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Flashcards in Genitourinary Disorders Deck (173)
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1

The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question
would be most important for the nurse to ask during the admission interview?
1. “Have you recently traveled outside the United States?”
2. “Did you recently begin a vigorous exercise program?”
3. “Is there a chance you have been exposed to a virus?”
4. “What over-the-counter medications do you take regularly?”

4. Medications such as nonsteroidal antiinflammatory drugs (NSAIDs) and some
herbal remedies are nephrotoxic; therefore,
asking about medications is appropriate.

2

The client is diagnosed with ARF. Which laboratory values are most significant for diagnosing
ARF?
1. BUN and creatinine.
2. WBC and hemoglobin.
3. Potassium and sodium.
4. Bilirubin and ammonia level.

1. Blood urea nitrogen (BUN) levels reflect
the balance between the production and
excretion of urea from the kidneys. Creatinine is a byproduct of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the
laboratory value most significant in diagnosing renal failure.

3

The client is diagnosed with rule out ARF. Which condition would predispose the client
to developing pre-renal failure?
1. Diabetes mellitus.
2. Hypotension.
3. Aminoglycosides.
4. Benign prostatic hypertrophy.

2. Hypotension, which causes a decreased
blood supply to the kidney, is one of the
most common causes of pre-renal failure
(before the kidney).

4

The client is diagnosed with ARF. Which signs/symptoms would indicate to the nurse
that the client is in the recovery period? Select all that apply.
1. Increased alertness and no seizure activity.
2. Increase in hemoglobin and hematocrit.
3. Denial of nausea and vomiting.
4. Decreased urine-specific gravity.
5. Increased serum creatinine level.

1. Renal failure affects almost every system
in the body. Neurologically the client may
have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client would be alert and not have seizures.
2. In renal failure, levels of erythropoietin are
decreased, leading to anemia. An increase
in hemoglobin and hematocrit indicates the
client is in the recovery period.
3. Nausea, vomiting, and diarrhea are common in the client with ARF; therefore, an
absence of these indicates the client is in
the recovery period.

5

The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which
collaborative treatment would the nurse anticipate for the client?
1. Administer a phosphate binder.
2. Type and cross-match for whole blood.
3. Assess the client for leg cramps.
4. Prepare the client for dialysis.

4. Normal potassium level is 3.5–5.5 mEq/L.
A level of a 6.8 mEq/L is life threatening
and could lead to cardiac dysrhythmias.
Therefore, the client may be dialyzed to
decrease the potassium level quickly. This
would be done with an order from a healthcare
provider, so it is a collaborative intervention.

6

The nurse is developing a plan of care for a client diagnosed with ARF. Which statement
would be an appropriate outcome for the client?
1. Monitor intake and output every shift.
2. Decrease of pain by 3 levels on a 1–10 scale.
3. Electrolytes are within normal limits.
4. Administer enemas to decrease hyperkalemia.

3. Renal failure causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore the desired client
outcome would be that all the electrolytes
are within normal limits.

7

The client diagnosed with ARF is admitted to the intensive care department and placed
on a therapeutic diet. Which diet would be most appropriate for the client?
1. A high-potassium and low-calcium diet.
2. A low-fat and low-cholesterol diet.
3. A high-carbohydrate and restricted-protein diet.
4. A regular diet with six (6) small feedings a day.

3. Carbohydrates are increased to provide for
the client’s caloric intake and protein is restricted to minimize protein breakdown
and to prevent accumulation of toxic end
products.

8

The client diagnosed with ARF is placed on bed rest. The client asks the nurse, “Why
do I have to stay in bed, I don’t feel that bad.” Which scientific rationale would support the nurse’s response?
1. Bed rest helps increase the blood return to the renal circulation.
2. Bed rest reduces the metabolic rate during the acute stage.
3. Bed rest decreases the workload of the left side of the heart.
4. Bed rest aids in reduction of peripheral and sacral edema.

2. Bed rest reduces exertion and the metabolic
rate, thereby reducing catabolism and
subsequent release of potassium and accumulation of endogenous waste products
(urea and creatinine).

9

The nurse and unlicensed nursing assistant are caring for clients on a medical floor.
Which nursing task would be most appropriate for the nurse to delegate?
1. Collect a clean voided midstream urine specimen.
2. Evaluate the client’s 8-hour intake and output.
3. Assist in checking a unit of blood prior to hanging.
4. Administer a cation-exchange resin enema.

1. The assistant can collect specimens. Collecting a midstream urine specimen requires
the client to clean the perineal area,
to urinate a little, and then collect the rest
of the urine output in a sterile container.

10

The client is admitted to the emergency department after a gunshot wound to the
abdomen. Which nursing intervention would the nurse implement first to prevent
ARF?
1. Administer normal saline IV.
2. Take vital signs.
3. Place client on telemetry.
4. Assess abdominal dressing.

1. Preventing and treating shock with blood
and fluid replacement will prevent acute
renal failure from hypoperfusion of the
kidneys. Significant blood loss would be expected in the client with a gunshot wound.

11

The unlicensed nursing assistant tells the nurse that the client with ARF has a white
layer on top of the skin that looks like crystals. Which intervention should the nurse
implement?
1. Have the assistant apply a moisture barrier cream to the skin.
2. Instruct the nursing assistant to bathe the client in cool water.
3. Tell the nursing assistant not to turn the client in this condition.
4. Explain that this is normal and do not do anything to the client.

2. These crystals are uremic frost resulting
from irritating toxins deposited in the
client’s tissues. Bathing in cool water will
remove the crystals, promote client comfort,
and decrease the itching that occurs
from uremic frost.

12

The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level?
1. Erythropoietin.
2. Calcium gluconate.
3. Regular insulin.
4. Osmotic diuretic.

3. Regular insulin, along with glucose, will
drive potassium into the cells, thereby
lowering serum potassium levels temporarily.

13

The client diagnosed with end-stage renal disease (ESRD) is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client?
1. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH.
2. A shortened life span of red blood cells because of damage secondary to dialysis
treatments. This, in turn, leads to metabolic acidosis.
3. The kidney cannot excrete increased levels of acid because the kidneys cannot
excrete ammonia or cannot reabsorb sodium bicarbonate.
4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.

3. This is the correct scientific rationale for
metabolic acidosis occurring in the client
with ESRD.

14

The nurse in the dialysis center is initiating the morning dialysis run. Which client
should the nurse assess first?
1. The client who has hemoglobin of 9.8 mg/dL and hematocrit of 30%.
2. The client who does not have a palpable thrill or auscultated bruit.
3. The client who is complaining of being exhausted and is sleeping.
4. The client who did not take antihypertensive medication this morning.

2. This client’s dialysis access is compromised
and should be assessed first.

15

The male client in ESRD has received the initial dose of erythropoietin, a biologic
response modifier, 1 week ago. Which complaint by the client would indicate the need to notify the health-care provider?
1. The client complains of flulike symptoms.
2. The client complains of being tired all the time.
3. The client reports an elevation in his blood pressure.
4. The client reports discomfort in his legs and back.

3. After the initial administration of erythropoietin, a client’s antihypertensive medications may need to be adjusted. Therefore, this complaint requires notification of the HCP. Erythropoietin therapy is contraindicated in clients with hypertension that cannot be controlled.

16

The nurse is developing a nursing care plan for the client diagnosed with ESRD.
Which nursing problem would have priority for the client?
1. Low self-esteem.
2. Knowledge deficit.
3. Activity intolerance.
4. Excess fluid volume.

4. Excess fluid volume is priority because of
the stress placed on the heart and vessels,
which could lead to heart failure, pulmonary
edema, and death.

17

The client with ESRD is placed on a fluid restriction of 1500 milliliters per day. On
the 7 A.M. to 7 P.M. shift the client drank an eight (8)-ounce cup of coffee, 4 ounces of
juice, 12 ounces of tea, and 2 ounces of water with medications. What amount of fluid
can the 7 P.M. to 7 A.M. nurse give to the client? _____________

Answer: 720 mL. The nurse must add up how many milliliters of fluid the client drank on the 7 A.M. to 7 P.M. shift and then subtract that number from 1500 mL to determine how much fluid the client can receive on the 7 P.M. to 7 A.M. shift. One
(1) ounce is equal to 30 mL. The client drank 26 ounces (8 4 12 2) of fluid, or 780 mL (26
30) of fluid. Therefore, the client can have 720 mL (1500 - 780) of fluid on the 7 P.M. to 7 A.M. shift.

18

The client diagnosed with ESRD has a new arteriovenous fistula in the left forearm.
Which intervention should the nurse implement?
1. Teach the client to carry heavy objects with the right arm.
2. Perform all laboratory blood tests on the left arm.
3. Instruct the client to lie on the left arm during the night.
4. Discuss the importance of not performing any hand exercises.

1. Carrying heavy objects in the left arm could
cause the fistula to clot by putting undue
stress on the site, so the client should carry
objects in the right arm.

19

The male client diagnosed with ESRD secondary to diabetes has been receiving dialysis for 12 years. The client is notified that he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis
treatments. Which response would be most therapeutic?
1. “You cannot just quit your dialysis. This is not an option.”
2. “Are you angry at not being on the list, so you want to quit dialysis?”
3. “I will call your nephrologist right now so you can talk to the HCP.”
4. “Make your funeral arrangements because you are going to die.”

2. Reflecting the client’s feelings and restating
them are therapeutic responses that the
nurse should use when addressing the
client’s issues.

20

The nurse is discussing kidney transplants with clients at a dialysis center. Which
population is less likely to participate in organ donation?
1. Caucasian.
2. African American.
3. Asian.
4. Hispanic.

2. The African American culture believes that
the body must be kept intact after death,
and organ donation is rare among African
Americans. This is also why a client of
African American descent will be on a
transplant waiting list longer than people
of other races. This is because of tissuetyping compatibility.

21

The client receiving dialysis is complaining of being dizzy and light-headed. Which
action should the nurse implement first?
1. Place the client in the Trendelenburg position.
2. Turn off the dialysis machine immediately.
3. Bolus the client with 500 mL of normal saline.
4. Notify the health-care provider as soon as possible.

1. The nurse should place the client’s chair
with the head lower than the body, which
will shunt blood to the brain; this is the
Trendelenburg position.

22

The nurse caring for a client diagnosed with ESRD writes a client problem of “noncompliance of dietary restrictions.” Which intervention should be included in the plan of care?
1. Teach the client the proper diet to eat while undergoing dialysis.
2. Refer the client and significant other to the dietician.
3. Explain the importance of eating the proper foods.
4. Determine the reason for the client not adhering to the diet.

