Renal Exam practice

A patient with end-stage renal disease (ESRD) asks the nurse about options for transplantation. Which of the following are viable options? Select all that apply

Living Donor, Cadaver donor, paired donor

To assess whether there is any improvement in a patient's dysuria, which question would the nurse ask the patient? "Do you have to urinate at night?" "Do you have blood in your urine?" "Do you have pain when you urinate?" "Do you have to urinate frequently?"

"Do you have pain when you urinate?"

A home health nurse teaches a patient with neurogenic bladder how to use intermittent catheterization for bladder emptying. Which patient statement indicates that teaching was successful?

"I will clean the catheter carefully before and after each catheterization."

A nurse is preparing to administer dextrose 5% in 0.45% sodium chloride 1L to infuse at 100 mL/hr. The nurse is using microtubing. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round to the nearest whole number.) Answer with a number only.

100

A nurse is preparing to administer 40 mEq of potassium chloride in 45% sodium chloride (NaCl) 500 mL IV to infuse 10 mEq/hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) Answer with number only.

125

A nurse is preparing to administer levothyroxine 0.275 mg PO daily to a client. The amount available is levothyroxine 137 mcg/tablet. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) Answer with a number only.

2

A nurse is preparing to infuse 1 liter of 0.9% sodium chloride IV over 8 hr with a tubing set that delivers 15 gtts/mL. The nurse should set the manual IV infusion to deliver how many drops/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) Answer with a number only.

31

A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft?

a. a fistula is much less likely to clot

The nurse receives a call from a patient concerned about urinating brown-colored urine after taking nitrofurantoin for a urinary tract infection. The nurse would make which appropriate response? "Take magnesium hydroxide with your medication to lighten up the urine color." "Discontinue taking the medication and make an appointment for a urine culture." "Decrease you medication to half the dose because your urine is so concentrated." "Continue taking the medication; the brown urine is expected and not harmful."

"Continue taking the medication; the brown urine is expected and not harmful."

A nurse is caring for a patient who has recurrent kidney stones and is scheduled for an intravenous pyelogram (IVP). Which statement by the patient would the nurse report to the provider? "I don't eat shellfish because it gives me hives." "The last time I voided it was painful and red-tinged." "The pain in my back is severe and colicky." "I drink at least 8 glasses of fluid every day."

"I don't eat shellfish because it gives me hives."

Which statement by a patient with end-stage renal disease (ESRD) indicates that the nurse's teaching about management of kidney disease has been effective? "I need erythropoietin injections because they prevent infection." "I will increase my intake of fruits and vegetables to 15 per day." "I will keep my daily fluid intake amount between 32 and 40 ounces." "I need to get all of my protein from low-fat dairy products."

"I need erythropoietin injections because they prevent infection."

A nurse is providing teaching to a patient who has nephrotic syndrome. The nurse should recognize which patient statement indicates a need for further teaching? "I can expect to have swelling in my face." "I should increase my sodium intake." "I will lose protein in my urine." "I will eat small, frequent meals."

"I should increase my sodium intake."

A 74-year-old patient who is in end-stage renal disease asks the nurse, "Do you think I should go on dialysis?" Which initial response by the nurse is the most therapeutic? "Many people your age use dialysis and have a good quality of life." "Tell me more about what you are thinking regarding dialysis." "It depends on which type of dialysis you are considering." You are the only one who can make the decision about dialysis."

"Tell me more about what you are thinking regarding dialysis."

A nurse is preparing to administer indomethacin 75 mg PO bid. Available is indomethacin 25 mg/5mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) Answer with a number only.

15

Which nursing action is the highest priority for a patient with renal calculi who is experiencing gross hematuria and severe colicky left flank pain? Monitor temperature every 4 hours Give antiemetics as needed for nausea Encourage increased oral fluid intake Administer prescribed opioid analgesics

Administer prescribed opioid analgesics

Phenazopyridine is prescribed for a patient with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation? A reddish-orange discoloration of the urine is present Urine is clear amber Urination is not painful Urge incontinence is not present

A reddish-orange discoloration of the urine is present

A patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first? Give sodium polystyrene sulfonate Place the patient on a cardiac monitor Insert an indwelling urethral catheter Administer epoetin alfa

Give sodium polystyrene sulfonate

A nurse is discussing indications for urinary catheterization with a newly licensed nurse. Which indications should the nurse include? Select all that apply. An open perineal wound Measurement of residual urine after urination Convenience for the nursing staff or the client's family Routine acquisition of a urine specimen Relief of urinary retention

An open perineal wound, Measurement of residual urine after urination, Relief of urinary retention.

