2.
Check the discharge for occult blood before
catheterization
3. Heavily lubricate the catheter before insertion
4. Delay catheterization and notify the doctor
45.
What change indicates recovery in a patient with nephritic
syndrome?
1. Disappearance of protein from the urine
2. Decrease in blood pressure to normal
3. Increase in serum lipid levels
4. Gain in body weight
46. Which statement correctly distinguishes renal failure from prerenal
failure?
1. With prerenal failure, vasoactive substances such as
dopamine (Intropin) increase blood pressure
2. With prerenal failure, there is less response to such
diuretics as furosemide (Lasix)
3. With prerenal failure, an IV isotonic saline infusion
increases urine output
4. With prerenal failure, hemodialysis reduces the BUN level
47. Which criterion is required before a patient can be considered for
continuous peritoneal dialysis?
1. The patient must be hemodynamically stable
2. The vascular access must have healed
3. The patient must be in a home setting
4. Hemodialysis must have failed
48. Polystyrene sulfonate (Kayexalate) is used in renal failure to:
1. Correct acidosis
2. Reduce serum phosphate levels
3. Exchange potassium for sodium
4. Prevent constipation from sorbitol use
49. Your patient has complaints of severe right-sided flank pain, nausea,
vomiting and restlessness. He appears slightly pale and is diaphoretic.
Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33
breaths/minute, and temperature, 98.0F. Which subjective data supports
a diagnosis of renal calculi?
1. Pain radiating to the right upper quadrant
2. History of mild flu symptoms last week
3. Dark-colored coffee-ground emesis
4. Dark, scant urine output
50. Immunosuppression following Kidney transplantation is continued:
1.
For life
2.
24 hours after transplantation
3.
A week after transplantation
4. Until the kidney is not anymore rejected
Answers and Rationales
1. B. Costovertebral angle tenderness, flank pain, and chills are
symptoms of acute pyelonephritis. Jaundice indicates gallbladder
or liver obstruction. A burning sensation on urination is a sign of
lower urinary tract infection.
2. B. A common symptom of a UTI is dysuria. A patient with a UTI
often reports frequent voiding of small amounts and the urgency to
void. Urine that smells sweet is often associated with diabetic
ketoacidosis.
3. D. Pyridium is taken to relieve dysuria because is provides an
analgesic and anesthetic effect on the urinary tract mucosa. The
patient can stop taking it after the dysuria is relieved. The urine may
temporarily turn red or orange due to the dye in the drug. The drug
isn’t taken before voiding, and is usually taken 3 times a day for 2
days.
4. C. Women are more prone to UTI’s after menopause due to reduced
estrogen levels. Reduced estrogen levels lead to reduced levels of
vaginal Lactobacilli bacteria, which protect against infection. Angina,
asthma and fractures don’t increase the risk of UTI.
5. A. Tubing problems are a common cause of outflow difficulties,
check the tubing for kinks and ensure that all clamps are open.
Other measures include having the patient change positions
(moving side to side or sitting up), applying gentle pressure over the
abdomen, or having a bowel movement.
6. A. Dialysate should be infused quickly. The dialysate should be
infused over 15 minutes or less when performing peritoneal dialysis.
The fluid exchange takes place over a period ranging from 30
minutes to several hours.
7. B. Don’t take blood pressure readings in the arm with the fistula
because the compression could damage the fistula. IV lines
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
shouldn’t be inserted in the arm used for hemodialysis. Palpate
pulses below the fistula. Lack of bruit or thrill should be reported to
the doctor.
B. Disequilibrium syndrome is caused by a rapid reduction in urea,
sodium, and other solutes from the blood. This can lead to cerebral
edema and increased intracranial pressure (ICP). Signs and
symptoms include headache, nausea, restlessness, vomiting,
confusion, twitching, and seizures.
B. Treatment includes administering normal saline or hypertonic
normal saline solution because muscle cramps can occur when the
sodium and water are removed to quickly during dialysis. Reducing
the rate of dialysis, not increasing it, may alleviate muscle cramps.
D. Calcium-phosphate deposits in the skin may cause pruritus.
Scratching leads to excoriation and breaks in the skin that increase
the patient’s risk of infection. Keeping fingernails short and clean
helps reduce the risk of infection.
D. All urine should be strained through gauze or a urine strainer to
catch stones that are passed. The stones are then analyzed for
composition. Ambulation may help the movement of the stone
down the urinary tract. Encourage fluid to help flush the stones out.
C. The most common form of acute glomerulonephritis is caused by
goup A beta-hemolytic streptococcal infection elsewhere in the
body.
A. Narcotic analgesics are usually needed to relieve the severe pain
of renal calculi. Muscle relaxants are typically used to treat skeletal
muscle spasms. NSAIDS and salicylates are used for their
anti-inflammatory and antipyretic properties and to treat less severe
pain.
C. Invasive procedures such as catheterization can introduce
bacteria into the urinary tract. A lack of fluid intake could cause
concentration of urine, but wouldn’t necessarily cause infection.
C. Hematuria and proteinuria indicate acute glomerulonephritis.
These finding result from increased permeability of the glomerular
membrane due to the antigen-antibody reaction. Generalized edema
is seen most often in nephrosis.
B. Oliguria is defined as urine output of less than 400ml/24hours.
B. Increased BUN is usually an early indicator of decreased renal
function.
C. Stress incontinence is an involuntary loss of a small amount of
urine due to sudden increased intra-abdominal pressuer, such as
with coughing or sneezing.
B. Hemorrhage is a potential complication. Urine retention isn’t a
problem soon after surgery because a catheter is in place.
Pneumonia may occur if the patient doesn’t cough and deep
breathe. Thrombosis may occur later if the patient doesn’t
ambulate.
D. An elevated prostate-specific antigen level indicates prostate
cancer, but it can be falsely elevated if done after the prostate gland
is manipulated. A digital rectal examination should be done as part
of the yearly screening, and then the antigen test is done if the
digital exam suggests cancer. MRI is used in staging the cancer.
D. Kidney damage is still a concern. Microavascular changes occur
in both of the patient’s kidneys as a complication of the diabetes.
Diabetic nephropathy is the leading cause of end-stage renal
disease. The kidneys continue to produce urine until the end stage.
Nephropathy occurs even with insulin management.
D. Drinking 2-3L of water daily inhibits bacterial growth in the
bladder and helps flush the bacteria from the bladder. The patient
should be instructed to void after sexual activity.
A. The drug turns the urine orange. It may be prescribed for longer
than 7 days and is usually ordered three times a day after meals.
Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.
C. Mild to moderate HTN may result from sodium or water retention
and inappropriate rennin release from the kidneys. Oliguria and
fatigue also may be seen. Other signs are proteinuria and azotemia.
B. Fluid volume excess because the kidneys aren’t removing fluid
and wastes. The other diagnoses may apply, but they don’t take
priority.
A. Apply pressure when discontinuing hemodialysis and after
removing the venipuncture needle until all the bleeding has stopped.
Bleeding may continue for 10 minutes in some patients.
B.
28. A. Daily doubling of the urine output indicates that the nephrons are
healing. This means the patient is passing into the second phase
(dieresis) of acute renal failure.
29. D. Pressure on the fistula or the extremity can decrease blood flow
and precipitate clotting, so avoid taking blood pressure on the
affected arm.
30. B. The patient should follow a low-protein diet with a prescribed
amount of water. The patient requires some protein to meet
metabolic needs. Salt substitutes shouldn’t be used without a
doctor’s order because it may contain potassium, which could make
the patient hyperkalemic. Fluid and protein restrictions are needed.
31. A. Disequilibrium occurs when excess solutes are cleared from the
blood more rapidly than they can diffuse from the body’s cells into
the vascular system.
32. B. Instruct the patient with neurogenic bladder to write down his
voiding pattern and empty the bladder at the same times each day.
33. C. Because of damage to the nephrons, the kidney can’t excrete all
the metabolic wastes of protein, so this patient’s protein intake
must be restricted. A higher intake of carbs, fats, and vitamin
supplements is needed to ensure the growth and maintenance of
the patient’s tissues.
34. D. The vibration or thrill felt during palpation ensures that the fistula
has the desired turbulent blood flow. Pinching the fistula could
cause damage. Aspirating blood is a needless invasive procedure.
35. A. Bones lose calcium when a patient can no longer bear weight.
The calcium lost from bones form calculi, a concentration of
mineral salts also known as a stone, in the renal system.
36. B. Kidneys are unable to rid the body of excess fluids which results
in fluid volume excess during ESRD.
37. D. The patient with ESRD may develop arrhythmias caused by
hypokalemi. Call the doctor after checking the patient’s potassium
values. Lidocaine may be ordered if the PVCs are frequent and the
patient is symptomatic.
38.
A. Cyclosporine suppresses the immune response to prevent
rejection of the transplanted kidney. The use of cyclosporine places
the patient at risk for tumors.
39. A. The immunosuppressive activity of cyclosporine places the
patient at risk for infection, and steroids can mask the signs of
infection. The patient may not be able to resume normal fluid intake
or return to work for an extended period of time and the patient may
need cyclosporine therapy for life.
40. C. Symptoms of rejection include fever, rapid weight gain,
hypertension, pain over the graft site, peripheral edema, and
diminished urine output.
41. C. Urine output less than 50ml in 24 hours signifies oliguria, an early
sign of renal failure. Anuria is uncommon except in obstructive renal
disorders.
42. B. Acute renal failure causes hypervolemia as a result of
overexpansion of extracellular fluid and plasma volume with the
hypersecretion of rennin. Therefore, hypervolemia causes
hypertension.
43. B. A total UO of 120ml is too low. Assess the patient’s circulation
and hemodynamic stability for signs of hypovolemia. A fluid bolus
may be required, but only after further nursing assessment and a
doctor’s order.
44. D. Bleeding at the urethral meatus is evidence that the urethra is
injured. Because catheterization can cause further harm, consult
with the doctor.
45. A. With nephrotic syndrome, the glomerular basement membrane of
the kidney becomes more porous, leading to loss of protein in the
urine. As the patient recovers, less protein is found in the urine.
46. C. Prerenal failure is caused by such conditions as hypovolemia that
impairs kidney perfusion; giving isotonic fluids improves urine
output. Vasoactive substances can increase blood pressure in both
conditions.
47. A. Hemodynamic stability must be established before continuous
peritoneal dialysis can be started.
48. C. In renal failure, patients become hyperkalemic because they can’t
excrete potassium in the urine. Polystyrene sulfonate acts to
excrete potassium by pulling potassium into the bowels and
exchanging it for sodium.
49. D. Patients with renal calculi commonly have blood in the urine
caused by the stone’s passage through the urinary tract. The urine
appears dark, tests positive for blood, and is typically scant.
50. A. For life.
TEST 2 - GENITOURINARY SYSTEM
1. The nurse is aware that the following findings would be further
evidence of a urethral injury in a male client during rectal examination?
1. A low-riding prostate
2. The presence of a boggy mass
3. Absent sphincter tone
4. A positive Hemoccult
2. When a female client with an indwelling urinary (Foley) catheter insists
on walking to the hospital lobby to visit with family members, nurse Rose
teaches how to do this without compromising the catheter. Which client
action indicates an accurate understanding of this information?
1. The client sets the drainage bag on the floor while sitting
down.
2. The client keeps the drainage bag below the bladder at
all times.
3. The client clamps the catheter drainage tubing while
visiting with the family.
4. The client loops the drainage tubing below its point of
entry into the drainage bag.
3. A female client has just been diagnosed with condylomata acuminata
(genital warts). What information is appropriate to tell this client?
1. This condition puts her at a higher risk for cervical
cancer; therefore, she should have a Papanicolaou (Pap)
smear annually.
2. The most common treatment is metronidazole (Flagyl),
which should eradicate the problem within 7 to 10 days.
3. The potential for transmission to her sexual partner will
be eliminated if condoms are used every time they have
sexual intercourse.
4. The human papillomavirus (HPV), which causes
condylomata acuminata, can’t be transmitted during oral
sex.
4. A male client with bladder cancer has had the bladder removed and an
ileal conduit created for urine diversion. While changing this client’s
pouch, the nurse observes that the area around the stoma is red,
weeping, and painful. What should nurse Katrina conclude?
1. The skin wasn’t lubricated before the pouch was applied.
2. The pouch faceplate doesn’t fit the stoma.
3. A skin barrier was applied properly.
4. Stoma dilation wasn’t performed.
5. The nurse is aware that the following laboratory values supports a
diagnosis of pyelonephritis?
1. Myoglobinuria
2. Ketonuria
3. Pyuria
4. Low white blood cell (WBC) count
6. A female client with chronic renal failure (CRF) is receiving a
hemodialysis treatment. After hemodialysis, nurse Sarah knows that the
client is most likely to experience:
1. hematuria.
2. weight loss.
3. increased urine output.
4. increased blood pressure.
7. Nurse Lea is assessing a male client diagnosed with gonorrhea. Which
symptom most likely prompted the client to seek medical attention?
1. Rashes on the palms of the hands and soles of the feet
2. Cauliflower-like warts on the penis
3. Painful red papules on the shaft of the penis
4. Foul-smelling discharge from the penis
8. Nurse Agnes is reviewing the report of a client’s routine urinalysis.
Which value should the nurse consider abnormal?
1. Specific gravity of 1.03
2. Urine pH of 3.0
3. Absence of protein
4. Absence of glucose
9. A male client is scheduled for a renal clearance test. Nurse Maureen
should explain that this test is done to assess the kidneys’ ability to
remove a substance from the plasma in:
1. 1 minute.
2. 30 minutes.
3. 1 hour.
4. 24 hours.
10. A male client in the short-procedure unit is recovering from renal
angiography in which a femoral puncture site was used. When providing
postprocedure care, the nurse should:
1. keep the client’s knee on the affected side bent for 6
hours.
2. apply pressure to the puncture site for 30 minutes.
3. check the client’s pedal pulses frequently.
4. remove the dressing on the puncture site after vital signs
stabilize.
11. A female client is admitted for treatment of chronic renal failure
(CRF). Nurse Juliet knows that this disorder increases the client’s risk of:
1. water and sodium retention secondary to a severe
decrease in the glomerular filtration rate.
2. a decreased serum phosphate level secondary to kidney
failure.
3. an increased serum calcium level secondary to kidney
failure.
4. metabolic alkalosis secondary to retention of hydrogen
ions.
12. Because of difficulties with hemodialysis, peritoneal dialysis is
initiated to treat a female client’s uremia. Which finding signals a
significant problem during this procedure?
1. Potassium level of 3.5 mEq/L
2. Hematocrit (HCT) of 35%
3. Blood glucose level of 200 mg/dl
4. White blood cell (WBC) count of 20,000/mm3
13. For a male client in the oliguric phase of acute renal failure (ARF),
which nursing intervention is most important?
1. Encouraging coughing and deep breathing
2. Promoting carbohydrate intake
3. Limiting fluid intake
4. Providing pain-relief measures
14. A female client requires hemodialysis. Which of the following drugs
should be withheld before this procedure?
1. Phosphate binders
2. Insulin
3. Antibiotics
4. Cardiac glycosides
15. A client comes to the outpatient department complaining of vaginal
discharge, dysuria, and genital irritation. Suspecting a sexually
transmitted disease (STD), Dr. Smith orders diagnostic tests of the
vaginal discharge. Which STD must be reported to the public health
department?
1. Chlamydia
2. Gonorrhea
3. Genital herpes
4. Human papillomavirus infection
16. A male client with acute pyelonephritis receives a prescription for
co-trimoxazole (Septra) P.O. twice daily for 10 days. Which finding best
demonstrates that the client has followed the prescribed regimen?
1. Urine output increases to 2,000 ml/day.
2. Flank and abdominal discomfort decrease.
3. Bacteria are absent on urine culture.
4. The red blood cell (RBC) count is normal.
17. A 26-year-old female client seeks care for a possible infection. Her
symptoms include burning on urination and frequent, urgent voiding of
small amounts of urine. She’s placed on trimethoprim-sulfamethoxazole
(Bactrim) to treat possible infection. Another medication is prescribed to
decrease the pain and frequency. Which of the following is the most likely
medication prescribed?
1. nitrofurantoin (Macrodantin)
2. ibuprofen (Motrin)
3. acetaminophen with codeine
4. phenazopyridine (Pyridium)
18. A triple-lumen indwelling urinary catheter is inserted for continuous
bladder irrigation following a transurethral resection of the prostate. In
addition to balloon inflation, the nurse is aware that the functions of the
three lumens include:
1. Continuous inflow and outflow of irrigation solution.
2. Intermittent inflow and continuous outflow of irrigation
solution.
3. Continuous inflow and intermittent outflow of irrigation
solution.
4.
Intermittent flow of irrigation solution and prevention of
hemorrhage.
19. Nurse Claudine is reviewing a client’s fluid intake and output record.
Fluid intake and urine output should relate in which way?
1. Fluid intake should be double the urine output.
2. Fluid intake should be approximately equal to the urine
output.
3. Fluid intake should be half the urine output.
4. Fluid intake should be inversely proportional to the urine
output.
20. After trying to conceive for a year, a couple consults an infertility
specialist. When obtaining a history from the husband, nurse Jenny
inquires about childhood infectious diseases. Which childhood infectious
disease most significantly affects male fertility?
1. Chickenpox
2. Measles
3. Mumps
4. Scarlet fever
21. A male client comes to the emergency department complaining of
sudden onset of sharp, severe pain in the lumbar region, which radiates
around the side and toward the bladder. The client also reports nausea
and vomiting and appears pale, diaphoretic, and anxious. The physician
tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays.
Renal calculi can form anywhere in the urinary tract. What is their most
common formation site?
1. Kidney
2. Ureter
3. Bladder
4. Urethra
22. A female client with acute renal failure is undergoing dialysis for the
first time. The nurse in charge monitors the client closely for dialysis
equilibrium syndrome, a complication that is most common during the
first few dialysis sessions. Typically, dialysis equilibrium syndrome
causes:
1. confusion, headache, and seizures.
2. acute bone pain and confusion.
3. weakness, tingling, and cardiac arrhythmias.
4. hypotension, tachycardia, and tachypnea.
23. Dr. Marquez prescribes norfloxacin (Noroxin), 400 mg P.O. twice daily,
for a client with a urinary tract infection (UTI). The client asks the nurse
how long to continue taking the drug. For an uncomplicated UTI, the
usual duration of norfloxacin therapy is:
1. 3 to 5 days.
2. 7 to 10 days.
3. 12 to 14 days.
4. 10 to 21 days.
24. Nurse Joy is providing postprocedure care for a client who underwent
percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted
through a nephrostomy tube into the renal pelvis generates
ultra–high-frequency sound waves to shatter renal calculi. The nurse
should instruct the client to:
1. limit oral fluid intake for 1 to 2 weeks.
2. report the presence of fine, sandlike particles through the
nephrostomy tube.
3. notify the physician about cloudy or foul-smelling urine.
4. report bright pink urine within 24 hours after the
procedure.
25. A client is frustrated and embarrassed by urinary incontinence. Which
of the following measures should nurse Bea include in a bladder
retraining program?