4. Noncompliance is a choice the client has a
right to make, but the nurse should determine
the reason for the noncompliance and
then take appropriate actions based on the
client’s rationale. For example, if the client
has financial difficulties, the nurse may
suggest how the client can afford the
proper foods along with medications, or
the nurse may be able to refer the client to
a social worker.

23

The client diagnosed with ESRD is receiving peritoneal dialysis. Which assessment
data warrant immediate intervention by the nurse?
1. Inability to auscultate a bruit over the fistula.
2. The client’s abdomen is soft, is nontender, and has bowel sounds.
3. The dialysate being removed from the client’s abdomen is clear.
4. The dialysate instilled into the client was 1500 mL and that removed was 1500 mL.

4. Because the client is in ESRD, fluid must be
removed from the body so the output should be more than the amount instilled.
These assessment data require intervention
by the nurse.

24

The client receiving hemodialysis is being discharged home from the dialysis center.
Which instruction should the nurse teach the client?
1. Notify the HCP if oral temperature is 102F or greater.
2. Apply ice to the access site if it starts bleeding at home.
3. Keep fingernails short and try not to scratch the skin.
4. Encourage significant other to make decisions for the client.

3. Uremic frost, which results when the skin
attempts to take over the function of the
kidneys, causes itching, which can lead to
scratching that results in a break in the skin.

25

The client is admitted to a nursing unit from a long-term care facility with a hematocrit
of 56% and a serum sodium level of 152 mEq/L. Which condition would be a
cause for these findings?
1. Overhydration.
2. Anemia.
3. Dehydration.
4. Renal failure.

3. Dehydration results in concentrated serum
that causes lab values to increase because
the blood has normal constituents but not
enough volume to dilute the values to
within normal range or possibly lower.

26

The client who has undergone an exploratory laparotomy and subsequent removal of a large intestinal tumor has a nasogastric tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should be reported to the HCP?
1. The pump keeps sounding an alarm that the high pressure has been reached.
2. Intake is 1800 mL, NGT output is 550 mL, and Foley output 950 mL.
3. On auscultation, crackles and rales in all lung fields are noted.
4. Client has negative pedal edema and an increasing level of consciousness.

3. Crackles and rales in all lung fields indicate
that the body is not able to process the
amounts of fluids being infused. This
should be brought to the HCP’s attention.

27

The client diagnosed with diabetes insipidus weighed 180 pounds when the daily
weight was taken yesterday. This morning’s weight is 175.6 pounds. One liter of fluid
weighs approximately 2.2 pounds. How much fluid has the client lost? ______

2000 mL has been lost. First, determine how
many pounds the client has lost:
180 - 175.6 = 4.4 pounds lost
Then, based on the fact that 1 liter of fluid weighs 2.2 pounds, determine how many liters of fluid have been lost.
4.4 ÷ 2.2 = 2 liters lost. Then, because the question asks for the answer in
milliliters convert 2 liters into milliliters.
2 x 1000= 2000 mL

28

The nurse writes the nursing problem of “fluid volume excess” (FVE). Which intervention should be included in the plan of care?
1. Change the IV fluid from 0.9% NS to D5W.
2. Restrict the client’s sodium in the diet.
3. Monitor blood glucose levels.
4. Prepare the client for hemodialysis.

2. Fluid volume excess refers to an isotonic
expansion of the extracellular fluid by an
abnormal expansion of water and sodium.
Therefore sodium is restricted to allow the
body to excrete the extra volume.

29

The client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented?
1. Encourage fluids orally.
2. Administer 10% saline solution IVPB.
3. Administer antidiuretic hormone intranasally.
4. Place on seizure precautions.

4. Clients with sodium levels less than 120
mEq/L are at risk for seizures as a complication.
The lower the sodium level, the greater the risk of a seizure.

30

The telemetry monitor technician notifies the nurse of the morning telemetry readings.
Which client should the nurse assess first?
1. The client in normal sinus rhythm with a peaked T wave.
2. The client diagnosed with atrial fibrillation with a rate of 100.
3. The client diagnosed with a myocardial infarction who has occasional PVC.
4. The client with a first-degree AV block and a rate of 92.

1. A client with a peaked wave could be
experiencing hyperkalemia. Changes in
potassium levels can initiate cardiac
dysrhythmias and instability.

31

The client post-thyroidectomy complains of numbness and tingling around the mouth
and the tips of the fingers. Which intervention should the implement first?
1. Notify the health-care provider immediately.
2. Tap the cheek about two (2) cm anterior to the ear lobe.
3. Check the serum calcium and magnesium levels.
4. Prepare to administer calcium gluconate IVP.

2. These are signs and symptoms of hypocalcemia, and the nurse can confirm this by tapping the cheek to elicit the Chvostek’s
sign. If the muscles of the cheek begin to
twitch, then the HCP should be notified
immediately because hypocalcemia is a
medical emergency.

32

Which statement best explains the scientific rationale for Kussmaul’s respirations in
the client diagnosed with diabetic ketoacidosis (DKA)?
1. The kidneys produce excess urine and the lungs try to compensate.
2. The respirations increase the amount of carbon dioxide in the bloodstream.
3. The lungs speed up to release carbon dioxide and increase the pH.
4. The shallow and slow respirations will increase the HCO3 in the serum.

3. The lungs attempt to increase the blood
pH level by blowing off the carbon dioxide
(carbonic acid).

33

The client is NPO and is receiving total parenteral nutrition (TPN) via a subclavian
line. Which precautions should the nurse implement? Select all that apply.
1. Place the solution on an IV pump at the prescribed rate.
2. Monitor blood glucose every six (6) hours.
3. Weigh the client weekly, first thing in the morning.
4. Change the IV tubing every three (3) days.
5. Monitor intake and output every shift.

1. TPN is a hypertonic solution that has
enough calories, proteins, lipids, electrolytes,
and trace elements to sustain life. It is
administered via a pump to prevent too
rapid infusion.
2. TPN contains 50% dextrose solution;
therefore, the client is monitored to ensure
that the pancreas is adapting to the high
glucose levels.
5. Intake and output are monitored to
observe for fluid balance.

34

The client has received IV solutions for three (3) days through a 20-gauge IV catheter
placed in the left cephalic vein. On morning rounds the nurse notes the IV site is
tender to palpation and a red streak has formed. Which action should the nurse implement first?
1. Start a new IV in the right hand.
2. Discontinue the intravenous line.
3. Complete an incident record.
4. Place a warm washrag over the site.

2. The client has signs of phlebitis and the IV
must be removed to prevent further complications.

35

The nurse and an unlicensed nursing assistant are caring for a group of clients. Which nursing intervention should the nurse perform?
1. Measure the client’s output from the indwelling catheter.
2. Record the client’s intake and output on the I & O sheet.
3. Instruct the client on appropriate fluid restrictions.
4. Provide water for a client diagnosed with diabetes insipidus.

3. The nurse cannot delegate teaching.

36

The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor?
1. Serum calcium.
2. Serum phosphorus.
3. Serum potassium.
4. Serum sodium.

3. Clients lose potassium from the GI tract or
through the use of diuretic medications.
Potassium imbalances can lead to cardiac
arrhythmias.

37

The client from a long-term care facility is admitted with a fever, hot flushed skin, and
clumps of white sediment in the indwelling catheter. Which intervention should the
nurse implement first?
1. Start an IV with a 20-gauge catheter.
2. Initiate antibiotic therapy IVPB.
3. Collect a urine specimen for culture.
4. Change the indwelling catheter.

4. Unless the nurse can determine that the
catheter has been inserted within a few
days, the nurse should replace the catheter
and then get a specimen. This will provide
the most accurate specimen for analysis.

38

The nurse is inserting an indwelling catheter into a female client. Which interventions
should be implemented? Select all that apply.
1. Explain the procedure to the significant other.
2. Set up the sterile field.
3. Inflate the catheter bulb.
4. Place absorbent pads under the client.
5. Clean the perineum from clean to dirty with Betadine.

2. Inserting an indwelling catheter is a sterile
procedure.
3. The bulb of the catheter should be tested
to make sure it will inflate and deflate prior
to inserting the catheter into the client.
4. Incontinence pads should be placed under
the client before beginning the sterile part
of the procedure.
5. During the procedure the perineum is
swiped with Betadine swabs from front to
back and also down the middle, then side to
side with new swabs (clean to dirty).

39

The nurse performs bladder irrigation through an indwelling catheter. The nurse
instilled 90 mL of sterile normal saline. The catheter drained 710 mL. What is the
client’s output? ________

620 mL of urine. The amount of sterile normal
saline is subtracted from the total volume removed from the catheter.

40

The nurse is examining a 15-year-old female who is complaining of pain, frequency,
and urgency when urinating. After asking the parent to leave the room, which question
should the nurse ask the client?
1. “When was your last menstrual cycle?”
2. “Have you noticed any change in the color of the urine?”
3. “Are you sexually active?”
4. “What have you taken for the pain?”

3. These are symptoms of cystitis, a bladder
infection that may be caused by sexual
intercourse resulting from the introduction
of bacteria into the urethra during the physical act. A teenager may not want to divulge this information in front of the parent.

41

The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test
would the nurse expect the HCP to order first?
1. A midstream urine for culture.
2. A sonogram of the kidney.
3. An intravenous pyelogram for renal calculi.
4. A CT scan of the kidneys.

1. Fever, chills, and costovertebral pain are
symptoms of a urinary tract infection (acute
pyelonephritis), which requires a urine
culture first to confirm the diagnosis.

42

The client with chronic pyelonephritis is being admitted to a medical unit for intensive
intravenous therapy. Which assessment data support the diagnosis of chronic
pyelonephritis?
1. The client has fever, chills, flank pain, and dysuria.
2. The client complains of fatigue, headaches, and increased urination.
3. The client had a group b beta hemolytic strep infection last week.
4. The client has an acute viral pneumonia infection.

2. Fatigue, headache, and polyuria as well as
loss of weight, anorexia, and excessive thirst
are symptoms of chronic pyelonephritis.

43

The female client in an outpatient clinic is being sent home with a diagnosis of urinary
tract infection. Which instruction should the nurse teach to prevent a recurrence of a
UTI?
1. Clean the perineum from back to front after a bowel movement.
2. Take warm tub baths instead of hot showers daily.
3. Void immediately preceding sexual intercourse.
4. Avoid coffee, tea, colas, and alcoholic beverages.

4. Coffee, tea, cola, and alcoholic beverages
are urinary tract irritants.

44

The pregnant client is admitted to a medical unit for the treatment of acute pyelonephritis.
Which scientific rationale supports the client being hospitalized for this condition?
1. The client must be treated aggressively to prevent maternal/fetal complications.
2. The nurse can force the client to drink fluids and avoid nausea and vomiting.
3. The client will be dehydrated and there won’t be sufficient blood flow to the baby.
4. Pregnant clients historically are afraid to take the antibiotics as ordered.