A patient who receives hemodialysis has requested a snack. Which choices are appropriate for the nurse to offer to the patient? Apples Carrot sticks Grapes Cantaloupe pieces Bananas​​

Apples, carrot sticks, grapes.

A nurse is caring for a patient who has undergone a renal biopsy. Which nursing action is essential for the patient immediately after the renal biopsy? Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function Insert a urinary catheter and test urine for gross or microscopic hematuria Check blood glucose to assess for hyperglycemia or hypoglycemia Apply a pressure dressing and keep the patient on the affected side for 30 minutes

Apply a pressure dressing and keep the patient on the affected side for 30 minutes

After the insertion of an arteriovenous graft in the right forearm, the patient reports pain and coldness of the right fingers. Before contacting the surgeon, which action should the nurse take? Teach the patient about normal arteriovenous graft function Elevate the patient's arm on pillows above the heart level Remind the patient to take a daily low-dose aspirin tablet Assess and compare the patient's radial and ulnar pulses in both arms

Assess and compare the patient's radial and ulnar pulses in both arms

Which action will the nurse include in the plan of care to maintain the patency of a patient's left arm arteriovenous fistula? Cannulate and irrigate the fistula site with saline every shift Compare blood pressures in the left and right arms Auscultate for a bruit at the fistula site Assess the quality of the right radial pulse

Auscultate for a bruit at the fistula site

A nurse in an outpatient clinic is caring for a female patient that is complaining of recurrent urinary tract infections. What would the nurse teach this patient regarding prevention of urinary tract infections? Select all that apply. Avoid douches and bubble baths Stop taking antibiotics when you start feeling better Decrease fluid intake to lessen dysuria Wipe from front to back after urinating Empty your bladder before and after sex

Avoid douches and bubble baths, Wipe from front to back after urinating Empty your bladder before and after sex

A nurse is reviewing the laboratory values of a patient who has chronic glomerulonephritis. Which is an expected finding for this patient? Serum creatinine 0.8 mg/dL BUN 100 mg/dL Serum potassium 4.0 mEq/L RBC 4.9 mm3

BUN 100 mg/dL

A 32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of cigarette smoking is scheduled for an annual physical examination. Which risk will the nurse include in the teaching for this patient? Bladder cancer Renal failure Renal calculi Pyelonephritis

Bladder cancer

A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV? Urine volume Cardiac rhythm Creatinine level Neurologic statu

Cardiac Rhythm

A patient who has bladder cancer had a cystectomy with the creation of a Kock pouch. Which will the nurse include in patient teaching? Application of ostomy appliances Catheterization technique and schedule Analgesic use before emptying the pouch Barrier products for skin protection

Catheterization technique and schedule

A patient with acute kidney injury has wider QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? Notify the patient's health care provider Check the patient's most recent potassium level Review the chart for the patient's current creatinine level Document the QRS interval measurement

Check the patient's most recent potassium level

Which information will be included when the nurse is teaching self-management to a patient who is starting peritoneal dialysis? Select all that apply Choose high protein foods for most meals Take phosphorus binders with every meal Restrict fluid intake to 600mL daily Have at least 5 servings of dairy products daily Avoid commercial salt substitutes

Choose high protein foods for most meals Take phosphorus binders with every meal Avoid commercial salt substitutes

A patient who does peritoneal dialysis is complaining of abdominal pain and chills. Which assessment finding will be most important to report to the health care provider? Serum creatinine level of 6.9 Cloudy appearance of dialysis effluent Blood pressure of 149/71 Hemoglobin level of 11.3

Cloudy appearance of dialysis effluent

A nurse observes an unlicensed assistive personnel (UAP) taking the following actions when caring for a patient with a urethral catheter. Which action requires that the nurse intervene? Taping the catheter to the skin on the patient's upper inner thigh Disconnecting the catheter from the drainage tube to obtain a specimen Cleaning around the patient's urinary meatus with soap and water Using an alcohol-based gel hand cleaner before performing catheter care

Disconnecting the catheter from the drainage tube to obtain a specimen

A male patient has a tentative diagnosis of urethritis. The nurse would assess the patient for which manifestations of this disorder? Dysuria and penile discharge Hematuria and urgency Dysuria and proteinuria Hematuria and glycosuria

Dysuria and penile discharge

A nurse is planning care for a female patient who is paralyzed from the waist down and is at risk for acquiring urinary tract infections. Which action should the nurse include in the patient's plan of care? Cleanse the perineum from back to front Encourage fluid intake at and between meals Offer the patient the bed side commode every 2 hours Obtain a prescription for an indwelling urinary catheter