1. Establishing a predetermined fluid intake pattern for the
client
2. Encouraging the client to increase the time between
voidings
3. Restricting fluid intake to reduce the need to void
4. Assessing present elimination patterns
26. After having transurethral resection of the prostate (TURP), a Mr. Lim
returns to the unit with a three-way indwelling urinary catheter and
continuous closed bladder irrigation. Which finding suggests that the
client’s catheter is occluded?
1. The urine in the drainage bag appears red to pink.
2. The client reports bladder spasms and the urge to void.
3. The normal saline irrigant is infusing at a rate of 50
drops/minute.
4.
About 1,000 ml of irrigant have been instilled; 1,200 ml of
drainage have been returned.
27. Nurse Mary is inserting a urinary catheter into a client who is
extremely anxious about the procedure. The nurse can facilitate the
insertion by asking the client to:
1. initiate a stream of urine.
2. breathe deeply.
3. turn to the side.
4. hold the labia or shaft of penis.
28. A female adult client admitted with a gunshot wound to the abdomen
is transferred to the intensive care unit after an exploratory laparotomy.
Which assessment finding suggests that the client is experiencing acute
renal failure (ARF)?
1. Blood urea nitrogen (BUN) level of 22 mg/dl
2. Serum creatinine level of 1.2 mg/dl
3. Serum creatinine level of 1.2 mg/dl
4. Urine output of 400 ml/24 hours
29. A 55-year old client with benign prostatic hyperplasia doesn’t respond
to medical treatment and is admitted to the facility for prostate gland
removal. Before providing preoperative and postoperative instructions to
the client, Nurse Gerry asks the surgeon which prostatectomy procedure
will be done. What is the most widely used procedure for prostate gland
removal?
1. Transurethral resection of the prostate (TURP)
2. Suprapubic prostatectomy
3. Retropubic prostatectomy
4. Transurethral laser incision of the prostate
30. A female client with suspected renal dysfunction is scheduled for
excretory urography. Nurse January reviews the history for conditions
that may warrant changes in client preparation. Normally, a client should
be mildly hypovolemic (fluid depleted) before excretory urography. Which
history finding would call for the client to be well hydrated instead?
1. Cystic fibrosis
2. Multiple myeloma
3. Gout
4. Myasthenia gravis
31. Nurse Karen is caring for a client who had a cerebrovascular accident
(CVA). Which nursing intervention promotes urinary continence?
1. Encouraging intake of at least 2 L of fluid daily
2. Giving the client a glass of soda before bedtime
3. Taking the client to the bathroom twice per day
4. Consulting with a dietitian
32. When examining a female client’s genitourinary system, Nurse Sandy
assesses for tenderness at the costovertebral angle by placing the left
hand over this area and striking it with the right fist. Normally, this
percussion technique produces which sound?
1. A flat sound
2. A dull sound
3. Hyperresonance
4. Tympany
33. A male client with chronic renal failure has a serum potassium level
of 6.8 mEq/L. What should nurse Olivia assess first?
1. Blood pressure
2. Respirations
3. Temperature
4. Pulse
34. Nurse Harry is aware that the following is an appropriate nursing
diagnosis for a client with renal calculi?
1. Ineffective tissue perfusion
2. Functional urinary incontinence
3. Risk for infection
4. Decreased cardiac output
35. A male client develops acute renal failure (ARF) after receiving I.V.
therapy with a nephrotoxic antibiotic. Because the client’s 24-hour urine
output totals 240 ml, Nurse Billy suspects that the client is at risk for:
1. cardiac arrhythmia.
2. paresthesia.
3. dehydration.
4. pruritus.
36. After undergoing transurethral resection of the prostate to treat
benign prostatic hyperplasia, a male client returns to the room with
continuous bladder irrigation. On the first day after surgery, the client
reports bladder pain. What should Nurse Anthony do first?
1. Increase the I.V. flow rate.
2.
3.
4.
Notify the physician immediately.
Assess the irrigation catheter for patency and drainage.
Administer meperidine (Demerol), 50 mg I.M., as
prescribed.
37. When performing a scrotal examination, Nurse Payne finds a nodule.
What should the nurse do next?
1. Notify the physician.
2. Change the client’s position and repeat the examination.
3. Perform a rectal examination.
4. Transilluminate the scrotum.
38. A male client who has been treated for chronic renal failure (CRF) is
ready for discharge. Nurse Billy should reinforce which dietary
instruction?
1. “Be sure to eat meat at every meal.”
2. “Monitor your fruit intake, and eat plenty of bananas.”
3.
“Increase your carbohydrate intake.”
4. “Drink plenty of fluids, and use a salt substitute.”
39. Nurse Gil is aware that the following statements describing urinary
incontinence in the elderly is true?
1. Urinary incontinence is a normal part of aging.
2. Urinary incontinence isn’t a disease.
3. Urinary incontinence in the elderly can’t be treated.
4. Urinary incontinence is a disease.
40. The client underwent a transurethral resection of the prostate gland
24 hours ago and is on continuous bladder irrigation. Nurse Yonny is
aware that the following nursing interventions is appropriate?
1. Tell the client to try to urinate around the catheter to
remove blood clots.
2. Restrict fluids to prevent the client’s bladder from
becoming distended.
3. Prepare to remove the catheter.
4. Use aseptic technique when irrigating the catheter.
41. A female client with a urinary tract infection is prescribed
co-trimoxazole (trimethoprim-sulfamethoxazole). Nurse Dolly should
provide which medication instruction?
1. “Take the medication with food.”
2. “Drink at least eight 8-oz glasses of fluid daily.”
3. “Avoid taking antacids during co-trimoxazole therapy.”
4. “Don’t be afraid to go out in the sun.”
42. A male client is admitted for treatment of glomerulonephritis. On
initial assessment, Nurse Miley detects one of the classic signs of acute
glomerulonephritis of sudden onset. Such signs include:
1. generalized edema, especially of the face and periorbital
area.
2. green-tinged urine.
3. moderate to severe hypotension.
4. polyuria.
43. A client reports experiencing vulvar pruritus. Which assessment
factor may indicate that the client has an infection caused by Candida
albicans?
1. Cottage cheese–like discharge
2. Yellow-green discharge
3. Gray-white discharge
4. Discharge with a fishy odor
44. A 24-year old female client has just been diagnosed with
condylomata acuminata (genital warts). What information is appropriate
to tell this client?
1. This condition puts her at a higher risk for cervical
cancer; therefore, she should have a Papanicolaou (Pap)
smear annually.
2. The most common treatment is metronidazole (Flagyl),
which should eradicate the problem within 7 to 10 days.
3. The potential for transmission to her sexual partner will
be eliminated if condoms are used every time they have
sexual intercourse.
4. The human papillomavirus (HPV), which causes
condylomata acuminata, can’t be transmitted during oral
sex.
45. Nurse Vic is monitoring the fluid intake and output of a female client
recovering from an exploratory laparotomy. Which nursing intervention
would help the client avoid a urinary tract infection (UTI)?
1. Maintaining a closed indwelling urinary catheter system
and securing the catheter to the leg
2. Limiting fluid intake to 1 L/day
3.
Encouraging the client to use a feminine deodorant after
bathing
4. Encouraging the client to douche once a day after
removal of the indwelling urinary catheter
46. Nurse Eve is caring for a client who had a cerebrovascular accident
(CVA). Which nursing intervention promotes urinary continence?
1. Encouraging intake of at least 2 L of fluid daily
2. Giving the client a glass of soda before bedtime
3. Taking the client to the bathroom twice per day
4. Consulting with a dietitian
47. A female client with an indwelling urinary catheter is suspected of
having a urinary tract infection. Nurse Angel should collect a urine
specimen for culture and sensitivity by:
1. disconnecting the tubing from the urinary catheter and
letting the urine flow into a sterile container.
2. wiping the self-sealing aspiration port with antiseptic
solution and aspirating urine with a sterile needle.
3. draining urine from the drainage bag into a sterile
container.
4. clamping the tubing for 60 minutes and inserting a sterile
needle into the tubing above the clamp to aspirate urine.
48. Nurse Grace is assessing a male client diagnosed with gonorrheA.
Which symptom most likely prompted the client to seek medical
attention?
1. Rashes on the palms of the hands and soles of the feet
2. Cauliflower-like warts on the penis
3. Painful red papules on the shaft of the penis
4. Foul-smelling discharge from the penis
49. Nurse Erica is planning to administer a sodium polystyrene sulfonate
(Kayexalate) enema to a client with a potassium level of 5.9 mEq/L.
Correct administration and the effects of this enema would include
having the client:
1. retain the enema for 30 minutes to allow for sodium
exchange; afterward, the client should have diarrhea.
2. retain the enema for 30 minutes to allow for glucose
exchange; afterward, the client should have diarrhea.
3. retain the enema for 60 minutes to allow for sodium
exchange; diarrhea isn’t necessary to reduce the
potassium level.
4. retain the enema for 60 minutes to allow for glucose
exchange; diarrhea isn’t necessary to reduce the
potassium level.
50. When caring for a male client with acute renal failure (ARF), Nurse
Fatrishia expects to adjust the dosage or dosing schedule of certain
drugs. Which of the following drugs would not require such adjustment?
1. acetaminophen (Tylenol)
2. gentamicin sulfate (Garamycin)
3. cyclosporine (Sandimmune)
4. ticarcillin disodium (Ticar)
Answers and Rationales
1. Answer B. When the urethra is ruptured, a hematoma or collection
of blood separates the two sections of urethra. This may feel like a
boggy mass on rectal examination. Because of the rupture and
hematoma, the prostate becomes high riding. A palpable prostate
gland usually indicates a nonurethral injury. Absent sphincter tone
would refer to a spinal cord injury. The presence of blood would
probably correlate with GI bleeding or a colon injury.
2. Answer B. To maintain effective drainage, the client should keep the
drainage bag below the bladder; this allows the urine to flow by
gravity from the bladder to the drainage bag. The client shouldn’t lay
the drainage bag on the floor because it could become grossly
contaminated. The client shouldn’t clamp the catheter drainage
tubing because this impedes the flow of urine. To promote drainage,
the client may loop the drainage tubing above — not below — its
point of entry into the drainage bag.
3. Answer A. Women with condylomata acuminata are at risk for
cancer of the cervix and vulva. Yearly Pap smears are very
important for early detection. Because condylomata acuminata is a
virus, there is no permanent cure. Because condylomata acuminata
can occur on the vulva, a condom won’t protect sexual partners.
HPV can be transmitted to other parts of the body, such as the
mouth, oropharynx, and larynx.
4. Answer B. If the pouch faceplate doesn’t fit the stoma properly, the
skin around the stoma will be exposed to continuous urine flow
5.
6.
7.
8.
9.
10.
11.
12.
13.
from the stoma, causing excoriation and red, weeping, and painful
skin. A lubricant shouldn’t be used because it would prevent the
pouch from adhering to the skin. When properly applied, a skin
barrier prevents skin excoriation. Stoma dilation isn’t performed with
an ileal conduit, although it may be done with a colostomy if
ordered.
Answer C. Pyelonephritis is diagnosed by the presence of
leukocytosis, hematuria, pyuria, and bacteriuria. The client exhibits
fever, chills, and flank pain. Because there is often a septic picture,
the WBC count is more likely to be high rather than low, as indicated
in option D. Ketonuria indicates a diabetic state.
Answer B. Because CRF causes loss of renal function, the client
with this disorder retains fluid. Hemodialysis removes this fluid,
causing weight loss. Hematuria is unlikely to follow hemodialysis
because the client with CRF usually forms little or no urine.
Hemodialysis doesn’t increase urine output because it doesn’t
correct the loss of kidney function, which severely decreases urine
production in this disorder. By removing fluids, hemodialysis
decreases rather than increases the blood pressure.
Answer D. Symptoms of gonorrhea in men include purulent,
foul-smelling drainage from the penis and painful urination. Rashes
on the palms of the hands and soles of the feet are symptoms of
the secondary stage of syphilis. Cauliflower-like warts on the penis
are a sign of human papillomavirus. Painful red papules on the shaft
of the penis may be a sign of the first stage of genital herpes.
Answer B. Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is
abnormal. Urine specific gravity normally ranges from 1.002 to
1.035, making this client’s value normal. Normally, urine contains no
protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red
blood cells should measure 0 to 3 per high-power field; white blood
cells, 0 to 4 per high-power field. Urine should be clear, its color
ranging from pale yellow to deep amber.
Answer A. The renal clearance test determines the kidneys’ ability to
remove a substance from the plasma in 1 minute. It doesn’t
measure the kidneys’ ability to remove a substance over a longer
period.
Answer C. After renal angiography involving a femoral puncture site,
the nurse should check the client’s pedal pulses frequently to detect
reduced circulation to the feet caused by vascular injury. The nurse
also should monitor vital signs for evidence of internal hemorrhage
and should observe the puncture site frequently for fresh bleeding.
The client should be kept on bed rest for several hours so the
puncture site can seal completely. Keeping the client’s knee bent is
unnecessary. By the time the client returns to the short-procedure
unit, manual pressure over the puncture site is no longer needed
because a pressure dressing is in place. The nurse shouldn’t remove
this dressing for several hours — and only if instructed to do so.
Answer A. A client with CRF is at risk for fluid imbalance —
dehydration if the kidneys fail to concentrate urine, or fluid retention
if the kidneys fail to produce urine. Electrolyte imbalances
associated with this disorder result from the kidneys’ inability to
excrete
phosphorus;
such
imbalances
may
lead
to
hyperphosphatemia with reciprocal hypocalcemia. CRF may cause
metabolic acidosis, not metabolic alkalosis, secondary to inability of
the kidneys to excrete hydrogen ions.
Answer D. An increased WBC count indicates infection, probably
resulting from peritonitis, which may have been caused by insertion
of the peritoneal catheter into the peritoneal cavity. Peritonitis can
cause the peritoneal membrane to lose its ability to filter solutes;
therefore, peritoneal dialysis would no longer be a treatment option
for this client. Hyperglycemia occurs during peritoneal dialysis
because of the high glucose content of the dialysate; it’s readily
treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L
can be treated by adding potassium to the dialysate solution. An
HCT of 35% is lower than normal. However, in this client, the value
isn’t abnormally low because of the daily blood samplings. A lower
HCT is common in clients with chronic renal failure because of the
lack of erythropoietin.
Answer C. During the oliguric phase of ARF, urine output decreases
markedly, possibly leading to fluid overload. Limiting oral and I.V.
fluid intake can prevent fluid overload and its complications, such as
heart failure and pulmonary edema. Encouraging coughing and
deep breathing is important for clients with various respiratory
disorders. Promoting carbohydrate intake may be helpful in ARF but
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
doesn’t take precedence over fluid limitation. Controlling pain isn’t
important because ARF rarely causes pain.
Answer D. Cardiac glycosides such as digoxin should be withheld
before hemodialysis. Hypokalemia is one of the electrolyte shifts
that occur during dialysis, and a hypokalemic client is at risk for
arrhythmias secondary to digitalis toxicity. Phosphate binders and
insulin can be administered because they aren’t removed from the
blood by dialysis. Some antibiotics are removed by dialysis and
should be administered after the procedure to ensure their
therapeutic effects. The nurse should check a formulary to
determine whether a particular antibiotic should be administered
before or after dialysis.
Answer B. Gonorrhea must be reported to the public health
department. Chlamydia, genital herpes, and human papillomavirus
infection aren’t reportable diseases.
Answer C. Co-trimoxazole is a sulfonamide antibiotic used to treat
urinary tract infections. Therefore, absence of bacteria on urine
culture indicates that the drug has achieved its desired effect.
Although flank pain may decrease as the infection resolves, this isn’t
a reliable indicator of the drug’s effectiveness. Co-trimoxazole
doesn’t affect urine output or the RBC count.
Answer D. Phenazopyridine may be prescribed in conjunction with
an antibiotic for painful bladder infections to promote comfort.
Because of its local anesthetic action on the urinary mucosa,
phenazopyridine specifically relieves bladder pain. Nitrofurantoin is
a urinary antiseptic with no analgesic properties. While ibuprofen
and acetaminophen with codeine are analgesics, they don’t exert a
direct effect on the urinary mucosa.
Answer A. When preparing for continuous bladder irrigation, a
triple-lumen indwelling urinary catheter is inserted. The three
lumens provide for balloon inflation and continuous inflow and
outflow of irrigation solution.
Answer B. Normally, fluid intake is approximately equal to the urine
output. Any other relationship signals an abnormality. For example,
fluid intake that is double the urine output indicates fluid retention;
fluid intake that is half the urine output indicates dehydration.
Normally, fluid intake isn’t inversely proportional to the urine output.
Answer C. Mumps is the most significant childhood infectious
disease affecting male fertility. Chickenpox, measles, and scarlet
fever don’t affect male fertility.
Answer A. The most common site of renal calculi formation is the
kidney. Calculi may travel down the urinary tract with or without
causing damage and may lodge anywhere along the tract or may
stay within the kidney. The ureter, bladder, and urethra are less
common sites of renal calculi formation.
Answer A. Dialysis equilibrium syndrome causes confusion, a
decreasing level of consciousness, headache, and seizures. These
findings, which may last several days, probably result from a relative
excess of interstitial or intracellular solutes caused by rapid solute
removal from the blood. The resultant organ swelling interferes with
normal physiologic functions. To prevent this syndrome, many
dialysis centers keep first-time sessions short and use a reduced
blood flow rate. Acute bone pain and confusion are associated with
aluminum intoxication, another potential complication of dialysis.
Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia,
which is associated with renal failure. Hypotension, tachycardia, and
tachypnea signal hemorrhage, another dialysis complication.
Answer B. For an uncomplicated UTI, norfloxacin therapy usually
lasts 7 to 10 days. Taking the drug for less than 7 days wouldn’t
eradicate such an infection. Taking it for more than 10 days isn’t
necessary. Only a client with a complicated UTI must take
norfloxacin for 10 to 21 days.
Answer C. The client should report the presence of foul-smelling or
cloudy urine. Unless contraindicated, the client should be instructed
to drink large quantities of fluid each day to flush the kidneys.
Sandlike debris is normal due to residual stone products. Hematuria
is common after lithotripsy.
Answer D. The guidelines for initiating bladder retraining include
assessing the client’s intake patterns, voiding patterns, and reasons
for each accidental voiding. Lowering the client’s fluid intake won’t
reduce or prevent incontinence. The client should actually be
encouraged to drink 1.5 to 2 L of water per day. A voiding schedule
should be established after assessment.
26. Answer B. Reports of bladder spasms and the urge to void suggest
that a blood clot may be occluding the catheter. After TURP, urine
normally appears red to pink, and normal saline irrigant usually is
infused at a rate of 40 to 60 drops/minute or according to facility
protocol. The amount of retained fluid (1,200 ml) should correspond
to the amount of instilled fluid, plus the client’s urine output (1,000
ml + 200 ml), which reflects catheter patency.
27. Answer B. When inserting a urinary catheter, facilitate insertion by
asking the client to breathe deeply. Doing this will relax the urinary
sphincter. Initiating a stream of urine isn’t recommended during
catheter insertion. Turning to the side or holding the labia or penis
won’t ease insertion, and doing so may contaminate the sterile field.