1. A pregnant client diagnosed with a UTI
will be admitted for aggressive IV antibiotic
therapy. After symptoms subside the
client will be sent home to complete the
course of treatment with oral medications.
The mother and child need aggressive
treatment to prevent systemic bacteremia.

45

The nurse is discharging a client with a nosocomial urinary tract infection. Which
information should the nurse include in the discharge teaching?
1. Limit fluid intake so the urinary tract can heal.
2. Collect a routine urine specimen for culture.
3. Take all antibiotics as prescribed.
4. Be sure to void every five (5) to six (6) hours.

3. The client should be taught to take all the
prescribed medication any time a prescription
is written for antibiotics.

46

The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which would be a long-term goal?
1. The client will have a blood pressure within normal limits.
2. The client will show no protein in the urine.
3. The client will maintain renal function.
4. The client will have clear lung sounds.

3. A long-term complication of glomerulonephritis is that it can become chronic if unresponsive to treatment and this can lead to end-stage renal disease. Maintaining renal function would be an appropriate long-term goal.

47

The elderly client is diagnosed with chronic glomerulonephritis. Which lab value indicates
the condition has gotten worse?
1. The BUN is 15 mg/dL.
2. The creatinine level is 1.2 mg/dL.
3. The glomerular filtration rate is 40 mL/minute.
4. The 24-hour creatinine clearance is 100 mL/minute.

3. Glomerular filtration rate (GFR) is approximately 120 mL per minute. If the GFR is
decreased to 40 mL per minute, the kidneys
are functioning at about one-third filtration
capacity.

48

The client diagnosed with chronic pyelonephritis is given a prescription for Bactrim, trimethoprim sulfa, a sulfa antibiotic, twice a day for 90 days. Which statement is the scientific rationale for prescribing this medication?
1. The antibiotic will treat the bladder spasms that accompany a urinary tract infection.
2. If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth.
3. In three (3) months the client should be rid of all bacteria in the urinary tract.
4. The HCP is providing the client with enough medication to treat future infections.

2. Some clients develop a chronic infection
and must receive antibiotic therapy as a
routine daily medication to suppress the
bacterial growth. The prescription will be
refilled after the 90 days and continued.

49

The nurse empted 2000 mL from the drainage bag of a continuous irrigation of a client who had a transurethral resection of the prostate (TURP). The amount of irrigation
in the bag hanging was 3000 mL at the beginning of the shift. There was 1800 mL left in the bag eight (8) hours later. What is the correct urine output at the end of the eight (8) hours? _____

800 mL. First, determine the amount of irrigation fluid: 3000 - 1800 = 1200 mL of irrigation fluid. Then, subtract 1200 of irrigation fluid from the drainage of 2000 to determine the urine output: 2000 - 1200= 800 mL of urine output.

50

The nurse observes red urine and several large clots in the tubing of the normal saline
continuous irrigation catheter for the client who is 1 day postoperative TURP. Which
intervention should the nurse implement?
1. Remove the indwelling catheter.
2. Titrate the NS irrigation to run faster.
3. Administer protamine sulfate IVP.
4. Administer vitamin K slowly.

2. Increasing the irrigation fluid will flush out
the clots and blood.

51

Which data would support the client’s diagnosis of acute bacterial prostatitis?
1. Terminal dribbling.
2. Urinary frequency.
3. Stress incontinence.
4. Sudden fever and chills.

4. Clients with acute bacterial prostatitis will
frequently experience a sudden onset of
fever and chills. Clients with chronic prostatitis
have milder symptoms.

52

When preparing a teaching plan for the client with chronic prostatitis, which intervention should the nurse include?
1. Sit in a warm sitz bath for 10 to 20 minutes several times daily.
2. Sit in the chair with the feet elevated for two (2) hours daily.
3. Drink at least 3000 mL of oral fluids, especially tea and coffee, daily.
4. Stop broad-spectrum antibiotics as soon as the symptoms subside.

1. The client should sit in a warm sitz bath for
10–20 minutes several times each day to
provide comfort and assist with healing.

53

Which nursing diagnosis would be priority for the client who has undergone a TURP?
1. Potential for sexual dysfunction.
2. Potential for an altered body image.
3. Potential for chronic infection.
4. Potential for hemorrhage.

4. This is a potential life-threatening problem.

54

Which data would indicate that discharge teaching has been effective for the client
who is postoperative TURP?
1. “I will call the surgeon if I experience any difficulty urinating.”
2. “I will take my Proscar daily, the same as before my surgery.”
3. “I will continue restricting my oral fluid restriction.”
4. “I will need to take my pain medication routinely even if I do not hurt.”

1. This indicates that teaching is effective.

55

The client is one (1) day postoperative TURP. Which nursing task can be delegated to
the unlicensed assistive personnel?
1. Increase the irrigation fluid to clear clots from the tubing.
2. Elevate the scrotum on a towel roll for support.
3. Change the dressing on the first postoperative day.
4. Teach the client how to care for the continuous irrigation catheter.

2. Elevating the scrotum on a towel for
support is an intervention that can be delegated to the UAP.

56

The client with a TURP who has a continuous irrigation catheter complains of the need to urinate. Which intervention should the nurse implement first?
1. Call the surgeon to inform the HCP of the client’s complaint.
2. Give the client a narcotic medication for pain.
3. Tell him that the sensation happens frequently.
4. Assess the continuous irrigation catheter for patency.

4. The nurse should always assess any complaint before dismissing it as a commonly
occurring problem.

57

The client who is postoperative TURP asks the nurse, “When will I know if I will be
able to have sex after my TURP?” Which response would be most appropriate by the
nurse?
1. “You seem anxious about your surgery.”
2. “Tell me about your fears of impotency.”
3. “Potency can return in six (6) to eight (8) weeks.”
4. “Did you ask your doctor about your concern?”

3. This is usually the length of time clients
need to wait prior to having sexual intercourse;
this is the information that the
client wants to know.

58

The client asks, “What does an elevated PSA test mean?” On which scientific rationale would the nurse base the response?
1. An elevated PSA can result from several different causes.
2. An elevated PSA can be only from prostate cancer.
3. An elevated PSA can be diagnostic for testicular cancer.
4. An elevated PSA is the only test used to diagnose benign prostatic hypertrophy.

1. An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate
infarct.

59

The client returned from surgery after having a TURP and has a P 110, R 24, B/P
90/40, and cool and clammy skin. Which interventions should the nurse implement?
Select all that apply.
1. Assess the red urine in the continuous irrigation drainage bag.
2. Increase the irrigation fluid in the continuous irrigation catheter.
3. Lower the head of the bed while raising the foot of the bed.
4. Contact the surgeon to give an update in the client’s condition.
5. Monitor the client’s postoperative hematocrit and hemoglobin.

1. The nurse should assess the drain postoperative.
2. The nurse should increase the irrigation
fluid to clear the red urine.
3. The head of the bed should be lowered and
the foot should be elevated to protect the
brain.
4. The surgeon needs to be notified of the
change in condition.
5. These laboratory values should be assessed
for bleeding.

60

Which expected outcome would indicate that the client’s condition following a TURP
is improving?
1. The client is using the maximum amount allowed by the PCA pump.
2. The client’s bladder spasms are relieved by medication.
3. The client’s scrotum is swollen and tender with movement.
4. The client has passed a large, hard, brown stool this morning.

2. Bladder spasms are common, but being relieved with medication indicates the condition is improving.

61

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement?
1. Encourage the client to eat a low-purine diet and limit foods such as organ meats.
2. Explain the importance of not drinking water two (2) hours before bedtime.
3. Discuss the importance of limiting vitamin D–enriched foods.
4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

3. Dietary changes for preventing renal
stones include reducing the intake of the
primary substance forming the calculi. In
this case, limiting vitamin D will inhibit the
absorption of calcium from the gastrointestinal
tract.

62

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first?
1. Monitor the client’s urinary output.
2. Assess the client’s pain and rule out complications.
3. Increase the client’s oral fluid intake.
4. Use a safety gait belt when walking the client.

2. Assessment is the first part of the nursing
process and is always priority. The intensity
of the renal colic pain can be so intense it
can cause a vasovagal response, with resulting
hypotension and syncope.

63

The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure?
1. Ask if the client is allergic to shell fish or iodine.
2. Keep the client NPO eight (8) hours prior to the ultrasound.
3. Ensure the client has a signed informed consent form.
4. Explain the test is noninvasive and there is no discomfort.

4. No special preparation is needed for this
noninvasive, nonpainful test. A conductive
gel is applied to the back or flank and then
a transducer is applied that produces sound
waves that produce a picture.

64

Which clinical manifestations would the nurse expect to assess for the client diagnosed with a ureteral renal stone?
1. Dull, aching flank pain and microscopic hematuria.
2. Nausea; vomiting; pallor; and cool, clammy skin.
3. Gross hematuria and dull suprapubic pain with voiding.
4. No symptoms.

2. The severe flank pain associated with a
stone in the ureter often causes a sympathetic
response with associated nausea;
vomiting; pallor; and cool, clammy skin.

65

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen
collection. Which interventions should the nurse implement? Select all that apply.
1. Check for the ordered diet and medication modifications.
2. Instruct the client to urinate, and discard this urine when starting collection.
3. Collect all urine during 24 hours and place in appropriate specimen container.
4. Insert a Foley catheter in client after having the client empty the bladder.
5. Post notices on the client’s door to save all urine output.

1. The health-care provider may order certain
foods and medications when obtaining 24-
hour urine collection to evaluate for
calcium oxalate or uric acid.
2. When the collection begins, the client
should completely empty the bladder and
discard that urine.
3. All urine for 24 hours should be saved and
put in a container with preservative, refrigerated, or put on ice as indicated. Not
following specific instructions will result in
an inaccurate test result.
5. Posting signs will help ensure that all the
urine is saved during the 24-hour period. If
any urine is discarded, the test may result
in inaccurate information or the need to
start the test over.

66

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client?
1. Fluid volume loss.
2. Knowledge deficit.
3. Impaired urinary elimination.
4. Pain.

4. Pain is priority. The pain can be so severe
that a sympathetic response may occur,
causing nausea; vomiting; pallor; and cool,
clammy skin.

67

The client diagnosed with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task would be most appropriate to delegate to the unlicensed nursing assistant (NA)?
1. Monitor the amount, color, and consistency of urine output.
2. Teach the client about care of the indwelling Foley catheter.
3. Assist the client to the car when being discharged home.
4. Take the client’s post-procedural vital signs.

