Renal NCLEX Questions

You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely? "I pee a lot." "It burns when I pee." "I go hours without the urge to pee." "My pee smells sweet."

"It burns when I pee." A common symptom of a UTI is dysuria. A patient with a UTI often reports frequent voiding of small amounts and the urgency to void. Urine that smells sweet is often associated with diabetic ketoacidosis.

You're planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include? "Your urine might turn bright orange." "You need to take this antibiotic for 7 days." "Take this drug between meals and at bedtime." "Don't take this drug if you're allergic to penicillin."

"Your urine might turn bright orange." The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.

Which patient is at greatest risk for developing a urinary tract infection (UTI)? A 35 y.o. woman with a fractured wrist A 20 y.o. woman with asthma A 50 y.o. postmenopausal woman A 28 y.o. with angina

A 50 y.o. postmenopausal woman Women are more prone to UTI's after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Angina, asthma and fractures don't increase the risk of UTI.

The nurse is planning to teach the client about the signs and symptoms of a urinary tract infection. The nurse should include: (Mark all that apply) A. dysuria. B. foul smelling cloudy urine. C. urgency. D. back pain.

A. dysuria B. foul smelling cloudy urine C. urgency Rationale: Signs and symptoms of urinary tract infections include dysuria, frequency, urgency, foul odor, pyuria, hematuria and pain in the suprapubic area.

A client diagnosed with pyelonephritis asks the nurse "What is the disease?" The nurse's best response "Pyelonephritis is an: A. inflammation of the kidney and renal pelvis." B. inflammation of the prostate gland." C. inflammation of the urethra." D. inflammation of the bladder."

A. inflammation of the kidney and renal pelvis." Rationale: Pyelonephritis is an inflammation of the kidney and renal pelvis. Prostatis is an inflammation of the prostate gland. Urethritis is an inflammation of the urethra. Cystitis is an inflammation of the bladder.

A client with a history of urinary tract infection should be instructed by the nurse to avoid: A. tea and coffee. B. cranberry juice. C. apple juice. D. bananas.

A. tea and coffee Rationale: A client with urinary tract infections should be instructed to avoid caffeine, citrus juices, artificial sweeteners as these substances irritate the bladder and can increase urgency and spasms.

The nurse is developing a teaching plan for the sexually active woman for preventing urinary tract infections. The nurse should instruct the client to: (Mark all that apply) A. wear cotton briefs. B. void before and after intercourse. C. take antibiotics before intercourse. D. increase fluids to 2.5 quarts per day.

A. wear cotton briefs B. void before and after intercourse D. Increase fluids to 2.5 quarts per day Rationale: In order to prevent urinary tract infections a client should be taught to drink 2.0 to 2.5 quarts of fluid per day, empty the bladder every 3 to 4 hours, cleanse from front to back after voiding or defecating, void before and after intercourse, avoid bubble baths and hygiene sprays and douches, wear cotton briefs and consume cranberry juice and ascorbic acid.

A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have lead to the low specific gravity of urine? a) Repeated diarrhea b) Excess fluid intake c) Frequent vomiting d) Urine retention

B) Excessive fluid intake Excess fluid intake results in low specific gravity of urine. Excessive fluid intake will result in formation of dilute urine. When the urine is diluted, it results in low specific gravity of urine. Frequent vomiting, repeated diarrhea, and urine retention will result in high specific gravity of urine.

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? a) Give medications that promote fluid retention. b) Limit sodium and water intake. c) Teach client behaviors that decrease urination. d) Assess for dehydration.

B) Limit sodium and water intake Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? a) Bradycardia b) Tachycardia c) Increased urine output d) Vasodilation

B) Tachycardia Fluid volume deficit, or hypovolemia, occurs when the loss of extracellular fluid exceeds the intake of fluid. Clinical signs include oliguia, rapid heart rate, vasoconstriction, cool and clammy skin, and muscle weakness. The nurse monitors for rapid, weak pulse and orthostatic hypotension.

A nurse has collected nutritional data from a client with a diagnosis of cystitis. The nurse determines that which beverage needs to be eliminated from the client's diet to minimize the recurrence of cystitis? a) fruit juice b) tea c) water d) lemonade

B) tea Caffeine and alcohol can irritate the bladder. Therefore, alcohol and caffeine-containing beverages such as coffee, tea, and cocoa are avoided to minimize the risk. Water helps flush bacteria out of the bladder, and an intake of six to eight glasses per day is encouraged. Lemonade and fruit juice are acceptable items to drink.