28. Answer D. ARF, characterized by abrupt loss of kidney function,
commonly causes oliguria, which is demonstrated by a urine output
of 400 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn’t
diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of
100.2° F (37.8° C) wouldn’t result from this disorder.
29. Answer A. TURP is the most widely used procedure for prostate
gland removal. Because it requires no incision, TURP is especially
suitable for men with relatively minor prostatic enlargements and
for those who are poor surgical risks. Suprapubic prostatectomy,
retropubic prostatectomy, and transurethral laser incision of the
prostate are less common procedures; they all require an incision.
30. Answer B. Fluid depletion before excretory urography is
contraindicated in clients with multiple myeloma, severe diabetes
mellitus, and uric acid nephropathy — conditions that can seriously
compromise renal function in fluid-depleted clients with reduced
renal perfusion. If these clients must undergo excretory urography,
they should be well hydrated before the test. Cystic fibrosis, gout,
and myasthenia gravis don’t necessitate changes in client
preparation for excretory urography.
31. Answer A. By encouraging a daily fluid intake of at least 2 L, the
nurse helps fill the client’s bladder, thereby promoting bladder
retraining by stimulating the urge to void. The nurse shouldn’t give
the client soda before bedtime; soda acts as a diuretic and may
make the client incontinent. The nurse should take the client to the
bathroom or offer the bedpan at least every 2 hours throughout the
day; twice per day is insufficient. Consultation with a dietitian won’t
address the problem of urinary incontinence.
32. Answer B. Percussion over the costovertebral angle normally
produces a dull, thudding sound, which is soft to moderately loud
with a moderate pitch and duration. This sound occurs over less
dense, mostly fluid-filled matter, such as the kidneys, liver, and
spleen. In contrast, a flat sound occurs over highly dense matter
such as muscle; hyperresonance occurs over the air-filled,
overinflated lungs of a client with pulmonary emphysema or the
lungs of a child (because of a thin chest wall); and tympany occurs
over enclosed structures containing air, such as the stomach and
bowel.
33. Answer D. An elevated serum potassium level may lead to a
life-threatening cardiac arrhythmia, which the nurse can detect
immediately by palpating the pulse. The client’s blood pressure may
change, but only as a result of the arrhythmia. Therefore, the nurse
should assess blood pressure later. The nurse also can delay
assessing respirations and temperature because these aren’t
affected by the serum potassium level.
34. Answer C. Infection can occur with renal calculi from urine stasis
caused by obstruction. Options A and D aren’t appropriate for this
diagnosis, and retention of urine usually occurs, rather than
incontinence.
35. Answer A. As urine output decreases, the serum potassium level
rises; if it rises sufficiently, hyperkalemia may occur, possibly
triggering a cardiac arrhythmia. Hyperkalemia doesn’t cause
paresthesia (sensations of numbness and tingling). Dehydration
doesn’t occur during this oliguric phase of ARF, although typically it
does arise during the diuretic phase. In a client with ARF, pruritus
results from increased phosphates and isn’t associated with
hyperkalemia.
36. Answer C. Although postoperative pain is expected, the nurse
should make sure that other factors, such as an obstructed
irrigation catheter, aren’t the cause of the pain. After assessing
catheter patency, the nurse should administer an analgesic, such as
meperidine, as prescribed. Increasing the I.V. flow rate may worsen
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
the pain. Notifying the physician isn’t necessary unless the pain is
severe or unrelieved by the prescribed medication.
Answer D. A nurse who discovers a nodule, swelling, or other
abnormal finding during a scrotal examination should
transilluminate the scrotum by darkening the room and shining a
flashlight through the scrotum behind the mass. A scrotum filled
with serous fluid transilluminates as a red glow; a more solid lesion,
such as a hematoma or mass, doesn’t transilluminate and may
appear as a dark shadow. Although the nurse should notify the
physician of the abnormal finding, performing transillumination first
provides additional information. The nurse can’t uncover more
information about a scrotal mass by changing the client’s position
and repeating the examination or by performing a rectal
examination.
Answer C. In a client with CRF, unrestricted intake of sodium,
protein, potassium, and fluid may lead to a dangerous accumulation
of electrolytes and protein metabolic products, such as amino acids
and ammonia. Therefore, the client must limit intake of sodium;
meat, which is high in protein; bananas, which are high in
potassium; and fluid, because the failing kidneys can’t secrete
adequate urine. Salt substitutes are high in potassium and should
be avoided. Extra carbohydrates are needed to prevent protein
catabolism.
Answer B. Urinary incontinence isn’t a normal part of aging nor is it
a disease. It may be caused by confusion, dehydration, fecal
impaction, restricted mobility, or other causes. Certain medications,
including diuretics, hypnotics, sedatives, anticholinergics, and
antihypertensives, may trigger urinary incontinence. Most clients
with urinary incontinence can be treated; some can be cured.
Answer D. If the catheter is blocked by blood clots, it may be
irrigated according to physician’s orders or facility protocol. The
nurse should use sterile technique to reduce the risk of infection.
Urinating around the catheter can cause painful bladder spasms.
Encourage the client to drink fluids to dilute the urine and maintain
urine output. The catheter remains in place for 2 to 4 days after
surgery and is only removed with a physician’s order.
Answer B. When receiving a sulfonamide such as co-trimoxazole,
the client should drink at least eight 8-oz glasses of fluid daily to
maintain a urine output of at least 1,500 ml/day. Otherwise,
inadequate urine output may lead to crystalluria or tubular deposits.
For maximum absorption, the client should take this drug at least 1
hour before or 2 hours after meals. No evidence indicates that
antacids interfere with the effects of sulfonamides. To prevent a
photosensitivity reaction, the client should avoid direct sunlight
during co-trimoxazole therapy.
Answer A. Generalized edema, especially of the face and periorbital
area, is a classic sign of acute glomerulonephritis of sudden onset.
Other classic signs and symptoms of this disorder include
hematuria (not green-tinged urine), proteinuria, fever, chills,
weakness, pallor, anorexia, nausea, and vomiting. The client also
may have moderate to severe hypertension (not hypotension),
oliguria or anuria (not polyuria), headache, reduced visual acuity,
and abdominal or flank pain.
Answer A. The symptoms of C. albicans include itching and a scant
white discharge that has the consistency of cottage cheese.
Yellow-green discharge is a sign of Trichomonas vaginalis.
Gray-white discharge and a fishy odor are signs of Gardnerella
vaginalis.
Answer A. Women with condylomata acuminata are at risk for
cancer of the cervix and vulva. Yearly Pap smears are very
important for early detection. Because condylomata acuminata is a
virus, there is no permanent cure. Because condylomata acuminata
can occur on the vulva, a condom won’t protect sexual partners.
HPV can be transmitted to other parts of the body, such as the
mouth, oropharynx, and larynx.
Answer A. Maintaining a closed indwelling urinary catheter system
helps prevent introduction of bacteria; securing the catheter to the
client’s leg also decreases the risk of infection by helping to prevent
urethral trauma. To flush bacteria from the urinary tract, the nurse
should encourage the client to drink at least 10 glasses of fluid daily,
if possible. Douching and feminine deodorants may irritate the
urinary tract and should be discouraged.
Answer A. By encouraging a daily fluid intake of at least 2 L, the
nurse helps fill the client’s bladder, thereby promoting bladder
retraining by stimulating the urge to void. The nurse shouldn’t give
the client soda before bedtime; soda acts as a diuretic and may
make the client incontinent. The nurse should take the client to the
bathroom or offer the bedpan at least every 2 hours throughout the
day; twice per day is insufficient. Consultation with a dietitian won’t
address the problem of urinary incontinence.
47. Answer B. Most catheters have a self-sealing port for obtaining a
urine specimen. Antiseptic solution is used to reduce the risk of
introducing microorganisms into the catheter. Tubing shouldn’t be
disconnected from the urinary catheter. Any break in the closed
urine drainage system may allow the entry of microorganisms. Urine
in urine drainage bags may not be fresh and may contain bacteria,
giving false test results. When there is no urine in the tubing, the
catheter may be clamped for no more than 30 minutes to allow
urine to collect.
48. Answer D. Symptoms of gonorrhea in men include purulent,
foul-smelling drainage from the penis and painful urination. Rashes
on the palms of the hands and soles of the feet are symptoms of
the secondary stage of syphilis. Cauliflower-like warts on the penis
are a sign of human papillomavirus. Painful red papules on the shaft
of the penis may be a sign of the first stage of genital herpes.
49. Answer A. Kayexalate is a sodium exchange resin. Thus the client
will gain sodium as potassium is lost in the bowel. For the exchange
to occur, Kayexalate must be in contact with the bowel for at least
30 minutes. Sorbitol in the Kayexalate enema causes diarrhea,
which increases potassium loss and decreases the potential for
Kayexalate retention.
50. Answer A. Because acetaminophen is metabolized in the liver, its
dosage and dosing schedule need not be adjusted for a client with
ARF. In contrast, the dosages and schedules for gentamicin and
ticarcillin, which are metabolized and excreted by the kidney, should
be adjusted. Because cyclosporine may cause nephrotoxicity, the
nurse must monitor both the dosage and blood drug level in a client
receiving this drug.
TEST 3 - ACUTE RENAL FAILURE
1) The cause of ___________ failure is impaired blood supply to the kidney
(Fluid Volume Deficit, hemorrhage, heart failure, shock)
1. prerenal
2. Intrarenal
3. Postrenal
4. perirenal
2) What electrolytes are in urine?
1. Na
2. K
3. Cl
4. HCO35. All of the above
3) Which diagnostic test would be monitored to evaluate glomerulat
filtration rateand renal function?
1. Sreum creatinine and BUN
2. Urinalysis
3. Kidney biopsy
4. creatinine clearance
4) Marina with acute renal failure moves into the diuretic phase after one
week of therapy. During this phase the client must be assessed for signs
of developing:
1. Hypovolemia
2. renal failure
3. metabolic acidosis
4. hyperkalemia
5) true or false? Creatinine, phosphate, sulfates, and uric acid should not
be present in urine because they signify renal failure.
1. True
2. False
6) The nurse is reviewing laboratory results on a client with acute renal
failure. Which one of the following should be reported immediately?
1. Blood urea nitrogen 50 mg/dl
2. Hemoglobin of 10.3 mg/dl
3. Venous blood pH 7.30
4. Serum potassium 6 mEq/L
7)Nurse Liza is assigned to care for a client who has returned to the
nursing unit after left nephrectomy. Nurse Liza’s highest priority would
be…
1. Hourly urine output
2. Temperature
3. Able to turn side to side
4. Able to sips clear liquidQ.
8) The charge nurse assigned in the care for a client with acute renal
failure and hypernatremia to you, a newly graduated RN. Which actions
can you delegate to the nursing assistant?
1. Provide oral care every 3-4 hours
2. Monitor for indications of dehydration
3. Administer 0.45% saline by IV line
4. Assess daily weights for trends
9) __________ in BUN/Creatinine ratio indicate fluid volume
excess,malnutrition and fluid volume excess or malnutrition ?
1. Increase
2. Decrease
10) The most serious electrolyte disorder associated with kidney disease
is
1. hypermagnesemia
2. hyponatremia
3. hyperkalemia
4. metabolic acidosis
11) A client in acute renal failure is a candidate for continuous renal
placement therapy (CRRT). The most common indication for use of CRRT
is
1. azotemia
2. pericarditis
3. hyperkalemia
4. fluid overload
12) A history of infection specifically caused by group A beta-hemolytic
streptococci is associated with which of the following disorders?
1. Acute glomerulonephritis
2. Acute renal failure
3. Chronic renal failure
4. Nephrotic syndrome
13) The leading cause of ESRD is the client with a history of
1. hypotension
2. anemia
3. prostate cancer
4. diabetes Mellitus
14) The risk for __________________ is particularly high when ischemia and
exposure to a nephrotoxin occur at the same time.
1. acute tubular necrosis or tubular necrosis
2. acute glomerulonephritis
3. chronic renal failure
4. UTI
15) What controls the amount of water absorption?
1. antidiuretic hormone (Vasopressin)
2. melanin
3. thyroxine
4. prolactin
16) What does urine mostly consist of?
1. H2O (Water)
2. NaCl (Salt)
3. Urea
4. KCl
17) How much water do normal kidneys excrete each day?
1. 3-4 liters
2. 5-6 liters
3. 1-2 liters
4. 7-8 liters
18) Chronic kidney disease is defined by Kidney Disease Outcomes
Quality Initiative (K/DOQI) as evidence of structural or functional kidney
abnormalities (abnormal urinalysis, imaging studies, or histology) that
persists for at least ______________ months, with or without a decreased
GFR.
1. 1
2. 2
3. 3
4. 6
5. 12
19) What is the # 1 renal function test?
1. Renal Clearance/Creatinine Clearance
2. Osmolarity
3. Serum Creatinine
4. BUN
20) For a male client in the oliguric phase of acute renal failure (ARF),
which nursing intervention is most important?
1. Encouraging coughing and deep breathing
2. Promoting carbohydrate intake
3. Limiting fluid intake
4. Providing pain-relief measures
21) How much salt do normal kidneys excrete each day?
1. 1-2 mg
2. 5 g
3. 3-4 g
4. 6-8 g
22) Which is a normal value of Blood Urea Nitrogen (BUN)?
1. 0.5-1.1 mg/dL
2. 5-20 mg/dL
3. 40-70 mg/dL
4. 250-500 mg/dL
23) When the kidneys cannot effectively regulate fluid and electrolyte
balance and eliminate metabolic waste products, intake of these
substances must be regulated. Fluid and Sodium intake are ________.
1. encouraged
2. limited
3. restricted
24) The nurse is caring for the client who has had a renal biopsy. Which
of the following interventions would the nurse avoid in the care of the
client after this procedure?
1. Encourage fluids to at least 3L in the first 24 hours
2. Administering narcotics as needed
3. Testing serial samples iwth dipsticks for occult blood
4. Ambulating the client in the room and hall for short
distances
25) A female client is admitted with a diagnosis of acute renal failure.
She is awake, alert, oriented, and complaining of severe back pain,
nausea and vomiting and abdominal cramps. Her vital signs are blood
pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature
100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2
mEq/L; her urinary output for the first 8 hours is 50 ml. The client is
displaying signs of which electrolyte imbalance?
1. Hyponatremia
2. Hyperkalemia
3. Hyperphosphatemia
4. Hypercalcemia
26) how many ml/hr of urine output is the normal minimum?
1. 30
2. 35
3. 40
4. 45
27) Signs and symptoms of acute kidney rejection that the nurse should
teach the patient to observe for include
1. tachycardia and headache
2. fever and painful transplant site
3. severe hypotension and weight loss
4. recurrent urinary tract infections and oral yeast infections
28) ________ renal failure is a slow, insidious process of kidney
destruction. It may go unrecognized for years as nephrons are destroyed
and renal mass is reduced.
1. Chronic
2. Acute
29) The client with renal failure should be on which type of diet?
1. high protein, high carbohydrate, low calorie
2. adequate calorie intake, high carbohydrate, limited
protein
3. Limited protein, low carbohydrate, adequate calorie
intake
4. Low calorie, limited protein, low carbohydrate
30) A client suffering from acute renal failure has an unexpected increase
in urinary output to 150ml/hr. The nurse assesses that the client has
entered the second phase of acute renal failure. Nursing actions
throughout this phase include observation for signs and symptoms of
1. Hypervolemia, hypokalemia, and hypernatremia.
2. Hypervolemia, hyperkalemia, and hypernatremia.
3. Hypovolemia, wide fluctuations in serum sodium and
potassium levels.
4. Hypovolemia, no fluctuation in serum sodium and
potassium levels.
31) _________ is the most frequent complication during hemodialysis.
1. hypertension
2. bleeding
3. Infection
4. Dialysis dementia
32) After 1 week a client with acute renal failure moves, into the diuretic
phase. During this phase the client must be carefully assessed for signs
of:
1. Hypovolemia
2. Hyperkalemia
3. Metabolic acidosis
4. Chronic renal failure
33) What is the #1 cause of death when kidneys fail?
1. hyperkalemia
2. hypokalemia
3. hypernatremia
4. hyponatremia
34) The nurse is reviewing laboratory results on a client with acute renal
failure. Which one of the following should be reported IMMEDIATELY?
1. Blood urea nitrogen 50 mg/dl
2. Hemoglobin of 10.3 mg/dl
3. Venous blood pH 7.30
4. Serum potassium 6 mEq/L
35) When the kidneys have too few nephrons to excrete metabolic
wastes and regulate fluid and electrolyte balance adequately, the client is
said to have ____________, the final stage of Chronic Renal Failure.
1. End-stage renal disease (ESRD)
2. renal insufficiency
3. acute tubular necrosis
4. dialysis
36) _________ renal Failure is a rapid decline in renal function with an
abrupt onset
1. acute
2. chronic
37) How do kidneys control Na+ levels and K+ levels?
1. The kidneys release renin, which controls angiotensin.
The angiotensin controls aldosterone. Aldosterone
controls the levels of Na+ and K+
2. Kidneys release aldosterone which controls renin. Renin
causes the release of angiotensin. Angiotensin controls
the levels of Na+ and K+
3. The kidneys release renin which controls K+. The kidneys
release angiotensin which causes Na+ realease.
38) Anti-hypertensive therapy in patients with chronic renal disease is
for?
1. Renal protection
2. Cardiovascular protection
3. Both renal and cardiovascular protection
4. None of the above
39) ____________ is a treatment for renal failure in which blood id
continuously circulated (artery to vein or vein to vein) and filtered,
allowing excess water and solutes to empty into a collecting device. Fluid
may be replaced with a balanced electrolyte solution as needed during
treatment.
1. Hemodialysis
2. Continuous ambulatory peritoneal dialysis
3. Continuous cyclic peritoneal dialysis
4. Continuous Renal Replacement Therapy
40) __________ failure is caused by obstruction of urine flow. (urethral
obstruction by enlarged prostate or tumor; ureteral or kidney pelvis
obstruction by calculi)
1. prerenal
2. intrarenal
3. postrenal
4. perirenal
41) Agents that damage the kidney tissue are called:
1. nephrons
2. nephrotoxins
3. antibodies
4. enterotoxins
42) Which phase of Acute Renal Failure results in FVE and edema due to
salt and water retention, hypertension, Azotemia, hyperkalemia, muscle
weakness, nausea, diarrhea, and high serum creatinine and BUN levels?
1. initiation phase
2. maintenance phase
3. recovery phase
4. intrarenal phase
43) A patient rapidly progressing toward ESRD asks about the possibility
of a kidney transplant. In responding to the patient, the nurse knows that
contraindications to kidney transplantation include
1. hepatitis C infection
2. extensive vascular disease
3. coronary artery disease
4. refractory hypertension
44) Which of the following medications does not interfere with either
creatinine secretion or the assay used to measure the serum creatinine?
1. Ibuprofen
2. Cimetidine
3. Trimethoprim
4. Cefoxitin
5. Flucytosine
45) A female client with acute renal failure is undergoing dialysis for the
first time. The nurse in charge monitors the client closely for dialysis
equilibrium syndrome, a complication that is most common during the
first few dialysis sessions. Typically, dialysis equilibrium syndrome
causes:
1. confusion, headache, and seizures.