3. The NA could assist the client to the car
once the discharge has been completed.

68

Which statement indicates that the client diagnosed with calcium phosphate renal
calculi understands the discharge teaching for ways to prevent future calculi formation?
1. “I should increase my fluid intake, especially in warm weather.”
2. “I should eat foods that contain cocoa and chocolate.”
3. “I will walk about a mile every week and not exercise often.”
4. “I should take one vitamin a day that has extra calcium.”

1. An increased fluid intake that ensures
2–3L of urine a day prevents the stone-forming
salts from becoming concentrated enough
to precipitate.

69

Which intervention is most important for the nurse to implement for the client diagnosed
with rule out renal calculi?
1. Assess the client’s neurological status every 2 hours.
2. Strain all urine and send any sediment to the laboratory.
3. Monitor the client’s creatinine and BUN levels.
4. Take a 24-hour dietary recall during the client interview.

2. Passing a renal stone may negate the need
for the client to have lithotripsy or a surgical
procedure. Therefore, all urine must be
strained, and a stone, if found, should be
sent to the laboratory to determine what
caused the stone.

70

The client with a history of renal calculi calls the clinic and reports having burning on
urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client?
1. Increase water intake for the next 24 hours.
2. Take two Tylenol to help decrease the temperature.
3. Come to the clinic and give a urinalysis specimen.
4. Use a sterile 4 4 gauze to strain the client’s urine.

3. A urinalysis can assess for hematuria (red
blood cells in the urine), the presence of
white blood cells, crystal fragments, or all
three, which can determine if the client has
a urinary tract infection or possibly a renal
stone, with accompanying signs/symptoms
of UTI.

71

The client had surgery to remove a kidney stone. Which laboratory assessment data
would warrant immediate intervention by the nurse?
1. A serum potassium level of 3.8 mEq/L.
2. A urinalysis that shows microscopic hematuria.
3. A creatinine level of 0.8 mg/100 mL.
4. A white blood cell count of 14,000 mm/dL.

4. This white blood cell count is elevated;
normal is 5,000–10,000 mm.

72

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence?
1. Beer and colas.
2. Asparagus and cabbage.
3. Venison and sardines.
4. Cheese and eggs.

3. Venison, sardines, goose, organ meats, and
herrings are high purine foods, which
should be eliminated from the diet to help
prevent uric acid stones.

73

The nurse is working on a renal surgery unit. After the afternoon report, which client
should the nurse assess first?
1. The male client who just returned from a CT scan and states that he left his glasses
in the x-ray department.
2. The client who is one (1) day post-op and has a moderate amount of serous drainage
on the dressing.
3. The client who is scheduled for surgery in the morning and wants an explanation
of the operative procedure before signing the permit.
4. The client who had ileal conduit surgery this morning and has not had any drainage
in the drainage bag.

4. An ileal conduit is a procedure that diverts
urine from the bladder and provides an
alternate cutaneous pathway for urine to
exit the body. Urinary output should always
be at least 30 mL per hour. This client
should be assessed to make sure that the
stents placed in the ureters have not
become dislodged or to ensure that edema
of the ureters is not occurring.

74

Which is a modifiable risk factor for the development of cancer of the bladder?
1. Previous exposure to chemicals.
2. Pelvic radiation therapy.
3. Cigarette smoking.
4. Parasitic infections of the bladder.

3. Cigarette smoke contains more than 400
chemicals, 17 of which are known to cause
cancer. The risk is directly proportional to
the amount of smoking.

75

The client diagnosed with cancer of the bladder is scheduled to have a cutaneous
urinary diversion procedure. Which preoperative teaching intervention specific to the procedure should be included?
1. Demonstrate turn, cough, and deep breathing.
2. Explain that a bag will drain the urine from now on.
3. Instruct the client on the use of a PCA pump.
4. Take the client to the ICD so that he or she can become familiar with it.

2. A urinary diversion procedure involves the
removal of the bladder. In a cutaneous procedure the ureters are implanted in some
way to allow for stoma formation on the
abdominal wall, and the urine then drains
into a pouch. There are numerous methods
used for creating the stoma.

76

The client diagnosed with cancer of the bladder is undergoing intravesical chemotherapy. Which instruction should the nurse provide the client about the pre-therapy routine?
1. Instruct the client to remain NPO after midnight before the procedure.
2. Explain the use of chemotherapy in bladder cancer.
3. Teach the client to administer Neupogen, a biologic response modifier.
4. Have the client take Tylenol, an analgesic, before coming to the clinic.

1. The client will have medication instilled in
the bladder that must remain in the bladder
for a prescribed length of time. For this
reason, the client must remain NPO before
the procedure.

77

The nurse is planning the care of a postoperative client with an ileal conduit. Which intervention should be included in the plan of care?
1. Provide meticulous skin care and pouching.
2. Apply sterile drainage bags daily.
3. Monitor the pH of the urine weekly.
4. Assess the stoma site every day.

1. Urine is acidic and the abdominal wall
tissue is not designed to tolerate acidic
environments. The stoma is pouched so
that urine will not touch the skin.

78

The nurse and a licensed practical nurse (LPN) are caring for a group of clients.
Which intervention should be assigned to the LPN?
1. Assessment of the client who has had a Kock pouch procedure.
2. Monitoring of the post-op client with a WBC of 22,000 mm/dL.
3. Administration of the prescribed antineoplastic medications.
4. Care for the client going for a MRI of the kidneys.

4. It is in the scope of practice for the LPN to
care for this client.

79

The male client diagnosed with metastatic cancer of the bladder is emaciated and
refuses to eat. Which nursing action is an example of the ethical principle of paternalism?
1. The nurse allows the client to talk about not wanting to eat.
2. The nurse tells the client that if he does not eat, a feeding tube will be placed.
3. The nurse consults the dietitian about the client’s nutritional needs.
4. The nurse asks the family to bring favorite foods for the client to eat.

2. Paternalism is deciding for the client what
is best, such as a parent making decisions
for a child. Feeding a client, as with a feeding
tube, without the client wishing to eat is
paternalism.

80

The client diagnosed with cancer of the bladder states, “I have young children. I am
too young to die.” Which statement is the nurse’s best response?
1. “This cancer is treatable and you should not give up.”
2. “Cancer occurs at any age. It is just one of those things.”
3. “You are afraid of dying and what will happen to your children.”
4. “Have you talked to your children about your dying?”

3. This is an example of restating, a therapeutic
technique used to clarify the client’s
feelings and encourage a discussion of those
feelings.

81

The client with a continent urinary diversion is being discharged. Which discharge
instructions should the nurse include in the teaching?
1. Have the client demonstrate catheterizing the stoma.
2. Instruct the client on how to pouch the stoma.
3. Explain the use of a bedside drainage bag at night.
4. Tell the client to call the HCP if the temperature is 99F or less.

1. A continent urinary diversion is a surgical
procedure in which a reservoir is created
that will hold urine until the client can selfcatheterize the stoma. The nurse should
observe the client’s technique before discharge.

82

Which information regarding the care of a cutaneous ileal conduit should the nurse
teach?
1. Teach the client to instill a few drops of vinegar into the pouch.
2. Tell the client that the stoma should be slightly dusky colored.
3. Inform the client that large clumps of mucus are expected.
4. Tell the client that it is normal for the urine to be pink or red in color.

1. Vinegar will act as a deodorizing agent in
the pouch and help prevent a strong urine
smell.

83

The client is two (2) days post-ureterosigmoidostomy for cancer of the bladder. Which assessment data warrant notification of the HCP by the nurse?
1. The client complains of pain at a “3,” 30 minutes after being medicated.
2. The client complains that it hurts to cough and deep breathe.
3. The client ambulates to the end of the hall and back before lunch.
4. The client is lying in a fetal position and has a rigid abdomen.

4. The client is drawn up in a position that
takes pressure off the abdomen; a rigid
abdomen is an indicator of peritonitis, a
medical emergency.

84

The female client diagnosed with bladder cancer with a cutaneous urinary diversion
states, “Will I be able to have children now?” Which statement is the nurse’s best
response?
1. “Cancer does not make you sterile, but sometimes the therapy can.”
2. “Are you concerned that you can’t have children?”
3. “You will be able to have as many children as you want.”
4. “Let me have the chaplain come to talk with you about this.”

1. This client is asking for information and
should be given factual information. The
surgery will not make the client sterile, but
chemotherapy can induce menopause and
radiation therapy to the pelvis can render a
client sterile.

85

The elderly client being seen in the clinic has complaints of urinary frequency, urgency, and “leaking.” Which intervention should the nurse implement?
1. Ensure communication is nonjudgmental and respectful.
2. Set the temperature for comfort in the examination room.
3. Speak loudly to ensure the client understands the nurse.
4. Discuss incontinence problems with female clients only.

1. Clients who have urinary incontinence are
hesitant to discuss this problem because
they may be embarrassed. Many clients will
try to hide this condition from others, so it
is the responsibility of the nurse to approach
this subject with respect and consideration.

86

The client is experiencing urinary incontinence. Which intervention should the nurse implement?
1. Teach the client to drink prune juice weekly.
2. Encourage the client to eat a high-fiber diet.
3. Discuss the need to urinate every six (6) hours.
4. Administer diuretics at 2100 every day.

2. Clients experiencing incontinence should
eat a high-fiber diet to avoid constipation.

87

Which information would indicate to the nurse that teaching about treatment of urinary incontinence has been effective?
1. The client prepares a scheduled voiding plan.
2. The client verbalizes the need to increase fluid intake.
3. The client explains how to perform pelvic floor exercises.
4. The client attempts to retain the vaginal cone in place the entire day.

1. There are several plans for training the
bladder to decrease frequency and incontinence. One plan is to schedule each voiding two (2) to three (3) hours apart, and when the client has remained consistently dry,
the interval is increased by about 15
minutes.

88

Which intervention should the nurse implement first for the client diagnosed with
urinary incontinence?
1. Palpate the bladder after an incontinent episode to assess for urinary retention.
2. Administer oxybutynin, an anticholinergic agent, to decrease bladder contractions.
3. Prepare the client for surgical intervention to repair the problem.
4. Administer a cognitive function examination to determine abilities to function.

1. The nurse should assess first to determine
the etiology of the incontinence before the
treatment plan can be formulated. By palpating
the bladder after voiding, the nurse
can determine if the incontinence was the
result of overdistention of the bladder.

89

The client recovering from a prostatectomy has been experiencing stress incontinence.
Which independent nursing intervention should the nurse discuss with the client?
1. Establish a set voiding frequency of every two (2) hours while awake.
2. Encourage a family member to check every two (2) hours and assist the client to void.
3. Apply a transurethral electrical stimulator to relieve symptoms of urinary urgency.
4. Discuss the use of a “bladder drill,” including a timed voiding schedule.