A client with pyelonephritis is being discharged from the hospital, and the nurse provides instructions to the client to prevent recurrence. The nurse determines that the cleint understands the information that was given if the client states an intention to: a) increase fluids for 2 days if signs and symptoms of a urinary tract infection develop b) take the prescribed antibiotics until all symptoms subside c) return to the physician's office for scheduled follow-up urine cultures d) decrease fluid intake if frequent urination occurs

C) return to the physician's office for follow-up urine cultures The client with pyelonephritis should take the full course of antibiotic therapy that has been prescribed and return to the physician's office for follow-up urine cultures if so instructed. The client should learn the signs and symptoms of a urinary tract infection, and report them immediately if they occur. The client should also drink 3 L of fluid per day.

A male client is complaining of urinary frequency, dysuria, pain, fever and chills for the third time in 9 months. The nurse should expect which diagnostic test to be ordered since this is the third infection in 9 months? A. Urinalysis B. X-ray of kidneys, ureter and bladder C. Intravenous pyelography D. Computed tomography of the abdomen

C. Intravenous pyelography Rationale: An intravenous pyelograph evaluates the structure and excretory function of the kidneys, ureter and bladder for abnornalies such as vesicoureteral refex in people who have frequent infections. Urine culture and sensitivity is appropriate but repetitive infections may indicate an underlying problem. Flat plate and CT scan of abdomen will only evaluate structures of the kidneys, ureter and bladder.

The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? a) Pregnancy b) Diabetes mellitus c) Neuromuscular disorders d) Hypotension

D) Hypotension Hypertension, not hypotension, is a risk factor for kidney disease.

A client has been diagnosed with renal obstruction due to calculi. The nurse should evaluate the client for the complication of: A. Congestive heart failure. B. hypokalemia. C. hypophospholemia. D. hydronephosis.

D. Hydronephrosis Rationale: The client who has a urinary tract obstruction can develop hydronephrosis which is distention of the renal pelvis, calyces and ureter because the kidneys continue to produce urine behind the obstruction.

Your patient has complaints of severe right-sided flank pain, nausea, vomiting and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi? Pain radiating to the right upper quadrant History of mild flu symptoms last week Dark-colored coffee-ground emesis Dark, scant urine output

Dark, scant urine output Patients with renal calculi commonly have blood in the urine caused by the stone's passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant.

What change indicates recovery in a patient with nephritic syndrome (or glomerulonephritis)? Disappearance of protein from the urine Decrease in blood pressure to normal Increase in serum lipid levels Gain in body weight

Disappearance of protein from the urine With nephrotic syndrome, the glomerular basement membrane of the kidney becomes more porous, leading to loss of protein in the urine. As the patient recovers, less protein is found in the urine.

A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching? Take cool baths Avoid tampon use Avoid sexual activity Drink 8 to 10 eight-oz glasses of water daily

Drink 8 to 10 eight-oz glasses of water daily Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity.

Clinical manifestations of acute glomerulonephritis include which of the following? Chills and flank pain Oliguria and generalized edema Hematuria and proteinuria Dysuria and hypotension

Hematuria and proteinuria Hematuria and proteinuria indicate acute glomerulonephritis. These finding result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis.

Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient? Dysuria, frequency, and urgency Back pain, nausea, and vomiting Hypertension, oliguria, and fatigue Fever, chills, and right upper quadrant pain radiating to the back

Hypertension, oliguria, and fatigue Mild to moderate HTN may result from sodium or water retention and inappropriate rennin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.

You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi? Increased calcium loss from the bones Decreased kidney function Decreased calcium intake High fluid intake

Increased calcium loss from the bones Bones lose calcium when a patient can no longer bear weight. The calcium lost from bones form calculi, a concentration of mineral salts also known as a stone, in the renal system.

Which of the following causes the majority of UTI's in hospitalized patients? Lack of fluid intake Inadequate perineal care Invasive procedures Immunosuppression

Invasive procedures Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection.

An 18 y.o. student is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which would most likely be in this student's health history? Renal calculi Renal trauma Recent sore throat Family history of acute glomerulonephritis

Recent sore throat The most common form of acute glomerulonephritis is caused by goup A beta-hemolytic streptococcal infection elsewhere in the body.

Which intervention do you plan to include with a patient who has renal calculi? Maintain bed rest Increase dietary purines Restrict fluids Strain all urine

Strain all urine All urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Ambulation may help the movement of the stone down the urinary tract. Encourage fluid to help flush the stones out.