2. acute bone pain and confusion.
3. weakness, tingling, and cardiac arrhythmias.
4. hypotension, tachycardia, and tachypnea.
46) Clients with chronic renal failure should notify the physician of any
weight:
1. loss of 2 pounds over a 5 day period
2. gain of 2 pounds over a 2 day period
3. loss of 5 pounds over a 5 day period
4. gain of 5 pounds over a 2 day period
47) Nurse Tristan is caring for a male client in acute renal failure. The
nurse should expect hypertonic glucose, insulin infusions, and sodium
bicarbonate to be used to treat:
1. hypernatremia.
2. hypokalemia.
3. hyperkalemia.
4. hypercalcemia.
48) The client with ESRD tells the nurse that she hates the thought of
being tied to the machine, but is also glad to start dialysis because she
will be able to eat and drink what she wants. Based on this information,
the nuse identifies the nursing diagnosis of
1. self-esteem disturbance related to dependence on
dialysis
2. anxiety related to perceived threat to health status and
role functioning
3. ineffective management of therapeutic regimen related
to lack of knowledge of treatment plan
4. risk for imbalanced nutrition: more than body
requirements, related to increased dietary intake
49) How acidic is urine compared to blood?
1. 100 times more acidic
2. 200 times less acidic
3. 1000 times more acidic
4. 2000 times more acidic
50) Impaired metabolic processes such as Hyperkalemia, Acidosis,
Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of
___________.
1. hematuria
2. oliguria
3. uremia
4. nephrotoxins
51) ________ failure is caused by Acute damage to renal tissue and
nephrons or acute tubular necrosis: abrupt decline in tubular and
glomerular function due to either prolonged ischemia and/or exposure to
nephrotoxins. (Acute glomerulonephritis, malignant hypertension,
ischemia; nephrotoxic drugs or substances; red blood cell destruction;
muscle tissue breakdown due to trauma, heatstroke)
1. Prerenal
2. Intrarenal
3. Postrenal
4. Perirenal
52) Common early manifestations of kidney disease are loss of
concentration and dilute urine and loss of ability to concentrate and
dilute urine .
1. True
2. False
53) A client with acute renal failure is aware that the most serious
complication of this condition is:
1. Constipation
2. Anemia
3. Infection
4. Platelet dysfunction
54) The nurse is performing an assessment on a client who has returned
from the dialysis unit following hemodialysis. The client is complaining of
a headache and nausea and is extremely restless. Which of the following
is the most appropriate nursing action?
1. Notify the physician
2. Monitor the client
3. Elevate the head of the bed
4. Medicate the client for nausea
55) How much KCL do normal kidneys excrete each day?
1. 6-8 g
2. 1 g
3. 6-8 mg
4. 3 mg
56) Clients on continuous ambulatory peritoneal dialysis (CAPD) must
empty their peritoneal cavity and replace the dialysate every __________
hours.
1. 24
2. 6-8
3. 4-6
4. 48
57) Which of these drugs is nephrotoxic?
1. Diuretics
2. ACE inhibitors
3. NSAIDs
4. Sodium bicarbonate/ Potassium bicarbonate
58) A client is admitted to the hospital and has a diagnosis of early stage
chronic renal failure. Which of the following would the nurse expect to
note on assessment of the client?
1. Polyuria
2. Polydipsia
3. Oliguria
4. Anuria
59) A client on peritoneal dialysis notices that the collecting bag of
dialysate is cloudy, what is this an indication of?
1. The client needs to change their dialysate
2. The patient needs a kidney transplant
3. Medication was added to the dialysate
4. The patient is infected and experiencing peritonitis
60) End-stage renal disease is defined as GFR less than ________________
ml/min per 1.73m2.
1. 45
2. 30
3. 15
4. 10
5. 5
61) During the _________ phase of Acute Renal Failure, Oliguria develops
and the kidneys cannot efficiently eliminate metabolic wastes, water,
electrolytes, and acids.
1. maintenance
2. initiation
3. recovery
62) What tests and results prove the presence of dilute urine?
1. Fixed Specific Gravity (1.010), and/or Fixed osmolality
(300 mOsm/l)
2. GFR (100 ml/min), and/or Specific Gravity (1.030)
3. Serum Creatinine (1.5 mg/dl)
63) Which of the following are abnormal to be found in the urine?
1. K
2. Amino acids
3. Glucose
4. all of the above
5. Amino acids and glucose
64) ESRD occurs when the GFR is less than ___ per minute.
1. 5 ml
2. 10 ml
3. 15 ml
4. 25 ml
65) “urine in the blood”
1. uremia
2. urticaria
3. urethritis
4. urethrorrhea
Answers and Rationales
1. A. prerenal
2. E. All of the above
3. D. creatinine clearance
4. A. Hypovolemia
5. B. False . Creatinine, phosphate, sulfates, and uric acid should be
found in urine.
6. D. Serum potassium 6 mEq/L . Although all of these findings are
abnormal, the elevated potassium is a life threatening finding and
must be reported immediately.
7. A. Hourly urine output . After nephrectomy, it is necessary to
measure urine output hourly. This is done to assess the
effectiveness of the remaining kidney also to detect renal failure
early.
8. A. Provide oral care every 3-4 hours . Providing oral care is within
the scope of practice for the nursing assistant. Monitoring and
assessing clients, as well as administering IV fluids, require the
additional education and skill of the RN.
9. B. Decrease
10. C. hyperkalemia
11. D. fluid overload
12. A. Acute glomerulonephritis
○
Acute glomerulonephritis is also associated with varicella
zoster virus, hepatitis B, and Epstein-Barr virus.
○
Acute renal failure is associated with hypoperfusion to the
kidney, parenchymal damage to the glomeruli or tubules, and
obstruction at a point distal to the kidney.
○
Chronic renal failure may be caused by systemic disease,
hereditary lesions, medications, toxic agents, infections, and
medications.
○
Nephrotic syndrome is caused by disorders such as chronic
glomerulonephritis, systemic lupus erythematosus, multiple
myeloma, and renal vein thrombosis.
13. D. diabetes Mellitus
14. A. acute tubular necrosis or tubular necrosis
15. A. antidiuretic hormone
16. A. H2O (Water)
17. C. 1-2 liters
18. C. 3
19. A. Renal Clearance/Creatinine Clearance
20. C. Limiting fluid intake . During the oliguric phase of ARF, urine
output decreases markedly, possibly leading to fluid overload.
Limiting oral and I.V. Fluid intake can prevent fluid overload and its
complications, such as heart failure and pulmonary edema.
Encouraging coughing and deep breathing is important for clients
with various respiratory disorders. Promoting carbohydrate intake
may be helpful in ARF but doesn’t take precedence over fluid
limitation. Controlling pain isn’t important because ARF rarely
causes pain.
21. D. 6-8 g
22. B. 5-20 mg/dL
23. B. limited
24. D. Ambulating the client in the room and hall for short distances
25. A. Hyponatremia . The normal serum sodium level is 135 – 145
mEq/L. The client’s serum sodium is below normal. Hyponatremia
also manifests itself with abdominal cramps and nausea and
vomiting
26. A. 30
27. B. fever and painful transplant site
28. A. chronic
29. B. adequate calorie intake, high carbohydrate, limited protein
30. C. Hypovolemia, wide fluctuations in serum sodium and potassium
levels. The second phase of ARF is the diuretic phase or high
output phase. The diuresis can result in an output of up to 10L/day
of dilute urine. Loss of fluids and electrolytes occur.
31.
32.
33.
34.
A. hypertension
A. Hypovolemia
A. hyperkalemia
D. Serum potassium 6 mEq/L. Although all of these findings are
abnormal, the elevated potassium is a life threatening finding and
must be reported immediately.
35. A. End-stage renal disease (ESRD)
36. A. acute
37. A. The kidneys release renin, which controls angiotensin. The
angiotensin controls aldosterone. Aldosterone controls the levels
of Na+ and K+
38. C. Both renal and cardiovascular protection
39. D. Continuous Renal Replacement Therapy
40. C. postrenal
41. B. nephrotoxins
42. B. maintenance phase
43. B. extensive vascular disease
44. A. Ibuprofen
45. A. confusion, headache, and seizures. Dialysis equilibrium
syndrome causes confusion, a decreasing level of consciousness,
headache, and seizures. These findings, which may last several
days, probably result from a relative excess of interstitial or
intracellular solutes caused by rapid solute removal from the
blood. The resultant organ swelling interferes with normal
physiologic functions. To prevent this syndrome, many dialysis
centers keep first-time sessions short and use a reduced blood
flow rate. Acute bone pain and confusion are associated with
aluminum intoxication, another potential complication of dialysis.
Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia,
which is associated with renal failure. Hypotension, tachycardia,
and tachypnea signal hemorrhage, another dialysis complication.
46. D. gain of 5 pounds over a 2 day period
47. C. hyperkalemia. Hyperkalemia is a common complication of acute
renal failure. It’s life-threatening if immediate action isn’t taken to
reverse it. The administration of glucose and regular insulin, with
sodium bicarbonate if necessary, can temporarily prevent cardiac
arrest by moving potassium into the cells and temporarily reducing
serum potassium levels. Hypernatremia, hypokalemia, and
hypercalcemia don’t usually occur with acute renal failure and
aren’t treated with glucose, insulin, or sodium bicarbonate.
48. C. ineffective management of therapeutic regimen related to lack
of knowledge of treatment plan
49. C. 1000 times more acidic
50. C. uremia
51. B. Intrarenal
52. A. True
53. C. Infection . Infection is responsible for one third of the traumatic
or surgically induced death of clients with renal failure as well as
medical induced acute renal failure (ARF)
54. A. Notify the physician
55. A. 6-8 g
56. C. 4-6
57. C. NSAIDs
58. A. Polyuria
59. D. The patient is infected and experiencing peritonitis
60. C. 15
61. A. maintenance
62. A. Fixed Specific Gravity (1.010), and/or Fixed osmolality (300
mOsm/l)
63. E. Amino acids and glucose. Amino acids (proteins) found in the
urine indicate trauma to the glomeruli. Glucose found in the urine
indicates BS levels to be above the renal threshold.
64. C. 15 ml
65. A. uremia
TEST 4 - BENIGN PROSTATIC HYPERPLASIA
Q.1) After undergoing a transurethral resection of the prostate to treat
benign prostatic hypertrophy, a patient is returned to the room with
continuous bladder irrigation in place. One day later, the patient reports
bladder pain. What should the nurse do first?
1. Increase the I.V. flow rate
2. Notify the doctor immediately
3. Assess the irrigation catheter for patency and drainage
4. Administer meperidine (Demerol) as prescribed
Q.2) Alpha blockers in the treatment of BPH are associated with all of the
following except:
1. Improvement in symptoms in 2-3 weeks
2. Side effects of dizziness and fatigue
3. Once daily dosing
4. 25% decrease in prostate size
5. Minimal changes in blood pressure
Q.3) Of the options below, is NOT a symptom of BPH?
1. Urinary incontinence
2. Difficulty urinating
3. Intestinal pain
4. Sexual dysfunction
Q.4) An eighty five year old man was admitted for surgery for benign
prostatic hypertrophy. Preoperatively he was alert, oriented, cooperative,
and knowledgeable about his surgery. Several hours after surgery, the
evening nurse found him acutely confused, agitated, and trying to climb
over the protective side rails on his bed. The most appropriate nursing
intervention that will calm an agitated client is
1. limit visits by staff.
2. encourage family phone calls.
3. position in a bright, busy area.
4. speak soothingly and provide quiet music.
Q.5) What is the relationship between prostate cancer and the condition
of an enlarged prostate, also known as BPH?
1. BPH and prostate cancer are unrelated
2. BPH causes prostate cancer
3. BPH is a symptom of prostate cancer
Q.6) How common is BPH?
1. 10% of men in their 60s
2. 30% of men in their 60s
3. 50% of men in their 60s
4. 90% of men in their 60s
Q.7) Romeo Diaz, age 78, is admitted to the hospital with the diagnosis of
benign prostatic hyperplasia (BPH). He is scheduled for a transurethral
resection of the prostate (TURP). It would be inappropriate to include
which of the following points in the preoperative teaching?
1. TURP is the most common operation for BPH.
2. Explain the purpose and function of a two-way irrigation
system.
3. Expect bloody urine, which will clear as healing takes
place.
4. He will be pain free.
Q.8) The obstructive and irritative symptom complex caused by benign
prostatic hypertrophy is termed
1. prostatism.
2. prostatitis.
3. prostaglandin.
4. prostatectomy.
Q.9) Transurethral resection of the prostate (TURP) is associated with all
of the following except:
1. Outpatient procedure in most cases
2. Transfusion rate of 2-4%
3. Retrograde ejaculation in 50% of men
4. Most effective long term treatment
5. Erectile dysfunction in 2%
Q.10) A client is admitted to the hospital with benign prostatic
hyperplasia, the nurse most relevant assessment would be:
1. Flank pain radiating in the groin
2. Distention of the lower abdomen
3. Perineal edema
4. Urethral discharge
Q.11) What question would be most important to ask a male client who is
in for a digital rectal examination?
1. “Have you noticed a change in the force of the urinary
system?”
2. “Have you noticed a change in tolerance of certain foods
in your diet?”
3. “Do you notice polyuria in the AM?”
4. “Do you notice any burning with urination or any odor to
the urine?”
Q.12) The nurse is administering a psychotropic drug to an elderly client
who has a history of benign prostatic hypertrophy. It is most important
for the nurse to teach this client to:
1. Add fiber to his diet.
2. Exercise on a regular basis.
3. Report incomplete bladder emptying
4. Take the prescribed dose at bedtime.
Q.13) Which of the following is true of laser therapy?
1. Laser light exhibits all photons in phase (coherence)
2. The photons travel at right angles (collimation)
3. The photons have varying wavelengths (polychronicity)
4. May be legally performed in 48 of the 50 US states
5. Cause eye damage in most surgeons after prolonged use
Answers and Rationales
1. C. Assess the irrigation catheter for patency and drainage .
Although postoperative pain is expected, the nurse should ensure
that other factors, such as an obstructed irrigation catheter, aren’t
the cause of the pain. After assessing catheter patency, the nurse
should administer an analgesic such as meperidine as prescribed.
Increasing the I.V. flow rate may worsen the pain. Notifying the
doctor isn’t necessary unless the pain is severe or unrelieved by
the prescribed medication.
2. D. 25% decrease in prostate size
3. C. Intestinal pain. Recent studies suggest that there is a correlation
between lower urinary tract symptoms and sexual dysfunction in
aging patients. In fact, the severity of urinary symptoms and the
degree of sexual dysfunction are strongly correlated, indepently of
age. In particular, community-based studies have found that a
significant number of patients with symptomatic BPH have sexual
dysfunction.
4. D. speak soothingly and provide quiet music. The client needs
frequent visits by the staff to orient him and to assess his safety.
Phone calls from his family will not help a client who is trying to
climb over the side rails and may even add to his danger. Putting
the client in a bright, busy area would probably add to his
confusion. The environment is an important factor in the
prevention of injuries. Talking softly and providing quiet music
have a calming effect on the agitated client.
5. A. BPH and prostate cancer are unrelated
6. C. 50% of men in their 60s . Although the prostate continues to
grow during most of a man’s life, the enlargement doesn’t usually
cause problems until late in life. BPH rarely causes symptoms
before the age of 40, but more than half of men in their 60s, and as
many as 90% in their 70s and 80s, have some symptoms of BPH
7. D. He will be pain free. Surgical interventions involve an experience
of pain for the client which can come in varying degrees. Telling
the pain that he will be pain free is giving him false reassurance.
8. A. prostatism. Symptoms of prostatism include increased
frequency of urination, nocturia, urgency, dribbling, and a sensation
that the bladder has not completely emptied. Prostatitis is an
inflammation of the prostate gland.Prostaglandins are
physiologically active substances present in tissues with
vasodilator properties. Prostatectomy refers to the surgical
removal of the prostate gland.
9. A. Outpatient procedure in most cases
10. B. Distention of the lower abdomen . This indicates that the
bladder is distended with urine, therefore palpable.
11. A. “Have you noticed a change in the force of the urinary system?”
This change would be most indicative of a potential complication
with (BPH) benign prostate hypertrophy.
12. C. Report incomplete bladder emptying . Urinary retention is a
common anticholinergic side effect of psychotic medications, and
the client with benign prostatic hypertrophy would have increased
risk for this problem. Adding fiber to one’s diet and exercising
regularly are measures to counteract another anticholinergic
effect, constipation. Depending on the specific medication and
how it is prescribed, taking the medication at night may or may not
be important. However, it would have nothing to do with urinary
retention in this client.
13. A. Laser light exhibits all photons i phase (coherence)
TEST 5 - BLADDER CANCER
1) A client with bladder cancer is being treated with iridium seed
implants. The nurse’s discharge teaching should include telling the client
to:
1. Strain his urine
2. Increase his fluid intake
3. Report urinary frequency
4. Avoid prolonged sitting
2) Aniline dyes have been linked to cancer
1. true
2. false
3) Does not respond at all to radiation
1. grade 2
2. grade 3
3. grade 1
4. grade 4
4) Occupational exposure to pizza making has been linked to bladder
cancer
1. true
2. false
5) Toxicity levels are unacceptable if the patient is worse off then before
treatment
1. true
2. false
6) Superficial bladder cancer can be treated by direct installation of the
antineoplastic antibiotic agent mitomycin (Mutamycin). This process is
termed:
1. Intraventricular administration
2. Intravesical administration
3. Intravascular administration
4. Intrathecal administration
7) very low degree of malignancy
1. grade 2
2. grade 3
3. grade 1
4. grade 4
8) A client has been diagnosed as having bladder cancer, and a
cystectomy and an ileal conduit are scheduled. Preoperatively, the nurse
plans to:
1. Limit fluid intake for 24 hours
2. Teach the procedure for irrigation of the stoma
3. Teach muscle-tightening exercises
4. Provide cleansing enemas and laxatives as ordered
9) anticholinergics
1. drugs that decrease bladder outlet resistance
2. drugs that simulate detrusor contractility and promote
bladder emptying
3. drugs that inhibit contractility and promote urine storage
4. drugs that increase bladder outlet resistance
10) What is the most common type of Bladder Cancer?
1. Squamous Cell Carcinoma
2. Transistional cell carcinoma
3. Epithelial hyperplasia
11) Can coffee cause bladder tumors?
1. yes
2. no
12) How does bladder cancer rate on the most commonly occurring GU
cancer in adults list?
1. 1st
2. 2nd
3. 4th
4. 8th
13) Well differentiated but fully malignant
1. grade 1
2. grade 2
3. grade 3
4. grade 4
14) Recurring UTI, N/V and leukopenia are all adverse reactions to
Chemotherapy and what else is one?