4. Use of the bladder training drill is helpful
in stress incontinence. The client is
instructed to void at scheduled intervals.
After consistently being dry, the interval is
increased by 15 minutes until the client
reaches an acceptable interval.

90

The nurse is preparing the plan of care for the client diagnosed with a neurogenic flaccid bladder. Which expected outcome would be appropriate for this client?
1. The client has conscious control over bladder activity.
2. The client’s bladder does not become overdistended.
3. The client has bladder sensation and no discomfort.
4. The client is able to check for bladder location in relation to the umbilicus.

2. The treatment goal of the flaccid bladder
would be to prevent overdistention.

91

Which intervention would be the most important before attempting to catheterize a
client?
1. Determine the client’s history of catheter use.
2. Evaluate the level of anxiety of the client.
3. Verify that the client is not allergic to latex.
4. Assess the client’s sensation level and ability to void.

3. The nurse should always assess for allergies
for latex prior to inserting a latex
catheter or using a drainage system because
if the client is allergic to latex, use of
it could cause a life-threatening reaction.
This is the most important intervention.

92

Which client should not be assigned to an unlicensed nursing assistant (NA) working on
a surgical floor?
1. The client with a suprapubic catheter inserted yesterday.
2. The client who has had an indwelling catheter for the past week.
3. The client who is on a bladder-training regimen.
4. The client who had a catheter removed this morning and is being discharged

1. This client would require the most skill
and knowledge because this client has the
greatest potential for an infection; therefore
the client should not be assigned to an
NA.

93

The nurse is caring for an elderly client who has an indwelling catheter. Which data
warrant further investigation?
1. The client’s temperature is 98.0F.
2. The client has become confused and irritable.
3. The client’s urine is clear and light yellow.
4. The client has no discomfort or pain.

2. When an elderly client’s mental status
changes to confused and irritable, the nurse
should seek the etiology, which may be a
UTI secondary to an indwelling catheter.
Elderly clients often do not present with
classic signs and symptoms of infection.

94

The nurse is observing the unlicensed nursing assistant (NA) provide direct care to a client with a Foley catheter. Which data warrant immediate intervention by the nurse?
1. The NA secures the tubing to the client’s leg with tape.
2. The NA provides catheter care with the client’s bath.
3. The NA positions the collection bag on the client’s bed.
4. The NA cares for the catheter after washing the hands.

3. The drainage bag should be kept below the
level of the bladder to prevent reflux of
urine into the renal system; it should not be
placed on the bed.

95

Which intervention should the nurse implement when caring for the client with a
nephrostomy tube?
1. Change the dressing only if soiled by urine.
2. Clean the end of the tubing and the connecting tube with Betadine.
3. Clean the drainage system every day with bleach and water.
4. Assess the tube for kinks to prevent obstruction.

4. The nephrostomy tube should never be
clamped or have kinks because an obstruction
can cause pyelonephritis.

96

The client is 12 hours postoperative renal surgery. Which data warrant immediate
intervention by the nurse?
1. The abdomen is soft, nontender, and rounded.
2. Pain is not felt with dorsal flexion of the foot.
3. The urine output is 60 mL for the past two hours.
4. The trough vancomycin level is 24 mcg/mL.

4. The client who has restricted kidney function
from surgery should be monitored for
damage as a result of the use of aminoglycoside antibiotics, such as vancomycin, which are nephrotoxic.

97

The nurse is teaching the client diagnosed with tuberculosis of the urinary tract prior
to discharge. Which information should the nurse include specific to this diagnosis?
1. Instruct the client to take the medication with food.
2. Explain that condoms should be used during treatment.
3. Discuss the need for follow-up chest x-rays.
4. Encourage a well-balanced diet and fluid intake.

2. Clients who have been diagnosed with
tuberculosis of the renal tract should use
condoms to prevent transmission of the
mycobacterium. If the infection is located
in the penis or urethra, abstaining from
sexual activity is recommended.

98

The nurse is assessing a client diagnosed with urethral strictures. Which data support
the diagnosis?
1. Complaints of frequency and urgency.
2. Clear yellow drainage from the urethra.
3. Complaints of burning during urination.
4. A diminished force and stream during voiding.

4. The client with urethral strictures will report
a decrease in force and stream during
voiding. The stricture is treated by dilation
using small filiform bougies.

99

The nurse is providing discharge teaching to the client diagnosed with polycystic
kidney disease. Which statement made by the client indicates that the teaching has
been effective?
1. “I need to avoid any activity that may pose a risk for injury to my kidney.”
2. “I should avoid taking medications that treat high blood pressure.”
3. “When I urinate there may be normal blood streaks in my urine.”
4. “I don’t need to report any burning during urination or frequency.”

1. Polycystic kidney disease poses an increased risk for rupture of the kidney, and
therefore sports activities or occupations
that have risks for trauma should be
avoided.

100

Which intervention should the nurse include when assessing the client for urinary
retention? Select all that apply.
1. Inquire if the client has the sensation of fullness.
2. Percuss the suprapubic region for a dull sound.
3. Scan the bladder with the ultrasound scanner.
4. Palpate from the umbilicus to the suprapubic area.
5. Insert an indwelling catheter in the bladder.

1. The nurse needs to assess the client’s sensation of needing to void or feeling of fullness.
2. A dull sound heard when percussing the
bladder indicates it is filled with urine.
3. A portable bladder scan is used to assess for the presence of urine, rather than using a
straight catheter.
4. A distended bladder can be palpated.

101

The nurse has been assigned to train the unlicensed nursing assistant about prioritizing care. Which client should the nurse instruct the unlicensed nursing assistant to see first?
1. The client who needs both sequential compression devices removed.
2. The elderly woman who needs assistance ambulating to the bathroom.
3. The surgical client who needs help changing the gown after bathing.
4. The male client who needs the intravenous fluid discontinued.

2. The elderly woman has age-related changes
that can cause this request to be met as
soon as possible. The elderly female client
has a decreased bladder capacity, can be
incontinent if not emptied frequently, has
weakened urinary sphincter muscles, and
has shortened urethras. The client is at risk
for falling while attempting to get to the
bathroom.

102

The nurse is caring for the client recovering from a percutaneous renal biopsy. Which
data indicate that the client is complying with client teaching?
1. The client lies flat in the supine position for 12 hours.
2. The client continues oral fluids restriction while on bed rest.
3. The client’s family changed the dressing on return to the room.
4. The family activates the patient-controlled analgesia pump.

1. The client needs to lie flat on the back to
apply pressure that prevents bleeding.

103

Which intervention should the nurse implement for the client who has had an ileal
conduit?
1. Pouch the stoma with a one (1)-inch margin around the stoma.
2. Refer the client to the United Ostomy Association for discharge teaching.
3. Report to the health-care provider any decrease in urinary output.
4. Monitor the stoma for signs and symptoms of infection every shift.

3. The output should be monitored to detect
a decreased amount that may indicate an
obstruction from edema or ureteral stenosis.
Any decrease should be reported to the
health-care provider.

104

The nurse is preparing the plan of care for a client with fluid volume deficit. Which
interventions should the nurse include in the plan of care? Select all that apply.
1. Monitor vital signs every two (2) hours until stable.
2. Measure the client’s oral intake and urinary output daily.
3. Administer mouth care every eight (8) hours.
4. Weigh the client in the same clothing at the same time daily.
5. Assess skin turgor and mucous membranes every shift.

1. Vital signs should be monitored every two
(2) hours until stable and more frequently
if the client is unstable.
3. Mouth care should be given as often as
needed. A minimum of care should be every
eight (8) hours.
4. The client should be weighed daily at the
same time wearing the same clothing to
ensure the reliability of this indicator.
5. Skin turgor and mucous membranes should
be assessed every shift or more often depending on the client’s condition.

105

Which outcome should the nurse identify for the client diagnosed with fluid volume
excess?
1. The client will void a minimum of 30 mL per hour.
2. The client will have elastic skin turgor.
3. The client will have no adventitious breath sounds.
4. The client will have a serum creatinine of 1.4 mg/dL.

3. The client with fluid volume excess has too
much fluid. Excess fluid would be reflected
by adventitious breath sounds. Therefore
an expected outcome would be to have no
excess fluid, as evidenced by normal, clear
breath sounds.

106

The nurse is caring for a client diagnosed with rule out nephrotic syndrome. Which
intervention should be included in the plan of care?
1. Monitor the urine for bright-red bleeding.
2. Evaluate the calorie count of the 500-mg protein diet.
3. Assess the client’s sacrum for dependent edema.
4. Monitor for a high serum albumin level.

3. The classic sign and symptom of nephritic
syndrome is dependent edema located on
the client’s sacrum and ankles.

107

The nurse is preparing a teaching care plan for the client diagnosed with nephrotic
syndrome. Which intervention should the nurse include?
1. Discontinue the use of steroid therapy immediately if symptoms develop.
2. Take diuretics as needed to treat the dependent edema in ankles.
3. Increase the intake of dietary sodium every day to decrease fluid retention.
4. Report any decrease in daily weight during treatment to the HCP.

2. Treatment includes diuretics to eliminate
dependent edema, usually in the ankles and
sacrum.

108

The nurse is preparing the discharge teaching plan for the male client with a left-sided nephrectomy. Which data indicate that the teaching was effective?
1. The client informs the nurse he is returning to work on a loading dock of a factory.
2. The client reports that he will notify the HCP if there is a decrease in urine output.
3. The client says that there is no reason to keep track of the amount of urinary output.
4. The client tells the nurse he is glad to be able to eat and drink what he pleases now.

2. The client or family needs to contact the
surgeon if the client develops chills, flank
pain, decreased urinary output, or fever.

109

The client on the medical unit is exhibiting peaked T waves on the electrocardiogram.
Which interventions should the nurse implement? List in order of priority.
1. Assess the client for leg and muscle cramps.
2. Check the serum potassium level.
3. Notify the health-care provider.
4. Arrange for a transfer to the telemetry floor.
5. Administer Kayexalate, a cation resin.

In order of priority: 1, 2, 3, 5, 4
1. The nurse should assess to determine if the
client is symptomatic of hyperkalemia.
2. A peaked T wave is indicative of hyperkalemia;
therefore, the nurse should obtain
a potassium level.
3. Hyperkalemia is a life-threatening situation
because of the risk of cardiac dysrhythmias;
therefore the nurse should notify the
health-care provider.
5. Kayexalate is a medication that will help
remove potassium through the gastrointestinal
system and should be administered
to decrease the potassium level.
4. The client should be monitored continuously
for cardiac dysrhythmias so a transfer
to the telemetry unit is warranted.