The client has been diagnosed to have glomerulonephritis. What should the nurse observe in the urine? a) blood b) pus c) white blood cells d) glucose

a) blood

A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen level drops to: a) 3 mg/dL b) 15 mg/dL c) 29 mg/dL d) 35 mg/dL

b) 15 mg/dL the normal blood urea nitrogen level is 8 to 25 mg/dL

Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? a) Jaundice and flank pain b) Costovertebral angle tenderness and chills c) Burning sensation on urination d) Polyuria and nocturia

b) Costovertebral angle tenderness and chills Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection.

The client with acute renal failure has a serum potassium of 6.0 mEq/L. The nurse would plan which of the following as a priority action? a) check the sodium level b) place the client on a cardiac monitor c) encourage increased vegetables in the diet d) allow an extra 500 ml of fluid intake to dilute the electrolyte concentration

b) place the client on a cardiac monitor

An elderly client is diagnosed with interstitial cystitis. Which finding differentiates interstitial cystitis for other forms of cystitis? a) The client is asymptomatic b) The urine is free from bacteria c) The urine contains blood d) Males are affected more often

b) the urine is free from bacteria The finding that differentiates Interstitial Cystitis from other forms of cystitis is the absence of bacteria in the urine. IC is characterized by urgency, frequency and pain in the bladder and pelvis. A patient is diagnosed with IC/PBS (interstitial cystitis/ painful bladder syndrome) when no other causes can be determined.

Which of the following responses would be accurate if given to the nurse during an initial interview from a patient with benign prostatic hypertrophy (BPH)? a) "I have pain and swelling of my both ankles." b) "I frequently drink wine with my evening meals." c) "I have difficulty starting a stream of urine, and it is a weak stream." d) "My bladder doesn't feel empty after I urinate, and I have to strain to pass the urine."

c) "I have difficulty starting a stream of urine, and it is a weak stream." Rationale: The symptoms of BPH are sometimes referred to as "nuisances," and include difficulty starting a stream of urine that is described as weak and the need to strain to urinate. Ultimately, in advanced cases, azotemia and renal failure can occur. Red wine is not a direct causative agent here.

A adult client has had laboratory work done as part of a routine physical examination. The nurse interprets that the client may have a mild degree of renal insufficiency if which of the following serum creatinine levels is noted? a) 0.2 mg/dlL b) 0.5 mg/dL c) 1.9 mg/dL d) 3.5 mg/dL

c) 1.9 mg/dL the normal serum creatinine level for adults is 0.6 to 1.3 mg/dL. The client with a mild degree of renal insufficiency would have a slight elevated level. A creatinine level of 0.2 mg/dL is low, and a level of 0.5 mg/dL is just below normal. A creatinine level of 3.5 mg/dL may be associated with acute or chronic renal failure.

Diagnosis of acute pyelonephritis has been established your nursing intervention includes the following except: a) provide health teaching and discharge planning b) administer antibiotic c) measure I and O d) provide adequate comfort and rest

c) measure I and O

Which of the following complaints is common in a client with pyelonephritis? a) right upper quadrant pain b) left upper quadrant pain c) pain at the costovertebral region d) pain at the suprapubic region

c) pain at the costovertebral region

A nurse is assessing a client who is diagnosed with cystitis. Which assessment finding is inconsistent with the typical clinical manifestations noted in this disorder? a) hematuria b) low back pain c) urinary retention d) burning on urination

c) urinary retention

While caring for a 77-year old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. The clinical manifestations the patient is most likely to experience include: a) cloudy urine and fever b) urethral burning and blood urine c) vague abdominal pain and disorientation d) suprapubic pain and slight decline in body temperature

c) vague abdominal pain and disorientation The usual classic symptoms of UTI are often absent in older adults, who tend to experience nonlocalized abdominal pain rather than dysuria and suprapubic pain. They may also experience cognitive impairment characterized by confusion or decreased level of consciousness.

Which of the following may be included in the diet of the client with chronic renal failure? a) orange slices b) watermelon slices c) cantaloupe slices d) apple slices

d) apple slices the client with renal failure should be given low potassium diet because of hyperkalemia. Apple contains very little potassium. So, it can be given to the client.

A client has been admitted to the hospital with a diagnosis of acute glomerulonephritis. During history-taking the nurse first asks the client about a recent history of: a) bleeding ulcer b) deep vein thrombosis c) myocardial infarction d) streptococcal infection

d) streptococcal infection