1. fistula’s
2. BPH
3. Penile Prosthetic
4. nephrotoxicity
15) Beta-adrenergics
1. drugs that increase bladder outlet resistance
2. drugs that inhibit contractility and promote urine storage
3. drugs that simulate detrusor contractility and promote
bladder emptying
4. drugs that decrease bladder outlet resistance
16) Response is poor to radiation
1. grade 3
2. grade 1
3. grade 2
4. grade 4
17) The female client who has been receiving radiation therapy for
bladder cancer tells the nurse that it feels as if she is voiding through the
vagina. The nurse interprets that the client may be experiencing:
1. Rupture of the bladder
2. The development of a vesicovaginal fistula
3. Extreme stress caused by the diagnosis of cancer
4. Altered perineal sensation as a side effect of radiation
therapy
18) What would be a indication to use Chemotherapy?
1. complete resolution of abnormal serum tumor markers
2. location of tumor
3. chronic reflux
4. N/V
5. Recurring CIS
19) High degree of malignancy, usually anaplastic CA
1. grade 2
2. grade 1
3. grade 4
4. grade 3
20) Transitional cell carcinoma (TCC) is
1. a poorly differentiated carcinoma often without any
papillary growth
2. a benign proliferation of urothelium in response to
inflammation or irritation
3. a type of malignancy that arises from the urothelial lining
of the urinary tract
4. a cancerous growth on the urothelium causing
disintegration of the bladder wall and urothelium.
21) What is a random bladder biopsy done for?
1. stage and grade verification
2. invasive
3. noninvasive
4. smaller tumors
5. stages T1-T4
22) From below what are symptoms of bladder cancer? (Choose answer
that apply)
1. painful hematuria
2. frequency and urgency
3. dysuria
4. flank pain
5. abdominal pain
23) estrogens
1. drugs that simulate detrusor contractility and promote
bladder emptying
2. drugs that increase bladder outlet resistance
3. drugs that decrease bladder outlet resistance
4. drugs that inhibit contractility and promote urine storage
24) drugs that decrease bladder outlet resistance
1. alpha-adrenergics blockers
2. Estrogens
3. beta-adrenergics
4. alpa-adrenergics
25) The health of the patient is a factor in deciding to use or not to use
Chemo
1. true
2. false
26) Does respond to radiation
1. grade 3
2. grade 4
3. grade 2
4. grade 1
27) Beta-adrenergic blockers
1. drugs that increase bladder outlet resistance
2. drugs that decrease bladder outlet resistance
3. drugs that simulate detrusor contractility and promote
bladder emptying
4. drugs that inhibit contractility and promote urine storage
28) Alpha-adrenergics
1. drugs that inhibit contractility and promote urine storage
2. drugs that decrease bladder outlet resistance
3. drugs that simulate detrusor contractility and promote
bladder emptying
4. drugs that increase bladder outlet resistance
29) A male client is being transferred to the nursing unit for admission
after receiving a radium implant for bladder cancer. The nurse in-charge
would take which priority action in the care of this client?
1. Place client on reverse isolation.
2. Admit the client into a private room.
3. Encourage the client to take frequent rest periods.
4. Encourage family and friends to visit.
30) lowest degree of malignancy
1. grade 1
2. grade 2
3. grade 3
4. grade 4
31) Resistant
1. grade 1
2. grade 2
3. grade 3
4. grade 4
32) Cigarette smoking can cause bladder cancer, but at what ratio to
non-smokers?
1. 3 times greater
2. 4 times greater
3. 5 times greater
4. 2 times greater
33) most frequent presenting symptom is?
1. painless hematuria
2. flank pain due to ureteral obstruction or pelvic mass
3. frequency
4. constipation
34) Occupational exposure to aromatic amines cannot cause cancer
1. true
2. false
35) How many grades of cancer are there?
1. 5
2. 4
3. 3
4. 6
5. 8
36) What percentage of bladder cancers does squamous cell carcinoma
account for?
1. 3%
2. 5%
3. 50%
4. 95%
5. 75%
37) Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a
cystectomy with the creation of an ileal conduit in the morning. He is
wringing his hands and pacing the floor when the nurse enters his room.
What is the best approach?
1. “Good evening, Mr. Pablo. Wasn’t it a pleasant day,
today?”
2. “Mr, Pablo, you must be so worried, I’ll leave you alone
with your thoughts.
3. “Mr. Pablo, you’ll wear out the hospital floors and
yourself at this rate.”
4. “Mr. Pablo, you appear anxious to me. How are you
feeling about tomorrow’s surgery?”
38) Tricyclic antidepressants
1. drugs that inhibit contractility and promote urine storage
2. drugs that increase bladder outlet resistance
3. drugs that simulate detrusor contractility and promote
bladder emptying
4. drugs that decrease bladder outlet resistance
39) A male client with bladder cancer has had the bladder removed and
an ileal conduit created for urine diversion. While changing this client’s
pouch, the nurse observes that the area around the stoma is red,
weeping, and painful. What should nurse Katrina conclude?
1. The skin wasn’t lubricated before the pouch was applied.
2. The pouch faceplate doesn’t fit the stoma.
3. A skin barrier was applied properly.
4. Stoma dilation wasn’t performed.
40) cholinergics
1. drugs that increase bladder outlet resistance
2. drugs that inhibit contractility and promote urine storage
3.
drugs that simulate detrusor contractility and promote
bladder emptying
4. drugs that decrease bladder outlet resistance
41) Drugs that inhibit contractility and promote urine storage
1. antispasmodics
2. alpha-adrenergics
3. cholinergics
4. external sphincter/striated muscle relaxant
42) A male client is receiving the cell cycle–nonspecific alkylating agent
thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as
part of a chemotherapeutic regimen to treat bladder cancer. The client
asks the nurse how the drug works. How does thiotepa exert its
therapeutic effects?
1. It interferes with deoxyribonucleic acid (DNA) replication
only.
2. It interferes with ribonucleic acid (RNA) transcription
only.
3. It interferes with DNA replication and RNA transcription.
4. It destroys the cell membrane, causing lysis.
43) artificial sweeteners, pelvic irradiation and chronic cystitis can’t
cause cancer
1. true
2. false
44) higher levels of toxicity are acceptable if the cure can be achieved?
1. true
2. false
Answers and Rationales
1. A. Strain his urine . Iridium seeds can be expelled during urination,
so the client should be taught to strain his urine and report to the
doctor if any of the seeds are expelled. Increasing fluids, reporting
urinary frequency, and avoiding prolonged sitting are not necessary
2. A. true
3. D. grade 4
4.
B. false
5. A. true
6. B. Intravesical administration. Medications administered
intravesically are instilled into the bladder. Intraventricular
administration involves the ventricles of the brain. Intravascular
administration involves blood vessels. Intrathecal administration
involves the fluid surrounding the brain and spinal cord.
7. A. grade 2
8. D. Provide cleansing enemas and laxatives as ordered
9. C. drugs that inhibit contractility and promote urine storage
10. B. Transistional cell carcinoma
11. A. yes
12. B. 2nd
13. C. grade 3
14. D. nephrotoxicity
15. B. drugs that inhibit contractility and promote urine storage
16. C. grade 2
17. B. The development of a vesicovaginal fistula. A vesicovaginal
fistula is a genital fistula that occurs between the bladder and
vagina. The fistula is an abnormal opening between these two
body parts and, if this occurs, the client may experience drainage
of urine through the vagina.
18. A. complete resolution of abnormal serum tumor markers, B.
location of tumor
19. C. grade 4
20. C. a type of malignancy that arises from the urothelial lining of the
urinary tract
21. A. stage and grade verification
22. B. frequency and urgency, C. dysuria, D. flank pain
23. B. drugs that increase bladder outlet resistance
24. A. alpha-adrenergics blockers
25. A. true
26. A. grade 3
27. A. drugs that increase bladder outlet resistance
28. D. drugs that increase bladder outlet resistance
29. B. Admit the client into a private room. The client who has a
radiation implant is placed in a private room and has a limited
number of visitors. This reduces the exposure of others to the
radiation.
30. A. grade 1
31. A. grade 1
32.
33.
34.
35.
36.
37.
B. 4 times greater
A. painless hematuria
B. false
B. 4
A. 3%
D. “Mr. Pablo, you appear anxious to me. How are you feeling about
tomorrow’s surgery?” The client is showing signs of anxiety
reaction to a stressful event. Recognizing the client’s anxiety
conveys acceptance of his behavior and will allow for verbalization
of feelings and concerns.
38. A. drugs that inhibit contractility and promote urine storage
39. B. The pouch faceplate doesn’t fit the stoma. If the pouch
faceplate doesn’t fit the stoma properly, the skin around the stoma
will be exposed to continuous urine flow from the stoma, causing
excoriation and red, weeping, and painful skin. A lubricant
shouldn’t be used because it would prevent the pouch from
adhering to the skin. When properly applied, a skin barrier prevents
skin excoriation. Stoma dilation isn’t performed with an ileal
conduit, although it may be done with a colostomy if ordered.
40. C. drugs that simulate detrusor contractility and promote bladder
emptying
41. A. antispasmodics
42. C.
It
interferes
with
DNA
replication
and
RNA
transcription.Thiotepa interferes with DNA replication and RNA
transcription. It doesn’t destroy the cell membrane.
43. B. false
44. A. true
TEST 6 - CYSTITIS
1) The physician has prescribed Cytoxan (cyclophosphamide) for a client
with nephotic syndrome. The nurse should:
1. Encourage the client to drink extra fluids
2. Request a low-protein diet for the client
3. Bathe the client using only mild soap and water
4. Provide additional warmth for swollen, inflamed joints
2) Symptoms of interstitial cystitis are similar to what other condition?
1. Bladder Cancer
2. Urinary Tract Infection
3. Tuberculosis of the bladder
4. Radition Cystisis
3) What test is used to diagnose interstitial cystitis?
1. Cystoscopy
2. Ultrasound of bladder
3. Biopsy
4. Urine culture
4) Which of the following may cause an increase in the cystitis
symptoms?
1. Water
2. Orange juice
3. Coffee
4. Mango juice
5) Interstitial cystitis is a condition of which organ of the body?
1. Uterus
2. Bladder
3. Prostate
4. Colon
6) Which of the following terms is used to refer to inflammation of the
renal pelvis?
1. Pyelonephritis
2. Cystitis
3. Urethritis
4. Interstitial nephritis
7) Over 700,000 Americans have interstitial cystitis. What causes the
disease?
1. A defect
2. Autoimmune
3. The cause is unknown
4. Hereditary
8) Which of the following are the most commonly assessed findings in
cystitis?
1. Frequency, urgency, dehydration, nausea, chills, and flank
pain
2. Nocturia, frequency, urgency dysuria, hematuria, fever
and suprapubic pain
3.
Dehydration, hypertension, dysuria, suprapubic pain,
chills, and fever
4. High fever, chills, flank pain nausea, vomiting, dysuria,
and frequency
9) Interstitial cystitis affects whom?
1. Woman
2. Children
3. Men
4. All of these
10) Which of the following are the most commonly assessed findings in
cystitis?
1. Frequency, urgency, dehydration, nausea, chills, and flank
pain
2. Nocturia, frequency, urgency dysuria, hematuria, fever
and suprapubic pain
3. Dehydration, hypertension, dysuria, suprapubic pain,
chills, and fever
4. High fever, chills, flank pain nausea, vomiting, dysuria,
and frequency
Answers and Rationales
1. A. Encourage the client to drink extra fluids . The client taking
Cytoxan should increase his fluid intake to prevent hemorrhagic
cystitis.
2. B. Urinary Tract Infection. IC can have some similar symptoms of
the incorrect answers but is most similar to a UTI. The biggest
difference between them is that a UTI is caused by bacteria and
treated with antibiotics. Since IC is not bacterial, antibiotics don’t
help IC patients. The common symptoms are frequency of
urination, urgency to urinate (accompanied by pain, pressure
and/or spasms) Pain in the bladder, pelvic region, and/or urethral.
IC patients have a wide variety of symptoms. Some have all the
mentioned symptoms (plus other symptoms) while some have
only a few.
3. A. Cystoscopy . A cystoscopy under general or regional anesthesia
is to needed to check for glomerulations (pinpoint hemorrages)
Before a cystoscopy there are other tests performed. Such as urine
culture and potassium sensitivity test. It is not uncommon to
suffer for years before receiving a diagnosis.
4. C. Coffee
5. B. Bladder. Interstitial cystitis (IC) is a chronic inflammatory
condition of the bladder wall.
6. A. Pyelonephritis . Pyelonephritis is an upper urinary tract
inflammation, which may be acute or chronic. Cystitis is
inflammation of the urinary bladder. Urethritis is inflammation of
the urethra. Interstitial nephritis is inflammation of the kidney.
7. C. The cause is unknown. Researchers have yet to determine one
specific cause. There are many theories that have been looked
into. The one gaining the most attention in the medical community
is a antiproliferative factor (APF) Which blocks the normal growth
of cells in the bladder lining. APF is found almost exclusively in IC
patients. Many other theories are out there such as; inflammatory
response to injury, autoimmune disorder, undetected bacteria, and
hereditary.
8. B. Nocturia, frequency, urgency dysuria, hematuria, fever and
suprapubic pain. Manifestations of cystitis include, frequency,
urgency, dysuria, hematuria nocturia, fever, and suprapubic pain.
Dehydration, hypertension, and chills are not typically associated
with cystitis. High fever chills, flank pain, nausea, vomiting, dysuria,
and frequency are associated with pvelonephritis.
9. D. All of these . IC can affect people of any age, race or sex. Statics
do show that 90% of cases are women. The average age of onset
is 40.
10. B. Nocturia, frequency, urgency dysuria, hematuria, fever and
suprapubic pain. Manifestations of cystitis include, frequency,
urgency, dysuria, hematuria nocturia, fever, and suprapubic pain.
Dehydration, hypertension, and chills are not typically associated
with cystitis. High fever chills, flank pain, nausea, vomiting, dysuria,
and frequency are associated with pvelonephritis.
TEST 7 - KIDNEY STONES, BLADDER CANCER AND PROSTATE
DISORDERS
1. A client is complaining of severe flank and abdominal pain. A flat plate
of the abdomen shows urolithiasis. Which of the following interventions
is important?
1. Strain all urine
2. Limit fluid intake
3. Enforce strict bed rest
4. Encourage a high calcium diet
2.
A client is receiving a radiation implant for the treatment of
bladder cancer. Which of the following interventions is appropriate?
1. Flush all urine down the toilet
2. Restrict the client’s fluid intake
3. Place the client in a semi-private room
4. Monitor the client for signs and symptoms of cystitis
3.
A client has just received a renal transplant and has started
cyclosporine therapy to prevent graft rejection. Which of the following
conditions is a major complication of this drug therapy?
1. Depression
2. Hemorrhage
3. Infection
4. Peptic ulcer disease
4.
A client received a kidney transplant 2 months ago. He’s
admitted to the hospital with the diagnosis of acute rejection. Which of
the following assessment findings would be expected?
1. Hypotension
2. Normal body temperature
3. Decreased WBC count
4. Elevated BUN and creatinine levels
5.
The client is to undergo kidney transplantation with a living
donor. Which of the following preoperative assessments is important?
1. Urine output
2. Signs of graft rejection
3. Signs and symptoms of rejection
4. Client’s support system and understanding of lifestyle
changes.
6.
A client had a transurethral prostatectomy for benign prostatic
hypertrophy. He’s currently being treated with a continuous bladder
irrigation and is complaining of an increase in severity of bladder
spasms. Which of the interventions should be done first?
1. Administer an oral analgesic
2. Stop the irrigation and call the physician
3. Administer a belladonna and opium suppository as
ordered by the physician.
4. Check for the presence of clots, and make sure the
catheter is draining properly.
7.
A client is admitted with a diagnosis of hydronephrosis
secondary to calculi. The calculi have been removed and postobstructive
diuresis is occurring. Which of the following interventions should be
done?
1. Take vital signs every 8 hours
2. Weigh the client every other day
3. Assess for urine output every shift
4. Monitor the client’s electrolyte levels.
8.
A client has passed a renal calculus. The nurse sends the
specimen to the laboratory so it can be analyzed for which of the
following factors?
1. Antibodies
2. Type of infection
3. Composition of calculus
4. Size and number of calculi
9.
Which of the following symptoms indicate acute rejection of a
transplanted kidney?
1. Edema, nausea
2. Fever, anorexia
3. Weight gain, pain at graft site
4. Increased WBC count, pain with voiding
10. Adverse reactions of prednisone therapy include which of the
following conditions?
1. Acne and bleeding gums
2. Sodium retention and constipation
3. Mood swings and increased temperature
4. Increased blood glucose levels and decreased wound
healing.
11. The nurse suspects that a client with polyuria is experiencing water
diuresis. Which laboratory value suggests water diuresis?
1. High urine specific gravity
2. High urine osmolarity
3. Normal to low urine specific gravity
4. Elevated urine pH
12. A client is diagnosed with prostate cancer. Which test is used to
monitor progression of this disease?
1. Serum creatinine
2. Complete blood cell count (CBC)
3. Prostate specific antigen (PSA)
4. Serum potassium
13. a 27-year old client, who became paraplegic after a swimming
accident, is experiencing autonomic dysreflexia. Which condition is the
most common cause of autonomic dysrelexia?
1. Upper respiratory infection
2. Incontinence
3. Bladder distention
4. Diarrhea
14. When providing discharge teaching for a client with uric acid calculi,
the nurse should an instruction to avoid which type of diet?
1. Low-calcium
2. Low-oxalate
3. High-oxalate
4. High-purine
15. The client with urolithiasis has a history of chronic urinary tract
infections. The nurse concludes that this client most likely has which of
the following types of urinary stones?
1. Calcium oxalate
2. Uric acid
3. Struvite
4. Cystine
16. The nurse is receiving in transfer from the postanesthesia care unit a
client who has had a percutaneous ultrasonic lithrotripsy for calculuses
in the renal pelvis. The nurse anticipates that the client’s care will involve
monitoring which of the following?
1. Suprapubic tube
2. Urethral stent
3. Nephrostomy tube
4. Jackson-Pratt drain
17. The client is admitted to the ER following a MVA. The client was
wearing a lap seat belt when the accident occurred. The client has
hematuria and lower abdominal pain. To determine further whether the
pain is due to bladder trauma, the nurse asks the client if the pain is
referred to which of the following areas?
1. Shoulder
2. Umbilicus
3. Costovertebral angle
4. Hip
18. The client complains of fever, perineal pain, and urinary urgency,
frequency, and dysuria. To assess whether the client’s problem is related
to bacterial prostatitis, the nurse would look at the results of the prostate
examination, which should reveal that the prostate gland is:
1. Tender, indurated, and warm to the touch
2. Soft and swollen
3. Tender and edematous with ecchymosis
4. Reddened, swollen, and boggy.
19. The nurse is taking the history of a client who has had benign
prostatic hyperplasia in the past. To determine whether the client
currently is experiencing difficulty, the nurse asks the client about the
presence of which of the following early symptoms?
1. Urge incontinence
2. Nocturia
3. Decreased force in the stream of urine
4. Urinary retention
20. The client who has a cold is seen in the emergency room with
inability to void. Because the client has a history of BPH, the nurse
determines that the client should be questioned about the use of which
of the following medications?
1. Diuretics
2. Antibiotics
3. Antitussives
4. Decongestants
21. The nurse is preparing to care for the client following a renal scan.
Which of the following would the nurse include in the plan of care?