110

Which intervention would be the most important for the nurse to implement for the
client with a left nephrectomy?
1. Assess the intravenous fluids for rate and volume.
2. Change surgical dressing every day at the same time.
3. Monitor the client’s medication levels daily.
4. Monitor the percentage of each meal eaten.

1. Assessing the rate and volume of intravenous fluid is the most important intervention for clients who have one (1) kidney
because an overload of fluids can result in
pulmonary edema.

111

You are admitting a patient with complaints of abdominal pain, nausea, and vomiting. A bowel obstruction is suspected. You assess this patient for which anticipated primary acid-base imbalance if the obstruction is high in the intestine?

A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

B. Metabolic alkalosis

Because gastric secretions are rich in hydrochloric acid, the patient who is vomiting will lose a significant amount of gastric acid and be at an increased risk for metabolic alkalosis.

112

When assessing the patient with a multi-lumen central line, the nurse notices that the cap is off one of the lines. On assessment, the patient is in respiratory distress, and the vital signs show hypotension and tachycardia. What is the nurse's priority action?

A. Administer oxygen.
B. Notify the physician.
C. Rapidly administer more IV fluid.
D. Reposition the patient to the right side.

A. Administer oxygen

The cap off the central line could allow entry of air into the circulation. For an air emboli, oxygen is administered; the catheter is clamped; the patient is positioned on the left side with the head down. Then the physician is notified

113

The patient was admitted for a paracentesis to remove ascites fluid. Five liters of fluid was removed. What IV solution may be used to pull fluid into the intravascular space after the paracentesis?

A. 0.9% sodium chloride
B. 25% albumin solution
C. Lactated Ringer's solution
D. 5% dextrose in 0.45% saline

B. 25% albumin solution

After a paracentesis of 5 L or greater of ascites fluid, 25% albumin solution may be used as a volume expander. Normal saline, lactated Ringer's, and 5% dextrose in 0.45% saline will not be effective for this action.

114

The dehydrated patient is receiving a hypertonic solution. What assessments must be done to avoid risk factors of these solutions (select all that apply)?

A. Lung sounds
B. Bowel sounds
C. Blood pressure
D. Serum sodium level
E. Serum potassium level

A. Lung sounds
C. Blood pressure
D. Serum sodium level

BP, lung sounds, and serum sodium levels must be monitored frequently because of the risk for excess intravascular volume with hypertonic solutions.

115

The patient is admitted with metabolic acidosis. Which system is not functioning normally?

A. Buffer system
B. Kidney system
C. Hormone system
D. Respiratory system

B. Kidney system
When the patient has metabolic acidosis, the kidneys are not combining H+ with ammonia to form ammonium or eliminating acid with secretion of free hydrogen into the renal tubule. The buffer system neutralizes hydrochloric acid by forming a weak acid. The hormone system is not directly related to acid-base balance. The respiratory system releases CO2 that combines with water to form hydrogen ions and bicarbonate. The hydrogen is then buffered by the hemoglobin.

116

The patient has chronic kidney disease and ate a lot of nuts, bananas, peanut butter, and chocolate. The patient is admitted with loss of deep tendon reflexes, somnolence, and altered respiratory status. What treatment should the nurse expect for this patient?

A. Renal dialysis
B. IV potassium chloride
C. IV furosemide (Lasix)
D. IV normal saline at 250 mL per hour

A. Renal dialysis
Renal dialysis will need to be administered to remove the excess magnesium that is in the blood from the increased intake of foods high in magnesium. If renal function was adequate, IV potassium chloride would oppose the effects of magnesium on the cardiac muscle. IV furosemide and increased fluid would increase urinary output which is the major route of excretion for magnesium.

117

While performing patient teaching regarding hypercalcemia, which statements are appropriate (select all that apply)?

A. Have patient restrict fluid intake to less than 2000 mL/day.
B. Renal calculi may occur as a complication of hypercalcemia.
C. Weight-bearing exercises can help keep calcium in the bones.
D. The patient should increase daily fluid intake to 3000 to 4000 mL.
E. Treatment of heartburn can best be managed with Tums as needed.

B. C. D.
A daily fluid intake of 3000 to 4000 mL is necessary to enhance calcium excretion and prevent the formation of renal calculi, a potential complication of hypercalcemia. Tums are a calcium-based antacid that should not be used in patients with hypercalcemia. Weight-bearing exercise does enhance bone mineralization.

118

While caring for a patient with metastatic bone cancer, which clinical manifestations would alert the nurse to the possibility of hypercalcemia in this patient?

A. Weakness
B. Paresthesia
C. Facial spasms
D. Muscle tremors

A. Weakness

Signs of hypercalcemia are lethargy, headache, weakness, muscle flaccidity, heart block, anorexia, nausea, and vomiting. Paresthesia, facial spasms, and muscle tremors are symptoms of hypocalcemia.

119

When planning care for adult patients, which oral intake is adequate to meet daily fluid needs of a stable patient?

A. 500 to 1500 mL
B. 1200 to 2200 mL
C. 2000 to 3000 mL
D. 3000 to 4000 mL

C. 2000mL to 3000mL

Daily fluid intake and output is usually 2000 to 3000 mL. This is sufficient to meet the needs of the body and replace both sensible and insensible fluid losses. These would include urine output and fluids lost through the respiratory system, skin, and GI tract.

120

When planning care for a patient with dehydration related to nausea and vomiting, the nurse would anticipate which fluid shift to occur because of the fluid volume deficit?

A. Fluid movement from the blood vessels into the cells
B. Fluid movement from the interstitial spaces into the cells
C. Fluid movement from the blood vessels into interstitial spaces
D. Fluid movement from the interstitial space into the blood vessels

D. Fluid movement from the interstitial space into the blood vessels.

In dehydration, fluid is lost first from the blood vessels. To compensate, fluid moves out of the interstitial spaces into the blood vessels to restore circulating volume in that compartment. As the interstitial spaces then become volume depleted, fluid moves out of the cells into the interstitial spaces.

121

When planning the care of a patient with dehydration, what would the nurse instruct the unlicensed assistive personnel (UAP) to report?

A. 60 mL urine output in 90 minutes
B. 1200 mL urine output in 24 hours Incorrect
C. 300 mL urine output per 8-hour shift
D. 20 mL urine output for 2 consecutive hours

D. 20mL urine output for 2 consecutive hours

The minimal urine output necessary to maintain kidney function is 30 mL/hr. If the output is less than this for 2 consecutive hours, the nurse should be notified so that additional fluid volume replacement therapy can be instituted.

122

Which nursing intervention is most appropriate when caring for a patient with dehydration?

A. Auscultate lung sounds every 2 hours.
B. Monitor daily weight and intake and output.
C. Monitor diastolic blood pressure for increases.
D. Encourage the patient to reduce sodium intake.

B. Monitor daily weight and intake and output.

Measuring weight is the most reliable means of detecting changes in fluid balance. Weight loss would indicate the dehydration is worsening, whereas weight gain would indicate restoration of fluid volume. Recall that a 1-kg weight gain indicates a gain of approximately 1000 mL of body water.

123

When assessing a patient admitted with nausea and vomiting, which finding supports the nursing diagnosis of deficient fluid volume?

A. Polyuria
B. Decreased pulse
C. Difficulty breathing
D. General restlessness

D. General restlessness

Restlessness is an early cerebral sign that dehydration has progressed to the point where an intracellular fluid shift is occurring. If the dehydration is left untreated, cerebral signs could progress to confusion and later coma.

124

You are caring for an older patient who is receiving IV fluids postoperatively. During the 8:00 AM assessment of this patient, you note that the IV solution, which was ordered to infuse at 125 mL/hr, has infused 950 mL since it was hung at 4:00 AM. What is the priority nursing intervention?

A. Notify the physician and complete an incident report.
B. Slow the rate to keep vein open until next bag is due at noon. Incorrect
C. Obtain a new bag of IV solution to maintain patency of the site.
D. Listen to the patient's lung sounds and assess respiratory status.

D. listen to the patient's lung sounds and assess respiratory status

After 4 hours of infusion time, 500 mL of IV solution should have infused, not 950 mL. This patient is at risk for fluid volume excess, and you should assess the patient's respiratory status and lung sounds as the priority action and then notify the physician for further orders.

125


You are caring for a patient admitted with diabetes mellitus, malnutrition, and massive GI bleed. In analyzing the morning lab results, the nurse understands that a potassium level of 5.5 mEq/L could be caused by which factors in this patient (select all that apply)?

A. The potassium level may be increased if the patient has renal nephropathy.
B. The patient may be excreting extra sodium and retaining potassium because of malnutrition.
C. The potassium level may be increased as a result of dehydration that accompanies high blood glucose levels.
D. There may be excess potassium being released into the blood as a result of massive transfusion of stored hemolyzed blood.
E. The patient has been overeating raisins, baked beans, and salt substitute that increase the potassium level.

A. C. D.

Hyperkalemia may result from hyperglycemia, renal insufficiency, and/or cell death. Diabetes mellitus, along with the stress of hospitalization and illness, can lead to hyperglycemia. Renal insufficiency is a complication of diabetes. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient's potassium level. Stored hemolyzed blood can cause hyperkalemia when large amounts are transfused rapidly. The patient with a massive GI bleed would have an NG tube and not be eating.

126

You are caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. Which classification of medications should you withhold until consulting with the physician?

A. Antibiotics
B. Loop diuretics
C. Bronchodilators
D. Antihypertensives

B. loope diuretics

Loop diuretics are contraindicated during episodes of hypokalemia because these medications cause the kidneys to excrete sodium and potassium. Thus administration of this type of medication at this time would worsen the hypokalemia, putting the patient at risk for dysrhythmias. The prescribing physician should be consulted for potassium replacement therapy, and the drug should be withheld until the potassium has returned to normal range.

127

You are caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which serum laboratory result would you identify as an adverse effect related to this therapy?

A. Sodium falling to 138 mEq/L
B. Potassium rising to 4.1 mEq/L
C. Magnesium rising to 2.9 mg/dL
D. Phosphorus falling to 2.1 mg/dL

D. Phosphorus falling to 2.1mg/dL

Calcium has an inverse relationship with phosphorus in the body. When phosphorus levels fall, calcium rises, and vice versa. Since hypercalcemia rarely occurs as a result of calcium intake, the patient's phosphorus falling to 2.1 mg/dL (normal 2.4-4.4 mg/dL) may be a result of the phosphate-binding effect of calcium carbonate.