Encourage fluid intake at and between meals

The health care provider has prescribed a creatinine clearance for a patient. Which actions will the nurse take to collect this specimen? Select all that apply. Have the patient urinate at the end of 24 hours and add it to the collection Collect all of the patient's urine for 24 hours Use a dipstick to assess the urine for protein at the end of 24 hours Discard the first urination when the test is started Have the patient start voiding and collect the specimen 1 to 2 seconds after voiding starts

Have the patient urinate at the end of 24 hours and add it to the collection Collect all of the patient's urine for 24 hours Discard the first urination when the test is started

A patient with end-stage renal disease (ESRD) is scheduled to receive a prescribed dose of epoetin alfa. Which information should the nurse report to the health care provider before giving the medication? Hemoglobin level 14g/dL Creatinine 1.6mg/dL Oxygen saturation 92% Blood pressure 98/56 mm Hg

Hemoglobin level 14g/dL

The nurse is caring for a patient with an acute kidney injury (AKI) who is in the diuretic phase of the condition. Which of the following conditions are critically important to monitor for? Select all that apply Hyponatremia Hypercalcemia Hyperkalemia Hypovolemia Hypotension

Hyponatremia, hyperkalemia

A 72-year-old patient is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? Draw a complete blood count (CBC) Infuse normal saline at 50mL/hour Obtain renal ultrasound Insert indwelling coude catheter

Insert indwelling coude catheter

A nurse is caring for a patient who has acute glomerulonephritis with peripheral edema and is producing 35 mL of urine per hour. The nurse should place the patient on which diet? ​​ Regular diet, no added salt Low-carbohydrate, low-protein diet Low-sodium, fluid-restricted Low-protein, low-potassium diet

Low sodium, fluid-restricted

A patient who has had progressive chronic kidney disease (CKD) for several years has just begun hemodialysis treatments. Which information about diet will the nurse include in patient teaching?

More protein is allowed because urea and creatinine are removed by dialysis

After change-of-shift report, which patient should the nurse see first? Patient who voided bright red urine immediately after returning from lithotripsy Patient with a urethral stricture who has not voided for 12 hours Patient who has pink tinged urine after orthotopic bladder reconstruction Patient with polycystic kidney disease whose blood pressure is 160/88 mm Hg

Patient with a urethral stricture who has not voided for 12 hours

Which menu choices by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful? Oatmeal with cream, half a banana, and herbal tea Cheese sandwich, tomato soup, and cranberry juice Split-pea soup, English muffin, and nonfat milk Poached eggs, 1/2 cup of grapes, and apple juice

Poached eggs, 1/2 cup of grapes, and apple juice

A nurse is caring for a patient who has not voided for 8 hours following the removal of an indwelling urinary catheter. Which action should be the nurse take first? Reinsert the indwelling catheter Perform a bladder scan Increase fluids Provide assistance to bathroom

Reinsert the indwelling catheter

Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein? Give all medications through the vascular access catheter Discontinue the indwelling urethral catheter Place patient on a zero protein diet Restrict physical activity to bedrest

Restrict physical activity to bedrest

A nurse is caring for a patient with a medical diagnoses of nephrotic syndrome. Which nursing diagnosis would be most appropriate for this patient's plan of care? Constipation Risk for infection Fluid volume deficit Over flow urinary incontinence

Risk for infection

A patient with diabetes who has bacterial pneumonia is being treated with an aminoglycoside antibiotic. What should the nurse monitor for adverse effects of the medication? Serum glucose Urine osmolality Serum creatinine Urine calcium

Serum Creatinine

A 55-year-old female patient admitted for a surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is most appropriate to include in the plan of care?

Teach the patient how to perform Kegel exercises

Which information from a patient who had transurethral resection of the bladder tumor (TURBT) with fulguration for bladder cancer 3 days ago is most important for the nurse to report to the health care provider? The patient is anxious about the cancer The patient has seen clots in the urine The patient is using opioids for pain The patient is voiding every 4 hours

The patient has seen clots in the urine

Which finding for a patient admitted with glomerulonephritis indicates to the nurse that the treatment has been effective? The patient no longer must self-catheterize The urine dipstick is negative for nitrites The patient denies pain with voiding The periorbital and peripheral edema is resolved

The periorbital and peripheral edema is resolved

A nurse working in an urgent care setting is caring for a patient diagnosed with an uncomplicated urinary tract infection. Which medication would the nurse expect the health care provider to prescribe for this patient?

trimethoprim/sulfamethoxazole

The nurse is caring for a patient with an acute kidney injury (AKI) who has hyperkalemia. Match the following hyperkalemia treatments with how long the treatment lasts. Use each answer only one time

​​Hemodialysis Most efficient, short-term treatment • Regular insulin intravenously Temporary, but quick, treatment • Patiromer Delayed action medication, not for emergency use • Dietary restriction of potassium Long-term treatment for recurrent elevation ​