1. Place the client on radiation precautions for 18 hours
2. Save all urine in a radiation safe container for 18 hours
3. Limit contact with the client to 20 minutes per hour.
4. No special precautions except to wear gloves if in
contact with the client’s urine.
22. The client passes a urinary stone, and lab analysis of the stone
indicates that it is composed of calcium oxalate. Based on this analysis,
which of the following would the nurse specifically include in the dietary
instructions?
1. Increase intake of meat, fish, plums, and cranberries
2. Avoid citrus fruits and citrus juices
3. Avoid green, leafy vegetables such as spinach.
4. Increase intake of dairy products.
23. The client returns to the nursing unit following a pyelolithotomy for
removal of a kidney stone. A Penrose drain is in place. Which of the
following would the nurse include on the client’s postoperative care?
1. Sterile irrigation of the Penrose drain
2. Frequent dressing changes around the Penrose drain
3. Weighing the dressings
4. Maintaining the client’s position on the affected side
24. The nurse is caring for a client following a kidney transplant. The
client develops oliguria. Which of the following would the nurse
anticipate to be prescribed as the treatment of oliguria?
1. Encourage fluid intake
2. Administration of diuretics
3. Irrigation of foley catheter
4. Restricting fluids
25.
A week after kidney transplantation the client develops a
temperature of 101, the blood pressure is elevated, and the kidney is
tender. The x-ray results the transplanted kidney is enlarged. Based on
these assessment findings, the nurse would suspect which of the
following?
1. Acute rejection
2. Chronic rejection
3. Kidney infection
4. Kidney obstruction
26. The client with BPH undergoes a transurethral resection of the
prostate. Postoperatively, the client is receiving continuous bladder
irrigations. The nurse assesses the client for signs of transurethral
resection syndrome. Which of the following assessment data would
indicate the onset of this syndrome?
1. Bradycardia and confusion
2. Tachycardia and diarrhea
3. Decreased urinary output and bladder spasms
4. Increased urinary output and anemia
27. The client is admitted to the hospital with BPH, and a transurethral
resection of the prostate is performed. Four hours after surgery the nurse
takes the client’s VS and empties the urinary drainage bag. Which of the
following assessment findings would indicate the need to notify the
physician?
1. Red bloody urine
2. Urinary output of 200 ml greater than intake
3. Blood pressure of 100/50 and pulse 130.
4. Pain related to bladder spasms.
28. Which of the following symptoms is the most common clinical
finding associated with bladder cancer?
1. Suprapubic pain
2. Dysuria
3. Painless hematuria
4. Urinary retention
29. A client who has been diagnosed with bladder cancer is scheduled
for an ileal conduit. Preoperatively, the nurse reinforces the client’s
understanding of the surgical procedure by explaining that an ileal
conduit:
1. Is a temporary procedure that can be reversed later.
2. Diverts urine into the sigmoid colon, where it is expelled
through the rectum.
3. Conveys urine from the ureters to a stoma opening in the
abdomen.
4. Creates an opening in the bladder that allows urine to
drain into an external pouch.
30. After surgery for an ileal conduit, the nurse should closely evaluate
the client for the occurrence of which of the following complications
related to pelvic surgery?
1. Peritonitis
2. Thrombophlebitis
3. Ascites
4. Inguinal hernia
31. The nurse is assessing the urine of a client who has had an ileal
conduit and notes that the urine is yellow with a moderate amount of
mucus. Based on the assessment data, which of the following nursing
interventions would be most appropriate at this time?
1. Change the appliance bag
2. Notify the physician
3. Obtain a urine specimen for culture
4. Encourage a high fluid intake
32. When teaching the client to care for an ileal conduit, the nurse
instructs the client to empty the appliance frequently, primarily to prevent
which of the following problems?
1. Rupture of the ileal conduit
2. Interruption of urine production
3. Development of odor
4. Separation of the appliance from the skin
33. The client with an ileal conduit will be using a reusable appliance at
home. The nurse should teach the client to clean the appliance routinely
with what product?
1. Baking soda
2. Soap
3. Hydrogen peroxide
4. Alcohol
34. The nurse is evaluating the discharge teaching for a client who has
an ileal conduit. Which of the following statements indicates that the
client has correctly understood the teaching? Select all that apply.
1. “If I limit my fluid intake I will not have to empty my
ostomy pouch as often.”
2. “I can place an aspirin tablet in my pouch to decrease
odor.”
3. “I can usually keep my ostomy pouch on for 3 to 7 days
before changing it.”
4. “I must use a skin barrier to protect my skin from urine.”
5. “I should empty my ostomy pouch of urine when it is full.”
35. A female client with a urinary diversion tells the nurse, “This urinary
pouch is embarrassing. Everyone will know that I’m not normal. I don’t
see how I can go out in public anymore.” The most appropriate nursing
diagnosis for this patient is:
1. Anxiety related to the presence of urinary diversion.
2. Deficient Knowledge about how to care for the urinary
diversion.
3. Low Self-Esteem related to feelings of worthlessness
4. Disturbed Body Image related to creation of a urinary
diversion.
36. The nurse teaches the client with a urinary diversion to attach the
appliance to a standard urine collection bag at night. The most important
reason for doing this is to prevent:
1. Urine reflux into the stoma
2. Appliance separation
3. Urine leakage
4. The need to restrict fluids
37. The nurse teaches the client with an ileal conduit measures to
prevent a UTI. Which of the following measures would be most effective?
1. Avoid people with respiratory tract infections
2. Maintain a daily fluid intake of 2,000 to 3,000 ml
3. Use sterile technique to change the appliance
4. Irrigate the stoma daily.
38. A client who has been diagnosed with calculi reports that the pain is
intermittent and less colicky. Which of the following nursing actions is
most important at this time?
1. Report hematuria to the physician
2. Strain the urine carefully
3. Administer meperidine (Demerol) every 3 hours
4. Apply warm compresses to the flank area
39. A client has a ureteral catheter in place after renal surgery. A priority
nursing action for care of the ureteral catheter would be to:
1. Irrigate the catheter with 30 ml of normal saline every 8
hours
2. Ensure that the catheter is draining freely
3. Clamp the catheter every 2 hours for 30 minutes.
4. Ensure that the catheter drains at least 30 ml an hour
40. Which of the following interventions would be most appropriate for
preventing the development of a paralytic ileus in a client who has
undergone renal surgery?
1. Encourage the client to ambulate every 2 to 4 hours
2.
Offer 3 to 4 ounces of a carbonated beverage
periodically.
3. Encourage use of a stool softener
4. Continue intravenous fluid therapy
41. The nurse is conducting a postoperative assessment of a client on
the first day after renal surgery. Which of the following findings would be
most important for the nurse to report to the physician?
1. Temperature, 99.8
2. Urine output, 20 ml/hour
3. Absence of bowel sounds
4. A 2×2 inch area of serous sanguineous drainage on the
flank dressing.
42. Because a client’s renal stone was found to be composed to uric
acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which
of the following food items into the home diet would indicate that the
client understands the necessary diet modifications?
1. Milk, apples, tomatoes, and corn
2. Eggs, spinach, dried peas, and gravy.
3. Salmon, chicken, caviar, and asparagus
4. Grapes, corn, cereals, and liver.
43. Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with
renal calculi to take home. The nurse should teach the client about which
of the following side effects of this medication?
1. Retinopathy
2. Maculopapular rash
3. Nasal congestion
4. Dizziness
44. The client has a clinic appointment scheduled 10 days after
discharge. Which laboratory finding at that time would indicate that
allopurinol (Zyloprim) has had a therapeutic effect?
1. Decreased urinary alkaline phosphatase level
2. Increased urinary calcium excretion
3. Increased serum calcium level
4. Decreased serum uric acid level
45.
When developing a plan of care for the client with stress
incontinence, the nurse should take into consideration that stress
incontinence is best defined as the involuntary loss of urine associated
with:
1. A strong urge to urinate
2. Overdistention of the bladder
3. Activities that increase abdominal pressure
4. Obstruction of the urethra
46. Which of the following assessment data would most likely be related
to a client’s current complaint of stress incontinence?
1. The client’s intake of 2 to 3 L of fluid per day.
2. The client’s history of three full-term pregnancies
3. The client’s age of 45 years
4. The client’s history of competitive swimming
47. The nurse is developing a teaching plan for a client with stress
incontinence. Which of the following instructions should be included?
1. Avoid activities that are stressful and upsetting
2. Avoid caffeine and alcohol
3. Do not wear a girdle
4. Limit physical exertion
48. A client has urge incontinence. Which of the following signs and
symptoms would the nurse expect to find in this client?
1. Inability to empty the bladder
2. Loss of urine when coughing
3. Involuntary urination with minimal warning
4. Frequent dribbling of urine
49. A 72-year old male client is brought to the emergency room by his
son. The client is extremely uncomfortable and has been unable to void
for the past 12 hours. He has known for some time that he has an
enlarged prostate but has wanted to avoid surgery. The best method for
the nurse to use when assessing for bladder distention in a male client is
to check for:
1. A rounded swelling above the pubis.
2. Dullness in the lower left quadrant
3. Rebound tenderness below the symphysis
4. Urine discharge from the urethral meatus
50. During a client’s urinary bladder catherization, the bladder is emptied
gradually. The best rationale for the nurse’s action is that completely
emptying an overdistended bladder at one time tends to cause:
1. Renal failure
2. Abdominal cramping
3. Possible shock
4. Atrophy of bladder musculature
51. The primary reason for taping an indwelling catheter laterally to the
thigh of a male client is to:
1. Eliminate pressure at the penoscrotal angle
2. Prevent the catheter from kinking in the urethra
3. Prevent accidental catheter removal
4. Allow the client to turn without kinking the catheter
52. The primary function of the prostate gland is:
1. To store underdeveloped sperm before ejaculation
2. To regulate the acidity and alkalinity of the environment
for proper sperm development.
3. To produce a secretion that aids in the nourishment and
passage of sperm
4. To secrete a hormone that stimulates the production and
maturation of sperm
53. The nurse is reviewing a medication history of a client with BPH.
Which medication should be recognized as likely to aggravate BPH?
1. Metformin (Glucophage)
2. Buspirone (BuSpar)
3. Inhaled ipratropium (Atrovent)
4. Ophthalmic timolol (Timoptic)
54. A client is scheduled to undergo a transurethral resection of the
prostate gland (TURP). The procedure is to be done under spinal
anesthesia. Postoperatively, the nurse should be particularly alert for
early signs of:
1. Convulsions
2. Cardiac arrest
3. Renal shutdown
4. Respiratory paralysis
55. A client with BPH is being treated with terazosin (Hytrin) 2mg at
bedtime. The nurse should monitor the client’s:
1. Urinary nitrites
2. White blood cell count
3. Blood pressure
4. Pulse
56. A client underwent a TURP, and a large three way catheter was
inserted in the bladder with continuous bladder irrigation. In which of the
following circumstances would the nurse increase the flow rate of the
continuous bladder irrigation?
1. When the drainage is continuous but slow
2. When the drainage appears cloudy and dark yellow
3. When the drainage becomes bright red
4. When there is no drainage of urine and irrigating solution
57. A priority nursing diagnosis for the client who is being discharged t
home 3 days after a TURP would be:
1. Deficient fluid volume
2. Imbalanced Nutrition: Less than Body Requirements
3. Impaired Tissue Integrity
4. Ineffective Airway Clearance
58. If a client’s prostate enlargement is caused by a malignancy, which
of the following blood examinations should the nurse anticipate to
assess whether metastasis has occurred?
1. Serum creatinine level
2. Serum acid phosphatase level
3. Total nonprotein nitrogen level
4. Endogenous creatinine clearance time
59. Steroids, if used following kidney transplantation would cause which
of the following side effects?
1. Alopecia
2. Increase Cholesterol Level
3. Orthostatic Hypotension
4. Increase Blood Glucose Level
60. Mr. Roberto was readmitted to the hospital with acute graft rejection.
Which of the following assessment finding would be expected?
1. Hypotension
2. Normal Body Temperature
3. Decreased WBC
4. Elevated BUN and Creatinine
Answers and Rationales
1. A. Urine should be strained for calculi and sent to the lab for
analysis. Fluid intake of 3 to 4 L is encouraged to flush the urinary
tract and prevent further calculi formation. A low-calcium diet is
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
recommended to help prevent the formation of calcium calculi.
Ambulation is encouraged to help pass the calculi through gravity.
D. Cystitis is the most common adverse reaction of clients
undergoing radiation therapy; symptoms include dysuria,
frequency, urgency, and nocturia. Clients with radiation implants
require a private room. Urine of clients with radiation implants for
bladder cancer should be sent to the radioisotopes lab for
monitoring. It is recommended that fluid intake be increased.
C. Infections is the major complication to watch for in clients on
cyclosporine therapy because it’s an immunosuppressive drug.
Depression may occur posttransplantation but not because of
cyclosporine. Hemorrhage is a complication associated with
anticoagulant therapy. Peptic ulcer disease is a complication of
steroid therapy.
D. In a client with acute renal graft rejection, evidence of
deteriorating renal function is expected. The nurse would see
elevated WBC counts and fever because the body is recognizing
the graft as foreign and is attempting to fight it. The client would
most likely have acute hypertension.
D. The client undergoing a renal transplantation will need vigilant
follow-up care and must adhere to the medical regimen. The client
is most likely anuric or oliguric preoperatively, but postoperatively
will require close monitoring of urine output to make sure the
transplanted kidney is functioning optimally. While the client will
always need to be monitored for signs and symptoms of infection,
it’s most important post-op will require close monitoring of urine
output to make sure the transplanted kidney is functioning
optimally. While the client will always need to be monitored for
signs and symptoms of infection, it’s most important
postoperatively due to the immunosuppressant therapy. Rejection
can occur postoperatively.
D. Blood clots and blocked outflow if the urine can increase
spasms. The irrigation shouldn’t be stopped as long as the
catheter is draining because clots will form. A belladonna and
opium suppository should be given to relieve spasms but only
afterassessment of the drainage. Oral analgesics should be given
if the spasms are unrelieved by the belladonna and opium
suppository.
D. Postobstructive diuresis seen in hydronephrosis can cause
electrolyte imbalances; lab values must be checked so electrolytes
can be replaced as needed. VS should initially be taken every 30
minutes for the first 4 hours and then every 2 hours. Urine output
needs to be assessed hourly. The client’s weight should be taken
daily to assess fluid status more closely.
C. The calculus should be analyzed for composition to determine
appropriate interventions such as dietary restrictions. Calculi don’t
result in infections. The size and number of calculi aren’t relevant,
and they don’t contain antibodies.
C. Pain at the graft site and weight gain indicates the transplanted
kidney isn’t functioning and possibly is being rejected. Transplant
clients usually have edema, anorexia, fever, and nausea before
transplantation, so those symptoms may not indicate rejection.
D. Steroid use tends to increase blood glucose levels, particularly
in clients with diabetes and borderline diabetes. Steroids also
contribute to poor wound healing and may cause acne, mood
swings, and sodium and water retention. Steroids don’t affect
thermoregulation, bleeding tendencies, or constipation.
C. Water diuresis causes low urine specific gravity, low urine
osmolarity, and a normal to elevated serum sodium level. High
specific gravity indicates dehydration. Hypernatremia signals
acidosis and shock. Elevated urine pH can result from potassium
deficiency, a high-protein diet, or uncontrolled diabetes.
C. The PSA test is used to monitor prostate cancer progression;
higher PSA levels indicate a greater tumor burden. Serum
creatinine levels may suggest blockage from an enlarged prostate.
CBC is used to diagnose anemia and polycythemia. Serum
potassium levels identify hypokalemia and hyperkalemia.
C. Autonomic dysreflexia is a potentially life-threatening
complication of spinal cord injury, occurring from obstruction of
the urinary system or bowel. Incontinence and diarrhea don’t result
in obstruction of the urinary system or bowel, respectively. An URI
could obstruct the respiratory system, but not the urinary or bowel
system.
14. D. To control uric acid calculi, the client should follow a low-purine
diet, which excludes high-purine foods such as organ meats. A
low-calcium diet decreases the risk for oxalate renal calculi.
Oxalate is an essential amino acid and must be included in the
diet. A low-oxalate diet is used to control calcium or oxalate
calculi.
15. C. Struvite stones commonly are referred to as infection stones
because they form in urine that is alkaline and rich in ammonia,
such as with a urinary tract infection. Calcium oxalate stones
result from increased calcium intake or conditions that raise serum
calcium concentrations. Uric acid stones occur in clients with gout.
Cystine stones are rare and occur in clients with a genetic defect
that results in decreased renal absorption of the amino acid
cystine.
16. C. A nephrostomy tube is put in place after a percutaneous
ultrasonic lithotripsy to treat calculuses in the renal pelvis. The
client may also have a foley catheter to drain urine produced by the
other kidney. The nurse monitors the drainage from each of these
tubes and strains the urine to detect elimination of the calculus
fragments.
17. A. Bladder trauma or injury is characterized by lower abdominal
pain that may radiate to one of the shoulders. Bladder injury pain
does not radiate to the umbilicus, CV angle, or hip.
18. A. The client with prostatitis has a prostate gland that is swollen
and tender but that is also warm to the touch, firm, and indurated.
Systemic symptoms include fever with chills, perineal and low
back pain, and signs of urinary tract infection (which often
accompany the disorder).
19. C. Decreased force in the stream of urine is an early sign of BPH.
The stream later becomes weak and dribbling. The client then may
develop hematuria, frequency, urgency, urge incontinence, and
nocturia. If untreated, complete obstruction and urinary retention
can occur.
20. D. In the client with BPH, episodes of urinary retention can be
triggered by certain medications, such as decongestants,
anticholinergics, and antidepressants. The client should be
questioned about the use of these medications if the client has
urinary retention. Retention can also be precipitated by other
factors, such as alcoholic beverages, infection, bedrest, and
becoming chilled.
21. D. No specific precautions are necessary following a renal scan.
Urination into a commode is acceptable without risk from the
small amount of radioactive material to be excreted. The nurse
wears gloves to maintain body secretion precautions.
22. C. Oxalate is found in dark green foods such as spinach. Other
foods that raise urinary oxalate are rhubarb, strawberries,
chocolate, wheat bran, nuts, beets, and tea.
23. B. Frequent dressing changes around the Penrose drain is required
to protect the skin against breakdown from urinary drainage. If
urinary drainage is excessive, an ostomy pouch may be placed
over the drain to protect the skin. A Penrose drain is not irrigated.
Weighing the dressings is not necessary. Placing the client on the
affected side will prevent a free flow of urine through the drain.
24. B. To increase urinary output, diuretics and osmotic agents are
considered. The client should be monitored closely because fluid
overload can cause hypertension, congestive heart failure, and
pulmonary edema. Fluid intake would not be encouraged or
restricted. Irrigation of the foley catheter will not assist in
allievating this oliguria.
25. A. Acute rejection most often occurs in the first 2 weeks after
transplant. Clinical manifestations include fever, malaise, elevated
WBC count, acute hypertension, graft tenderness, and
manifestations of deteriorating renal function. Chronic rejection
occurs gradually during a period of months to years. Although
kidney infection or obstruction can occur, the symptoms presented
in the question do not relate specifically to these disorders.