128

You are caring for a patient admitted with a diagnosis of chronic obstructive pulmonary disease (COPD) who has the following arterial blood gas results: pH 7.33, PaO2 47 mm Hg, PaCO2 60 mm Hg, HCO3 32 mEq/L, and O2 saturation of 92%. What is the correct interpretation of these results?

A. Fully compensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Normal acid-base balance with hypoxemia
D. Normal acid-base balance with hypercapnia

B. Partially compensated respiratory acidosis.

A low pH (normal 7.35-7.45) indicates acidosis. In the patient with respiratory disease such as COPD, the patient retains carbon dioxide (normal 35-45 mm Hg), which acts as an acid in the body. For this reason, the patient has respiratory acidosis. The elevated HCO3 indicates a partial compensation for the elevated CO2

129

You are caring for a patient admitted with an exacerbation of asthma. After several treatments, the ABG results are pH 7.40, PaCO2 40 mm Hg, HCO3 24 mEq/L, PaO2 92 mm Hg, and O2 saturation of 99%. You interpret these results as

A. within normal limits.
B. slight metabolic acidosis.
C. slight respiratory acidosis.
D. slight respiratory alkalosis.

A. within normal limits
The normal pH is 7.35 to 7.45. Normal PaCO2 levels are 35 to 45 mm Hg, and HCO3 is 22 to 26 mEq/L. Normal PaO2 is >80 mm Hg. Normal oxygen saturation is >95%. Since the patient's results all fall within these normal ranges, the nurse can conclude that the patient's blood gas results are within normal limits.

130

You receive a physician's order to change a patient's IV from D5½ NS with 40 mEq KCl/L to D5NS with 20 mEq KCl/L. Which serum laboratory values on this same patient best support the rationale for this IV order change?

A. Sodium 136 mEq/L, potassium 4.5 mEq/L
B. Sodium 145 mEq/L, potassium 4.8 mEq/L
C. Sodium 135 mEq/L, potassium 3.6 mEq/L
D. Sodium 144 mEq/L, potassium 3.7 mEq/L

A. Sodium 136mEq/L, potassium 4.5 mEq/L

The normal range for serum sodium is 135 to 145 mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L. The change in the IV order decreases the amount of potassium and increases the amount of sodium. Therefore for this order to be appropriate, the potassium level must be near the high end and the sodium level near the low end of their respective ranges.

131

Which serum potassium result best supports the rationale for administering a stat dose of potassium chloride 20 mEq in 250 mL of normal saline over 2 hours?

A. 3.1 mEq/L
B. 3.9 mEq/L
C. 4.6 mEq/L
D. 5.3 mEq/L

A. 3.1 mEq/L

The normal range for serum potassium is 3.5 to 5.0 mEq/L. This IV order provides a substantial amount of potassium. Thus the patient's potassium level must be low. The only low value shown is 3.1 mEq/L.

132

What should the nurse expect to do to prepare a patient for an intravenous pyelogram (IVP)?

A. Administer a cathartic or enema.
B. Assess patient for allergies to penicillin.
C. Keep the patient NPO for 4 hours preprocedure.
D. Advise the patient that a metallic taste may occur during procedure.

A. Administer a cathartic or enema

Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity, keep the patient NPO for 8 hours preprocedure, and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.

133

In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which physiologic processes are performed by the kidneys (select all that apply)?

A. Production of renin
B. Activation of vitamin D
C. Carbohydrate metabolism
D. Erythropoietin production
E. Hemolysis of old red blood cells (RBCs)

A. B. D.

In addition to urine formation, the kidneys release renin to maintain blood pressure, activate vitamin D to maintain calcium levels, and produce erythropoietin to stimulate RBC production. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are performed by the kidneys.

134

As a component of the head-to-toe assessment of a patient who has been recently transferred to the clinical unit, the nurse is preparing to palpate the patient's kidneys. How should the nurse position the patient for this assessment?

A. Prone
B. Supine
C. Seated at the edge of the bed
D. Standing, facing away from the nurse

B. Supine

To palpate the right kidney, the patient is positioned supine, and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it.

135

Which effect of aging on the urinary system is most likely to affect the action of bumetanide (Bumex)?

A. Benign enlargement of prostatic tissues
B. Decreased sensation of bladder capacity
C. Decreased function of the loop of Henle
D. Less absorption in the Bowman's capsule

C. Decreased function of the loop of Henle

Bumetanide (Bumex) is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus the circulating levels of drugs are increased and their effects prolonged. The benign enlargement of prostatic tissue, decreased sensation of bladder capacity, and loss of concentrating ability do not directly affect the action of loop diuretics.

136

The patient had surgery and a urinary catheter. Eight hours after catheter removal and drinking fluids, the patient has not been able to void. What should the nurse do first to assess for urinary retention?

A. Bladder scan
B. Cystometrogram
C. Residual urine test
D. Kidneys, ureters, bladder (KUB) x-ray

A. bladder scan

If the patient is unable to void, the bladder may be palpated for distention, percussed for dullness if it is full, or a bladder scan may be done to determine the approximate amount of urine in the bladder. A cystometrogram visualizes the bladder and evaluates vesicoureteral reflux. A KUB x-ray delineates size, shape, and positions of kidneys and possibly a full bladder. Neither of these would be useful in this situation. A residual urine test requires urination before catheterizing the patient to determine the amount of urine left in the bladder, so this assessment would not be helpful for this patient.

137

The patient called the clinic with manifestations of burning on urination, dysuria, and frequency. What is the best advice for the nurse to give the patient?

A. "Drink less fluid so you don't have to void so often."
B. "Take some acetaminophen to decrease the discomfort."
C. "Come in so we can check a clean catch urine specimen."
D. "Avoid caffeine and spicy food to decrease inflammation."

C.

The patient's symptoms are typical of a urinary tract infection (UTI). To verify this, a clean catch urine specimen must be obtained for a specimen of urine to culture. Drinking less fluid will not improve the symptoms. Acetaminophen would not decrease the discomfort; an antibiotic would be needed. Avoiding caffeine and spicy food may decrease bladder inflammation but will not affect these symptoms.

138

The patient in the intensive care unit is receiving gentamicin for pneumonia from Pseudomonas. What assessment results should the nurse report to the health care provider?

A. Decreased weight
B. Increased appetite
C. Increased urinary output
D. Elevated creatinine level

D. Elevated creatinine level

Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the physician as it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have side effects of anorexia.

139

When the patient reports acute, severe, renal colic pain in the lower abdomen, the nurse knows that the patient is most likely to have an obstruction at which area?

A. Kidney
B. Urethra
C. Bladder
D. Ureterovesical junction

D. Ureterovesical junction

The ureterovesical junction (UVJ) is the narrowest part of the urethra and easily obstructed by urinary calculi. With a stone in the kidney or at the ureteropelvic junction (UPJ), the pain may be dull costovertebral flank pain. Stones in the bladder do not cause obstruction or symptoms unless they are staghorn stones. The urethra seldom has obstruction related to stones.

140

Which urinalysis result should the nurse recognize as an abnormal finding?

A. pH 6.0
B. Amber yellow color
C. Specific gravity 1.025
D. White blood cells (WBCs) 9/hpf

D. White blood cells 9/hpf

Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average; amber yellow is normal coloration, and the reference ranges for specific gravity are 1.003 to 1.030.

141

A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure?

A. "You might have pink-tinged urine and burning after your cystoscopy."
B. "You'll need to refrain from eating or drinking after midnight the day before the test."
C. "You'll require a urinary catheter inserted before the cystoscopy, and it will be in place for a few days."
D. "The morning of the test, the nurse will ask you to drink some water that contains a contrast solution."

A.

Pink-tinged urine, burning, and frequency are common following a cystoscopy. The patient does not need to be NPO prior to the test, and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.

142

A 70-year-old male patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should the nurse document this abnormal assessment finding?

A. Anuria
B. Dysuria
C. Oliguria
D. Enuresis

B. Dysuria

Painful and difficult urination is characterized as dysuria. Anuria is an absence of urine production, whereas oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.

143

A nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find what clinical manifestations as the "classic triad" occurring in patients with renal cancer?

A. Fever, chills, flank pain
B. Hematuria, flank pain, palpable mass
C. Hematuria, proteinuria, palpable mass
D. Flank pain, palpable abdominal mass, and proteinuria

B. Hematuria, flank pain, palpable mass

There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.

144

What is the nurse's priority when changing the appliance of a patient with an ileal conduit?

A. Keep the skin free of urine.
B. Inspect the peristomal area.
C. Cleanse and dry the area gently.
D. Affix the appliance to the faceplate.

A. keep the skin free of urine

The nurse's priority is to keep the skin free of urine because the peristomal skin is at high risk for damage from the urine if it is alkaline. The peristomal area will be assessed; the area will be gently cleaned and dried, and the appliance will be affixed to the faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage.

145

The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving orders, what should the nurse do?

A. Keep the patient on bed rest.
B. Use 5 mL of sterile saline to irrigate.
C. Use 30 mL of water to gently irrigate.
D. Have the patient turn from side to side.

B. Use 5mL of sterile saline to irrigate

With a nephrostomy tube, if the tube is occluded and irrigation is ordered, the nurse should use 5 mL or less of sterile saline to gently irrigate it. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency.

146

A 22-year-old patient's blood pressure at her physical done for her new job was 110/68. At the health fair two months later, her blood pressure is 154/96. What renal problem should the nurse be aware of that could contribute to this abrupt rise in blood pressure?

A. Renal trauma
B. Renal artery stenosis
C. Renal vein thrombosis
D. Benign nephrosclerosis

B. Renal artery stenosis

Renal artery stenosis contributes to an abrupt rise in blood pressure, especially in people under 30 or over 50 years of age. Renal trauma usually has hematuria. Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome. Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension.

147

The patient is wondering why anesthesia is needed when the lithotripsy being done is noninvasive. The nurse explains that the anesthesia is required to ensure the patient's position is maintained during the procedure. The nurse knows that this type of lithotripsy is called

A. laser lithotripsy. Incorrect
B. electrohydraulic lithotripsy.
C. percutaneous ultrasonic lithotripsy.
D. extracorporeal shock-wave lithotripsy (ESWL).

D. extracorporeal shock wave lithotripsy

ESWL is noninvasive, but anesthesia is used to maintain the patient's position. The other types of lithotripsy are invasive. Laser lithotripsy uses an ureteroscope and small fiber to reach the stone. Electrohydraulic lithotripsy positions a probe directly on the stone; then continuous saline irrigation flushes are used to rinse the stone out. Percutaneous ultrasonic lithotripsy places an ultrasonic probe in the renal pelvis via a percutaneous nephroscope inserted through an incision in the flank.

148

Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor?

A. Tighten both buttocks together.
B. Squeeze thighs together tightly.
C. Contract muscles around rectum.
D. Lie on back and lift legs together.