26. A. Transurethral resection syndrome is caused by increased
absorption of nonelectrolyte irrigating fluid used during surgery.
The client may show signs of cerebral edema and increased
intracranial pressure such as increased blood pressure,
bradycardia, confusion, disorientation, muscle twitching, visual
disturbances, and nausea and vomiting.
27. C. Frank bleeding (arterial or venous) may occur during the first
few days after surgery. Some hematuria is usual for several days
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
after surgery. A urinary output of 200 ml of greater than intake is
adequate. Bladder spasms are expected to occur after surgery. A
rapid pulse with a low blood pressure is a potential sign of
excessive blood loss. The physician should be notified.
C. Painless hematuria is the most common clinical finding in
bladder cancer. Other symptoms include frequency, dysuria, and
urgency, but these are not as common as the hematuria.
Suprapubic pain and urinary retention do not occur in bladder
cancer.
C. An ileal conduit is a permanent urinary diversion in which a
portion of the ileum is surgically resected and one end of the
segment is closed. The ureters are surgically attached to this
segment of the ileum, and the open end of the ileum is brought to
the skin surface on the abdomen to form the stoma. The client
must wear a pouch to collect the urine that continually flows
through the conduit. The bladder is removed during the surgical
procedure and the ileal conduit is not reversible. Diversion of the
urine to the sigmoid colon is called a ureteroileosigmoidostomy. An
opening in the bladder that allows urine to drain externally is called
a cystostomy.
B. After pelvic surgery, there is an increased chance of
thrombophlebitis owing to the pelvic manipulation that can
interfere with circulation and promote venous stasis. Peritonitis is
a potential complication of any abdominal surgery, not just pelvic
surgery. Ascites is most frequently an indication of liver disease.
Inguinal hernia may be caused by an increase in abdominal
pressure or a congenital weakness of the abdominal wall; ventral
hernia occurs at the site of a previous abdominal surgery.
D. Mucus is secreted by the intestinal segment used to create the
conduit and is a normal occurrence. The client should be
encouraged to maintain a large fluid intake to help flush the mucus
out of the conduit. Because mucus in the urine is expected, it is not
necessary to change the appliance bag or notify the physician. The
mucus is not an indication of an infection, so a urine culture is not
necessary.
D. If the appliance becomes too full, it is likely to pull away from
the skin completely or to leak urine onto the skin. A full appliance
will not rupture the ileal conduit or interrupt urine production. Odor
formation has numerous causes.
B. A reusable appliance should be routinely cleaned with soap and
water.
C, D. The client with an ileal conduit must learn self-care activities
related to care of the stoma and ostomy appliances. The client
should be taught to increase fluid intake to about 3,000 ml per day
and should not limit intake. Adequate fluid intake helps to flush
mucus from the ileal conduit. The ostomy appliance should be
changed approximately every 3 to 7 days and whenever a leak
develops. A skin barrier is essential to protecting the skin from the
irritation of the urine. An aspirin should not be used as a method of
odor control because it can be an irritant to the stoma and lead to
ulceration. The ostomy pouch should be emptied when it is
one-third to one-half full to prevent the weight from pulling the
appliance away from the skin.
D. It is normal for clients to express fears and concerns about the
body changes associated with a urinary diversion. Allowing the
client time to verbalize concerns in a supportive environment and
suggest that she discuss these concerns with people who have
successfully adjusted to ostomy surgery can help her begin coping
with these changes in a positive manner. Although the client may
be anxious about this situation and self-esteem may be
diminished, the underlying problem is disturbance in body image.
There are no data to support a diagnosis of Deficient Knowledge.
A. The most important reason for attaching the appliance to a
standard urine collection bag at night is to prevent reflux into the
stoma and ureters, which can result in infection. Use of a standard
collection bag also keeps the appliance from separating from the
skin and helps prevent urine leakage from an overly full bag, but
the primary purpose is to prevent reflux of urine. A client with a
urinary diversion should drink 2000-3000 ml of fluid each day; it
would be inappropriate to suggest decreasing fluid intake.
B. Maintaining a fluid intake of 2,000 to 3,000 ml/day is likely to be
effective in preventing UTI. A high fluid intake results in high urine
output, which prevents urinary stasis and bacterial growth.
Avoiding people with respiratory tract infections will not prevent
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
urinary tract infections. Clean, not sterile, technique is used to
change the appliance. An ileal conduit stoma is not irrigated.
B. Intermittent pain that is less colicky indicates that the calculi
may be moving along the urinary tract. Fluids should be
encouraged to promote movement, and the urine should be
strained to detect passage of the stone. Hematuria is to be
expected from the irritation of the stone. Analgesics should be
administered when the client needs them, not routinely. Moist heat
to the flank area is helpful when renal colic occurs, but it is less
necessary as pain is lessened.
B. The ureteral catheter should drain freely without bleeding at the
site. The catheter is rarely irrigated, and any irrigation would be
done by the physician. The catheter is never clamped. The client’s
total urine output (ureteral catheter plus voiding or foley catheter
output) should be 30 ml/hour.
A. Ambulation stimulates peristalsis. A client with paralytic ileus is
kept NPO until peristalsis returns. Intravenous fluid infusion is a
routine postoperative order that does not have any effect on
preventing paralytic ileus. A stool softener will not stimulate
peristalsis.
B. The decrease in urinary output may indicate inadequate renal
perfusion and should be reported immediately. Urine output of 30
ml/hour or greater is considered acceptable. A slight elevation in
temperature is expected after surgery. Peristalsis returns gradually,
usually the second or third day after surgery. Bowel sounds will be
absent until then. A small amount of serous sanguineous drainage
is to be expected.
A. Because a high-purine diet contributes to the formation of uric
acid, a low-purine diet is advocated. An alkaline-ash diet is also
advocated, because uric acid crystals are more likely to develop in
acid urine. Foods that may be eaten as desired in a low-purine diet
include milk, all fruits, tomatoes, cereals, and corn. Food allowed
on an alkaline-ash diet include milk, fruits (except cranberries,
plums, and prunes), and vegetables (especially legumes and green
vegetables). Gravy, chicken, and liver are high in purine.
B. Allopurinol is used to treat renal calculi composed of uric acid.
Side effects of allopurinol include drowsiness, maculopapular rash,
anemia, abdominal pain, nausea, vomiting, and bone marrow
depression. Clients should be instructed to report skin rashes and
any unusual bleeding or bruising. Retinopathy, nasal congestion,
and dizziness are not side effects of allopurinol.
D. By inhibiting uric acid synthesis, allopurinol decreases its
excretion. The drug’s effectiveness is assessed by evaluating for a
decreased serum uric acid concentration. Allopurinol does not
alter the level of alkaline phosphatase, not does it affect urinary
calcium excretion or the serum calcium level.
C. Stress incontinence is the involuntary loss of urine during such
activities as coughing, sneezing, laughing, or physical exertion.
These activities increase abdominal and detrusor pressure. A
strong urge to urinate is associated with urge incontinence.
Overdistention of the bladder can lead to overflow incontinence.
Obstruction of the urethra can lead to urinary retention.
B. The history of three pregnancies is most likely the cause of the
client’s current episodes of stress incontinence. The client’s fluid
intake, age, or history of swimming would not create an increase in
intra-abdominal pressure.
B. Client’s with stress incontinence are encouraged to avoid
substances such as caffeine and alcohol which are bladder
irritants. Emotional stressors do not cause stress incontinence. It
is caused most commonly be relaxed pelvic musculature. Wearing
girdles is not contraindicated. Although clients may be inclined to
limit physical exertion to avoid incontinence episodes, they should
be encouraged to seek treatment instead of limiting their activities.
C. A characteristic of urge incontinence is involuntary urination
with little or no warning. The inability to empty the bladder is
urinary retention. Loss of urine when coughing occurs with stress
incontinence. Frequent dribbling of urine is common in male
clients after some types of prostate surgery or may occur in
women after the development of vesicovaginal or urethrovaginal
fistula.
A. The best way to assess for a distended bladder in either a male
or female client is to check for a rounded swelling above the pubis.
The swelling represents the distended bladder rising above the
pubis into the abdominal cavity. Dullness does not indicate a
distended bladder. The client might experience tenderness or
pressure above the symphysis. No urine discharge is expected; the
urine flow is blocked by the enlarged prostate.
50. C. Rapid emptying of an overdistended bladder may cause
hypotension and shock due to the sudden change of pressure
within the abdominal viscera. Previously, removing no more than
1,000 ml at one time was the standard of practice, but this is no
longer thought to be necessary as long as the overdistended
bladder is emptied slowly.
51. A. The primary reason for taping an indwelling catheter to a male
client soothe penis is held in a lateral position to prevent pressure
at the penoscrotal angle. Prolonged pressure at the penoscrotal
angle can cause a urethrocutaneous fistula.
52. C. The prostate gland is located below the bladder and surrounds
the urethra. It serves one primary purpose: to produce a secretion
that aids in the nourishment and passage of sperm.
53. C. Atrovent is a bronchodilator, and its anticholinergic effects can
aggravate urinary retention. Glucophage and BuSpar do not affect
the urinary system; timolol does not have a systemic effect.
54. D. If paralysis of vasomotor nerves in the upper spinal cord occurs
when spinal anesthesia is used, the client is likely to develop
respiratory paralysis. Artificial ventilation is required until the
effects of the anesthesia subside. Convulsions, cardiac arrest, and
renal shutdown are not likely results of spinal anesthesia.
55. C. Terazosin (Hytrin) is an antihypertensive drug that is also used
in the treatment of BPH. Blood pressure must be monitored to
ensure that the client does not develop hypotension, syncope, or
postural hypotension. The client should be instructed to change
positions slowly. Urinary nitrites, white blood cell count, and pulse
rate are not affected by terazosin.
56. C. The decision made by the surgeon to insert a catheter after a
TURP or prostatectomy depends on the amount of bleeding that is
expected after the procedure. During continuous bladder irrigation
after a TURP or prostatectomy, the rate at which the solution
enters the bladder should be increased when the drainage
becomes brighter red. The color indicates the presence of blood.
Increasing the flow of irrigating solution helps flush the catheter
well so clots do not plug it. There would be no reason to increase
the flow rate when the return is continuous or when the return
appears cloudy and dark yellow. Increasing the flow would be
contraindicated when there is no return of urine and irrigating
solution.
57. A. Deficient Fluid Volume is a priority diagnosis, because the client
needs to drink a large amount of fluid to keep the urine clear. The
urine should be almost without color. About 2 weeks after a TURP,
when desiccated tissue is sloughed out, a secondary hemorrhage
could occur. The client should be instructed to call the surgeon or
go to the ED if at any time the urine turns bright red. The client is
not specifically at risk for nutritional problems after a TURP. The
client is not specifically at risk for impaired tissue integrity
because there is no external incision, and the client is not
specifically at risk for airway problems because the procedure is
done after spinal anesthesia.
58. B. The most specific examination to determine whether a
malignancy extends outside of the prostatic capsule is a study of
the serum acid phosphatase level. The level increases when a
malignancy has metastasized. The prostate specific antigen (PSA)
determination and a digital rectal examination are done when
screening for prostate cancer. Serum creatinine level, total
nonprotein nitrogen level, and endogenous creatinine clearance
time give information about kidney function, not prostate
malignancy.
59. D.
60. D.
TEST 8 - RENAL FAILURE AND DIALYSIS
1. Dialysis allows for the exchange of particles across a semipermeable
membrane by which of the following actions?
1. Osmosis and diffusion
2. Passage of fluid toward a solution with a lower solute
concentration
3. Allowing the passage of blood cells and protein
molecules through it.
4. Passage of solute particles toward a solution with a
higher concentration.
2.
A client is diagnosed with chronic renal failure and told she
must start hemodialysis. Client teaching would include which of the
following instructions?
1. Follow a high potassium diet
2. Strictly follow the hemodialysis schedule
3. There will be a few changes in your lifestyle.
4. Use alcohol on the skin and clean it due to integumentary
changes.
3. A client is undergoing peritoneal dialysis. The dialysate dwell time is
completed, and the dwell clamp is opened to allow the dialysate to drain.
The nurse notes that the drainage has stopped and only 500 ml has
drained; the amount the dialysate instilled was 1,500 ml. Which of the
following interventions would be done first?
1. Change the client’s position.
2. Call the physician.
3. Check the catheter for kinks or obstruction.
4. Clamp the catheter and instill more dialysate at the next
exchange time.
4. A client receiving hemodialysis treatment arrives at the hospital with a
blood pressure of 200/100, a heart rate of 110, and a respiratory rate of
36. Oxygen saturation on room air is 89%. He complains of shortness of
breath, and +2 pedal edema is noted. His last hemodialysis treatment
was yesterday. Which of the following interventions should be done first?
1. Administer oxygen
2. Elevate the foot of the bed
3. Restrict the client’s fluids
4. Prepare the client for hemodialysis.
5. A client has a history of chronic renal failure and received
hemodialysis treatments three times per week through an arteriovenous
(AV) fistula in the left arm. Which of the following interventions is
included in this client’s plan of care?
1. Keep the AV fistula site dry.
2. Keep the AV fistula wrapped in gauze.
3. Take the blood pressure in the left arm
4. Assess the AV fistula for a bruit and thrill
6. Which of the following factors causes the nausea associated with
renal failure?
1. Oliguria
2. Gastric ulcers
3. Electrolyte imbalances
4. Accumulation of waste products
7. Which of the following clients is at greatest risk for developing acute
renal failure?
1. A dialysis client who gets influenza
2. A teenager who has an appendectomy
3. A pregnant woman who has a fractured femur
4. A client with diabetes who has a heart catherization
8.
In a client in renal failure, which assessment finding may
indicate hypocalcemia?
1. Headache
2. Serum calcium level of 5 mEq/L
3. Increased blood coagulation
4. Diarrhea
9. 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. Which finding indicates that the fistula is patent?
1. Absence of bruit on auscultation of the fistula.
2. Palpation of a thrill over the fistula
3. Presence of a radial pulse in the left wrist
4. Capillary refill time less than 3 seconds in the nail beds
of the fingers on the left hand.
10. The client with chronic renal failure is at risk of developing dementia
related to excessive absorption of aluminum. The nurse teaches that this
is the reason that the client is being prescribed which of the following
phosphate binding agents?
1. Alu-cap (aluminum hydroxide)
2. Tums (calcium carbonate)
3. Amphojel (aluminum hydroxide)
4. Basaljel (aluminum hydroxide)
11. The client newly diagnosed with chronic renal failure recently has
begun hemodialysis. Knowing that the client is at risk for disequilibrium
syndrome, the nurse assesses the client during dialysis for:
1. Hypertension, tachycardia, and fever
2. Hypotension, bradycardia, and hypothermia
3.
4.
restlessness, irritability, and generalized weakness
Headache, deteriorating level of consciousness, and
twitching.
12. A client with chronic renal failure has completed a hemodialysis
treatment. The nurse would use which of the following standard
indicators to evaluate the client’s status after dialysis?
1. Potassium level and weight
2. BUN and creatinine levels
3. VS and BUN
4. VS and weight.
13. The hemodialysis client with a left arm fistula is at risk for steal
syndrome. The nurse assesses this client for which of the following
clinical manifestations?
1. Warmth, redness, and pain in the left hand.
2. Pallor, diminished pulse, and pain in the left hand.
3. Edema and reddish discoloration of the left arm
4. Aching pain, pallor, and edema in the left arm.
14. A client is admitted to the hospital and has a diagnosis of early stage
chronic renal failure. Which of the following would the nurse expect to
note on assessment of the client?
1. Polyuria
2. Polydipsia
3. Oliguria
4. Anuria
15. The client with chronic renal failure returns to the nursing unit
following a hemodialysis treatment. On assessment the nurse notes that
the client’s temperature is 100.2. Which of the following is the most
appropriate nursing action?
1. Encourage fluids
2. Notify the physician
3. Monitor the site of the shunt for infection
4. Continue to monitor vital signs
16. The nurse is performing an assessment on a client who has returned
from the dialysis unit following hemodialysis. The client is complaining of
a headache and nausea and is extremely restless. Which of the following
is the most appropriate nursing action?
1. Notify the physician
2. Monitor the client
3. Elevate the head of the bed
4. Medicate the client for nausea
17. The nurse is assisting a client on a low-potassium diet to select food
items from the menu. Which of the following food items, if selected by
the client, would indicate an understanding of this dietary restriction?
1. Cantaloupe
2. Spinach
3. Lima beans
4. Strawberries
18. The nurse is reviewing a list of components contained in the
peritoneal dialysis solution with the client. The client asks the nurse
about the purpose of the glucose contained in the solution. The nurse
bases the response knowing that the glucose:
1. Prevents excess glucose from being removed from the
client.
2. Decreases risk of peritonitis.
3. Prevents disequilibrium syndrome
4. Increases osmotic pressure to produce ultrafiltration.
19. The nurse is preparing to care for a client receiving peritoneal
dialysis. Which of the following would be included in the nursing plan of
care to prevent the major complication associated with peritoneal
dialysis?
1. Monitor the clients level of consciousness
2. Maintain strict aseptic technique
3. Add heparin to the dialysate solution
4. Change the catheter site dressing daily
20. A client newly diagnosed with renal failure is receiving peritoneal
dialysis. During the infusion of the dialysate the client complains of
abdominal pain. Which action by the nurse is most appropriate?
1. Slow the infusion
2. Decrease the amount to be infused
3. Explain that the pain will subside after the first few
exchanges
4. Stop the dialysis
21. The nurse is instructing a client with diabetes mellitus about
peritoneal dialysis. 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. Infection
2. Hyperglycemia
3. Fluid overload
4. Disequilibrium syndrome
22. The client with acute renal failure has a serum potassium level of 5.8
mEq/L. The nurse would plan which of the following as a priority action?
1. Allow an extra 500 ml of fluid intake to dilute the
electrolyte concentration.
2. Encourage increased vegetables in the diet
3. Place the client on a cardiac monitor
4. Check the sodium level
23.
The client with chronic renal failure who is scheduled for
hemodialysis this morning is due to receive a daily dose of enalapril
(Vasotec). The nurse should plan to administer this medication:
1. Just before dialysis
2. During dialysis
3. On return from dialysis
4. The day after dialysis
24. The client with chronic renal failure has an indwelling catheter for
peritoneal dialysis in the abdomen. The client spills water on the catheter
dressing while bathing. The nurse should immediately:
1. Reinforce the dressing
2. Change the dressing
3. Flush the peritoneal dialysis catheter
4. Scrub the catheter with providone-iodine
25. The client being hemodialyzed suddenly becomes short of breath
and complains of chest pain. The client is tachycardic, pale, and anxious.
The nurse suspects air embolism. The nurse should:
1. Continue the dialysis at a slower rate after checking the
lines for air
2. Discontinue dialysis and notify the physician
3. Monitor vital signs every 15 minutes for the next hour
4. Bolus the client with 500 ml of normal saline to break up
the air embolism.
26. The nurse has completed client teaching with the hemodialysis client
about self-monitoring between hemodialysis treatments. The nurse
determines that the client best understands the information given if the
client states to record the daily:
1. Pulse and respiratory rate
2. Intake, output, and weight
3. BUN and creatinine levels
4. Activity log
27. The client with an arteriovenous shunt in place for hemodialysis is at
risk for bleeding. The nurse would do which of the following as a priority
action to prevent this complication from occurring?
1. Check the results of the PT time as they are ordered.
2. Observe the site once per shift
3. Check the shunt for the presence of a bruit and thrill
4. Ensure that small clamps are attached to the AV shunt
dressing.
28. The nurse is monitoring a client receiving peritoneal dialysis and
nurse notes that a client’s outflow is less than the inflow. Select actions
that the nurse should take.
1. Place the client in good body alignment
2. Check the level of the drainage bag
3. Contact the physician
4. Check the peritoneal dialysis system for kinks
5. Reposition the client to his or her side.
29. The nurse assesses the client who has chronic renal failure and
notes the following: crackles in the lung bases, elevated blood pressure,
and weight gain of 2 pounds in one day. Based on these data, which of
the following nursing diagnoses is appropriate?
1. Excess fluid volume related to the kidney’s inability to
maintain fluid balance.
2. Increased cardiac output related to fluid overload.
3. Ineffective tissue perfusion related to interrupted arterial
blood flow.
4. Ineffective therapeutic Regimen Management related to
lack of knowledge about therapy.
30. The nurse is caring for a hospitalized client who has chronic renal
failure. Which of the following nursing diagnoses are most appropriate
for this client? Select all that apply.
1. Excess Fluid Volume
2. Imbalanced Nutrition; Less than Body Requirements
3. Activity Intolerance
4. Impaired Gas Exchange
5. Pain.
31. What is the primary disadvantage of using peritoneal dialysis for long
term management of chronic renal failure?
1. The danger of hemorrhage is high.
2. It cannot correct severe imbalances.
3. It is a time consuming method of treatment.
4. The risk of contacting hepatitis is high.
32. The dialysis solution is warmed before use in peritoneal dialysis
primarily to:
1. Encourage the removal of serum urea.
2. Force potassium back into the cells.
3. Add extra warmth into the body.
4. Promote abdominal muscle relaxation.
33. During the client’s dialysis, the nurse observes that the solution
draining from the abdomen is consistently blood tinged. The client has a
permanent peritoneal catheter in place. Which interpretation of this
observation would be correct?
1. Bleeding is expected with a permanent peritoneal
catheter
2. Bleeding indicates abdominal blood vessel damage
3. Bleeding can indicate kidney damage.
4. Bleeding is caused by too-rapid infusion of the dialysate.
34. Which of the following nursing interventions should be included in
the client’s care plan during dialysis therapy?
1. Limit the client’s visitors
2. Monitor the client’s blood pressure
3. Pad the side rails of the bed
4. Keep the client NPO.
35. Aluminum hydroxide gel (Amphojel) is prescribed for the client with
chronic renal failure to take at home. What is the purpose of giving this
drug to a client with chronic renal failure?
1. To relieve the pain of gastric hyperacidity
2. To prevent Curling’s stress ulcers
3. To bind phosphorus in the intestine
4. To reverse metabolic acidosis.
36. The nurse teaches the client with chronic renal failure when to take
the aluminum hydroxide gel. Which of the following statements would
indicate that the client understands the teaching?
1. “I’ll take it every 4 hours around the clock.”
2. “I’ll take it between meals and at bedtime.”
3. “I’ll take it when I have a sour stomach.”
4. “I’ll take it with meals and bedtime snacks.”
37. The client with chronic renal failure tells the nurse he takes
magnesium hydroxide (milk of magnesium) at home for constipation.
The nurse suggests that the client switch to psyllium hydrophilic
mucilloid (Metamucil) because:
1. MOM can cause magnesium toxicity
2. MOM is too harsh on the bowel
3. Metamucil is more palatable
4. MOM is high in sodium
38. In planning teaching strategies for the client with chronic renal
failure, the nurse must keep in mind the neurologic impact of uremia.
Which teaching strategy would be most appropriate?
1. Providing all needed teaching in one extended session.
2. Validating frequently the client’s understanding of the
material.
3. Conducting a one-on-one session with the client.
4. Using videotapes to reinforce the material as needed.
39. The nurse helps the client with chronic renal failure develop a home
diet plan with the goal of helping the client maintain adequate nutritional
intake. Which of the following diets would be most appropriate for a
client with chronic renal failure?
1. High carbohydrate, high protein
2. High calcium, high potassium, high protein
3. Low protein, low sodium, low potassium
4. Low protein, high potassium
40. A client with chronic renal failure has asked to be evaluated for a
home continuous ambulatory peritoneal dialysis (CAPD) program. The
nurse should explain that the major advantage of this approach is that it:
1. Is relatively low in cost
2.
3.
Allows the client to be more independent
Is faster and more efficient than standard peritoneal
dialysis
4. Has fewer potential complications than standard
peritoneal dialysis
41. The client asks whether her diet would change on CAPD. Which of
the following would be the nurse’s best response?
1. “Diet restrictions are more rigid with CAPD because
standard peritoneal dialysis is a more effective
technique.”
2. “Diet restrictions are the same for both CAPD and
standard peritoneal dialysis.”
3. “Diet restrictions with CAPD are fewer than with standard
peritoneal dialysis because dialysis is constant.”
4. “Diet restrictions with CAPD are fewer than with standard
peritoneal dialysis because CAPD works more quickly.”
42. Which of the following is the most significant sign of peritoneal
infection?
1. Cloudy dialysate fluid
2. Swelling in the legs
3. Poor drainage of the dialysate fluid
4. Redness at the catheter insertion site
43. The main indicator of the need for hemodialysis is:
1. Ascites
2. Acidosis
3. Hypertension
4. Hyperkalemia
44. To gain access to the vein and artery, an AV shunt was used for Mr.
Roberto. The most serious problem with regards to the AV shunt is:
1. Septicemia
2. Clot formation
3. Exsanguination
4. Vessel sclerosis
45. When caring for Mr. Roberto’s AV shunt on his right arm, you should:
1. Cover the entire cannula with an elastic bandage
2. Notify the physician if a bruit and thrill are present
3. User surgical aseptic technique when giving shunt care
4. Take the blood pressure on the right arm instead
Answers and Rationales
1. A. Osmosis allows for the removal of fluid from the blood by
allowing it to pass through the semipermeable membrane to an area
of high concentrate (dialysate), and diffusion allows for passage of
particles (electrolytes, urea, and creatinine) from an area of higher
concentration to an area of lower concentration. Fluid passes to an
area with a higher solute concentration. The pores of a
semipermeable membrane are small, thus preventing the flow of
blood cells and protein molecules through it.
2. B. To prevent life-threatening complications, the client must follow
the dialysis schedule. Alcohol would further dry the client’s skin
more than it already is. The client should follow a low-potassium
diet because potassium levels increase in chronic renal failure. The
client should know hemodialysis is time-consuming and will
definitely cause a change in current lifestyle.
3. C. The first intervention should be to check for kinks and
obstructions because that could be preventing drainage. After
checking for kinks, have the client change position to promote
drainage. Don’t give the next scheduled exchange until the dialysate
is drained because abdominal distention will occur, unless the
output is within parameters set by the physician. If unable to get
more output despite checking for kinks and changing the client’s
position, the nurse should then call the physician to determine the
proper intervention.
4. A. Airway and oxygenation are always the first priority. Because the
client is complaining of shortness of breath and his oxygen
saturation is only 89%, the nurse needs to try to increase his levels
by administering oxygen. The client is in pulmonary edema from
fluid overload and will need to be dialyzed and have his fluids
restricted, but the first interventions should be aimed at the
immediate treatment of hypoxia. The foot of the bed may be
elevated to reduce edema, but this isn’t the priority.
5. D. Assessment of the AV fistula for bruit and thrill is important
because, if not present, it indicates a non-functioning fistula. No
blood pressures or venipunctures should be taken in the arm with
the AV fistula. When not being dialyzed, the AV fistula site may get
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
wet. Immediately after a dialysis treatment, the access site is
covered with adhesive bandages.
D. Although clients with renal failure can develop stress ulcers, the
nausea is usually related to the poisons of metabolic wastes that
accumulate when the kidneys are unable to eliminate them. The
client has electrolyte imbalances and oliguria, but these don’t
directly cause nausea.
D. Clients with diabetes are prone to renal insufficiency and renal
failure. The contrast used for heart catherization must be eliminated
by the kidneys, which further stresses them and may produce acute
renal failure. A teenager who has an appendectomy and a pregnant
woman with a fractured femur isn’t at increased risk for renal failure.
A dialysis client already has end-stage renal disease and wouldn’t
develop acute renal failure.
D. In renal failure, calcium absorption from the intestine declines,
leading to increased smooth muscle contractions, causing diarrhea.
CNS changes in renal failure rarely include headache. A serum
calcium level of 5 mEq/L indicates hypercalcemia. As renal failure
progresses, bleeding tendencies increase.
B. The nurse assesses the patency of the fistula by palpating for the
presence of a thrill or auscultating for a bruit. The presence of a
thrill and bruit indicate patency of the fistula. Although the presence
of a radial pulse in the left wrist and capillary refill time less than 3
seconds in the nail beds of the fingers on the left hand are normal
findings, they do not assess fistula patency.
B. Phosphate binding agents that contain aluminum include
Alu-caps, Basaljel, and Amphojel. These products are made from
aluminum hydroxide. Tums are made from calcium carbonate and
also bind phosphorus. Tums are prescribed to avoid the occurrence
of dementia related to high intake of aluminum. Phosphate binding
agents are needed by the client in renal failure because the kidneys
cannot eliminate phosphorus.
D. Disequilibrium syndrome is characterized by headache, mental
confusion, decreasing level of consciousness, nausea, and vomiting,
twitching, and possible seizure activity. Disequilibrium syndrome is
caused by rapid removal of solutes from the body during
hemodialysis. At the same time, the blood-brain barrier interferes
with the efficient removal of wastes from brain tissue. As a result,
water goes into cerebral cells because of the osmotic gradient,
causing brain swelling and onset of symptoms. The syndrome most
often occurs in clients who are new to dialysis and is prevented by
dialyzing for shorter times or at reduced blood flow rates.
D. Following dialysis, the client’s vital signs are monitored to
determine whether the client is remaining hemodynamically stable.
Weight is measured and compared with the client’s predialysis
weight to determine effectiveness of fluid extraction. Laboratory
studies are done as per protocol but are not necessarily done after
the hemodialysis treatment has ended.
B. Steal syndrome results from vascular insufficiency after creation
of a fistula. The client exhibits pallor and a diminished pulse distal
to the fistula. The client also complains of pain distal to the fistula,
which is due to tissue ischemia. Warmth, redness, and pain more
likely would characterize a problem with infection.
A. Polyuria occurs early in chronic renal failure and if untreated can
cause severe dehydration. Polyuria progresses to anuria, and the
client loses all normal functions of the kidney. Oliguria and anuria
are not early signs, and polydipsia is unrelated to chronic renal
failure.
D. The client may have an elevated temperature following dialysis
because the dialysis machine warms the blood slightly. If the
temperature is elevated excessively and remains elevated, sepsis
would be suspected and a blood sample would be obtained as
prescribed for culture and sensitivity purposes.
A. Disequilibrium syndrome may be due to the rapid decrease in
BUN levels during dialysis. These changes can cause cerebral
edema that leads to increased intracranial pressure. The client is
exhibiting early signs of disequilibrium syndrome and appropriate
treatments with anticonvulsant medications and barbituates may be
necessary to prevent a life-threatening situation. The physician must
be notified.
C. Cantaloupe (1/4 small), spinach (1/2 cooked) and strawberries (1
¼ cups) are high potassium foods and average 7 mEq per serving.
Lima beans (1/3 c) averages 3 mEq per serving.
18. D. Increasing the glucose concentration makes the solution
increasingly more hypertonic. The more hypertonic the solution, the
greater the osmotic pressure for ultrafiltration and thus the greater
amount of fluid removed from the client during an exchange.
19. B. The major complication of peritoneal dialysis is peritonitis. Strict
aseptic technique is required in caring for the client receiving this
treatment. Although changing the catheter site dressing daily may
assist in preventing infection, this option relates to an external site.
20. C. Pain during the inflow of dialysate is common during the first few
exchanges because of peritoneal irritation; however, the pain usually
disappears after 1 to 2 weeks of treatment. The infusion amount
should not be decreased, and the infusion should not be slowed or
stopped.
21. B. 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.
22. C. The client with hyperkalemia is at risk for developing cardiac
dysrhythmias and cardiac arrest. Because of this the client should
be placed on a cardiac monitor. Fluid intake is not increased
because it contributes to fluid overload and would not affect the
serum potassium level significantly. Vegetables are a natural source
of potassium in the diet, and their use would not be increased. The
nurse may also assess the sodium level because sodium is another
electrolyte commonly measured with the potassium level. However,
this is not a priority action at this time.
23. C. Antihypertensive medications such as enalapril are given to the
client following hemodialysis. This prevents the client from
becoming hypotensive during dialysis and also from having the
medication removed from the bloodstream by dialysis. No rationale
exists for waiting a full day to resume the medication. This would
lead to ineffective control of the blood pressure.
24. B. Clients with peritoneal dialysis catheters are at high risk for
infection. A dressing that is wet is a conduit for bacteria for bacteria
to reach the catheter insertion site. The nurse assures that the
dressing is kept dry at all times. Reinforcing the dressing is not a
safe practice to prevent infection in this circumstance. Flushing the
catheter is not indicated. Scrubbing the catheter with
povidone-iodine is done at the time of connection or disconnecting
of peritoneal dialysis.
25. B. If the client experiences air embolus during hemodialysis, the
nurse should terminate dialysis immediately, notify the physician,
and administer oxygen as needed.
26. B. The client on hemodialysis should monitor fluid status between
hemodialysis treatments by recording intake and output and
measuring weight daily. Ideally, the hemodialysis client should not
gain more than 0.5 kg of weight per day.
27. D. An AV shunt is a less common form of access site but carries a
risk for bleeding when it is used because two ends of an external
cannula are tunneled subcutaneously into an artery and a vein, and
the ends of the cannula are joined. If accidental connection occurs,
the client could lose blood rapidly. For this reason, small clamps are
attached to the dressing that covers the insertion site to use if
needed. The shunt site should be assessed at least every four
hours.
28. A, B, D, E. If outflow drainage is inadequate, the nurse attempts to
stimulate outflow by changing the client’s position. Turning the
client to the other side or making sure that the client is in good body
alignment may assist with outflow drainage. 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. There is no reason to
contact the physician.
29. A. Crackles in the lungs, weight gain, and elevated blood pressure
are indicators of excess fluid volume, a common complication in
chronic renal failure. The client’s fluid status should be monitored
carefully for imbalances on an ongoing basis.
30. A, B, C. Appropriate nursing diagnoses for clients with chronic renal
failure include excess fluid volume related to fluid and sodium
retention; imbalanced nutrition, less than body requirements related
to anorexia, nausea, and vomiting; and activity intolerance related to
fatigue. The nursing diagnoses of impaired gas exchange and pain
are not commonly related to chronic renal failure.
31. C. The disadvantages of peritoneal dialysis in long-term
management of chronic renal failure is that is requires large blocks
of time. The risk of hemorrhage or hepatitis is not high with PD. PD
is effective in maintaining a client’s fluid and electrolyte balance.
32. A. The main reason for warming the peritoneal dialysis solution is
that the warm solution helps dilate peritoneal vessels, which
increases urea clearance. Warmed dialyzing solution also
contributes to client comfort by preventing chilly sensations, but
this is a secondary reason for warming the solution. The warmed
solution does not force potassium into the cells or promote
abdominal muscle relaxation.
33. B. Because the client has a permanent catheter in place, blood
tinged drainage should not occur. Persistent blood tinged drainage
could indicate damage to the abdominal vessels, and the physician
should be notified. The bleeding is originating in the peritoneal
cavity, not the kidneys. Too rapid infusion of the dialysate can cause
pain.
34. B. Because hypotension is a complication of peritoneal dialysis, the
nurse records intake and output, monitors VS, and observes the
client’s behavior. The nurse also encourages visiting and other
diversional activities. A client on PD does not need to be placed in
bed with padded side rails or kept NPO.
35. C. A client in renal failure develops hyperphosphatemia that causes
a corresponding excretion of the body’s calcium stores, leading to
renal osteodystrophy. To decrease this loss, aluminum hydroxide gel
is prescribed to bind phosphates in the intestine and facilitate their
excretion. Gastric hyperacidity is not necessarily a problem
associated with chronic renal failure. Antacids will not prevent
Curling’s stress ulcers and do not affect metabolic acidosis.
36. D. Aluminum hydroxide gel is administered to bind the phosphates
in ingested foods and must be given with or immediately after
meals and snacks. There is no need for the client to take it on a
24-hour schedule. It is not administered to treat hyperacidity in
clients with CRF and therefore is not prescribed between meals.
37. A. Magnesium is normally excreted by the kidneys. When the
kidneys fail, magnesium can accumulate and cause severe
neurologic problems. MOM is harsher than Metamucil, but
magnesium toxicity is a more serious problem. A client may find
both MOM and Metamucil unpalatable. MOM is not high in sodium.
38. B. Uremia can cause decreased alertness, so the nurse needs to
validate the client’s comprehension frequently. Because the client’s
ability to concentrate is limited, short lesions are most effective. If
family members are present at the sessions, they can reinforce the
material. Written materials that the client can review are superior to
videotapes, because the clients may not be able to maintain
alertness during the viewing of the videotape.
39. C. Dietary management for clients with chronic renal failure is
usually designed to restrict protein, sodium, and potassium intake.
Protein intake is reduced because the kidney can no longer excrete
the byproducts of protein metabolism. The degree of dietary
restriction depends on the degree of renal impairment. The client
should also receive a high carbohydrate diet along with appropriate
vitamin and mineral supplements. Calcium requirements remain
1,000 to 2,000 mg/day.
40. B. The major benefit of CAPD is that it frees the client from daily
dependence on dialysis centers, home health care personnel, and
machines for life-sustaining treatment. The independence is a
valuable outcome for some people. CAPD is costly and must be
done daily. Side effects and complications are similar to those of
standard peritoneal dialysis.
41. C. Dietary restrictions with CAPD are fewer than those with standard
peritoneal dialysis because dialysis is constant, not intermittent.
The constant slow diffusion of CAPD helps prevent accumulation of
toxins and allows for a more liberal diet. CAPD does not work more
quickly, but more consistently. Both types of peritoneal dialysis are
effective.
42. A. Cloudy drainage indicates bacterial activity in the peritoneum.
Other signs and symptoms of infection are fever, hyperactive bowel
sounds, and abdominal pain. Swollen legs may be indicative of
congestive heart failure. Poor drainage of dialysate fluid is probably
the result of a kinked catheter. Redness at the insertion site
indicates local infection, not peritonitis. However, a local infection
that is left untreated can progress to the peritoneum.
43. D.
44. C.
45. C.