C. Contract muscles around rectum

To teach pelvic floor exercises, or Kegel exercise, the nurse should instruct the patient (without contracting the legs, buttocks, or abdomen) to contract the muscles around the rectum (pelvic floor muscles) as if stopping a stool, which should result in a pelvic lifting sensation.

149

When caring for a patient with nephrotic syndrome, the nurse should know the patient understands dietary teaching when the patient selects which food item?

A. Peanut butter and crackers
B. One small grilled pork chop
C. Salad made of fresh vegetables
D. Spaghetti with canned spaghetti sauce

C. Salad made of fresh vegetables

Of the options listed, only salad made with fresh vegetables would be acceptable for the diet that limits sodium and protein as well as saturated fat if hyperlipidemia is present. Peanut butter and crackers are processed so they contain significant sodium, and peanut butter contains some protein. A pork chop is a high-protein food with saturated fat. Canned spaghetti sauce is also high in sodium.

150

The patient has scleroderma and is experiencing hypertension. The nurse should know that this could be related to which renal problem?

A. Obstructive uropathy
B. Goodpasture syndrome
C. Chronic glomerulonephritis
D. Calcium oxalate urinary calculi

C. Chronic glomerulonephritis

Hypertension occurs with chronic glomerulonephritis that may be found in patients with scleroderma. Obstructive uropathy, Goodpasture syndrome, and calcium oxalate urinary calculi are not related to scleroderma and do not cause hypertension.

151

The patient with type 2 diabetes has a second UTI within one month of being treated for a previous UTI. Which medication should the nurse expect to teach the patient about taking for this infection?

A. Ciprofloxacin (Cipro)
B. Fosfomycin (Monurol)
C. Nitrofurantoin (Macrodantin)
D. Trimethoprim/sulfamethoxazole (Bactrim)

A. Ciprofloxacin (Cipro)

This UTI is a complicated UTI because the patient has type 2 diabetes and the UTI is recurrent. Ciprofloxacin (Cipro) would be used for a complicated UTI. Fosfomycin (Monurol), nitrofurantoin (Macrodantin), and trimethoprim/sulfamethoxazole (Bactrim) should be used for uncomplicated UTIs.

152

The urinalysis of a male patient reveals a high microorganism count. What data should the nurse use to determine the area of the urinary tract that is infected (select all that apply)?

A. Pain location
B. Fever and chills
C. Mental confusion
D. Urinary hesitancy
E. Urethral discharge
F. Post-void dribbling

A. E.

Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis, but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.

153

Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which measure should the nurse first recommend in an attempt to resolve the woman's incontinence?

A. Kegel exercises
B. Use of adult incontinence pads
C. Intermittent self-catheterization
D. Dietary changes including fluid restriction

A. Kegel exercises

Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem, and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.

154

Which nursing diagnosis is a priority in the care of a patient with renal calculi?

A. Acute pain
B. Risk for constipation
C. Deficient fluid volume
D. Risk for powerlessness

A. Acute pain

Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.

155

The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. What are priority nursing assessments in the care of this patient?

A. Assessment of pain and level of consciousness
B. Assessment of serum calcium and phosphorus levels
C. Blood pressure and assessment for orthostatic hypotension
D. Daily weights and measurement of the patient's abdominal girth

D. Daily weights and measurement of the patient's abdominal girth

Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the diagnosis of nephrotic syndrome.

156

An older male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)?

A. High-purine diet
B. Sedentary lifestyle
C. Benign prostatic hyperplasia (BPH)
D. Recent use of broad-spectrum antibiotics

C. Benign prostatic hyperplasia

BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi.

157

Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)?

A. Help the patient cope with the rapid progression of the disease.
B. Suggest genetic counseling resources for the children of the patient.
C. Expect the patient to have polyuria and poor concentration ability of the kidneys.
D. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

B. Suggest genetic counseling

PKD is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.

158

The nurse preparing to administer a dose of calcium acetate (PhosLo) to a patient with chronic kidney disease (CKD) should know that this medication should have a beneficial effect on which laboratory value?

A. Sodium
B. Potassium
C. Magnesium
D. Phosphorus

D. Phosphorus

Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. PhosLo will not have an effect on sodium, potassium, or magnesium levels.

159

When caring for a patient during the oliguric phase of acute kidney injury (AKI), what is an appropriate nursing intervention?

A. Weigh patient three times weekly.
B. Increase dietary sodium and potassium.
C. Provide a low-protein, high-carbohydrate diet.
D. Restrict fluids according to previous daily loss.

D. Restrict fluids according to previous daily loss.

Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention. Therefore they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 ml for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times each week.

160

The physician has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient?

A. Hemodialysis (HD) 3 times per week
B. Automated peritoneal dialysis (APD)
C. Continuous venovenous hemofiltration (CVVH)
D. Continuous ambulatory peritoneal dialysis (CAPD)

C. Continous venovenous hemofiltration

CVVH removes large volumes of water and solutes from the patient over a longer period of time by using ultrafiltration and convection. HD 3 times per week would not be used for this patient because fluid and solutes build up and then are rapidly removed. With APD (used at night instead of during the day) fluid and solutes build up during the day and would not benefit this patient as much. CAPD will not as rapidly remove large amounts of fluid as CVVH can do.

161

A 24-year-old female donated a kidney via a laparoscopic donor nephrectomy to a non-related recipient. The patient is experiencing a lot of pain and refuses to get up to walk. How should the nurse handle this situation?

A. Have the transplant psychologist convince her to walk.
B. Encourage even a short walk to avoid complications of surgery.
C. Tell the patient that no other patients have ever refused to walk.
D. Tell the patient she is lucky she did not have an open nephrectomy.

B. Encourage even a short walk to avoid complications of surgery.

Because ambulating will improve bowel, lung, and kidney function with improved circulation, even a short walk with assistance should be encouraged after pain medication. The transplant psychologist or social worker's role is to determine if the patient is emotionally stable enough to handle donating a kidney, while postoperative care is the nurse's role. Trying to shame the patient into walking by telling her that other patients have not refused and telling the patient she is lucky she did not have an open nephrectomy (implying how much more pain she would be having if it had been open) will not be beneficial to the patient or her postoperative recovery.

162

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do for the patient?

A. Administer hypertonic saline.
B. Administer a blood transfusion.
C. Decrease the rate of fluid removal.
D. Administer antiemetic medications.

C. Decrease the rate of fluid removal

The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.

163

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse should know that ultrafiltration in peritoneal dialysis is achieved by which method?

A. Increasing the pressure gradient
B. Increasing osmolality of the dialysate
C. Decreasing the glucose in the dialysate
D. Decreasing the concentration of the dialysate

B. Increasing osmolality of the dialysate

Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream.

164

Which patient should be taught preventive measures for CKD by the nurse because this patient is most likely to develop CKD?

A. A 50-year-old white female with hypertension
B. A 61-year-old Native American male with diabetes Correct
C. A 40-year-old Hispanic female with cardiovascular disease
D. A 28-year-old African American female with a urinary tract infection

B. It is especially important for the nurse to teach CKD prevention to the 61-year-old Native American with diabetes. This patient is at highest risk because diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD 6 times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. African Americans have the highest rate of CKD because hypertension is significantly increased in African Americans. A UTI will not cause CKD unless it is not treated or UTIs occur recurrently.

165

A 78-year-old patient has Stage 3 CKD and is being taught about a low potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat?

A. Apple, green beans, and a roast beef sandwich
B. Granola made with dried fruits, nuts, and seeds
C. Watermelon and ice cream with chocolate sauce
D. Bran cereal with ½ banana and milk and orange juice

A. When the patient selects an apple, green beans, and a roast beef sandwich, the patient demonstrates understanding of the low potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate sauce, bran cereal, banana, and orange juice all have elevated levels of potassium, at or above 200 mg per 1/2 cup.

166

The patient has had type 1 diabetes mellitus for 25 years and is now reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse finds that the patient has newly developed hypertension and difficulty with blood glucose control. The nurse should know that which diagnostic study will be most indicative of chronic kidney disease (CKD) in this patient?

A. Serum creatinine
B. Serum potassium
C. Microalbuminuria
D. Calculated glomerular filtration rate (GFR)

D. The best study to determine kidney function or chronic kidney disease (CKD) that would be expected in the patient with diabetes is the calculated GFR that is obtained from the patient's age, gender, race, and serum creatinine. It would need to be abnormal for 3 months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.

167

The nurse knows the patient with AKI has entered the diuretic phase when what assessments occur (select all that apply)?

A. Dehydration
B. Hypokalemia
C. Hypernatremia
D. BUN increases
E. Serum creatinine increases

A. B. Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Therefore the serum BUN and serum creatinine levels also begin to decrease.

168

The patient has a form of glomerular inflammation that is progressing rapidly. She is gaining weight, and the urine output is steadily declining. What is the priority nursing intervention?

A. Monitor the patient's cardiac status.
B. Teach the patient about hand washing.
C. Obtain a serum specimen for electrolytes.
D. Increase direct observation of the patient.

A. The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart, and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as ordered by the health care provider.

169

The patient was diagnosed with prerenal AKI. The nurse should know that what is most likely the cause of the patient's diagnosis?

A. IV tobramycin (Nebcin)
B. Incompatible blood transfusion
C. Poststreptococcal glomerulonephritis
D. Dissecting abdominal aortic aneurysm

D. A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and poststretpcoccal glomerulonephritis are intrarenal causes of AKI.

170

Which assessment finding is a consequence of the oliguric phase of AKI?

A. Hypovolemia
B. Hyperkalemia
C. Hypernatremia
D. Thrombocytopenia

B. In AKI the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.

171

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. What is an expected assessment finding for this patient during this early stage of recovery?

A. Hypokalemia
B. Hyponatremia
C. Large urine output
D. Leukocytosis with cloudy urine output

C. Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

172

A patient with a history of end-stage kidney disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which assessments should the nurse prioritize before, during, and after his treatment?

A. Level of consciousness
B. Blood pressure and fluid balance
C. Temperature, heart rate, and blood pressure
D. Assessment for signs and symptoms of infection

B. Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the nature of the procedure indicates a particular need to monitor the patient's blood pressure and fluid balance.

173

Which statement by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure?

A. "It is essential that you maintain aseptic technique to prevent peritonitis."
B. "You will be allowed a more liberal protein diet once you complete CAPD."
C. "It is important for you to maintain a daily written record of blood pressure and weight."
D. "You will need to continue regular medical and nursing follow-up visits while performing CAPD."

A. Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of preventing this from occurring. Although the other teaching statements are accurate, they do not have the potential for morbidity and mortality as does peritonitis, thus making that statement of highest priority.